Nevin Manimala

Lancet Public Health. 2025 Nov;10(11):e979-e987. doi: 10.1016/S2468-2667(25)00226-9.

ABSTRACT

BACKGROUND: Premature mortality rates are higher in the USA than other peer nations. Few studies have assessed the association between cumulative unsecured debt and subsequent premature mortality. The aim of this study was to investigate the association between cumulatively accrued unsecured debt over 20 years of early adulthood and subsequent premature mortality in midlife (age 41-62 years).

METHODS: For this longitudinal analysis, we used data from 6954 participants included in the US National Longitudinal Survey of Youth 1979. Participants were followed up from 1985 to 2004 to assess debt trajectory, and from 2004 to 2018 to assess premature mortality. A group-based trajectory model was used to classify four groups of unsecured debt trajectories: no debt, constant low debt, constant medium debt, and increasing debt. Multivariable adjusted Cox proportional hazards models were used to assess associations between debt trajectory and mortality.

FINDINGS: Of the 6954 participants included in our analysis, 5670 (81·5%) individuals had constant low debt, 712 (10·2 %) had constant medium debt, 148 (2·1%) had increasing debt, and 424 (6·1%) had no debt. In adjusted models, the risk of mortality was 89% higher in the increasing debt group than the constant low debt group (hazard ratio 1·89 [95% CI 1·14-3·12]). In unadjusted models, individuals with no debt had a numerically higher risk of premature mortality compared with those with constant low debt; however, this difference was not statistically significant.

INTERPRETATION: Cumulative increasing unsecured debt in early adulthood was associated with increased risk of premature mortality in midlife. Interventions and policies targeting unsecured debt might reduce premature mortality.

FUNDING: National Institute of Health National Institute on Aging.

PMID:41162131 | DOI:10.1016/S2468-2667(25)00226-9

Lancet Public Health. 2025 Nov;10(11):e971-e978. doi: 10.1016/S2468-2667(25)00227-0.

ABSTRACT

BACKGROUND: Living in poverty increases the risk for mortality. Existing research that examines life course poverty typically relies on measures separated by decades of time. Here, we aimed to estimate the association of 20-year cumulative poverty exposure from emerging adulthood through to established adulthood with premature mortality assessed over the following 15 years.

METHODS: We included National Longitudinal Survey of Youth 1979 study participants with three or more family income measures between 1985 and 2004. Participants were, on average, aged 23 years at the start and aged 42 years at the end of this period. Follow-up for premature mortality began in 2004 and ended in 2019, at which time participants were aged 53-62 years. We defined cumulative poverty by the proportion of family size-adjusted income measures less than 200% of the Federal Poverty Level: never in poverty, sometimes in poverty (>0 and less than a third of measures), often in poverty (a third or more but not all measures), and always in poverty. Primary analyses used confounder-adjusted Cox proportional hazards regression models. Our outcome was mortality between 2004 and 2019.

FINDINGS: Our sample included 5653 participants, with 1484 (26·2%) never in poverty, 1867 (33·0%) sometimes in poverty, 1852 (32·8%) often in poverty, and 450 (8·0%) always in poverty. 363 (6·4%) participants were reported deceased over follow-up. Compared with participants never in poverty, those sometimes, often, and always in poverty had 1·10 (95% CI 0·79-1·53), 1·53 (1·09-2·14), and 2·53 (1·61-3·96) times higher rates of premature mortality, respectively.

INTERPRETATION: Greater cumulative exposure to poverty across emerging and established adulthood is associated with a greater risk for premature mortality. To inform public health action and policy, future research should evaluate the effects of providing support to individuals who are experiencing financial hardships during these important life stages on health and longevity.

FUNDING: National Institute of Health’s National Institute on Aging.

PMID:41162130 | DOI:10.1016/S2468-2667(25)00227-0

Lancet Public Health. 2025 Nov;10(11):e943-e954. doi: 10.1016/S2468-2667(25)00163-X.

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to substantial health services disruption in England. Health-care policy makers need reliable national-level information on disease burden to plan services. Whole-population individual-level data, which are routinely collected and linked across multiple sources, provide comprehensive estimates that can be regularly updated at low cost. We aimed to measure the burden of cardiovascular diseases in the whole population of England from 2020 to 2024.

METHODS: Using linked National Health Service England hospital, primary care, death, and specialist registers between Jan 1, 2020, and May 31, 2024, we defined 79 common and rare cardiovascular diseases, and estimated incidence, prevalence, 30-day case fatality, and post-diagnosis rates of myocardial infarction and ischaemic stroke, focusing on five common conditions (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, and peripheral vascular disease), as well as pulmonary embolism, myocarditis, and intracranial venous thrombosis. We conducted subgroup analyses based on and adjusted for age, sex, ethnicity, long-term conditions, deprivation, and geographical area.

