Tag: nevin manimala

JAMA Netw Open. 2026 May 1;9(5):e2615550. doi: 10.1001/jamanetworkopen.2026.15550.

ABSTRACT

IMPORTANCE: Buprenorphine can prevent opioid overdose deaths among patients with opioid use disorder (OUD). Among privately insured patients using buprenorphine, it is unclear whether switching from a non-high-deductible health plan (HDHP) to an HDHP is associated with changes in buprenorphine dispensing or OUD-related health care visits.

OBJECTIVE: To evaluate the association between switching to an HDHP, buprenorphine dispensing, and OUD-related health care visits.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional difference-in-differences analysis of the 2010 to 2023 Optum Labs Data Warehouse, a longitudinal clinical database with deidentified claims. Analyses included privately insured adults who were continuously enrolled throughout a baseline and follow-up year and had buprenorphine dispensing in the baseline year. The treatment group included patients who switched from a non-HDHP to an HDHP. The control group included patients who remained in a non-HDHP. Data were analyzed from January 1, 2025, through February 1, 2026.

EXPOSURE: Switching to an HDHP.

MAIN OUTCOMES AND MEASURES: Annual number of days with active buprenorphine prescriptions; annual number of OUD-related outpatient visits; annual number of OUD-related emergency department visits or hospitalizations. Linear models with patient fixed effects compared changes in outcomes among the treatment and control groups. In a subgroup analysis, the treatment group was limited to patients experiencing a deductible increase exceeding the median of $1250.

RESULTS: Among 14 801 included patients (9419 [63.6%] male), switching to an HDHP was associated with a differential decrease in the number of days with active buprenorphine prescriptions (-29.0; 95% CI, -35.0 to -22.9) but not with changes in OUD-related outpatient visits (-0.5; 95% CI, -1.0 to 0.05) or OUD-related emergency department visits and hospitalizations (4.0 events per 100 patients; 95% CI, -0.5 to 8.4 events per 100 patients). In the subgroup analysis, switching to an HDHP was associated with a differential decrease in the number of OUD-related outpatient visits (-1.0; 95% CI, -1.8 to -0.3). Results for other outcomes were similar to the overall analysis.

CONCLUSIONS AND RELEVANCE: In this repeated cross-sectional study using difference-in-differences analysis of privately insured patients using buprenorphine, those who switched to an HDHP were more likely to decrease buprenorphine use. When deductible increases were large, patients who switched to an HDHP were also more likely to decrease the number of OUD-related outpatient visits. Findings suggest that switching to an HDHP may be associated with heightened barriers to OUD treatment.

PMID:42207512 | DOI:10.1001/jamanetworkopen.2026.15550

JAMA. 2026 May 28. doi: 10.1001/jama.2026.6214. Online ahead of print.

ABSTRACT

IMPORTANCE: Adverse drug effects from blood pressure (BP)-lowering drugs contribute to significant undertreatment and poor overall BP control rates.

OBJECTIVE: To review adverse effects and discontinuation of BP-lowering drugs and their combinations from the 5 major classes in short-term clinical trials.

DATA SOURCES AND STUDY SELECTION: Cochrane Central Register of Controlled Trials for randomized clinical trials, MEDLINE, and Epistemonikos were searched from the date of inception until December 31, 2024, for double-blind randomized clinical trials of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs), thiazide and thiazide-like diuretics, or their combinations, with follow-up durations between 4 and 26 weeks.

DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by 2 independent reviewers. Synthesis was performed using fixed-effect network meta-analyses according to drug class, summarized using odds ratios (ORs) and 95% credible intervals (CrIs) and surface under the cumulative ranking curves. Final statistical analysis was conducted in April 2026.

MAIN OUTCOMES AND MEASURES: Treatment discontinuation due to adverse events (AEs), defined as discontinuation of randomized treatment due to an AE. Secondary outcomes included headache, dizziness, edema, and cough.

