Tag: nevin manimala

J Ultrasound Med. 2026 May 13. doi: 10.1002/jum.70295. Online ahead of print.

NO ABSTRACT

PMID:42126885 | DOI:10.1002/jum.70295

JAMA Netw Open. 2026 May 1;9(5):e2612199. doi: 10.1001/jamanetworkopen.2026.12199.

ABSTRACT

IMPORTANCE: Information regarding risk factors among service member families for different child maltreatment types is needed to improve prevention efforts.

OBJECTIVE: To identify factors associated with first occurrences of 4 child maltreatment types and examine child age-related changes in risk for each type among active duty service member families.

DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study used data from the Child Maltreatment in Military Families Life Course Study on active duty service member families with a first occurrence of child maltreatment in fiscal years 2009 through 2018 and a representative sample of active duty families without child maltreatment incidents. Data were analyzed from August 2023 to February 2026.

EXPOSURE: One or more parents serving as an active duty service member.

MAIN OUTCOMES AND MEASURES: First documented occurrences of neglect, physical abuse, emotional abuse, and sexual abuse, identified using Family Advocacy Program data. Associations between sociodemographic, family, and military-related characteristics and first occurrences of maltreatment types were examined in univariable and multivariable logistic regressions.

RESULTS: The study included 618 101 active duty service member families (28 684 [4.64%] with a first occurrence of child maltreatment and 589 417 [95.36%] without child maltreatment incidents), consisting of 1 070 510 family-months (FM); the total weighted sample was 65 142 809 FM (59 031 293 male service member FM [90.62%]; mean [SD] age, 32.74 [6.97] years). Crude rates of child maltreatment were highest for child neglect (22.16 per 100 000 FM) followed by physical abuse (10.97 per 100 000 FM), emotional abuse (4.23 per 100 000 FM), and sexual abuse (2.66 per 100 000 FM). Factors associated with higher odds of all child maltreatment types in multivariable models were female service member families (eg, sexual abuse: odds ratio [OR], 1.39 [95% CI, 1.18-1.64]; physical abuse: OR, 1.82 [95% CI, 1.70-1.95]), early parenting (age <21 years) (eg, neglect: OR, 1.32 [95% CI, 1.22-1.41]; sexual abuse: OR, 2.12 [95% CI, 1.75-2.56]), larger number of dependent children (≥3) (eg, emotional abuse: OR, 1.63 [95% CI, 1.48-1.79]; sexual abuse: OR, 2.32 [95% CI, 2.06-2.61]), and never-deployed status (eg, sexual abuse: OR, 1.90 [95% CI, 1.55-2.32]; emotional abuse: OR, 3.76 [95% CI, 3.09-4.57]). Risk rates peaked at 3 months of age for neglect (48.61 per 100 000 FM) and physical abuse (25.49 per 100 000 FM). Risk of emotional and sexual abuse peaked in middle childhood (age 5-12 years) and adolescence but was generally lower (<6 per 100 000 FM) than risk of other child maltreatment types across all ages.

CONCLUSIONS AND RELEVANCE: In this cohort study, families with female service members, never-deployed service members, 3 or more children, and young parents had higher risk of child maltreatment. Dynamic prevention approaches appear to be needed to address evolving risk factors across the family life course.

PMID:42126881 | DOI:10.1001/jamanetworkopen.2026.12199

JAMA Netw Open. 2026 May 1;9(5):e2612232. doi: 10.1001/jamanetworkopen.2026.12232.

ABSTRACT

IMPORTANCE: Medicare home health is a critical postacute care source for individuals with Alzheimer disease and related dementias (ADRD). The Home Health Value-Based Purchasing (HHVBP) program has substantially reshaped financial incentives in home health, but its implications for patients with ADRD are unclear.

