Nevin Manimala

JAMA Netw Open. 2026 Jul 1;9(7):e2624175. doi: 10.1001/jamanetworkopen.2026.24175.

ABSTRACT

IMPORTANCE: Previous studies suggest that spouses of individuals with dementia may be at increased risk of developing dementia, but evidence regarding subgroup variation and absolute risk remains limited.

OBJECTIVE: To examine whether spouses of individuals with dementia have an increased risk of developing dementia and to assess whether this association is modified by demographic, socioeconomic, and family context factors.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cohort study used Taiwan’s National Health Insurance Research Database from 1998 to 2022, with follow-up through 2022. To address prior limitations of small sample size and limited subgroup evaluation, spouses of individuals with incident dementia were identified and matched 1 to 4 to unexposed controls by birth year, sex, income, and urbanicity. The analysis was conducted between July 15, 2025, and May 15, 2026.

EXPOSURE: Spousal exposure to incident dementia.

MAIN OUTCOMES AND MEASURES: Incident all-cause dementia, Alzheimer disease, and vascular dementia. Hazard ratios (HRs) and 5-year absolute risk differences were estimated using Cox regression and g-computation.

RESULTS: The matched cohort included 955 105 individuals, with 118 904 exposed women and 72 117 exposed men as well as 475 616 unexposed women and 288 468 unexposed men. The largest proportion were aged 65 to 74 years at cohort entry, for women (47 084 [39.6%]) and men (28 477 [39.5%]). Spouses of individuals with dementia had a higher risk of all-cause dementia than unexposed spouses. For women, the HR was 1.74 (95% CI, 1.70-1.78), with a 5-year adjusted risk difference of 2.75 percentage points (pp) (95% CI, 2.63-2.87 pp). For men, the HR was 1.69 (95% CI, 1.64-1.73), with a 5-year adjusted risk difference of 3.49 pp (95% CI, 3.30-3.69 pp). Similar patterns were observed in analyses of Alzheimer disease and vascular dementia. Relative risks were more prevalent at younger ages, whereas absolute risk differences increased with age. For all-cause dementia, the association was attenuated among individuals with higher income or more children. Associations were otherwise broadly similar across sex and urbanicity.

CONCLUSIONS AND RELEVANCE: In this cohort study of married individuals in Taiwan, spouses of individuals with dementia had a higher risk of dementia than unexposed spouses. The association varied across family and socioeconomic contexts, highlighting the relevance of household context in dementia risk assessment.

PMID:42475091 | DOI:10.1001/jamanetworkopen.2026.24175

J Magn Reson Imaging. 2026 Jul 20. doi: 10.1002/jmri.70459. Online ahead of print.

ABSTRACT

BACKGROUND: Progressive supranuclear palsy (PSP) is both an underdiagnosed and a frequently misdiagnosed disorder. To remedy these diagnostic limitations, MRI has been used to investigate brain morphology to differentiate PSP from Parkinson’s disease (PD) and multiple system atrophy (MSA). However, while nigrostriatal degeneration and tau aggregation are prominent in PSP, and result in iron accumulation and atrophy in the region, substantia nigra (SN) atrophy remains an underexplored diagnostic marker.

PURPOSE: To investigate the diagnostic utility of QSM-derived SN parameters for PSP.

STUDY TYPE: Retrospective.

POPULATION: 123 (59 Males/64 Females) PD patients, 48 (26 M/22 F) MSA patients, and 22 (11 M/11 F) PSP patients were included in the main dataset. MSA patients include 20 parkinsonian type (MSA-P) (11 M/9 F) and 18 cerebellar type (MSA-C) (9 M/9 F) of MSA with 10 undetermined subtype. The external validation set included 12 (6 M/6 F) healthy controls, 13 PD (7 M/6 F), and 10 PSP (6 M/4 F) patients.

FIELD STRENGTH AND SEQUENCE: 3 T, MPRAGE T₁-weighted imaging and multi-echo gradient echo imaging (mGRE) for QSM.

ASSESSMENT: Group level differences of SN volume, magnetic susceptibility, and susceptibility-to-volume ratio (SVR) among PSP, PD, and MSA groups, and these metrics’ differentiating power are measured. Bivariate logistic regression with T₁-based morphological markers alongside SN metrics is performed.

STATISTICAL TESTS: Mann-Whitney U test for group comparisons. Receiver operating characteristic analysis with bootstrapping. p < 0.05 after Bonferroni correction is defined as statistically significant result.

RESULTS: The SN SVR was significantly higher in the PSP group compared to the MSA group and the MSA-P group. Moreover, using pons measurements with SN SVR in a bivariate model resulted in the highest differentiation between the PSP and MSA groups (AUC = 0.88, 95% CI: [0.78-0.95]), particularly driven by the increased differentiation between the PSP and MSA-P groups (AUC = 0.88, 95% CI: [0.75-0.98]). External validation supported the generalizability of SN SVR, yielding 100% sensitivity and 80% specificity for differentiating PSP from HC and PD.