RESULTS: A total of 716 trials were included, with mean (SD) follow-up of 8.6 (5) weeks, including 159 362 participants (mean [SD] age, 54.6 [7] years; 44% female; mean baseline BP, 158/100 mm Hg). Compared with placebo, treatment discontinuation due to AEs was significantly increased by CCBs (OR, 1.43 [95% CrI, 1.23-1.67]; risk difference [RD], 1.2% [95% CrI, 0.6%-2.0%]), angiotensin-converting enzyme inhibitors plus CCBs (OR, 1.46 [95% CrI, 1.13-1.87]; RD, 1.1% [95% CrI, 0.2%-2.4%]), and β-blockers plus thiazide diuretics (OR, 1.58 [95% CrI, 1.04-2.47]; RD, 1.7% [95% CrI, 0.1%-4.3%]). All ARB-containing regimens had fewer treatment discontinuations due to AEs than placebo, and these differences were statistically significant for ARB monotherapy (OR, 0.73 [95% CrI, 0.61-0.86]; RD, -0.8% [95% CrI, -1.3% to -0.4%]) and ARBs plus CCBs (OR, 0.61 [95% CrI, 0.47-0.79]; RD, -1.2% [95% CrI, -1.8% to -0.6%]). In network meta-analyses, 5 combination and 2 monotherapy regimens had higher surface under the cumulative ranking curve values than placebo for treatment discontinuation due to AEs, suggesting overall symptomatic improvement compared with placebo. All regimens significantly increased dizziness, and all but CCBs significantly decreased headache compared with placebo.

CONCLUSIONS AND RELEVANCE: This meta-analysis of short-term randomized clinical trials found that adverse drug effects that led to discontinuation of BP-lowering therapy varied by drug class and regimen, with several combination therapies being better tolerated than monotherapies. Some regimens were associated with fewer drug withdrawals than placebo, suggesting a net symptomatic improvement. These findings are based on trial-level results and rely on assumptions underlying the network meta-analysis; they may not apply to individual patients.

PMID:42207501 | DOI:10.1001/jama.2026.6214

Am J Phys Med Rehabil. 2026 May 28. doi: 10.1097/PHM.0000000000003046. Online ahead of print.

ABSTRACT

BACKGROUND: People with mobility disabilities experience significant barriers to regular physical activity, increasing risks of chronic disease and reducing quality of life. Mobile health (mHealth) programs may help by offering accessible, home-based exercise options. This study compared a 24-week mHealth intervention-with and without social networking-to an attention control condition.

METHODS: In this type 1 hybrid randomized controlled trial, 459 adults with mobility disabilities were randomized to one of three groups: M2M (exercise videos), M2Mplus (exercise videos plus social networking and optional coaching), or attention control (health articles). The 24-week intervention was delivered via a tablet-based app with follow-up through 48 weeks. The primary outcome was the Godin Leisure-Time Exercise Questionnaire (GLTEQ) health contribution score, measured at baseline, 12, 24, and 48 weeks.

RESULTS: At the 24-week primary endpoint, the M2Mplus group showed significantly greater increases in GLTEQ health contribution scores compared with attention control (LSM=4.8; 95% CI 1.7-7.8; P=.002). By 48 weeks, the difference was no longer statistically significant.

DISCUSSION: This large hybrid trial shows that scalable mHealth exercise programs can increase short-term physical activity among adults with mobility disabilities, though sustaining activity after the intervention ends remains challenging.

PMID:42207491 | DOI:10.1097/PHM.0000000000003046

Reprod Sci. 2026 May 28. doi: 10.1007/s43032-026-02128-1. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the impact of unfractionated heparin (UFH) use during pregnancy on maternal bone mineral density (BMD) by assessing BMD in pregnant women with heparin exposure using an artificial intelligence (AI)-assisted analysis of chest radiographs.

METHODS: This retrospective cohort study was conducted between April 2013 and October 2023. Pregnant women who received UFH therapy and underwent cesarean section (CS) were compared, using preoperative chest radiographs, with a control group who underwent CS without medication. Estimated BMD (eBMD) values for the lumbar spine (LS) and femoral neck (FN) were obtained via an AI-assisted diagnostic system. Statistical analyses included univariate and multivariate methods, adjusted for covariates.

RESULTS: Compared with the control group (n = 213), the UFH group (n = 86) exhibited significantly lower eBMD values at both LS and FN. Body mass index (BMI) correlated with eBMD in both groups, with underweight participants showing significantly lower eBMD, particularly in the UFH group. Multivariate analysis identified UFH as an independent factor associated with reduced eBMD in patients with LS. No significant correlation was found between the total UFH dose and eBMD.

