Nevin Manimala

JMIR Public Health Surveill. 2025 Jul 18;11:e72590. doi: 10.2196/72590.

ABSTRACT

BACKGROUND: Caring for individuals with rare diseases (RDs) presents unique challenges that can significantly impact caregivers’ quality of life (QoL). The World Health Organization Quality of Life-BREF (WHOQOL-BREF) is a widely used tool for assessing QoL across different populations.

OBJECTIVE: This study examines the QoL of caregivers of individuals with RDs and evaluates the psychometric properties of the WHOQOL-BREF in this population.

METHODS: A self-administered, anonymous, computer-assisted web-based survey was conducted among family caregivers of individuals with RDs in Poland between March and August 2024. Due to the lack of a national registry of patients with RDs, participants were recruited through convenience sampling via associations, foundations, and organizations of patients with RDs. Eligibility criteria included being 18 years and older of age, speaking Polish, being a caregiver of a person with a confirmed RD diagnosis, and providing informed consent. The survey included sociodemographic questions and the Polish version of the WHOQOL-BREF, which assesses QoL across 4 domains: physical health, psychological health, social relationships, and environment. Internal consistency was assessed using Cronbach α, and confirmatory factor analysis was conducted to examine the instrument’s structural validity.

RESULTS: A total of 942 caregivers of individuals with various RDs participated in the study. Confirmatory factor analysis supported the 4-domain structure, with further improvement in a finally modified WHOQOL-BREF model (χ2243=1043.0; P<.001; Comparative Fit Index=0.919; Tucker-Lewis Index=0.907; root-mean-square error of approximation=0.059). Internal consistency was satisfactory, with Cronbach α values ranging from 0.70 (social relationships) to 0.84 (psychological health). Mean domain scores on a scale of 0-100 were 50.2 (SE 0.59; physical health), 54.9 (SE 0.59; psychological health), 51.3 (SE 0.67; social relationships), and 52.1 (SE 0.56; environment), with minimal floor and ceiling effects (≤1.4%) across domains. Younger female caregivers reported significantly lower psychological health (eg, mean 43.6, SE 0.59 vs mean 59.9, SE 10.0 for younger male caregivers) and social relationships (mean 39.3, SE 3.34 vs mean 55.0, SE 4.75) well-being compared to other groups. Exactly 151 (16%) of caregivers rated their overall QoL as poor or very poor, and 289 (30.7%) were dissatisfied or very dissatisfied with their health, with female caregivers reporting more dissatisfaction (n=263, 32.4%) than male caregivers (n=26, 20%). Overall, our findings demonstrate the robust psychometric properties of the WHOQOL-BREF among caregivers of people with RDs and provide domain-specific normative data to guide future research and interventions.

CONCLUSIONS: The WHOQOL-BREF is a reliable and valid instrument for assessing QoL among caregivers of individuals with RDs, though the social relationship domain may require further refinement. Caregivers experience varying QoL outcomes depending on demographic factors, highlighting the need for targeted support interventions. Future research should explore cultural adaptations and potential supplementary modules to enhance the instrument’s applicability in caregiver populations.

PMID:40680179 | DOI:10.2196/72590

Eur J Cardiothorac Surg. 2025 Jul 18:ezaf241. doi: 10.1093/ejcts/ezaf241. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the outcome of a frail patients electively treated for abdominal aortic aneurysm (AAA) by open surgery with enhanced repair protocol (OSER) or endovascular aneurysm repair (EVAR).

METHODS: A retrospective study on frail AAA patients treated by EVAR and OSER was conducted. Patients were defined as frail if presenting a normalized total psoas muscle area (nTPA) <500 mm2/m2. This study aimed to evaluate the association between sarcopenia and AAA-related as well as all-cause mortality rates. Secondary outcomes included reinterventions, operative time, blood transfusion, length of ICU and postoperative hospital stay.

RESULTS: A total of 403 patients were included in the study, of which 122 (30.3%) had a nTPA < 500mm2/m2. Among them, 272 (67.5%) patients were treated with EVAR while 131 (32.5%) with OSER. Although EVAR was more frequently performed in sarcopenic patients than OSER (p < 0.001), there were no significant differences between the two groups in terms of intraoperative and postoperative outcomes. Likewise, no statistically significant differences were found regarding mortality and reintervention rates at Kaplan-Meier analysis. However, sarcopenic patients undergoing OSER exhibited a significantly higher all-cause mortality rate at 1 month (p = 0.031) and cumulative follow-up (p = 0.004) compared to all other subgroups.

