Nevin Manimala

JAMA Health Forum. 2025 Aug 1;6(8):e252258. doi: 10.1001/jamahealthforum.2025.2258.

ABSTRACT

IMPORTANCE: The utilization of elective surgical procedures is lower for patients enrolled in Medicare Advantage (MA) than in traditional Medicare (TM), but it remains unclear whether surgical episode costs differ between MA and TM for comparable patients.

OBJECTIVE: To compare the estimated costs, markers of resource use (eg, length of stay and location of surgery), and outcomes of surgical episodes for similar patients enrolled in MA and TM.

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, 2019 Medicare claims and encounters data were analyzed to compare differences in surgical episode costs for beneficiaries with MA vs TM who underwent common elective surgical procedures across 11 categories. Procedures performed in either inpatient or outpatient settings were included in the analysis. Data were analyzed from January 2023 to March 2025.

EXPOSURES: Enrollment in MA or TM.

MAIN OUTCOMES AND MEASURES: The primary outcomes were estimated 30-day costs of surgical episodes and factors affecting costs and/or outcomes, including share of inpatient procedures, length of stay, share of patients discharged home, and 30-day readmission rates. A secondary outcome explored potential facility selection and patient steering by estimating the distance traveled to surgery. Multivariable linear regression models adjusted for the type of surgical procedure, patient characteristics, and their Elixhauser Comorbidity Index were used to compare outcomes of surgical episodes in patients with MA vs TM within hospital referral regions.

RESULTS: The analysis included 1 177 700 surgical procedures among 1 110 263 Medicare beneficiaries (mean [SD] age, 73.42 [5.8] years; 686 708 females [58.3%]). The overall rate of surgery utilization was lower among MA patients vs TM patients (difference in rate, -4.4%; 95% CI, -4.8% to -4.1%), with variation found across surgical categories. Across procedures, 30-day surgical episode costs for MA patients vs TM patients were, on average, $671 (95% CI, $639-$702) lower. The share of procedures billed at the higher inpatient rate was 5.41 (95% CI, 5.23-5.58) percentage points (pp) lower for MA patients than for TM patients, and the mean length of inpatient stay was 0.27 (95% CI, 0.26-0.29) days shorter. The share of patients discharged home was higher for those with MA vs TM (3.82 [95% CI, 3.65-3.99] pp). MA patients traveled a mean of 2.32 (95% CI, 1.62-3.01) miles farther for surgery. Readmission rates were lower for patients with MA (-0.70 [95% CI, -0.83 to -0.58] pp).

CONCLUSIONS AND RELEVANCE: This study found that in addition to lower utilization of common elective surgical procedures, the costs of surgical episodes were lower for patients enrolled in MA than those enrolled in TM. MA plans had lower costs because more procedures were performed in outpatient settings, required shorter lengths of stay, and less expensive postacute care, with no apparent harm to overall quality. Physician and surgical facility selection and patient steering likely contributed to these cost differences. These findings highlight potential mechanisms by which MA plans may achieve cost savings compared with TM plans.

PMID:40748544 | DOI:10.1001/jamahealthforum.2025.2258

J Math Biol. 2025 Aug 1;91(2):23. doi: 10.1007/s00285-025-02237-6.

ABSTRACT

We study a reaction-diffusion system involving two species competing in temporally periodic and spatially heterogeneous environments. In this system, the species move horizontally and vertically with different probabilities, which can be regarded as dispersal strategies. The selection mechanisms in this case are more intricate than those observed in random diffusion scenarios. We investigate the stability of the semi-trivial periodic solutions in terms of the sign of the principal eigenvalue associated with a linear periodic eigenvalue problem. Furthermore, we provide sufficient conditions for the coexistence of two species. Additionally, numerical simulations are performed to facilitate further research and exploration.

PMID:40748525 | DOI:10.1007/s00285-025-02237-6

Res Health Serv Reg. 2025 Aug 1;4(1):11. doi: 10.1007/s43999-025-00071-3.

