Tag: nevin manimala

Am J Manag Care. 2025 Sep;31(9):457-461. doi: 10.37765/ajmc.2025.89786.

ABSTRACT

OBJECTIVE: To evaluate the relationship between the frequency of routine primary care visits and total health care expenditures among commercially insured adults.

STUDY DESIGN: Retrospective cross-sectional statistical analysis of a nationally representative data set of health care utilization and expenditures over a 2-year period.

METHODS: We used multivariate regression analysis to evaluate the association between the annualized number of visits with a primary care physician for routine care and total health care expenditures for commercially insured adults younger than 65 years, adjusting for underlying clinical complexity measured through risk scoring. Data were drawn from information collected by the Agency for Healthcare Research and Quality between 2021 and 2022.

RESULTS: For a sample cohort of 3879 participants, more frequent primary care visits were associated with incremental reductions in expenditures only for participants with high underlying clinical complexity. A relative risk level of approximately 2 times the average commercially insured adult was identified as an inflection point, above which cost reductions vs counterfactual prediction were observed, up to a limited number of visits.

CONCLUSIONS: Our results show a relationship between primary care visit frequency and health care expenditures with similar directionality and risk dependency as has been observed in other studies for Medicare-insured adults. This finding suggests that certain commercial populations may benefit from risk-stratified, high-touch primary care models like those being employed for some Medicare populations. The health care cost reduction benefits of these models appear premised more on clinical need than coverage type. Demonstrating this relationship is useful for health care providers, insurers, and policy makers who are developing advanced primary care models.

PMID:40966635 | DOI:10.37765/ajmc.2025.89786

Europace. 2025 Sep 1;27(9):euaf156. doi: 10.1093/europace/euaf156.

ABSTRACT

AIMS: Catheter ablation is the standard treatment for symptomatic atrial fibrillation (AF) and can be performed under general anaesthesia (GA) or varying levels of sedation to optimize patient comfort and lesion formation. However, the effect of different anaesthesia strategies on AF recurrence rates remains uncertain.

METHODS AND RESULTS: We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomized controlled trials (RCTs) and observational studies comparing outcomes of catheter ablation under GA vs. sedation (including deep, moderate, and conscious sedation). We pooled risk ratios (RR) with 95% confidence intervals (CI) with a random effects model. R version 4.4.1 was used for statistical analyses. Our systematic review and meta-analysis included 6 RCTs and 17 observational studies, corresponding to 12 302 patients assigned to either sedation (n = 8952) or GA (n = 3350). There was no difference in recurrence of atrial tachyarrhythmias (ATAs) between groups (RR 1.15; 95% CI 0.97-1.36; P = 0.10; 95% prediction interval 0.66-2.01). There was no significant subgroup interaction in the recurrence of AF according to sedation type (conscious vs. mild vs. moderate sedation vs. deep sedation) (P = 0.20) or AF type (persistent AF vs. non-persistent) (P = 0.20).

CONCLUSION: In patients undergoing catheter ablation for AF, there was no significant difference in recurrence of ATA between GA and sedation.

PMID:40966626 | DOI:10.1093/europace/euaf156

Europace. 2025 Sep 1;27(9):euaf152. doi: 10.1093/europace/euaf152.

ABSTRACT

AIMS: Persistent atrial fibrillation (AF) patients undergoing a catheter ablation are at risk for adverse outcomes, due to comorbidities and a more advanced arrhythmia substrate. There may be barriers to catheter ablation in patients with persistent AF, compared to those with paroxysmal AF. We compared long-term outcomes after ablation in patients with paroxysmal and persistent AF.

METHODS AND RESULTS: Patients undergoing de novo AF catheter ablation from April 2012 to March 2022 in Ontario, Canada, were included. The primary outcome was a composite of all-cause mortality and all-cause hospitalization. Inverse probability of treatment weighting created balanced cohorts of paroxysmal and persistent AF patients. Cox proportional hazards models estimated the effect on persistent vs. paroxysmal AF. There were 10 788 patients who underwent an ablation. Persistent AF patients accounted for 25% of the population. In our weighted cohort, patients had similar age (standardized difference 0.027), female sex [standardized difference (SD) 0.018], and medical comorbidities (Charlson comorbidity score; 0.5% in both, SD 0.018). In the weighted cohort, the primary composite outcome occurred in 5.5% in paroxysmal AF and 6.3% in persistent AF at 30 days (HR 1.15, 95% CI 0.94-1.40, P = 0.168), 19.8% vs. 19.7% at 1 year (HR 1.00, 95% CI 0.90-1.11, P = 0.971), and 34.1% vs. 35.4% at 3 years (HR 1.05, 95% CI 0.97-1.13, P = 0.269). There was no increased risk of the individual components at 30 days, 1 year, or 3 years.