CONCLUSIONS: the present experience demonstrates that less invasive approaches, but surgical or endovascular, are viable for AAA patients with no significant difference in intraoperative and immediate postoperative outcomes. Nevertheless, the potential of EVAR as a preferred strategy should be considered for frail patients based on ascertained sarcopenia.

PMID:40680178 | DOI:10.1093/ejcts/ezaf241

J Med Internet Res. 2025 Jul 18;27:e68200. doi: 10.2196/68200.

ABSTRACT

BACKGROUND: Protecting public health depends on the effective communication of health-related information to the public, especially during public health emergencies. Health communication campaigns traditionally relied on mass media outlets but increasingly incorporate social media platforms. This paper presents a content analysis of original communications posted to X (formerly Twitter) by the Chicago Department of Public Health (CDPH) from May 1, 2022, to April 30, 2023, a time characterized by the concurrent COVID-19 pandemic and mpox epidemic public health emergencies.

OBJECTIVE: This paper aims to investigate: (1) what information was being discussed by CDPH, (2) how information was presented, (3) the nature of communications, and (4) the impact of communication attributes on engagement. Secondary objectives included investigating the correlation between mpox cases and mpox-related communications and using a bioethical risk communication framework to characterize the intent of mpox-related communications.

METHODS: Original communications posted by the CDPH from May 1, 2022, to April 30, 2023, were collected. Communication attributes including the date and time of posting, the communication text, accompanying media, text in image-based accompanying media, and the language of the text were extracted at the time of collection. A total of 2 researchers independently reviewed the communications using a coding schema that was developed to codify the health topics and the bioethical framework to codify the intent of mpox-related communications. Percent agreement and Cohen kappa were used to establish intercoder reliability. Negative binomial regressions were used to investigate the impact of attributes on public engagement. Spearman rank correlation coefficients were used to measure the strength and direction of the correlation between the weekly number of mpox cases and the number of weekly mpox-related communications.

RESULTS: A total of 1105 original communications were posted, a majority of which discussed communicable diseases (n=539, 51.8%), were posted in English (n=801, 72.5%), during the standard workday (n=1003, 90.8%), and with additional media (n=839, 75.9%). All communications were proactive in nature, and none directly responded to other accounts. Regression analysis suggested that communications posted during the workday (event rate ratio [ERR]=1.25) and those with images (ERR=2.59) or videos (ERR=2.40) received significantly higher levels of engagement, as did those discussing maternal and child health (ERR=2.35), mental health (ERR=1.48), and substance use (ERR=1.61). Communications discussing communicable diseases were not among the health topics with higher levels of engagement. Communications posted exclusively in Spanish received significantly lower levels of engagement (ERR=0.67). In addition, mpox-related communications were positively correlated with reported mpox cases at a significant level, and most mpox-related communications sought to inform the public (n=60, 60.6%), as opposed to influence behavior (n=39, 39.4%).

CONCLUSIONS: Social media platforms can represent valuable tools for risk communication during public health emergencies but should supplement other dissemination vehicles that may be more appropriate for communicating nuanced information, achieving behavior change, and reaching certain demographic groups.

PMID:40680161 | DOI:10.2196/68200

J Crohns Colitis. 2025 Jul 18:jjaf131. doi: 10.1093/ecco-jcc/jjaf131. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Outcomes of patients admitted with acute severe ulcerative colitis(ASUC) in the post biologic era are under explored, as well as ability of scoring indices to predict early steroid non-response.

METHODS: This Retrospective cohort study included adults hospitalized with ASUC(2010-2022) at London Health Sciences Centre, Canada. Steroid response, need for rescue therapy, colectomy during index hospitalization and colectomy and hospitalization at 3- and 12-months following discharge was assessed. Logistic regression identified predictors of steroid non-response, defined as need for rescue therapy or colectomy during hospitalization.

