Nevin Manimala

MSMR. 2026 Jul 31;33(6-7):13-20.

ABSTRACT

This annual summary documents the frequencies, rates, trends, and distributions of hospitalizations, or inpatient care, among members of the active component of the U.S. Armed Forces, based on standardized records from U.S. military and civilian medical facilities worldwide. In 2025, overall hospitalization rates for U.S. active component service members fell to a 10-year low of 49.2 per 1,000 person-years, driven by a pronounced decline in admissions to military hospitals and clinics. While mental health disorders remained the leading cause of hospitalization, this category experienced the largest absolute decline in admissions compared to 2023, whereas pregnancy and delivery saw the greatest absolute increase.

PMID:42623601

MSMR. 2026 Jul 31;33(6-7):4-12.

ABSTRACT

This annual summary quantifies the impacts of various illnesses and injuries among members of the active component of the U.S. Armed Forces, using a disease classification system and morbidity burden measures derived from the Global Burden of Disease Study. In 2025, the burden of health care for U.S. service members in the active component was determined by medical diagnostic categories within a limited range: Injuries, mental health disorders, and musculoskeletal diseases accounted for the vast majority of health care provided. This concentration was most evident in ambulatory, or outpatient, care, to which only 5 specific conditions constituted one-third of all outpatient medical encounters. Inpatient treatment for mental health-related disorders comprised 51.0% of all hospital bed days for active component service member health care.

PMID:42623596

JCO Glob Oncol. 2026 Aug;12(8):e2500684. doi: 10.1200/GO-25-00684. Epub 2026 Aug 20.

ABSTRACT

PURPOSE: To conduct a scoping review to identify publications that used data from Caribbean cancer registries (CRs) to characterize the type of information disseminated and identify knowledge gaps.

METHODS: We searched PubMed, Scopus, Web of Science: Core Collection and SciELO, and Latin American and Caribbean Literature on Health Sciences for articles published in English, French, Dutch, or Spanish between January 2012 and May 2023. Articles that used data from a CR located in one or more Caribbean country/territory were included. In Covidence, a two-step screening process at title/abstract and full text was completed by two reviewers independently. Data were extracted from each included article independently by two reviewers using Covidence. A gray literature search of online and paper reports using CR data was also conducted to supplement the literature searches.

RESULTS: A total of 126 articles met the inclusion criteria and reported CR data from 1958 to 2018. Of the 33 Caribbean countries/territories included, 12 had at least one publication. Most publications (95%) used data from population-based CRs (PBCRs). Three countries/territories with PBCRs had <3 publications, and three had none. Breast, cervical, and colorectal were the most reported cancers. Ten of 14 (71%) countries/territories with a PBCR had at least one cancer incidence report available from the past 5 years.

CONCLUSION: Caribbean CRs have contributed substantially to the peer-reviewed literature, but this is limited to fewer than half of the Caribbean countries and primarily those with a PBCR. Efforts are needed to establish and support PBCRs to produce high-quality data and to bridge the gap between the collection and dissemination of CR data to address key knowledge gaps, prioritize research questions, and inform cancer control policies.

PMID:42623595 | DOI:10.1200/GO-25-00684

JCO Oncol Pract. 2026 Aug 20:OP2600117. doi: 10.1200/OP-26-00117. Online ahead of print.

ABSTRACT

PURPOSE: To compare cancer survival in the United States during the past half century in adolescent and young adult (AYA) patients of age 15-39 years with younger and older patients.

METHODS: Annual survival data were obtained from 8 US SEER regions during 1975-2017 for AYAs, younger (age 0-14 years), and older (age 40-59 and ≥65 years) populations. The average annual percent change (AAPC) in 5-year relative survival was determined with and without deaths from HIV/AID-associated malignancies that compromised overall cancer survival in males during the HIV/AIDS epidemic of 1981-1998. Joinpoint analysis identified time trends and statistical significances.

RESULTS: During 1975-1997, the AAPC in 5-year relative survival in AYAs was 0.66 (95% CI, 0.63 to 0.69), which was less than that in both younger, age <15 years, 0.93 (95% CI, 0.82 to 1.05) and older, age 40-64 years, 1.12 (95% CI, 0.10 to 1.14) patients. Subsequently, the 2000-2017 AAPC in AYAs was 0.47 (95% CI, 0.45 to 0.49), which was greater than that in both younger, age <15 years, 0.40 (95% CI, 0.34 to 0.45) and older, age 40-64 years, 0.43 (95% CI, 0.42 to 0.44) patients. In males, whose overall cancer survival was seriously compromised by the HIV epidemic in the 1980s and 1990s, much of the overall progress occurred as a result of the epidemic’s cessation. Excluding HIV-associated cancers, however, showed even greater progress than the results for males and females considered together.

