Tag: nevin manimala

JMIR Diabetes. 2026 May 27;11:e95855. doi: 10.2196/95855.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index has demonstrated promising predictive capability in clinical studies, but its distribution characteristics across different age and sex groups in the Chinese population have not been fully characterized.

OBJECTIVE: This study aimed to describe the population-based distribution of the TyG index.

METHODS: A total of 4621 participants aged 20-80 years from the China National Health Survey were included in this study. The TyG index was calculated from fasting blood glucose and triglycerides. The age- and sex-specific distribution values of the TyG index were obtained using the percentiles method.

RESULTS: Males had higher BMI (23.32, SD 2.63 vs 22.72, SD 2.60 kg/m2), triglyceride (133.78, SD 78.07 vs 111.58, SD 61.18 mg/dL), fasting glucose (97.05, SD 11.95 vs 94.34, SD 10.46 mg/dL), and TyG index values (8.63, SD 0.54 vs 8.45, SD 0.50) than females. The TyG index of males reached its peak value at approximately 40 years of age. The lower limit percentile values for females exceeded that of males around age 50. After the age of 60, the upper limit of the distribution values in females was higher than in males.

CONCLUSIONS: This study characterized the age- and sex-specific distribution of the TyG index among Chinese adults aged 20-80 years. The results of this study contribute to a more precise assessment of glucolipid metabolism.

PMID:42201745 | DOI:10.2196/95855

JAMA Netw Open. 2026 May 1;9(5):e2614490. doi: 10.1001/jamanetworkopen.2026.14490.

ABSTRACT

IMPORTANCE: Peer support is a promising strategy to improve breastfeeding outcomes, but evidence for online formats is limited.

OBJECTIVE: To evaluate whether structured peer support delivered via video calls improves exclusive breastfeeding rates and maternal breastfeeding self-efficacy.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized clinical trial enrolled first-time mothers with low breastfeeding confidence from 4 public postnatal wards in Hong Kong from January 31, 2021, to June 30, 2024. Participants were randomly assigned (1:1) to intervention or control. The primary analysis was conducted from July 1 to 31, 2024, with final data analysis completed by December 31, 2025.

INTERVENTION: The intervention included usual postnatal care, consisting of access to lactation consultants and standard breastfeeding information from the Department of Health, plus at least 2 video call sessions with trained peer support volunteers at 10 days and 1 month post partum.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of infants who were exclusively breastfed at 6 months post partum. Secondary outcomes included exclusive breastfeeding at 1, 2, and 4 months post partum and maternal self-efficacy (measured using the Breastfeeding Self-Efficacy Scale-Short Form) at 2 and 4 months. All outcomes were analyzed on an intention-to-treat basis.

RESULTS: Among 442 participants, 224 were allocated to the intervention group and 218 were allocated to the control group. The mean (SD) maternal age was 32.4 (4.0) years (32.4 [4.2] years in the intervention group and 32.3 [3.9] years in the control group). The primary 6-month outcome did not differ significantly between groups (37 of 184 [20.1%] vs 29 of 186 [15.6%]; adjusted odds ratio [AOR], 1.57 [95% CI, 0.85-2.89]; P = .15); however, exclusive breastfeeding at 2 months (a secondary outcome) was significantly higher in the intervention group (54 of 199 [27.1%] vs 38 of 200 [19.0%]; AOR, 1.80 [95% CI, 1.08-3.01]; P = .02). Longitudinal analysis confirmed higher odds of exclusive breastfeeding in the intervention group over time, with the largest difference at 2 months. Breastfeeding self-efficacy showed significantly greater improvement in the intervention group (time × intervention interaction: β = 1.01 [95% CI, 0.21-1.81]; P = .01), with a higher score at 4 months (adjusted β, 4.65 [95% CI, 1.60-7.70]; P = .01).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, video call-based peer support did not increase exclusive breastfeeding at 6 months; however, it significantly increased exclusive breastfeeding at 2 months and improved maternal breastfeeding self-efficacy, offering a scalable model for postnatal care integration.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04621266.