RESULTS: Of 261 adults hospitalized with ASUC(male : 51.7%, mean age : 40.6 years), 71.2% had extensive colitis. After intravenous corticosteroid therapy during index admission, 55.7%(n = 147) had response, 37.9%(n = 99) received rescue therapy (infliximab: 98, tofacitinib: 1 and cyclosporine: 0), and 8%(21/261) underwent colectomy. Additionally, 11.6%(28/240) of patients discharged from hospital underwent colectomy within the first 12 months (8.3% at 3-months and 3.3% between 3-12 months). There was no difference between steroid responders and steroid non-responders for colectomy(11%vs12.6%) or hospitalization(33.5%vs32.6%) at 12 months. The overall cumulative probabilities of colectomy of entire cohort at 1 year, 3 years and 5 years were 13.5%, 16.1%, and 17.4%, respectively. On multivariate analysis, Day-3 Oxford criteria was the only factor found to be statistically significant in predicting steroid non-response(odds ratio 4.70, 95%CI [1.06-20.80]).

CONCLUSIONS: Day-3 Oxford criteria was an independent predictor of steroid non-response. The risk of colectomy remains substantial after discharge despite low in-hospital colectomy rate following an episode of ASUC. Initial steroid response did not affect long-term colectomy rate at 12 months.

PMID:40680157 | DOI:10.1093/ecco-jcc/jjaf131

Microb Genom. 2025 Jul;11(7). doi: 10.1099/mgen.0.001439.

ABSTRACT

Chitin is a highly abundant biopolymer of bioeconomic, biochemical and commercial importance. This carbohydrate is a source of nutrients for chitinolytic bacteria and can influence natural competence, surface adsorption and other fundamental aspects of prokaryote physiology. Bacterial enzymatic degradation of chitin is mediated by a well-studied set of hydrolytic enzymes, transcriptional regulators and carbohydrate transport proteins. Many of these gene products have been functionally characterized in vitro or in vivo, but there is a reliance on in silico genomic approaches to study the variation of these metabolic components amongst diverse bacteria. Computational surveys of bacterial genomes to date have tended to focus on determining the presence and absence of chitin metabolism genes in diverse genomes, but not on the diversity of sequences amongst these gene families. To enable future research into chitin metabolism variation in vibrios and other bacteria, we present ChiVariARIBA, a workflow for extracting chitin metabolism genes from published genome sequences of chitinolytic Vibrio species and their relatives, compatible with the rapid gene-finding and variant-characterizing tool ARIBA, with which to describe the presence of chitin-metabolising genes in genomes of interest and to characterize the sequence variation of these genes across diverse bacteria.

PMID:40679853 | DOI:10.1099/mgen.0.001439

JAMA Netw Open. 2025 Jul 1;8(7):e2521902. doi: 10.1001/jamanetworkopen.2025.21902.

ABSTRACT

IMPORTANCE: Hypertension contributes to US maternal-infant morbidity and mortality, with potential attenuation from breastfeeding. Little is known regarding breastfeeding outcomes among mother-infant dyads exposed to hypertensive disorders of pregnancy (HDP).

OBJECTIVE: To quantify the extent to which HDP is associated with never breastfeeding and the time to breastfeeding cessation among postpartum women in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationally representative data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System (PRAMS). Participants included women from 43 US states, Washington, DC, and Puerto Rico who had a live birth between January 2016 and November 2022. Complete data for HDP exposure, outcomes of breastfeeding noninitiation or cessation, and all covariates were included in the analysis, performed from October to December 2024.

EXPOSURE: Self-reported high blood pressure or hypertension, preeclampsia, or eclampsia before or during pregnancy.

MAIN OUTCOMES AND MEASURES: Odds of never breastfeeding, hazard of breastfeeding cessation, and median time to breastfeeding cessation, adjusted for sociodemographic and maternal-infant health covariates.

RESULTS: Of 205 247 women (weighted number, 10 915 302), mean (SD) age was 30.0 (5.8) years; 99.0% were first-time mothers; 54.0% had private and 40.0% had Medicaid insurance; and 91.0% delivered a term infant. HDP and breastfeeding initiation were reported by approximately 17.0% and 88.0% of women, respectively. Adjusting for covariates, HDP was associated with higher odds of never breastfeeding (adjusted odds ratio, 1.11; 95% CI, 1.05-1.18), and among those who breastfed, a higher adjusted hazard of breastfeeding cessation (adjusted hazard ratio, 1.17; 95% CI, 1.14-1.21). The median time to breastfeeding cessation among those with HDP was 17 weeks shorter than among those without HDP (unadjusted median duration, 17 [IQR, 5.0 to >46.7] vs 34 [IQR, 9.0 to >46.7] weeks).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study representing more than 10 million US postpartum women, HDP was associated with higher odds of never breastfeeding and a higher hazard of breastfeeding cessation. Studies to understand the potential mechanisms of this association are required to develop targeted breastfeeding support strategies for individuals with HDP.

