Nevin Manimala

JAMA Netw Open. 2025 Dec 1;8(12):e2547104. doi: 10.1001/jamanetworkopen.2025.47104.

ABSTRACT

IMPORTANCE: Pediatric obesity rates are rising, and adverse childhood experiences (ACEs) may contribute by promoting stress-induced weight gain. Few studies have examined the association of ACEs with body mass index (BMI) and youth-reported protective factors, particularly among Latinx and Hispanic youths, who face higher rates of ACEs and obesity.

OBJECTIVE: To evaluate the association of ACEs with BMI in a population-based cohort and determine whether youth-reported protective factors (eg, self-coping skills, caregiver or friend support, or overall support) moderate this association, with a focus on Latinx and Hispanic youths.

DESIGN, SETTING, AND PARTICIPANTS: This large, cross-sectional study of youths aged 11 to 12 years was conducted using year 2 data (July 2018 to March 2020) of the Adolescent Brain Cognitive Development (ABCD) study, a prospective, 10-year longitudinal, 21-site dataset comprised of a population-cohort of US youths. Data were analyzed between August 2024 and March 2025.

EXPOSURES: Cumulative ACEs (12 categories) and youth-reported protective factors (4 categories).

MAIN OUTCOME AND MEASURES: The primary outcome was the ability of self-reported protective factors to moderate the hypothesized association of ACEs with BMI in Latinx and Hispanic youths. Linear mixed-effects models explored associations of ACEs, protective factors, and ethnicity (ie, Latinx and Hispanic or non-Hispanic) with BMI, while controlling for confounders (eg, sex, age, puberty, and socioeconomic status).

RESULTS: There were 5435 youths with available data at ages 11 to 12 years (1141 Latinx and Hispanic [21.0%]; 2636 female [48.5%]; mean [SD] age, 143.1 [7.6] months). Compared with non-Hispanic youths, Latinx and Hispanic youths had greater BMI (mean [SD], 22.1 [5.0] vs 20.3 [4.6]; P < .001) and more ACEs (mean [SD], 2.1 [1.7] vs 1.7 [1.7]; P < .001). Across all youths, ACEs were significantly associated with BMI, with a 0.431 BMI increase for every 1.7-point increase (1 SD) in ACE score. In Latinx and Hispanic youths only, self-coping (β = -0.74; 95% CI, -1.03 to -0.46; P < .001), caregiver support (β = -0.38; 95% CI, -0.66 to -0.11; P = .006), and overall protective score (β = -0.55; 95% CI, -0.61 to -0.06; P < .001) moderated the association of ACEs with BMI.

CONCLUSIONS AND RELEVANCE: These findings highlight the clinical importance of early ACE screening to identify at-risk youths for targeted, trauma-informed weight management interventions, and gather support for the cultivation of resiliency-focused skills like self-coping and caregiver support. Pediatric obesity is a pressing public health issue, and these strategies hold potential to alter weight trajectories, which may improve health outcomes and reduce health disparities.

PMID:41343209 | DOI:10.1001/jamanetworkopen.2025.47104

J Glob Health. 2025 Dec 5;15:04326. doi: 10.7189/jogh.15.04326.

ABSTRACT

BACKGROUND: Most medical research on pneumonia in children focuses on those <5 years, leaving a gap in understanding pneumonia in children aged 5-9. We aimed to identify the characteristics of children from this age group who had pneumonia and required hospital care, including critical care service.

METHODS: In this retrospective chart analysis, we examined clinical, demographic, and laboratory characteristics of children aged 5-9 years with clinical and radiologic pneumonia admitted to Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, from 2011 to 2020. We categorised the children into two groups: those who required critical care (admitted to the intensive care unit (ICU)) and those who did not. We compared the two groups to identify factors independently associated with the need for critical care using a log binomial regression model.

