Tag: nevin manimala

Biotech Histochem. 2025 Dec 1:1-9. doi: 10.1080/10520295.2025.2583966. Online ahead of print.

ABSTRACT

The ability to escape immune surveillance is a hallmark of malignancy. Programmed death ligand 1 (PD-L1) facilitates tumor progression by binding to the immune inhibitory receptor known as programmed cell death protein 1 (PD1) on immune cells, resulting in suppression of the cytotoxic T lymphocyte function. The degree of PD-L1 expression may have a prognostic value in some cancer types, and it may vary according to the genetic makeup and the ethnicity of patients. The expression level of PD-L1 in 63 cases of primary head and neck squamous cell carcinoma (HNSCC) tumor tissues was evaluated using immunohistochemistry (IHC). Also, PD-L1 association with various clinicopathologic characteristics and overall survival was studied. The positive expression rate of PD-L1 in HNSCC was 85.7%, 60.3%, and 52.3% of the total number of cases using combined positive score (CPS) ≥ 1, CPS ≥ 5, and CPS ≥ 20 cutoff values, respectively. Statistical analysis revealed no significant relationship between the expression of PD-L1 protein and clinicopathological features except for tobacco use using a cutoff CPS ≥ 20. The log-rank chi-square results showed that PD-L1 was not a significant factor affecting the 4-year overall survival of HNSCC patients. Also, the overall survival rate was not significantly affected by the patient’s age, tumor differentiation, tumor size, and lymphovascular invasion. However, survival curves demonstrated lower overall survival in HNSCC female patients, disease recurrence, and positive perineural invasion. Our findings showed relatively high PDL-1 expression in most HNSCC patients. No significant association was found between PD-L1 protein expression and overall survival.

PMID:41324994 | DOI:10.1080/10520295.2025.2583966

JAMA Netw Open. 2025 Dec 1;8(12):e2545712. doi: 10.1001/jamanetworkopen.2025.45712.

ABSTRACT

IMPORTANCE: Home hospital provides hospital-level care at home for patients with acute illness who would traditionally be cared for in a brick-and-mortar (BAM) hospital. While most home hospital programs have been implemented in urban areas, its feasibility in rural areas, where access to care is a major challenge, is unknown.

OBJECTIVE: To compare home hospital care with BAM hospital care for patients residing in rural areas.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial took place from 2022 to 2023 with a 30-day follow-up in 3 rural areas in the US and Canada. Participants were adults recruited in the emergency department who required hospital-level care for select acute conditions (infections, heart failure, chronic obstructive pulmonary disease or asthma, and other diagnoses).

INTERVENTIONS: Patients in the home hospital group received acute care at home, including in-home nurse and/or paramedic visits, remote physician care, intravenous medications, remote monitoring, video communication, and point-of-care testing. Patients in the BAM group received services at a rural BAM hospital.

MAIN OUTCOMES AND MEASURES: The primary outcome was the relative change in the acute care episode’s direct cost. Secondary outcomes were 30-day readmission, days at home within 30 days of discharge, and physical activity. Exploratory outcomes included the Picker Experience Score and Net Promoter Score.