CONCLUSION: UFH administration during pregnancy may be associated with decreased maternal eBMD, especially in underweight women, with the LS appearing more susceptible to bone loss than the FN. The estimation system may provide a safe, accessible, and effective method for early detection and risk stratification of pregnancy-associated bone loss, supporting future clinical management in at-risk populations.

PMID:42207474 | DOI:10.1007/s43032-026-02128-1

World J Pediatr. 2026 May 28. doi: 10.1007/s12519-026-01045-2. Online ahead of print.

ABSTRACT

BACKGROUND: Despite substantial global progress in reducing neonatal mortality, the deceleration in neonatal mortality decline in many low- and middle-income countries threatens attainment of Sustainable Development Goal 3.2. Intrapartum-related events and complications of preterm birth remain the leading causes of neonatal deaths. Therefore, this study aimed to examine temporal trends in neonatal and under-five mortality due to birth asphyxia, trauma, and prematurity from 2000 to 2021, with projections to 2040.

METHODS: This study used the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) cause-of-death dataset, which provides standardized annual estimates of under-five and neonatal mortality from birth asphyxia/trauma and prematurity for 194 countries and territories between 2000 and 2021. Causes of death were defined according to the dataset’s standardized classification. Country-specific mortality trends were examined in relation to four country-level indicators (the Socio-demographic Index, Human Development Index, Universal Health Coverage service coverage index, and Healthcare Access and Quality Index) using regression analyses. Temporal trends in cause-specific mortality were quantified using the estimated annual percentage change, and future mortality through 2040 was projected under three scenarios: (1) current-trend; (2) regional best-performer; (3) high-income country convergence based on country-specific annual rates of reduction.

RESULTS: Globally, neonatal mortality declined from 7.52 deaths per 1000 live births [90% uncertainty interval (90% UI): 7.13-7.88] to 4.18 (3.81-4.82) for birth asphyxia/trauma, and from 10.63 (10.05-11.33) to 6.49 (6.05-7.38) for prematurity between 2000 and 2021. West and Central Africa and Eastern and Southern Africa had the highest neonatal mortality in 2021 and achieved the slowest progress, whereas East Asia and Pacific and Eastern Europe and Central Asia had the most pronounced declines. Countries with lower sociodemographic and health system indicator values showed slower declines in mortality, while the greatest reductions were observed in those with intermediate-to-upper levels. Projections suggest that disparities could remain substantial by 2040 if current trends continue, although accelerated progress in high-burden regions could yield further reductions.

CONCLUSION: Despite substantial progress since 2000, neonatal mortality from birth asphyxia/trauma and prematurity remains persistently high, particularly in Africa, but scenario analyses suggest that substantial reductions could be achieved if future declines follow trajectories observed in the best-performing settings.

PMID:42207468 | DOI:10.1007/s12519-026-01045-2

Clin Rheumatol. 2026 May 28. doi: 10.1007/s10067-026-08186-9. Online ahead of print.

ABSTRACT

BACKGROUND: Heterogeneity in inflammatory arthritis (IA) outcomes limits the effectiveness of non-individualized treatment approaches, and digital health platforms can capture psychosocial and behavioral signals that may stratify responses beyond diagnosis or baseline severity.

OBJECTIVE: To identify clinically interpretable patient clusters and evaluate their associations with 12-week outcomes in IA, testing whether cluster membership adds information beyond demographics, diagnosis, and baseline symptom burden.

METHODS: We retrospectively analyzed the use of a CE-certified rheumatology application among adult patients. Baseline clinical and psychosocial variables (Patient’s Global Assessment of Disease Activity (PGADA) and Patient’s Global Assessment of Pain Intensity, sleep quality, social support, distress, fatigue, activity, diet/fasting) were winsorized (1st/99th), z-scaled, and imputed by median/mode for features only; outcomes were complete-case. Unsupervised k-means (k = 5) was selected based on silhouette, gap, and consensus diagnostics. The primary validation outcome was remission (12-week PGADA ≤ 20 mm for patients with baseline PGADA ≥ 40 mm), with distributional changes in PGADA and percentage change as secondary endpoints.

RESULTS: Among 2,924 patients, five clusters were identified (size range 17.7-22.9% of the cohort). The 12-week remission rate was 7.0%, with the “resilience” profile (characterized by better sleep, stronger social support, and lower distress) showing the highest probability of remission and the most favourable PGADA distribution. In contrast, distress-dominant clusters (characterized by poor sleep and weak support) showed the lowest remission rates and minimal improvement. The median ΔPGADA% was 8.3% (IQR – 8.2% to 32.0%). In adjusted analyses, the cluster signal persisted beyond baseline severity; percentage-change estimates were attenuated for clusters with lower baseline PGADA.