RESULTS: Among a total of 154 children who fulfilled the enrolment criteria, 34 were admitted to the ICU requiring critical care, and 120 children were treated in the inpatient ward, as they did not require any critical care. The median age of the children requiring critical care was 69 (interquartile range (IQR) = 60-81) months, compared to 72 (IQR = 62-84) months for those who didn`t require critical care (P = 0.259). Using a log binomial regression model we found hypoxemia (odds ratio (OR) = 10.1; 95% confidence interval (CI) = 1.42-71.92, P = 0.021), convulsion (OR = 281.37; 95% CI = 12.99-6091.72, P < 0.001], sepsis (OR = 27.69; 95% CI = 3.33-230.39, P = 0.002), hypokalaemia (OR = 10.37; 95% CI = 1.40-76.96, P = 0.022) were the independently associated with critical care service among children aged five to nine with pneumonia.

CONCLUSIONS: Our results suggest that early recognition and prompt treatment of hypoxemia, convulsions, sepsis, and hypokalaemia may significantly reduce the need for critical care and possibly avert fatal consequences in children with pneumonia, aged 5-9, especially in resource-limited settings.

PMID:41343207 | DOI:10.7189/jogh.15.04326

Am J Speech Lang Pathol. 2025 Dec 4:1-16. doi: 10.1044/2025_AJSLP-25-00141. Online ahead of print.

ABSTRACT

PURPOSE: The Speech Assessment of Children’s Home Language(s) (SACHL) offers a new, evidence-based clinical protocol for speech-language pathologists (SLPs) to assess speech in unfamiliar languages. This study used implementation science to investigate SLPs’ current multilingual speech assessment practices, determine the prospective acceptability of the SACHL, and compare current confidence to prospective confidence with the SACHL.

METHOD: The Consolidated Framework for Implementation Research and the Theoretical Framework of Acceptability were used to explore innovation deliverers’ (SLPs and student SLPs) prospective acceptability of the innovation (SACHL). Attendees at in-person and online SACHL presentations were invited to participate. A total of 360 participants responded to an online questionnaire exploring current practices, transcription skills, confidence, and acceptability of the SACHL. Statistical tests compared attendees at different presentations, SLPs and student SLPs, and monolingual and multilingual participants.

RESULTS: The majority of participants indicated low current confidence in assessing multilingual children. Most SLPs assessed, transcribed, and analyzed multilingual children’s speech in English but rarely or never applied these practices in children’s home language(s). The majority of participants rated the SACHL as being culturally responsive, well designed, and easy to understand and that it could increase diagnostic accuracy. There were concerns around the time burden in using the SACHL. Most (87.45%) indicated they would like to use the SACHL in clinical practice, and there was a statistically significant improvement between current confidence and prospective confidence.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.30716981.

PMID:41343205 | DOI:10.1044/2025_AJSLP-25-00141

J Glob Health. 2025 Dec 5;15:04291. doi: 10.7189/jogh.15.04291.

ABSTRACT

BACKGROUND: Globally, the issue of ischaemic heart disease (IHD) has emerged as a prominent public health challenge in the ongoing process of ageing. Previous assessments relied upon data constrained by geographical scope and lacking a thorough worldwide evaluation. We aimed to present the incidence, prevalence, death, and disability-adjusted life years (DALYs) due to IHD at global, regional, and national levels from 1990 to 2021, emphasising decomposition and progressive analysis. We aim to provide relevant information to guide health policy decisions, allocate medical resources effectively, and improve patient care protocols for greater efficiency.

METHODS: We aimed to accurately depict the health impact of IHD by applying standardised Global Burden of Disease approaches and analysing four key epidemiological indicators: prevalence, incidence, mortality, and DALYs. We quantified temporal trends in the burden of IHD from 1990 to 2021 using the estimated annual percentage change (EAPC) metric. We conducted an in-depth examination of global trends, categorising them by age group, gender, and the sociodemographic index (SDI) to provide a more nuanced understanding. Decomposition analyses of IHD DALYs, which examine the effects of age distribution, population dynamics, and changes in disease patterns, enabled us to accurately quantify the specific contributions of each factor to the overall IHD burden. Using frontier analytical methods, we intended to pinpoint the minimal plausible burden of IHD, contingent on the level of development, as gauged by the SDI.