FINDINGS: Analysis of data for 57 406 990 people in England between 2020 and 2024 revealed changes in cardiovascular disease burden. Although incidences after the pandemic were generally stable for the five common diagnoses, myocardial infarction (events per 100 000 person-years: 245·2 vs 216·9; -12%, 95% CI -17 to -6; p=0·0003) and peripheral vascular disease (97·9 vs 86·5; -12%, -21 to -1; p=0·032) showed decreases compared with January to February, 2020. Prevalence increased for ischaemic stroke (1·5% vs 1·8%; +16%, 10 to 21; p<0·0001), heart failure (0·9% vs 1·2%; +25%, 17 to 34; p<0·0001), and atrial fibrillation (2·8% vs 2·9%; +3%; 2 to 5; p=0·0001). There was little change in 30-day case fatality for most common diagnoses before and after the pandemic. Post-diagnosis myocardial infarction and stroke rates from 30 days to 1 year increased for myocardial infarction (events per 100 000 person-years: 18 850 vs 21 289; +13%, 5 to 22; p=0·0023), ischaemic stroke (11 849 vs 13 574; +15%, 7 to 23; p=0·0008), and heart failure (5821 vs 6393; +10%, 1 to 19; p=0·031) after the pandemic. Subgroup analyses indicated higher burdens among older adults, males, deprived populations, people with multiple long-term conditions, and Asian or Black ethnicities. There were clear regional variations in the incidence of stroke, myocardial infarction, heart failure, atrial fibrillation, and peripheral vascular disease.

INTERPRETATION: Our study offers new insights into recent cardiovascular disease patterns and reveals important health inequalities at a whole-population scale for multiple cardiovascular diseases, during and after the COVID-19 pandemic. These inequalities are targets for the improvement of cardiovascular health.

FUNDING: British Heart Foundation Data Science Centre (Health Data Research UK).

PMID:41162129 | DOI:10.1016/S2468-2667(25)00163-X

Lancet Public Health. 2025 Nov;10(11):e923-e932. doi: 10.1016/S2468-2667(25)00225-7.

ABSTRACT

BACKGROUND: Prospective data on the natural history of alcohol-use disorders (AUD) from adolescence into middle adulthood are scarce. This study aims to describe the prevalence, incidence, and remission of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 AUD from adolescence into middle adulthood and thereafter characterise those who do and do not develop AUD symptoms or experience remission.

METHODS: In this prospective cohort study, data were drawn from the Australian 11-wave population-based Victorian Adolescent Health Cohort Study (N=1943; 1000 female and 943 male participants). Between wave 7 (1998) and wave 11 (2019-21), we assessed 12-month DSM-5 AUD symptoms at age 21 years and 24 years (late adolescence), age 29 years and 35 years (young adulthood), and age 42 years (early middle adulthood) using the Composite International Diagnostic Interview (CIDI). The CIDI was administered by a trained interviewer, with AUD symptoms scored to align with DSM-5 AUD clinical diagnosis. We estimated incidence and incidence rate using flexible parametric survival models, and symptom prevalence and remission from symptoms using proportions, with and without cessation of heavy drinking. We used risk ratios and relative risk ratios from univariable generalised linear regression models to describe participant characteristics associated with symptoms of AUD and remission. Multiple imputation was used to address missing data.

FINDINGS: At any wave between ages 21 years and 42 years, estimated cumulative incidence of AUD symptoms using multiply imputed data was 58·0% (95% CI 52·3-63·8), and highest in male individuals (71·6% [65·1-78·1]). Incidence and prevalence increased markedly from age 21 years to 24 years, peaking at age 24 years, then decreased and stabilised across the subsequent assessment waves at age 29 years, 35 years, and 42 years. By age 42 years, 25·0% (95% CI 21·2-28·8) of the population had either ongoing or middle-adulthood-onset AUD, 11-13% had persistent AUD symptoms from late adolescence (age 21-24 years), and most experienced remission from AUD (67·0% [61·1-73·0]), with a majority also reporting cessation from heavy drinking (63·6% [58·6-65·5]). Remission from AUD was most common between the assessment waves at age 29 years and age 35 years (43·9% [95% CI 34·5-53·3]), and in female individuals (55·3% [42·6-67·9]), with a distinct reduction in remission for male individuals between the assessment waves at age 35 years and age 42 years (32·4% [24·8-39·9]). In both male and female individuals, remission from AUD was more common in those with higher education, in stable relationships, or without long-term other substance use.

INTERPRETATION: Cumulative incidence of AUD from late adolescence to middle adulthood is high. Although most individuals with AUD remit by age 42 years, greater investment in public health prevention and health service responses is needed for those with persistent AUD, particularly in male individuals.