PMID:42201735 | DOI:10.1001/jamanetworkopen.2026.14490

JAMA Netw Open. 2026 May 1;9(5):e2614909. doi: 10.1001/jamanetworkopen.2026.14909.

ABSTRACT

IMPORTANCE: Surveillance of postacute sequelae of SARS-CoV-2 infection (PASC) depends on diagnostic coding systems that capture fewer than one-half of affected individuals, rendering millions invisible to health systems and policymakers.

OBJECTIVE: To quantify the gap between true PASC burden and diagnostic code-based estimates, determine the proportion representing chronic disease, and characterize organ system heterogeneity and temporal trends across diverse populations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used electronic health record data from 58 hospitals and affiliated clinics in 4 US regions, from 2017 to 2025. Adults (aged ≥18 years) with laboratory-confirmed SARS-CoV-2 infection or a COVID-19 diagnosis code were included. A custom artificial intelligence algorithm, the Precision Phenotyping for Research Cohorts (P2RC), was implemented using federated infrastructure.

EXPOSURE: Laboratory-confirmed SARS-CoV-2 infection or COVID-19 diagnosis code.

MAIN OUTCOMES AND MEASURES: The primary outcomes were PASC prevalence, the proportion classified as chronic conditions, organ system distribution, and temporal trends from 2020 to 2024. χ2 Tests were used to assess organ system heterogeneity across regions, and negative binomial regression was used to model quarterly temporal trends, yielding incidence rate ratios (IRRs) with 95% CIs.

RESULTS: In this cohort study of 457 950 COVID-19 cases (mean age, 52.05 years; 275 107 [60.07%] female), the P2RC algorithm identified 74 560 PASC cases (16.28% overall; 28 585 [18.58%] in New England, 978 [19.55%] in Southeast Texas, 10 534 [22.69%] in Southern California, and 34 463 [13.64%] in Western Pennsylvania), more than 2-fold higher than the proportion identified by code-based surveillance (<7%). Of 883 International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes associated with PASC, 594 (67.27%) represented chronic or potentially chronic conditions. Of 74 560 patients with PASC, 66 587 (89.31%) developed chronic conditions requiring ongoing clinical management; this represents 14.54% of the total number of 457 950 patients with COVID-19. Substantial organ system heterogeneity was observed (χ2 = 2504.73; P < .001): New England demonstrated thyroid-predominant endocrine patterns, while Southeast Texas, Southern California, and Western Pennsylvania showed metabolic-predominant profiles. Negative binomial regression revealed increasing PASC prevalence through mid-2024 (IRR per quarter, 1.01 [95% CI, 1.00-1.01; P < .001] in New England; 1.00 [95% CI, 1.00-1.01; P < .001] in Southern California; and 1.02 [95% CI, 1.01-1.02; P < .001] in Western Pennsylvania), indicating an accumulating rather than resolving burden.

CONCLUSIONS AND RELEVANCE: In this cohort study, approximately 1 in 6 patients with COVID-19 developed PASC, and 89.31% of these patients had at least 1 chronic condition. Current diagnostic coding captured fewer than one-half of the cases, obscuring a substantial chronic disease burden. The persistently increasing prevalence through 2024 indicated an accumulating health care burden requiring investment in surveillance infrastructure and integrated care pathways.

PMID:42201733 | DOI:10.1001/jamanetworkopen.2026.14909

JAMA Netw Open. 2026 May 1;9(5):e2614919. doi: 10.1001/jamanetworkopen.2026.14919.

ABSTRACT

IMPORTANCE: Broad genomic profiling (BGP) is recommended for several types of metastatic cancer but remains underused. Over half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), where cost-containment strategies may limit access to BGP. Whether Medicare payer type and geographic region are associated with BGP use is not well established.

OBJECTIVES: To evaluate whether BGP use differs by Medicare payer type (MA vs fee-for-service Medicare [FFS]) and to characterize geographic variation in BGP use across hospital referral regions (HRRs).

