Tag: nevin manimala

JAMA Netw Open. 2025 Apr 1;8(4):e253435. doi: 10.1001/jamanetworkopen.2025.3435.

ABSTRACT

IMPORTANCE: Large regional variations in outcomes after out-of-hospital cardiac arrest (OHCA) exist.

OBJECTIVE: To assess whether neighborhood rurality or economic deprivation where an OHCA occurred is associated with variation in emergency medical services (EMS) outcomes after OHCA.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data collated by ESO Inc on US adult patients (aged ≥18 years) with nontraumatic OHCA receiving chest compressions or defibrillation from EMS between January 1, 2022, and December 31, 2023.

EXPOSURES: Rurality was assessed using Rural-Urban Commuting Area codes. Deprivation was assessed using the Area Deprivation Index. Both were derived from US Census data and grouped by EMS agency.

MAIN OUTCOMES AND MEASURES: Outcomes were restoration of spontaneous circulation (ROSC) at emergency department (ED) arrival, survival to hospital discharge, and favorable discharge destination. Discharge outcomes were only available for patients transported to hospitals using health data exchange. Generalized estimating equations were used to account for correlated data.

RESULTS: A total of 162 289 patients with OHCA had resuscitation attempted (median [IQR] age, 66 [53-76] years; 62.3% male). Overall, 28.1% of these patients lived in rural or suburban locations, 12.3% lived in areas with high deprivation, 18.7% had a first rhythm of ventricular tachycardia or ventricular fibrillation or shockable by automated external defibrillator rhythm, and 27.6% received bystander cardiopulmonary resuscitation. The mean (SD) EMS response time was 8.7 (5.6) minutes. Upon arrival at the ED, 23.7% of patients had ROSC. Compared with OHCAs in urban areas with low deprivation, those in rural areas with high deprivation (adjusted odds ratio [AOR], 0.81; 95% CI, 0.72-0.91), moderate deprivation (AOR, 0.75; 95% CI, 0.70-0.81), or low deprivation (AOR, 0.74; 95% CI, 0.62-0.88) had lower odds of ROSC at ED arrival. Among patients transported to hospitals using health data exchange, OHCAs in urban areas with high or moderate deprivation had lower odds of survival (AOR, 0.78 [95% CI, 0.68-0.90] and 0.82 [95% CI, 0.75-0.89], respectively) and favorable discharge destination (AOR, 0.65 [95% CI, 0.53-0.79] and 0.77 [95% CI, 0.69-0.87], respectively).

CONCLUSIONS AND RELEVANCE: In this cohort study, OHCAs in rural areas of all levels of economic deprivation were associated with less ROSC at ED arrival vs urban areas with low deprivation, and OHCAs in urban areas with high or moderate deprivation are associated with less survival and less favorable discharge destination, suggesting worse neurologic outcomes. Care improvements alone may not reduce geographic differences in outcomes after OHCA.

PMID:40232722 | DOI:10.1001/jamanetworkopen.2025.3435

JAMA Netw Open. 2025 Apr 1;8(4):e255033. doi: 10.1001/jamanetworkopen.2025.5033.

ABSTRACT

IMPORTANCE: Although patients enrolled in trials have superior survival outcomes compared with those in routine practice, it is unknown whether such differences extend to contact days, a measure of time toxicity.

OBJECTIVE: To evaluate differences in contact days for patients with advanced stage non-small cell lung cancer (NSCLC) receiving care in trials or routine practice.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective, matched cohort study assessed adults from Ontario, Canada, who were diagnosed with advanced-stage NSCLC between January 1, 2010, and December 31, 2017, and who died between January 1, 2010, and December 31, 2019. The maximum follow-up time from diagnosis was 2 years. Data analysis was performed from May 5, 2024, to October 22, 2024.

EXPOSURE: Patients receiving specific, systemic, palliative-intent, cancer-directed drug(s) as part of a trial were matched 1:1 with patients who received the same drug(s) after approval in routine practice in the same line of treatment.

MAIN OUTCOMES AND MEASURES: Contact days (days with in-person health care contact) were identified through administrative claims data. Models were fitted with cubic splines to describe trajectories of weekly percentage of contact days.

