Tag: nevin manimala

JAMA Netw Open. 2025 Sep 2;8(9):e2532469. doi: 10.1001/jamanetworkopen.2025.32469.

ABSTRACT

IMPORTANCE: COVID-19 remains a disease with high burden in the US, prompting continued debate about optimal targets for annual vaccination.

OBJECTIVE: To project COVID-19 burden in the US for April 2024 to April 2025 under 6 scenarios of immune escape (20% and 50% per year) and levels of vaccine recommendation (no recommendation, vaccination for individuals at high risk only, vaccination for all eligible groups) and to assess the potential benefit of vaccine recommendations in reducing disease burden.

DESIGN, SETTING, AND PARTICIPANTS: For this decision analytical model, the US Scenario Modeling Hub, a collaborative modeling effort, convened 9 teams to provide scenario projections of US COVID-19 hospitalizations and deaths for April 2024 to April 2025, under 6 scenarios combining levels of immune escape and possible vaccine recommendations.

EXPOSURE: Annually reformulated vaccines were assumed to be 75% effective against hospitalization for variants circulating on June 15, 2024, and available on September 1, 2024. Age- and state-specific coverage was assumed to be as reported in September 2023 to April 2024.

MAIN OUTCOMES AND MEASURES: Ensemble estimates were made for weekly COVID-19 hospitalizations and deaths. Projections are presented for relative and absolute prevented hospitalizations and deaths averted due to vaccination over the April 2024 to April 2025 period.

RESULTS: For the US population (332 million, with an estimated 58 million aged ≥65 years), COVID-19 was expected to cause 814 000 (95% projection interval [PI], 400 000-1.2 million) hospitalizations and 54 000 (95% PI, 17 000-98 000) deaths for April 2024 to April 2025, comparable in magnitude to the prior year. Vaccination of high-risk groups only was projected to reduce hospitalizations (compared to no vaccination recommendation) by 76 000 (95% CI, 34 000-118 000) and deaths by 7000 (95% CI, 3000-11 000) across both immune escape scenarios. Compared with vaccinating high-risk groups only, a universal vaccine recommendation was projected to provide direct and indirect benefits, further preventing 11 000 hospitalizations and 1000 deaths in those aged 65 years and older.

CONCLUSIONS AND RELEVANCE: In this decision analytical modeling study of COVID-19 burden in the US in 2024 to 2025, ensemble projections suggested that although vaccinating high-risk groups had substantial benefits in reducing disease burden, maintaining the vaccine recommendation for all individuals had the potential to save thousands more lives. Despite divergence of projections from observed disease trends in 2024 to 2025-possibly driven by variant emergence patterns and immune escape-averted COVID-19 burden due to vaccination was robust across immune escape scenarios, emphasizing the substantial benefit of broader vaccine availability for all individuals.

PMID:40965885 | DOI:10.1001/jamanetworkopen.2025.32469

JAMA Netw Open. 2025 Sep 2;8(9):e2532494. doi: 10.1001/jamanetworkopen.2025.32494.

ABSTRACT

IMPORTANCE: Gender-affirming surgery (GAS) is an effective treatment for gender dysphoria among transgender, nonbinary, and gender diverse (TGD) individuals. Research is needed to assess GAS history, factors associated with GAS satisfaction, desired yet unobtained GAS, and barriers and facilitators to GAS access for TGD individuals.

OBJECTIVE: To assess of the prevalence of GAS, surgical satisfaction, and encountered barriers among TGD adults and the factors associated with these outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted from October 2024 to June 2025, used baseline electronic survey data from TGD adult primary care patients enrolled in LEGACY, a longitudinal cohort study. Data were collected from February 2019 to March 2021.

EXPOSURES: Age, gender identity, race, Latine or Hispanic ethnicity, educational attainment, homelessness, income, health insurance, HIV status, gender marker change, gender-affirming hormone use, severe psychological distress, self-rated health, and participation during the COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES: The main outcomes were receipt of GAS, high surgical satisfaction, and encountered barriers to GAS (eg, waiting lists, cost). Descriptive analyses and logistic regression models, stratified by gender identity, were used to examine the association between the exposures and these outcomes.

