Nevin Manimala

Cancer Causes Control. 2025 Aug 6. doi: 10.1007/s10552-025-02039-7. Online ahead of print.

ABSTRACT

PURPOSE: The positive predictive value (PPV) of cervical cancer screening was projected to decrease in the era of human papillomavirus (HPV) vaccination.

METHODS: We conducted a retrospective cohort study at three U.S. healthcare systems during 2010-2018. Females aged 21-38 years with an abnormal cervical cancer screening test result for which colposcopy was guideline-recommended were included. We estimated age-specific PPVs of cervical intraepithelial neoplasia grade 2 or more severe diagnosis (≥ CIN 2) in HPV-vaccinated and unvaccinated females.

RESULTS: The age-specific PPV point estimates were lower in vaccinated versus unvaccinated females in each age group (21-24; 25-29; and 30-38 years), but the difference was statistically significant only among 25-29-year-olds (PPV = 16.4% [95% CI (confidence interval), 14.6-18.4%] and PPV = 19.8% [95% CI 18.5-21.1%], respectively). Among vaccinated 25-29-year-olds, the PPV was lower in those who received their first dose at ≤ 20 versus > 20 years of age (PPV = 12.1% [95% CI 9.5-15.2%] and PPV = 18.8% [95% CI 16.4-21.4%], respectively). Among all age groups combined, the PPV was lower in vaccinated versus unvaccinated females.

CONCLUSIONS: Our findings suggest that among females with a cervical test result recommended for colposcopy, the PPV for ≥ CIN2 was lower in those vaccinated versus unvaccinated, and was relatively lower in those vaccinated at younger ages. Future studies will have greater ability to estimate the impact of vaccination at the recommended age (9-12 years) on the PPV as more recent birth cohorts, who had greater vaccine uptake, age-in to screening eligibility.

PMID:40768171 | DOI:10.1007/s10552-025-02039-7

JAMA Netw Open. 2025 Aug 1;8(8):e2524783. doi: 10.1001/jamanetworkopen.2025.24783.

ABSTRACT

IMPORTANCE: Although the use of pneumococcal conjugate vaccines (PCV) has reduced the overall burden of pneumococcal disease, recent measurements of pneumococcal pneumonia incidence are lacking.

OBJECTIVE: To prospectively quantify the burden of pneumococcal pneumonia and to assess the potential impact of the recently approved adult-specific 21-valent pneumococcal conjugate vaccine (V116).

DESIGN, SETTINGS, AND PARTICIPANTS: This cross-sectional study for prospective active surveillance included adults residing in defined catchment areas in Tennessee and Georgia hospitalized with clinical and radiographical evidence of community-acquired pneumonia (CAP) at 3 hospitals between 2018 and 2022. Data were analyzed from July 2024 to January 2025.

MAIN OUTCOMES AND MEASURES: Pneumococcal etiology was determined using an on-market serotype-agnostic urinary antigen test, serotype-specific urinary antigen detection assays covering 30 serotypes, and routine clinical tests. Overall and age-stratified incidence rates for pneumonia hospitalizations were estimated accounting for the probability of enrollment and hospital market share of enrolling hospitals within the catchment area.

RESULTS: Among 2016 patients hospitalized for CAP, the median (IQR) age was 60.1 (47.0-70.2) years; 726 patients (36.0%) were Black, 81 (4.0%) were Hispanic, and 1209 (60.0%) were White; 1863 patients (92.4%) lived in a community dwelling. A total of 279 patients (13.8%) hospitalized for CAP had evidence of pneumococcal pneumonia, and 198 (9.8%) had detection of serotypes included in V116. The overall estimated annual incidence of hospitalizations for all-cause CAP was 340 per 100 000 adults. The incidence of hospitalizations for pneumococcal CAP and pneumococcal CAP due to serotypes included in V116 was 43 and 30 per 100 000 adults, respectively. The burden of all-cause and pneumococcal CAP was consistently highest among adults age 65 years or older.

CONCLUSIONS AND RELEVANCE: This prospective surveillance study demonstrated a large burden of hospitalizations for CAP among US adults, with the highest burden of disease among adults age 65 years or older. A sizable fraction of CAP was caused by Streptococcus pneumoniae, especially by serotypes included in V116.

