Nevin Manimala

JAMA Netw Open. 2026 Jul 1;9(7):e2623860. doi: 10.1001/jamanetworkopen.2026.23860.

ABSTRACT

IMPORTANCE: Patients experiencing homelessness face particular barriers to hospital discharge, which may result in an alternate level of care (ALC) designation, a delayed discharge status describing patients occupying beds while not requiring the intensity of care provided in the hospital. Evidence quantifying disparities in ALC designation among patients with recent experience of homelessness relative to matched comparators is limited.

OBJECTIVE: To compare ALC rates among hospitalized patients with a recent experience of homelessness and matched patients from neighborhoods with the lowest level of material resources.

DESIGN, SETTING, AND PARTICIPANTS: This population-based matched cohort study was conducted in Ontario, Canada, among 51 377 hospital patients aged 16 years or older discharged from April 1, 2022, to March 31, 2024.

EXPOSURE: Patients with a recent experience of homelessness, classified using a validated definition using health administrative data. Unexposed patients from neighborhoods with the lowest level of material resources were matched 4:1 on age, sex, year and month of admission, health region, and Charlson Comorbidity Index.

MAIN OUTCOMES AND MEASURES: ALC designation and duration of ALC. Weighted standardized differences and negative binomial models were used to assess significance of disparities.

RESULTS: The study included 11 168 patients with a recent experience of homelessness (mean [SD] age, 48.5 [16.5] years; 7384 male [66.1%]) and 40 209 matched comparators (mean [SD] age, 49.6 [16.7] years; 25 561 male [63.6%]). Patients with a recent experience of homelessness had a more than 4-fold higher ALC designation rate (9.1% [1014 of 11 168] vs 2.0% [810 of 40 209]; weighted standardized difference = 0.32; rate ratio, 4.51 [95% CI, 4.11-4.95]). Health region-level variation was substantial, ranging from 2.39 (95% CI, 1.40-4.01) times higher in the Central West region to 7.88 (95% CI, 5.21-12.11) times higher in the Central region. Among patients designated an ALC, those with a recent experience of homelessness had a significantly longer ALC stay duration (incidence rate ratio, 1.22 [95% CI, 1.09-1.37]; difference of margins, 4.7 days [95% CI, 2.1-7.4 days]) after adjusting for key demographic and clinical factors.

CONCLUSIONS AND RELEVANCE: In this cohort study of hospitalized patients in Ontario, Canada, recent experience of homelessness was significantly associated with higher rates of ALC designation and increased lengths of ALC stay, reflecting structural barriers to accessing safe discharge locations and gaps in transitional and postacute care. Regional differences suggest that local capacity and supports may mitigate or exacerbate challenges. Interventions such as medical respite and supportive housing are critical to reducing delayed discharge among patients experiencing homelessness and promoting equitable health system performance.

PMID:42467431 | DOI:10.1001/jamanetworkopen.2026.23860

JAMA Netw Open. 2026 Jul 1;9(7):e2623880. doi: 10.1001/jamanetworkopen.2026.23880.

ABSTRACT

IMPORTANCE: Hormonal contraceptive use has important implications for both reproductive and general health. However, the patterns and trends of short-acting hormonal contraceptive use among US premenopausal females remain insufficiently characterized.

OBJECTIVE: To evaluate trends in and factors associated with prescribed short-acting hormonal contraceptive use among US premenopausal females.

DESIGN, SETTING, AND PARTICIPANTS: Serial, cross-sectional analyses were conducted using US nationally representative data from the National Health and Nutrition Examination Survey (NHANES), including 10 survey cycles between 1999 to 2000 and 2017 to 2020 (before the COVID-19 pandemic). Participants included noninstitutionalized premenopausal females aged 15 years to younger than 60 years without a history of breast cancer. Data were analyzed from January to November 2025.

EXPOSURES: NHANES cycle.