ABSTRACT

BACKGROUND: Maternal and infant mortality is a major public health concern especially in South Asian nations. A significant proportion of mothers and infant died as a result of complications during birth. The delivery of healthcare facilities plays key role to lowering these mortality rates. The present study aimed to explore the prevalence of institutional delivery and its determinants in five South Asian countries.

METHODS: Data were extracted from five South Asian countries latest demographic and health survey data, including Afghanistan (2015), Bangladesh (2017-18), Nepal (2016), Myanmar (2015-16), and Pakistan (2017-18), all of which were pooled for the present study. A total of 38,975 women were included in this study after data handling. A multivariate binary logistic regression model was performed to identify the factors influencing institutional delivery.

RESULTS: More than half of all deliveries among the women were reported as occurring in a medical facility. The proportion of institutional deliveries was highest in Pakistan (68.80%), and lowest in Myanmar (40.60%). This study found that women who give birth at after 20 years’ age had 1.25 times higher chance of getting healthy facility during delivery (OR 1.25, [1.19, 1.32]). The odds of institutional delivery were 2.18 times higher for highly educated women (OR 2.18, [1.89, 2.52]) and 2.88 times higher for rich women (OR 2.88, [2.70, 3.07]). The likelihood of getting his wife delivered in a hospital increased with the husband’s education level. Women who accessed by any media showed 33% higher chance of getting healthy facility during child birth. Women who did not obtain ANC from a skilled provider had a reduced likelihood of selecting healthcare facility delivery by 71% (OR 0.29, [0.28, 0.31]) compared to women who did. Women who didn’t take any health care decision by-self had 16% lower chance of getting institutional delivery facility than others. Most importantly, rural area in south Asian countries presented lower odds of receiving healthy facility during delivery (OR 0.63, [0.59, 0.68]).

CONCLUSIONS: In conclusion, improving maternal health among South Asian countries requires addressing both individual and community-level factors. Women with higher education, better socioeconomic status, media exposure, and access to prenatal care are more likely to utilize medical services. Strengthening evidence-based health policies and ensuring strong leadership can enhance women’s quality of life through better access to health care.

PMID:40748514 | DOI:10.1007/s43999-025-00071-3

Rheumatol Int. 2025 Aug 1;45(8):177. doi: 10.1007/s00296-025-05931-2.

ABSTRACT

Previous studies have shown the role of uric acid in triggering inflammatory reactions through its influence on a large group of cytokines. Therefore, searching for possible relationships between treating hyperuricemia and the course of inflammatory processes may provide valuable knowledge for clinical practice. The study was designed to determine the relationship between uric acid levels and interleukin-6 (IL-6) and interleukin-1-beta (IL-1 beta) levels determined in older adults during hospitalization. Patients were assigned to different study groups based on the uric acid levels and effectiveness, lack of treatment, or recognition of hyperuricemia. Classical variance analysis methods or nonparametric Kruskal-Wallis tests were used for statistical analysis. The analysis showed different correlations between the concentration of uric acid and the mentioned interleukins and designated study groups. In the case of properly treated hyperuricemia, a weak negative correlation is observed between the level of uric acid and interleukin IL-1β. There is a statistically significant positive correlation between the value of uric acid and interleukins IL-6 and IL-1β in people with untreated hyperuricemia and, to a lesser extent, in people with normal uric acid levels. The study’s results suggest that effective treatment may be associated with appropriate control of uric acid concentration and modulation of the inflammatory response. However, due to several measurement limitations, further research is warranted to better elucidate these associations.

PMID:40748502 | DOI:10.1007/s00296-025-05931-2

J Orofac Orthop. 2025 Aug 1. doi: 10.1007/s00056-025-00605-x. Online ahead of print.

ABSTRACT

PURPOSE: To ascertain the relationship between malocclusion severity, treatment expectations, socioeconomic status, objective orthodontic treatment need, and oral health-related quality of life (OHRQoL) in adolescents with class II malocclusion.

