Nevin Manimala

Eur J Public Health. 2026 Apr 11;36(3):ckag064. doi: 10.1093/eurpub/ckag064.

ABSTRACT

The COVID-19 pandemic has changed work organization in hospitals, notably with the expansion of telework. This study aimed to assess perceptions of telework among hospital workers throughout the pandemic and to identify factors associated with telework perceptions in the post-pandemic period. An observational cross-sectional study was conducted from October to December 2023. All hospital workers, regardless of their occupation or status, were invited to participate in an online survey. Perceptions of telework were assessed using visual analog scales, ranging from 0 (very negative) to 100 (very positive), across three periods: before the COVID-19 pandemic, during the first French lockdown, and after the pandemic. A total of 882 hospital workers were included in the analysis. Throughout the pandemic, 41.4% reported adopting telework. Overall, perceptions of telework became significantly more positive over time, rising from a mean score of 54.3 ± 25.3 before the pandemic, to 62.7 ± 27.4 during the first lockdown, and to 66.0 ± 27.5 after the pandemic (P < .001). Experiencing telework for the first time was associated with more favorable perceptions, with high levels sustained among those who continued teleworking post-pandemic. Perceptions of telework improved significantly among hospital workers throughout the pandemic with notable shifts in work practices, with nearly one third of participants teleworking in the post-pandemic period. Experiencing telework was associated with more positive perceptions.

PMID:42054081 | DOI:10.1093/eurpub/ckag064

Eur J Public Health. 2026 Apr 11;36(3):ckag032. doi: 10.1093/eurpub/ckag032.

ABSTRACT

China’s “one-child policy” limited many households in China to only one child. This policy had an impact on birth outcomes due to the birth order effects, as firstborn infants typically have lower birth weights. This study aimed to estimate the impact of the “universal two-child policy” on birth weight in China by analyzing individual-level data collected from a major tertiary obstetrics hospital located in Shanghai, the largest metropolitan area in China. Medical records for all births were obtained from a major metropolitan obstetrics hospital between 2013 and 2018. Using difference-in-differences (DID) and quantile DID (QDID) methods while controlling for maternal characteristics and socioeconomic factors, we examined the policy’s impact on birth weight. Analyses included stratification by maternal migrant status, age, and delivery mode. Insurance was found to mediate the treatment effect significantly. Analysis of 133 358 live births showed the policy increased birth weight by 21 g, corresponding to approximately 0.04 standard deviations of birth weight in our sample, with effects varying across maternal age groups and residency status. Insurance coverage mediated 41.3% of the total effect on birth weight. The “universal two-child policy” demonstrated beneficial impact on birth weight in China during the study period, particularly affecting older women, Shanghai residents, and those with natural births.

PMID:42054080 | DOI:10.1093/eurpub/ckag032

JAMA Netw Open. 2026 Apr 1;9(4):e269091. doi: 10.1001/jamanetworkopen.2026.9091.

ABSTRACT

IMPORTANCE: Patients with inflammatory bowel disease (IBD) are at increased risk of major adverse cardiovascular events (MACE), driven by chronic inflammation, endothelial dysfunction, and use of certain therapeutic regimens. Whether different IBD treatments mitigate this risk remains unclear.

OBJECTIVE: To examine the association of the use of immunomodulators or biologics vs 5-aminosalicylic acid (5-ASA) with risk of MACE among older patients with IBD.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study was conducted among a 15% Medicare claims sample of patients with IBD aged 65 years or older was identified, with entry defined by the first prescription of immunomodulators, biologics, or 5-ASA between January 1, 2012, and December 31, 2020. Follow-up extended to the outcome, switch or discontinuation of study drug, the study’s administrative end, or up to 3 years, whichever occurred first. Propensity score matching at a 1:3 ratio balanced demographics, comorbidities, and medication use between groups. Data analyses were conducted between January and September 2025.

EXPOSURES: Exposures were use of immunomodulators or biologics compared with 5-ASA, identified using National Drug Codes and Healthcare Common Procedure Coding System procedure codes.

MAIN OUTCOMES AND MEASURES: The primary outcome was time to the first emergency department or inpatient visit caused by a MACE, defined as myocardial infarction, stroke, or all-cause mortality. Hazard ratios (HRs) and 95% CIs for MACE risk with immunomodulators or biologics vs 5-ASA were estimated using Cox proportional hazards models.