PMID:40768150 | DOI:10.1001/jamanetworkopen.2025.24783

JAMA Netw Open. 2025 Aug 1;8(8):e2525222. doi: 10.1001/jamanetworkopen.2025.25222.

ABSTRACT

IMPORTANCE: With acute care utilization and mortality rates increasing among people with opioid use disorder, hospital addiction consult services can provide an important touchpoint for care, potentially leading to improved outcomes.

OBJECTIVE: To study the effectiveness of interprofessional hospital addiction consultation services on postdischarge acute care utilization and mortality.

DESIGN, SETTING, AND PARTICIPANTS: In this pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) clinical trial, 6 New York City public hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Participants included adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Eligible patients had an admission or discharge diagnosis of opioid use disorder or opioid poisoning or adverse effects, were hospitalized at least 1 night in a medical or surgical inpatient unit, and were not receiving medication for opioid use disorder before hospitalization.

INTERVENTION: Hospitals implemented the Consult for Addiction Treatment and Care in Hospitals (CATCH) program, an interprofessional inpatient addiction consult service providing specialty care for substance use disorders, with teams consisting of a medical clinician, social worker or addiction counselor, and peer counselor.

MAIN OUTCOMES AND MEASURES: Acute care utilization (hospitalizations and emergency department [ED] visits) and mortality rates (all-cause deaths, overdose deaths, and opioid-involved overdose deaths) 1 year after hospital discharge. Data for the eligible patients were analyzed July 2023 to September 2024.

RESULTS: In total, 1355 eligible admissions were identified (968 [71.4%] men; mean [SD] age, 46.6 [12.4] years). A majority of patients (835 [61.5%]) had at least 1 subsequent hospitalization or ED visit. There were 113 deaths, including 34 overdose deaths (30.1%), of which 28 (82.4%) involved opioids. ED admissions were lower in the intervention period compared with TAU (incidence rate ratio, 0.79 [95% CI, 0.72-0.88]; P < .001). There were no statistically significant differences between CATCH and TAU periods in numbers of hospitalizations (incidence rate ratio, 0.99 [95% CI, 0.87-1.13]) or mortality (eg, hazard ratio for all-cause death, 1.14 [95% CI, 0.98-1.92]).

CONCLUSIONS AND RELEVANCE: In this prespecified secondary analysis of a cluster randomized clinical trial, postdischarge ED visits decreased with the CATCH program, highlighting the potential of hospital-based addiction consult services to address needs of patients with opioid use. Nonetheless, high rates of acute care utilization and mortality persisted, underscoring the need for comprehensive care strategies that extend beyond the hospital walls, and addressing the complex health and social needs of individuals with opioid use.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03611335.

PMID:40768148 | DOI:10.1001/jamanetworkopen.2025.25222

JAMA Netw Open. 2025 Aug 1;8(8):e2525355. doi: 10.1001/jamanetworkopen.2025.25355.

ABSTRACT

IMPORTANCE: The Cheetah randomized trial demonstrated that changing sterile gloves and instruments before wound closure reduces surgical site infections (SSI) in abdominal surgery. However, its environmental impact remains unclear.

OBJECTIVES: To estimate the global carbon footprint associated with changing sterile gloves and instruments before closure abdominal wound.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytic model compared the carbon footprint of a glove and instrument change intervention against a control (no glove and instrument change). Model parameters were sourced from a large cluster randomized trial conducted in 7 low- and middle-income countries (LMICs) between June 2020 and March 2022, as well as data from stakeholder engagement and existing research. Boundaries included the trial intervention and in-hospital resources used to manage SSI. The analysis was stratified by wound contamination status (clean-contaminated, contaminated-dirty) and country-income classification.

MAIN OUTCOME AND MEASURES: Average per-patient wound-specific carbon footprint, calculated as the sum of the carbon footprint of glove and instrument change and SSI. Sensitivity analyses were based on the lowest and highest possible values for key model parameters: intervention effectiveness, intervention carbon footprint, and SSI carbon footprint. The best-case analysis was based on highest possible intervention effectiveness, lowest possible intervention carbon footprint, highest possible SSI carbon footprint. The worst-case analysis was based on lowest intervention effectiveness, highest intervention carbon footprint, and lowest SSI carbon footprint.

