Tag: nevin manimala

Singapore Med J. 2026 Jul 17. doi: 10.4103/singaporemedj.SMJ-2025-292. Online ahead of print.

ABSTRACT

INTRODUCTION: Sarcopenia and cardiovascular-kidney-metabolic (CKM) syndrome are common comorbidities. We evaluated their cumulative impact on all-cause and cardiovascular mortality, and the modifying effect of a Composite Dietary Antioxidant Index (CDAI).

METHODS: This prospective study used data from the National Health and Nutrition Examination Survey linked to the National Death Index. Sarcopenia (Foundation for the National Institutes of Health criteria) and CKM syndrome (American Heart Association stages, dichotomised into advanced/non-advanced) defined the primary exposure. Outcomes were all-cause and cardiovascular mortality. Cox models estimated hazard ratios (HRs). Maximally selected rank statistics determined optimal outcome-specific CDAI thresholds.

RESULTS: Among 8782 participants (median follow-up 131 months), advanced CKM syndrome was associated with sarcopenia (odds ratio 2.29, 95% confidence interval [CI] 1.48-3.53). This study demonstrated a cumulative risk of comorbid advanced CKM syndrome and sarcopenia on mortality, with this group exhibiting the highest risk for all-cause (HR 3.11, 95% CI 1.72-5.61) and cardiovascular (HR 1.80, 95% CI 1.04-3.12) mortality. Furthermore, we identified an inverse relationship between disease burden and protective CDAI thresholds for all-cause mortality, whereas cardiovascular mortality exhibited a distinctly higher threshold. Specifically, the comorbidity group required lower antioxidant intake (CDAI >-3.80) than the non-comorbidity group (CDAI >-1.19) for all-cause mortality. Conversely, cardiovascular mortality required a substantially higher threshold (CDAI >3.04).

CONCLUSION: Coexisting advanced CKM syndrome and sarcopenia present a significant cumulative mortality risk. Exploratory analyses suggest that this risk may be mitigated by dietary antioxidants, but the protective threshold is context-dependent. Modest dietary improvement was associated with improved all-cause survival in high-risk patients, whereas higher antioxidant intake correlated with better cardiovascular outcomes. These results suggest that precision nutrition strategies may vary depending on the specific health outcome.

PMID:42467916 | DOI:10.4103/singaporemedj.SMJ-2025-292

Eur J Gastroenterol Hepatol. 2026 Jun 2. doi: 10.1097/MEG.0000000000003228. Online ahead of print.

ABSTRACT

OBJECTIVE: Rectal disease activity in ulcerative colitis is associated with a high symptom burden. The British Society of Gastroenterology (BSG) provides evidence-based recommendations for the management of ulcerative proctitis, which are relevant to patients with rectal disease activity; however, real-world adherence and outcomes remains unclear. This study aimed to evaluate adherence to BSG guideline-recommended management and its relationship with treatment timing and clinical outcomes.

METHODS: We conducted a retrospective observational cohort study at a single tertiary center (2022-2024). Adults with endoscopically confirmed rectal disease activity in ulcerative colitis were included. Guideline adherence was assessed using predefined criteria derived from the BSG algorithm. Clinical, biochemical, endoscopic, and histological remission were evaluated at 12 months.

RESULTS: Of 119 patients, 63 (52.9%) received guideline-adherent management. Adherence was significantly higher when treatment decisions were made at endoscopy compared with deferral to clinic (73 vs. 22%, RR: 0.30, 95% CI: 0.16-0.51; P < 0.001). At 12 months, clinical remission was achieved in 97/119 (81.5%), biochemical remission in 80/96 (83.3%), endoscopic remission in 36/68 (52.9%), and histological remission in 30/68 (44.1%). Guideline-adherent management showed numerically higher clinical remission rates, though not statistically significant. Deferral of treatment decisions was associated with a lower rate of clinical remission (72 vs. 86%), although not statistically significant (P = 0.06).

CONCLUSION: Guideline adherence is suboptimal in real-world practice. Endoscopy-led decision-making were strongly associated with guideline adherence and represents a modifiable system-level factor in care delivery. High overall remission rates suggest that guideline adherence alone may be an incomplete surrogate for care quality.

PMID:42467913 | DOI:10.1097/MEG.0000000000003228

JMIR Res Protoc. 2026 Jul 17;15:e69733. doi: 10.2196/69733.