DESIGN, SETTING, AND PARTICIPANTS: This nationwide retrospective cohort study used Medicare Chronic Conditions Data Warehouse claims and service records to identify beneficiaries aged 66 years or older with a new diagnosis of metastatic cancer, including bladder, breast, colorectal, endometrial, kidney, lung, melanoma, pancreatic, prostate, or thyroid, from January 1, 2020, to June 30, 2022. Data analysis was conducted from October 2024 to March 2026.

EXPOSURES: Medicare type (FFS vs MA) and HRR.

MAIN OUTCOMES AND MEASURES: The primary outcome was receipt of BGP within 2 months before through 6 months after diagnosis. Mixed-effects logistic regression models were used to estimate adjusted odds ratios (AORs) for the association between Medicare type and BGP use, controlling for demographic, clinical, and geographic factors. HRR-level variation was summarized using the median odds ratio (MOR). Subgroup analyses stratified cancers by the strength of guideline recommendations for BGP.

RESULTS: Of 254 720 Medicare beneficiaries with metastatic cancer (median age, 74 years [IQR, 70-79 years]; 141 964 female [55.7%]), 112 637 (44.2%) were enrolled in MA and 142 083 (55.8%) in FFS. Overall, 64 351 (25.3%) received BGP. FFS beneficiaries had higher BGP use than MA beneficiaries (36 633 of 142 083 [25.8%] vs 27 718 of 112 637 [24.6%]; AOR, 1.08 [95% CI, 1.06-1.10]). BGP use was more frequent among FFS vs MA beneficiaries for cancers with equivocal BGP recommendations (AOR, 1.15 [95% CI, 1.11-1.19]) and, to a lesser extent, cancers with explicit recommendations (AOR, 1.04 [95% CI, 1.02-1.07]). Adjusted BGP use varied widely across HRRs (range, 13.8%-35.9%; median, 24.5% [IQR, 21.8%-27.6%]; MOR, 1.28 [95% CI, 1.25-1.31]).

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries with metastatic cancer, BGP use differed by Medicare payer type and showed substantial regional variation. These findings highlight opportunities to improve guideline-concordant molecular testing.

PMID:42201732 | DOI:10.1001/jamanetworkopen.2026.14919

JAMA Netw Open. 2026 May 1;9(5):e2615005. doi: 10.1001/jamanetworkopen.2026.15005.

ABSTRACT

IMPORTANCE: Intellectual and developmental disabilities (IDDs) include cognitive and adaptive deficits beginning before ages 18 to 22 years. People with IDDs experience disparities in pregnancy and infant outcomes, yet little is known about how risks differ across IDD subtypes or the extent to which associated maternal health conditions contribute to these disparities.

OBJECTIVES: To evaluate the associations between maternal IDD subtypes and adverse infant outcomes and to estimate how much these associations may be explained by modifiable maternal health conditions.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed births in California from January 1, 2007, to December 31, 2021, using data from the Study of Outcomes in Mothers and Infants, which links vital statistics on births and infant deaths with maternal and infant hospital inpatient and emergency department records. All 6 435 742 singleton births with gestation between 22 and 44 weeks were included. Statistical analyses were completed on February 19, 2026.

EXPOSURES: Maternal IDD diagnoses, including autism spectrum disorder, cerebral palsy, intellectual disability, chromosomal differences, and other IDDs (eg, fetal alcohol syndrome, tuberous sclerosis, and congenital malformations), were identified from hospital records. Potential mediators included prenatal care utilization, prenatal tobacco use, preexisting chronic and neuropsychiatric conditions, and body mass index.

MAIN OUTCOMES AND MEASURES: Outcomes included neonatal intensive care unit (NICU) admission, small-for-gestational-age (SGA) birth, preterm birth (PTB) at less than 37 weeks, and very PTB at less than 32 weeks.