MAIN OUTCOMES AND MEASURES: The prevalence of prescribed short-acting hormonal contraceptive use was extracted from the prescription medication data collected during household interviews. Data primarily reflect oral contraceptives and were categorized as combined estrogen and progestin or progestin-only formulations.

RESULTS: Data on 15 531 premenopausal females (14.7% aged 15 to <20 years, 59.3% aged 20 to <40 years, 26.1% aged 40 to <60 years) were analyzed. Participants predominantly had an educational level higher than high school (59.8%), were privately insured (59.3%), and never smoked (58.7%). From 1999 to 2020, the prevalence of prescribed short-acting hormonal contraceptive use significantly increased from 5.2% (95% CI, 2.2%-11.5%) to 15.1% (95% CI, 10.7%-20.7%) for females aged 15 to younger than 20 years, was stable for females aged 20 to younger than 40 years (16.7% [95% CI, 13.2%-21.0%] to 13.3% [95% CI, 10.7%-16.4%]), and remained low among those aged 40 to younger than 60 years (3.8% [95% CI, 1.5%-9.3%] to 7.0% [95% CI, 4.0%-12.1%]). Compared with non-Hispanic White females, non-Hispanic Black and Hispanic females had lower prevalence of use and exhibited the greatest relative increases (prevalence ratio, 3.7 [95% CI, 1.0-13.7] among non-Hispanic Black females and 1.8 [95% CI, 0.9-3.7] among Hispanic females) from 1999 to 2020. Progestin-only formulations accounted for 0.4% (95% CI, 0.1%-2.5%) of the prescribed short-acting hormonal contraceptive prescriptions in 1999 to 2000 and remained low (5.2% [95% CI, 3.0%-8.9%)] in 2017-2020. The prevalence of short-acting hormonal contraceptive use varied by race and ethnicity in all age groups, by family income to poverty ratio, educational attainment, health insurance coverage, marital status, and weight status among females aged 20 to younger than 40 years and by family income to poverty ratio and smoking status among females aged 40 to younger than 60 years.

CONCLUSIONS AND RELEVANCE: In this serial cross-sectional study of US premenopausal females, prescribed short-acting hormonal contraceptive use increased among females aged 15 to younger than 20 years and among non-Hispanic Black and Hispanic females. Across all groups, the use of progestin-only formulations remained low over time.

PMID:42467430 | DOI:10.1001/jamanetworkopen.2026.23880

Womens Health (Lond). 2026 Jan-Dec;22:17455057261470175. doi: 10.1177/17455057261470175. Epub 2026 Jul 17.

ABSTRACT

BackgroundMaternal mortality in the United States has doubled over the last two decades, primarily due to cardiovascular disease, with more than half of deaths occurring postpartum. Despite national calls to action, attendance at postpartum clinic visits remains low. The role of alternative care delivery strategies, such as home visiting, remains insufficiently studied.ObjectiveTo describe postpartum clinic visit attendance among participants in a large national home visiting program, identify sociodemographic and clinical factors associated with attendance, and examine how timing and duration of enrollment relate to postpartum follow-up.DesignWe conducted a retrospective cohort study of pregnancy episodes among mothers enrolled in the Parents as Teachers (PAT) national home visiting program between July 2016 and September 2024.MethodsThe primary outcome was documented attendance at a postpartum clinic visit within 12 weeks of delivery. Descriptive analyses estimated overall attendance rates and characterized variation by pregnancy risk status, geography, calendar year, and sequential pregnancies. Multilevel logistic regression with random intercepts for participant and site was used to account for repeated pregnancies and clustering. Sensitivity analyses included all pregnancies, including those exiting home visiting prior to 12 weeks postpartum.ResultsAmong 46,899 pregnancy episodes from 39,498 participants, median maternal age was 27 years (IQR 18-36). Overall, 30.1% (95% CI 29.6-30.5) attended a postpartum clinic visit within 12 weeks, including 33.2% (95% CI 32.3-34.1) among high-risk pregnancies. Attendance was lower among Black (adjusted OR 0.80 [95% CI 0.75-0.86]), American Indian/Alaska Native (0.61 [0.55-0.68]), rural participants (0.77 [0.73-0.82]), and participants who primarily used the emergency room or urgent care for medical care before pregnancy (0.78 [0.72-0.85]). Attendance washigher among recent immigrants (1.17 [1.05-1.30]), women with high-risk pregnancies (1.13 [1.06, 1.20]),and those enrolled prenatally (1.93 [1.84-2.04]).ConclusionsPostpartum clinic attendance was low in this national home visiting cohort. Prenatal and sustained engagement in home visiting were associated with higher odds of attendance. Home visiting is a potential complementary care model to extend early care beyond clinical settings and promote sustained engagement in clinical follow-up.