CONCLUSION: Cluster-level phenotypes derived from routinely collected app data align with short-term clinical outcomes, highlighting sleep, social support, and distress as modifiable factors that may influence short-term outcomes. Programs should emphasize the quality of activity and recovery (not just volume), particularly for patients with high distress and poor sleep. Future work should evaluate cluster-informed, multicomponent interventions in prospective studies. Key Points • Clinical-psychosocial archetypes derived from routinely collected app data (symptoms, sleep, social support, distress, lifestyle) were strongly associated with 12-week remission and PGADA change, beyond diagnosis and baseline severity. • Distress-dominant archetypes with poor sleep and weak social support had the lowest remission rates and minimal improvement, indicating that unaddressed psychological burden and sleep problems can blunt the benefits of otherwise appropriate pharmacological care. • Resilient archetypes, with better sleep, stronger social support, lower distress, and healthier lifestyle patterns, showed the most favourable outcomes, supporting a stratified care model in which digital tools help identify high-risk patients and prioritise targeted behavioral, psychosocial, and recovery-focused interventions rather than simply prescribing more physical activity.

PMID:42207465 | DOI:10.1007/s10067-026-08186-9

J Autism Dev Disord. 2026 May 28. doi: 10.1007/s10803-026-07367-4. Online ahead of print.

ABSTRACT

PURPOSE: Mental health (MH) challenges in autistic youth are often under-identified due in part to limited availability of assessment tools developed or adapted for the autism population. The K-CAT^®, a battery of computerized adaptive tests assessing up to nine MH domains in the general population, shows promise in addressing this need. Because these general instruments may not be valid or acceptable for use with autistic individuals, we evaluated the K-CAT^®‘s content validity for autistic youth with input from the autism community.

METHODS: Feedback was obtained from autistic youth, caregivers, and clinicians on the K-CAT^® through a mixed methods research design. One-hundred-fifty-one youth and caregivers provided feedback on ease of administration, relevance, comprehensiveness, and comprehensibility of the K-CAT^® overall. Thirty youth/caregiver dyads and 15 clinicians then participated in the mixed methods study of the K-CAT^® at the module- and item-level.

RESULTS: While participants had positive impressions of the K-CAT^® overall, weaknesses were identified by most participants and several recommendations for change were provided. The modules identified as most challenging were the Mania, Oppositional Defiant Disorder, and Conduct Disorder (CD) modules of the Child Version and the CD, Mania, and Anxiety modules of the Parent Version. The most commonly reported concerns were comprehension/clarity issues and symptom overlap between MH conditions and autism.

CONCLUSIONS: Modifications to the K-CAT^® appear both necessary and feasible. Findings will inform the development of a K-CAT^® Autism Version, which has the potential to transform the detection and monitoring of MH symptoms in autistic youth.

PMID:42207447 | DOI:10.1007/s10803-026-07367-4

J Behav Med. 2026 May 28. doi: 10.1007/s10865-026-00680-4. Online ahead of print.

ABSTRACT

Upwards of 40% of adults in the United States (US) meet criteria for obesity, highlighting obesity as a critical, ongoing public health crisis. Pain affects 33-40% of individuals with obesity, contributing to increased distress and added burden which necessitates a higher degree of coping resources. Individuals with obesity often manage distress through maladaptive eating behaviors, yet it is unclear what mechanisms may contribute to these individual differences in eating behaviors. One mechanism that is relevant to both obesity and pain is rumination, an aspect of repetitive negative thinking that is focused on past negative thoughts or problems and can influence behavioral responses. However, the role of rumination in terms of eating behavior among adults with obesity and pain is unexplored. The present study examined the role of rumination, including its sub-facets (brooding and reflection) in relation to emotional, external, and restrained eating behavior and related cognitions among individuals with comorbid obesity and pain. Participants were 137 adults with comorbid obesity and pain (M_age = 31.96 years, SD = 10.82, age range 18-75 years; 62.0% female). Results indicated that rumination was statistically significantly associated with emotional and external eating, such that higher levels of rumination were related to increased engagement in these specific eating behaviors and related cognitions. These findings indicate that rumination, and ruminative brooding specifically, may serve as a modifiable, clinically actionable mechanism, highlighting a novel opportunity to improve outcomes for maladaptive eating in individuals with comorbid obesity and pain.Trial Registration Number: NCT03917901. Registered 13 April 2019.