PMID:40679825 | DOI:10.1001/jamanetworkopen.2025.21902

JAMA Health Forum. 2025 Jul 3;6(7):e251923. doi: 10.1001/jamahealthforum.2025.1923.

ABSTRACT

IMPORTANCE: Health care organizations are increasingly measuring social risk using Z codes. Types of social risk captured in Z codes include issues related to employment, housing, education, or other psychosocial circumstances. Prior work has found low use of Z codes overall, but measurement may be biased in other ways that have implications for risk adjustment and resource allocation.

OBJECTIVE: To characterize Z code measurement among hospitalized Medicare beneficiaries across levels of clinical complexity and historical health care utilization and examine implications of these patterns for mortality prediction.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included Medicare beneficiaries with an inpatient hospital admission in 2022. Data were analyzed from May 2024 to June 2025.

MAIN OUTCOMES AND MEASUREMENTS: Presence of Z codes (codes Z55 to Z65) in any diagnosis field for a hospital admission, variation in Z code documentation across beneficiaries categorized by clinical risk (Elixhauser Comorbidity Index risk scores and predicted 30-day mortality risk) and historical utilization levels (number of hospitalizations in the prior year), and the association between Z code documentation and observed 30-day mortality, controlling for hospital fixed effects.

RESULTS: Among 7 069 611 hospitalized Medicare beneficiaries in 2022, 3 816 420 (54.0%) were female, and 6 093 932 (86.1%) were 65 years or older. A total of 148 592 (2.1%) had at least 1 Z code on the index hospital claim. Within-hospital Z code prevalence was higher for beneficiaries with lower Elixhauser Comorbidity Index clinical risk scores (2.8% vs 1.5%) and higher among patients with at least 2 hospitalizations in the prior year (2.6%) than patients with zero (1.8%) or 1 (2.1%) prior hospitalizations. Despite known population-level associations between social risk and increased mortality, Z code prevalence was highest among beneficiaries with the lowest predicted 30-day mortality risk (4.4%) and lowest among beneficiaries with the highest mortality risk (1.6%). Correspondingly, in within-hospital analyses that did not adjust for patient-level covariates such as demographic characteristics and clinical risk, the presence of a Z code was associated with a lower probability of observed 30-day mortality (5.1% vs 4.2%; difference, -0.9 percentage points; 95% CI, -1.0 to -0.8).

CONCLUSIONS AND RELEVANCE: This cohort study found that Z code use patterns likely underrepresent social risk among clinically complex patients, resulting in a spurious negative association between documented social risk and mortality. Alternative socioeconomic indicators, including data collected for population and public health surveillance, may offer more reliable measures of social risk than Z codes.

PMID:40679817 | DOI:10.1001/jamahealthforum.2025.1923

JAMA Health Forum. 2025 Jul 3;6(7):e251952. doi: 10.1001/jamahealthforum.2025.1952.

ABSTRACT

IMPORTANCE: Radiation treatments are an essential but expensive component of cancer care.

OBJECTIVE: To elucidate trends in radiation spending and identify factors associated with practice-level variations across the US health care system to inform alternative payment model design.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study analyzed fee-for-service Medicare beneficiaries from 2009 to 2020. Patients were continuously enrolled in fee-for-service Medicare Parts A and B during the 1 year prior through 28 days after a radiation treatment episode. Data were analyzed from January 2023 to September 2024.

EXPOSURES: Medicare beneficiaries with cancer who received radiation therapy.

MAIN OUTCOMES AND MEASURES: Radiation treatment-specific standardized spending and utilization during 90-day treatment episodes were examined and characterized by radiation type (conformal, intensity modulated, stereotactic, proton, or brachytherapy) and number of fractions. Linear regression models with practice random effects to understand practice-level variation in standardized radiation spending were estimated. Variables were added to adjust for year, patient demographics, cancer type, geography, radiation technology, and number of fractions per episode.