RESULTS: The study cohort of 2176 patients were a mean (SD) age of 30.3 (10.3) years; 1413 (64.9%) identified as transmasculine (TM), 763 (35.1%) as transfeminine (TF), and 672 (30.9%) as nonbinary. A total of 634 patients (29.1%) identified as a member of a racial minority group and 237 (10.9%) as Latine or Hispanic. Overall, 946 patients (43.5%) had received GAS, and 776 of these patients (82.0%) reported high satisfaction. The most desired surgeries were hysterectomy (868 of 1413 [61.4%]) for TM patients and facial feminization (516 of 763 [67.6%]) for TF patients. Most patients (2054 [94.4%]) encountered a barrier to GAS, with the most common being cost (1455 [66.9%]). In multivariable models, younger age (eg, 18-24 years vs ≥40 years) was associated with lower odds of GAS (TM patients: adjusted odds ratio [AOR], 0.19 [95% CI, 0.11-0.34]; TF patients: AOR, 0.22 [95% CI, 0.12-0.42]) and higher odds of encountering a barrier (TM patients: AOR, 3.16 [95% CI, 1.59-6.30]; TF patients: AOR, 9.39 [95% CI, 2.47-35.67]). Gender marker change (TM patients: AOR, 8.61 [95% CI, 6.19-11.98]; TF patients: AOR, 6.29 [95% CI, 4.01-9.87) and hormone use (TM patients: AOR, 4.71 [95% CI, 3.02-7.34]; TF patients: AOR, 7.69 [95% CI, 1.79-33.04]) were associated with greater odds of GAS; lack of insurance was associated with lower satisfaction (TM patients: AOR, 0.31 [95% CI, 0.13-0.76]; TF patients: AOR, 0.09 [95% CI, 0.02-0.49]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, TGD patients reported high GAS satisfaction but substantial unmet need and frequent barriers to care. Efforts appear to be needed to improve accessibility for TGD patients desiring GAS.

PMID:40965883 | DOI:10.1001/jamanetworkopen.2025.32494

JAMA Netw Open. 2025 Sep 2;8(9):e2532660. doi: 10.1001/jamanetworkopen.2025.32660.

ABSTRACT

IMPORTANCE: Hispanic and non-Hispanic Black patients with ST-segment elevation myocardial infarction (STEMI) are less likely than White non-Hispanic patients to receive guideline-recommended percutaneous coronary intervention (PCI). Research suggests disparities arise before and during STEMI treatment, but it is unclear when the largest disparities in PCI emerge.

OBJECTIVE: To assess when in the care process the largest disparities in PCI receipt occur in patients with STEMI presenting to an emergency department.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study evaluated adult patients with STEMI presenting to Florida hospitals from January 1, 2011, to December 31, 2021. Data were analyzed from June 29, 2023, to May 29, 2025.

EXPOSURE: Patient race and ethnicity.

MAIN OUTCOMES AND MEASURES: The main outcomes were presentation to PCI-capable hospitals, receipt of PCI if initially presenting to PCI-capable hospitals, transfer if initially presenting to non-PCI capable hospitals, and receipt of PCI at receiving hospital if transferred. Logistic regression was used to compare outcomes for patients with STEMI by race and ethnicity, controlling for payer, age, sex, weekend presentation, time of presentation, comorbidities, and hospital characteristics.

