Nevin Manimala

JAMA Netw Open. 2025 Jun 2;8(6):e2517616. doi: 10.1001/jamanetworkopen.2025.17616.

ABSTRACT

IMPORTANCE: As the primary facilities authorized to dispense methadone, opioid treatment programs (OTPs) are a critical access point for medications for opioid use disorder (MOUD). However, research is limited on the extent to which OTPs offer a broad range of MOUD and on the characteristics of programs that provide more comprehensive medication offerings.

OBJECTIVE: To assess the percentage of US OTPs offering all 3 forms of MOUD (methadone, buprenorphine, and naltrexone) and compare organizational and county characteristics of OTPs with different MOUD service offerings.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cross-sectional study used data on a panel of OTPs listed in the annual National Directory of Drug and Alcohol Use Treatment Facilities from 2017 to 2023.

MAIN OUTCOMES AND MEASURES: Measures included the percentage of OTPs offering buprenorphine, extended-release naltrexone, or all 3 MOUD from 2017 to 2023 (assuming all OTPs offered methadone). Descriptive statistics on organizational and county characteristics of OTPs by MOUD offerings were collected. Three longitudinal logistic regression models were used to estimate the odds of different MOUD offerings within OTPs, adjusting for organizational and county-level characteristics.

RESULTS: This analysis included 10 298 facility-year observations, ranging from 1211 in 2017 to 1421 in 2023. From 2017 to 2023, the percentage of OTPs offering MOUD beyond methadone increased (buprenorphine: 811 [67.0%] in 2017 to 1209 [85.1%] in 2023; naltrexone: 463 [38.2%] in 2017 to 749 [52.7%] in 2023; all 3 MOUD: 402 [33.2%] in 2017 to 639 [45.0%] in 2023). OTPs offering all 3 MOUD (3985 [38.7%]) had significantly higher odds of accepting Medicare (adjusted odds ratio [AOR], 2.14; 95% CI, 1.67-2.74); offering peer services (AOR, 1.63; 95% CI, 1.25-2.12), mental health services (AOR, 2.07; 95% CI, 1.53-2.80), and telemedicine services (AOR, 1.53; 95% CI, 1.22-1.92); and being private nonprofit (AOR, 7.45; 95% CI, 4.67-11.87) or government operated (AOR, 41.83; 95% CI, 19.71-88.75) compared with private for profit.

CONCLUSIONS: In this cross-sectional study of OTPs, although the availability of MOUD beyond methadone increased over time, most OTPs still did not offer all 3 forms of MOUD as of 2023. Specific organizational characteristics, such as being government operated and accepting Medicare, were associated with more comprehensive MOUD offerings. Future research should evaluate why OTPs vary in their MOUD offerings.

PMID:40569596 | DOI:10.1001/jamanetworkopen.2025.17616

JAMA Netw Open. 2025 Jun 2;8(6):e2518493. doi: 10.1001/jamanetworkopen.2025.18493.

ABSTRACT

IMPORTANCE: Despite expanded efforts to improve treatment access, inequities exist in the receipt of medications for opioid use disorder by race and ethnicity and insurance type.

OBJECTIVE: To examine inequities in access to medications for opioid use disorder (MOUD)-specifically buprenorphine and naltrexone-by race and ethnicity and insurance type after opioid-related health care events.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Institute for Health Equity Research Multi-Payor Claims Database, which includes more than 130 million individuals across commercial, Medicaid, and Medicare Advantage insurance plans. The cohort consisted of patients aged 18 years or older with an opioid use disorder (OUD)-related health care event (opioid-related overdose, infection, or treatment event) that occurred between January 1, 2017, and December 31, 2022. Statistical analysis was conducted from October 2023 to December 2024.

EXPOSURE: Race and ethnicity and insurance type, including commercial insurance, Medicaid, and Medicare Advantage, were the primary exposures.

MAIN OUTCOMES AND MEASURES: The primary outcome was receipt of MOUD (buprenorphine or naltrexone) within 180 days of an OUD-related health care event. Logistic regression models were used to assess the associations of MOUD receipt with race and ethnicity and with insurance type, adjusting for demographic, clinical, time, and geographical covariates.