RESULTS: In LMICs, the difference in carbon footprints between the intervention and control groups was 10.97 kg CO2 equivalents (kgCO2e) (scenario range, -2.53 to 33.50 kgCO2e) for clean-contaminated and 22.60 kgCO2e (scenario range, -1.62 to 61.17 kgCO2e) for contaminated-dirty surgeries. In high-income countries, differences were 4.14 kgCO2e (scenario range, -3.38 to 17.95 kgCO2e) and 10.48 kgCO2e (scenario range, -3.06 to 37.62 kgCO2e), respectively. Country-level modeling found the intervention to be consistently associated with a lower wound-specific carbon footprint across all countries.

CONCLUSIONS AND RELEVANCE: In this decision analytic model, sterile glove and instrument change before wound closure was associated with a reduced wound-specific carbon footprint across all country income settings. Alongside clinical and economic benefits, this intervention may support more sustainable surgical care; national associations and governments should consider its adoption to improve outcomes for both patients and the planet.

PMID:40768147 | DOI:10.1001/jamanetworkopen.2025.25355

JAMA Netw Open. 2025 Aug 1;8(8):e2525652. doi: 10.1001/jamanetworkopen.2025.25652.

ABSTRACT

IMPORTANCE: Breast and cervical cancers are leading causes of cancer mortality in low-resource countries, yet awareness remains critically understudied among displaced populations in humanitarian crises. Lebanese women displaced to Syria represent a group navigating compounded vulnerabilities associated with conflict, displacement, and a collapsed health care system and may experience important gaps in cancer knowledge and access.

OBJECTIVE: To evaluate knowledge of breast and cervical cancer risk factors and symptoms and screening for early cancer detection among displaced Lebanese women in Syria.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study measured breast cancer, cervical cancer, and human papillomavirus (HPV) knowledge using a survey containing validated, Arabic-translated scales administered via structured interviews from November to December 2024. Lebanese women (aged ≥18 years) displaced to Syria and visiting outpatient health care facilities in Damascus were included. Women who were not Lebanese and with acute or severe physical or mental health conditions were excluded.

EXPOSURE: Breast cancer and cervical cancer knowledge.

MAIN OUTCOMES AND MEASURES: The primary outcome was knowledge of cancer symptoms, risk factors, and screening practices. Analyses included Fisher exact test, Kruskal-Wallis test, Mann-Whitney U test, and Spearman rank correlation.

RESULTS: Among 378 displaced Lebanese women in Syria (median [IQR] age, 30 [23-39] years), 196 (51.9%) were married, 187 (49.5%) held a university degree, and 222 (58.7%) were unemployed. Only 85 participants (22.5%) had ever undergone breast imaging, 64 (16.9%) had undergone a Papanicolaou test, 274 (72.5%) rarely or never examined their breasts, and 135 (35.7%) ignored observed breast changes. Knowledge gaps were prominent, with 348 (92.1%) having a low awareness of HPV and only 4 (1.1%) correctly identifying age as an important risk factor for breast cancer. Higher educational attainment was significantly associated with improved screening rates and knowledge of breast and cervical cancer (χ23 = 11.661; P = .009), whereas financial status showed no association.

CONCLUSIONS AND RELEVANCE: These findings suggest that displaced women during humanitarian crises may face substantial breast and cervical cancer screening barriers, underscoring the need for crisis-responsive health care.

PMID:40768145 | DOI:10.1001/jamanetworkopen.2025.25652

JAMA Netw Open. 2025 Aug 1;8(8):e2525671. doi: 10.1001/jamanetworkopen.2025.25671.

ABSTRACT

IMPORTANCE: Suicide attempts (SA) are a major public health concern and a preventable cause of premature death with a significant societal cost. Suicide reattempt (SR) rates are high in the postdischarge period for an SA. Brief contact interventions (BCIs) aim to prevent SR by recontacting patients after discharge through crisis cards, calls, letters, or messages. A nationwide BCI was deployed in 6 French regions between 2015 and 2017.