RESULTS: Among 139 629 patients with STEMI included in the analysis, 68.81% were male. Mean (SD) age was 64.4 (13.0) years. A total of 9.09% identified as Black, 15.17% as Hispanic, 70.56% as White, and 5.17% as other or missing race. In adjusted analyses, Black (-1.8 [95% CI, -2.6 to 1.1] percentage points [pp]) and Hispanic (-3.1 [95% CI, -3.7 to -2.4] pp) patients were less likely than White patients to present to PCI-capable hospitals (P < .001 for both). Among patients initially presenting to PCI-capable hospitals, Black patients were less likely to receive PCI than White patients (-8.6 [95% CI, -9.5 to -7.7] pp; P < .001). Among patients initially presenting to non-PCI-capable hospitals, Black (-4.0 [95% CI, -6.4 to -1.5] pp; P = .001) and Hispanic (-4.2 [95% CI, -6.3 to -2.0] pp; P < .001) patients were less likely to be transferred than White patients. Among transferred patients, Black patients were less likely to undergo PCI at the receiving hospital than White patients (-13.3 [95% CI, -16.6 to -9.9] pp; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study examining racial and ethnic disparities in receipt of PCI for patients with STEMI, racial and ethnic disparities persisted throughout the care process. The largest magnitude of disparity was PCI receipt if transferred, but the disparity with the largest impact was PCI receipt when initially presenting to PCI-capable hospitals.

PMID:40965882 | DOI:10.1001/jamanetworkopen.2025.32660

JAMA Netw Open. 2025 Sep 2;8(9):e2532672. doi: 10.1001/jamanetworkopen.2025.32672.

ABSTRACT

IMPORTANCE: General practitioners (GPs) sometimes initiate a treatment despite not expecting it to improve patients’ symptoms by any physiological mechanism. These essentially placebo treatments are ethically controversial, and their frequency is unclear. They involve risks for patients, but to estimate these, more data are needed.

OBJECTIVE: To develop a more precise overview of the rate at which GPs prescribe essentially placebo treatments.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study included currently practicing GPs from 20 European countries and Israel who responded to online questionnaires. The online questionnaires were taken between December 12, 2019, and August 4, 2021, and analyzed on April 28, 2022. Respondents were contacted by national representatives, either through personal networks (convenience sampling) or an existing database (volunteer sampling).

MAIN OUTCOMES AND MEASURES: The main outcome was the rate of essentially placebo prescriptions, given as the rate per week and the proportion of consultations. Secondary outcomes were the associations between this rate and GP background characteristics (gender, age, education about placebos, years of experience, patients seen, and working hours per week).

RESULTS: A total of 952 practicing GPs responded (453 of 745 [61%] female; mean [SD] age of 48.02 [11.95] years), and 669 answered all questions. Overall, 689 of 818 respondents (84%) indicated they had prescribed an essentially placebo treatment at least once. Overall, the median (IQR) rate of essentially placebo prescriptions was 0.5 (0.1 to 2.0) per week or 0.67% (0.06% to 2.50%) of consultations. The prescription rate was higher in men (β = 1.94 [95% CI, 0.58 to 3.29]; P = .005), those with more work experience (β = 0.12 [95% CI, 0.06 to 0.18]; P < .001), and those who work fewer hours per week (β = -0.08 [95% CI, -0.13 to -0.03]; P = .001).

CONCLUSIONS AND RELEVANCE: In this survey study of GPs across 21 countries, essentially placebo prescriptions featured in a small minority of consultations, but they nevertheless occurred regularly for most GPs. Rates varied only slightly by GP background characteristics. This suggests that essentially placebo prescriptions were common at a population level, which poses risks for the patient-GP relationship and creates medical risks for patients. Future research should further investigate the decision-making process behind these prescriptions and their effects on patients.

PMID:40965881 | DOI:10.1001/jamanetworkopen.2025.32672

JAMA Oncol. 2025 Sep 18. doi: 10.1001/jamaoncol.2025.3377. Online ahead of print.

ABSTRACT

IMPORTANCE: The oral microbiota may be involved in the development of pancreatic cancer, yet current evidence is largely limited to bacterial 16S amplicon sequencing and small retrospective case-control studies.

OBJECTIVE: To test whether the oral bacterial and fungal microbiome is associated with the subsequent development of pancreatic cancer.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from 2 epidemiological cohorts: the American Cancer Society Cancer Prevention Study-II Nutrition Cohort and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Among cohort participants who provided oral samples, those who prospectively developed pancreatic cancer were identified during follow-up. Control participants who remained free of cancer were selected by 1:1 frequency matching on cohort, 5-year age band, sex, race and ethnicity, and time since oral sample collection. Data were collected from August 2023 to September 2024, and data were analyzed from August 2023 to January 2025.