OBJECTIVE: To assess the association between residence in a state with an HHVBP program and home health service volume within 30 days of home health initiation among Medicare beneficiaries with ADRD, and how this varies by patient race and/or ethnicity, dual eligibility, and home health agency (HHA) racial composition.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study linked 2021 to 2022 Medicare claims data with Home Health Focus and Provider of Services files for Medicare fee-for-service beneficiaries with ADRD older than 65 years who initiated home health care within 14 days of hospital discharge in the 9 states in which an HHVBP program was piloted compared with non-HHVBP states. The analysis was conducted from November 2024 to June 2025.

EXPOSURE: Residence in an HHVBP pilot state vs a non-HHVBP state.

MAIN OUTCOMES AND MEASURES: Number of nursing and therapy visits received within 30 days (main analysis) and 14 days (sensitivity analysis) of home health initiation. Negative binomial regression models with HHA random effects were estimated, and average marginal effects were reported.

RESULTS: The analytic cohort included 264 601 Medicare beneficiaries with ADRD (median [IQR] age, 83 [77-89] years; 160 947 males [60.8%]), of whom 68 765 (26.0%) resided in HHVBP states. The overall racial and ethnic composition included Asian (3.1%; n = 8099), non-Hispanic Black (8.9%; n = 23 634), Hispanic (6.3%; n = 16 562), and non-Hispanic White (81.7%; n = 216 306) individuals, as determined by Research Triangle Institute race codes from the Master Beneficiary Summary File. Adjusted 30-day outcomes showed HHVBP state residence vs non-HHVBP state residence was associated with 0.46 fewer nursing visits (3.94 vs 4.40 visits; average marginal effect [AME] = -0.46; 95% CI, -0.52 to -0.41; P < .001) and 0.32 more therapy visits (6.37 vs 6.05 visits; AME = 0.32; 95% CI, 0.24-0.39; P < .001). In non-HHVBP states, dual-eligible beneficiaries and those receiving care from HHAs primarily serving a racial and ethnic minority population received more nursing but fewer therapy visits compared with non-dual-eligible beneficiaries and those receiving care from HHAs serving a predominantly White population. These differences became smaller in HHVBP states. For example, therapy visit gaps between patients receiving care from HHAs primarily serving a racial and ethnic minority population and those receiving care from HHAs serving a predominantly White patient population narrowed from -0.81 (95% CI, -0.90 to -0.73) to -0.27 (95% CI, -0.44 to -0.09) visits in non-HHVBP vs HHVBP states (P < .001). The findings of increasing use of therapy visits and smaller group differences were consistent within a 14-day window.

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries with ADRD, residence in an HHVBP state was associated with increased therapy use and smaller differences in home health service patterns between racial and/or ethnic minority and White patients, dual-eligible and non-dual-eligible beneficiaries, and patients receiving care from minority-serving HHAs and those receiving care from HHAs serving a predominantly White patient population compared with residence in a non-HHVBP state. These findings suggest that VBP models could reduce differences in postacute care.

PMID:42126880 | DOI:10.1001/jamanetworkopen.2026.12232

JAMA Netw Open. 2026 May 1;9(5):e2612319. doi: 10.1001/jamanetworkopen.2026.12319.

ABSTRACT

BACKGROUND: Unhealthy alcohol and drug use have significant health-related sequelae. Given racial and ethnic disparities in complications of substance use, successful screening and medication prescribing for addictions are important in community health settings serving diverse populations.

OBJECTIVE: To evaluate alcohol and drug use screening and prescribing of medications for addiction treatment in adults by race, ethnicity, and language preference.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included US adults seen between 2012 and 2020 in a multistate electronic health record (EHR) network (1394 primary care clinics). Analyses were completed October 2024.

EXPOSURE: Race and ethnicity with language preference groups: non-Hispanic White, non-Hispanic Black, Latino with Spanish language preferred, and Latino with English language preferred.

MAIN OUTCOME(S) AND MEASURES: Multivariable logistic regression estimated covariate-adjusted odds ratios (aOR) of receipt of alcohol and drug screening and EHR-documented prescription of medication for alcohol (AUD) or opioid use disorders (OUD).