RESULTS: Among 176 997 index events involving 164 728 patients between 2017 and 2022, the mean (SD) patient age was 40.0 (13.1) years; 104 005 (58.8%) involved men; 1083 events (0.6%) were among Asian patients, 23 424 (13.2%) were among Black patients, 10 302 (5.8%) were among Hispanic patients, 90 124 (50.9%) were among White patients, and 4697 (2.7%) were among patients of other race and ethnicity; and 147 257 (83.2%) were covered by Medicaid. Black (adjusted estimated probability, 17.1% [95% CI, 13.0%-21.1%]) and Hispanic (adjusted estimated probability, 16.2% [95% CI, 11.6%-20.8%]) patients were significantly less likely than White patients (adjusted estimated probability, 20.5% [95% CI, 16.4%-24.7%]) to receive buprenorphine (Black patients: adjusted odds ratio [AOR], 0.75 [95% CI, 0.63-0.90]; adjusted risk difference [ARD], -3.4 percentage points [pp] [95% CI, -6.5 to -0.4 pp]; Hispanic patients: AOR, 0.69 [95% CI, 0.51-0.92]; ARD, -4.4 pp [95% CI, -9.1 to 0.4 pp]) but received naltrexone at similar rates. Patients with Medicaid (AOR, 1.39 [95% CI, 1.14-1.69]; ARD, 3.5 pp [95% CI, 0.9-6.1 pp]) or Medicare Advantage (AOR, 1.40 [95% CI, 1.05-1.86]; ARD, 3.6 pp [95% CI, -0.6 to 7.7 pp]) were more likely to receive buprenorphine compared with those with commercial insurance. Buprenorphine access improved incrementally from 2017 to 2022, reflecting recent clinical and policy changes; however, disparities persisted.

CONCLUSIONS AND RELEVANCE: In this cohort study of more than 17 600 opioid-related index health care events, race and ethnicity-based and insurance-based disparities in access to MOUD persisted despite efforts to expand treatment availability. These findings underscore the need for targeted interventions, including culturally tailored care, expanded access points, and policy reforms to address structural barriers and reduce inequities contributing to the overdose crisis.

PMID:40569592 | DOI:10.1001/jamanetworkopen.2025.18493

Am J Physiol Gastrointest Liver Physiol. 2025 Jun 26. doi: 10.1152/ajpgi.00100.2025. Online ahead of print.

ABSTRACT

Introduction: Defecatory dysfunction (DD) is a common cause of chronic constipation resulting from functional abnormalities or structural pelvic pathologies. Accurate diagnosis requires combining anorectal manometry (ARM), balloon expulsion test (BET), and defecography. This study evaluates the diagnostic utility of these modalities and explores uncertainties in their performance and interpretation. Methods: This retrospective study included 325 adult patients assessed for DD between 2020 and 2023. All patients went through ARM, BET in the left lateral position, and defecography. Statistical associations between test outcomes were analyzed to assess diagnostic concordance and significance. Results: A strong correlation was observed between ARM and defecography, with 65% of patients with normal anal relaxation on ARM achieving normal rectal evacuation on defecography (p < 0.0001). Conversely, patients with paradoxical contraction during ARM demonstrated a higher likelihood of evacuation failure. BET demonstrated high specificity but limited sensitivity in association with relaxation on ARM and evacuation on defecography. BET failure did not demonstrate a significant association with the presence of pelvic floor pathologies. Conclusion: Combining ARM, BET, and defecography provides a comprehensive framework for diagnosing DD, addressing its functional and structural components. This integrated approach facilitates targeted interventions, ultimately improving clinical outcomes.

PMID:40569575 | DOI:10.1152/ajpgi.00100.2025

Epileptic Disord. 2025 Jun 26. doi: 10.1002/epd2.70057. Online ahead of print.

ABSTRACT

OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a major cause of epilepsy-related mortality, especially in patients with drug-resistant epilepsy. However, pediatric data remain limited, and specific risk assessment tools for children are lacking. This study evaluates the association between peri-ictal prone positioning, postictal generalized EEG suppression (PGES), and SUDEP-7 Inventory scores in pediatric patients with epilepsy.

METHODS: A retrospective review was conducted on 273 generalized convulsive seizures (GCS) from 117 pediatric patients who underwent video-EEG monitoring from 2002 to 2022. We assessed body position during seizures, PGES presence and duration, and SUDEP-7 Inventory scores. Statistical comparisons were made across PGES-positive and -negative, and prone vs. non-prone subgroups.

RESULTS: Prone positioning occurred in 5.86% of seizures, with 91.6% of prone-onset seizures remaining in the prone position throughout. PGES was present in 50.4% of patients (mean duration: 120.5 s). SUDEP-7 scores were significantly higher in PGES-positive patients (mean: 7.04) compared to PGES-negative (mean: 6.36; p = 0.031). Daytime GCS occurred significantly earlier after sleep onset than night time GCS (53.3 vs. 131.4 minutes; p = 0.001).