RESULTS: A total of 16 387 patients (mean [SD] age, 74.73 [6.79] years; 9861 [60.18%] female) were included in the analysis. In the immunomodulators vs 5-ASA and biologics vs 5-ASA cohort, the mean (SD) ages were 74.05 (6.43) years and 73.68 (6.01) years, respectively, after matching. Both cohorts had more female participants (2580 [58.85%] and 1780 [58.09%], respectively). Baseline comorbidities were mostly balanced between groups. Compared with 5-ASA, there was no statistically significant difference in the risk of MACE for immunomodulators (HR, 0.84 [95% CI, 0.61-1.17]) or biologics (HR, 0.86 [95% CI, 0.59-1.24]), although point estimates were below 1.

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness study of Medicare beneficiaries with IBD, there was no statistically significant difference in MACE risk between those who used immunomodulators or biologics vs 5-ASA.

PMID:42054028 | DOI:10.1001/jamanetworkopen.2026.9091

JAMA Netw Open. 2026 Apr 1;9(4):e269673. doi: 10.1001/jamanetworkopen.2026.9673.

ABSTRACT

IMPORTANCE: Hypertrophic cardiomyopathy (HCM) is associated with an elevated risk of sudden cardiac death, often preceded by an out-of-hospital cardiac arrest (OHCA). However, population-based estimates of OHCA risk in patients with HCM are limited.

OBJECTIVE: To estimate the risk of OHCA in patients with HCM and identify characteristics associated with OHCA.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used multiple Danish registers during an observation period ranging from June 1, 2001, to December 31, 2022, and included a nested case-control study. All Danish residents aged 18 to 85 years during the study period constituted the source population. Patients with HCM were identified using codes from the International Statistical Classification of Diseases, Tenth Revision. The cohort included patients with a first-time HCM diagnosis and exposure-matched controls. In the nested case-control study, patients with HCM who experienced OHCA were risk-set matched with controls with HCM and no OHCA at the index time. Analyses were performed between September 1 and November 30, 2025.

EXPOSURE: First-time diagnosis of HCM.

MAIN OUTCOMES AND MEASURES: Time to OHCA from exposure or the matching date was the primary outcome. Risk estimates were determined using the Aalen-Johansen estimator. Association between covariates and OHCA was determined by conditional logistic regression.

RESULTS: The cohort included a total of 29 240 individuals: 5901 patients with HCM (median age, 65 [IQR, 54-75] years; 3277 male [55.5%]) and 23 339 matched controls (median age, 65 [IQR, 55-75] years; 12 982 male [55.6%]). In the group aged 61 to 85 years, the 10-year risk of OHCA was 4.3% (95% CI, 3.4%-5.1%) in patients and 3.3% (95% CI, 3.0%-3.7%) in controls. In the group aged 18 to 60 years, the 10-year risk was 2.8% (95% CI, 1.9%-3.7%) in patients and 1.5% (95% CI, 1.2%-1.8%) in controls. The nested case-control study included 250 cases with HCM and OHCA (167 male [66.8%]; median age, 68 [IQR, 59-76] years) and 1000 controls with HCM and no OHCA (668 male [66.8%]; median age, 68 [IQR, 59-76] years). Heart failure, both recent and longer term, was associated with an increased rate of OHCA (hazard ratio, 3.63 [95% CI, 1.55-8.50] and 2.82 [95% CI, 1.88-4.22], respectively).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that HCM was associated with an increased risk of OHCA in people aged 18 to 85 years. The rate of OHCA was associated with heart failure, underscoring the need for improved risk stratification to optimize primary prevention.

PMID:42054027 | DOI:10.1001/jamanetworkopen.2026.9673

JAMA Netw Open. 2026 Apr 1;9(4):e269753. doi: 10.1001/jamanetworkopen.2026.9753.

ABSTRACT

IMPORTANCE: Syringe services programs (SSPs) are evidence-based interventions that reduce bloodborne infections and injection-related harms among people who inject drugs, yet access remains limited and geographically uneven across the US.

OBJECTIVE: To quantify the travel time, distance, and cost required to reach the nearest SSP from population-weighted census tracts nationwide and to examine differences by urbanicity, state, and SSP legality.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional geospatial study linked all known SSP locations as of August 2024 to the population-weighted centroids of census tracts in the 50 US states and the District of Columbia. Analyses were conducted between December 2024 and February 2026.

MAIN OUTCOMES AND MEASURES: Population-weighted mean and median driving time, distance, and cost to access the nearest SSP, stratified by National Center for Health Statistics urban-rural county category and SSP legal status. Costs were estimated using 2024 Internal Revenue Service (IRS) medical mileage deduction rates and 2022 state-specific gasoline prices.

