Tag: nevin manimala

JAMA Netw Open. 2025 May 1;8(5):e258558. doi: 10.1001/jamanetworkopen.2025.8558.

ABSTRACT

IMPORTANCE: Evidence of cost savings attributable to indicated and timely care remain rare in psychiatry. Interventions to provide evidence-based psychiatric care to Medicaid patients that lower total costs of care are particularly challenging.

OBJECTIVE: To investigate Medicaid costs and care outcomes associated with use of an outpatient telepsychiatry clinic.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed Medicaid patients using and not using the services of an outpatient telepsychiatry clinic (Frontier Psychiatry, Billings, Montana) in 2022. Data analysis was performed from June to September 2024.

EXPOSURE: Receipt of care through an outpatient telepsychiatry clinic.

MAIN OUTCOMES AND MEASURES: Differences in Medicaid costs and cost subtypes between telepsychiatry patients and controls were assessed. Quality metrics, including inpatient hospitalizations, hospital readmissions, and admissions from the emergency department, were also compared.

RESULTS: In total, there were 2686 patients using the outpatient telepsychiatry clinic’s services (1665 female [62.0%]; mean [SD] age, 30.55 [14.67] years) and 2686 propensity-matched controls (1665 female [62.0%]; mean [SD] age, 31.37 [15.92] years). Across categories examined, the telepsychiatry patients had care costs per member per month (PMPM) similar to those for propensity-matched control patients ($685.5 [95% CI, $632.9-$738.2] vs $734.0 [95% CI, $645.7-$822.3]; P = .10) over the study period. PMPM costs to Medicaid from the telepsychiatry clinic’s patients were higher for professional services vs control patients ($464.0 [95% CI, $443.4-$484.5] vs $388.4 [95% CI, $368.1-$408.7]; P < .001) but were lower for inpatient hospitalization fees ($201.6 [95% CI, $146.2-$228.7] vs $260.6 [95% CI, $220.2-$341.5]; P = .04). Telepsychiatry clinic patients had a 38.0% lower mean annualized hospitalization rate per 1000 patients than controls (274.3 [95% CI, 237.1-311.6] hospitalizations per 1000 patients vs 442.6 [95% CI, 396.5-488.7] hospitalizations per 1000 patients; P < .001) and a 17.9% lower rate of admissions from the emergency department (patients vs controls, 299.7 admissions [47.7%] vs 519.0 admissions [58.1%]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 5372 patients, use of an outpatient telepsychiatry clinic’s services was associated with decreases in inpatient hospitalization rates and lower rates of admissions from the emergency department, with similar costs to Medicaid. These findings suggest that outpatient telepsychiatry care could play an important role in reducing hospital admissions among patients enrolled in Medicaid.

PMID:40323598 | DOI:10.1001/jamanetworkopen.2025.8558

JAMA Pediatr. 2025 May 5. doi: 10.1001/jamapediatrics.2025.0682. Online ahead of print.

ABSTRACT

IMPORTANCE: Parental technology use in a child’s presence (hereafter, PTU), often referred to as technoference, is a growing concern in family dynamics, and no studies have quantitatively synthesized associations with children’s health and development.

OBJECTIVE: To systematically review and synthesize literature on associations between PTU in their child’s presence and motor development, cognitive development, psychosocial health, physical activity, screen time, and sleep in early childhood.

DATA SOURCES: Peer-reviewed studies from MEDLINE, CINAHL, SPORTDiscus, PsycINFO, PsycArticles, Web of Science, Scopus, and ProQuest published from inception to July 2024.

STUDY SELECTION: A total of 6212 studies were initially identified. Studies were included if they examined associations between PTU in the presence of their apparently healthy children (birth to age 4.9 years) and motor development, cognitive development, psychosocial health, physical activity, screen time, or sleep.

DATA EXTRACTION AND SYNTHESIS: PRISMA guidelines were followed. Random-effect models were conducted to determine the pooled estimates of the associations and moderating effects of the type of exposure (distraction/interruption). The risk of bias was assessed using the JBI critical appraisal tools.