SIGNIFICANCE: PGES appears to be a reliable marker associated with higher SUDEP-7 scores and may indicate increased SUDEP risk in children. While SUDEP-7 has limitations in pediatric use, it remains the most accessible clinical tool. Integrating EEG and body position metrics could enhance individualized monitoring for pediatric patients at risk.

PMID:40569567 | DOI:10.1002/epd2.70057

J Behav Med. 2025 Jun 26. doi: 10.1007/s10865-025-00582-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Most individuals who complete a behavioral weight loss intervention (BWLI) regain weight. The current study is a preliminary investigation into the efficacy of a telephone coaching intervention to aid recovery from weight regain during weight loss maintenance.

METHODS: Participants (n = 77) who had recently completed a BWLI and had lost ≥ 5% of their initial body weight were instructed to engage in daily weighing using a “smart” scale. Participants were randomized to receive four consecutive weeks of brief coaching phone calls or no intervention. Randomization was activated when individuals regained > 1.5% of their baseline weight. Assessments were completed at baseline and 12 months.

RESULTS: Sixty-six participants (M ± SD age = 54.2 ± 9.9 years, 68% female) regained > 1.5% and were included in analyses. Individuals who received coaching completed 3.9 ± 0.5 calls and showed statistically-significant improvements in weight compared to the control group in the short-term (i.e., from randomization activation to 40 days later; M±SE Coaching: -1.05%±0.30 vs. Control: 0.37%±0.31, p < 0.001). However, there were not significant differences in weight regain by group at the 12-month study end (Coaching: 5.18%±0.72 vs. Control: 5.71%±0.76, p = 0.62).

CONCLUSIONS: Brief telephone coaching is a promising intervention for reversing short-term weight regain. Future research should focus on improving the coaching intervention to promote long-term weight loss maintenance, including exploration into offering multiple rounds of coaching.

CLINICAL TRIAL REGISTRATION: NCT04293055.

PMID:40569564 | DOI:10.1007/s10865-025-00582-x

J Community Health. 2025 Jun 26. doi: 10.1007/s10900-025-01497-z. Online ahead of print.

ABSTRACT

Seasonal influenza represents a significant public health challenge, with high hospitalization and mortality rates among the most vulnerable populations. Despite healthcare recommendations and the availability of safe and effective vaccines, vaccination coverage remains below the targets set by the WHO. This study analyzes the role of socioeconomic factors, knowledge, and individual attitudes in adherence to influenza vaccination in the City of Syracuse, Italy. A cross-sectional study was conducted on 394 adults from the ASP of Siracusa, recruited through General Practitioners. A questionnaire collected sociodemographic data, vaccination information, and assessments of knowledge and attitudes. Statistical analysis was performed using logistic regressions to evaluate the factors associated with vaccination. Multivariate analysis highlighted a significant association between vaccination adherence and socioeconomic and demographic factors. Older age was associated with a higher likelihood of vaccination (OR = 1.04; p = 0.002), while being married or cohabiting was linked to a lower probability of getting vaccinated (OR = 0.33; p = 0.002). Moreover, residents of small towns had a significantly lower probability of vaccination compared to those living in urban areas (OR = 0.04; p < 0.001). Knowledge about the vaccine had a marginal impact on adherence, whereas a favorable attitude did not show a significant association. Adherence to influenza vaccination is influenced by sociodemographic factors, with lower coverage in small municipalities and younger age groups. The active involvement of General Practitioners and targeted strategies for communication and accessibility could improve vaccination coverage.

PMID:40569554 | DOI:10.1007/s10900-025-01497-z

Int J Clin Oncol. 2025 Jun 26. doi: 10.1007/s10147-025-02814-1. Online ahead of print.

NO ABSTRACT

PMID:40569523 | DOI:10.1007/s10147-025-02814-1

J Immigr Minor Health. 2025 Jun 26. doi: 10.1007/s10903-025-01729-3. Online ahead of print.

ABSTRACT

This study examines the attitudes of students in Medical and Health Sciences faculties in Turkey toward Syrians and identifies the factors shaping these attitudes. 465 students were included in the cross-sectional study. Data were collected via an online survey form, which included demographic questions and the Attitudes Towards Syrians Scale. The survey included demographic questions and the Attitudes Toward Syrians Scale. Descriptive statistics, t-tests, ANOVA, and linear regression analysis were employed for data analysis. Age was negatively correlated with discrimination scores (r=-0.203, p < 0.001), suggesting that older students exhibited lower levels of discrimination. Students with negative experiences involving Syrians had significantly higher discrimination scores (p < 0.001). Those perceiving fewer cultural similarities also had higher discrimination scores (p < 0.001). Faculty differences were significant, with Health Sciences students displaying higher discrimination scores than medical students (p = 0.008). Among departments, Emergency and Disaster Management students reported the highest levels of discrimination (p < 0.001). Age, cultural perceptions, and personal experiences influence students’ attitudes toward Syrians. Cultural awareness programs and opportunities for positive interactions may help reduce discrimination, particularly among younger students and those with limited cultural engagement. These findings emphasize the importance of inclusive education policies in fostering social cohesion within healthcare settings.