FUNDING: National Health and Medical Research Council of Australia.

PMID:41162127 | DOI:10.1016/S2468-2667(25)00225-7

Lancet Public Health. 2025 Nov;10(11):e901. doi: 10.1016/S2468-2667(25)00247-6.

NO ABSTRACT

PMID:41162124 | DOI:10.1016/S2468-2667(25)00247-6

Lancet Public Health. 2025 Nov;10(11):e1001-e1005. doi: 10.1016/S2468-2667(25)00245-2.

ABSTRACT

Assisted dying (encompassing euthanasia and assisted suicide) has emerged as a legally sanctioned option for end-of-life care in an increasing number of countries. Over 200 million people now live in jurisdictions permitting some form of assisted dying, with at least 12 countries having implemented national or subnational legislation as of May, 2025. Legal frameworks, terminology, and procedures remain highly heterogeneous, affecting how assisted dying is perceived, delivered, and monitored. Terminological variation and the absence of specific ICD codes impede international data comparability, limiting public health surveillance and cross-country learning. In jurisdictions permitting both euthanasia and assisted suicide, euthanasia accounts for most assisted deaths, suggesting that system-level factors, such as integration into hospital-based care, procedural routines, and access barriers, might shape uptake alongside individual preferences. Socioeconomic inequalities further influence access to assisted dying and broader end-of-life care, highlighting persistent equity challenges. This Viewpoint emphasises the need for harmonised terminology, transparent and comparable data, and clear standards of care to support ethical, equitable, and patient-centred implementation. Strengthening these foundations is essential for evidence-based policy and the responsible integration of assisted dying into public health systems.

PMID:41162116 | DOI:10.1016/S2468-2667(25)00245-2

Handb Clin Neurol. 2025;213:17-29. doi: 10.1016/B978-0-443-29884-4.00004-2.

ABSTRACT

Placebo effects are a family of diverse effects that tap into the brain and body’s latent endogenous therapeutic potential. Unlike placebo responses, which can reflect statistical artifacts and natural history, placebo effects are driven by multiple types of psychological and brain responses to the treatment context. These include memories and learned associations from past experiences, expectations about future outcomes, cognitive appraisals of the self and context, and emotional states arising from these. Likewise, these psychological and brain responses to placebo arise from multiple aspects of the therapeutic encounter, including the relationship with the care provider, specific treatment cues like procedures and setting, and suggestions. Thus, many forms of placebo effect depend on the thoughts and imagination of the patient, and their interaction with the social and physical elements of the treatment context. In this way, placebo effects may overlap with cognitive self-regulation, a family of techniques that involve using attention, appraisal, and imagination to influence one’s emotions, pain, and motivation based on regulatory goals. In this chapter, we focus on the relationship between placebo effects and self-regulation of emotion. We review research on placebo effects, focusing on the idea that changes in brain processes related to affect and motivation are central and consistently identified across disorders. We then describe studies of the cognitive regulation of emotion and pain, highlighting several commonalities shared by self-regulation and placebo. The picture that is emerging is one in which appraisals of the treatment context – influenced by both placebo treatments and self-regulatory goals – shape brain systems involved in the construction of value, feelings, and motivation. These systems are central to clinical outcomes that depend on feelings and function, and interact with learning processes to alter therapeutic trajectories across disorders.

PMID:41161956 | DOI:10.1016/B978-0-443-29884-4.00004-2

Air Med J. 2025 Nov-Dec;44(6):548-552. doi: 10.1016/j.amj.2025.08.006. Epub 2025 Sep 13.

ABSTRACT

Obstetric transport to higher levels of maternal care for critically ill pregnant individuals is recommended to reduce maternal and neonatal morbidity, yet data on these transports are lacking. We aimed to describe the characteristics of obstetric transports of 1 integrated health system’s perinatal transport service from January 2020 to December 2023, with a specific focus on assessing factors associated with transport directly to an intensive care unit (ICU) rather than an emergency room or labor and delivery unit. During the study period, 1,087 obstetric transports occurred, most frequently for preterm labor (28.8%), preeclampsia (28.7%), and preterm prelabor rupture of membranes (18.7%). Transport most often occurred via rotor wing (48.0%). Transport to the ICU occurred in 3.2% of cases. Transport to the ICU was associated with longer physician consultation time (17.0 minutes [interquartile range 9.75-31.0] vs. 11.0 minutes [7.0-18.0], P = .006), shorter flight team dispatch time (13 minutes [8.0-33.0] vs. 20.0 minutes [13.5-29.0], P = .03), longer stabilization time before departure (19.0 minutes [15.0-33.0] vs. 15.0 minutes [12.0-20.0], P < .001), and longer time to load the patient to the aircraft (10.0 minutes [7.0-14.0] vs. 7.0 minutes [5.0-10.0], P = .002). Factors associated with transport to the ICU included a diagnosis of coronavirus disease 2019 (adjusted odds ratio [aOR], 11.85, 95% confidence interval [CI] 3.14-36.79), being postpartum (aOR 54.93, 95% CI 21.52-144.81), and further distance traveled (aOR 1.01 per mile traveled, 95% CI 1.00-1.01). Obstetric transports to the ICU are uncommon but require specialized patient care.