ABSTRACT

BACKGROUND: Hypnosis is a focused state of consciousness that enhances concentration, attention, and responsiveness to suggestion. It has shown efficacy in treating psychiatric disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD). However, its potential for addressing burnout and related symptoms remains underexplored. This systematic review and meta-analysis aims to assess the effectiveness of hypnotherapy in alleviating symptoms of burnout and associated conditions, including depression, anxiety, and PTSD.

OBJECTIVE: This study aims to evaluate the efficacy of hypnotherapy in treating burnout and its related psychopathologies, including depression, anxiety, and PTSD.

METHODS: A comprehensive search was conducted across PubMed, Scopus, and PsycINFO for peer-reviewed, English-language observational and experimental studies published up to February 2024. Only studies with adults (>18 y) who received hypnotherapy for psychiatric symptoms will be included. Data extraction will focus on treatment effects related to burnout and associated psychiatric conditions. Statistical analysis will be performed using Comprehensive Meta-Analysis (version 4.0). A random-effects model will be used to account for heterogeneity, with Cochran Q and I² statistics used to assess variability. Subgroup analyses will explore moderators such as sociodemographic factors, country, and study quality. Sensitivity analyses will identify influential studies, and publication bias will be assessed using funnel plots and the Egger test. All analyses will be 2-sided (P<.05), and the results will be presented in forest plots.

RESULTS: The search strategy underwent a PRESS (Peer Review of Electronic Search Strategies) review in December 2023 and was registered in PROSPERO (International Prospective Register of Systematic Reviews) in January 2024. Database searches were completed between February and April 2024, followed by title and abstract screening from May to November 2024. Full-text screening began in December 2024, with data extraction conducted from January through April 2025. A preliminary narrative synthesis was completed between May and August 2025. Quantitative analysis began in September 2025 and is ongoing, with completion anticipated in early summer 2026. The final findings are expected to be submitted for publication by fall 2026.

CONCLUSIONS: This review aims to synthesize existing evidence on the potential role of hypnotherapy for burnout and related psychiatric symptoms. This systematic review will provide an updated synthesis of evidence on hypnotherapy for burnout and associated psychological outcomes. Limitations include variability in study designs and measurement tools. The results will be disseminated through peer-reviewed journals and scientific meetings to guide future clinical and research applications.

PMID:42467904 | DOI:10.2196/69733

J Appl Microbiol. 2026 Jul 17:lxag180. doi: 10.1093/jambio/lxag180. Online ahead of print.

ABSTRACT

AIMS: To develop a user-friendly and portable reference material (RM) for onsite validation of medical sterilization equipment, addressing the limitations of conventional biological indicators that require specialized laboratory facilities.

METHODS AND RESULTS: A lyophilized microsphere-based RM containing Bacillus atrophaeus spores was developed by optimizing lyoprotectant formulation. The RM demonstrated excellent homogeneity (F statistic < F critical) and satisfactory stability over 14 days at 4°C and 25°C, rigorously according to ISO 33405: 2024 standard method. When applied to validate UV sterilization devices by quantifying viable spore reduction, it further provided precise and reliable log reduction value measurements. The simple reconstitute-and-culture procedure enabled non-specialists to perform onsite checks. For instance, in UV validation, optimal conditions (e.g., ≥3-log reduction within 30 min at a distance of 150 cm) were easily determined using this RM. Preliminary assessments also confirmed its applicability for ozone and ethylene oxide sterilizers.

CONCLUSIONS: This study presents the first preparation of a convenient, lyophilized spore RM that fulfills ISO 33405: 2024 criteria. Its successful application in validating multiple sterilization modalities demonstrates significant potential for routine quality control and compliance testing in healthcare settings, particularly where advanced laboratory facilities are unavailable.

PMID:42467903 | DOI:10.1093/jambio/lxag180

Rev Esc Enferm USP. 2026 Jul 17;60:e20250589. doi: 10.1590/1980-220X-REEUSP-2025-0589en. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify and map the main guidelines for carrying out home-based enzyme replacement therapy (ERT) administered to children and adolescents diagnosed with mucopolysaccharidosis.

METHOD: A scoping review, conducted according to JBI Manual for Evidence Synthesis (Edition 2024). Twelve data sources were consulted using specific search strategies. Data were extracted using a specific form and analyzed using simple descriptive statistics and a qualitative PAGER approach.