RESULTS: In 2021, the age-standardised incidence rate (ASIR) of IHD decreased compared with 1990 (EAPC = -0.44; 95% confidence interval = -0.47, -0.42). Moreover, the age-standardised mortality rates (ASMR) and DALYs (ASDR) decreased over time. The overall IHD burden was marginally higher in males than in females. The global rates for prevalence, incidence, deaths, and DALYs related to IHD demonstrated an overall rising trend along with age. Among all regions, the North Africa and Middle East region exhibited the highest ASIR (ASIR = 895.85; 95% uncertainty interval (UI) = 786.65, 1043.49) and age-standardised prevalence rate (ASPR) (ASPR = 6404.84; 95% UI = 5872.02, 7041.08) for IHD in 2021. Central Asia recorded the highest ASMR (ASMR = 265.51; 95% UI = 240.67, 290.42) and ASDR (ASDR = 4864.49; 95% UI = 4415.55, 5338.75) in 2021. Decomposition analysis revealed population growth and ageing as primary factors driving the rise in IHD DALYs. Frontier analysis illuminated ample room for enhancement across the entire development continuum.

CONCLUSIONS: The variability in IHD burden is influenced by gender, age, and geographic location. The global burden of IHD has persistently increased during the last three decades, notably among older males. The escalating ageing population and demographic expansion underscore the importance of bolstering public health measures and optimising resource allocation, particularly in etiological investigation, prompt diagnosis, preventive measures, and locally tailored management for IHD.

PMID:41343197 | DOI:10.7189/jogh.15.04291

J Glob Health. 2025 Dec 5;15:04359. doi: 10.7189/jogh.15.04359.

ABSTRACT

BACKGROUND: With declining funding for population-based household surveys, routine health facility data offer a promising alternative for tracking newborn health and service quality. However, their utility depends on data quality. We assessed the quality of ten data elements within routine health information systems in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda, seven of which align with the Every Newborn Action Plan core newborn indicators.

METHODS: We conducted a cross-sectional study in 97 emergency obstetric and newborn care facilities across 4 countries between November 2022 and July 2024. We extracted three months of routine register and summary report data on ten maternal and newborn elements (two denominators, three outcome numerators, five newborn care interventions) and one tracer maternal indicator. We evaluated data quality on four dimensions (availability, completeness, accuracy, and internal consistency) and measured internal consistency using the ratio of (total births – live births)/stillbirths, with a value of 1 suggesting ideal internal consistency.

RESULTS: Denominator completeness exceeded 90% in Uganda and Tanzania, but was lower in the CAR (87%) and Ethiopia (82%). Impact numerator completeness averaged 79% for neonatal mortality and 81% for low birth weight, with Ethiopia performing worst, with scores of 45% and 32%, respectively). Completeness for newborn interventions (early breastfeeding, kangaroo mother care, bag-mask ventilation, sepsis management) remained below 90%, with the CAR lacking neonatal sepsis data and Ethiopia lacking early breastfeeding data. Accuracy was poor: concordance between register recounts and summary reports ranged from 9% to 40%. Internal consistency checks revealed mismatches in 80% of facilities, including negative ratios in Uganda and ratios >1 in the CAR.

CONCLUSIONS: Significant gaps in completeness, accuracy, and internal consistency undermine the reliability of newborn and stillbirth data in routine health information systems, highlighting a need for their strengthening, the integration of standardised newborn indicators, and institutionalized quality verification processes to ensure timely, reliable, and actionable data for improving newborn care.

PMID:41343194 | DOI:10.7189/jogh.15.04359

JAMA Otolaryngol Head Neck Surg. 2025 Dec 4. doi: 10.1001/jamaoto.2025.4203. Online ahead of print.

ABSTRACT

IMPORTANCE: Historical evidence demonstrated that delays or interruptions in radiotherapy (RT) are associated with poorer oncologic outcomes in head and neck squamous cell carcinoma (HNSCC). Substantial concerns arose during the COVID-19 pandemic, when treatment schedules were frequently disrupted.

OBJECTIVE: To determine the association of RT interruptions with locoregional failure (LRF) and overall survival (OS).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective review and secondary analysis of 3 randomized clinical trials (NRG/RTOG 0129, 0522, and 1016) included patients enrolled in the trials who were treated with RT. Patients with HNSCC were grouped as (1) p16-positive oropharynx (p16+ OPSCC) and (2) p16-negative oropharynx and all other subsites regardless of p16 status (called locally advanced HNSCC [LAHNSCC])). Cox proportional hazards models were fit to assess the association of an RT interruption (binary model) and length of RT interruption (continuous model) with LRF and OS.