RESULTS: There were 2 191 945 patients across 25 states (mean (SD) age, 41.3 [15.2] years; 1 236 818 female [56.4%]); 416 607 identified as non-Hispanic Black (19.0%), 1 015 066 non-Hispanic White (46.3%), 474 389 Latino with Spanish-language preference (21.6%), and 285 883 Latino with English-language preference (13.0%). Over the study period, 869 609 (39.7%) had documented completed alcohol screening, and 862 263 (39.3%) completed drug screening-113 629 (5.2%) had a diagnosis of AUD and 247 530 (11.3%) had an OUD diagnosis. Spanish-preferring Latino patients had 59% increased odds of screening compared with non-Hispanic White patients (aOR, 1.59; 95% CI, 1.31-1.93). All minoritized race and ethnicity with language preference groups had lower odds of prescribed medications for addictions treatment compared with non-Hispanic White patients; non-Hispanic Black patients had the lowest odds of any group (AUD: aOR, 0.55; 95% CI, 0.43-0.69; OUD: aOR, 0.38; 95% CI, 0.31-0.46).

CONCLUSIONS AND RELEVANCE: In this cohort study, there was an overall low likelihood of completed screening for alcohol and drug use among all minoritized race and ethnicity with language preference groups. All minoritized groups had lower odds of receipt of medications for addiction treatment compared with the non-Hispanic White group. Improving screening and addressing this emerging treatment inequity should be prioritized.

PMID:42126879 | DOI:10.1001/jamanetworkopen.2026.12319

JAMA Netw Open. 2026 May 1;9(5):e2612323. doi: 10.1001/jamanetworkopen.2026.12323.

ABSTRACT

IMPORTANCE: Although hepatocellular carcinoma (HCC) incidence has decreased in the US, it is unclear if rural residents have experienced similar trends.

OBJECTIVE: To examine rural-urban differences in HCC incidence and incidence-based mortality trends by sex, race and ethnicity, and stage at diagnosis.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed HCC diagnoses from 2001 to 2022 and deaths from 2007 to 2022 using data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results (SEER) programs for incidence and the SEER-21 program for incidence-based mortality. Rurality was classified using the 2013 Rural-Urban Continuum Codes. All analyses were performed from October 2025 to February 2026.

MAIN OUTCOMES AND MEASURES: Annual incidence and incidence-based mortality rates per 100 000 people were calculated and age standardized to the 2000 US standard population. The annual percentage change (APC) and the average APC in incidence and incidence-based mortality rates were then estimated using Joinpoint regression.

RESULTS: The study analyzed 264 633 HCC cases (77.0% among men and 86.6% in urban areas). Among men, HCC incidence was 4.5 (95% CI, 4.4-4.5) per 100 000 people in rural counties and 5.8 (95% CI, 5.8-5.8) per 100 000 people in urban counties; among women, HCC incidence was 1.2 (95% CI, 1.2-1.2) per 100 000 people in rural counties and 1.5 (95% CI, 1.5-1.5) per 100 000 people in urban counties. In rural counties, HCC incidence increased by 1.1% (95% CI, 0.6%-1.6%) per year among men from 2007 to 2022 and 1.7% (95% CI, 1.2%-2.3%) per year among women from 2001 to 2022, whereas in urban counties, HCC rates decreased by 1.4% (95% CI, -1.7% to -1.1%) per year among men from 2008 to 2022 and by 1.0% (95% CI, -1.4% to -0.6%) per year among women from 2009 to 2022. Among men, incidence-based mortality rates were 2.7 (95% CI, 2.3-3.0) per 100 000 people in rural counties and 3.8 (95% CI, 3.6-3.9) per 100 000 people in urban counties; among women, the incidence-based mortality rates were 0.8 (95% CI, 0.6-0.9) per 100 000 people in rural counties and 0.9 (95% CI, 0.8-1.0) per 100 000 people in urban counties. In rural counties, incidence-based mortality rates increased by 1.2% (95% CI, 0.3%-2.1%) per year among men and remained stable among women (APC, 0.3% [95% CI, -1.1% to 1.7%]), whereas in urban counties, incidence-based mortality rates decreased by 1.4% per year (95% CI, -1.7% to -1.1%) among men and 1.0% (95% CI, -1.7% to -0.4%) per year among women.