MAIN OUTCOMES AND MEASURES: Association between PTU in the child’s presence and motor development, cognitive development, psychosocial health, physical activity, screen time, and sleep.

RESULTS: Twenty-one studies involving 14 900 participants from 10 countries were included in the meta-analysis. Significant associations were found between parental technology use in the child’s presence and cognition (r = -0.14; 95% CI, -0.23 to -0.04), internalizing behavior and emotions (r = 0.13; 95% CI, 0.08 to 0.19), externalizing behavior (r = 0.15; 95% CI, 0.09 to 0.21), prosocial behavior (r = -0.08; 95% CI, -0.13 to -0.02), attachment (r = -0.10; 95% CI, -0.19 to -0.01), and screen time (r = 0.23; 95% CI, 0.13 to 0.32). No moderating effects of the type of PTU exposure on any associations were found. No study examined motor development, physical activity, or sleep.

CONCLUSIONS AND RELEVANCE: Parents’ use of technology in their child’s presence was negatively associated with cognitive and psychosocial outcomes and screen time among young children, although the effect sizes were small. Further research focusing on potential impacts on physical activity, sleep, and motor skills is needed. Understanding these associations is crucial for informing research and guidelines aimed at minimizing the potential negative effects of this phenomenon on early childhood development.

PMID:40323594 | DOI:10.1001/jamapediatrics.2025.0682

J Craniofac Surg. 2025 May 5. doi: 10.1097/SCS.0000000000011422. Online ahead of print.

ABSTRACT

PURPOSE: Temporal mandibular joint (TMJ) space volume is pivotal in upholding optimal joint function and occlusal stability. Mandibular setback surgery can impact TMJ space volume due to condylar positioning adjustments. This study aims to investigate the changes in TMJ space volume following mandibular setback surgery with intended manual condylar positioning.

METHODS: This is a retrospective study of 20 patients of class III (skeletal), who underwent Le Fort I osteotomy and BSSO surgery at the OMFS Department of PNUDH between 2015 and 2022 by one surgeon. CBCT scans were obtained preoperatively (T0) and at specified postoperative time points (T1) and (T2). The groups were categorized into group A (Total space volume), group B (non-asymmetric), and group C (asymmetric). TMJ space volume measurements were taken using CBCT imaging software. Each slice of the TMJ space was drawn manually using specialized software. The measured areas in each slice were added to determine the TMJ volumes, and the statistical analysis was done.

RESULTS: Preliminary findings from this study indicate that there was a highly significant difference in TMJ space volume between group A, group B, and group C at T0, T1, and T2 following surgery. However, there were no significant differences within the groups, which means that the intended manual condylar positioning gives stability to the TMJ joint space.

CONCLUSIONS: This study suggests that mandibular setback surgery with intended manual condylar positioning can lead to transient changes in TMJ space volume, with subsequent recovery and adaptation.

PMID:40323583 | DOI:10.1097/SCS.0000000000011422

Eur J Epidemiol. 2025 May 5. doi: 10.1007/s10654-025-01235-8. Online ahead of print.

ABSTRACT

In multi-analyst studies, several analysts use the same data to independently investigate identical research questions. Multi-analyst studies have been conducted mainly in psychology, social sciences, and neuroscience, but rarely in epidemiology. Sixteen analyst groups (24 researchers) with backgrounds mainly in statistics, mathematics, and epidemiology were asked to independently perform an analysis on the influence of marital status (never married versus cohabiting married) on cardiovascular outcomes. They were asked to use data from the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study of 140,000 persons aged 50 years and above from 28 European countries and Israel, and to provide an effect estimate, a comment on their results, and the full syntax of their analyses. In additional analyses beyond the multi-analyst approach, one group selected an exemplary regression model and varied definitions of exposure and outcome and the confounder adjustment set. Each analysis was unique. The size of the 16 datasets used for the analyses ranged from 15,592 to 336,914 observations. The effect estimates (odds ratios, hazard ratios, or relative risks) ranged from 0.72 to 1.02 (reference: cohabiting married) in strictly or partly cross-sectional analyses and from 0.95 to 1.31 in strictly longitudinal analyses. The choice of regression models, adjustment sets for confounding, and variations in the precise definition of exposure and outcome, all had only small effects on the effect estimates. The range of results was mainly due to differences from cross-sectional versus longitudinal analyses rather than to single analytical decisions each of which had less influence.