CONCLUSION: The risk of all-cause mortality and hospitalization outcomes in persistent and paroxysmal AF patients undergoing ablation was similar at 30 days, 1 year, and 3 years post-ablation. The impact of persistent AF on long-term outcomes (i.e. all-cause mortality) is primarily attributable to comorbid conditions.

PMID:40966624 | DOI:10.1093/europace/euaf152

JMIR Res Protoc. 2025 Sep 18;14:e73927. doi: 10.2196/73927.

ABSTRACT

BACKGROUND: Everyday life has changed since the COVID-19 pandemic. Existing health disparities among underserved communities have been exacerbated. Latino and Native Hawaiian and Pacific Islander (NHPI) populations disproportionately experience health disparities, even when compared to other minority populations. Both populations have heart disease, cancer, and diabetes as the leading causes of death, and both have high rates of obesity. As we recover from the pandemic, we must consider the intersection of continued health disparities, new social norms and attitudes, and new patterns of health behavior.

OBJECTIVE: The overarching goal of this project is to reduce health disparities among Latino and NHPI populations, considering new health behavior patterns, social norms, and increased technology use. The research project-specific aims are to (1) conduct key informant interviews and focus groups among Latino and NHPI populations; (2) develop and implement a community health and health behavior survey; and (3) co-design, develop, and test new technology that is meaningful and responsive to community needs and preferences.

METHODS: Using community-based participatory research (CBPR) and mixed methods approaches, the interdisciplinary research team will develop new technology based on community insights (key informant interviews, focus groups, and a community health survey). With our community liaisons, we will recruit adult (18+ years old) Latino and NHPI community members from the northern region in San Diego County (ie, Oceanside, San Marcos, and Escondido), largely from culturally related groups and organizations, such as dance schools (hālaus) and churches. Qualitative data will be analyzed using directed content analysis, and quantitative data will be analyzed using descriptive and multivariate statistics. The main outcomes include the identification of community health needs, culturally appropriate interventions, desired modality of intervention strategies, and acceptability of the technology. We expect the new technology to be focused on mobile health (mHealth) smartphone apps. Components will likely include strategies to improve obesity-related health behaviors and mental health.

RESULTS: This study received funding from the National Institute of General Medical Sciences in April 2022 as part of the Support for Research Excellence (SuRE) Program (R16). Key informant interviews and focus groups were completed in July 2023. Community health surveys were completed in August 2024. The development of the beta mHealth app began in September 2024 in partnership with California State University San Marcos (CSUSM) computer science students. Beta testing and evaluation will be completed by December 2025. The qualitative findings, identifying themes for a new mHealth app, were published in June 2025.

CONCLUSIONS: A major strength of this study is that it works with the communities of intended impact to directly inform new innovations to promote health behaviors. This study includes unique partnerships and an interdisciplinary team of researchers, students, community members, and consultants/collaborators to inform practices that can impact health disparities among Latino and NHPI populations with technology and strategies that are innovative and effective.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/73927.

PMID:40965967 | DOI:10.2196/73927

Sci Prog. 2025 Jul-Sep;108(3):368504251381584. doi: 10.1177/00368504251381584. Epub 2025 Sep 18.