METHODS: Cephalometric measurement values, arch discrepancy values, and clinical examination findings were recorded to determine the severity of malocclusion in 104 adolescents with class II malocclusion who requested orthodontic treatment. Objective orthodontic treatment need was determined by the Index of Complexity, Outcome, and Need (ICON) and Dental Aesthetic Index (DAI) scores. The Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) and the Oral Health Impact Profile-14 (OHIP-14) were used to assess the OHRQoL. Treatment expectations and the socioeconomic status were also evaluated.

RESULTS: Patients with proclined upper incisors exhibited higher PIDAQ scores than those with retroclined upper incisors. Contrary, no significant difference was observed between the PIDAQ and OHIP-14 scores of the patients categorized according to overjet, overbite, growth pattern, or objective orthodontic treatment need. No statistically significant correlation was identified between socioeconomic status, OHRQoL, age, and DAI scores, except for socioeconomic status and ICON scores. Patients who reported the treatment expectation to improve their social relationships and communication skills exhibited the highest OHIP-14 scores, indicating the poorest OHRQoL.

CONCLUSION: Significantly poorer OHRQoL was observed in adolescents with class II malocclusion who presented an increased proclination of their upper incisors and requested orthodontic treatment with the expectation of improvement in social relations and communication skills. Larger study samples would improve the generalizability of the results.

PMID:40748482 | DOI:10.1007/s00056-025-00605-x

Naunyn Schmiedebergs Arch Pharmacol. 2025 Aug 1. doi: 10.1007/s00210-025-04482-4. Online ahead of print.

ABSTRACT

Acute basilar artery occlusion (BAO) is a rare but devastating type of ischemic stroke that significantly impacts outcomes. This systematic review and meta-analysis aim to evaluate the efficacy and safety of combining IVT with EVT (EVT + IVT) versus EVT alone in treating acute BAO, focusing on functional independence, mortality, reperfusion success, and hemorrhagic and procedural complications. We conducted a comprehensive search up to May 2025. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), and statistical significance was determined using p-values. Risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was rated via the GRADE framework. Eight observational studies comprising 5252 patients (1777 EVT + IVT and 3475 EVT alone) were included. The analysis revealed that EVT + IVT showed higher odds of functional independence (mRS 0-2) compared to EVT alone, with an odds ratio of 1.23 (95% CI 1.06-1.43, p = 0.0080). Additionally, EVT + IVT significantly reduced mortality, with an odds ratio of 0.81 (95% CI 0.68-0.96, p = 0.0141). No significant differences were observed in symptomatic intracerebral hemorrhage, subarachnoid hemorrhage, reperfusion success (mTICI 2b/3), or procedural complications. This meta-analysis demonstrates that EVT + IVT is associated with improved functional independence and reduced mortality in acute BAO compared to EVT alone, without increasing the risk of hemorrhagic or procedural complications. These results are, however, based on very low certainty evidence. While bridging therapy appears to provide clinical benefits, high-quality randomized trials are urgently needed to confirm these findings and refine treatment protocols for posterior circulation strokes.

PMID:40748475 | DOI:10.1007/s00210-025-04482-4

Int Orthop. 2025 Aug 1. doi: 10.1007/s00264-025-06623-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the effectiveness of an intelligent fracture reduction robotic system in assisting closed reduction and intramedullary nailing of femoral shaft fractures with that of conventional fluoroscopy-assisted manual reduction and fixation.

METHODS: In this prospective, non-randomized controlled study, 30 patients with newly diagnosed femoral shaft fractures were enrolled, with 15 cases in the experimental group (robot-assisted) and 15 cases in the control group (conventional). The experimental group utilized an orthopaedic surgical navigation system to assist in closed reduction and intramedullary nailing, while the control group underwent fluoroscopy-assisted manual reduction and fixation. The reduction time, total operation time, intraoperative fluoroscopy count, blood loss, and reduction error were compared between the two groups.