PMID:40569517 | DOI:10.1007/s10903-025-01729-3

Environ Sci Pollut Res Int. 2025 Jun 26. doi: 10.1007/s11356-025-36619-6. Online ahead of print.

ABSTRACT

Land management practices have been implemented in various regions of Ethiopia since the 1980s to address land degradation, enhance land productivity, and improve the livelihoods of rural communities. Therefore, this study aimed to assess the impacts of watershed management on crop yield potential in the Yezat watershed. Crop yield data were collected from 45 fixed plots using quadrant measurements (5 × 5 m) and from 346 households through a questionnaire survey within the watershed area. One-way ANOVA was employed to assess the mean variances of crop yield and yield attributes across different treatment groups. Additionally, a post hoc analysis was conducted to determine statistically significant differences in crop yields among the various treatments. A paired-samples t-test was also applied to compare teff crop yields before and after watershed management interventions. The findings of the study revealed a statistically significant difference in plant height across physical, bio-physical, and control farmlands (P ≤ 0.05). The tallest teff plants were found in areas with bio-physical watershed management interventions, followed by those with physical treatments, while the shortest plants were observed in untreated areas of the watershed. Similarly, the longest spike length (47.4 cm) was recorded in farmlands with bio-physical treatments, followed by those with physical treatments (44.4 cm). In contrast, the shortest spike length (30.3 cm) was observed in untreated farmlands. This difference is likely due to soil erosion, reduced soil moisture, and high bulk density in the untreated areas. Furthermore, the number of productive tillers in a 25-m2 area (from the upper, middle, and lower watershed), aboveground biomass yield, straw yield, and crop yields were significantly influenced by watershed management interventions (both bio-physical and physical types) (P ≤ 0.05). These improvements are likely linked to soil and water conservation (SWC) techniques, which enhance soil moisture availability by increasing infiltration and preventing the loss of vital soil nutrients through erosion. However, the number of tillers did not show a statistically significant difference (P ≤ 0.05) between treated and untreated areas of the study. Overall, the results suggest that watershed management positively impacts crop yield and yield attributes, demonstrating its effectiveness in improving agricultural productivity.

PMID:40569511 | DOI:10.1007/s11356-025-36619-6

Jpn J Ophthalmol. 2025 Jun 26. doi: 10.1007/s10384-025-01239-7. Online ahead of print.

ABSTRACT

PURPOSE: To assess the effect of increased injection volume on intraocular pressure (IOP) following intravitreal injections of aflibercept 8 mg (70 µl) compared to conventional anti-vascular endothelial growth factor drugs.

STUDY DESIGN: Retrospective observational study METHODS: This retrospective observational study included eyes treated with 50 µl of either aflibercept 2 mg or faricimab 6 mg, followed by a switch to 70 µl of aflibercept 8 mg. IOP was measured before and 30 minutes after intravitreal injections. IOP changes in treated and fellow eyes were analyzed, with potential associations examined between IOP changes and clinical parameters.

RESULTS: A total of 88 eyes from 85 patients were switched to aflibercept 8 mg during the study period. Due to incomplete data, 17 eyes from 15 patients were excluded, leaving 71 eyes from 70 patients for the analysis. IOP significantly increased from 13.2 ± 2.9 mmHg to 19.1± 5.4 mmHg (P< 0.001) with 50 µl injections and from 13.3 ± 2.9 mmHg to 19.8 ± 4.8 mmHg (P<0.001) with 70 µl injections. The IOP increases were 6.0 ± 5.0 mmHg with 50 µl injections and 6.5 ± 4.3 mmHg with 70 µl injections, with no statistically significant difference (P = 0.20). An IOP exceeding 26 mmHg was observed in 6 eyes treated with 50 µl injections and 10 eyes with 70 µl injections, with no significant difference in IOP distribution between the volumes (P = 0.20).

CONCLUSION: There was no additional increase in IOP 30 minutes after intravitreal injections when switching from 50 µl to 70 µl volumes.

PMID:40569499 | DOI:10.1007/s10384-025-01239-7