Tag: nevin manimala

Am J Public Health. 2026 Jun;116(6):798-805. doi: 10.2105/AJPH.2026.308513.

ABSTRACT

Objectives. To examine the magnitude of heat-related emergency medical services (EMS) activations across the United States and identify factors that increase the risk of heat exposure illness. Methods. We extracted heat-related EMS activations from April through September for 2020 through 2024 from the National Emergency Medical Services Information System (NEMSIS) database. We linked information from the 2022 Centers for Disease Control and Prevention (CDC) Social Vulnerability Index with heat-related EMS activations using county of residence. Our analysis focused on heat-related illness by patient demographic, geographic, and EMS system factors. Results. Among the 79 077 804 EMS activations meeting study inclusion criteria, 261 687 (0.3%) were heat related. The rate of heat-related EMS activations was 16.46 per 100 000 population, with higher rates among older adults, males, African Americans, and Native Hawaiians/Pacific Islanders. Rates were higher in rural counties and in counties characterized by the CDC Social Vulnerability Index as having relatively worse socioeconomic or environmental conditions. Heat-related EMS activations were commonly reported in the afternoon and in indoor locations. Conclusions. The NEMSIS database provides novel information that improves our ability to monitor heat-related adverse health outcomes. Public Health Implications. The timely collection and sharing of data provide critical situational awareness to inform public health response efforts during a heat wave. (Am J Public Health. 2026;116(6):798-805. https://doi.org/10.2105/AJPH.2026.308513).

PMID:42127377 | DOI:10.2105/AJPH.2026.308513

Am J Public Health. 2026 Jun;116(6):851-854. doi: 10.2105/AJPH.2026.308459.

ABSTRACT

Objectives. To examine trends in meningococcal B (MenB) vaccination coverage among US adolescents aged 16 and 17 years. Methods. We conducted cross-sectional and longitudinal analyses of 2018 to 2023 National Immunization Survey-Teen data to calculate the annual percentage of eligible adolescents who received the MenB vaccine and to assess changes over time. Results. Only 19.8% of the 41 505 eligible adolescents initiated MenB vaccination between 2018 and 2023. A total of 24.5% (95% confidence interval [CI] = 22.5, 26.6) of adolescents received 1 or more MenB vaccinations in 2023, as compared with 13.2% (95% CI = 11.7, 14.6) in 2018. Among initiators, most received only 1 dose. Conclusions. MenB vaccination coverage among 16- and 17-year-old adolescents increased modestly between 2018 and 2023. As of 2023, approximately 3 out of 4 adolescents in this age group had not received the MenB vaccine. Public Health Implications. As of 2023, less than one quarter of 16- and 17-year-old adolescents had initiated MenB vaccination. Given that MenB has accounted for most meningococcal disease among adolescents and young adults since 2013, efforts to improve uptake are warranted. (Am J Public Health. 2026;116(6):851-854. https://doi.org/10.2105/AJPH.2026.308459).

PMID:42127373 | DOI:10.2105/AJPH.2026.308459

Am J Public Health. 2026 Jun;116(6):841-850. doi: 10.2105/AJPH.2026.308508.

ABSTRACT

Objectives. To expand the understanding of food security among a racially and ethnically diverse sample of US adults living below 200% of the federal poverty line (FPL). Methods. I performed a cross-sectional analysis of the National Health Interview Survey (2019-2023) that included 37 748 respondents. I estimated unadjusted proportions and adjusted probabilities of food security for non-Hispanic White, Black, American Indian/Alaska Native (AIAN), Asian, and Hispanic adults living in severe (< 50% FPL), moderate (50% to < 100% FPL), and near poverty (100% to < 200% FPL). Results. The study reveals important nuances in food security by race and ethnicity. Non-Hispanic Asian adults in severe poverty experienced higher food security than their counterparts in less dire economic situations, non-Hispanic Whites and Hispanics were more similar than previously reported, and non-Hispanic AIAN adults reported extremely low probabilities of food security. Conclusions. Thoroughly documenting and expanding on these patterns of food security for lower-income adults could lead to better understanding of policy mechanisms that could alleviate food insecurity and reduce health disparities by racial and ethnic identity in the United States. (Am J Public Health. 2026;116(6):841-850. https://doi.org/10.2105/AJPH.2026.308508).

PMID:42127364 | DOI:10.2105/AJPH.2026.308508

JMIR Med Inform. 2026 May 13;14:e79929. doi: 10.2196/79929.

