Nevin Manimala

R I Med J (2013). 2026 Sep 1;109(9):31-36.

ABSTRACT

BACKGROUND: Co-occurrence of Bipolar Disorder (BD) and Substance Use Disorder (SUD) increases the risk of negative mental health outcomes, including both intentional (i.e., suicide self-poisoning) and unintentional overdose (i.e., accidental). While it is clear that both forms of overdose are a relevant concern, less is understood about the differences in phenomenology between intentional and unintentional overdose among this high-risk group.

METHODS: Demographic and clinical characteristics were drawn from a sample of patients at a Rhode Island hospital during their baseline session of a larger psychosocial intervention clinical trial.

RESULTS: Among 171 participants with co-occurring BD-SUD, 77% reported a history of any type of overdose, 48% reported a history of unintentional overdose, 56% reported a lifetime suicide attempt via intentional overdose, and 28% reported experiencing both intentional and unintentional overdose. Collectively, antidepressant/antipsychotic/mood-stabilizing medications were the most frequently reported substances for intentional overdose, followed by sedating medications and alcohol. Opioids were the most frequently reported substance for accidental overdose, followed by alcohol and stimulants. Polysubstance use was indicated for 62% of intentional overdose events and 43% of accidental overdose events. Compared to participants with a history of intentional overdose only, those who have experienced both types of overdose were significantly younger and more likely to have co-occurring alcohol use disorder and drug use disorder.

CONCLUSIONS: Our findings suggest that psychotropic medications traditionally used to treat BD and other psy- chiatric disorders are often implicated in intentional over- dose. Additionally, our results highlight the need for a focus on prevention of polysubstance overdose across the intentionality spectrum.

PMID:42647834

R I Med J (2013). 2026 Sep 1;109(9):23-30.

ABSTRACT

PURPOSE: Sexual and gender minority (SGM) individuals experience heightened mental health problems and substance misuse. Improved approaches to screening for behavioral health in this population are needed. We evaluated the implementation of a digital intake platform incorporating behavioral health screenings at a sexual health clinic serving SGM individuals.

METHODS: Patients presenting to a sexual health clinic March 2021 through April 2023 were screened for depression, hazardous drinking, and illicit substance use using a digital intake platform. To identify SGM subpopulations most in need of services, we evaluated relationships between demographic and sexual health factors and depression, hazardous drinking, and illicit substance use.

RESULTS: In total, N=1,277 people presented for care; 28% identified as gay/lesbian, 30% as bisexual+ (attracted to more than one gender), and 12% as transgender/gender diverse. Thirteen percent reported a sexually transmitted infection in the past 12 months, 11% screened positive for a depressive disorder, 50% for hazardous drinking, and 26% for illicit substance use. Individuals 18-39 years were more likely to be depressed than adults 40+, and transgender/gender diverse individuals had 1.93-fold greater odds of depression than cisgender men. Regarding substance use, cisgender men had 2.42-fold greater odds of use compared to cisgender women, and lesbian/gay individuals had 5.08-fold increased odds compared to heterosexual individuals.

CONCLUSION: A digital intake platform for behavioral health screening identified SGM at risk for depression and substance use challenges within a sexual health clinic. This protocol was able to identify subpopulations at higher risk for these disorders, increasing opportunities for recognition and response.

PMID:42647833

BJS Open. 2026 Jul 3;10(4):zrag126. doi: 10.1093/bjsopen/zrag126.

ABSTRACT

BACKGROUND: Since 2015, multidisciplinary team (MDT) discussion is recommended for all Swedish patients diagnosed with gastric cancer. However, few studies have explored the association of MDT discussion with survival.

METHODS: This study included all Swedish patients diagnosed with gastric adenocarcinoma between 2006 and 2021. Multivariable logistic regression was used to investigate the probability of receiving treatment recommendation at an MDT meeting, whereas the association between receiving an MDT treatment recommendation and overall survival was examined using Cox regression and Kaplan-Meier methods.

RESULTS: Of 7813 patients, 5279 (68%) were discussed at an MDT meeting. Advanced age (80-89 years; odds ratio (OR) 0.30; 95% confidence interval (c.i.) 0.21 to 0.43) and lower performance status (Eastern Cooperative Oncology Group performance status 1; OR 0.68; 95% c.i. 0.56 to 0.81) were associated with a lower probability of receiving an MDT treatment recommendation. Clinical disease stages II and III, compared with stage I, were associated with a higher probability of an MDT discussion (OR 1.38 (95% c.i. 1.10 to 1.75) and 1.42; (95% c.i. 1.09 to 1.85), respectively), as was a later year of diagnosis (OR 1.37; 95% c.i. 1.35 to 1.40). In adjusted survival analysis with multivariable Cox regression, MDT discussion was associated with better survival (hazard ratio 0.89; 95% c.i. 0.83 to 0.95). In addition, median survival was longer in the group with than without MDT treatment recommendations (12.0 versus 5.9 months).

CONCLUSION: Receiving a treatment recommendation at an MDT meeting was associated with better survival in patients with gastric adenocarcinoma. Patients with advanced disease and older age were less likely to receive an MDT treatment recommendation but, if they did, it was associated with better survival.