RESULTS: A total of 161 patients (79 home; 82 BAM) with mean (SD) age of 64.4 (17.2) years (home) and 64.9 (14.1) years (control) were included. Most were female (home, 52 [65.8%]; BAM, 50 [61.0%]). The adjusted mean cost of the acute episode was not significantly different (home vs BAM, 14% greater; 95% CI, -6% to 39%; P = .19). There were no significant differences in 30-day readmission (home vs BAM: 8 [10.1%] vs 14 [17.1%]) or mean (SD) days at home within 30 days of discharge (home vs BAM: 28.6 [3.4] vs 28.4 [3.4] days). Patients in the home hospital group were less sedentary, according to accelerometer measurements, than those in the BAM group (mean [SD], 78.0% [10.4%] vs 86.0% [7.2%] of the day sedentary; mean difference, -8.0%; 95% CI, -12.8% to -3.3%; P < .001) and had more mean (SD) steps daily (834.1 [1219.6] vs 120.4 [206.0] steps; mean difference, 713.7 steps; 95% CI, 290.2 to 1137.2 steps; P < .001). Total mean (SD) length of stay (ie, BAM and home hospital days for intervention patients and BAM days for control patients) was not significantly different (home vs BAM: 6.7 [5.0] days vs 5.4 [4.4] days), although patients receiving care at home transferred late in their course (mean [SD] day of transfer, 4.2 [4.3] of 6.7 days). Patients in the home hospital group reported better experiences than those in the BAM hospital group: the mean (SD) Picker experience score was 13.4 (2.6) vs 11.0 (3.8) (mean difference, 2.4; 95% CI, 1.0 to 3.8; P < .001), and the mean (SD) net-promoter score was 88.4 (32.3) vs 45.5 (69.9) (mean difference, 43.0; 95% CI, 17.5 to 68.5; P < .001). Safety events occurred in 11 (14.1%) home patients vs 10 (12.4%) BAM patients (mean difference, 1.8%; 95% CI, -8.1% to 11.6%; P = .74).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of home hospital care in rural settings, cost and readmission were unchanged while patient activity and experience improved. Late transfer home likely attenuated the intervention’s effect.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05256303.

PMID:41324962 | DOI:10.1001/jamanetworkopen.2025.45712

JAMA Netw Open. 2025 Dec 1;8(12):e2545826. doi: 10.1001/jamanetworkopen.2025.45826.

ABSTRACT

IMPORTANCE: State policies provide variable health insurance coverage for the 3 million immigrant children in the US, with limited understanding of associations with health care access.

OBJECTIVES: To (1) examine disparities in health insurance and health care access between immigrant and US-born children and (2) analyze associations of state insurance policies with health care access outcomes for immigrant children.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cross-sectional study sampled from the National Survey of Children’s Health (2016 to 2022) to facilitate national estimates. Caregivers of children aged 0 to 17 years completed the survey. Data were analyzed from May to December 2024.

EXPOSURES: Child immigration status and state-level health insurance policies for immigrant children, categorized as least inclusive (5-year waiting period and eligibility restricted by immigration status), moderately inclusive (waived 5-year waiting period), and most inclusive (waived 5-year waiting period and all immigrant children eligible).

MAIN OUTCOMES AND MEASURES: Primary outcomes were (1) uninterrupted health insurance in the past 12 months, (2) usual place for primary care, (3) usual place for sick care, (4) having foregone medical care, and (5) having difficulty with referrals. For each outcome, multivariable logistic regression models examined the association with immigration status, adjusting for state-level policies and individual variables, reporting adjusted odds ratios (aORs) and 95% CIs.

RESULTS: There were 277 386 children included (population estimate, 72 473 052 children) with 8835 immigrant children (population estimate, 3 097 329 children [4.3%]; 1 513 509 [48.9%] aged 12-17 years; 1 542 412 female [49.8%]) and 268 551 US-born children (population estimate, 69 375 723 children [95.7%]; 23 450 439 [33.8%] aged 12-17 years; 33 876 023 female [48.8%]). In multivariable analyses, immigrant compared with US-born children had lower odds of uninterrupted health insurance (aOR, 0.48; 95% CI, 0.41-0.56), usual place for primary care (aOR, 0.44; 95% CI, 0.38-0.52), and usual place for sick care (aOR, 0.62; 95% CI, 0.55-0.70), and increased odds of having foregone medical care (aOR, 1.61; 95% CI, 1.22-2.14) and difficulty with subspecialty referral (aOR, 1.54; 95% CI, 1.16-2.04). Immigrant children in the most compared with least inclusive policy states had increased odds of uninterrupted health insurance (aOR, 3.01; 95% CI, 1.89-4.79) and usual place for primary care (aOR, 1.61; 95% CI, 1.07-2.41).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US children, immigrant compared with US-born children had disparities in health care access, which were attenuated in states with the most inclusive state insurance policies, suggesting that inclusive state insurance eligibility policies for immigrant children may improve health care access outcomes for this population.