RESULTS: Of 6 435 742 singleton births, 4492 were to mothers with IDD diagnoses (mean [SD] maternal age at birth: IDD cohort, 29 [7] years; overall cohort, 30 [6] years). Infants born to mothers with IDD had higher risks of NICU admission (14% [628 of 4492] vs 5% [327 345 of 6 426 048]; adjusted risk ratio [ARR], 2.76 [95% CI, 2.56-2.98]), SGA birth (14% [614 of 4492] vs 9% [569 146 of 6 426 048]; ARR, 1.56 [95% CI, 1.44-1.68]), PTB (16% [717 of 4492] vs 7% [452 177 of 6 426 048]; ARR, 2.34 [95% CI, 2.18-2.51]), and very PTB (3% [122 of 4492] vs 1% [62 290 of 6 426 048]; ARR, 3.20 [95% CI, 2.66-3.86]) compared with infants born to mothers without IDD. Risks were highest for maternal diagnoses of chromosomal differences, other IDDs, and intellectual disability. Preexisting hypertension, epilepsy, and mental health conditions were associated with a substantial portion of the risk, particularly for NICU admission.

CONCLUSIONS AND RELEVANCE: In this cohort study of births in California, pregnant people with IDD diagnoses had substantially higher risks of adverse infant outcomes. Preexisting hypertension and neuropsychiatric conditions were key variables and may represent modifiable targets for preconception and prenatal intervention.

PMID:42201731 | DOI:10.1001/jamanetworkopen.2026.15005

JAMA Psychiatry. 2026 May 27. doi: 10.1001/jamapsychiatry.2026.1064. Online ahead of print.

ABSTRACT

IMPORTANCE: Although both recurrent copy number variants (rCNVs) and polygenic scores (PGSs) impart risk for psychiatric disorders, it remains unclear how they contribute jointly to this risk.

OBJECTIVE: To estimate and compare absolute risk of psychiatric disorders associated with rCNVs and PGSs, independently and jointly.

DESIGN, SETTING, AND PARTICIPANTS: This genetic association study applied data from the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) case-cohort sample of individuals born in Denmark (1981-2008) and followed up until 2015, including all individuals with a hospital diagnosis of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), schizophrenia spectrum disorder (SSD), or major depressive disorder (MDD), and a subcohort randomly drawn from the source population. Data were analyzed from September 2023 to May 2025.

EXPOSURES: Carrier status was determined at 27 autosomal rCNV loci and PGSs for psychiatric (and other) outcomes from neonatal blood samples genotyped on microarrays and summary statistics from published association studies.

MAIN OUTCOMES AND MEASURES: Absolute risks were estimated for ADHD, ASD, MDD, and SSD during follow-up using a weighted survival analysis framework, and joint effects of rCNV carriage and PGSs were assessed by fitting generalized linear models.

RESULTS: In 94 276 unrelated European-ancestry individuals (mean [SD] age at follow-up, 21.9 [7.0] years; 50 653 male [53.7%]), rCNV carriage was associated with increased risk of ASD, ADHD, and SSD but not MDD (β = 0.33; 95% CI, 0.27-0.39; β = 0.29; 95% CI, 0.23-0.35; β = 0.25; 95% CI, 0.17-0.33; and β = 0.04; 95% CI, -0.03 to 0.11, respectively); each PGS was positively associated with risk of the corresponding disorder (β = 0.14; 95% CI, 0.12-0.16; β = 0.28; 95% CI, 0.26-0.30; β = 0.28; 95% CI, 0.26-0.30; and β = 0.38; 95% CI, 0.36-0.40, respectively). PGSs identified more individuals than rCNV carriage at comparable levels of absolute risk, except for ASD. A negative interaction was observed between 16p13.11 duplication and ADHD-PGS on ADHD risk (β = -0.51; 95% CI, -0.86 to -0.16), and there was a trend toward negative rCNV-PGS interaction coefficients across aggregated rCNV groups and each of the 9 most common rCNVs (27 of 39 tests, P binomial = .01).