RESULTS: In 1338 SSPs across 83 780 census tracts, the population-weighted mean 1-way driving time to the nearest SSP was 46.1 minutes (95% CI, 45.7-46.5 minutes) and the median was 23.3 minutes (IQR, 12.2-58.5 minutes). Altogether, 23.1% of the population lived more than 60 minutes from an SSP and 12.6% lived over 120 minutes away. The mean 1-way driving distance was 41.8 miles (95% CI, 41.3-42.2 miles). The mean 1-way driving cost was $8.77 (95% CI, $8.68-$8.86) using the 2024 IRS mileage rate and $6.91 (95% CI, $6.84-$6.98) using state mean gasoline prices in 2022. In states where SSPs were legal, mean driving time was 30.1 minutes (95% CI, 29.8-30.4 minutes) and mean cost by IRS mileage rates was $4.94 (IQR, $4.88-$5.00), compared with 110.7 minutes (95% CI, 109.6-111.8 minutes) and $24.19 (IQR, $23.92-$24.46) in states where SSPs were illegal.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of travel burden to SSPs found substantial geographic and financial barriers to accessing SSPs across the US, particularly in nonmetropolitan areas. Targeting new SSPs to areas with the greatest travel burden could improve utilization and reduce drug-related morbidity.

PMID:42054025 | DOI:10.1001/jamanetworkopen.2026.9753

JAMA Netw Open. 2026 Apr 1;9(4):e269816. doi: 10.1001/jamanetworkopen.2026.9816.

ABSTRACT

IMPORTANCE: Approximately 10% of cancers are attributable to heritable germline variants, yet identification of individuals at risk remains suboptimal.

OBJECTIVE: To assess the feasibility of personal history and family health history (FHH) risk assessment technology via the electronic medical record (EMR) to enhance identification of patients at risk for a broad array of inherited cancer syndromes.

DESIGN, SETTING, AND PARTICIPANTS: This single-arm, nonrandomized clinical trial was completed from October 1, 2021, to September 1, 2023, with no follow-up period in unselected patients receiving care at Vanderbilt University Medical Center. Adult patients (aged ≥18 years) were invited through their EMR patient portals to complete an eligibility survey. Eligible participants completed the survey, were English speaking, and had no prior genetic counseling. The data analysis was performed between August 15 and November 7, 2025.

INTERVENTION: Electronic medical record-integrated risk assessment platform that collected self-reported personal history and FHH to assess risk for 24 hereditary cancer syndromes.

MAIN OUTCOMES AND MEASURES: The primary outcome was the completion rate of the risk assessment platform. Secondary outcomes included the percentage of newly identified participants meeting guideline criteria for genetic counseling and whether previsit FHH collection increased genetic counseling capacity by decreasing time spent in counseling.

RESULTS: A total of 1685 patients were consented to participate (mean [SD] age, 55.4 [15.1] years; 1217 female [72.2%]; 95 of Black or African American [5.6%] 1405 of White [83.4%], and 181 of other [multiracial, other, or unknown] [10.6%] race; 38 of Hispanic or Latino [2.3%], 1388 of non-Hispanic or Latino [82.4%], and 111 of unknown [6.6%] ethnicity). Among participants consented, 1483 (88.0%) were provided access to the risk assessment, 1106 (74.6%) started the assessment, 636 (57.5%) completed it, and 544 (49.1%) received a risk report. Younger age and unknown race and ethnicity were the only significant variables associated with completion (mean [SD] age, 53.5 [15.3] vs 56.9 [14.8] years for completers vs noncompleters, respectively; unknown race, 77 [14.2%] vs 43 [7.6%] for noncompleters; unknown ethnicity, 49 [9.0%] vs 20 [3.6%] for completers vs noncompleters, respectively). Among participants who completed the risk assessment, 155 (28.5%) met guideline criteria for genetic counseling, yet 74 (47.7%) were previously identified as at risk by billing codes. A total of 31 participants (20.0%) eligible for genetic counseling attended. Manual outreach efforts and counseling duration did not differ between risk assessment-assisted and usual care visits.

CONCLUSIONS AND RELEVANCE: In this nonrandomized clinical trial, almost one-third of the population met national genetic counseling criteria for an inherited cancer syndrome, highlighting a substantial gap in usual care identification. Integrating patient-facing FHH collection and assessment tools for primary care patients improves inherited cancer risk identification and highlights opportunities to further enhance both risk assessment processes and genetic counseling attendance.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05079334.

PMID:42054024 | DOI:10.1001/jamanetworkopen.2026.9816

JAMA Netw Open. 2026 Apr 1;9(4):e269828. doi: 10.1001/jamanetworkopen.2026.9828.