DATA CONCLUSION: QSM-based SN morphometry can complement T₁-weighted imaging for Parkinsonism assessment.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 2.

PMID:42475080 | DOI:10.1002/jmri.70459

Pain. 2026 Jul 20. doi: 10.1097/j.pain.0000000000004064. Online ahead of print.

ABSTRACT

Complex regional pain syndrome (CRPS) is a chronic, treatment-refractory neuropathic disorder associated with substantial functional impairment and socioeconomic burden. Although socioeconomic conditions have been implicated in vulnerability to chronic pain, evidence on the association between income dynamics and the risk of developing CRPS remains limited. Using the Korean National Health Insurance Service database, we conducted a nationwide cohort study including 3,437,021 adults in South Korea who underwent national health screening in 2012 and were followed through to 2022. Income-related indicators-including baseline income level, cumulative income exposure, income change, and income volatility during the 5 years preceding baseline-were assessed. Incident CRPS was identified using Korean Standard Classification of Diseases codes combined with registration in the Rare Intractable Disease program. Compared with the highest income quartile, individuals in the lowest income quartile had a higher CRPS risk (adjusted hazard ratio [aHR], 3.74; 95% confidence interval [CI], 3.07-4.56). Risk increased with longer duration of low-income status (aHR, 1.91; 95% CI, 1.48-2.45 for 5 vs 0 years) and decreased with longer duration of high-income status (aHR, 0.55; 95% CI, 0.44-0.70 for 5 vs 0 years). In addition, high-income volatility (highest vs lowest quartile aHR, 1.48; 95% CI, 1.23-1.78) and downward income changes (peak aHR, 1.84; 95% CI, 1.24-2.73) were independently associated with increased CRPS risk. These findings suggest that income dynamics represent an important socioeconomic risk factor for CRPS and highlight the relevance of longitudinal socioeconomic vulnerability in the development of disabling chronic pain conditions.

PMID:42475049 | DOI:10.1097/j.pain.0000000000004064

Psychol Methods. 2026 Jul 20. doi: 10.1037/met0000860. Online ahead of print.

ABSTRACT

The ability of a student can be conceptualized as either a continuously varying entity (e.g., conventional analysis using dichotomous item response theory [IRT] models; Lord & Novick, 1968) or a bundle of latent classes (e.g., cognitive diagnostic models [CDMs]; Rupp et al., 2010; von Davier & Lee, 2019). This article builds on recent efforts to focus on predictive differences between measurement models in an attempt to examine the degree to which such approaches, which utilize quite distinctive notions regarding the nature of ability, produce different predictions of response behavior in the real world. We first present two simulation studies in which data are generated from variants of CDMs that differ in sample size, attribute hierarchical structures, and attribute estimation methods. We illustrate that, as we would expect given that they were used to generate data, CDM-based predictions uniformly outperform those of IRT models. We then compare the performance of CDM- and IRT-based approaches across 11 empirical data sets previously analyzed using CDMs. Our findings indicate that overfitting is a pervasive issue across CDM-based predictions, particularly with the generalized deterministic inputs, noisy “and” gate model. Furthermore, in no case does the CDM show superior performance when using the maximum a posteriori estimator, and only six out of 11 data sets show improved model fit for CDMs over the two-parameter logistic model when using the marginal mastery probabilities estimator. Researchers and practitioners may need to balance the diagnostic appeal of CDMs with the fact that their complexity can come at the cost of predictive accuracy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42475042 | DOI:10.1037/met0000860

Psychol Assess. 2026 Jul 20. doi: 10.1037/pas0001476. Online ahead of print.

ABSTRACT

Multi-informant assessments are considered the gold standard in the assessment of youth psychopathology. Although best practice dictates that this approach should extend to the assessment of youth involved in the justice system, few studies have examined the effect of multiple informants in a forensic context. Using a sample of 580 youth-caregiver dyads, we conducted a series of polynomial regressions to test whether statistical interactions between scores on the Youth Self-Report and scores on the Child Behavior Checklist (completed by caregivers) predicted psychiatric diagnoses. Psychiatric diagnoses were coded from the youth’s final forensic assessment report and included anxiety disorder, depressive disorder, conduct disorder, oppositional defiant disorder, and attention-deficit hyperactivity disorder. A significant interaction was found when modeling the effect of youth-caregiver reports of rule-breaking behavior on receiving a conduct disorder diagnosis, and when modeling the effect of youth-caregiver reports of aggressive behavior on receiving an attention-deficit hyperactivity diagnosis. No significant interactions were found when modeling the effect of youth-caregiver reports of internalizing symptomology on receiving an anxiety or depressive disorder diagnosis. Results suggest that youth and caregiver reports are integrated differently depending on whether the clinician is making an internalizing or externalizing spectrum diagnosis. Study implications for forensic assessments with multiple informants are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42475031 | DOI:10.1037/pas0001476

J Relig Health. 2026 Jul 20. doi: 10.1007/s10943-026-02734-y. Online ahead of print.