CONCLUSIONS AND RELEVANCE: Findings of this genetic association study highlight the complementary value of rCNVs and PGSs for risk assessment in psychiatric disorders, with indications that PGSs can stratify risk among medium- and high-impact rCNV carriers and rCNV-associated risk may, in some instances, be attenuated among individuals with low PGSs.

PMID:42201728 | DOI:10.1001/jamapsychiatry.2026.1064

JAMA Psychiatry. 2026 May 27. doi: 10.1001/jamapsychiatry.2026.1078. Online ahead of print.

ABSTRACT

IMPORTANCE: Nearly all psychopathology is inherently continuous, but both clinical practice and research often require categorical decisions (eg, treat or wait, pay for treatment or decline, enroll in study or not); therefore, thresholds are applied to continuous phenomena to guide these decisions. The most common strategy is to select cutoffs by focusing on diagnoses, but this may be unhelpful in many decisions (eg, selective prevention, choice between treatment options). This review evaluates strategies for developing thresholds for psychopathology dimensions that may enhance clinical decision-making, drawing on methods used in psychiatry, psychology, internal medicine, and health economics.

OBSERVATIONS: One strategy used extensively in neuropsychology, child psychiatry, clinical psychology, and laboratory medicine is to define multiple thresholds (eg, mild, moderate, and severe), using statistical deviance vis-à-vis the general population. A second strategy is to select thresholds in reference to functional impairment, as has been done for some psychopathology measures. A third approach, common in internal medicine but underused in psychiatry, references probability of a negative outcome (eg, mortality). A fourth option, gaining momentum in European psychiatry, is to select thresholds based on costs and benefits of a clinical action at different levels of severity or risk. Common examples of these 4 strategies are reviewed, comparing their strengths and limitations. They are relevant not only to clinical measures but also research instruments. Value judgments are inherent in approaches 2, 3, and 4; thus, selection of such thresholds requires stakeholder input. Importantly, clinicians make decisions by considering all information, and thresholds are only 1 factor.

CONCLUSIONS AND RELEVANCE: Although diagnosis-focused thresholds are sometimes valuable, the field would be served best by also considering the aforementioned alternative strategies. These approaches have been greatly underused in psychiatry, and studies are urgently needed to address this gap. Herein, recommendations are offered for this research.

PMID:42201715 | DOI:10.1001/jamapsychiatry.2026.1078

JAMA Cardiol. 2026 May 27. doi: 10.1001/jamacardio.2026.1208. Online ahead of print.

ABSTRACT

IMPORTANCE: Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is a frequent condition that can lead to significant morbidity and mortality; statins, monoclonal antibody proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, and their combination are associated with a reduced risk of VTE. The effect of bempedoic acid on VTE risk is unknown.

OBJECTIVE: To determine whether bempedoic acid is associated with a reduced risk of VTE.

DESIGN, SETTING, AND PARTICIPANTS: CLEAR Outcomes was a randomized, double-blind, placebo-controlled, cardiovascular outcomes clinical trial. Statin-intolerant individuals at high risk for or with established atherosclerotic cardiovascular disease who were aged 18 to 85 years were enrolled between December 22, 2016, and August 14, 2019, in 1250 centers across 32 countries. The statistical analysis for the present study was conducted between March 10, 2025, and February 19, 2026.

INTERVENTIONS: Participants were randomized to oral bempedoic acid, 180 mg, or placebo daily.

MAIN OUTCOMES AND MEASURES: The main outcome for this analysis was the time to first occurrence of VTE (composite of deep vein thrombosis or pulmonary embolism). The occurrences of deep vein thrombosis and pulmonary embolism were also assessed.