PMID:41324961 | DOI:10.1001/jamanetworkopen.2025.45826

JAMA Netw Open. 2025 Dec 1;8(12):e2545996. doi: 10.1001/jamanetworkopen.2025.45996.

ABSTRACT

IMPORTANCE: Medicaid expansion under the Affordable Care Act broadened eligibility for government-funded health coverage. This may have improved access to early diagnosis and rapid treatment, potentially impacting survival in patients with resectable non-small cell lung cancer (NSCLC), a leading cause of cancer-related death in the US.

OBJECTIVE: To evaluate the association between state-level Medicaid expansion and all-cause mortality in patients with resectable NSCLC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of patients aged 20 to 64 years who were diagnosed with stage I to IIIA NSCLC used data from the Surveillance, Epidemiology, and End Results registry collected between January 1, 2006, to December 31, 2019, with outcomes administratively censored at 2 and 4 years. Data were analyzed between March 1 and September 10, 2025.

EXPOSURE: Medicaid expansion status of patients’ state of residence at diagnosis. Patients’ states of residence were categorized as nonexpansion, early expansion (2011), 2014 expansion, or late expansion (after 2014).

MAIN OUTCOMES AND MEASURES: Primary outcomes were 2- and 4-year all-cause mortality. Cox proportional hazards regression models within a difference-in-differences framework were used to estimate adjusted hazard ratios (HRs) for death. Secondary analyses evaluated postexpansion mortality trends and changes in early-stage (I-II) diagnoses using logistic regression.

RESULTS: Among 53 842 patients included in the analysis (24 849 [46.2%] 60-64 years of age; 27 027 [50.2%] male), propensity score-matched analyses showed lower 2-year mortality in states with early expansion (HR, 0.95; 95% CI, 0.91-0.99; P = .02) and 2014 expansion (HR, 0.91; 95% CI, 0.86-0.95; P < .001) compared with nonexpansion control states, whereas no significant difference was observed in late expansion states (HR, 0.95; 95% CI, 0.89-1.02; P = .15). All expansion groups showed decreased mortality. Mortality decreases were observed after the first 3 years and persisted throughout the study period. The proportion of early-stage diagnoses did not change post expansion, suggesting benefits may have been mediated by improved postdiagnostic care rather than earlier detection.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with stage I to IIIA NSCLC, Medicaid expansion was associated with lower mortality at 2 and 4 years. These findings suggest that expanded insurance coverage may have enhanced access to effective cancer care and improved population-level outcomes.

PMID:41324959 | DOI:10.1001/jamanetworkopen.2025.45996

JAMA Netw Open. 2025 Dec 1;8(12):e2546002. doi: 10.1001/jamanetworkopen.2025.46002.

ABSTRACT

IMPORTANCE: Some US states established state medical operations coordination centers (SMOCCs) during the pandemic to coordinate transfers and maximize care delivery when available beds were limited. Understanding their associations might inform their continued value in helping reduce delays and minimize strain during public health emergency conditions.

OBJECTIVE: To examine the association of SMOCC establishment with adult interhospital transfers (IHTs) during pandemic surges.

DESIGN, SETTING, AND PARTICIPANTS: This interrupted time series cohort study evaluated hospitalized adults (aged ≥18 years) from 8 US states. Data analysis was completed in March 2025.

EXPOSURE: SMOCC establishment. SMOCC initiation was adjudicated through a published survey and inquiries with state health departments.

MAIN OUTCOMES AND MEASURES: Outcome measures were immediate and long-term change in IHT by emergency medical services (EMS) agencies that continuously reported in the National EMS Information Systems database between June 1, 2020, and December 30, 2022. The inflection point (SMOCC establishment) was centered using relative dates while controlling for seasonality. Hospital occupancy stress was measured using daily hospital census and staffed bed counts and weighted by fixed bed capacity. Effect modification by increasing occupancy stress across study states was tested using an interaction term. Findings were validated in several subset analyses.