PMID:42207434 | DOI:10.1007/s10865-026-00680-4

World J Microbiol Biotechnol. 2026 May 28;42(6):309. doi: 10.1007/s11274-026-05058-x.

ABSTRACT

Microplastics (MPs) accumulate in soils, forming microbial habitats termed the “plastisphere”, which can concentrate hydrophobic pollutants like phenanthrene (PHE). This study investigated how PHE stress influences the microbial community in the polypropylene-amended soil plastisphere compared to bulk soil, revealing its “microbial refuge” function. Significant differences in microbial composition were observed. Under PHE stress, the number of unique genera in the plastisphere increased from 4 (without PHE) to 9, and the composition of significantly enriched genera changed substantially, with only 1 out of 6 enriched genera shared between PHE-stressed and non-stressed conditions. In contrast, the depleted genera remained largely consistent. Functional prediction indicated that PHE stress was associated with reduced health risks in the plastisphere relative to bulk soil. Carbon and methane metabolism pathways were significantly enriched in the plastisphere regardless of PHE stress. In contrast, nitrogen metabolism, aromatic compound degradation, and PAH degradation pathways did not differ significantly between the plastisphere and soil. Although several pathways reached statistical significance, fewer than 8.33% exhibited an absolute log₂FC > 1. This discrepancy indicates that microplastics exert a limited biological impact on the overall metabolic potential of the soil microbiome, irrespective of PHE contamination. Microbial co-occurrence networks initially showed similar complexity between plastisphere and soil. However, PHE stress markedly reduced network complexity (degree) in the plastisphere and increased the proportion of negative correlations (indicating competition/antagonism) from ~ 60% to ~ 50% in both habitats. This study advances the mechanistic understanding of pollutant-driven microbial responses in soil plastispheres, with a focus on how this unique plastic-associated microbial niche mediates microbial composition, function, and network under PAH stress, thereby informing targeted bioremediation and ecological risk models for microplastic-organic co-contaminated environments.

PMID:42207427 | DOI:10.1007/s11274-026-05058-x

Brain Imaging Behav. 2026 May 28;20(3):96. doi: 10.1007/s11682-026-01165-3.

ABSTRACT

Identifying brain phenotypes influencing social participation may help understand social deficits in psychiatric disorders. Previous research shows methodological inconsistencies, lacking consensus on which brain regions are crucial. Data-driven variable selection may overcome this, facilitating unbiased replication and discovery of social brain regions. We compare data-driven selection to literature-identification of brain regions in explaining social participation variation. In 37,576 UK Biobank participants (mean age 65 ± 8, 53% female) with structural and functional neuroimaging data, social participation (range 0-10) was derived by combining leisure activity participation and friend/family visits. First, literature review identified a subset of brain regions previously associated with social measures. Secondly, recursive feature elimination selected a subset of imaging-derived phenotypes in 25% (n = 9,394) of the sample. Hierarchical regression in the remaining 75% (n = 28,152) compared whether data-selected or literature-identified brain phenotype-sets explained more variance in social participation. Individual p-values were corrected for multiple comparisons using the false discovery rate. Recursive feature elimination selected 198 imaging-derived phenotypes. Data-selected imaging-derived-phenotypes explained more variance in social participation (1.31%) than literature-identified (0.84%, F = 3.17, p < 0.0001). Seventeen imaging-derived-phenotypes were associated with social participation including mid-posterior-cingulate, inferior-frontal/orbital and insular thickness, and functional connectivity between pericentral with medial frontoparietal and cerebellar networks. Multi-modal brain imaging-derived phenotypes can predict small but significant variation in social participation. We confirmed previously identified social brain associations of pericentral and medial frontoparietal, and orbital regions while also implicating novel relationships with the insula, acoustic radiation, and lateral frontoparietal networks. This highlights the value of data-driven approaches in solidifying social brain regional involvement, outperforming literature-based methods, and revealing previously undetected relationships.

PMID:42207420 | DOI:10.1007/s11682-026-01165-3