RESULTS: The final sample consisted of 13 articles published between 2007 and 2020, mostly conducted in European countries, with a predominance of authors affiliated with the Royal Manchester Children’s Hospital. Five patterns were identified for consolidating qualified and safe care in the context of homebased ERT administered to children and adolescents with types I, II, IV-A, and VII mucopolysaccharidoses. The nurse emerges as an essential professional in all stages and activities presented.

CONCLUSION: Despite the progress made regarding guidelines for the decentralization of ERT, challenges to its implementation still persist, among which the need for dissemination of technical and scientific knowledge stands out.

PMID:42467880 | DOI:10.1590/1980-220X-REEUSP-2025-0589en

JAMA Health Forum. 2026 Jul 2;7(7):e262207. doi: 10.1001/jamahealthforum.2026.2207.

ABSTRACT

IMPORTANCE: Supply-side challenges combined with high costs and limited insurance coverage led to a robust market for compounded glucagon-like peptide-1 receptor agonists (GLP-1 RAs). However, assessment of this market since the end of the semaglutide and tirzepatide shortages is needed.

OBJECTIVE: To characterize available compounded GLP-1 RA products, describe aspects of patient care and monitoring, and identify source pharmacies of available compounded products.

DESIGN, SETTING, AND PARTICIPANTS: From August to October 2025, a cross-sectional secret shopper study was conducted of brick-and-mortar weight-loss clinics and medical spas advertising GLP-1 RAs for weight loss and offering compounded GLP-1 RAs. These businesses were identified in January 2025 using a web mapping application to perform location-based searches that were supplemented with a review of business websites and publicly available data regarding compounding facilities. The businesses were located in 2 states (West Virginia and Oklahoma) with potentially high demand for compounded GLP-1 RAs that were purposively selected based on obesity rate and insurance mix.

MAIN OUTCOMES AND MEASURES: Compounded GLP-1 RAs offered by weight-loss clinics and medical spas; aspects of patient care and monitoring; and characteristics of compounding suppliers, including facility type, licensing status, objectionable conditions noted by investigators, and disciplinary actions.

RESULTS: A total of 75 weight-loss clinics and medical spas offering compounded GLP-1 RAs were identified and included in the analysis. Of these businesses, 7 (9.3%) reported offering oral compounded GLP-1 RA formulations and 42 (56.0%) reported offering compounded GLP-1 RA products combined with B vitamins. Twenty-three compounding facilities were identified as suppliers, 4 (of 21; 19.0%) of which were not licensed to perform sterile compounding. Since 2023, 1 facility (4.3%) had received multiple US Food and Drug Administration warning letters and 3 of 22 (13.6%) had been subject to state-level disciplinary action.

CONCLUSIONS AND RELEVANCE: Findings of this study show that, after the end of the semaglutide and tirzepatide shortages, compounding facilities have continued to manufacture GLP-1 RAs with added ingredients. Compounded GLP-1 RA sourcing is diverse but includes facilities without licenses to perform sterile compounding or that have been subject to recent disciplinary action, posing clinical and regulatory challenges.

PMID:42467450 | DOI:10.1001/jamahealthforum.2026.2207

JAMA Health Forum. 2026 Jul 2;7(7):e262226. doi: 10.1001/jamahealthforum.2026.2226.

ABSTRACT

IMPORTANCE: Forty-three state Medicaid programs have bed-hold policies that reimburse nursing homes (NHs) to reserve a resident’s bed during a hospitalization or other temporary absence. Although bed-hold policies are intended to increase continuity of care, some evidence suggests they may incentivize NHs to hospitalize residents; however, these data are outdated, and the impact of bed-hold policies on resident outcomes remains understudied.

OBJECTIVE: To examine the association between Medicaid bed-hold policies and hospitalizations and emergency department (ED) visits among NH residents receiving long-term care.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of long-stay NH residents in the US used claims data for a 20% national sample of Medicare fee-for-service beneficiaries from 2013 through 2018. Adjusted comparisons between states that did and did not adopt bed-hold policies were conducted using a staggered difference-in-differences design. Sensitivity analyses were conducted that (1) used composite outcomes combining death with hospitalization and ED visits, (2) restricted the sample to dually eligible residents, (3) excluded hospital-based NHs, (4) restricted the sample to NHs that were present for the entire study period, (5) restricted the sample to for-profit NHs, and (6) used alternate approaches to adjust standard errors. Data were analyzed between April and November 2025.