RESULTS: Of the 250 patients (mean [SD] age, 63.6 [9.2] years; 140 [56.0%] male), 125 were trial participants and 125 were receiving care in routine practice. Trial participants were younger (median [IQR] age, 63 [56-69] years vs 64 [58-70] years in routine care patients; standardized difference, 0.21) and had fewer comorbidities (eg, hypertension [45 (36.0%) vs 59 (47.2%); standardized difference, 0.23]). Median (IQR) contact days from diagnosis to death were higher for trial participants compared with those in routine practice (79 [62-104] vs 68 [46-98] days; standardized difference, 0.26). However, trial participants had a longer median (IQR) overall survival (eg, 12.8 [8.7-18.0] vs 10.5 [5.2-14.7] months; standardized difference, 0.46) and a slightly lower median percentage of contact days after adjusting for survival (20.3% [95% CI, 18.1%-21.7%] vs 21.2% [95% CI, 19.3%-25.7%]). During treatment, trial participants experienced a lower median percentage of contact days (18.4% [95% CI, 16.3%-20.8%] vs 25.5% [95% CI, 20.7%-30.3%]); inpatient care accounted for 18.5% (95% CI, 11.1%-29.6%) of on-treatment contact days for trial participants vs 40.0% (95% CI, 30.0%-47.6%) in routine practice. Normalized contact-day trajectories were U-shaped for all groups, with lower peaks and troughs among trial participants.

CONCLUSIONS AND RELEVANCE: In this population-based cohort study, patients receiving systemic therapy as part of trials experienced a lower percentage of contact days, accounted for by greater hospitalization rates in routine practice. Addressing the predominantly outpatient, protocol-mandated visits may represent opportunities to decrease trial-related time toxicity.

PMID:40232720 | DOI:10.1001/jamanetworkopen.2025.5033

JAMA Netw Open. 2025 Apr 1;8(4):e255047. doi: 10.1001/jamanetworkopen.2025.5047.

ABSTRACT

IMPORTANCE: Health-related social risks are increasingly recognized as important contributors to health. Compared with individual screening, neighborhood measures are potentially a lower cost, scalable strategy for identifying social risk.

OBJECTIVE: To inform health resource planning and social risk screening strategies by comparing self-reported vs neighborhood-level social risk with inpatient, emergency department (ED), and outpatient care.

DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of self-reported social risks measured during Medicaid enrollment and neighborhood-level social risk in relation to health care use was conducted. Members of Kaiser Permanente Northern California, a large integrated health care delivery system, who completed the Medicaid Integrated Outcomes Questionnaire from January 1, 2018, to February 29, 2020, were included. Analysis took place from January 8 to November 29, 2024.

EXPOSURE: Neighborhood-level social risk (living in the least-resourced Neighborhood Deprivation Index quartile) and self-reported social risk (indicating a need or wanting help with finances, food, housing, or transportation domains).

MAIN OUTCOMES AND MEASURES: Hospital and ED admissions, primary care, specialty care, mental health, and social work visits in the year prior to questionnaire completion. Multivariable negative binomial regression models were analyzed for each type of health care use, controlling for demographic characteristics and several health conditions (eg, asthma, hypertension, and chronic pain).

RESULTS: Among 13 527 respondents (8631 [63.8%] female; 5289 [39.1%] aged 25-44 years; 2846 [21.0%] Asian, 1986 [14.7%] Black or African American, 3040 [22.5%] Hispanic, 4602 [34.0%] White, and 1053 [7.8%] other race or ethnicity), 33.8% in the most-resourced neighborhood reported at least 1 social risk vs 40.1% in the least-resourced quartile (P < .001). Individual- and neighborhood-level measures were each associated with ED visits (marginal effect estimate for both measures: 0.23; 95% CI, 0.17-0.29). Neither measure was associated with hospital admissions. Individual risk was associated with greater use of all outpatient services (ranging from primary care visit marginal effect estimate: 0.22; 95% CI, 0.13-0.31 to mental health visit marginal effect estimate: 1.21; 95% CI, 0.67-1.75). Neighborhood-level risk was not associated with most outpatient visits and was negatively associated with mental health visits.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, associations were found for hospital and ED use but not outpatient visits, especially mental health visits. These findings suggest that individual social risk screening appears to provide distinct information compared with neighborhood social risk.

PMID:40232719 | DOI:10.1001/jamanetworkopen.2025.5047

JAMA Netw Open. 2025 Apr 1;8(4):e255253. doi: 10.1001/jamanetworkopen.2025.5253.

ABSTRACT

IMPORTANCE: Unlike convenience, cost, and quality, camaraderie with other similar patients has not been reported as a prominent patient consideration when choosing a health care system or practitioner. As the Veterans Affairs (VA) Health System expands choice of practitioners for its enrollees, it is important to identify ways to promote veteran camaraderie in community care settings.

OBJECTIVE: To determine whether camaraderie with other veterans is important to veterans using the VA Health System.