PMID:42467419 | DOI:10.1177/17455057261470175

Am J Cardiovasc Drugs. 2026 Jul 17. doi: 10.1007/s40256-026-00814-8. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide cardiovascular benefits in diabetes, but their role in the acute post-myocardial infarction (MI) setting is uncertain. This study evaluated the association of empagliflozin with left ventricular ejection fraction (LVEF) recovery and major adverse cardiac events (MACE) in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

METHODS: In a single-center, double-blind, randomized, placebo-controlled trial, patients with STEMI were randomized to empagliflozin 10 mg or placebo daily for 40 days. The primary endpoint was change in left ventricular ejection fraction (LVEF) from baseline to day 40, with sample size calculated a priori based on data from the EMMY trial (minimum 27 per group; 53 per group enrolled). Major adverse cardiac events (MACE)-defined as cardiovascular death, myocardial infarction, or stroke-were assessed as a secondary exploratory endpoint.

RESULTS: A total of 117 patients were randomized (59 empagliflozin, 58 placebo), of whom 106 completed follow-up and were analyzed (53 per group). Empagliflozin was associated with significantly greater LVEF recovery at day 40 (mean increase: 7.35% ± 6.11% versus 2.96% ± 5.49%; mean difference 4.39%, 95% CI 2.09-6.70%; P = 0.000272), which remained significant after adjustment for baseline LVEF, age, sex, and diabetes status (adjusted difference: 3.44%, 95% CI 1.22-5.66%; P = 0.003; Cohen’s d = 0.756). The benefit was numerically greater in younger and nondiabetic patients, though no subgroup interaction reached significance after multiplicity correction. MACE did not differ significantly between groups (3.8 versus 7.5%; P = 0.68), with no recurrent MI or stroke in either group. Adverse events were rare and comparable, with no diabetic ketoacidosis, amputation, or acute kidney injury observed.

CONCLUSIONS: In this preliminary single-center trial, empagliflozin was associated with significantly greater LVEF recovery in patients with STEMI after PCI, with effects robust to covariate adjustment, and without increasing adverse events. Although MACE was not significantly reduced-as expected given the study was not powered for hard clinical events-the LVEF improvement represents a promising early prognostic signal. These findings are applicable to lower-risk patients with STEMI with successful reperfusion and may not generalize to higher-risk patients with failed PCI or hemodynamic compromise. Larger, adequately powered, long-term multicenter trials are needed to confirm clinical benefits.

TRIAL REGISTRATION: Registered at the Iranian Registry of Clinical Trials identifier no. IRCT20220809055645N7.

PMID:42467386 | DOI:10.1007/s40256-026-00814-8

Eur J Clin Microbiol Infect Dis. 2026 Jul 17. doi: 10.1007/s10096-026-05596-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of 2% chlorhexidine gluconate (2%CHG) bathing every other day on the number of infections, catheter-related bloodstream infections (CLABSI), average length of stay, and number of deaths.

METHODS: This is a systematic review and meta-analysis. The searches and data extraction were performed by two independent authors in six databases in February 2026. We calculated Risk Ratios (RR) and Mean Difference (MD) with 95% confidence intervals for all analyses.