CONCLUSION: While compared with younger and older patients with cancer, American AYAs had the slowest improvement in 5-year relative survival before 1998, they since have had a greater improvement rate. Much of this progress can be attributed to national efforts led by NCI-funded cooperative groups to focus on AYA oncology.

PMID:42623568 | DOI:10.1200/OP-26-00117

J Exp Bot. 2026 Aug 20:erag411. doi: 10.1093/jxb/erag411. Online ahead of print.

ABSTRACT

Understanding crop population history requires genetic material that predates modern breeding. Here, we analyzed historical seeds of rice landraces assembled in Southeast Asia from 1957 to 1958. Target capture resequencing of coding regions yielded high-quality genomic data from 66 historical accessions (seven from North Vietnam, 30 from South Vietnam, 13 from Cambodia, two from Laos, and 14 from Thailand). When integrated with published rice panels, all historical accessions were assigned to indica, and the previously described major regional structure was recovered. Within the historical collection, South Vietnamese, Cambodian, and Thai accessions formed a largely continuous group, whereas North Vietnamese accessions were clearly distinct and comprised two differentiated groups corresponding to the traditional growth seasons (fifth- and tenth-month rice). Notably, the fifth-month rice accessions were assigned to the recently reported Vietnam-I5 cluster. Admixture graph, f-statistics, and qpAdm analyses further indicated that Vietnam-I5 is closely related to a China-associated lineage; however, this relationship was not fully explained by sampled indica, japonica, or aus proxies. Together, these results show that major components of the present-day indica regional structure were already present before modern cultivar replacement, and highlight northern Vietnam as a historical zone of lineage differentiation between Chinese and mainland Southeast Asian rice.

PMID:42623552 | DOI:10.1093/jxb/erag411

Lupus. 2026 Aug 20:9612033261479099. doi: 10.1177/09612033261479099. Online ahead of print.

ABSTRACT

BackgroundSystemic Lupus Erythematosus (SLE) is a heterogeneous autoimmune disease characterized by dysregulated type I interferon signaling. Epigenetic alterations, particularly DNA methylation changes in interferon-regulated genes, have emerged as promising biomarkers for disease diagnosis and stratification. Among these, IFI44L promoter hypomethylation has been repeatedly reported as one of the most consistent and disease specific in SLE.ObjectiveTo systematically evaluate the evidence on IFI44L promoter methylation in SLE and to quantitatively synthesize its epigenetic and diagnostic performance across diverse populations using meta-analytic approaches.MethodsA systematic search of published literature was conducted to identify studies reporting IFI44L promoter methylation in patients with SLE and controls. Study characteristics, ethnicity, cell type, direction of methylation, CpG hypo/hyper methylation counts were extracted. Descriptive analyses were performed across ethnicities and cell types. Diagnostic performance was summarized as the pooled area under the receiver operating characteristic (ROC) curve (AUC). Variance of AUC estimates was approximated using the Hanley-McNeil method, and a random-effects meta-analysis (DerSimonian-Laird) was applied to account for between-study heterogeneity.Results16 study datasets reporting hypomethylation of the IFI44L promoter were included. IFI44L promoter hypomethylation was consistently observed across ethnic groups and biological sample types. Descriptive subgroup analyses identified heterogeneity in the magnitude of IFI44L promoter hypomethylation across ethnic groups, study periods, and methylation profiling methodologies, whereas differences according to biological sample type were less pronounced and did not reach statistical significance. Hypomethylation predominated over hypermethylation among studies reporting both methylation directions. Diagnostic AUC values varied across studies but were largely independent of sample size and the magnitude of hypomethylation. The pooled area under the curve (AUC) was 0.74 (95% CI 0.64-0.84), indicating moderate overall diagnostic performance.ConclusionIFI44L promoter hypomethylation represents a significant and reproducible epigenetic signature of SLE across populations and study designs. Despite variability in methylation magnitude, its diagnostic performance remains consistent, supporting IFI44L methylation as a promising biomarker for SLE.

