Nevin Manimala

JAMA Intern Med. 2024 Nov 4. doi: 10.1001/jamainternmed.2024.5932. Online ahead of print.

ABSTRACT

IMPORTANCE: Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements.

OBJECTIVE: To examine the association between work requirements and safety-net program enrollment.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Medicaid and Supplemental Nutrition Assistance Program (SNAP) enrollees in Connecticut. The impact of SNAP work requirements for able-bodied adults without dependents-the target population-was estimated using a triple-differences research design comparing outcomes before and after the policy (first difference) in affected and exempted towns (second difference) between the targeted population and untargeted parents and caregivers (third difference). SNAP and Medicaid enrollment trends were assessed for a 24-month period, and the characteristics of individuals most likely to lose coverage were examined. Data were collected from August 2015 to April 2018, and data were analyzed from August 2022 to September 2024.

EXPOSURES: The reintroduction of SNAP work requirements in 2016.

MAIN OUTCOMES AND MEASURES: Proportion of enrollees disenrolled from SNAP and Medicaid.

RESULTS: Of 81 888 Medicaid enrollees in Connecticut, 46 872 (57.2%) were female, and the mean (SD) age was 36.6 (7.0) years. Of these, 38 344 were able-bodied adults without dependents, of which 19 172 were exposed to SNAP work requirements, and 43 544 were parents or caregivers exempted from SNAP work requirements. SNAP coverage declined 5.9 percentage points (95% CI, 5.1-6.7), or 25%, following work requirements. There were no statistically significant changes in Medicaid coverage (0.2 percentage points; 95% CI, -1.4 to 1.0). Work requirements disproportionately affected individuals with more chronic illnesses, targeted beneficiaries who were older, and beneficiaries with lower incomes. Individuals with diabetes were 5 percentage points (95% CI, 0.8-9.3), or 91%, likelier to lose SNAP coverage than those with no chronic conditions; older SNAP beneficiaries (aged 40 to 49 years) with multiple comorbidities were 7.3 percentage points (95% CI, 4.3-11.3), or 553%, likelier to disenroll than younger beneficiaries (aged 25 to 29 years) without chronic conditions; and households with the lowest incomes were 18.6 percentage points (95% CI, 11.8-25.4), or 204%, likelier to lose coverage than the highest income SNAP beneficiaries.

CONCLUSIONS AND RELEVANCE: In this cohort study, SNAP work requirements led to substantial reductions in SNAP coverage, especially for the most clinically and socioeconomically vulnerable. Work requirements had little effect on Medicaid coverage, suggesting they did not lead to sufficient increases in employment to transition beneficiaries off the broader safety net.

PMID:39495527 | DOI:10.1001/jamainternmed.2024.5932

Mil Psychol. 2024 Nov 4:1-9. doi: 10.1080/08995605.2024.2423110. Online ahead of print.

ABSTRACT

Linkages among psychological health problems, intimate relationship distress, and suicide risk have been widely studied, but less is known about how these factors interact, especially in military populations. With steady increases in suicide rates among active military and post-service members (SMs), it is critical to better understand the relation among known risk factors. The current study addresses this gap by testing a model hypothesizing that the association between intimate-relationship problems and suicidal ideation is mediated by individual mental health symptoms. We tested this model on a sample of 862 active-duty Air Force members in committed relationships. The sample consisted of 35.0% women and 64.8% men, with an average age of 21.9 years and a mean relationship length of 2.8 years. Findings supported the hypothesized statistical mediation model. Results indicated that relationship problems contribute to psychological health problems, which, in turn, are related to suicidal ideation. These findings may help direct suicide intervention and prevention protocols that consider intimate relationship distress as a significant risk factor. Limitations and further implications for policies regarding suicide prevention in the armed forces are discussed.

PMID:39495505 | DOI:10.1080/08995605.2024.2423110

Eur J Epidemiol. 2024 Nov 4. doi: 10.1007/s10654-024-01166-w. Online ahead of print.