PMID:40323573 | DOI:10.1007/s10654-025-01235-8

Biodegradation. 2025 May 5;36(3):40. doi: 10.1007/s10532-025-10131-7.

ABSTRACT

Heavy metal pollution in urban freshwater, driven by anthropogenic activities, poses significant risks to aquatic ecosystems and human health due to its toxicity and persistence. Recently, urease-producing bacteria have gained attention for their ability to remove heavy metals through microbial-induced carbonate precipitation (MICP). In this study, eight urease-producing bacteria were exposed to individual solutions of zinc (Zn²⁺), cadmium (Cd²⁺), and nickel (Ni²⁺) at concentrations ranging from 0 to 6 mM to assess their resistance. Three strains-Bacillus subtilis HMZC1 (B2), Bacillus sp. HMZCSW (B6), and Comamonas sp. HMZC (B11)-survived at 4 mM and 6 mM, while most others could not tolerate 4 mM. Their urea-degrading ability was tested at different pH levels, identifying an optimal pH of 7 for MICP. Heavy metal carbonate precipitation experiments at 4 mM and 6 mM revealed that all three strains achieved > 93% removal of Zn²⁺, Ni²⁺, and Cd²⁺ within 72 h. Comamonas sp. HMZC exhibited the highest efficiency, achieving > 95% removal of certain heavy metals at 6 mM. Statistical analysis using one-way ANOVA revealed significant differences (p < 0.05) in heavy metal removal efficiencies among the strains for certain treatment conditions (Cd²⁺ and Zn²⁺ at 4 mM), although not all comparisons reached statistical significance. Scanning Electron Microscopy and X-ray Diffraction confirmed the morphology and composition of the precipitated heavy metal carbonates. Our findings demonstrate that urease-producing bacteria can effectively immobilize multiple heavy metals, highlighting the MICP process as a practical and sustainable biological approach for ecological restoration and wastewater treatment.

PMID:40323541 | DOI:10.1007/s10532-025-10131-7

Int Ophthalmol. 2025 May 5;45(1):170. doi: 10.1007/s10792-025-03553-y.

ABSTRACT

PURPOSE: We aimed to compare corneal thickness maps and ocular surface parameters with anterior segment optical coherence tomography (AS-OCT) between severe obstructive sleep apnea syndrome (OSAS) patients and healthy controls.

METHODS: The study included patients with severe OSAS and healthy subjects. Ocular surface parameters (Schirmer, Tear break-up time (TBUT)), Oxford corneal staining score(OCSS), and Ocular surface disease index (OSDI) score were evaluated, and corneal thickness maps (total and epithelial) were obtained by AS-OCT in all participants.

RESULTS: The mean ages of the control (n:30) and patient (n:30) groups were 44.80 ± 6.5 and 48.3 ± 8.9 years, respectively (p:0.09). The mean Apnea hypopnea index (AHI) in the patient group was 64.53 ± 21.25, mean body mass index (BMI) was 31.33 ± 3.66. TBUT, Schirmer tests, OCSS and OSDI score were statistically significantly different between the groups (p < 0.001, p:0.037, p < 0.001, p < 0.001, respectively). There was no significant difference between the groups in the parameters in the corneal thickness maps using OCT.

CONCLUSION: Ocular surface parameters may worsen in OSAS. There were no significant differences among groups in corneal epithelial thickness mapping using AS-OCT. Further research is needed to explore the long-term effects of the disease on corneal morphology.

PMID:40323536 | DOI:10.1007/s10792-025-03553-y

Inflammopharmacology. 2025 May 5. doi: 10.1007/s10787-025-01770-6. Online ahead of print.