ABSTRACT

Spiritual abuse is a form of harm in religious communities that disrupts positive social connections and causes negative health impacts. Without objective assessment methods, religious groups that are spiritually abusive can be difficult to identify. This study introduces spiritual safety-the ability to practice one’s spirituality without coercion, manipulation, or emotional abuse-as a measure for the risk of spiritual abuse in a faith-based organization. Sixty items were developed based on themes from the literature on spiritual abuse and psychological safety. The items were refined through content validity index and psychometrically validated across two separate studies with primarily North American Christian participants. In Study 1 (n = 331), exploratory factor analysis identified three underlying factors which were named psychological safety, leadership, and culture. Study 2 (n = 491) confirmed the three-factor structure using confirmatory factor analysis and validated a final 20-item version of the scale. The Spiritual Safety Scale (S-SAFE) demonstrated excellent reliability (α = 0.97), a strong correlation with individual psychological safety (r = 0.82), a strong negative correlation with PTSD symptomatology (r = – 0.56), and a moderate negative correlation with negative religious coping (r = – 0.43). Fit indices demonstrated good model fit (CFI = 0.95, TLI = 0.94, RMSEA = 0.07). ANOVA supported the statistical significance of scoring groups for healthy, unhealthy, and unsafe categories. The S-SAFE therefore offers a practical tool for assessing spiritual safety and risk of spiritual abuse in North American Christian communities.

PMID:42474978 | DOI:10.1007/s10943-026-02734-y

J Patient Rep Outcomes. 2026 Jul 20. doi: 10.1186/s41687-026-01149-3. Online ahead of print.

ABSTRACT

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, chronic disease that significantly affects quality of life (QoL). Despite improved survival, many patients experience persistent symptoms and complex care needs. Patient-reported data on QoL and perceived care quality remain limited, particularly in Italy. This study aimed to assess health-related QoL and patient-perceived care quality among Italian EGPA patients and to identify distinct patient profiles through cluster analysis to inform personalized, multidisciplinary care strategies.

METHODOLOGY: We conducted a cross-sectional, 77-item online survey among adult EGPA patients (self-reported diagnosis) between December 2024 and January 2025. The survey, developed with APACS APS (Associazione Pazienti con Sindrome di Churg-Strauss), was distributed via the SurveyMonkey platform. It included validated instruments: SF-36 for health-related QoL and PACIC (with PACIC-5As) for perceptions of chronic care. Additional demographic, clinical, and disease impact data were collected. Descriptive statistics and group comparisons were performed. SF-36 and PACIC domains were analyzed using principal component analysis (PCA), followed by k-means clustering to identify patient subgroups.

RESULTS: Seventy-two patients completed the survey (mean age 56; 65% female; median disease duration 7 years; 84.7% on biologics; 41.7% on glucocorticoids). SF-36 scores showed moderate QoL impairment (mean PCS 56.3 ± 24.6; MCS 59.3 ± 24.1), with lower QoL among females, divorced/separated individuals, and those with neurological involvement. Paresthesia had the greatest impact, affecting multiple QoL domains and daily functioning (p < 0.05). PACIC scores reflected moderate perceptions of care (2.8-3.5), with lowest scores in “Goal Setting” and “Care Coordination.” PACIC-5As scores were low (mean 2.3), indicating suboptimal collaborative care. Cluster analysis identified three profiles: (1) poor QoL with high healthcare engagement (n = 12); (2) best QoL and care ratings (n = 38); (3) intermediate health status but lowest PACIC scores (n = 22), reflecting perceived lack of support. Differences across clusters were statistically significant (p < 0.001).

CONCLUSIONS: Italian EGPA patients report impaired QoL and only moderate care quality, with notable heterogeneity in experiences. Personalized, multidisciplinary approaches are needed, especially for patients who feel under-supported despite moderate disease activity.

PMID:42474947 | DOI:10.1186/s41687-026-01149-3

J Occup Rehabil. 2026 Jul 20. doi: 10.1007/s10926-026-10416-5. Online ahead of print.

ABSTRACT

PURPOSE: Many people diagnosed with cancer are of working age and experience challenges returning to and retaining-paid work. Existing interventions to support return to work have shown mixed effectiveness, and their cost-effectiveness is often unknown. The STEPS work participation program, based on the Stages of Change, aims to support employed cancer survivors in work resumption and retention. This study evaluated its cost-effectiveness compared to usual care.