ABSTRACT

The mechanism underlying the co-occurrence of major depressive disorder (MDD) and gynecological diseases remains unclear. This study aimed to investigate the familial co-aggregation and shared genetic loading between MDD and gynecological diseases, namely dysmenorrhea, endometriosis, uterine leiomyomas (UL), and polycystic ovary syndrome (PCOS). Overall, 2,121,632 females born 1970-1999 with parental information were enrolled from the Taiwan National Health Insurance Research Database (NHIRD); 25,142 same-sex twins and 951,779 persons with full-sibling(s) were selected. Genome-wide genotyping data were available for 67,882 unrelated female participants from the Taiwan Biobank linked to the NHIRD. A generalized linear model with a logistic link function was used to examine the associations of individual history, family history in parents/full-siblings/same-sex twins, and polygenic risk scores (PRS) for MDD with the risk of gynecological diseases; generalized estimating equations were used to consider the non-independence of data. Both parents affected with MDD was associated with four gynecological diseases, and its magnitude of association was higher than either affected parent; maternal MDD showed a higher magnitude of association than paternal MDD. Full-siblings of patients with MDD had a higher risk of four gynecological diseases; same-sex twins of patients with MDD had a greater association with dysmenorrhea and PCOS. PRS for MDD was associated with dysmenorrhea and endometriosis. Familial co-aggregation was observed in the co-occurrence of MDD and four gynecological diseases. There exists a shared polygenic liability between MDD and dysmenorrhea and endometriosis. Individuals with MDD-affected relatives or a higher PRS for MDD should be monitored for gynecological diseases.

PMID:39495462 | DOI:10.1007/s10654-024-01166-w

J Imaging Inform Med. 2024 Nov 4. doi: 10.1007/s10278-024-01292-7. Online ahead of print.

ABSTRACT

Next-generation virtual/augmented reality (VR/AR) headsets may rival the desktop computer systems that are approved for clinical interpretation of radiologic images, but require validation for high-resolution low-luminance diagnoses like diverticulitis. The primary aim of this study is to compare diagnostic performance for detecting diverticulitis on CT between radiologists using a headset versus a desktop. The secondary aim is to survey participating radiologists about the usage of both devices. This pilot study retrospectively included 110 patients (mean age 64 ± 14 years, 62 women) who had abdomen/pelvis CT scans for which the report mentioned the presence or absence of diverticulitis. Scans were dichotomized and matched by time, for a total of 55 cases with diverticulitis and 55 controls with no diverticulitis. Six radiologists were oriented to the VR/AR headset (Apple Vision Pro) and viewer app (Visage Ease VP) using ten scans. They each scored 100 unknown scans on a 6-level scale for diverticulitis (1 = no diverticulitis, 6 = diverticulitis) on the headset and then on a desktop. Time per case was recorded. Finally, they completed a survey using 5-level scales about the ease of use of the headset and viewer app (1 = difficult, 5 = easy), about their experience with the headset (1 = bad, 5 = good), and about their preference between devices (1 = desktop, 5 = headset). Summary statistics and multi-reader multi-case ROC curves were calculated. The AUC (and 95% confidence interval) for diverticulitis was 0.93 (0.88-0.97) with the headset and 0.94 (0.91-0.98) with the desktop (p = 0.40). The median (and first-third quartiles) of time per case was 57 (41-76) seconds for the headset and 31 (22-64) seconds for the desktop (p < 0.001). Average survey scores ranged from 3.3 to 5 for ease of use, from 3 to 4.7 for experience, and from 2.2 to 3.3 for preference. Diagnostic performance for detecting diverticulitis on CT was similar between the next-generation VR/AR headset and desktop. Ease of use, experience, and preference varied across different aspects of the devices and among radiologists.

PMID:39495441 | DOI:10.1007/s10278-024-01292-7

Radiol Med. 2024 Nov 4. doi: 10.1007/s11547-024-01906-8. Online ahead of print.

ABSTRACT

PURPOSE: This multicenter prospective study aims to compare transradial access versus transfemoral access in conventional transarterial chemoembolization (c-TACE) procedures, focusing on operators radiations exposure, patients comfort, technical success and vascular access complications.

MATERIALS AND METHODS: Patients were affected by hepatocellularcarcinoma (HCC) in intermediate stage or previous stages unfit for ablation and/or surgery; they were randomized into two groups according to arterial access site (Group F: right femoral access in standard position; Group R: radial access with left arm abduced 90°). Overall fluoroscopy time was recorded. Eight thermoluminescence dosimeters were positioned immediately before each procedure to monitor radiation doses. Technical success was intended as complete HCC nodules lipiodolization at final plain cone-beam CT.

RESULTS: Group F included 23 patients, while group R 19. Mean fluoroscopy time was lower in group F but difference was not statistically significant (p-value > 0.05). In terms of operators radiations exposure, no significant differences were found (p-value > 0.05). Technical success was obtained in 81.5% in group F and 84.8% in group R, without significant differences (p-value > 0.05). Patients discomfort was significantly (p-value < 0.05) higher in group F. Concerning minor complications, no statistical differences were appreciated (p-value > 0.05); no major complications occurred.