ABSTRACT

BACKGROUND: Antibiotic therapies are the main treatment for bacterial infections, but growing antibiotic resistance is a major global health threat, severely impacting patients with sepsis. Rapid selection of the most effective antibiotic therapy is critical for survival and for preventing further resistance. Physicians must consider numerous factors for proper empiric treatment selection. A clinical decision support system (CDSS) aims to support physicians in this process, facilitating rapid and targeted therapy.

OBJECTIVE: The purpose of this work is to explore the extent to which the realization of a CDSS is possible based on the data available to us and to document insights gained during the development of a foundational model designed to assist physicians in determining empiric treatment options for patients with sepsis. In this regard, rather than aiming to develop a CDSS for clinical application, we highlight the importance of close interprofessional collaboration between scientists from various disciplines and analyze the effects of data quality and quantity on the performance of our statistical models.

METHODS: Empirical scientists conducted interviews with medical practitioners to acquire the medical knowledge required to develop sound statistical models. We developed and applied 2-step cross-sectional, as well as time-series classification models, to carefully preprocessed data of patients with sepsis admitted to the intensive care unit of a German hospital.

RESULTS: We identified several factors as crucial information for valid decisions on empiric therapy for treating patients with sepsis. These include the patients’ core data, especially the infection focus. To prevent further resistance, individual risk factors such as travel history and professional background should be considered. The evaluation of a therapy’s effectiveness is mainly based on the patient’s general condition and blood values such as procalcitonin and interleukin 6. One key factor in the acceptance of a CDSS is the explainability of the results produced by the applied methods. Our models demonstrated mainly weak predictive ability for all considered empiric antibiotic therapies. However, they are not yet suitable for use in clinical practice, especially as they are based on prescribing habits rather than on optimal treatment decisions.

CONCLUSIONS: This work highlights the importance of interprofessional collaboration between medical experts and model developers, ensuring that data quality and clinical relevance are central to the process. It emphasizes the urgent need for high-quality, comprehensive data to overcome challenges such as data discontinuity and improve model performance, particularly through enhanced digitization in health care. This feasibility study will facilitate future efforts to develop a CDSS for treating patients with sepsis and to translate it into clinical use.

PMID:42127362 | DOI:10.2196/79929

Acute Med. 2025;24(3):139-146. doi: 10.52964/AMJA.1019.

ABSTRACT

INTRODUCTION: Use of procalcitonin (PCT) across Acute Medical Units (AMUs) in the United Kingdom (UK) post-COVID-19 is not well understood. We aim to explore clinician knowledge and behaviours relating to PCT-guided antimicrobial decision making for patients managed in NHS AMUs across the UK.

METHODS: A web-based survey was sent via email to members of the Society for Acute Medicine Results: There were 342 individual responses from 133 organisations, of which half (52.6%) had access to PCT. Self-reported knowledge of PCT was rated adequate or good for most respondents (84.3%), despite the majority of respondents reporting non-availability or unawareness of local PCT guidance (66.2% organisations). The greatest influences of PCT use were previous experience, personal review of evidence, and local culture. A majority of respondents (115/211;54.5%) felt PCT often (≥40% of the time) had a role in guiding antimicrobial decision making in the AMU.

CONCLUSIONS: There is widespread variation in practice, driven in part by inconsistency around local guidelines and a lack of national guidance to inform the use of this biomarker. We recommend the development of national, evidence-based guidance around the use of PCT to ensure consistency of approach and high-quality care for patients with suspected infection.

PMID:42127353 | DOI:10.52964/AMJA.1019

Acute Med. 2025;24(3):132-138. doi: 10.52964/AMJA.1018.

ABSTRACT

Acute Internal Medicine (AIM) is a dynamic specialty that addresses the urgent medical needs of adult patients. This study analyses data from the RCP 2023 workforce census to understand for the first time how Acute Physicians allocate their clinical working time across key service areas. Results reveal that the majority of AIM consultants focus on Acute Medical Units (AMU) and Same Day Emergency Care (SDEC), with occasional involvement in newer services such as virtual wards and hospital at home. There is also a significant proportion of time spent performing clinical activity within the Emergency Department, which likely reflects ongoing pressures within the urgent and emergency care system taking Acute Physicians outside of their intended working environments. These findings provide a baseline for future workforce planning and highlight the evolving priorities in AIM.

