Tag: nevin manimala

JMIR Ment Health. 2026 Aug 10;13:e94753. doi: 10.2196/94753.

ABSTRACT

BACKGROUND: Two-fold increases in the prevalence of youth anxiety and depression over the last two decades have mirrored exponential growth in opportunities for adolescent online social interaction via social media, short messaging service (SMS), and internet text messaging apps on smartphones. However, studies to date of self-reported online social interaction time have produced conflicting results. Understanding the role of dispositional and developmental differences in individuals’ responses to online versus offline social interactions may help elucidate whether and how online social interaction is related to anxiety and depression.

OBJECTIVE: This study aimed to investigate the relationship between older adolescents’ and emerging adults’ (18-24-year-olds) mental health and (1) objectively measured time spent on smartphones and online social interaction apps, (2) momentary affective and affiliative responses to online and offline social interactions, and (3) the moderating role of developmentally and dispositionally elevated social sensitivity.

METHODS: Smartphone, social media (eg, Instagram), SMS, and internet (eg, WhatsApp) text messaging app time from participants’ screen use settings, as well as symptoms of anxiety and depression, and social sensitivity, were measured in 190 older adolescents and emerging adults (mean age 20.4, SD 2.2 years). Participants then completed a novel ecological momentary assessment (EMA) capturing affective and affiliative responses to recent online or offline social interactions 3× daily for 1 week. Symptoms of mental health were assessed again after 1 month.

RESULTS: Total online social interaction (combined social media and text messaging) app time, but not total smartphone time, was associated with greater anxiety, at both baseline and one month later. Affective and affiliative responses were less positive for online social interactions compared to in-person interactions. Anxiety, but not depression, was associated with feeling less happy, but not less included, after social interactions. Affective and affiliative responses to in-person, but not online, social interactions were negatively associated with depression across the 1-month study period. Finally, social sensitivity moderated the relationship between affective and affiliative responses to social media interactions and depression at baseline. Overall effect sizes were small.

CONCLUSIONS: These findings emphasize the need to investigate individual factors influencing for whom online social interaction is harmful or beneficial. To do so, this study provides a novel, ecologically valid tool for understanding young people’s momentary responses to online and offline social interactions, as well as initial evidence for stronger associations between in-person than online social interaction responses and mental health for older adolescents and emerging adults. It also introduces evidence of social sensitivity as a potential, developmentally relevant vulnerability to the effects of online social interaction. Further research is needed in younger adolescent populations over longer timeframes.

PMID:42574044 | DOI:10.2196/94753

J Mater Chem B. 2026 Aug 10. doi: 10.1039/d6tb00880a. Online ahead of print.

ABSTRACT

Early diagnosis of Alzheimer’s disease (AD) remains a major clinical challenge, particularly during the mild cognitive impairment (MCI) stage, where subtle cognitive changes overlap with normal ageing and reliable diagnostic indicators are limited. Plasma phosphorylated tau at threonine-181 (pTau-181) has emerged as a disease-specific biomarker associated with tau pathology and early neurodegenerative progression, with increasing evidence supporting its relevance for identifying individuals at risk of AD during the prodromal phase. However, accurate quantification of plasma pTau-181 is hindered by its extremely low concentration and the complex biochemical environment of blood. In this study, a label-free electrochemical impedance biosensor was developed for sensitive detection of plasma pTau-181 using a self-assembled two-dimensional MXene-gold nanorod (MXene-GNR) hybrid interface. Modification of a glassy carbon electrode with the MXene-GNR nanocomposite enhanced interfacial charge-transfer behaviour and increased the electroactive surface area by approximately 37%, enabling improved anti-pTau-181 immobilization and signal transduction. The biosensor exhibited a concentration-dependent impedance response toward pTau-181 over a wide dynamic range and achieved an ultrasensitive limit of detection of 12.561 fg mL^-1 in 10% plasma spiked samples while maintaining high analytical selectivity. Clinical plasma analysis demonstrated statistically significant differentiation of AD and MCI groups from healthy controls (p < 0.001), supporting the relevance of plasma pTau-181 measurement for assessing disease-associated cognitive impairment. These findings demonstrate the potential of the MXene-GNR electrochemical platform as a minimally invasive approach for plasma biomarker evaluation toward early AD diagnosis and monitoring.