METHODS: An economic evaluation was conducted alongside a 12-month multi-center randomized controlled trial in the Netherlands. Employed cancer survivors were randomized to STEPS (n = 123) or usual care (n = 116). Quality-adjusted life years (QALYs) were estimated using the EQ-5D-5L questionnaire. Costs were assessed from a societal perspective. Analyses followed the intention-to-treat principle, were conducted using seemingly unrelated regression adjusted for baseline utility and costs, with uncertainty assessed using bootstrapping.

RESULTS: Participants in the STEPS group accrued marginally more QALYs than those receiving usual care (adjusted mean difference: 0.004; 95%CI: – 0.018 to 0.025), but this difference was neither statistically significant nor clinically relevant. Total societal costs were higher in the STEPS group than in usual care, with an adjusted mean difference of €2933 (95%CI: – €2735 to €8600). The probability of STEPS being cost-effective compared to usual care was 0.17 at a willingness-to-pay of €20,000/QALY, increasing only to 0.21 at €80,000/QALY. Sensitivity analyses confirmed these findings.

CONCLUSION: The STEPS program cannot be considered cost-effective compared to usual care and is therefore not recommended for implementation in its current form.

PMID:42474940 | DOI:10.1007/s10926-026-10416-5

J Robot Surg. 2026 Jul 20;20(1):714. doi: 10.1007/s11701-026-03704-y.

ABSTRACT

Most early reports on the Hugo™ Robotic- assisted surgery (RAS) system originated from institutions with concurrent access to established robotic platforms, potentially introducing device selection bias. We conducted a retrospective assessment of 103 patients with localized prostate cancer treated using Hugo™ RAS-assisted robot-assisted radical prostatectomy at a Japanese municipal hospital where no alternative robotic platform was available. The analysis focused on perioperative performance, safety outcomes, and consistency of procedural implementation. A standardized surgical setup, including a W-shaped port configuration and predefined floor-marking-based docking strategy, was applied. Surgery was carried out by six surgeons with different levels of robotic experience, including one surgeon without prior robotic operative experience. Operative, console, and docking durations showed median values of 152 min (IQR 129-218.5), 108 min (IQR 85-174.5), and 5 min (IQR 4-7), respectively. Estimated intraoperative blood loss was 100 mL (IQR 50-214). Neither intraoperative blood transfusion nor conversion to open surgery was necessary in any patient. Postoperative complications occurred in four patients (3.9%), including one major complication (Clavien-Dindo > II; 1.0%). Positive surgical margins were observed in 35 patients (34.0%) and 79.6% achieved urinary continence at 3 months. In this Hugo-exclusive, single-platform environment, RARP using the Hugo™ RAS system was performed without major safety concerns across surgeons with varying experience. Although four independent-arm carts needed to be rolled in, the median docking time was 5 min, possibly facilitated by a standardized floor-marking strategy adopted at our institution.

PMID:42474937 | DOI:10.1007/s11701-026-03704-y

J Gastrointest Cancer. 2026 Jul 20;57(1):159. doi: 10.1007/s12029-026-01535-6.

ABSTRACT

BACKGROUND: Metastatic colorectal cancer (mCRC) with microsatellite instability-high or mismatch repair deficiency (MSI-H/dMMR) demonstrates limited responsiveness to conventional cytotoxic chemotherapy but increased susceptibility to immune checkpoint inhibition. Although randomized phase III trials have shown superiority of immune checkpoint inhibitors (ICIs) in the first-line setting, a comprehensive synthesis of survival outcomes across key molecular and clinical subgroups remains warranted.

METHODS: We conducted a systematic review and meta-analysis of randomized, open-label, phase III trials comparing first-line ICI-based therapy with standard chemotherapy in MSI-H/dMMR mCRC. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Prespecified subgroup analyses evaluated outcomes according to BRAF mutation status, KRAS/NRAS mutation status, and primary tumor location. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using random-effects models. Safety outcomes were analyzed using Mantel-Haenszel fixed-effect models. Statistical heterogeneity was assessed using the I² statistic.

RESULTS: Two phase III trials (KEYNOTE-177 and CheckMate-8HW), including more than 600 patients, were eligible. ICI-based therapy significantly improved PFS compared with chemotherapy (pooled HR 0.61; 95% CI, 0.51-0.73; I²=0%) and demonstrated a significant OS benefit (pooled HR 0.77; 95% CI, 0.63-0.94; I²=0%). Immunotherapy was associated with lower rates of overall and grade ≥ 3 adverse events, despite more frequent immune-related toxicities.

CONCLUSIONS: First-line ICI-based therapy provides significant and consistent survival benefits across BRAF-mutated and wild-type tumors, KRAS/NRAS-mutated and wild-type disease, and both right- and left-sided primary tumors, supporting its role as the standard of care for MSI-H/dMMR mCRC.

PMID:42474934 | DOI:10.1007/s12029-026-01535-6