ABSTRACT

This study determined the phytochemical profile and in vivo anti-arthritic potential and mechanistic effects of MeOH extract of Rhamnus prinoides. The liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS) were used in the phytochemical analysis of the extract. In the anti-arthritic assay, the rats were assigned into arthritic control, non-arthritic control, methotrexate control, and three extract-treated [100, 200, and 300 mg/kg body weight (bw)] groups. Complete Freund’s adjuvant was used to induce polyarthritis. The treatments were orally administered from day 8 post-induction of polyarthritis. The experimental animals were euthanized and blood was drawn for hematological parameter analysis on day 29. The ankle joint tissue and liver were detached and utilized in gene expression using RT-qPCR and standard antioxidant assays, respectively. One-factorial ANOVA and Tukey’s multiple comparisons were used to compute for statistical differences of the raw data. The LC-MS analysis identified phytochemicals of flavonoids, anthraquinones, lignans, and coumarins classes. Fatty acid methyl ester, benzofuran, and terpene were also detected using GC-MS. The extract significantly reduced ankle joint edema, reduced body weight loss and arthritis scores, improved elevated spleen and thymus indices, attenuated aberrant hematological parameters, lowered malonaldehyde levels, and enhanced enzymatic antioxidant activities in rats induced with polyarthritis (p < 0.05). The extract also significantly upregulated expression of I-κBα, IL-4, and IL-10 genes, as well as downregulated expression of STAT-3, NF-κB, RANKL, COX-2, TNF-α, and IL-6 genes in rats induced with polyarthritis (p < 0.05). The extract possesses phytochemicals with anti-arthritic potential and can be used as a potential lead in developing novel anti-arthritic agents.

PMID:40323528 | DOI:10.1007/s10787-025-01770-6

Jpn J Ophthalmol. 2025 May 5. doi: 10.1007/s10384-025-01208-0. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the clinical features and prognostic factors of patients with thyroid eye disease (TED) combined with myasthenia gravis (MG) at a tertiary comprehensive hospital in China during a 10-year period.

STUDY DESIGN: retrospective study.

METHODS: A case series of patients diagnosed with TED combined with MG was conducted at a tertiary general hospital over 10 years. Medical records of general conditions, clinical presentation, imaging and laboratory tests, treatment modalities, and prognostic outcomes were reviewed.

RESULTS: Twenty-three patients with TED combined with MG were found throughout the study period. The mean age was 42.57 ± 14.89 years with 10 men and 13 women. Ocular motility disorders (82.61%), diplopia (73.91%), and ptosis (73.91%) were the primary clinical manifestations, and ocular motility disorders with limited movement in all directions were common (17 eyes) (50.00%). Active (69.57%) and moderate-to-severe (82.61%) TED was common, and hyperthyroidism was the most common complication of thyroid disease (57.17%). Ocular MG was the predominant subtype of MG (86.96%). Chest CT or pathologic examination identified thymic hyperplasia in 4 patients (17.39%) and thymoma in 1 patient (4.35%). A statistically significant association was observed between smoking and an unfavorable prognosis of TED combined with MG (P<0.05).

CONCLUSIONS: MG should be taken into account in patients with TED who exhibit the following: unilateral or bilateral ptosis, ptosis in one eye and upper eyelid retraction in the other, obvious eye movement disorders without or with mild involvement of the extraocular muscles on imaging, and symptoms of morning and evening fluctuations. Ophthalmologists should refer these patients to the Department of Neurology to avoid misdiagnosis or underdiagnosis. The co-occurrence of TED and MG is rare clinically, mostly affecting young and middle-aged women, with ocular MG and hyperthyroidism as the main clinical subtype, and thymic hyperplasia or thymoma in a small percentage. Smoking is an independent risk factor for poor prognosis of TED combined with MG.

PMID:40323520 | DOI:10.1007/s10384-025-01208-0

Naunyn Schmiedebergs Arch Pharmacol. 2025 May 5. doi: 10.1007/s00210-025-04223-7. Online ahead of print.