ABSTRACT

ObjectiveSoft tissue sarcomas (STSs) are rare, heterogeneous tumors of mesenchymal origin that arise from muscle, fat, fibrous tissue, blood vessels, nerves, and connective tissue. They pose significant diagnostic and therapeutic challenges, and limited data exist on their epidemiology and outcomes in sub-Saharan Africa. This study assessed the clinicopathological characteristics and one-year survival of patients with STSs managed at a tertiary facility in Tanzania.MethodsA retrospective cohort review was conducted of medical records from January 2019 to April 2023. Data included patient demographics, tumor site, histological subtype, grade, stage at diagnosis, treatment modalities, and follow-up. Survival was estimated using Kaplan-Meier analysis, and Cox proportional hazards regression was applied to identify predictors of one-year survival.ResultsNinety-six cases were analyzed. Males constituted 54.2% of patients, and the majority (70.8%) were aged 15-64 years. Rhabdomyosarcoma was the most frequent histological type (34.4%), followed by sarcoma not otherwise specified (28.1%). Surgery was the predominant treatment modality. The overall one-year survival rate was 63.8% (95% CI: 48.0-71.7). Female sex (adjusted hazard ratio (HR): 3.36; 95% CI: 1.25-9.03; p = 0.016) and absence of surgery (adjusted HR: 5.57; 95% CI: 1.92-16.14; p = 0.002) were independent predictors of increased mortality. The advanced stage (Stage IV: HR = 9.37; unknown stage: HR 10.30) showed a trend toward poorer outcomes, although not statistically significant. Histological subtype was not clearly associated with mortality, though gastrointestinal stromal tumors (GISTs) trended toward improved survival (HR = 0.06; p = 0.057). Adjuvant chemotherapy was associated with increased mortality (HR = 4.39; p = 0.049), likely due to confounding by indication.ConclusionApproximately two-thirds of patients with STSs survive one year post-diagnosis. Prognosis is strongly influenced by sex, stage, and surgical management. These findings highlight the need for early diagnosis, appropriate surgery, and structured multidisciplinary care to improve survival outcomes in Tanzanian tertiary settings.

PMID:40965966 | DOI:10.1177/00368504251381584

Psychol Methods. 2025 Sep 18. doi: 10.1037/met0000770. Online ahead of print.

ABSTRACT

When processing and analyzing empirical data, researchers regularly face choices that may appear arbitrary (e.g., how to define and handle outliers). If one chooses to exclusively focus on a particular option and conduct a single analysis, its outcome might be of limited utility. That is, one remains agnostic regarding the generalizability of the results, because plausible alternative paths remain unexplored. A multiverse analysis offers a solution to this issue by exploring the various choices pertaining to data-processing and/or model building, and examining their impact on the conclusion of a study. However, even though multiverse analyses are arguably less susceptible to biases compared to the typical single-pathway approach, it is still possible to selectively add or omit pathways. To address this issue, we outline a novel, more principled approach to conducting multiverse analyses through crowdsourcing. The approach is detailed in a step-by-step tutorial to facilitate its implementation. We also provide a worked-out illustration featuring the Semantic Priming Across Many Languages project, thereby demonstrating its feasibility and its ability to increase objectivity and transparency. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40965962 | DOI:10.1037/met0000770

J Pediatr Endocrinol Metab. 2025 Sep 15. doi: 10.1515/jpem-2024-0626. Online ahead of print.

ABSTRACT

OBJECTIVES: There is little data on prevalence, incidence rate and clinical characteristics on diabetes amongst the pediatric and adolescent group in sub-Saharan Africa. Therefore, this study aimed to document annual case counts, describe clinical characteristics, and assess loss to follow-up among pediatric and adolescent patients with diabetes at Kenyatta National Hospital.

METHODS: This was a hospital-based retrospective, descriptive study carried out at Kenyatta National Hospital, Pediatric Endocrinology Unit, between January 2008 and December 2021 amongst diabetic patients aged 25 years and below. Data was analyzed using Statistical Package for Social Science (SPSS) version 23.0.

RESULTS: Type 1 diabetes was the leading form of diabetes at 99.3 % (n=288). Most, 56.3 %, of cases of type 1 diabetes got diagnosed within the ages of 6-18 years, majority being 6-11 years. Most patients, 90.2 % presented in diabetic ketoacidosis (DKA) at initial diagnosis. There was a sustained increasing trend in type 1 diabetes with a notable dip in hospital visitations during covid time, the year 2020. Patients with type 1 diabetes took an average of 2.5 months and a median interval of 18 days from symptom onset to diagnosis. A third of the cases of type 1 diabetes, 31.25 %, were lost to follow up.

CONCLUSIONS: The increasing cases of type 1 diabetes with delayed diagnosis require allocation of more resources and increased awareness creation. Measures need to be put in place to manage chronic conditions during pandemics. Hospital-based tracking system is required to prevent loss to follow up cases.