PMID:42574041 | DOI:10.1039/d6tb00880a

Health Technol Assess. 2026 Aug;30(61):1-154. doi: 10.3310/GJAC1008.

ABSTRACT

BACKGROUND: Our aim was to develop and evaluate the electronic frailty index+, a prognostic tool, including four integrated prognostic-decision models, to stratify older people into subgroups for targeting key interventions.

METHODS: Prognostic model development, internal validation and external validation using large data sets and longitudinal cohort study data, with decision curve and health economic analysis.

POPULATION: Patients aged 65+ years.

KEY OUTCOMES: The 12-month outcomes for prognostic models: new home care package care home admission emergency department attendance/hospitalisation with fall/fracture all-cause mortality.

STATISTICAL METHODS: We developed and internally validated models for our key outcomes in one large data set. We used internal-external cross-validation for the home care model and full external validation for the remaining three models in a second large data set. We used CARE75+ to investigate additional predictive value of clinical measures practical for primary care.

DECISION CURVE ANALYSIS: We translated the prognostic models into a framework to support clinical decision-making.

HEALTH ECONOMIC EVALUATION: We integrated the falls prediction models with effect size estimates from network meta-analysis to examine potential cost savings.

RESULTS: We used data from 660,417 patients in SAIL, 88,947 in Connected Bradford and 252 CARE75+ participants. Model performance was promising in internal-external cross-validation, with average calibration slope 1.00 (95% confidence interval 0.99 to 1.01), average calibration-in-the-large -0.01 (95% confidence interval -0.02 to 0.01), average observed/expected ratio 0.99 (95% confidence interval 0.98 to 1.01) and average C-statistic 0.81 (95% confidence interval 0.81 to 0.81).

EMERGENCY DEPARTMENT ATTENDANCE/HOSPITALISATION WITH FALL/FRACTURE: Model performance was promising on internal and external validation, although with some evidence for overprediction of falls risk, with calibration slope 1.25 (95% confidence interval 1.24 to 1.27), calibration-in-the-large -0.931 (95% confidence interval -0.938 to -0.920), observed/expected ratio 0.43 (95% confidence interval 0.42 to 0.44), C-statistic 0.83 (0.82 to 0.83).

CARE HOME ADMISSION: Model performance was promising on internal validation, but it showed some miscalibration on external validation, with calibration slope 0.75 (95% CI 0.74 to 0.76), calibration-in-the-large -1.60 (-1.62 to -1.58) and observed/expected ratio 0.25 (95% CI 0.24 to 0.25), C-statistic of 0.86 (95% CI 0.86 to 0.86).

ALL-CAUSE MORTALITY: The model showed excellent performance across the full range of predicted risks on external validation, with average calibration slope 1.00 (0.98 to 1.01), average calibration-in-the-large -0.23 (-0.27 to -0.19), average observed/expected ratio 0.77 (0.75 to 0.79) and average C-statistic 0.83 (0.82 to 0.83).

ECONOMIC MODELLING: Modelling indicated that provision of multifactorial assessment and treatment for people with an annual falls risk of ≥ 40% has the largest cost reduction per targeted person (£1025).

DISCUSSION: All four prediction models have promising predictive performance, although some had evidence of overprediction of risk (miscalibration). Decision curve analysis indicates potential clinical utility, and economic modelling provides novel information for policy-makers and commissioners.

FUTURE WORK: Future research should include model impact studies to evaluate use of the models in routine care.

LIMITATIONS: We were unable to complete external validation of the home care prediction model.

STUDY REGISTRATION: This study is registered as ClinicalTrials.gov ID NCT04113174.

FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 127905) and is published in full in Health Technology Assessment; Vol. 30, No. 61. See the NIHR Funding and Awards website for further award information.

