Nevin Manimala

J Hosp Med. 2025 Dec 13. doi: 10.1002/jhm.70245. Online ahead of print.

ABSTRACT

BACKGROUND: Left atrial enlargement (LAE) is predictive of cardiovascular morbidity and mortality. Prior studies of point-of-care ultrasound (POCUS) interpretation methods for identifying LAE utilized older echocardiographic reference ranges.

OBJECTIVES: Compare the test characteristics of hospitalist-performed POCUS techniques for identifying LAE as compared to contemporary echocardiographic reference ranges.

METHODS: Fully paired, comparative diagnostic accuracy study of two index tests applied to archived echocardiogram images: visual assessment of the left atrium to aorta diameter (LAE sign) and left atrial (LA) anteroposterior diameter >4 cm in the parasternal long axis view. The reference test was moderate to severe LAE by echocardiography-derived left atrial volumetric index.

RESULTS: After exclusion criteria, 239 of 321 (74.5%) exams were included. The LAE sign had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 67.5%, 71.4%, 32.1%, and 91.6%. LA diameter of >4 cm had a sensitivity, specificity, PPV, and NPV of 87.5%, 75.9%, 42.2%, and 96.8%. The difference in sensitivity (p = .005) and specificity (p = .049) between the index tests was statistically significant. The diameter measurement had better positive and negative likelihood ratios (LR + 3.63, LR-0.16) than the LAE sign (LR + 2.36, LR- 0.46).

CONCLUSIONS: Both POCUS techniques for diagnosing LAE performed reasonably well compared to current echocardiographic reference ranges, with LA diameter >4 cm having better sensitivity and specificity than visual estimation of the LAE sign. These tests can help identify patients at risk for cardiovascular disease who may benefit from echocardiogram referral.

PMID:41389028 | DOI:10.1002/jhm.70245

J Med Internet Res. 2025 Dec 12. doi: 10.2196/84393. Online ahead of print.

ABSTRACT

BACKGROUND: Cisgender lesbian, bisexual, and queer (LBQ+) women of color (WOC) experience barriers to accessing sexual and reproductive health (SRH) services in the United States (US). Barriers, including limited provider access and poor patient-provider communication, contribute to underutilization of SRH services and poorer outcomes compared to heterosexual counterparts. Digital health modalities, including telemedicine, mobile health, and artificial intelligence (AI)-enabled chatbots, offer potential to expand access to SRH information and services among LBQ+ WOC.

OBJECTIVE: This study investigated current use, influencing factors, acceptability, and concerns regarding digital health modalities (video calls, SMS text messaging, mobile apps) and AI-enabled chatbots to support SRH information and service access among LBQ+ WOC in the US. It also assessed awareness and knowledge of HPV and cervical cancer prevention, and attitudes toward HIV prevention medication.

METHODS: A self-administered online survey was conducted from November 2020 to March 2021 with 285 LBQ+ WOC (aged ≥18 years) residing in the US. The 88-item survey assessed digital health use, SRH knowledge and awareness, and acceptability of and concerns about digital health use for SRH information and services. Data were analyzed using descriptive statistics, Fisher’s exact tests, multivariable logistic regression, and thematic analysis.

RESULTS: Most respondents were comfortable using video calls (81.8%) to communicate with a healthcare provider for SRH support. Respondents with a bachelor’s degree or higher (95% CI 0.00-0.24, P < .001), with health insurance (95% CI 56.1-1025.7, P < .001), and without a usual place of care (95% CI 0.07-0.43, P < .001) were significantly more likely to agree with using video calls. Respondents with a bachelor’s degree or higher (95% CI 0.23-0.74, P < .001), aged <45 years (95% CI 0.07-0.25, P < .001), and with health insurance (95% CI 3.23-12.45, P < .001) were significantly more likely to agree with using a mobile app. Respondents ≥45 years (95% CI 0.14-0.53, P < .001), without health insurance (95% CI 0.01-0.06, P < .001), and with an income < $49,000 (95% CI 1.32-3.93, P < .001) were significantly more likely to agree with the use of SMS text messaging. High acceptance was reported for using chatbots to self-assess risk for sexually transmitted infections (80.3%), but lower acceptance for self-assessing cervical cancer risk (47.8%). Key concerns included data privacy and confidentiality, lack of affective communication, and technology connectivity and digital literacy issues. Respondents also demonstrated low knowledge of HPV and cervical cancer prevention.