ABSTRACT

IMPORTANCE: Studies have demonstrated lower odds of survival from out-of-hospital cardiac arrest (OHCA) during nighttime hours, but this has not been studied in North America since 2013, and it is unclear what factors might explain this survival difference.

OBJECTIVE: To identify whether OHCA survival during nighttime hours remains lower than during daytime hours using contemporary data and whether it can be explained by variable patient physiology or emergency care factors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adults (aged ≥18 years) with OHCA in the Cardiac Arrest Registry for Enhanced Survival from 2013 to 2024.

EXPOSURE: Daytime was defined as 7:00 am to 10:59 pm, and nighttime was defined as 11:00 pm to 6:59 am.

MAIN OUTCOME AND MEASURES: Primary outcomes were sustained return of spontaneous circulation (ROSC) and neurologically favorable survival (Cerebral Performance Category score of 2 or more). A multilevel mixed-effects logistic regression model with prehospital agency as a random effect and patient or treatment characteristics as fixed effects was used. A similar analysis of postresuscitation survival was performed among patients with sustained ROSC, adjusting for the time-to-cardiopulmonary resuscitation interval and defibrillation status. A mediation analysis was performed to identify whether the prehospital response interval mediates the association.

RESULTS: Of 1 151 845 patients in the registry, 874 415 were eligible and included in the analysis, and the median (IQR) age in the cohort was 64 (52-75) years with 557 515 males (63.8%) and 181 878 Black or African American patients (20.8%), 146 352 Hispanic or Latino patients (16.7%), and 447 646 White patients (51.2%). A minority of OHCA responses occurred at nighttime (241 967 [27.7%]), and the odds of sustained ROSC and neurologically favorable survival were lower at nighttime than daytime (sustained ROSC: 62 548 [25.8%] vs 193 486 [30.6%]; adjusted odds ratio [aOR], 0.85; 95% CI, 0.84-0.86; neurologically favorable survival: 16 234 [6.7%] vs 58 542 [9.3%]; aOR, 0.84; 95% CI, 0.82-0.86). Among those with sustained ROSC, the odds of postresuscitation survival at nighttime were also lower than daytime (aOR, 0.93; 95% CI, 0.90-0.95). The prehospital response interval partially mediated the nighttime survival disadvantage, with approximately 12.6% of the total effect mediated by the response interval.

CONCLUSIONS AND RELEVANCE: In this cohort study of OHCA, nighttime response was associated with lower adjusted odds of sustained ROSC, neurologically favorable survival, and postresuscitation survival. Emergency care factors accounted for only a portion of the decreased odds of survival at nighttime.

PMID:42054023 | DOI:10.1001/jamanetworkopen.2026.9828

JAMA. 2026 Apr 29. doi: 10.1001/jama.2026.5006. Online ahead of print.

ABSTRACT

IMPORTANCE: The US Department of Veterans Affairs (VA) Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no randomized clinical trials have tested its benefits.

OBJECTIVE: To evaluate the effectiveness of a whole health team intervention in VA patients with chronic pain compared with cognitive behavioral therapy and with usual care, and to evaluate the effectiveness of cognitive behavioral therapy compared with usual care in reducing long-term pain interference.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial involving 6 VA health systems in the US enrolled participants between September 18, 2020, and January 19, 2024. Final follow-up occurred on January 27, 2025. Analyses took place between April 1, 2025, and February 3, 2026. Participants were patients with chronic pain receiving VA primary care.

INTERVENTIONS: Patients with chronic pain were randomized (11:11:2) to receive a whole health team intervention (n = 343), cognitive behavioral therapy for chronic pain delivered in group sessions (n = 339), or usual care (n = 82) for 12 months. The whole health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach. The team provided interdisciplinary, individualized care consistent with the VA Whole Health model to attain personal health goals aligned with patients’ personal values and life goals.

MAIN OUTCOMES AND MEASURES: The primary outcome was the Brief Pain Inventory interference (BPI-I) subscale score (range, 0-10 points; higher scores indicate worse interference from pain; minimal clinically important difference, 1.0) at 12 months.

RESULTS: Of 764 randomized patients (mean [SD] age, 60.5 [12.3] years; 66.5% were men), 632 (82.7%) completed 12-month follow-up. At 12 months, the whole health group had significantly improved pain interference scores (from 6.6 to 4.9) compared with the cognitive behavioral therapy (from 6.4 to 5.5) (mean difference, -0.58 [97% CI, -1.11 to -0.05]; P = .02) and usual care (from 6.4 to 5.7) (mean difference, -0.77 [99% CI, -1.40 to -0.15]; P = .002) groups. At 12 months, cognitive behavioral therapy did not improve pain interference scores significantly more than usual care (mean difference, -0.19 [99% CI, -0.89 to 0.50]; P = .46). The most common adverse event was suicidal ideation, which occurred in 15.9% of patients in the cognitive behavioral therapy group, 13.7% in the whole health team group, and 13.4% in the usual care group.