RESULTS: Three studies were eligible for inclusion, comprising one randomized study, one quasi-experimental study, and one observational study, with a total population of 4,943 patients. There was no statistically significant difference between the 2% CHG and the control group for CLABSI (RR 0.98 [95% CI: 0.72; 1.31], p = 0.87, I² = 0%), Gram-positive infections (RR 0.99 [95% CI: 0.45; 2.20], p = 0.98, I² = 11%), Gram-negative infections (RR 1.23 [95% CI: 0.76; 1.99], p = 0.39, I² = 0%), CRAB infections (RR 1.79 [95% CI: 0.54; 5.92], p = 0.34; I²=78%) or VRE infections (RR 0.53 [95% CI: 0.20; 1.42], p = 0.21, I²=0%), Similarly, alternate-day 2%CHG bathing was not associated with a significant reduction in ICU length of stay (MD 0.62 [95% CI: -0.29; 1.52], p = 0.18, I² = 45%), hospital length of stay (MD 7.92 [95% CI: -1.92; 17.76], p = 0.11, I² = 79%), ICU deaths (RR 1.02 [95%CI 0.88; 1.19]; p = 0.77; I² = 0%), or in-hospital deaths (RR 1.01 [95%CI 0.91; 1.12]; p = 0.84; I²=0%).

CONCLUSION: Given that only three studies were available for inclusion and that the certainty of evidence ranged from low to very low, no definitive conclusions can currently be drawn regarding the effectiveness of alternate-day 2% CHG bathing in critically ill patients.

PMID:42467378 | DOI:10.1007/s10096-026-05596-0

Target Oncol. 2026 Jul 17. doi: 10.1007/s11523-026-01231-2. Online ahead of print.

ABSTRACT

BACKGROUND: Molecular tumor boards (MTBs) support precision oncology by translating genomic profiling into evidence-based treatment recommendations, for example according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT). Their clinical utility in real-world care depends on effective implementation within healthcare systems.

OBJECTIVES: To evaluate the implementation rate of MTB recommendations, associated determinants, and clinical outcomes in a real-world single-center cohort.

PATIENTS AND METHODS: At a single-center MTB, 582 consecutive cases (2020-2023) were retrospectively analyzed, with last survival follow-up in August 2025. Patient demographics, tumor characteristics, genomic alterations, ESCAT and ZPM (Zentrum für Personalisierte Medizin) evidence levels, targeted therapy recommendation and implementation rates, survival outcomes, and barriers to implementation were evaluated using descriptive and inferential statistics, as appropriate.

RESULTS: Of 582 patients (median age 61 years, 48.5% female, 78.2% UICC stage IV), 55.6% (n = 324) received a targeted therapy recommendation, most based on ESCAT I-II evidence (59.9%). Among patients with a therapy recommendation, implementation status was unknown in 83 cases, but at least 23.5% (n = 76) received the proposed therapy. Major barriers included continuation of alternative systemic therapy (n = 89, 53.9%) and best supportive care or death before initiation (n = 54, 32.7%). Stronger levels of evidence (ESCAT per level increase: OR 1.22, 95% CI 1.08-1.39, p = 0.003; ZPM per level increase: OR 1.43, 95% CI 1.19-1.75, p < 0.001) and lower gastrointestinal cancer (OR 2.39, 95% CI 1.13-4.93, p = 0.020) were positively associated with increased likelihood of therapy implementation, while extramural molecular profiling showed a trend toward lower uptake (OR 0.61, 95% CI 0.36-1.03, p = 0.062). Overall survival (OS) from the date of MTB discussion in the full cohort (n = 563) was 11.1 months (95% CI 9.7-12.8). In patients who received at least one prior therapy before MTB discussion (n = 202), OS was 20.1 months (95% CI 12.3-NA) in patients who received the MTB-recommended therapy (n = 62) versus 7.7 months (95% CI 6.5-12.5) in those who did not (n = 140; p < 0.001). Among 31 patients with paired data, PFS under MTB-guided therapy was significantly longer than in the prior line (p = 0.036), with 54.8% achieving a PFS2/PFS1 ratio ≥ 1.3.