CONCLUSIONS: Digital health was highly acceptable for supporting access to SRH information and services among LBQ+ WOC. Culturally tailored, digital tools and interventions could improve awareness, knowledge, and attitudes toward SRH services. Addressing varying levels of digital literacy, concerns about data privacy, technology access, and affective communication when developing digital health solutions may help to advance SRH equity among LBQ+ WOC.

PMID:41388972 | DOI:10.2196/84393

Biostatistics. 2024 Dec 31;26(1):kxaf044. doi: 10.1093/biostatistics/kxaf044.

ABSTRACT

Addressing health disparities across demographic groups remains a critical challenge in public health, with significant gaps in understanding how these disparities evolve over time. This paper extends the traditional Peters-Belson decomposition to a longitudinal setting, focusing on the role of a single explanatory variable, referred to as a modifier, that captures complex interactions with other covariates. The proposed method partitions disparities into 3 components: (i) the portion associated with differences in the conditional distribution of covariates, evaluated under a common distribution of the modifier across groups; (ii) the portion arising from differences in the distribution of the modifier and its interactions with other covariates; and (iii) the unexplained disparity not accounted for by observed covariates. Rather than aggregating the first 2 components into one “explained disparity,” the proposed method allows for a separate characterization of temporal patterns in disparities, distinguishing those that are unassociated with the modifier from those that are associated with it. We illustrate the method using a fetal growth study, examining disparities in fetal development trajectories across racial and ethnic groups during pregnancy.

PMID:41388844 | DOI:10.1093/biostatistics/kxaf044

Alzheimers Dement. 2025 Dec;21(12):e70936. doi: 10.1002/alz.70936.

ABSTRACT

INTRODUCTION: Current biomarkers used to assess cerebrovascular pathology largely reflect end-stage disease, and more sensitive biomarkers are needed. We examined the role of baseline placental growth factor (PlGF) as a susceptibility biomarker for the progression of white matter injury and longitudinal cognitive decline.

METHODS: A total of 272 functionally intact older adults completed baseline blood draws, with plasma analyzed for PlGF (Meso Scale Discovery), and longitudinal neuroimaging and neuropsychological testing. A subset of 110 participants (n = 110) had banked plasma assayed on a different biomarker platform (NULISAseq) to evaluate replicability.

RESULTS: Higher baseline PlGF was associated with steeper declines in memory and processing speed. Elevated baseline PlGF also associated with greater baseline white matter hyperintensities and lower global fractional anisotropy (FA), but not white matter or FA trajectories.

DISCUSSION: Elevated baseline plasma PlGF associated with faster declines in cognition even among functionally intact older adults across two biomarker platforms. Our findings highlight PlGF as a potential susceptibility/risk biomarker of vascular-related cognitive decline.

HIGHLIGHTS: Higher plasma placental growth factor (PlGF) concentrations relate to greater baseline white matter injury. Elevated baseline plasma PlGF associates with steeper cognitive decline over time. PlGF may represent an upstream biomarker of endothelial-related cognitive decline.

PMID:41388837 | DOI:10.1002/alz.70936

J Inj Violence Res. 2025 Dec 13;17(2). Online ahead of print.

ABSTRACT

BACKGROUND: Unintentional injuries are a major contributor to morbidity and healthcare burden in early childhood. While falls and fractures are globally recognized as the most common pediatric injuries, region-specific data from primary care emergency settings in Southeast Europe remain scarce. The objective was to investigate the mechanisms, anatomical distribution, and contextual factors of injuries in children aged 0 to 6 years treated in a primary care pediatric service in Bosnia and Herzegovina.

METHODS: This retrospective study included ninety-nine children aged 0 to 6 years who presented with injuries to a primary care service between September 2019 and December 2024. Data were collected from medical records and included age, sex, mechanism of injury, type of injury, anatomical site, supervision, home safety, and treatment outcome. Descriptive statistics and chi-square tests were used to analyze associations between demographic variables and injury characteristics. Logistic regression was also applied to examine predictors of fracture occurrence, adjusting for age group and sex.

RESULTS: Falls were the leading cause of injury, accounting for 69.7% of all cases, with the highest number recorded in the 13- to 36-month age group. Fractures were the most frequent injury type, of which 74.4% affected the upper limbs, particularly the radius and humerus. Head injuries were more prevalent among infants, while boys experienced a higher overall injury rate. No statistically significant associations were found between injury occurrence and supervision or home safety, largely due to missing data and limited sample size.