EXPOSURES: Presence of RT interruption.

MAIN OUTCOMES AND MEASURES: LRF and OS.

RESULTS: There were 1549 patients (200 female patients [12.9%]; mean [SD] age, 57 [6] years; 1048 p16+ OPSCC [67.7%]; 501 LAHNSCC [32.3%]) who were included in the binary model; 439 (28.3%) had RT interruption. There were 1083 patients (69.9%) with available length of RT interruption (continuous model). A binary RT interruption was associated with hazard ratios (HRs) of 1.04 (95% CI, 0.90-1.36) for LRF and 1.22 (95% CI, 0.99-1.50) for OS. As a continuous predictor, each 7-day interruption corresponded to HRs of 1.45 (95% CI, 1.12-1.89) for LRF and 1.41 (95% CI, 1.07-1.86) for OS. Analyses did not indicate effect modification by p16 status, and results are presented from models that estimated the effect of RT interruption across both groups. Using covariate-adjusted predictions from models that included clinical and tumor characteristics, a mean 7-day interruption in RT was associated with a 3-year LRF decrement of 4.1% in p16+ OPSCC and 9.1% in LAHNSCC. Predicted 3-year LRF detriment due to RT interruption ranged from 2.0% for a patient with non-T4, non-N3, p16+ OPSCC to 11.2% for a patients with LAHNSCC with a T4N3 p16-negative cancer.

CONCLUSIONS AND RELEVANCE: The secondary analysis suggests that RT treatment interruptions may be negatively associated with LRF and OS in HNSCC, but the magnitude of the association varies depending on p16 status and clinical characteristics. While treatment interruptions should globally be discouraged, patients with LAHNSCC or higher-stage disease may be most affected.

TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT00047008; NCT00265941; NCT01302834.

PMID:41343184 | DOI:10.1001/jamaoto.2025.4203

J Glob Health. 2025 Dec 5;15:04319. doi: 10.7189/jogh.15.04319.

ABSTRACT

BACKGROUND: Evidence regarding the association between physical activity (PA) and diabetic retinopathy (DR) remains inconsistent. Furthermore, its effects on retinal vessel diameters in type 2 diabetes are not well established. We aimed to investigate the relationship between PA, DR, and retinal vessel diameters, explore underlying mechanisms, and identify protective exercise regimens.

METHODS: We included patients with type 2 diabetes from the Shanghai Cohort Study of Diabetic Eye Disease. Retinal vessel diameters were measured using computer vision and deep learning. Anthropometric data were collected using standard methods, and PA data through interviews. In 2017, participants were categorised by their DR status. Those without DR were divided into active and inactive groups and followed for three years to assess the effect of PA. For statistical analyses, we used independent t-tests, χ² tests, one-way analysis of variance, Bonferroni tests, multiple linear and logistic regression models, Kaplan-Meier, and Cox regression models.

RESULTS: In the cross-sectional analysis, we analysed a sample of 42 992 individuals, with a mean age of 64.42 (standard deviation (SD) = 6.87) years. PA was associated with reduced odds of moderate and severe non-proliferative DR, and with wider retinal arterioles and venules. In the longitudinal cohort, we analysed 3669 individuals, with a mean age of 63.1 (SD = 6.65) years. PA was a protective factor against incident DR (hazard ratio = 0.812; 95% confidence interval = 0.679-0.971) and was associated with increased peripheral retinal arteriolar calibre and arterio-venous ratio.

CONCLUSIONS: PA improved retinal vessel diameters and lowered DR incidence, highlighting the necessity for further research into the physiological mechanisms linking PA and DR. Promoting awareness and engagement in moderate/high-intensity exercise may enhance diabetes health management.

REGISTRATION: ClinicalTrials.gov NCT03665090.

PMID:41343177 | DOI:10.7189/jogh.15.04319

JAMA Oncol. 2025 Dec 4. doi: 10.1001/jamaoncol.2025.5144. Online ahead of print.