PMID:42574037 | DOI:10.3310/GJAC1008

JAMA Netw Open. 2026 Aug 3;9(8):e2627708. doi: 10.1001/jamanetworkopen.2026.27708.

ABSTRACT

IMPORTANCE: People with disabilities experience persistent inequities in preventive care, yet contemporary, nationally representative data on prostate-specific antigen (PSA) testing disparities are limited.

OBJECTIVE: To evaluate the association between disability status and self-reported PSA testing among US men aged 55 to 69 years.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2023 data from the Behavioral Risk Factor Surveillance System (BRFSS), a US population-based telephone survey. The analytic sample included 10 508 male respondents aged 55 to 69 years with complete PSA testing and disability data; analyses incorporated BRFSS survey weights to generate nationally representative estimates. Data were analyzed from October 2024 to May 2025.

EXPOSURES: Any disability and disability types (mobility, cognitive, hearing, vision, self-care, independent living) measured using the standard 6-question sequence.

MAIN OUTCOMES AND MEASURES: The main outcome was self-reported PSA testing, assessed using BRFSS PSA items. Survey-weighted logistic regression was used to estimate adjusted odds ratios (AORs), controlling for sociodemographic factors, insurance, comorbidities, and health behaviors, with multiple imputation for missing covariates.

RESULTS: The weighted analytic sample represented 5 058 866 US men aged 55 to 69 years; 29.6% reported at least 1 disability. Overall, 62.7% (95% CI, 61.1%-64.3%) reported prior PSA testing, with lower testing among men with disabilities than among those without (57.2% [95% CI, 54.2%-60.2%] vs 65.1% [95% CI, 63.2%-67.0%]; P < .001). In adjusted survey-weighted models, disability was associated with lower odds of PSA testing (AOR, 0.83; 95% CI, 0.69-0.99). Among disability types, mobility disability was associated with lower testing (AOR, 0.77; 95% CI, 0.62-0.96). In an unweighted sensitivity analysis, the association between any disability and lower PSA testing remained significant (AOR, 0.86; 95% CI, 0.77-0.98).

CONCLUSIONS AND RELEVANCE: In this nationally representative cross-sectional study of US men aged 55 to 69 years, disability status was associated with lower PSA testing, with the most consistent disparity observed among men with mobility disability. These findings suggest disability, particularly mobility impairment, may be an under-recognized determinant of preventive care and may warrant targeted interventions to improve equitable access to shared decision-making and screening services.

PMID:42574016 | DOI:10.1001/jamanetworkopen.2026.27708

JAMA Netw Open. 2026 Aug 3;9(8):e2627722. doi: 10.1001/jamanetworkopen.2026.27722.

ABSTRACT

IMPORTANCE: Black women with epithelial ovarian cancer (EOC) have significantly worse survival than White women. How residential context contributes to these disparities is unclear.

OBJECTIVE: To examine whether there is an association of residential context with racial disparities in EOC survival.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, observational cohort study assessed women 18 years or older diagnosed with EOC between January 1, 2000, and May 31, 2023, and followed up through June 30, 2024, at the University of Alabama at Birmingham, part of the O’Neal National Cancer Institute Designated Comprehensive Cancer Center.

MAIN OUTCOME AND MEASURES: The primary outcome was all-cause mortality. Residential context was assessed at the census tract level using the 2020 Social Vulnerability Index (SVI). Data analyses were conducted between July 2024 and May 2026.