PMID:42647827 | DOI:10.1093/bjsopen/zrag126

BJS Open. 2026 Jul 3;10(4):zrag115. doi: 10.1093/bjsopen/zrag115.

ABSTRACT

BACKGROUND: Ampullary tumours are rare but present important clinical challenges. This meta-analysis aims to evaluate the outcomes of endoscopic resection (ER), transduodenal ampullectomy (TDA) and pancreatoduodenectomy (PD) for both benign and malignant ampullary tumours.

METHODS: A comprehensive search was performed up to 15 December 2025. Studies were included if they reported short-term outcomes including complete resection rate, recurrence, or complications of ampullary tumours after ER, TDA, or PD. Statistical analyses were performed using both random-effects and fixed-effects models to calculate pooled means. Publication bias was evaluated using funnel plots and Egger’s test, and risk of bias was assessed using ROBINS-I V2.

RESULTS: A total of 80 studies were included. For complete resection rate, ER showed high heterogeneity (29%-100%), TDA showed a pooled rate of 90% for benign and early-stage tumours and 66% for malignant tumours, whereas PD showed 99% and 97%, respectively. ER and TDA showed both a pooled recurrence rate of 12% for benign and early-stage tumours, whereas PD showed 6%. For recurrence of malignant tumours, TDA showed high heterogeneity (48%-90%) whereas PD had a pooled rate of 16%. For complications, ER and PD exhibited high heterogeneity (9%-95% and 27%-98%, respectively), whereas TDA had a pooled rate of 32%.

CONCLUSION: PD provides the best outcomes in terms of complete resection and recurrence, despite higher morbidity. ER is a viable option for benign tumours, offering lower morbidity and manageable recurrence rates. Further prospective research is needed to optimize preoperative diagnostics to distinguish benign tumours from malignant tumours accurately to select the appropriate treatment.

PMID:42647826 | DOI:10.1093/bjsopen/zrag115

Am J Public Health. 2026 Sep;116(S4):S276-S284. doi: 10.2105/AJPH.2026.308641.

ABSTRACT

Objectives. To evaluate workplace conditions in the Community Health Workers (CHWs) for COVID Response and Resilient Communities initiative using the workplace-related CHW Common Indicators and to conduct a preliminary validation of those indicators. Methods. A CHW survey conducted between February 12, 2024, and March 29, 2024, incorporated all or part of the workplace-related Common Indicators. We produced descriptive statistics to answer evaluation questions and conducted exploratory factor analyses to initially validate scalar portions of the indicators. Results. Our analyses revealed generally positive ratings of workplace conditions for CHWs in diverse sites around the United States. Scalar components of the Common Indicators achieved Cronbach alpha values above 0.8 and loaded on 1 principal factor per scale. Conclusions. Our findings from a definable large-scale sample confirm that the Common Indicators provide a practical, reliable, and valid way to measure workplace conditions that allow CHWs to be optimally effective across settings and jurisdictions. The positive results indicate that a federal CHW program can help to create beneficial workplace conditions for CHWs while making it possible to compare consistent data about the CHW workforce. (Am J Public Health. 2026;116(S4):S276-S284. https://doi.org/10.2105/AJPH.2026.308641).

PMID:42647812 | DOI:10.2105/AJPH.2026.308641

Am J Public Health. 2026 Sep;116(S4):S295-S304. doi: 10.2105/AJPH.2026.308660.

ABSTRACT

Objectives. To examine the roles and activities performed by community health workers (CHWs) involved in the national Community Health Workers for COVID Response and Resilient Communities (CCR) program and examine differences based on setting characteristics. Methods. We used data from a CHW self-report survey (n = 689) conducted February through March 2024 in the United States. We ran a series of ordered logistic regression models to examine the association between setting characteristics (i.e., type of organizational setting, organizational experience with CHWs, and populations of focus) and CHW core roles and COVID-19‒specific activities. Results. A total of 69.2% of CHWs in the analytic sample reported performing all 10 core roles. Organizational experience with CHWs and populations of focus emerged as the most salient predictors of CHW core roles and activities. Conclusions. A substantial proportion of CHWs performed the full range of core roles. Results suggest that CHWs in the CCR program tailored their roles and activities according to the unique factors of the communities in which they worked. Public Health Implications. Programs such as CCR may result in CHWs using a wide range of core roles across multiple settings. (Am J Public Health. 2026;116(S4):S295-S304. https://doi.org/10.2105/AJPH.2026.308660).

PMID:42647810 | DOI:10.2105/AJPH.2026.308660

Am J Public Health. 2026 Sep;116(S4):S305-S313. doi: 10.2105/AJPH.2026.308655.