RESULTS: A total of 13 970 participants (mean [SD] age, 65.5 [9.0] years; 6740 [48.2%] female) were randomized, 6992 to bempedoic acid and 6978 to placebo. At the time of randomization, 275 participants (2.0%) had a history of VTE, and 1219 (8.7%) were receiving systemic anticoagulation. The participants were followed up for a median (IQR) of 40.6 (37.1-46.2) months. A total of 106 VTE events occurred (39 in the bempedoic acid group and 67 in the placebo group; hazard ratio [HR], 0.58; 95% CI, 0.39-0.86; P = .006). Findings were consistent for deep vein thrombosis (HR, 0.56; 95% CI, 0.31-0.996; P = .045) and pulmonary embolism (HR, 0.61; 95% CI, 0.37-0.996; P = .046).

CONCLUSIONS AND RELEVANCE: Treatment with bempedoic acid among participants with statin intolerance at high risk for or with established cardiovascular disease was associated with a reduced risk of VTE.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02993406.

PMID:42201706 | DOI:10.1001/jamacardio.2026.1208

Infant Ment Health J. 2026 Jul;47(4):e70102. doi: 10.1002/imhj.70102.

ABSTRACT

Sex chromosome trisomies (SCTs) are genetic conditions caused by the presence of an additional sex chromosome. While recent studies have focused on analyzing the early competencies of children with SCTs, relatively few have investigated aspects of parent-child interaction. No studies have yet examined how parents support the development of children with SCTs. This study aims to (1) identify differences in supportive parenting behaviors between mothers of children with SCTs and mothers of typically developing (TD) children, and (2) observe these behaviors longitudinally at 8 months (T1) and 24 months (T2). Participants included 36 Italian mother-child dyads (19 with SCTs and 17 TD). At both T1 and T2, ten-minute semi-structured play interactions were video-recorded and coded using PICCOLO. At 8 months, mothers in the SCT group demonstrated fewer responsive and teaching behaviors than mothers in the TD group, and exhibited fewer encouraging behaviors at 24 months. However, longitudinally, the same mothers exhibited significantly more responsive and teaching behaviors at T2 than at T1. In conclusion, while awareness of their children’s condition, or differences in children’s behavior, may affect how mothers interact with their children with SCTs, these mothers also exhibit parenting skills that could benefit from targeted interventions to support their children, who are more likely to exhibit developmental delays.

PMID:42201645 | DOI:10.1002/imhj.70102

Radiol Med. 2026 May 27. doi: 10.1007/s11547-026-02224-x. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the feasibility of deriving coronary artery calcium (CAC) scores from Virtual-Non-Contrast (VNC) reconstructions obtained with dual-layer computed tomography (DLCT).

METHODS: A retrospective study was conducted on 100 patients who underwent coronary computed tomography angiography (CCTA) with a DLCT scanner. Conventional true non-contrast (TNC) images were reconstructed for CAC quantification (CAC_TNC). Post-contrast spectral datasets were processed to generate VNC reconstructions, and a 130 HU threshold was applied to calculate the volume of coronary calcified plaques (VOL_VNC). CAC values from VNC images (CAC_VNC) were derived through linear regression analysis. Correlation and agreement between CAC measurement methods were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Patients were assigned to risk categories according to Coronary Artery Calcium Data and Reporting System (CAC-DRS) to evaluate potential misclassifications.

RESULTS: The median CAC_TNC was 95 Agatston Unit (AU) [IQR:1-309], while the median CAC_VNC was 76 AU [IQR:0-340], with no statistically significant difference between the two methods (p = 0.653). An excellent correlation was found between CAC_TNC and CAC_VNC (ICC = 0.977), with good agreement demonstrated by Bland-Altman analysis, showing a mean difference of – 1.2 AU. CAC_VNC led to misclassification in 16% of patients, primarily underestimating the CAC-DRS risk category, yet maintaining strong agreement with CAC_TNC derived risk stratification.

CONCLUSIONS: VNC reconstructions from DLCT show excellent correlation and good agreement with conventional TNC images for CAC quantification. This approach has the potential to eliminate the need for a dedicated unenhanced scan, thereby reducing radiation exposure, and acquisition time while preserving diagnostic accuracy.

PMID:42201643 | DOI:10.1007/s11547-026-02224-x