RESULTS: Of the 2544 female patients, 509 were Black (median [IQR] age, 62 [54-70] years) and 2035 were White (median [IQR], 63 [54-72] years). Black women were more likely than White women to be diagnosed with EOC at a more advanced stage (346 [68.0%] vs 1274 [62.6%]) and less likely to have high-grade serous cancers (256 [50.3%] vs 1083 [53.2%]). Black women also had worse overall survival (adjusted hazard ratio [AHR], 1.45; 95% CI, 1.28-1.64). Living in areas of greater social vulnerability was associated with worse overall survival (AHR, 1.20; 95% CI, 1.06-1.35), with a significantly greater adverse effect for Black women (AHR, 1.77; 95% CI, 1.49-2.10) than for White women (AHR. 1.10; 95% CI, 0.96-1.26), indicating a 32.5% greater hazard than expected from the main effects of SVI and race. Black women residing in both low (AHR. 1.20; 95% CI, 1.01-1.44) and high (AHR, 1.60; 95% CI, 1.32-1.94) SVI areas had significantly greater hazards of death compared with White women residing in similar SVI areas. Mediation analyses revealed no pure mediation effect of SVI on the race-mortality association, but a significant 16.4% (95% CI, 2.1%-33.3%) of the race-mortality excess relative risk was attributable to mediated interactions between race and SVI. Overall, 40.3% (95% CI, 15.7%-61.8%) of the race-mortality excess relative risk operated through pathways involving residing in areas of greater social vulnerability.

CONCLUSIONS AND RELEVANCE: In this cohort study, residential context had a stronger association with survival for Black women and may partially explain the persistent racial disparities in EOC survival. More detailed studies of residential and individual nonbiological factors associated with EOC survival are needed to identify interventions to reduce poor outcomes, especially for Black women.

PMID:42574015 | DOI:10.1001/jamanetworkopen.2026.27722

JAMA Netw Open. 2026 Aug 3;9(8):e2628167. doi: 10.1001/jamanetworkopen.2026.28167.

ABSTRACT

IMPORTANCE: The Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 greatly expanded Veterans Affairs (VA) enrollees’ access to non-VA (community care) services. Since then, community-based utilization has increased substantially, but the quality of noncardiac surgical procedures has not been compared in VA and community care facilities.

OBJECTIVE: To compare surgical outcomes among veterans at VA vs community care facilities.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used adjusted restricted mean survival time (RMST) to compare survival at 30, 90, and 365 days after carotid endarterectomy (CEA), cholecystectomy (CCY), primary total hip arthroplasty (THA), and primary total knee arthroplasty (TKA) among VA enrollees at VA and community care facilities between October 1, 2019, and July 31, 2024. Follow-up was completed July 31, 2025.

EXPOSURE: CEA, CCY, THA, and TKA performed at VA vs community care settings.

MAIN OUTCOMES AND MEASURES: Adjusted RMST at 30, 90, and 365 days.

RESULTS: A total of 215 542 unique surgical procedures-87 653 in VA-based and 127 889 in community-based facilities-were observed. The mean (SD) age of patients was 65.6 (11.7) years; 191 958 procedures (89.1%) were performed in male patients, and 94 105 (43.7%) were performed in patients who lived in rural or highly rural areas. Actuarial mortality rates were meaningfully higher for community-based CEA (30 days, 1.6% vs 0.9%; 90 days, 3.0% vs 2.0%; and 365 days, 8.5% vs 6.3%) and CCY (30 days, 1.4% vs 0.5%; 90 days, 2.6% vs 1.0%; and 365 days, 5.7% vs 2.8%) but similar for TKA (30 days, 0.1% vs 0.2%; 90 days, 0.4% vs 0.3%; and 365 days, 1.3% vs 1.2%) and THA (30 days, 0.3% vs 0.2%; 90 days, 0.7% vs 0.5%; and 365 days, 2.0% vs 1.7%). After CEA in a VA setting, adjusted survival times at 30 days increased by 0.12 (95% CI, 0.04-0.21) days; at 90 days, by 0.82 (95% CI, 0.45-1.19) days; and at 365 days, by 7.11 (95% CI, 4.71-9.51) days. After CCY in a VA setting, adjusted survival times at 30 days increased by 0.14 (95% CI, 0.11-0.18) days; at 90 days, by 0.82 (95% CI, 0.67-0.96) days; and at 365 days, by 6.20 (95% CI, 5.33-7.06) days. After THA in a VA setting, adjusted survival at 30 days increased by 0.002 (95% CI, -0.02 to 0.02) days; at 90 days, by 0.07 (95% CI, -0.02 to 0.16) days; and at 365 days, by 0.44 (95% CI, -0.17 to 1.05) days. After TKA in a VA setting, adjusted survival at 30 days increased by 0.004 (95% CI, -0.01 to 0.01) days; at 90 days, by 0.01 (95% CI, -0.04 to 0.04) days; and at 365 days, by 0.31 (95% CI, -0.03 to 0.65) days.