EXPOSURES: The oral bacterial and fungal microbiome were characterized via whole-genome shotgun sequencing and internal transcribed spacer (ITS) sequencing, respectively. The association of periodontal pathogens of the red complex (Treponema denticola, Porphyromonas gingivalis, and Tannerella forsythia) and orange complex (Fusobacterium nucleatum, F periodonticum, Prevotella intermedia, P nigrescens, Parvimonas micra, Eubacterium nodatum, Campylobacter shower, and C gracilis) with pancreatic cancer was tested via logistic regression. The association of the microbiome-wide bacterial and fungal taxa with pancreatic cancer was assessed by Analysis of Compositions of Microbiomes With Bias Correction 2 (ANCOM-BC2). Microbial risk scores (MRS) for pancreatic cancer were calculated from the risk-associated bacterial and fungal species.

MAIN OUTCOMES AND MEASURES: Pancreatic cancer incidence.

RESULTS: Of 122 000 cohort participants who provided samples, 445 developed pancreatic cancer over a median (IQR) follow-up of 8.8 (4.9-13.4) years and were matched with 445 controls. Of these 890 participants, 474 (53.3%) were male, and the mean (SD) age was 67.2 (7.5) years. Three oral bacterial periodontal pathogens-P gingivalis, E nodatum, and P micra-were associated with increased risk of pancreatic cancer. A bacteriome-wide scan revealed 8 oral bacteria associated with decreased and 13 oral bacteria associated with increased risk of pancreatic cancer (false discovery rate-adjusted Q statistic less than .05). Of the fungi, genus Candida was associated with increased risk of pancreatic cancer. The MRS, based on 27 oral species, was associated with an increase in pancreatic cancer risk (multivariate odds ratio per 1-SD increase in MRS, 3.44; 95% CI, 2.63-4.51).

CONCLUSIONS AND RELEVANCE: In this cohort study, oral bacteria and fungi were significant risk factors for pancreatic cancer development. Oral microbiota hold promise as biomarkers to identify individuals at high risk of pancreatic cancer, potentially contributing to personalized prevention.

PMID:40965868 | DOI:10.1001/jamaoncol.2025.3377

JAMA Ophthalmol. 2025 Sep 18. doi: 10.1001/jamaophthalmol.2025.3070. Online ahead of print.

ABSTRACT

IMPORTANCE: Metformin has demonstrated protective effects in systemic diseases, including cancer, cardiovascular disease, and retinal diseases, such as diabetic retinopathy and choroidal neovascularization. Literature suggests metformin may reduce the risk of age-related macular degeneration (AMD), but a consensus has not been reached.

OBJECTIVE: To evaluate the association of metformin with the development of any AMD and progression to geographic atrophy and neovascular AMD using a large electronic health record (EHR) platform.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study had 2 exposed cohorts of participants aged 65 years or older who were prescribed metformin: one without AMD to assess development of any AMD and the other with mild or moderate nonexudative AMD to evaluate AMD progression to geographic atrophy or neovascular AMD. Corresponding nonexposed cohorts consisted of participants not prescribed metformin. Participants were required to meet inclusion criteria at least 6 months before the outcome of interest occurred. Those who had outcomes of interest before meeting inclusion criteria were excluded from analysis. This cohort study used a federated health research platform aggregating deidentified EHR data from 70 institutions (TriNetX). Data were collected from January 2013 to June 2025 and analyzed from September 2024 to June 2025.

EXPOSURES: Participants prescribed metformin.

MAIN OUTCOMES AND MEASURES: Propensity score matching controlled for confounders, such as age, sex, race, hypertension, diabetes, and other systemic conditions. Risk ratios (RRs) with 95% CIs were calculated to compare outcomes at 5 years, 10 years, and any time after meeting criteria. Any confidence intervals that crossed 0.90 to 1.10 were considered statistically not significant. Comparisons between exposed and unexposed groups were repeated requiring a diagnosis of cataract.