PMID:40965958 | DOI:10.1515/jpem-2024-0626

Psychol Trauma. 2025 Sep 18. doi: 10.1037/tra0002029. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined the effectiveness of trauma practice (TP), a multimodal, triphasic approach to trauma therapy, within a community-based setting, including phase-linked effects on therapeutic outcomes.

METHOD: The sample included 39 clients and 15 clinicians. Participants varied in terms of trauma exposure and comorbid mental health to increase generalizability of results and representation of various trauma presentations in research. Posttraumatic symptoms (Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition) and trauma-related distress (Trauma Symptom Checklist [TSC-40]) were measured at baseline, after each phase, and at 6 months posttherapy.

RESULTS: Mixed effects models, nested by participants and clinician education level, showed significant decreases in posttraumatic symptoms and trauma symptom distress, reflecting a shift from clinical to nonclinical levels with robust effect sizes and reliable change indices. Phase-based analyses indicated symptom improvement during each treatment phase, with the greatest improvement observed in Phase I. Treatment gains were maintained at follow-up; however, sample sizes at follow-up were small.

CONCLUSIONS: This study’s implications suggest a strong foundation for TP’s effectiveness and clinical utility, encouraging further exploration into its phase-specific benefits and broader application in trauma therapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40965953 | DOI:10.1037/tra0002029

Psychol Trauma. 2025 Oct;17(7):1548-1550. doi: 10.1037/tra0002013.

ABSTRACT

THE ISSUE: Criterion A, the event criterion in the posttraumatic stress disorder (PTSD) diagnosis, has been the subject of continuous debate over the years. The publication of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), has marked a significant change in the definition of potentially traumatic events. Most notably, secondary traumatization and indirect exposure are now an integral part of the PTSD diagnosis. However, the Manual includes one exclusion, noting that exposure through electronic media, television, movies, or pictures should not be considered as potentially traumatic, unless it is work-related.

RECOMMENDATIONS: In this article, we wish to strongly challenge this exclusion, using the events of October 7, 2023, in Israel as a unique case example. The events of that day included the killing of more than a thousand civilians and the abduction of more than 250 civilians and soldiers. During these events, millions worldwide were exposed to horrific, uncensored footage of killings and kidnapping. These were broadcast on social media and other informal media outlets (e.g., Telegram), which during the war have become a major source of information. Due to the lack of formal censorship or regulation, the materials shown were often very graphic. This represents a radical shift from traditional forms of media, to which we believe the DSM-5 referred in the first place. We would like to strongly argue that such coverage has a significant traumatic potential, as we already witness in large parts of Israeli society today. We therefore argue for the removal of the Criterion A4 exclusion from the DSM-5. Implications for clinical work and media policy are also discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40965950 | DOI:10.1037/tra0002013

Exp Clin Psychopharmacol. 2025 Sep 18. doi: 10.1037/pha0000791. Online ahead of print.

ABSTRACT

Despite awareness of polysubstance use-the co-use of multiple drugs-and its associated risks, there is a lack of research consensus on how to identify and classify individuals engaging in polysubstance use. Latent class analysis (LCA) and latent profile analysis (LPA) are data-driven approaches that may improve the identification and classification of polysubstance use. By clustering data using different indicators, LCA/LPA can extract subgroups of common drug use patterns within a sample. Variability in how LCA/LPA are conducted, however, can substantially impact how subgroups are extracted and have not been thoroughly reviewed. The present review was one of a two-part series preregistered on PROSPERO entitled, “A systematic review of studies using latent class analysis to examine patterns of polysubstance use in adults (Part 1) and adolescents (Part 2)” (CRD42022352293). The present review sourced relevant studies using LCA/LPA in the context of characterizing adult polysubstance use and identified factors influencing the number of latent classes extracted. Across several articles using LCA/LPA (n = 136), the current review found differences, for example, in the number of extracted classes based on study sample sizes (ρ = .275, p < .001) and the number of indicators used (r = .244, p = .004). The present review noted substantial heterogeneity in study methodologies, statistical analyses, and latent class solutions. For future research, the review suggests some methodological considerations including attention to sample sizes, study locations, and the number of indicators included in LCA/LPAs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40965924 | DOI:10.1037/pha0000791