CONCLUSIONS AND RELEVANCE: In this cohort study, veterans who underwent surgery at community care vs VA facilities had significantly decreased survival times at 30, 90, and 365 days after CEA and CCY and similar survival times after THA and TKA. The reasons for these survival differences deserve further study.

PMID:42574014 | DOI:10.1001/jamanetworkopen.2026.28167

JAMA Netw Open. 2026 Aug 3;9(8):e2628227. doi: 10.1001/jamanetworkopen.2026.28227.

ABSTRACT

IMPORTANCE: Regular physical activity promotes healthy aging, yet clinical risk stratification in older adults relies largely on comorbidity burden, often overlooking functional capacity. Objective fitness assessment may serve as a clinically relevant indicator of physiological reserve, but evidence from large cohorts evaluating multiple fitness domains remains limited.

OBJECTIVE: To evaluate associations between objectively measured physical fitness across multiple domains and all-cause mortality in older adults.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study included community-dwelling adults aged 65 years or older who completed standardized fitness assessments in Taiwan between January 11, 2015, and November 25, 2016. Participant data were linked to National Health Insurance records, with follow-up through December 31, 2022. Statistical analyses were conducted between July 1, 2025, and May 30, 2026.

EXPOSURES: Physical fitness was assessed across 4 domains: cardiorespiratory fitness (2-minute step test), muscular strength (30-second arm curl and chair stand tests), flexibility (back scratch and chair sit-and-reach tests), and balance and agility (1-leg stance and 8-foot up-and-go tests). A composite fitness index was constructed by summing sex-specific percentile ranks across all 7 assessments.

MAIN OUTCOME AND MEASURES: The main outcome was all-cause mortality, ascertained through linkage with the National Health Insurance death registry. Multivariable Cox proportional hazards models estimated adjusted hazard ratios (AHRs), adjusting for sociodemographic factors, comorbidities, and self-reported physical activity.

RESULTS: Of 13 423 participants (mean [SD] age, 72.9 [6.1] years; 8394 female [62.5%]), 1631 (12.2%) died during a median (IQR) follow-up of 7.0 (6.7-7.1) years. Compared with the lowest performance quintile, participants in the highest performance quintile had lower all-cause mortality across 4 physical fitness assessments: 8-foot up-and-go (AHR, 0.41 [95% CI, 0.33-0.51]), 1-leg stance (AHR, 0.50 [95% CI, 0.42-0.59]), 30-second chair stand (AHR, 0.55 [95% CI, 0.46-0.65]), and 2-minute step test (AHR, 0.58 [95% CI, 0.49-0.68]). The composite fitness index showed the lowest risk of all-cause mortality (AHR, 0.39 [95% CI, 0.32-0.48]).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, objectively measured physical fitness-particularly balance and agility, lower-body strength, and cardiorespiratory fitness-was associated with lower all-cause mortality in a graded manner. These findings suggest that integrating objective fitness assessments into routine practice may refine risk stratification and guide function-oriented interventions in older adults.

PMID:42574013 | DOI:10.1001/jamanetworkopen.2026.28227

JAMA Netw Open. 2026 Aug 3;9(8):e2628366. doi: 10.1001/jamanetworkopen.2026.28366.

ABSTRACT

IMPORTANCE: Advance care planning (ACP) is recommended to ensure that medical care for patients with serious illness aligns with their goals; however, effective pragmatic strategies have been elusive.