ABSTRACT

The research aims at identifying the risk of adverse events, including acute myocardial infarction (AMI) readmission, heart failure (HF) readmission, and cardiovascular (CV) death induced by sacubitril/valsartan in patients with end-stage renal disease (ESRD) and HF. This data came from the Taiwan National Health Insurance Research Database (NHIRD). Propensity scoring (PS) matching was used. Cox proportional hazard model was applied to calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse events among the study groups. After propensity score matching, among HF + ESRD patients, 854 received sacubitril/valsartan, and the other 854 patients did not. Compared to patients who did not receive sacubitril/valsartan, patients with sacubitril/valsartan were more likely to suffer AMI readmission (aHR = 1.85, 95% CI = 1.42-2.41), HF readmission (aHR = 2.21, 95% CI = 1.93-2.55), and CV death (aHR = 1.65, 95% CI = 1.28-2.12) after matching. Patients who received sacubitril/valsartan for less than 75 days had a greater risk of AMI readmission (aHR = 2.83, 95% CI = 2.27-3.53), HF readmission (aHR = 5.36, 95% CI = 4.75-6.06), and CV death (aHR = 2.27, 95% CI = 1.81-2.85) than non-sacubitril/valsartan cohorts. However, when the patients received sacubitril/valsartan for ≥ 185 days, they had a trend toward a lower risk of AMI readmission (aHR = 0.66, 95% CI = 0.41-1.04), HF readmission (aHR = 0.84, 95% CI = 0.68-1.03), and CV death (aHR = 0.83, 95% CI = 0.55-1.24) than the non-sacubitril/valsartan cohort, although it did not reach statistical significance. This study highlights significant risks associated with sacubitril/valsartan, particularly in the short term, and the protective effect of prolonged use of sacubitril/valsartan in HF + ESRD patients.

PMID:40323509 | DOI:10.1007/s00210-025-04223-7

Fam Cancer. 2025 May 5;24(2):44. doi: 10.1007/s10689-025-00466-8.

ABSTRACT

Germline (likely-)pathogenic variants (PV) in CDH1 predispose carriers to hereditary diffuse gastric cancer and lobular breast cancer. Previous studies from the United States suggest CDH1 variant carriers have an increased risk for adenomas or sessile serrated lesions (SSL), yet data linking CDH1 PVs and colorectal neoplasia are scarce. We aimed to investigate colonoscopy findings in CDH1 PVs. Adults carrying a PV/LPV in CDH1 with ≥ 1 colonoscopy between 01/01/2004-12/31/2023 were included. Patients were sourced from the David G. Jagelman Inherited Colorectal Cancer Registries at Cleveland Clinic and the German Consortium for Familial Intestinal Cancer. 103 CDH1 PV carriers were included. Most were female (66%) and white (93.1%). The median age at first colonoscopy was 47 years. The adenoma detection rate (ADR) was 29.4% (95% CI:19.9-41.1%) in the German cohort and 48.6% (95% CI: 33.0-64.4%) in the Cleveland cohort (p = 0.055) and significantly correlated with age (< 45 years, 13.6% (95% CI: 6.40-26.7%); 45-49 years, 52.4% (95% CI: 32.4-71.7%); ≥50 years, 52.6% (95% CI: 37.3-67.5%); p < 0.001). The ADR in Cleveland was higher than the U.S. average ADR but the difference was not statistically significant (48.6% vs. 35.6%, p = 0.08), and the ADR in the German cohort (29.4%) was similar to the national German average risk screening cohort (31.3% in men, p = 0.84; 20.1% in women, p = 0.08). In our screening cohort with CDH1 PV carriers, we demonstrated an ADR of 13.5% in individuals under 45 years, similar to the ADR in patients aged 25-40 years with a family history of CRC. Overall, SSL detection rate was 9.7%. Colorectal cancer was diagnosed in 3 patients (3.2%), 2/3 with an early age of onset before the age of 50 years. This first international study provides preliminary evidence of a higher ADR in U.S. CDH1 PV carriers compared to the general population, with a high number of adenomas detected before the age of 50. This may indicate an increased CRC risk that should be explored in larger studies.

PMID:40323501 | DOI:10.1007/s10689-025-00466-8