ABSTRACT

IMPORTANCE: Observational studies have associated use of aspirin and selective cyclooxygenase inhibitors with decreased recurrence and improved survival in patients with colon cancer. While randomized clinical trials have not shown benefit across all patients, these findings suggest that select subgroups may benefit from their use. Despite the well-established prognostic value of circulating tumor DNA (ctDNA), its role in guiding treatment remains unclear.

OBJECTIVE: To investigate the predictive value of postoperative ctDNA for survival outcomes with adjuvant celecoxib alongside conventional chemotherapy in patients with stage III colon cancer.

DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the phase 3 Cancer and Leukemia Group B (now Alliance)/Southwest Oncology Group 80702 randomized clinical trial (2010-2015) assessing adjuvant celecoxib vs placebo and 3 vs 6 months of adjuvant 5-fluorouracil, leucovorin, and oxaliplatin for stage III colon cancer. Patients consented to biospecimen collection and had ctDNA analysis performed. Data analysis was performed from September 2024 to June 2025.

EXPOSURES: Postoperative ctDNA positivity was determined using a clinically validated, tumor-informed 16-plex-polymerase chain reaction-next-generation sequencing assay (Signatera; Natera Inc) performed between surgery and initiation of adjuvant therapy.

MAIN OUTCOMES AND MEASURES: Disease-free survival (DFS) and overall survival (OS). Survival by ctDNA status and adjuvant celecoxib use were assessed as part of a post hoc companion study with prespecified statistical analysis plan.

RESULTS: Among 940 patients (mean [SD] age, 60.9 [10.8] years; 426 female [45.3%] and 515 male [54.7%] individuals; 222 [23.6%] with prior low-dose aspirin use; and median follow-up of 6.0 [95% CI, 6.0-6.0] years), 767 (81.6%) were ctDNA negative and 173 (18.4%) were ctDNA positive. ctDNA positivity was highly prognostic of worse DFS (reference, ctDNA negativity; adjusted hazard ratio [aHR], 6.12; 95% CI, 4.66-8.03) and OS (aHR, 5.86; 95% CI, 4.19-8.19). In patients with ctDNA positivity, celecoxib was associated with improved DFS (aHR, 0.61; 95% CI, 0.42-0.89) and OS (aHR, 0.62; 95% CI, 0.40-0.96) compared to placebo. Among patients with ctDNA negativity, celecoxib did not provide survival benefit (DFS: aHR, 0.76; 95% CI, 0.53-1.09; OS: aHR, 0.85; 95% CI, 0.54-1.36), although the interaction was not significant (P for interaction, .41 and .33 for DFS and OS, respectively). These findings persisted when stratifying patients by microsatellite instability status and PIK3CA mutational status.

CONCLUSION AND RELEVANCE: The findings of this post hoc analysis suggest that ctDNA status has the potential to inform clinical decision-making among patients with stage III colon cancer who should consider adjuvant celecoxib in addition to conventional chemotherapy.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01150045.

PMID:41343176 | DOI:10.1001/jamaoncol.2025.5144

J Glob Health. 2025 Dec 5;15:04314. doi: 10.7189/jogh.15.04314.

ABSTRACT

BACKGROUND: Low physical activity (LPA) is associated with cardiovascular and cerebrovascular pathologies. This study aimed to assess the prevalence of several noncommunicable diseases relating to LPA.

METHODS: Using the 2021 Global Burden of Disease data set, we modelled LPA-related disease burdens across 204 countries and territories, quantifying mortality counts, age-standardised mortality rates, and disability-adjusted life years (DALYs) for five noncommunicable diseases. We conducted multivariable stratification analyses to assess variations by gender, age, and sociodemographic index (SDI) quintiles. We used age-period-cohort modelling to project burden trajectories, while applying counterfactual decomposition frameworks to delineate synergistic interactions between LPA and risk factors.