OBJECTIVE: To compare the association of an appointment-based ACP behavioral intervention delivered with the patient just before a primary care visit vs a non-appointment-based intervention.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of patients from a cluster randomized trial of ACP interventions conducted October 2019 to June 2022 (data analysis June to November 2025). This included 50 primary care clinics across 3 academic health systems. Participants were primary care patients with serious illness 18 years and older without an advance directive (AD) or Physician Order for Life Sustaining Treatment (POLST) in the electronic health record (EHR).

EXPOSURE: Three different appointment-based automated ACP interventions delivered to patients 7 to 21 days before a primary care visit. Eligible patients who did not receive an appointment-based intervention received a non-appointment-based intervention after 6 months.

MAIN OUTCOMES AND MEASURES: Posthoc analysis of AD or POLST in the EHR at 12 and 24 months and documented patient-clinician ACP discussions by 24 months. Generalized estimating equation logistic regression models were used to compute adjusted differences.

RESULTS: Among the original study sample of 8707 patients, there were 5810 patients with no AD or POLST in the EHR at baseline (mean age 71 [15] years; 3017 [51.9%] male). Of these, 5435 (93.5%) received an ACP intervention by 24 months: 2842 patients (52.3%) received at least 1 appointment-based intervention, and 2593 (47.7%) received only non-appointment-based interventions. After 24 months, 475 patients (16.7%) receiving any appointment-based intervention had an AD or POLST in the EHR compared with 254 (9.8%) receiving only non-appointment-based interventions (adjusted difference, 6.5 percentage points [pp]; 95% CI, 4.9-8.2%. Among patients receiving appointment-based interventions, 1143 (40.2%) had ACP discussion documentation in the EHR compared with 714 (27.5%) of patients receiving only non-appointment-based interventions (adjusted difference, 12.2 pp; 95% CI, 8.7-15.6). Appointment-based interventions were associated with more AD or POLST and documented ACP discussions than non-appointment-based interventions across all 3 ACP intervention groups.

CONCLUSIONS AND RELEVANCE: In this cohort of primary care patients with serious illness, an ACP intervention designed to engage patients and promote ACP discussions was associated with greater uptake if delivered before an office visit.

PMID:42574012 | DOI:10.1001/jamanetworkopen.2026.28366

JAMA Netw Open. 2026 Aug 3;9(8):e2628371. doi: 10.1001/jamanetworkopen.2026.28371.

ABSTRACT

IMPORTANCE: Immigrants without US citizenship, or noncitizens, disproportionately endure poverty, labor exclusions, and inadequate health care access-structural drivers of adverse cancer outcomes. While screening is critical for preventing cancer deaths, and cancer is the leading cause of death among noncitizens, little is known about citizenship status and its potential influence on cancer screening.

OBJECTIVES: To examine cancer screening inequities associated with citizenship status, evaluate whether these inequities vary across states, and determine whether structural factors mediate these inequities.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationally representative data from the National Health Interview Survey (2010-2023). Eligibility for cancer screening and the timing and types of tests considered appropriate were determined using US Preventive Services Task Force guidelines. Data were analyzed from May to August 2025.

EXPOSURE: Citizenship status: noncitizen (regardless of documentation), naturalized, or US-born.

MAIN OUTCOMES AND MEASURES: Outcomes included colorectal, cervical, or breast cancer screening. Potential mediators included socioeconomic and health care factors (eg, poverty-to-income ratio and insurance), whereas clinical factors (eg, cancer history) were considered confounders. Mediation analysis using nonlinear multiple additive regression tree models was performed to evaluate associations between citizenship status and cancer screening and to identify mediators.