PMID:42623550 | DOI:10.1177/09612033261479099

Hepatol Commun. 2026 Aug 20;10(9):e01029. doi: 10.1097/HC9.0000000000001029. eCollection 2026 Sep 1.

ABSTRACT

BACKGROUND: Alcohol-associated liver disease (ALD) is a leading cause of advanced liver disease and liver transplantation worldwide. Cardiometabolic risk factors (CMRFs) may worsen ALD prognosis. While recent nomenclature acknowledges the impact of CMRFs in steatotic liver disease with low-to-moderate alcohol use, individuals with high alcohol intake are still classified as having ALD regardless of CMRF status. We conducted a systematic review to evaluate the impact of CMRFs, primarily diabetes, obesity, and metabolic syndrome, on clinical outcomes in patients with ALD.

METHODS: We performed a systematic review of peer-reviewed studies published through October 21, 2025, as well as abstracts from the AASLD, EASL, DDW, ACG, and APASL conferences from 2023 to 2025. We included studies involving adults (≥18 y) with ALD that assessed at least one CMRF (eg, diabetes, obesity, metabolic syndrome) and reported longitudinal clinical outcomes. Primary outcomes included incident cirrhosis, hepatocellular carcinoma (HCC), overall and cause-specific mortality, cardiovascular events, liver-related complications, and liver transplantation.

RESULTS: Nineteen studies comprising 132,054 patients with ALD met the inclusion criteria. Diabetes was consistently associated with increased risks of overall mortality [adjusted hazard ratio (aHR) 3.00], liver-related mortality (aHR 3.60), HCC (hazard ratios 1.6-21.7), and cardiovascular mortality (aHR 19.91). Elevated BMI was linked to higher all-cause mortality (aHR 1.16-1.58), cardiovascular mortality (aHR 3.76), HCC incidence (HR 2.0-2.9), and liver-related mortality (aHR 16.22). Metabolic syndrome was associated with increased overall (HR 1.27-2.37) and liver-related mortality (HR 1.47-2.06). A greater burden of CMRFs was correlated with lower transplant-free survival and reduced rates of hepatic recompensation.

CONCLUSION: Diabetes, obesity, and metabolic syndrome are associated with worse hepatic and extrahepatic outcomes in ALD.

PMID:42623525 | DOI:10.1097/HC9.0000000000001029

Hepatol Commun. 2026 Aug 20;10(9):e01019. doi: 10.1097/HC9.0000000000001019. eCollection 2026 Sep 1.

ABSTRACT

BACKGROUND: Falls are associated with frailty and are a significant cause of morbidity among the elderly. Due to accelerated physiologic aging, frailty is common among patients with cirrhosis. We sought to identify the patients with cirrhosis at highest risk of falling and to explore the relationship between falls and frailty in this population.

METHODS: We conducted a longitudinal, retrospective analysis of adults (above 18 y old) with cirrhosis from 2011 to 2021 in the multi-institutional CAPriCORN database. Falls were defined by validated International Classification of Diseases 9th and 10th edition codes. Frailty was defined using the Hospital Risk Frailty Score (mild <5, intermediate 5-15, severe >5). Multivariable Cox models identified risk factors for experiencing a first and second fall (HR: 95% CI).

RESULTS: In total, 42,046 patients with cirrhosis were included with a median (IQR) age of 59.3 years (51.4-66.9) and mean (IQR) follow-up of 3.4 years (0.6-5.7). In total, 58.0% were male (n=24,390) and 59.5% had baseline compensated cirrhosis (n=25,021). Overall, 7.1% (n=2997) experienced a fall within the study period, 2.6% within 1 year of cirrhosis diagnosis. Prior fall history (HR: 5.69, 4.93-6.58), severe frailty (HR: 2.37, 2.02-2.80), and intermediate frailty (HR: 1.71, 1.49-1.96) were the strongest fall risk factors. In total, 38.4% of patients who fell experienced an additional fall during follow-up, 35% of which occurred within 1 year. Fall history (HR: 1.50, 1.18-1.90) and severe frailty (HR: 1.51, 1.16-1.96) were the strongest risk factors for a second fall. Patients with severe frailty had a 10-year cumulative fall incidence of 19.6%.

CONCLUSIONS: Though 7% of patients experienced a fall, patients with a fall history or frailty were at significantly increased risk. These findings may help target patients with the highest fall risk and design fall-prevention interventions for this uniquely vulnerable population.

PMID:42623523 | DOI:10.1097/HC9.0000000000001019

JMIR Ment Health. 2026 Aug 20;13:e96331. doi: 10.2196/96331.