CONCLUSIONS: In this real-world analysis, implementation of MTB recommendations was associated with improved survival outcomes. However, systemic, clinical, and logistical barriers substantially limited uptake. Earlier integration of MTBs into treatment planning and targeted strategies to address these barriers may help increase their potential benefit for patients.

PMID:42467374 | DOI:10.1007/s11523-026-01231-2

J Immigr Minor Health. 2026 Jul 17. doi: 10.1007/s10903-026-01953-5. Online ahead of print.

ABSTRACT

The aging of Mexican-born undocumented farmworkers in the U.S. may compromise agricultural productivity and lead to increasing chronic disease in this population, yet research on aging and chronic disease among undocumented U.S. farmworkers is scarce. Observations were drawn from the National Agricultural Workers Survey (2001-2018). Our primary analyses focused on Mexican-born undocumented farmworkers aged 18 and older (n = 17,606). As a comparison, we descriptively examined Mexican-born farmworkers who were legal permanent residents (n = 8,216) or U.S. citizens (n = 1,608). Among undocumented farmworkers, we examined population aging from 2001 to 2018 and tested whether number of chronic conditions (self-reported doctor-diagnosed diabetes, hypertension, heart disease, and asthma), multimorbidity (≥ 2 chronic conditions), and individual conditions varied by age group and time. Statistical methods included weighted linear, negative binomial, and logistic regression. Undocumented Mexican-born farmworkers appeared to have the greatest increase in mean age but were consistently younger than the other legal status groups. Based on adjusted inferential analyses, the mean age of Mexican-born undocumented farmworkers increased by 9.4 years (95% CI:8.8-10.0) from 2001- 2002 to 2017-2018. Number of chronic conditions and the likelihood of multimorbidity or diabetes was greater among older undocumented farmworkers compared with other legal status groups. There was some evidence that chronic disease burden was greater in later waves. This study documents aging and potential growth in chronic disease burden among Mexican-born undocumented U.S. farmworkers. Our findings highlight the need for practical immigration policies, workplace protections, and chronic disease prevention tailored to undocumented U.S. farmworkers.

PMID:42467373 | DOI:10.1007/s10903-026-01953-5

MedScience. 2026 Jul 17. doi: 10.1007/s11684-026-1236-9. Online ahead of print.

ABSTRACT

Data on the clinical characteristics and outcomes of patients with pleural infection are limited. This retrospective study aimed to describe the clinical characteristics and outcomes associated with community-acquired pleural infection (CAPI) and hospital-acquired pleural infection (HAPI) in a large Chinese tertiary-care hospital in Beijing over 11 years. The study included 832 patients, of whom 84.9% had HAPI. The most common cause of CAPI was pneumonia and pleurisy, whereas the most common cause of HAPI was trauma or chest surgery. The predisposing factors with statistically significant differences between HAPI and CAPI included the presence of an abdominal indwelling catheter (P = 0.012), thoracic cavity drainage (⩾ 10 days) (P = 0.003), and use of broad-spectrum antibiotics (P = 0.002). Staphylococcus epidermidis (24.76%) and Streptococcus species (27.00%) were the most common Gram-positive bacteria in HAPI and CAPI, respectively, whereas Acinetobacter baumannii (8.61%) and Escherichia coli (4.38%) were the most common Gram-negative pathogens in HAPI and CAPI, respectively. Virtually any Gram-positive bacteria were resistant to linezolid and vancomycin, except Enterococcus faecium displaying resistance to vancomycin (9.88%). The 30-day mortality after the onset of pleural infection was 13.1%. Multivariable logistic regression analysis suggested that intensive care unit (ICU) admission, solid tumors, chronic renal failure, and a decreased serum albumin level were independent risk factors for pleural infection. No statistically significant difference in mortality was observed between patients with CAPI (11.9%) and those with HAPI (13.3%). Differences were noted in clinical characteristics between HAPI and CAPI. The findings might guide empirical treatments and help improve infection control strategies.