RESULTS: The sample included 131 501 participants eligible for colorectal (3687 [5.1%] noncitizen, median [IQR] age, 61.1 [55.0 to 67.0] years, 39 040 [47.8%] male), cervical (6812 [10.2%] noncitizen, median [IQR] age 41.1 [30.0-52.0]), or breast (1815 [5.1%] noncitizen, median [IQR] age 60.8 [55.0-66.0]) cancer screening. In 2023, noncitizens had significantly lower colorectal (43.6%; 95% CI, 38.7%-48.4% vs 75.5%; 95% CI, 74.6%-76.5%), cervical (57.1%; 95% CI, 53.1%-61.0% vs 71.6%; 95% CI, 70.3%-72.8%), and breast (73.0%; 95% CI, 66.4%-78.7% vs 80.1%; 95% CI, 78.8%-81.3%) cancer screening rates than US-born citizens. These citizenship-based disparities were observed throughout the study period and were present in many states. Noncitizens had significantly lower odds of receiving colorectal (OR, 0.35; 95% CI, 0.32-0.38), cervical (OR, 0.41; 95% CI, 0.38-0.44), and breast (OR, 0.57; 95% CI, 0.52-0.62) cancer screenings than US-born citizens, with socioeconomic and health care factors jointly mediating these inequities (proportion mediated, colorectal cancer: 56.6%; 95% CI, 49.1%-64.2%; cervical cancer: 39.6%; 95% CI, 32.3%-47.0%; breast cancer: 97.1%; 95% CI, 87.1%-107.1%).

CONCLUSIONS AND RELEVANCE: In this nationally representative study, noncitizens had lower rates of cancer screenings, an inequity largely explained by socioeconomic barriers and inadequate health care access. Efforts to increase cancer screening and reduce preventable cancer mortality among noncitizens should focus on improving their health care access.

PMID:42574011 | DOI:10.1001/jamanetworkopen.2026.28371

JAMA Netw Open. 2026 Aug 3;9(8):e2628380. doi: 10.1001/jamanetworkopen.2026.28380.

ABSTRACT

IMPORTANCE: The cost-effectiveness of remote rehabilitation for survivors following critical illness after intensive care unit (ICU) care is unknown.

OBJECTIVE: To evaluate the cost-effectiveness of remote multicomponent rehabilitation compared with standard care following discharge from hospital after an ICU admission.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation was conducted within a pragmatic, multicenter, assessor-blinded trial comparing remote rehabilitation delivered online with standard care after discharge from ICU from both National Health Service (NHS) and Personal Social Services (PSS) and societal perspectives over a 6-month time horizon. The trial was conducted from December 2022 to November 2025. The setting was 52 NHS hospitals in the United Kingdom. Participants were adults (aged ≥18 years) within 12 weeks of discharge from hospital that included an ICU admission for critical illness, requiring mechanical ventilation for 48 hours or longer.

INTERVENTIONS: A remotely delivered rehabilitation program or standard care.

MAIN OUTCOMES AND MEASURES: Costs including using questionnaires and microcosting approach (in 2024 UK pounds sterling) and quality-adjusted life-years (QALYs), derived directly from trial data, were calculated per group and reported in terms of incremental cost per QALY gained.

RESULTS: A total of 429 participants (245 men [57%]; mean [SD] age, 55.4 [13.9] years) were enrolled, including 231 (54%) in the intervention group and 198 (46%) in the standard group. From a UK NHS-PSS perspective, the rehabilitation intervention was associated with increased mean costs (£1250; 95% CI, £562-£1938) and QALYs (0.023; 95% CI, 0.007-0.040) per participant, compared with the standard care group. Incremental cost-effectiveness ratio (ICER) was £54 034 per QALY. The probability of rehabilitation intervention being cost-effective was 3% and 11% at UK willingness-to-pay thresholds of £20 000 and £30 000 per QALY, respectively. The intervention was cost-effective for patients with mechanical ventilation for 7 days or less (ICER, £21 476 per QALY) or if a societal perspective was adopted (ICER, £6341 per QALY).

CONCLUSIONS AND RELEVANCE: In this economic analysis, among ICU survivors overall, a remotely delivered multicomponent rehabilitation program was not cost-effective from a UK NHS-PSS perspective. Cost-effectiveness was more favorable from a societal perspective and for patients receiving mechanical ventilation for 7 days or less. For rehabilitation interventions to be both clinically and cost-effective a precision medicine approach to medical and psychosocial health care interventions is needed once patients are home from hospital.

PMID:42574010 | DOI:10.1001/jamanetworkopen.2026.28380