RESULTS: From 2009 to 2020, 1 898 864 beneficiaries with cancer (mean [SD] age, 74 [8.4] years; 48.5% female) initiated 2 149 385 radiation treatment episodes at 2150 practices. Mean (SD) 90-day standardized radiation treatment-specific spending was $13 683 ($8628). Practice-level per-episode radiation-specific spending variation was high (SD after adjusting for year, $4121). It remained high even after adjusting for patient demographic characteristics, cancer type, geography, radiation technology, and number of fractions (SD, $1487). From 2009 to 2020, unadjusted per-episode standardized radiation-specific spending increased slightly from $12 978 to $13 689 (P = .04). During this time, the median (IQR) number of fractions per episode decreased from 25 (10-33) to 16 (5-29) (P < .001), while the proportion of radiation episodes using intensity-modulated or proton radiation treatment increased (from 5% to 18% and 0.4% to 2%, respectively [both P < .001]) and use of conformal radiation treatment decreased from 61% to 38% (P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, there was substantial variation in practice-level radiation spending and number of fractions for older patients with cancer undergoing radiation treatment both within and across health care markets. This practice-level variation suggests that there may be opportunities for savings under population-based payment models.

PMID:40679816 | DOI:10.1001/jamahealthforum.2025.1952

J Psychiatr Pract. 2025 Jul 1;31(4):209-213. doi: 10.1097/PRA.0000000000000871.

ABSTRACT

Suicide among older adults is a critical yet often overlooked public health concern, with this population exhibiting the highest suicide rates globally. This article explores the multifaceted factors contributing to suicide in older adults, including depression, loneliness, chronic illness, financial stress, and a loss of purpose. It also addresses challenges in identifying and preventing suicide, such as stigma, limited access to mental health services, and misclassification of cases. Current prevention strategies, including screening tools like the Geriatric Depression Scale, integrated care models, and community-based interventions, are discussed alongside ethical debates surrounding autonomy in end-of-life decisions. The article highlights critical research gaps in understanding how various social, cultural, and economic factors intersect to influence suicide risk in older adults. It underscores the need for longitudinal studies and culturally tailored interventions, particularly leveraging telehealth solutions to improve access to care. Recommendations for primary care physicians include enhancing suicide risk screening, fostering collaboration with mental health specialists, and leveraging community resources to reduce isolation. By adopting a comprehensive and collaborative approach, health care providers, researchers, and policymakers can address the unique needs of this vulnerable population and work toward reducing suicide rates among older adults.

PMID:40679801 | DOI:10.1097/PRA.0000000000000871

J Psychiatr Pract. 2025 Jul 1;31(4):192-200. doi: 10.1097/PRA.0000000000000868.

ABSTRACT

OBJECTIVE: Women with bipolar disorder are at higher risk of complications during pregnancy, which may be associated with risky behaviors by the mother during acute episodes, as well as pharmacotherapy’s inherent risks to mother and/or infant. The goal of this narrative review is to discuss the treatment of bipolar disorder during pregnancy and breastfeeding.

METHODS: A literature search was conducted between October 2023 and July 2024 using the PubMed database, with MeSH terms “bipolar disorder” and “pregnancy” combined with the Boolean operator “AND.” Publications from 2014 to 2024 were considered, resulting in the identification of 573 articles. After titles were reviewed, 84 papers were selected for full-text review, 33 of which were included in the study.

RESULTS: Cardiopathies associated with lithium use during pregnancy in infants were reported in the 1970s, but more recent case-control and cohort studies have shown that this risk is much lower than was previously reported. However, maintaining lithium levels during pregnancy can be challenging due to physiological adaptations in renal function. Valproate exposure has been found to be associated with increased risk of neural tube defects, craniofacial, cardiac, genital, and musculoskeletal abnormalities in infants. There does not appear to be an increased risk of malformations associated with lamotrigine, and results of studies diverge concerning carbamazepine and oxcarbazepine. No statistically significant association has been reported concerning the risk of congenital malformations and prenatal exposure to antipsychotics as a group, as well as for the subgroup of atypical antipsychotics. However, it is possible that risperidone slightly increases the risk of cardiac malformations. Electroconvulsive therapy during pregnancy appears to be a relatively safe treatment; however, the small sample size reported in the literature limits more robust conclusions.

CONCLUSIONS: Pharmacotherapy during pregnancy and lactation requires careful discussion and documentation so that the prescriber and the patient can be aware of its risks and benefits.

PMID:40679799 | DOI:10.1097/PRA.0000000000000868