RESULTS: Across the study’s 8 states (Alaska, Colorado, Idaho, Maryland, North Carolina, Oregon, Utah, and Virginia), 441 709 transfers (median [IQR] age, 61.0 [44.0-73.0] years; 227 982 [51.6%] male) were analyzed, with 321 078 (72.8%) occurring after SMOCC establishment. SMOCC establishment was associated with an immediate increase (rate ratio [RR], 1.35; 95% CI, 1.05-1.74; P = .02) followed by a long-term decrease (RR, 0.94; 95% CI, 0.90-0.97; P < .001) in transfer rates. A significant increase in transfers per decile increase in occupancy stress was observed 40 weeks into SMOCC establishment (RR, 1.23; 95% CI, 1.06-1.42; P = .007). Findings were similar across transfers grouped by urbanicity, mode of transport, patient age, and acuity.

CONCLUSIONS AND RELEVANCE: In this cohort study of 8 US states, pandemic initiation of a SMOCC was associated with an immediate increase in transfer rates between hospitals of approximately 35% after establishment and, after a potential lag, appeared to meet an increasing demand for transferring patients during surges. These results suggest that activating SMOCCs during large-scale public health emergencies might improve access to care and mitigate transfer gridlocks, but their utility during routine times warrants study.

PMID:41324958 | DOI:10.1001/jamanetworkopen.2025.46002

JAMA Netw Open. 2025 Dec 1;8(12):e2546792. doi: 10.1001/jamanetworkopen.2025.46792.

ABSTRACT

IMPORTANCE: HIV preexposure prophylaxis (PrEP) is highly effective in HIV prevention; telemedicine is a promising avenue for delivering PrEP care.

OBJECTIVE: To explore telemedicine delivery of PrEP care (telePrEP) by the largest telePrEP company in the US.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-arm cohort study used health record data of patients receiving telePrEP from MISTR LLC, a for-profit telehealth company, from November 27, 2018, to March 5, 2025. Patient characteristics and AIDSVu data were assessed to determine levels of PrEP use nationally. Retention in care was assessed for persons initiating PrEP in 2020, 2021, and 2022. Data were analyzed from March 5 to May 29, 2025.

EXPOSURE: Use of telePrEP.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients receiving telePrEP among all patients receiving PrEP in the US. Persons were classified as PrEP users if they received at least 1 day of prescribed PrEP in a calendar year.

RESULTS: From 2018 through 2025, 162 422 unique patients received telePrEP prescriptions from the telehealth company. Patients were predominantly young (mean [SD] age, 33.3 [10.3] years) and male (156 255 of 162 417 [96%]). Of 162 406 patients with data available, 19 610 (12%) were African American or Black, 12 075 (7%) were Asian, 39 744 (25%) were Hispanic or Latino, 82 222 (51%) were White, and 8755 (5%) were of other race or ethnicity. Most had not previously used PrEP (57 597 of 74 860 [77%]), and more than one-third (58 761 of 162 403 [36%]) were uninsured. Most users (131 875 [81%]) opted for home laboratory specimen collection as part of their care. TelePrEP use increased substantially from 6443 patients in 2020 to 110 068 in 2024. TelePrEP as a proportion of all national PrEP use was 2% in 2020, 9% in 2022, and 19% in 2024. Retention in care was similar for cohorts starting in 2020, 2021, and 2022; 67% (16 716 of 24 976) to 73% (4571 of 6287) were retained in the calendar year after initiation, 42% (8408 of 19 916) to 43% (2732 of 6287) in the second year, and 32% (2043 of 6287) to 33% (6546 of 19 916) in the third year. Annual care reinitiation ranged from 2% to 5%.

CONCLUSIONS AND RELEVANCE: This cohort study found that nearly 1 in 5 PrEP users in the US received their PrEP prescriptions from a single national telemedicine company in 2024. Most were new to PrEP and more than one-third were uninsured. TelePrEP provision benefits from facilitating policies such as Affordable Care Act coverage and the 340B Drug Pricing Program. The rapid growth and overall magnitude of telePrEP provision suggests that it is a critical part of HIV prevention infrastructure in the US that merits continued regulatory support.