RESULTS: Before propensity score matching, cohort 1 (no AMD) included 297 008 participants exposed to metformin (mean [SD] age, 74.9 [7.0] years; 157 584 [53.1%] female) and 1 269 644 participants unexposed to metformin (mean [SD] age, 76.8 [7.9] years; 738 640 [58.2%] female). Before propensity score matching in cohort 2 (early or intermediate nonexudative AMD), there were 12 843 participants exposed to metformin (mean [SD] age, 79.5 [7.2] years; 7107 [55.3%] female) and 77 279 participants unexposed to metformin (mean [SD] age, 81.6 [7.2] years; 48 491 [62.7%] female). After propensity score matching, participants prescribed metformin had comparable risk of developing any AMD relative to those not prescribed metformin (RR, 0.90; 95% CI, 0.86-0.94). When stratified by time, the risk remained similar at 5 years (RR, 0.94; 95% CI, 0.90-0.99) and 10 years (RR, 0.91; 95% CI, 0.87-0.94). Similarly, participants prescribed vs not prescribed metformin had a comparable risk of AMD progression over these time spans (RR for geographic atrophy, 0.87; 95% CI, 0.76-1.01; RR for neovascular AMD, 1.03; 95% CI, 0.91-1.17).

CONCLUSION AND RELEVANCE: This study suggests that, overall, metformin is not associated with significant development or progression of AMD. Further studies and prospective analyses are necessary to evaluate whether dosage and longevity of metformin use are associated with AMD development or progression.

PMID:40965862 | DOI:10.1001/jamaophthalmol.2025.3070

Diagnosis (Berl). 2025 Sep 12. doi: 10.1515/dx-2025-0041. Online ahead of print.

ABSTRACT

OBJECTIVES: Among all of the swollen joints undergoing an aspiration in primary care, approximately 92 % are of nonseptic cause. This study therefore sought to develop a predictive model, based on simple clinical and paraclinical data, with the aim of predicting the aseptic nature of joint effusion.

METHODS: This is a cohort, prospective, monocentric study. Some explanatory variables were predetermined on the basis of the literature review. A predictive model has been established based on these variables. In order to prioritise the negative predictive value, a cut-off point considering the best specificity for an observed sensitivity greater than or equal to 98 % was retained.

RESULTS: A total of 328 participants, 49.1 % of whom were women, were included in this study, with a median age of 69 years. The median duration of evolution of joint effusion before the puncture was 30 days. Joint fluid had inflammatory characteristics in 46.0 % of cases and 8 septic arthritis were identified. The area under the receiver operating characteristic (ROC) curve of the predictive model was evaluated at 0.93. The model includes the maximum temperature, the polyarticular nature of the clinical picture and the macroscopic appearance of the joint fluid.

CONCLUSIONS: This study made it possible to develop a simple and easily accessible predictive model in a primary care setting. This tool could make it possible to exclude a priori the septic aetiology of one out of four native joint effusions. Its performances remain to be determined on an independent population in a subsequent study (confirmation cohort in progress).

PMID:40965856 | DOI:10.1515/dx-2025-0041

J Clin Psychiatry. 2025 Sep 15;86(4):25m15822. doi: 10.4088/JCP.25m15822.

ABSTRACT

Objective: This study examined the relationships between body fat mass percentage and mental health (depression and anxiety symptoms) during pregnancy, while assessing the moderating effects of physical activity and diet quality.

Methods: A prospective cohort of 219 pregnant women was recruited for a longitudinal study of maternal health during pregnancy and offspring outcomes. Pregnant participants were assessed at ∼12 and ∼36 weeks of pregnancy. Body composition was measured using air displacement plethysmography, physical activity was measured with ActiGraph wearables, and diet was measured using the National Institute of Health Diet History Questionnaire-III. Depression and anxiety symptoms were also evaluated using the Beck Depression Inventory-II and State-Trait Anxiety Inventory, respectively, at each study visits. Multivariable mixed linear models adjusted for demographic and socioeconomic factors were used to analyze relationships among these parameters. The study period is from October 2019 to August 2024.