CONCLUSIONS: Falls were the predominant cause of injury in early childhood, with upper limb fractures being common, especially among toddlers. While these findings provide important insights for prevention and pediatric emergency care planning in Bosnia and Herzegovina, larger prospective studies are needed to validate and extend these results.

PMID:41388830

J Inj Violence Res. 2025 Dec 7;17(2). Online ahead of print.

ABSTRACT

BACKGROUND: Suicide remains a critical global health crisis that disproportionately targets young adults, and medical students consistently display higher prevalence rates than their non-medical peers. The main aim of this study was investigation of the mediating roles of three intrapersonal factors-perfectionism, difficulties in emotion regulation, and self-disgust-in the relationship between psychological distress and suicidal ideation within in medical students.

METHODS: The present study utilized correlational research design with path analysis. A convenience sample of 404 medical students from Kermanshah University of Medical Sciences (KUMS), Iran was selected in the latter half of the 2024-2025 academic year. Data were collected using structured questionnaires, including the Psychological Distress Scale (PDS), Beck Scale for Suicidal Ideation (BSSI), Difficulties in Emotion Regulation Scale (DERS), Frost Multidimensional Perfectionism Scale (FROST-MPS), and Multidimensional Self-Disgust Scale (MSDS). SPSS software version 26 handled descriptive statistics and assumption checks, whereas Amos software performed the structural modeling.

RESULTS: The study found that psychological distress significantly predicted difficulties in emotion regulation (β = 0.370, P less than 0.001), perfectionism (β = 0.426, P less than 0.001), and self-disgust (β = 0.348, P less than 0.001). These variables mediated the relationship between psychological distress and suicidal ideation, with significant indirect effects through perfectionism (indirect effect = 0.094, p less than 0.001), difficulties in emotion regulation (indirect effect = 0.119, P less than 0.001), and self-disgust (indirect effect = 0.096, P less than 0.001). Among the total sample, 148 students (36.6%) were at high risk and 200 (49.5%) at very high risk of suicidal ideation.

CONCLUSIONS: There is a strong correlation between suicidal ideation and psychological distress among medical students. The findings highlight the roles of perfectionism, difficulties in emotion regulation, and self-disgust in this relationship. Universities should enhance mental health support and offer interventions targeting these factors to reduce suicide risk.

PMID:41388829

Med Care Res Rev. 2025 Dec 13:10775587251396723. doi: 10.1177/10775587251396723. Online ahead of print.

ABSTRACT

To compare the performance of the Chronic Conditions Warehouse (CCW) and the 38-condition Elixhauser Comorbidity Index in predicting all-cause mortality among Medicare beneficiaries with dementia, we used a national sample of 1,566,359 community-dwelling Medicare beneficiaries (age ≥65) with dementia, identified in 2018 claims data. Using elastic net logistic regression, we applied 30 CCW conditions and 38 Elixhauser comorbidities from 2018 to predict mortality at 30, 60, 180 days, and 1 year through December 31, 2019. Mortality rates were 2.42% (30 days), 4.27% (60 days), 10.77% (180 days), and 19.0% (1 year). All models demonstrated good discrimination (C-statistics: 0.696-0.731) and calibration, with no meaningful performance differences between the two measures. Elastic net models produced parsimonious predictors with performance comparable to traditional logistic regression. Both CCW and Elixhauser measures predicted all-cause mortality in dementia with similar accuracy. Elastic net offers a robust approach to claims-based mortality prediction.

PMID:41388825 | DOI:10.1177/10775587251396723

Orthod Craniofac Res. 2025 Dec 13. doi: 10.1111/ocr.70070. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the impact of seven key facial features on the perceived attractiveness of varying buccal corridor (BC) widths, aiming to inform personalied orthodontic treatment planning for enhanced smile aesthetics.

METHODS: A cross-sectional design was employed, using image manipulation software to alter BC widths (10%, 15%, 20%, and 25%) and modify seven key facial features: vertical facial type, upper and lower facial width, interpupillary distance, eye fissure width, ala nasi width and maxillary central incisor (MCI) width. Online questionnaires were used to assess aesthetic preferences for each BC width. Statistical analysis was performed using chi-square tests and multivariable logistic regression.

RESULTS: A total of 511 valid questionnaires were collected, BC widths of 15% and 20% were consistently rated as the most attractive, while extremely narrow or wide BCs were less preferred. Aesthetic suitability varied by age, gender, and facial features: slightly wider BCs were perceived as more harmonious for middle-aged individuals and dolichofacial males, especially when upper facial width was narrow. In contrast, broader ala nasi suited smaller BCs, while variations in interpupillary distance, eye fissure width, and MCI width had limited impact.