PMID:42467364 | DOI:10.1007/s11684-026-1236-9

Health Care Anal. 2026 Jul 17. doi: 10.1007/s10728-026-00587-w. Online ahead of print.

ABSTRACT

This mixed-methods study examines the push-pull factors influencing physician emigration from Turkey and assesses the feasibility of reverse brain drain, framing physician migration as a challenge for health governance rather than merely an individual career choice. Quantitative data from 1331 physicians (700 specialists, 631 interns) across 19 provinces and qualitative interviews with 32 emigrated physicians in four destination countries reveal that violence against healthcare workers (81.6%), low salary (74.3%), and challenging working conditions (59.8%) constitute the primary push factors. A statistically significant negative correlation between job satisfaction and brain drain attitudes (r = – 0.132, p < 0.01) confirms an association but explains only limited variance, indicating that structural and systemic conditions matter beyond individual satisfaction alone in shaping migration orientations. The qualitative findings identify professional burnout, performance system dysfunction, and sociopolitical instability as additional drivers. Only 2 of 32 emigrated physicians were considering return, and no female participant expressed return intention. Drawing on the ethics of health workforce governance, the study argues that when the state fails to protect physicians from violence and provide sustainable professional conditions, the normative responsibility for brain drain shifts from the emigrating individual to the institutional structures that render emigration rational. Policy interventions targeting salary alone are insufficient; comprehensive reforms in professional safety, meritocratic career pathways, workload standards, and sociopolitical stability are required.

PMID:42467353 | DOI:10.1007/s10728-026-00587-w

CNS Drugs. 2026 Jul 17. doi: 10.1007/s40263-026-01316-6. Online ahead of print.

ABSTRACT

BACKGROUND: Plexiform neurofibromas (PN) represent a significant cause of morbidity among patients diagnosed with neurofibromatosis type 1 (NF1). MEK inhibitors continue to be developed as targeted therapies by inhibiting the mitogen-activated protein kinase pathway to treat PN; nonetheless to this day, therapeutic responses have varied across different patient populations and clinical contexts, and the overall efficacy and tolerability of these agents remain incompletely characterized.

OBJECTIVE: We aimed to systematically evaluate the efficacy and safety of MEK inhibitor therapy in patients with NF1-associated PN and to evaluate differences among key subgroups based on the most contemporary metadata.

METHODS: A comprehensive search was performed across electronic databases to identify studies that reported outcomes related to MEK inhibitor therapy in NF1-associated PN. Pooled proportions were calculated using a random-effects meta-analysis with logit transformation. Outcomes assessed included objective response rate, disease control rate, disease progression rate, and grade ≥ 3 adverse events.

RESULTS: A total of 23 studies comprising 769 patients were included. The pooled objective response rate was estimated at 56% (95% confidence interval [CI] 46-65; I² = 79.2%), with significantly higher response rates observed in clinical trials (61%) compared with real-world cohorts (44%) [p = 0.035], while no statistically significant difference was observed between pediatric (58%) versus adult populations (51%) [p = 0.407]. The pooled disease control rate was 96% (95% CI 91-98; I² = 17%) and the pooled disease progression rate was estimated at 2% (95% CI 1-5; I² = 0%), both reflecting on-treatment outcomes. Grade ≥ 3 adverse events occurred in 13% of patients (95% CI 6-25; I² = 51.9%). Subgroup analyses revealed comparable disease control across study settings, with moderate variability in response and toxicity estimates.

CONCLUSIONS: The use of MEK inhibitors is associated with high rates of disease control and minimal tumor progression in patients with NF1-related PN, with consistent effects observed across clinical trial and real-world environments. Although tumor reduction occurs in some patients, the predominant therapeutic benefit appears to be sustained disease stabilization, with response variability noted among different age groups and study designs.

PMID:42467350 | DOI:10.1007/s40263-026-01316-6