OBJECTIVE: To assess the outcomes and the cost benefit of the program in reducing SR risk within 12 months after discharge.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective multicenter cohort study using nationwide data from the French health insurance database and emergency department surveillance system. Patients exposed to the program between 2015 and 2017 were matched 1:1 with unexposed patients based on age, sex, history of SA, and diagnosis codes using propensity scores and followed up for 12 months. Survival and cost-benefit analyses were conducted in [month to month] 2022.

EXPOSURE: Participation in the program, including structured follow-up using crisis cards, telephone calls, and/or postcards for up to 6 months after discharge.

MAIN OUTCOMES AND MEASURES: The primary outcome was time to first SR or suicide-related death within 12 months. The secondary outcome was the number of SRs and cost savings.

RESULTS: Among 23 146 individuals, 14 504 (62.6%) were female, 12 244 (52.9%) had no history of SA, and the mean (SD) age was 39 (17) years. Exposure to the program was associated with a lower risk of SR (adjusted hazard ratio [aHR], 0.62; 95% CI, 0.59-0.67). This association was consistent regardless of patients’ history of SAs (aHR, 0.63; 95% CI, 0.57-0.71 for those without prior attempts; aHR, 0.61; 95% CI, 0.56-0.66 for those with prior attempts) and appeared greater among female participants (aHR, 0.59; 95% CI, 0.54-0.68) than male participants (aHR, 0.68; 95% CI, 0.61-0.76). The program yielded a return on investment of €2.06 (95% CI, €1.58-€2.50) per euro spent.

CONCLUSION AND RELEVANCE: In this cohort study, exposure to the program was associated with a reduced risk of SR and favorable economic outcomes.

PMID:40768143 | DOI:10.1001/jamanetworkopen.2025.25671

Indian J Pediatr. 2025 Aug 6. doi: 10.1007/s12098-025-05690-9. Online ahead of print.

ABSTRACT

OBJECTIVES: To validate the disease-specific quality of life (QoL) instrument for pediatric inflammatory bowel disease (PIBD) patients in three Indian languages (Hindi, Tamil and Bengali). Additionally, also to reveal the significant factors which effect QoL of PIBD patients in India.

METHODS: One hundred and two (102) PIBD patients (mean age 13 ± 2.59 y) across 6 centres were enrolled. Each child completed two questionnaires – the IMPACT-III and Paediatric Quality of Life Inventory Version 4.0 Generic Core Scale (PedsQL™) – in one of the three languages. A uniform clinico-demographic proforma was completed for each recruit to reveal factors which determine QoL. During analysis authors used Cronbach’s alpha for internal consistency, principal component analysis for factor analysis, Spearman’s correlation between the questionnaires for concurrent validity and ANOVA analysis between IMPACT-III health-related quality of life (HRQoL) scores and disease severity to establish discriminant validity.

RESULTS: A five-domain structure was most suitable: ‘Concerns’, ‘Social acceptance’, ‘Mental disposition’, ‘Disease adjustment’ & ‘Self-confidence’, with good internal reliability (Cronbach’s α = 0.73-0.94). Concurrent and discriminant validity of the new questionnaire was also statistically significant (p < 0.001). Higher monthly family income led to better QoL scores in the ‘Concerns’ (p = 0.04) and ‘Disease adjustment’ (p = 0.03) domains while children with ulcerative colitis (UC) had better ‘Social acceptance’ scores than children with Crohn’s disease (CD) (p = 0.02).

CONCLUSIONS: Modified IMPACT-III questionnaire with a five-domain structure demonstrated good validity and reliability for Indian population. ‘Social acceptance’ was higher in patients with ulcerative colitis. There is a favourable impact of higher family income on ‘Concerns’ and ‘Disease adjustment’ in PIBD.

PMID:40768130 | DOI:10.1007/s12098-025-05690-9

Intern Emerg Med. 2025 Aug 6. doi: 10.1007/s11739-025-04072-5. Online ahead of print.