DESIGN, SETTING, AND PARTICIPANTS: In 2019, a web-based survey was administered to veterans who reported using VA health care. The survey included questions about cultural factors, such as camaraderie, practitioners’ understanding of veterans, trust of VA caregivers, and a scenario-based question to ascertain whether veterans would choose VA or private health care if cost and distance were equivalent. Data analysis was performed from November 2024 to January 2025.

EXPOSURE: Using the VA health care system.

MAIN OUTCOMES AND MEASURES: The primary outcome was the importance of camaraderie in selecting a health care system or practitioner, measured as the percentage of veterans who reported positive ratings on relevant survey items.

RESULTS: In this survey study of 652 veterans, the majority were male (486 veterans [74.54%]). Respondents were categorized into 3 age groups: 18 to 34 years (246 veterans [37.73%]), 35 to 64 years (320 veterans [49.08%]), and 65 years and older (86 veterans [13.19%]). In total, 52.41% of respondents rated camaraderie and being around other veterans as important; this increased to 75.88% among veterans aged 18 to 34 years and to 65.35% for those aged 35 to 64 years. For those aged 65 years and older, only 35.75% felt it was important. When asked whether they would choose VA or a private sector health system if cost and travel distance were equal, 69.00% of respondents indicated they would choose VA. The risk-adjusted model demonstrated those who valued being around veterans at VA were 2.24 times more likely (95% CI, 1.81-2.77) to choose VA.

CONCLUSIONS AND RELEVANCE: In this survey study of 652 veterans, camaraderie was important to most of these VA Health System users, especially younger veterans. As VA provides more choice of practitioners to its enrollees, it will be important to consider ways to preserve veterans’ ability to affiliate with other veterans in community care settings, especially for younger veterans who are often challenged in transitioning from military service to civilian life.

PMID:40232718 | DOI:10.1001/jamanetworkopen.2025.5253

JAMA Netw Open. 2025 Apr 1;8(4):e255258. doi: 10.1001/jamanetworkopen.2025.5258.

ABSTRACT

IMPORTANCE: Federally qualified community health centers (FQHCs) are potential partners in the quest to increase diversity in clinical trials. Despite this opportunity, there is limited knowledge about FQHC engagement in clinical trials.

OBJECTIVE: To assess levels of FQHC engagement in hypertension and type 2 diabetes (T2D) clinical trials and identify FQHC characteristics associated with engagement in the US.

EVIDENCE REVIEW: Six literature databases were searched for protocols and reports of clinical trials addressing hypertension or T2D among adults at FQHCs in the US, published between January 1, 2013, and November 6, 2023. Guided by a framework on community-engaged research, 4 levels of FQHC engagement in clinical trials were defined, ranging from level 1 (FQHC informed) to level 4 (FQHC driven). An ordinal regression analysis was conducted to investigate the association between FQHC organizational and patient demographic characteristics and levels of engagement in hypertension and T2D clinical trials using the publicly available data from Uniform Data System (UDS) for all identifiable FQHCs.

FINDINGS: The initial literature search identified 4552 articles. Following deduplication, title and abstract screening, full-text review, data extraction, and matching with available information in UDS, a total of 33 clinical trials were included. Together, these clinical trials engaged 67 FQHCs. In most cases, FQHC engagement occurred at level 1 (15 clinical trials engaging 19 FQHCs) or level 2 (8 clinical trials engaging 38 FQHCs). A higher ratio of full-time equivalent physicians to patients was associated with 54% (odds ratio [OR], 1.54; 95% CI, 1.06-2.23) higher odds of having a higher level of FQHC engagement in hypertension and T2D clinical trials. A higher ratio of full-time community and patient education specialists to patients was associated with 41% (OR, 1.41; 95% CI, 1.03-1.94) higher odds of having a higher level of FQHC engagement in hypertension and T2D clinical trials.

CONCLUSIONS AND RELEVANCE: In this systematic review of FQHC engagement in clinical trials, lower levels of engagement in hypertension and T2D clinical trials were found. Further research is required to identify clinical trial design and implementation strategies that promote FQHC participation in clinical trials and research capacity building.

PMID:40232717 | DOI:10.1001/jamanetworkopen.2025.5258

JAMA Netw Open. 2025 Apr 1;8(4):e255264. doi: 10.1001/jamanetworkopen.2025.5264.

ABSTRACT

IMPORTANCE: In September 2023, the Singapore Ministry of Health revised the national personal protective equipment (PPE) guideline for health care personnel (HCP) attending to suspected or confirmed patients with COVID-19, recommending the use of N95 respirators alone. However, data on the associations between PPE deescalation, staff COVID-19 incidence, and sustainability outcomes are limited.