RESULTS: Baseline characteristics were similar across both groups. The experimental group required significantly fewer intraoperative fluoroscopies (36.67 ± 25.41 vs. 117.26 ± 61.28, P < 0.001). Postoperative femoral length discrepancy (1.74 ± 1.37 mm) and anteversion difference (3.66 ± 3.37°) were significantly smaller in the experimental group compared to the control group (4.16 ± 2.67 mm, P = 0.004; 13.81 ± 9.58°, P = 0.001). Intraoperative blood loss was comparable between groups (experimental group: 207.33 ± 119.91 mL vs. control group: 240.00 ± 139.13 mL, P = 0.497). Reduction time was not statistically significant (experimental group: 74.27 ± 27.38 min vs. control group: 69.73 ± 34.10 min, P = 0.691).

CONCLUSIONS: The robot-assisted approach provided more precise fracture reduction, required fewer intraoperative X-ray fluoroscopies, and offered significant advantages over the conventional method for the minimally invasive treatment of femoral fractures.

PMID:40748453 | DOI:10.1007/s00264-025-06623-z

Infection. 2025 Aug 1. doi: 10.1007/s15010-025-02586-w. Online ahead of print.

NO ABSTRACT

PMID:40748451 | DOI:10.1007/s15010-025-02586-w

Psychol Health Med. 2025 Aug 1:1-15. doi: 10.1080/13548506.2025.2539943. Online ahead of print.

ABSTRACT

This study is conducted to analyze the relationship between the transformative power of suffering among nurses and their compassion level of others’ lives after the earthquake. Nurses are under the risk of experiencing a second trauma since they give care for earthquake survivors while they are also survivors at the same time. This study is a descriptive cross-sectional study. This study was conducted among 238 nurses. Data of the study were collected with Socio-demographic Form, the Transformative Power of Suffering Scale (TPSS) and Compassion of Others’ Lives Scale (COOL). The study was reported following the STROBE. The TPSS mean score of nurses was found as 20.61 ± 7.62, their total mean score of COOL was found as 10.63 ± 2.09. Statistically significant differences were found between the age, gender, working period, position in the unit of nurses and mean scores of TPSS. In the correlation analysis, a weak positive correlation between TPSS and total COOL and its subscales was found. It was found that TPSS mean score of nurses was at medium-level, that COOL total mean score of nurses was at good level and as the transformative power of suffering increased, the compassion of others’ lives increased.

PMID:40747634 | DOI:10.1080/13548506.2025.2539943

Hum Vaccin Immunother. 2025 Dec;21(1):2541496. doi: 10.1080/21645515.2025.2541496. Epub 2025 Aug 1.

ABSTRACT

The COVID-19 epidemic has significantly disrupted routine childhood immunization programs. This study assesses the impact of different COVID-19 prevalence phases on immunization coverage and timeliness in Shanghai, China. We employed a retrospective cohort design, encompassing children born between September 1, 2018, and August 30, 2023. Children were categorized into three COVID-19 phases based on their expected vaccination dates: baseline period, epidemic period, and pre/post-epidemic period. Kaplan-Meier estimators were utilized to ascertain the cumulative vaccination probabilities, with differences tested using the log-rank method. A multivariate Cox proportional hazards model was conducted to assess the impact of COVID-19 phases on vaccination timeliness. Vaccination timeliness significantly declined when the vaccination window coincided with an epidemic period, particularly for older children and during heightened epidemic activity. The probability of timely vaccination at 2 months was 0.89 (95% CI: 0.86-0.92) in the baseline period and 0.53 (95% CI: 0.51-0.55) in the epidemic period, compared to the pre/post-epidemic period. At 3 months, the probability of timely vaccination decreased 12% (HR = 0.88, 95% CI 0.86-0.90) and 49% (HR = 0.51, 95% CI 0.49-0.53), respectively. Similarly, for vaccinations scheduled at 4 months, the probabilities of timely vaccination were 0.87 (95% CI 0.85-0.89) and 0.49 (95% CI 0.47-0.51) times. At 5 months, the probabilities declined 9% (HR = 0.91, 95% CI 0.87-0.94) and 57% (HR = 0.43, 95% CI 0.40-0.46), correspondingly. Our study assessed the notable decline of vaccination timeliness during epidemic periods, highlighting the need for targeted strategies to mitigate disruptions in routine childhood immunization services.

PMID:40747582 | DOI:10.1080/21645515.2025.2541496