CONCLUSIONS: Aesthetic preferences for BC are influenced by both demographic and facial soft tissue characteristics. These findings offer clinical guidance for personalised orthodontic treatment planning to enhance smile aesthetics.

PMID:41388805 | DOI:10.1111/ocr.70070

Ann Med. 2025 Dec;57(1):2600747. doi: 10.1080/07853890.2025.2600747. Epub 2025 Dec 12.

ABSTRACT

OBJECTIVE: To assess the association between the blood pressure (BP) reduction mediated by BP-lowering agents and the risks of peripheral arterial disease (PAD) in patients with cardiometabolic risk factors.

METHODS: PubMed, EMBASE, the Cochrane Centre Register of Controlled Trials for Studies, the Scopus, Web of Science and Clinicaltrial.gov were searched from January 1980 to October 2023. Randomized controlled trials (RCTs) with statistically significant BP reduction in intensive BP-lowering treatments group compared with control treatment group, reporting the incidence of PAD were included. Regular and dose-response meta-analyses were both conducted.

RESULTS: In all, 15 RCTs involving 94482 participants were included. The standardized analysis based on systolic blood pressure (SBP) reduction revealed that each 10 mmHg reduction in SBP mediated by BP-lowering agents was associated with a 37% increase in the risk of PAD in patients with cardiometabolic risk factors (RR = 1.37, 95% CI 1.08 to 1.74). The difference of the SBP reduction from baseline between the intensive anti-hypertensive treatment group and the control group was associated with the increased risk of PAD (β=-0.1107, 95%CI, -0.219 to -0.002, p = 0.047). Dose-response analysis further confirmed a linear association between SBP reduction and the risk of PAD in patients with cardiometabolic risk factors, with a 3.22% increase in risk for every 1 mmHg decrease in SBP (RR = 1.032, 95% CI 1.008 to 1.057, p = 0.009).

CONCLUSION: Our meta-analysis revealed that intensive reductions in SBP mediated by BP-lowering agents conferred increase the risk of PAD in patients with cardiometabolic risk factors. A gradual and moderate BP reduction as well as regular BP monitoring should be recommended for patients at high risk of PAD.

PMID:41388746 | DOI:10.1080/07853890.2025.2600747

Fundam Clin Pharmacol. 2026 Jan;40(1):e70058. doi: 10.1111/fcp.70058.

ABSTRACT

BACKGROUND: The objective of this study was to assess the prevalence of dependence and abuse of psychoactive substances (PAS) among prison inmates, using data from the OPPIDUM program between 2013 and 2022.

METHODS: OPPIDUM is an annual, cross-sectional national program, conducted among users consulting in specialised addiction centres. Prison inmates were questioned about their PAS use during the week preceding their incarceration. Two groups of participants were compared: prison inmates who reported simple use of PAS and those with abuse/dependence problems.

RESULTS: A total of 2626 individuals responded to the program (men, 91.6%; mean age, 34.4 ± 9.30 years), reporting 5352 PAS. The main PAS consumed were cannabis (52.8%), cocaine/crack (28.6%), benzodiazepines (23.1%) and heroin (14.8%). Opioid substitution treatment (OST) was reported by 54.9% of participants. Several variables were associated with a significantly increased odds of abuse/dependence: intravenous use (OR, 4.608; 95% CI, 1.44-14.69; p = 0.01), PAS illegal acquisition (OR, 3.79; 95% CI, 2.19-6.58; p < 0.0001), heroin/speedball use (OR, 4.24; 95% CI, 1.16-15.48; p = 0.029) and cocaine/crack use (OR, 3.3; 95% CI, 1.47-7.39; p = 0.004). Conversely, being on OST protocol was associated with a lower odds of abuse/dependence (OR, 0.511; 95% CI, 0.28-0.93; p = 0.028).

LIMITATIONS AND CONCLUSION: The main limitations of the study include self-reported PAS use without objective diagnoses, sometimes incomplete data on PAS use and incarceration and a sample biased toward inmates linked to substance abuse services, which likely overestimates the prevalence of PAS use. However, these results highlight the importance of assessing factors associated with substance abuse and dependence for appropriate prevention and management among prison inmates.

PMID:41388738 | DOI:10.1111/fcp.70058