ABSTRACT

In cardiac arrest (CA) patients, arterial blood gas parameters, such as pH values, lactate concentrations, and base deficit (BD), are routinely evaluated in the emergency department (ED). We examined the relationship between BD and successful cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), neurological surveys, and intensive care unit (ICU) hospitalization length for in-and out-of-hospital CA (IHCA and OHCA, respectively) patients. We included non-traumatic adult CA patients in the present study. Age, gender, arterial blood gas (ABG) test results, CPR duration, ROSC, ICU hospitalization length, 30-day surveys, and neurological surveys were obtained for each patient. We included 448 CA patients. The mean age of the study group was 62.80 ± 17.64 years. The number of OHCA patients was 251 (56%), and IHCA patients consisted of 197 (44%). Mean BD values of the non-surviving OHCA patients was – 16.67 ± 6.72. This corresponding value in survival patients value was – 14.89 ± 6.62, but the difference was not statistically significant (p = 0.420). In the IHCA group, a weak negative correlation between BD levels and CPR duration (p < 0.001, r = – 0.247) was found. A weak positive correlation between BD and ICU hospitalization length (p < 0.001, r = 0.342) was also found. CPR duration correlated weakly and negatively with BD in the OHCA group (p = 0.03, r = – 0.192). In the IHCA group, BD was related to both ROSC (p < 0.001) and 30-day survival (p < 0.001). In the OHCA group, BD was related to ROSC (p = 0.020) and 30-day surveys (p = 0.042). In the IHCA group, a weak negative correlation between BD levels and CPR duration in addition to a weak positive correlation between BD and ICU hospitalization length was found. CPR duration negatively correlated with BD in the OHCA group.

PMID:40768124 | DOI:10.1007/s11739-025-04072-5

Eur J Epidemiol. 2025 Aug 6. doi: 10.1007/s10654-025-01281-2. Online ahead of print.

ABSTRACT

Complex multidimensional data are becoming more widely available and are drastically affecting the way epidemiological studies are designed and conducted. Novel frameworks such as the exposome-which encompasses the comprehensive and cumulative set of exposures affecting individuals throughout their lifetime and the complex mechanisms through which they act – provide a unique opportunity to transform how public health recommendations are identified at the population and individual level. This data revolution is accompanied by a growing interest in analytical approaches that can handle the complexity of these novel research questions. These include semi-parametric and non-parametric statistical and machine learning methodologies that provide compelling frameworks for analyzing large-scale databases while mitigating overfitting. Nevertheless, interpreting results from these complex methods is often challenging. While discussions on interpretability have largely focused on statistical inference, causal considerations and the practical applicability of the findings to inform the design of tangible interventions have received less attention-despite being essential components of epidemiological research. With this commentary we provide a general overview of these three levels of interpretability-statistical, causal, and actionable-and discuss available tools that can aid epidemiologists to improve results interpretability as they start utilizing more complex analytical approaches.

PMID:40768123 | DOI:10.1007/s10654-025-01281-2

J Community Genet. 2025 Aug 6. doi: 10.1007/s12687-025-00824-0. Online ahead of print.

ABSTRACT

Sickle cell disease (SCD) is a significant genetic disorder that imposes a considerable global health burden. The notable prevalence of SCD in Tanzania, coupled with extensive economic, psychological, and social ramifications, underscores the importance of premarital genetic screening to carriers of the sickle cell trait. This study aimed to assess the determinants of perception and willingness to uptake premarital genotype screening test for sickle cell disease carriers (PMGS) among health sciences undergraduate students in Dar es Salaam, Tanzania. An analytical cross-sectional design was used among 470 undergraduate students selected using a stratified random sampling technique. A structured questionnaire was used to collect data using Google Forms. Data were analyzed using the Statistical Package for the Social Sciences, version 25. Descriptive and inferential statistical analyses were performed. A total of 448 questionnaires were completed and submitted, with a response rate of 95.3%. More than half of the students (57.24%) had a good perception of PMGS, and the majority (92.2%) expressed their intention to participate in PMGS. Respondents who received information from healthcare professionals had a significant association (p = 0.031) with good perception. Most students were willing to participate in the PMGS program. As healthcare students, they are an important group in the development of national screening programs; similar studies in other universities in Tanzania are needed to obtain representative samples of undergraduates nationwide.

PMID:40768122 | DOI:10.1007/s12687-025-00824-0