CONCLUSIONS AND RELEVANCE: This cohort study revealed rural-urban disparities in HCC incidence and incidence-based mortality trends. These findings highlight the need for targeted prevention strategies and improved access to early detection and specialty care for rural populations.

PMID:42126878 | DOI:10.1001/jamanetworkopen.2026.12323

JAMA Netw Open. 2026 May 1;9(5):e2612332. doi: 10.1001/jamanetworkopen.2026.12332.

ABSTRACT

IMPORTANCE: Undocumented immigrants are more than 5 times as likely as US citizens to be uninsured. Before 2020, undocumented young adults aged 19 to 25 years in California were eligible for restricted-scope Medi-Cal, which only covers emergency services.

OBJECTIVE: To examine the association of the California 2020 full-scope Medi-Cal expansion to young adults aged 19 to 25 years regardless of immigration status with coverage outcomes and to assess subgroup differences by race and ethnicity, sex, and age.

DESIGN, SETTING, AND PARTICIPANTS: This cross sectional study included American Community Survey respondents who were noncitizens aged 19 to 25 years before (2016-2019) and after (2021-2022) the policy’s implementation in California; the treatment group was compared with California noncitizens aged 26 to 32 years and young adults aged 19 to 25 and 26 to 32 years from 6 comparison states (Arizona, Florida, Illinois, Nevada, New York, and Texas). Analysis was conducted from January 2024 to August 2025.

EXPOSURE: California’s 2020 Medi-Cal expansion.

MAIN OUTCOMES AND MEASURES: Triple difference analysis was used to estimate the association of the California Medi-Cal expansion with health insurance coverage (any, Medicaid, and private coverage) among noncitizens aged 19 to 25 years relative to California noncitizens aged 26 to 32 years and young adults in the 6 comparison states.

RESULTS: The sample included 19 773 and 32 515 noncitizen American Community Survey respondents in California aged 19 to 25 years and 26 to 32 years, respectively, and 28 535 and 43 213 individuals aged 19 to 25 years and 26 to 32 years, respectively, residing in comparison states. Baseline weighted percentages for the 19- to 25-year treatment group included 52.1% (95% CI, 51.0%-53.2%) male, 31.9% (95% CI, 30.7%-33.0%) Asian non-Hispanic, 1.8% (95% CI, 1.5%-2.2%) Black non-Hispanic, 54.6% (95% CI, 53.4%-55.9%) Hispanic, 9.7% (95% CI, 8.9%-10.5%) White non-Hispanic, and 2.0% (95% CI, 1.6%-2.3%) other race non-Hispanic. Medi-Cal expansion was associated with a 4.2 (95% CI, 1.3-7.1)-percentage-point increase in Medicaid and a 3.5 (95% CI, 0.2-6.8)-percentage-point increase in any coverage. In subgroup analyses, percentage-point increases in Medicaid were statistically significant for Hispanic young adults (6.7 [95% CI, 2.6-10.9] percentage points), males (3.6 [95% CI, 0.1-7.1] percentage points), females (5.0 [95% CI, 0.7-9.3] percentage points), those aged 19 to 22 years (4.4 [95% CI, 0.7-8.1] percentage points), and those aged 23 to 25 years (4.0 [95% CI, 0.7-7.3] percentage points). In post hoc analyses, the estimates translated to increases in Medi-Cal and any coverage of 24.4 and 20.3 percentage points, or 30 665 and 25 554 young adults, respectively.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the California 2020 Medi-Cal expansion was associated with significant coverage gains. Because the American Community Survey did not distinguish between restricted- and full-scope Medi-Cal, the analysis may have underestimated coverage increases, and further research is warranted to understand the health care and economic costs and benefits of California’s expansion.