Results: Higher body fat mass percentage was significantly associated with increased depression (β= 0.246, P=.014) and anxiety scores (β= 0.241, P=.002). Physical activity moderated the effect of body fat on depression (interaction β=-0.001, P=.017), while diet quality moderated the effect of body fat on anxiety (interaction β=-0.002, P=.047).

Conclusion: Higher body fat mass during pregnancy is associated with more symptoms of depression and anxiety. However, increased physical activity and adherence to high-quality diets can attenuate these effects, indicating that lifestyle interventions during pregnancy may improve mental health of pregnant women, particularly for those with obesity.

PMID:40965852 | DOI:10.4088/JCP.25m15822

J Cosmet Dermatol. 2025 Sep;24(9):e70464. doi: 10.1111/jocd.70464.

ABSTRACT

OBJECTIVE: This prospective randomized controlled trial aimed to evaluate the clinical value of recombinant bovine basic fibroblast growth factor (rb-bFGF)-based combined therapy in hair transplantation, focusing on its optimization effects on follicle survival rate, postoperative hair-loss dynamics, complication control, and patient satisfaction.

METHODS: Sixty patients with moderate-to-severe androgenetic alopecia were randomly assigned to either an rb-bFGF group or a control group. In the rb-bFGF group, harvested follicles were intraoperatively immersed in an rb-bFGF-enriched solution and patients received postoperative topical rb-bFGF gel for 3 weeks, in addition to baseline medications and minoxidil. Control group follicles were stored in saline, with postoperative minoxidil alone. Quantitative assessments include measurements of hair follicle viability and hair density at 3, 6, and 12 months postoperatively. Patient satisfaction was assessed using a three-level scale, and complication rates were recorded.

RESULTS: The rb-bFGF group demonstrated superior outcomes compared with controls, including higher 12-month follicle survival (91.1% vs. 81.0%), lower hair-loss rate (11.6% vs. 22.7%), greater patient satisfaction (96.7% vs. 80.0%), and fewer complications (20.0% vs. 85.3%). All differences were statistically significant (p < 0.001).

CONCLUSION: Intraoperative follicle immersion and postoperative topical application of rb-bFGF significantly enhance graft survival, reduce early hair loss, decrease complications, and improve overall outcomes in hair transplantation.

PMID:40965846 | DOI:10.1111/jocd.70464

J Clin Psychiatry. 2025 Sep 17;86(4):25m15941. doi: 10.4088/JCP.25m15941.

ABSTRACT

Background: Short-term studies have demonstrated antisuicidal effects of ketamine/esketamine for patients with treatment-resistant depression (TRD). However, long-term data and their impact in reducing suicidality-related health care utilization are limited. This 6-month mirror-image study compares suicidality-associated emergency department (ED) visits before and after acute treatment with ketamine/esketamine in a TRD cohort.

Method: This study included adults with TRD evaluated at Mayo Clinic Depression Center (Rochester, Minnesota) from May 2018 to May 2024, who received an acute series of intravenous (IV) ketamine or intranasal (IN) esketamine treatments. The primary outcome measure was the number of suicidality-associated ED visits in the 6 months before and after treatment. Negative binomial mixed-effects model was utilized to analyze suicidality-associated ED visits per person, estimating incidence rate ratios (IRRs) and 95% confidence intervals for the change between pre-and posttreatment periods.

Results: Of 124 eligible individuals, 27 were excluded due to unavailable data, leaving 97 for analysis. The cohort was 69% female, with a median age of 48.9 years; 97% had major depressive disorder, and most (75%) received IV ketamine. After the acute treatment phase, ED visits for suicidal ideation decreased by 84% (IRR=0.16, 95% CI, 0.06-0.46, P=.001), and total ED visits for suicidality decreased by 63% (IRR=0.37, 95% CI, 0.18-0.77, P=.007).

Conclusions: Ketamine and esketamine reduced long-term ED visits for suicidality in individuals with TRD. Further longer-term follow-up research is encouraged to ascertain if these benefits on suicidality reduction are mood state dependent or reflect an independent mechanism.

PMID:40965838 | DOI:10.4088/JCP.25m15941