CONCLUSIONS: In this study, no statistical differences were observed in terms of operators radiations exposure, fluoroscopy time and technical success during c-TACE performed with left radial access compared to right femoral access; patients comfort was significantly better with radial access. These data should lead interventional radiologists to favor radial access in c-TACE interventions.

PMID:39495436 | DOI:10.1007/s11547-024-01906-8

Int Urol Nephrol. 2024 Nov 4. doi: 10.1007/s11255-024-04266-4. Online ahead of print.

ABSTRACT

BACKGROUND: Prostate cancer is one of the most prevalent malignancies among men globally. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs), primarily used for type 2 diabetes mellitus (T2DM) management, have been investigated for their potential effects on cancer risks. This systematic review and meta-analysis aimed to assess the association between GLP-1 RA use and risk reduction of prostate cancer.

METHODS: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science up to July 30, 2024. Studies that met the inclusion criteria randomized controlled trials, cohort studies, case-control studies, and observational studies assessing the incidence of prostate cancer in GLP-1 RA-treated patients were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analysis was performed using a random effects model.

RESULTS: A total of five studies were included, analyzing data from diverse international contexts. The included studies showed a reduced risk of prostate cancer with both adjusted and unadjusted effect estimates with GLP-1 RAs. The meta-analysis revealed an RR of 0.72 (95% CI: 0.610 to 0.832), indicating a statistically significant 28% reduction in prostate cancer risk associated with GLP-1 RA use compared to placebo or other antidiabetic drugs. Moderate heterogeneity was observed (I² = 51%). Sensitivity analysis confirmed the results.

CONCLUSION: The findings suggest a significant protective association between GLP-1 RA use and reduced prostate cancer risk in men, particularly those with T2DM. This supports the potential of GLP-1 RAs not only in diabetes management but also as a strategy to mitigate cancer risk. Further research is required to confirm these findings and explore the underlying mechanisms, considering different dosages, durations of therapy, and patient subgroups based on demographic and metabolic characteristics.

PMID:39495435 | DOI:10.1007/s11255-024-04266-4

Discov Ment Health. 2024 Nov 4;4(1):50. doi: 10.1007/s44192-024-00101-5.

ABSTRACT

Adolescents experience numerous changes, both psychologically and physically, and they are also the age group with a high prevalence of mental problems that need counseling help. The study aims to assess the difficulties and the needs for psychological support, factors affecting the need to use psychological services among adolescents. A cross-sectional study was conducted on 672 high school students in Thu Duc City, Vietnam. The results showed that there was a statistically significant difference between grades 10-12 in student’s difficulties (DS) and a statistically significant difference in needs for psychological services (NPS, RPS). Additionally, there was a statistically significant difference in academic performance for DS. The findings also implied that RPS was predicted by a DS, NPS, and factors affecting the need to use psychological services (FA), in which NPS and DS were mediators in the relationship between FA and RPS. The study significantly contributes to research practices and the theoretical framework that the parliament and the government use to make counselors mandatory in schools. Meanwhile, the study suggested that school counselors, educators, and teachers must appropriately evaluate students’ counseling needs and psychological difficulties; this is essential to providing support and interventions when students deal with challenges promptly.

PMID:39495430 | DOI:10.1007/s44192-024-00101-5

Int J Cardiovasc Imaging. 2024 Nov 4. doi: 10.1007/s10554-024-03273-x. Online ahead of print.

ABSTRACT

We assessed the diagnostic performance of both ultra-high-resolution (UHR) and high-resolution (HR) modes of photon-counting detector (PCD)-CT within the confines of standard pre-TAVI CT scans, as well as the performance of UHR mode adjusted specifically for coronary imaging, using quantitative coronary angiography (QCA) as the reference. We included 60 patients undergoing pre-TAVI planning CT scans. Patients were divided into 3 groups: 20 scanned in HR mode, 20 in UHR mode, and 20 in adjusted UHR mode, on a dual-source PCD-CT. The adjusted UHR mode employed a lower tube voltage (90 kV vs. 120 kV) and a higher image quality level (65 vs. 34) to enhance coronary artery visualization. Patients underwent invasive coronary angiography as part of clinical routine. CCTA and QCA were reviewed to assess CAD presence defined as stenosis ≥ 50% in proximal and middle coronary segments. We included 60 patients (mean age 79 ± 7 years; 39(65%) men). Mean heart rate during scanning was 72 ± 13 bpm. Median coronary calcium score was 973 [379-2007]. QCA identified significant CAD in 24 patients (40%): 9 patients scanned with HR mode, 10 patients with the UHR mode, and 5 patients with the UHR adjusted mode. Per-patient area under the curves were 0.57 for HR, 0.80 for UHR, and 0.80 for adjusted UHR, with no significant differences between the scan modes, and per-vessel the area under the curves were 0.73 for HR, 0.69 for UHR, and 0.87 for adjusted UHR, with significant differences between UHR and adjusted UHR (p = 0.04). UHR and adjusted UHR modes of dual source PCD-CT show potential for improved sensitivity and negative predictive value for detecting CAD in patients undergoing pre-TAVI scans, however, no statistically significant difference from HR mode was observed.