PMID:42127352 | DOI:10.52964/AMJA.1018

Neurology. 2026 Jun 23;106(12):e218082. doi: 10.1212/WNL.0000000000218082. Epub 2026 May 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: The impact of pregnancy on the clinical course of myasthenia gravis (MG) remains uncertain, with existing evidence mainly derived from small case series. Using nationwide longitudinal register data, we aimed to assess the risk of MG exacerbation during pregnancy and up to 1 year postpartum.

METHODS: In this population-based cohort study, we included women with MG recorded in the Swedish National MG Register who had singleton pregnancies documented in the Medical Birth Register after MG diagnosis (1987-2019). The exposure was pregnancy, and the outcome was MG exacerbation. The primary outcome measure was hospital admissions with MG during pregnancy and the postpartum year, compared with the year preceding pregnancy. Cox proportional hazards models estimated hazard ratios (HRs), adjusting for disease duration and prior thymectomy. The secondary outcome measure was changes in immunosuppressive MG medications during pregnancy and postpartum.

RESULTS: We identified 112 women with MG (median age 30 years) with 176 singleton pregnancies. During pregnancy, women were not more likely to be hospitalized for MG than in the prepregnancy year (HR 0.74, 95% CI 0.39-1.41), and there was no increased risk of longer hospital admissions (HR 0.83, 95% CI 0.36-1.88). The postpartum period was associated with an increased risk of prolonged MG admissions during the first 3 months (HR 5.02, 95% CI 1.66-15.24), with a similar risk observed throughout the first 12 months postpartum (HR 4.52, 95% CI 1.26-16.14). During pregnancy, immunosuppressive MG medications were reduced or discontinued in 13 pregnancies and increased in 6. Postpartum, medications were initiated or escalated in 10 pregnancies and reduced in none. The risk of prolonged MG admissions was higher in periods outside of pregnancy compared with the prepregnancy year (HR 2.95, 95% CI 0.84-10.43), suggesting that women conceive during periods of relative disease stability.

DISCUSSION: Pregnancy was not associated with an increased risk of MG exacerbation. The postpartum period was linked to more severe or prolonged exacerbations in a minority of women, highlighting the importance of close monitoring after delivery. Milder exacerbations not requiring hospitalization or clear medication escalation may have been underestimated, underscoring the need for larger prospective international studies that include detailed clinical data.

PMID:42127347 | DOI:10.1212/WNL.0000000000218082

J Nurs Res. 2026 May 8. doi: 10.1097/jnr.0000000000000744. Online ahead of print.

ABSTRACT

BACKGROUND: With the increasing emphasis on sustainability in health care, it is essential to clarify how work conditions and professional identity influence sustainable behavior in nurses. Decent work environments may contribute to professionalism, which is known to foster sustainable practices.

PURPOSE: This study was designed to investigate the relationship between decent work practices and self-reported sustainable behavior in nurses, with a focus on the mediating role of professionalism.

METHODS: This cross-sectional study was conducted on a sample of 206 clinical nurses. Data were collected using validated Arabic versions of the Decent Work Scale, Nurses’ Professionalism Inventory, and Self-Reported Sustainable Behavior Scale. Statistical analyses included Pearson correlation, t-tests, analysis of variance (ANOVA), and mediation analysis.

RESULTS: The results revealed significantly positive associations between all of the study variables. Decent work practices were shown to correlate strongly with both professionalism (r=.870) and sustainable behavior (r=.897). Also, professionalism was found to correlate positively with sustainable behavior (r=.823). The results of the mediation analysis confirmed professionalism to significantly mediate the relationship between decent work and sustainable behavior (indirect effect β=0.332, 95% CI [0.194, 0.447]).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Decent work conditions enhance professionalism and, as a result, promote sustainable behavior in nurses. These findings underscore the importance of fostering supportive work environments and professionalism to achieve sustainable health care practices. Interventions that enhance decent work and professionalism may play a critical role in advancing sustainability in health care.

PMID:42127335 | DOI:10.1097/jnr.0000000000000744

Neurol Neuroimmunol Neuroinflamm. 2026 Jul;13(4):e200573. doi: 10.1212/NXI.0000000000200573. Epub 2026 May 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Primary CNS vasculitis (PCNSV) is a heterogeneous condition. This study examines a large cohort with long-term follow-up to identify potential disease subsets.

METHODS: We retrospectively analyzed 216 patients with PCNSV (Mayo Clinic, 1983-2023), using standardized diagnostic criteria, classifying by vessel size, histopathology, and outcomes. Subsets and predictors of functional and therapeutic outcomes were evaluated.