PMID:41324957 | DOI:10.1001/jamanetworkopen.2025.46792

Psychol Health Med. 2025 Dec 1:1-19. doi: 10.1080/13548506.2025.2597470. Online ahead of print.

ABSTRACT

Alzheimer’s disease and kidney health have become serious and urgent public health issues. Bicarbonate and blood urea nitrogen is closely related to kidney function but the relationship of the bicarbonate, blood urea nitrogen and cognitive function which is one of the most important symptoms of Alzheimer’s disease is still unclear. In this study we aimed to examine the association of the bicarbonate, blood urea nitrogen and cognitive function. This study used the NHANES database, from which 2681 eligible individuals over 60 years of age were selected. We also extracted cognitive related tests, bicarbonate and blood urea nitrogen concentration to statistically analyze. Logistic regression and restricted cubic splines (RCS) were performed with confounding variables such as gender, age, race, body mass index (BMI), and alcohol intake. After adjusting for multiple factors, statistical analyses indicated significant correlations between bicarbonate, blood urea nitrogen, and cognitive function tests, with varying strengths across different tests. A stratified analysis by gender revealed that there are also differences in the results by gender. Based on the research, we concluded that bicarbonate, blood urea nitrogen are correlated with cognitive function in older Americans. This effect varied across populations.

PMID:41324953 | DOI:10.1080/13548506.2025.2597470

Int J Aging Hum Dev. 2025 Dec 1:914150251401565. doi: 10.1177/00914150251401565. Online ahead of print.

ABSTRACT

The global rise in chronic noncommunicable diseases poses a growing challenge to healthcare systems, particularly in developing countries. This cross-sectional study aimed to investigate the associations between chronic diseases and mobility, balance, and visual memory in middle-aged adults. Ninety-seven participants aged 40-64 were categorized based on the Age-Adjusted Charlson Comorbidity Index. Assessments included the Timed Up and Go Test for mobility, the One-Leg Standing Balance Test for static balance, the Y Balance Test for dynamic balance, and the Rey-Osterrieth Complex Figure Test for visual memory. Individuals with chronic diseases had significantly lower scores in all outcome measures compared to those without (P < .05). However, after adjusting for confounders such as age, body mass index, education, and employment status, group differences were no longer statistically significant. Age, education level, static balance, and right foot dynamic balance were significantly associated with mobility. The results highlight the need for early assessment and preventive strategies targeting mobility, balance, and cognitive functioning in middle-aged individuals with chronic diseases.

PMID:41324948 | DOI:10.1177/00914150251401565

J Back Musculoskelet Rehabil. 2025 Dec 1:10538127251398406. doi: 10.1177/10538127251398406. Online ahead of print.

ABSTRACT

BackgroundLow back pain (LBP) is a common condition impacting the lumbar region, leading to significant dysfunction and diminished quality of life. This study focuses on understanding the burden of LBP in China and projects its incidence trends over the next 20 years. Data from the Global Burden of Disease Study 2021 (GBD 2021) was used to conduct the analysis.MethodsThe study employed multiple statistical approaches, including Joinpoint regression analysis, Age-Period-Cohort Model (APCM), Decomposition Analysis, and the Autoregressive Integrated Moving Average (ARIMA) model, to assess the trends in LBP prevalence, incidence, and Disability-Adjusted Life Years (DALYs) in China from 1990 to 2021 and predict future trends through 2041.ResultsIn 2021, LBP affected 628838475 individuals globally, with China accounting for 16% of this burden. Between 1990 and 2021, although the absolute number of LBP cases, incidence, and DALYs increased, the rates per 100000 people decreased. Age-specific analysis indicated LBP onset from age 5, peaking in the 55-59 age group. Females showed higher prevalence, incidence, and DALYs compared to males. Projections suggest the incidence rate will rise from 2343.78 per 100000 people in 2022 to 2560.92 per 100000 in 2041.ConclusionsThe findings highlight the increasing burden of LBP in China, emphasizing the urgent need for targeted prevention and treatment strategies. Future interventions should aim at reducing the impact of LBP to improve overall health and quality of life in affected populations.

PMID:41324923 | DOI:10.1177/10538127251398406