PMID:39495429 | DOI:10.1007/s10554-024-03273-x

Cogn Res Princ Implic. 2024 Nov 4;9(1):75. doi: 10.1186/s41235-024-00592-4.

ABSTRACT

People are often asked to self-evaluate their abilities, and these evaluations may not always reflect objective reality. Here, we investigated this issue for bilingual adults’ self-evaluations of language proficiency and usage. We specifically examined how people’s self-reported language solidarity impacted their first- (L1) and second-language (L2) self-evaluations, while statistically controlling for their objective language performance (i.e. LexTALE). We also investigated whether this impact varied for value-laden evaluations (e.g. how “good” am I at my L2) vs. usage-based evaluations (e.g. how often do I use my L2) for two sociolinguistically distinct groups (i.e. English-L1 speakers vs. French-L1 speakers in Montreal). Starting with value-laden self-evaluations, we found that French-L1 speakers with more favourable L2-English solidarity tended to underestimate their objective L2 ability, whereas French-L1 speakers with less favourable L2-English solidarity more accurately estimated their objective L2 ability. In contrast, English-L1 speakers with more favourable L2-French solidarity more accurately estimated their objective L2 ability than those with less favourable L2-French solidarity who underestimated their L2-French abilities. Turning to usage-based self-evaluations, we found that participants’ self-evaluations were generally more accurate reflections of their performance, in a manner that was less affected by individual differences in self-reported language solidarity. This implies that language solidarity (or perhaps language attitudes more generally) can implicitly or explicitly impact bilingual adults’ language self-evaluations when these evaluations are value-laden. These data suggest that people’s language attitudes can bias how they perceive their abilities, although self-evaluations based on language use may be less susceptible to bias than those that are value-laden. These data have implications for the study of language and cognition that depend on self-assessments of individual differences and are relevant to work on how people self-assess their abilities generally.

PMID:39495425 | DOI:10.1186/s41235-024-00592-4

Clin Oral Investig. 2024 Nov 4;28(11):624. doi: 10.1007/s00784-024-06019-0.

ABSTRACT

OBJECTIVE: Aimed to compare the volumetric calculations (VC) of intra-and-extraoral scanners on carious teeth before/after caries removal.

MATERIALS AND METHODS: 120 extracted human molars with ICDAS scores of 3, 4, and 5 were included. The teeth were scanned using an extraoral scanner (Ineos-X5, Dentsply Sirona) and three intraoral scanners (IOS) (iTero Element-5D, Align Technology; Primescan, Dentsply Sirona; Trios 4, 3Shape) before-and-after caries removal (CR). Eight Standard Tessellation Language (STL) data of each tooth sample were overlapped in Meshmixer (Autodesk) software for VC. Shapiro-Wilk, Paired Two-Sample T-test, repeated analysis of variance test statistics, and intraclass correlation coefficient (ICC) were used (p < 0.05).

RESULTS: In initial VC, a significant difference observed between Ineos-X5 and iTero Element-5D (p < 0.001) and Ineos-X5 and Primescan (p < 0.001), regardless of the ICDAS score. No significant difference observed after CR between Ineos-X5 and iTero Element-5D (p = 0.917), Ineos-X5 and Primescan (p = 0.936), and Ineos-X5 and Trios 4 (p = 0.727) respectively. There was also no difference between the three IOS after CR (p ≥ 0.05), whereas the iTero Element-5D scanner significantly calculated less volume than Primescan and Trios-4 initially (p = 0.003). Maximum ICC was observed between the Ineos-X5 and Primescan in the ICDAS 5 score, before CR (ICC = 1, p < 0.001) and triple comparisons of iTero Element-5D, Primescan, and Trios-4 (ICC = 1, p < 0.001).

CONCLUSION: Carious and irregular surfaces might affect the data collection of IOS.

CLINICAL RELEVANCE: Intra-and-extraoral data may present negligible differences in the volumetric calculation, depending on the caries status and anatomical properties. These differences and factors may be important for future artificial intelligence networks that simulate the aftermath of caries removal. The IOSs tested in the current study can successfully collect data from irregular, deep and shallow cavities after caries removal.

PMID:39495394 | DOI:10.1007/s00784-024-06019-0