OBJECTIVE: To evaluate the associations between PPE deescalation guidelines on staff COVID-19 incidence and the environmental sustainability outcomes of the measure.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective quality improvement study of hospital PPE usage using data from Tan Tock Seng Hospital and the National Centre for Infectious Diseases (NCID), analyzing monthly COVID-19 incidence rates among HCP (all medical staff, allied health care workers, ancillary staff, and administrative staff from the hospital campus) and in the community over 12 months before and after PPE deescalation measures (October 2021 to September 2022 and October 2022 to September 2023).

MAIN OUTCOMES AND MEASURES: COVID-19 incidence rates among HCP and in the community; economic and environmental outcomes of removing single-use gowns from routine COVID-19 care, including reductions in carbon footprint, plastic waste generation, and cost savings.

RESULTS: The mean (SD) monthly number of HCP was 10 774 (79) (range, 10 636-10 891) preimplementation and 11 099 (200) (range, 10 864-11 449) postimplementation. Our analysis revealed PPE deescalation was not associated with an increase in monthly COVID-19 infections among hospital staff, with the trends aligning with population infection rates. The median (IQR) staff COVID-19 infection rate relative to the community COVID-19 infection rate was 2.6 (1.9-3.6) preimplementation compared with 1.5 (0.9-3.1) postimplementation. An estimated 4 gowns per patient-day were saved, totaling 440 532 gowns over 12 months. This equated to an estimated reduction in health care costs by SGD 453 748 (approximately USD 333 970) and reductions of 398 681.46 kg carbon dioxide equivalent in carbon emissions and 66 080 kg of plastic waste.

CONCLUSIONS AND RELEVANCE: This quality improvement study of hospital PPE usage observed that the national PPE deescalation guidelines corresponded with the reductions in protective gown use, associated costs, carbon footprint, and plastic waste generation with no apparent compromise to staff safety and health.

PMID:40232716 | DOI:10.1001/jamanetworkopen.2025.5264

JAMA Netw Open. 2025 Apr 1;8(4):e255322. doi: 10.1001/jamanetworkopen.2025.5322.

ABSTRACT

IMPORTANCE: Screening mammography promotes early detection of breast cancer and is associated with reduced breast cancer mortality. Screening history prior to diagnosis may impact stage at diagnosis and breast cancer mortality but has not been comprehensively examined within a diverse US cohort.

OBJECTIVE: To determine whether having a prior screening is associated with earlier stage at breast cancer diagnosis and lower breast cancer-specific mortality.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used linked Surveillance, Epidemiology, and End Results-Medicare data of women aged at least 70 years, diagnosed with estrogen receptor-positive or human epidermal growth factor receptor 2-negative breast cancer from 2010 to 2017, and enrolled in fee-for-service Medicare Parts A and B from 5 years prior to through 1 year after diagnosis. Data were analyzed from March 1 to September 18, 2024.

EXPOSURE: Presence of 1 or more screening mammograms during the 5 years prior to the mammogram at breast cancer diagnosis.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were stage of breast cancer at diagnosis, dichotomized into very early (T1N0) vs later stage (T2+ or N1+) and breast cancer-specific mortality.

RESULTS: Among 13 028 included women, most had at least 1 prior screening (10 094 women [77.5%]) and were aged between 70 and 79 years (9034 women [69.4%]) and not dual-eligible for Medicare and Medicaid (11 475 women [88.1%]). Additionally, 3812 women (29.3%) were diagnosed with later-stage disease (T2+ or N1+) at the time of diagnosis. In multivariable analyses, prior screening was associated with 54% lower odds of later-stage breast cancer diagnosis (adjusted odds ratio, 0.46; 95% CI, 0.42-0.50) and 36% lower hazard of breast cancer-specific death (adjusted hazard ratio, 0.63; 95% CI, 0.52-0.76) compared with no prior screenin. In the adjusted Cox proportional hazards model, having 3 or 4 prior screenings was associated with 37% reduced hazard of breast cancer-specific mortality compared with having 1 prior screening (adjusted hazard ratio, 0.63; 95% CI, 0.44-0.89).

CONCLUSIONS AND RELEVANCE: In this cohort study of older women with screen-detected estrogen receptor-positive or human epidermal growth factor receptor 2-negative breast cancer, prior screening mammography was associated with earlier stage at breast cancer diagnosis and lower breast cancer mortality. These findings support the potential for routine screening to improve breast cancer outcomes. As with all observational studies, this study is limited by the potential effects of other differences between the screening and nonscreening groups.