RESULTS: Diagnosis was based on cerebral angiography in 142 patients and histologically confirmed in 74. Isolated small vessel involvement was positively associated with mass-lesion presentation (odds ratio [OR] 19.38, p = 0.02), meningeal-enhancing lesions (OR 39.10, p < 0.0001), elevated CSF protein (OR 4.04, p = 0.03), and β-amyloid vascular deposits (OR 23.43, p = 0.0001), but negatively with focal manifestations (OR 0.32, p = 0.04) and cerebral infarcts (OR 0.22, p = 0.003). Lymphocytic vasculitis was linked to younger age at diagnosis (p = 0.006), longer symptom-to-diagnosis interval (p = 0.05), more seizures (p = 0.04), and lower disability (p = 0.003) and mortality (p = 0.008). Necrotizing vasculitis was associated with intracranial hemorrhage (p = 0.008). Two or more relapses occurred in 12.7%, associated with histologic diagnosis (OR 3.15, p = 0.009) and inversely with gadolinium-enhanced lesions (OR 0.33, p = 0.01). Therapy response occurred in 82.9%, long-term remission in 23.6%. Cerebral infarcts, especially multiple, were associated with poor therapy response (OR 0.11, p = 0.03). Histologic diagnosis was inversely associated with long-term remission (OR 0.44, p = 0.03), whereas aspirin use was positively associated (OR 2.8, p = 0.002). A rapidly progressive course occurred in 13.4% of patients and was linked to increasing age (OR 1.34/10 years, p = 0.04), cognitive dysfunction (OR 5.59, p = 0.02), cerebral infarctions (OR 5.02, p = 0.004), and large vessel involvement (OR 3.51, p = 0.02). Gadolinium-enhanced lesions (OR 0.36, p = 0.04) and aspirin (OR 0.42, p = 0.08) were protective. Mortality (21.3%) was associated with older age (HR 1.42, p = 0.002), cognitive dysfunction (HR 3.93, p = 0.006), and cerebral infarctions (HR 1.94, p = 0.03).

DISCUSSION: PCNSV heterogeneity, driven by vessel size and histology, affects presentation and outcomes; our findings offer insights to improve diagnosis and treatment.

PMID:42127334 | DOI:10.1212/NXI.0000000000200573

J Clin Oncol. 2026 May 13:JCO2502719. doi: 10.1200/JCO-25-02719. Online ahead of print.

ABSTRACT

PURPOSE: Limited efficacy of current treatments for chordoma calls for novel therapeutic options. Combination of immune checkpoint inhibitors and antiangiogenic drugs has altered the landscape of cancer treatment but has rarely been investigated in chordoma.

METHODS: An investigator-initiated, single-center, phase II trial was conducted on camrelizumab (a PD-1 inhibitor, 200 mg once every 2 weeks) plus apatinib (an antiangiogenic drug, 250 mg and 500 mg on alternate days, that is, 250 mg one day, 500 mg the next day, alternating) in patients with refractory chordoma for 4-week cycles. The primary end point was the objective response rate (ORR) per RECIST version 1.1. Secondary end points included ORR per Choi criteria, progression-free survival (PFS), overall survival, the disease control rate, median duration of response (mDoR), safety, and quality of life. The trial is registered with Chictr.org.cn (ChiCTR2100042938).

RESULTS: Of the 38 patients initially screened between September 2021 and October 2024, 33 were enrolled. Median follow-up duration was 20.8 months (IQR, 13.35-26.55). ORR was 24.2% (8/33 [95% CI, 11.0 to 38.9]) per RECIST 1.1 and 48.5% (16/33 [95% CI, 30.8 to 66.5]) per Choi criteria. The median PFS was 28.4 months (95% CI, 13.53 to 43.28). The mDoR was not reached per RECIST 1.1 and was 22.2 months (95% CI, 12.5 to not reached) per Choi criteria. CDKN2A copy-number deletion or homozygous deletion was found to associate with worse prognosis. The most common grade 3 or 4 treatment-related adverse events included increased aspartate aminotransferase (13 [39.4%]) and increased alanine aminotransferase (11 [33.3%]). No treatment-related deaths occurred.

CONCLUSION: Combination of camrelizumab and apatinib offered encouraging efficacy with manageable toxicity in chordoma treatment. CDKN2A alterations are associated with worse prognosis and may prove to be a potential biomarker for treatment selection.

PMID:42127327 | DOI:10.1200/JCO-25-02719