ABSTRACT

BACKGROUND: Social media influencers occupy a pervasive role in billions of users’ daily digital lives, particularly among adolescents and young adults. Audiences develop parasocial engagement with these figures, including parasocial relationships (PSRs) and parasocial interactions (PSIs). Despite growing concern about their mental health implications, no prior meta-analysis has quantitatively synthesized this evidence.

OBJECTIVE: This systematic review and meta-analysis aimed to estimate the associations between influencer-directed parasocial engagement and mental health outcomes, examine prespecified moderators, and evaluate the quality of the existing evidence base.

METHODS: Seven databases (PsycINFO, Embase, MEDLINE, ERIC, PubMed, Web of Science, and Scopus) were searched from inception. Studies quantitatively assessing PSRs or PSIs with social media influencers and reporting mental health outcomes were eligible. A 3-level random-effects meta-analysis was conducted using Pearson r. Primary pooled estimates were calculated separately for positive or adaptive outcomes, and negative or maladaptive outcomes. Moderators examined included outcome domain, parasocial construct type, age group, gender, cultural region, and platform.

RESULTS: Seventeen studies (52 effect sizes) were included. Parasocial engagement was positively associated with both positive (k=28; r=0.38, 95% CI 0.18-0.55) and negative outcomes (k=24; r=0.24, 95% CI 0.08-0.38), with positive effects significantly stronger. Well-being showed the largest effects (r=0.42), followed by social media addiction (r=0.33). PSI demonstrated stronger associations than PSR (r=0.56 vs 0.22). Effects were largest among adolescents (r=0.44) and in Eastern samples (r=0.61 vs 0.29). No evidence of publication bias was detected (Egger P=.94; fail-safe N=18,643).

CONCLUSIONS: Parasocial engagement functions as a psychological double-edged sword, reliably linked to both enhanced well-being and problematic engagement. Positive mental health outcomes, particularly those involving well-being, were generally stronger and more consistent than negative ones. These findings suggest that parasocial engagement should not be understood as uniformly beneficial or harmful; rather, its psychological meaning depends on the outcome domain, parasocial construct type, developmental stage, and cultural context. Future longitudinal, mechanism-based research with diverse samples is needed to clarify when parasocial engagement is most beneficial or harmful.

PMID:42623515 | DOI:10.2196/96331

J Eval Clin Pract. 2026 Aug;32(5):e70563. doi: 10.1111/jep.70563.

ABSTRACT

RATIONALE: Hospital readmissions and excess inpatient length of stay remain important clinical and organisational concerns in cardiovascular care. Although discharge destination has been linked to postacute utilisation and spending, less is known about whether discharge destination is associated with inpatient days exceeding diagnosis-related expected stay.

AIMS AND OBJECTIVES: This study examined whether discharge destination was associated with excess length of stay above diagnosis-related expected stay among heart failure-related admissions and whether those additional inpatient days were associated with lower 30-day readmission.

METHOD: We conducted a retrospective observational study of administrative admissions recorded between August 2016 and October 2017 at a large academic urban teaching hospital. The primary outcome was excess length of stay, defined as max (length of stay-CMS geometric mean length of stay, 0). The primary explanatory variable was discharge destination, grouped as home, skilled nursing, other facility or discontinued care. Multivariable regression models estimated adjusted associations with excess length of stay, and a secondary generalised estimating equation model assessed 30-day readmission.

RESULTS: The final analytic sample included 1076 admissions from 743 unique patients. Mean excess length of stay was 2.47 days, and 24.3% of admissions were followed by a 30-day readmission. In adjusted models, discharge to skilled nursing was associated with 1.46 additional excess days versus home discharge (95% CI: 0.68-2.23; p < 0.001), while discharge to other facility settings was associated with 1.67 additional excess days (95% CI: 0.29-3.04; p = 0.017). Findings were directionally similar in sensitivity analyses. Excess stay was not associated with lower 30-day readmission, and nonhome discharge categories were not associated with lower readmission odds.

CONCLUSION: In this single-site observational sample, nonhome discharge, especially skilled nursing placement, was associated with longer stays above DRG-benchmarked expectations without lower short-term readmission. These findings may reflect greater discharge complexity and local postacute transition constraints, although the study did not directly measure the mechanisms underlying prolonged hospitalisation.

PMID:42623497 | DOI:10.1111/jep.70563