ABSTRACT

Objectives. To examine patterns of community health worker (CHW) core roles within the Community Health Workers for COVID Response and Resilient Communities (CCR) program through a latent class analysis (LCA). Methods. We used data from a CHW self-report survey (n = 689) conducted in the United States during February and March 2024. LCA was used to examine whether distinct classes existed according to patterns of reported engagement in CHW core roles in the CCR program. Results. The study findings supported a 2-class model: (1) “low assessment and evaluation CHWs,” which represented 52.6% of CHWs, and (2) “full range of core roles CHWs,” which represented 47.4% of CHWs. Conclusions. This study is the first to use LCA to identify patterns of CHW core roles. The fairly even split between the 2 classes suggests that a substantial proportion of CCR CHWs performed the full range of core roles and indicates assessment and evaluation as key areas to target for increased CHW involvement. Public Health Implications. Our findings can inform organizational policy to ensure that CHWs are supported in performing the full range of core roles. (Am J Public Health. 2026;116(S4):S305-S313. https://doi.org/10.2105/AJPH.2026.308655).

PMID:42647807 | DOI:10.2105/AJPH.2026.308655

Am J Public Health. 2026 Sep;116(S4):S331-S340. doi: 10.2105/AJPH.2026.308642.

ABSTRACT

Objectives. To describe the health care and social services needs addressed by community health workers (CHWs) through referrals in the Community Health Workers for COVID-19 Response and Resilient Communities (CCR) program. Methods. We performed a descriptive analysis of national performance measure data from 67 CCR recipients from 2021 to 2024 documenting referrals, alongside 2 web-based surveys of 63 program administrators and 689 CHWs in the United States in early 2024. Results. CHWs made 464 158 social and 323 769 health referrals, with 282 596 referrals completed. Referrals included services for food, housing, legal assistance, health insurance, lifestyle interventions, chronic disease management, COVID-19‒related care, and maternal and child health care. Referral success was aided by community resources, CHW knowledge, and networking, and limited by costs, mistrust, language barriers, transportation, and child care challenges. Conclusions. CHWs connect individuals to health care and provide follow-up care and social support. Comprehensive and coordinated health and social services are essential to optimize the referral and service delivery. Public Health Implications. Findings support policies promoting the integration, expansion, and sustainability of the CHW workforce. (Am J Public Health. 2026;116(S4):S331-S340. https://doi.org/10.2105/AJPH.2026.308642).

PMID:42647805 | DOI:10.2105/AJPH.2026.308642

Am J Public Health. 2026 Sep;116(S4):S285-S294. doi: 10.2105/AJPH.2026.308734.

ABSTRACT

Objectives. To examine characteristics of CHWs engaged in a nationwide program in the United States and the extent to which they were culturally congruent with program participants. Methods. In 2024, CHWs participating in a nationwide federal program completed a cross-sectional census survey (n = 689). Results. High CHW-centered congruence and varying levels of community-centered congruence were observed across racial/ethnic and other communities of identity. Among CHWs who self-identified with specific communities, proportions also serving those communities ranged from 86.4% to 100%; among communities defined in other ways, congruence ranged from 76.5% to 96.7%. Congruence was higher in community-based settings than in clinical or public health settings. Conclusions. As one of few studies examining CHW congruence in a large-scale national program, our findings demonstrate that substantial cultural congruence was achieved across diverse communities. Public Health Implications. Findings demonstrate that (1) CHWs are embedded within communities most affected by structural inequities, optimally positioned to address health disparities and (2) even in federally funded, multisite CHW programs, cultural congruence can be achieved at scale. (Am J Public Health. 2026;116(S4):S285-S294. https://doi.org/10.2105/AJPH.2026.308734).

PMID:42647797 | DOI:10.2105/AJPH.2026.308734

Age Ageing. 2026 Aug 3;55(8):afag254. doi: 10.1093/ageing/afag254.

ABSTRACT

BACKGROUND: Prescribing cascades occur when an adverse drug event is misinterpreted as a new medical condition, leading to the prescription of additional medications. They represent an important and preventable source of potentially inappropriate prescribing in older adults, yet their population-level incidence remains poorly documented in France.

METHODS: We conducted a nationwide retrospective cohort study in 2022 using the French National Health Data System, including all individuals aged ≥65 years in 2022. Clinically important prescribing cascades were identified using a consensus-based list (ThinkCascades). Two complementary approaches were applied: a conservative longitudinal analysis and prescription sequence symmetry analysis. Incidence ranges were estimated, and subgroup analyses were performed to identify factors associated with cascade initiation.

RESULTS: Among 16.6 million older adults, four of seven predefined potential prescribing cascades showed significant positive signals. The strongest associations were observed for benzodiazepine-antipsychotic (adjusted sequence ratio [aSR] 2.48, 99% CI 2.44-2.51) and antipsychotic-antiparkinsonian cascades (aSR 2.01, 99% CI 1.91-2.11). Incidence estimates ranged from 0.69% to 3.29%. Female sex, advanced age (≥85 years), hospital initiation of the index drug and lack of prescriber continuity were associated with higher risks for specific cascades.

CONCLUSIONS: Clinically important potential prescribing cascades are common among older adults in France. These findings suggest potential prescribing cascades as a persistent and preventable contributor to medication-related harm and underscore the importance of systematic medication review, particularly during transitions of care and when new prescriptions shortly follow treatment initiation, as potential signals of prescribing cascades.

PMID:42647768 | DOI:10.1093/ageing/afag254