PMID:42126877 | DOI:10.1001/jamanetworkopen.2026.12332

JAMA Netw Open. 2026 May 1;9(5):e2612390. doi: 10.1001/jamanetworkopen.2026.12390.

ABSTRACT

IMPORTANCE: Understanding toilet avoidance and stool withholding at school is essential, as this can adversely affect children’s health and well-being.

OBJECTIVE: To assess the prevalence of toilet avoidance and stool withholding at school, and to explore the differences of withholding behavior by gender and geographic location of the school, identify reasons for withholding, and describe physical symptoms and health care utilization.

DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study used an online questionnaire developed by experts from Amsterdam University Medical Center and the Dutch Digestive Health Fund. Children aged 8 to 16 years from primary schools (aged 8-12 years) and high schools (aged 13-16 years) were recruited by Verian, an external research agency, through a nationwide online panel in the Netherlands.

EXPOSURE: In July 2024, school-aged children completed the questionnaire.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the prevalence of stool withholding, reasons for withholding, gastrointestinal symptoms, and health care utilization. Secondary outcomes included differences between gender and geographic location of the school, children’s reasons for avoiding school toilets, and toilets’ perceived cleanliness. To assess potential differences in withholding behavior according to gender and geographic location, a Cochran-Armitage test was performed.

RESULTS: A total of 1000 children, 518 aged 8 to 12 years (264 [51.0%] male) and 482 aged 13 to 16 years (234 [48.5%] male) completed the questionnaire. Stool withholding was reported by 265 primary school children (51.2%) and 344 high school children (71.4%), with no significant differences by gender or geographic location. Hygiene and privacy concerns were the most commonly reported reasons for withholding stool with 610 (84.3%) of children accounting for hygiene and 574 (79.3%) citing privacy concerns, and 410 (41.0%) of children rated school toilet cleanliness as insufficient. Abdominal pain was frequently reported (365 of 724 [50.4%]) and 15 of 336 primary school children (4.5%) experienced fecal incontinence. Overall, 42 primary school children (12.5%) had consulted a physician for symptoms related to withholding.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, toilet avoidance and stool withholding at school were common among both primary and high school children, mostly due to hygiene and privacy concerns. Improving school toilet facilities may reduce withholding behavior, gastrointestinal symptoms, and related physician visits, thereby supporting children’s physical, psychological, and educational well-being.

PMID:42126876 | DOI:10.1001/jamanetworkopen.2026.12390

JAMA Dermatol. 2026 May 13. doi: 10.1001/jamadermatol.2026.1070. Online ahead of print.

ABSTRACT

IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of mortality in patients with psoriasis, yet structured CVD prevention is not routinely embedded in dermatology care.

OBJECTIVE: To evaluate the effectiveness of a text-messaging intervention in improving patient activation and cardiovascular risk factors among patients with psoriasis.

DESIGN, SETTING, AND PARTICIPANTS: This single-center, parallel-group randomized clinical trial took place at a tertiary hospital dermatology clinic in Australia from February 2024 to February 2025. Adults with dermatologist-confirmed psoriasis were randomized 1:1 during outpatient dermatology visits between April and July 2024. Data were analyzed from February to April 2025.

INTERVENTION: A 6-month text-messaging intervention (Tobacco, Exercise, and Diet Messages for Psoriasis [TEXTME PSO]), comprising 4 text messages per week, compared with standard care.

MAIN OUTCOMES AND MEASURES: The primary outcome was score on the 13-item Patient Activation Measure. Secondary outcomes included Mediterranean Diet Score, physical activity, cardiometabolic measures, psoriasis-CVD knowledge, medication adherence, Psoriasis Area and Severity Index, Dermatology Life Quality Index, and user feedback. Analysis of covariance was used to adjust for baseline values under an intention-to-treat framework with multiple imputation.