PMID:41161888 | DOI:10.1016/j.amj.2025.08.006

Air Med J. 2025 Nov-Dec;44(6):521-524. doi: 10.1016/j.amj.2025.08.005. Epub 2025 Sep 17.

ABSTRACT

OBJECTIVE: Although numerous studies have evaluated transport modes for pediatric trauma, few have addressed strategies for sepsis. This study evaluates whether ground versus rotor wing transport affects transport time, hospital length of stay (LOS), or mortality in pediatric patients with suspected sepsis.

METHODS: We performed a retrospective chart review at a 255-bed tertiary children’s hospital and level 1 trauma center (∼81,000 annual emergency department visits). Patients aged 0 to 18 years with a referring diagnosis of possible sepsis and transported by Pedi-Flite, a specialized neonatal/pediatric critical care team, between January 1, 2010, and January 1, 2020, were included; neonatal intensive care unit admissions were excluded. Data included demographics, transport time, fluid/antibiotic administration, vasopressor use, blood culture results, LOS, discharge disposition, and insurance status.

RESULTS: Of 87 patients, 63 were transported by ground and 24 by rotor wing. Baseline characteristics and outcomes did not differ significantly. Mean transfer time was 150 ± 80 minutes for ground and 210 ± 297 minutes for rotor (P = .40). Team arrival to the referring hospital was 72 ± 51 minutes for ground and 125 ± 296 minutes for rotor (P = .40). LOS was 10.78 days (ground) versus 9.22 days (rotor; P = .6), and survival was 97% (rotor) versus 90% (ground; P = .40). Most patients received intravenous fluids (97%) and antibiotics (95%), with no group differences in administration rates or mean volume (33.4 vs. 33.3 mL/kg; P = .77). Vasopressors were started during transport in 10% and by the receiving hospital in 63%. In addition, 12 patients (14%) were intubated. Blood cultures were obtained in 40%, with 17% positive; no differences were observed between the groups (all P > .30).

CONCLUSION: Transport mode was not associated with differences in care or outcomes for suspected pediatric sepsis. In regions with similar geography and dispatch logistics, ground transport by a specialized critical care team may provide equivalent outcomes to rotor wing.

PMID:41161884 | DOI:10.1016/j.amj.2025.08.005

Air Med J. 2025 Nov-Dec;44(6):497-504. doi: 10.1016/j.amj.2025.07.008.

ABSTRACT

OBJECTIVE: Helicopter emergency medical services (HEMS) provide time-sensitive transport and advanced prehospital care. Although traditional bibliometrics (eg, citation counts) have measured academic impact, the role of alternative metrics (altmetrics), such as social media and news mentions, in capturing real-time scholarly influence remains underexplored in HEMS research. To evaluate the relationship between traditional citation metrics and altmetric indicators in HEMS-related publications and to identify trends in online engagement and academic dissemination.

METHODS: This cross-sectional analysis included 817 HEMS-related articles published between 1984 and 2025, identified using Altmetric Explorer. Data were extracted from Altmetric Explorer, PlumX Metrics, and Springer Nature Citations, covering various traditional and alternative impact indicators. Descriptive statistics summarized citation and altmetric indicators. Spearman’s correlation analysis assessed relationships between Altmetric Attention Score (AAS), Mendeley readership, and citation counts from multiple sources (Dimensions, CrossRef, Scopus, PubMed). Geographic and temporal engagement patterns were also evaluated.

RESULTS: The mean AAS was 11.18 ± 28.80, and the mean citation count (Dimensions) was 17.04 ± 24.48. A strong positive correlation was found between AAS and X (formerly Twitter) mentions (ρ = 0.723, P < .001). Mendeley readers had strong positive correlations with citation counts. However, overall correlations between AAS and citation counts were weak. Social media engagement was highest in the United Kingdom and the United States. Nordic countries dominated policy and guideline citations.

CONCLUSION: This is the first comprehensive altmetric analysis of HEMS-related publications. Although AAS reflects online attention, it correlates only modestly with traditional academic impact. Altmetrics offer complementary insight into research dissemination, especially in the digital age, and may inform more holistic evaluation strategies in prehospital and emergency medicine scholarship.

PMID:41161880 | DOI:10.1016/j.amj.2025.07.008