CONCLUSIONS AND RELEVANCE: These results support use of the whole health team approach to attain a statistically significant but small improvement in pain interference in VA patients with chronic pain.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04330365.

PMID:42054020 | DOI:10.1001/jama.2026.5006

Health Educ Res. 2026 Mar 31;41(3):cyag014. doi: 10.1093/her/cyag014.

ABSTRACT

This single-site, pilot-scale randomized controlled study intended to evaluate the effects of a self-determination theory-informed (D6 gamification model-based) gamified breastfeeding counselling program on breastfeeding self-efficacy, breastfeeding success, and breast-related problems in postpartum participants. A pretest-posttest randomized controlled trial was conducted with 60 pregnant individuals recruited from a single university-affiliated private hospital in Türkiye, using a pilot-scale parallel group design. Participants were assigned to experimental (n = 30) and control (n = 30) groups by block randomization that was performed by an independent statistician. Due to the behavioural nature of the intervention, participant blinding was not feasible; however, outcome analyses were conducted by a blinded biostatistician. The intervention group received a digitally delivered gamified breastfeeding counselling program from gestational week 35 until week 2 postpartum, while the control group received routine prenatal and postnatal care. Data were obtained for validated measures of breastfeeding self-efficacy, breastfeeding success, and breast-related problems. Descriptive and inferential statistical analyses were conducted with SPSS 28.0 software. At week 2 postpartum, the mean breastfeeding self-efficacy scale-short form scores were significantly higher in the gamified counselling group than the control group (63.6 ± 6.2 versus 54.3 ± 8.4, P < .001, Cohen’s d = 1.26). Breastfeeding performance also favoured the intervention group, with higher infant breastfeeding assessment tool scores (8.6 ± 1.1 versus 7.3 ± 1.4, P < .001) and LATCH breastfeeding assessment scores (9.3 ± 0.7 versus 8.4 ± 1.1, P = .002). Furthermore, breast fullness severity that was assessed using a dichotomous self-reported outcome (present/absent) checklist in which higher scores indicate more severe fullness, was lower in the intervention group than the control group (2.5 ± 1.1 versus 4.0 ± 1.2, P < .001). Gamified breastfeeding counselling was effective in enhancing breastfeeding self-efficacy and breastfeeding success and reduced common breast-related problems. These findings provide preliminary evidence supporting the feasibility and short-term benefits of integrating gamification-based strategies into breastfeeding education, warranting larger multicenter studies with extended follow-up.

PMID:42054016 | DOI:10.1093/her/cyag014

J Periodontol. 2026 Apr 29. doi: 10.1002/jper.70058. Online ahead of print.

ABSTRACT

BACKGROUND: The accurate assessment of infraosseous periodontal defects is crucial for effective diagnosis and treatment planning. Cone-beam computed tomography (CBCT) enables detailed imaging of these defects; however, to leverage their full potential, CBCT images must be reconstructed in 3 dimensions (3D). Manual and semi-automatic (SA) segmentation methods are time-consuming and prone to human error. This study aimed to evaluate the performance of a deep learning (DL) model in segmenting mandibular infraosseous periodontal defects on CBCT scans.

METHODS: A multi-stage Segmentation Residual Network (SegResNet)-based DL model was used to segment CBCT scans from patients with stages III to IV periodontitis. Linear and volumetric measurements of infraosseous defects from DL-generated 3D models were compared to those obtained using SA segmentation. The depth (INFRA), width (WIDTH), angle (ANGLE), and volume of 48 infraosseous defects were assessed on both DL and SA segmentations.

RESULTS: Measurements made on the DL and SA segmentations correlated strongly. The intraclass correlation coefficient (ICC) was 0.941 (p < 0.0001) for INFRA, 0.943 (p < 0.0001) for WIDTH, 0.889 (p < 0.0001) for ANGLE, and 0.948 (p < 0.0001) for defect volume. These results indicate high reliability of the DL model in capturing key characteristics of infraosseous periodontal defects.

CONCLUSIONS: These findings support the use of DL-based CBCT segmentation as a valuable tool for enhancing periodontal diagnosis. However, as this study was limited to mandibular defects, applicability to maxillary cases remains to be validated.

PMID:42054008 | DOI:10.1002/jper.70058