RESULTS: Among 111 participants (mean [SD] age, 51.8 [13.2] years; 71 [65.1%] male), the intervention showed a statistically significant improved patient activation at 6 months compared with usual care (adjusted mean difference, 10.8 points; 95% CI, 7.0-14.6 points; P < .001). Statistically significant improvements were also observed in Mediterranean diet adherence (adjusted mean difference, 1.7; 95% CI, 1.0-2.4; P < .001), medication adherence (adjusted mean difference, 1.6; 95% CI, 0.8-2.5; P < .001), and psoriasis-CVD knowledge (adjusted mean difference, 6.6; 95% CI, 4.7-8.4; P < .001). Minutes per week of physical activity increased (adjusted mean difference, 127.9; 95% CI, 21.9-234.0; P = .02), and body mass index, calculated as weight in kilograms divided by height in meters squared, decreased (adjusted mean difference, -1.0; 95% CI, -1.4 to -0.7; P < .001). No statistically significant between-group differences were observed for lipid parameters, hemoglobin A1c, smoking behavior, dermatology-specific quality of life, or psoriasis severity.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a text-messaging intervention improved patient activation and cardiovascular risk behaviors in adults with psoriasis. While biomarker changes were modest or not statistically significant, findings support digital tools as an adjunct to cardiovascular risk in dermatology care.

TRIAL REGISTRATION: ANZCTR Identifier: ACTRN12624000498594.

PMID:42126867 | DOI:10.1001/jamadermatol.2026.1070

JAMA. 2026 May 13. doi: 10.1001/jama.2026.5663. Online ahead of print.

ABSTRACT

IMPORTANCE: Occupational burnout threatens care quality, workforce retention, and physician health. Childbearing physicians in training are at high risk due to stigma, low workplace support, and physical challenges compounding role transitions and increased home responsibilities, yet evaluations of mitigation strategies remain scarce.

OBJECTIVE: To assess the efficacy of a parental support package targeting perinatal stressors in reducing burnout and distress among childbearing physicians in training.

DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, randomized, controlled, parallel-group clinical trial. Pregnant (≥12 weeks’ gestation) residents and fellows were enrolled across 7 training institutions in the northeastern US from May 2023 to July 2024. Nonbirthing parents were excluded. Follow-up concluded in May 2025.

INTERVENTIONS: Participants were randomized 1:1, stratified by site and specialty type (procedural vs nonprocedural), to receive a parental support package (n = 78) or usual support (n = 78) from early pregnancy through 24 weeks post partum. The parental support package included a smart bassinet, wearable breast pump, virtual perinatal support, and formal faculty mentorship.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in burnout (Stanford Professional Fulfillment Index; score range, 0-10; and the emotional exhaustion and interpersonal disengagement subscales), from enrollment during pregnancy to 24 weeks post partum. Secondary outcomes included changes in professional fulfillment, organizational and personal values alignment, relationship strain, career dissatisfaction, and sleep-related impairment. Mixed-effects models analyzed outcomes. Effect sizes were standardized using the Cohen d (0.2: small; 0.5: medium; 0.8: large).

RESULTS: Of 156 randomized participants, 143 were included in the primary analysis (median age, 32 [IQR, 31-34] years; 71 in the parental support package group and 72 in the usual support group). From enrollment during pregnancy to 24 weeks post partum, mean burnout scores increased from 2.96 to 3.03 in the parental support package group and from 3.13 to 3.79 in the usual support group (adjusted between-group difference in change, -0.58; 95% CI, -1.10 to -0.07; P = .03; d = 0.65). Differences were driven by interpersonal disengagement (adjusted between-group difference in change, -0.70; 95% CI, -1.24 to -0.15; P = .01; d = 0.57). Emotional exhaustion scores were not statistically different between groups.

CONCLUSIONS AND RELEVANCE: Among childbearing physicians in training, a parental support package significantly mitigated postpartum burnout.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06014892.

PMID:42126852 | DOI:10.1001/jama.2026.5663