PMID:40232715 | DOI:10.1001/jamanetworkopen.2025.5322

J Vis. 2025 Apr 1;25(4):5. doi: 10.1167/jov.25.4.5.

ABSTRACT

Visual search is a fundamental natural task for humans and other animals. We investigated the decision processes that humans use in covert (single fixation) search with briefly presented displays having well-separated potential target locations. Performance was compared with the Bayesian-optimal decision process under the assumption that the information from the different potential target locations is statistically independent. Surprisingly, humans performed slightly better than optimal, despite humans’ substantial loss of sensitivity in the fovea (“foveal neglect”) and the implausibility of the human brain replicating the optimal computations. We show that three factors can quantitatively explain these seemingly paradoxical results. Most importantly, simple and fixed heuristic decision rules reach near optimal search performance. Second, foveal neglect primarily affects only the central potential target location. Finally, spatially correlated neural noise can cause search performance to exceed that predicted for independent noise. These findings have broad implications for understanding visual search tasks and other identification tasks in humans and other animals.

PMID:40232706 | DOI:10.1167/jov.25.4.5

J Community Psychol. 2025 Mar;53(3):e70008. doi: 10.1002/jcop.70008.

ABSTRACT

Interest in resilience at both the individual and group levels is increasing in response to disasters. The Conjoint Community Resiliency Assessment Measure-10 (CCRAM10), actively utilized in disaster-related research, is a shortened 10-item scale developed to measure community resilience. This study aims to explore the factor structure of CCRAM10 and to verify its measurement invariance. Data were collected from 1200 Korean adults, and factor analysis along with measurement invariance for gender and age groups was conducted. The analysis indicated that, like the original scale, CCRAM10 appropriately consists of five subfactors and has secured measurement invariance, confirming its usefulness for community resilience research.

PMID:40232685 | DOI:10.1002/jcop.70008

Indian J Gastroenterol. 2025 Apr 15. doi: 10.1007/s12664-025-01770-y. Online ahead of print.

ABSTRACT

BACKGROUND: Disorders of gut-brain interaction (DGBIs) constitute a global health challenge. Overlapping DGBIs amplify the clinical severity and have a profound impact on health-related quality of life (HRQoL) and somatization. Data on the prevalence and overlap of all individual DGBIs and their clinical ramifications remains limited. This study sought to elucidate these aspects within a northern Indian tertiary healthcare setting.

METHODS: This prospective cross-sectional study enrolled patients meeting Rome IV criteria for DGBIs and healthy controls (HC). Participants underwent elaborative assessments, including socio-demographic profiling, HRQoL evaluation (PROMIS Global-10) and somatization quantification (PHQ-12). Statistical analyses compared prevalence rates, overlap patterns and associated clinical outcomes between various groups.

RESULTS: Of the 2538 patients screened, 1044 (41.1%) with DGBIs (age 41.7 ± 12.6 years, 51.9% males) were enrolled; along with 1021 age and gender-matched HCs. Most common gastrointestinal region involved was gastroduodenal (49.9%), followed by bowel (39.7%) and esophageal (33.3%). Most common DGBIs were functional dyspepsia (FD; 44.4%), functional esophageal disorders (FEsD;32.4%), functional constipation (FC;18%), irritable bowel syndrome (IBS;16.1%). Overlapping DGBIs were present in 40.3% patients, with FD-FEsD (23.9%) and FD-FC(22.1%) and FD-IBS (52;12.4%) overlaps being the most common. Compared to HC, DGBI patients had significantly poorer HRQoL scores (19.1 ± 0.7 vs. 13.52 ± 3.39; p < 0.001) and significantly increased somatization scores (2.5 ± 1.7 vs. 18.5 ± 0.7; p < 0.001). Further, patients with overlapping DGBIs had significantly poorer HRQoL and significantly increased somatization scores compared to non-overlapping counterparts.

CONCLUSIONS: This study provides novel data on the clinical burden and the entire spectrum of overlapping and non-overlapping DGBIs, while studying their impact on HRQoL and somatization. DGBI patients had significantly poorer HRQoL and heightened somatization compared to HCs; with further detriments observed in those with overlapping DGBIs. These findings emphasize the need for an integrated multidisciplinary approach for the evaluation of possible overlaps and for assessment of HRQoL in all patients with DGBIs to improve clinical outcomes.

PMID:40232666 | DOI:10.1007/s12664-025-01770-y