RESULTS: We found that LPA accounted for 555 101 related deaths globally in 2021 across the five studied pathologies, mostly among individuals aged 60-94 years. Association between LPA-related disease burden and SDI followed a U-shaped distribution across regions and diseases. Among individuals aged 60-89 years, LPA-related deaths were significantly higher in women than in men, indicating a disproportionate burden on elderly females. Ischaemic heart disease (IHD) trends stabilised in low- and middle-SDI regions but declined significantly in high-SDI regions, underscoring global health disparities. From 2007 to 2011, LPA DALYs and mortality risk ratios for IHD, stroke, and lower extremity peripheral arterial disease declined from >1 to <1, whereas diabetes mellitus exhibited an opposite trend, highlighting LPA’s persistent and significant impact on diabetes-related morbidity. Demographic shifts and epidemiological transitions were primary drivers of LPA-related disease burden across five pathologies. In high-SDI regions, epidemiological changes predominated, whereas population growth was a key factor in low- and middle-SDI regions. Synergistic interaction of these factors with LPA is projected to substantially amplify future disease burden.

CONCLUSIONS: Physical activity should be increased among elderly women to address health risks associated with LPA. Likewise, urgent public health interventions are needed for LPA-related diabetes. As IHD burden rises in low- and middle-SDI regions, vascular disease care strategies require optimisation. Moreover, high-SDI regions should strengthen nationwide physical activity promotion, while low- and middle-SDI areas must enhance healthcare infrastructure and manage population growth to reduce LPA-related disease burdens.

PMID:41343173 | DOI:10.7189/jogh.15.04314

Clin Drug Investig. 2025 Dec 4. doi: 10.1007/s40261-025-01501-3. Online ahead of print.

ABSTRACT

BACKGROUND: With shifting perceptions about the therapeutic potential of cannabis and evolving regulatory frameworks, global prescribing of medicinal cannabis is increasing. While some emerging evidence supports its use for conditions like multiple sclerosis and epilepsy, its efficacy and safety profile for the treatment of mental health conditions remains controversial and under-explored. Previous reviews found inconclusive evidence due to heterogeneity in study design and quality. Accordingly, this review was designed as a scoping review, consistent with established methodological frameworks to map and characterise all available randomised controlled trial (RCT) evidence in this emerging and heterogeneous field. It specifically sought to synthesise the highest-quality trial evidence to date, addressing the question: How effective is medicinal cannabis in treating mental health conditions, as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and how safe and tolerable is it, as assessed through adverse events and treatment withdrawals?

METHODS: A scoping review was conducted comprising RCTs investigating medicinal cannabis for mental health conditions. Eligible studies were required to meet predefined inclusion criteria based on population, intervention, comparator, outcomes, and study design (PICOS framework). PubMed, Web of Science, and PsycINFO databases were searched, supplemented by citation tracking and Google Scholar, for studies published between 1980 and 2024.

RESULTS: The search identified 8061 studies, with 28 RCTs meeting inclusion criteria across 12 DSM-5 mental health conditions. Indications most frequently studied were schizophrenia (n = 5), cannabis use disorder (n = 4), cocaine use disorder (n = 4), post-traumatic stress disorder (n = 3), anxiety disorders (n = 3), and opioid use disorder (n = 2); there were two trials in autism spectrum disorder and single trials in depression, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, tobacco use disorder, and Tourette syndrome. Sample sizes ranged from 6 to 150 participants (median = 42), and follow-up durations from 1 day to 13 weeks (median = 6 weeks). Interventions included purified cannabidiol (CBD; single doses of 300-800 mg and daily regimens up to 1000 mg/day), nabiximols or other tetrahydrocannabinol (THC)/CBD oromucosal sprays (up to 113 mg THC/105 mg CBD per day), and smoked or vaporised cannabis flower of varying THC/CBD content. Findings showed substantial heterogeneity and variable quality, with some short-term benefits reported (notably in cannabis use disorder, autism spectrum disorder, and schizophrenia), but no trial demonstrated long-term efficacy.

CONCLUSION: Despite growing interest, substantial heterogeneity limits current evidence for medicinal cannabis in mental health. This review highlights key gaps, underscoring the need for robust, well-powered RCTs with extended follow-up to clarify its role in the management of mental ill health.

PMID:41343139 | DOI:10.1007/s40261-025-01501-3