EXPOSURES: State adoption of a Medicaid bed-hold policy.

MAIN OUTCOMES AND MEASURES: Hospitalizations and ED visits in a given month were the 2 primary outcomes.

RESULTS: The sample included 219 719 long-stay NH residents (mean [SD] age, 80.2 [12.6] years; 67.2% female) in 22 states and the District of Columbia, of which 16 states adopted bed-hold policies. There were no significant changes in differences in resident and NH characteristics between those in states that did and did not adopt the policies from the pre- to the post-adoption period. Adjusted estimates did not show statistically significant changes in the likelihood of hospitalization (-0.1 percentage points [pp]; 95% CI, -0.3 to 0.1 pp; P = .41) or an ED visit (0.0 pp; 95% CI, -0.1 to 0.2 pp; P = .68) associated with adoption of bed-hold policies. Results of sensitivity analyses were consistent with the primary analyses.

CONCLUSIONS AND RELEVANCE: This cohort study found that states’ adoption of Medicaid bed-hold policies was not associated with hospitalizations or ED visits among long-stay NH residents, suggesting that the goal of bed-hold policies may not be undermined by increases in these events.

PMID:42467449 | DOI:10.1001/jamahealthforum.2026.2226

JAMA Netw Open. 2026 Jul 1;9(7):e2623302. doi: 10.1001/jamanetworkopen.2026.23302.

ABSTRACT

IMPORTANCE: Puberty blockers are an established, reversible intervention for central precocious puberty in children and gender dysphoria in adolescents. Despite broad clinical support, these treatments are currently politically contested.

OBJECTIVE: To characterize the mental health of transgender youths prescribed puberty blockers compared with cisgender peers who received these medications for treatment of precocious puberty and with transgender and cisgender youths who did not receive these medications.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from a US nationwide, multipayer claims database from January 2016 to January 2025. Youths aged 10 to 17 years were categorized into 4 cohorts based on gender modality (transgender or cisgender) and prescription of a puberty blocker (yes or no).

MAIN OUTCOMES AND MEASURES: Primary outcomes were International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnoses of mood disorders and suicidal thoughts and behaviors. Inverse probability-weighted generalized estimating equation models were fit to obtain adjusted odds ratios (aORs) and 95% CIs, adjusting for demographics, payer type, region, year, socioeconomic disadvantage, and policy environment indices. In demographics, female gender marker is used to indicate that an F (female) has been applied as a marker for the individual by some entity (eg, a medical professional or government body).

RESULTS: Among 231 783 youths in the analytical sample, 41 472 youths (17.89%) were transgender (median [IQR] age at baseline, 9.00 [7.00-11.00] years; 31 246 with female gender marker [75.34%]) and 190 311 youths (82.11%) were cisgender (median [IQR] age at baseline, 8.00 [6.00-10.00] years; 128 942 with female gender marker [67.75%]). Being transgender was associated with higher odds of mood disorder diagnosis (aOR, 4.42 [95% CI, 4.24-4.60]) and suicidal thoughts and behaviors (aOR, 12.21 [95% CI, 10.69-13.95]) compared with being cisgender. Being prescribed a puberty blocker was associated with higher odds of mood disorder diagnosis (aOR, 2.11 [95% CI, 2.02-2.19]) and suicidal thoughts and behaviors (aOR, 3.04 [95% CI, 2.65-3.49]) compared with no prescription. However, among transgender youths, prescription of a puberty blocker was associated with decreased adjusted odds of mood disorder diagnosis (aOR, 0.52 [95% CI, 0.45-0.60]) and suicidal thoughts and behaviors (aOR, 0.20 [95% CI, 0.14-0.29]).

CONCLUSIONS AND RELEVANCE: In this study, transgender youths overall had substantially higher rates of diagnosed mood disorder and suicidal thoughts and behaviors than their cisgender peers, highlighting the need for population-specific interventions. Prescription of a puberty blocker was associated with partial attenuation of this disparity, suggesting mental health benefits associated with this treatment for transgender youth.

PMID:42467435 | DOI:10.1001/jamanetworkopen.2026.23302

JAMA Netw Open. 2026 Jul 1;9(7):e2623617. doi: 10.1001/jamanetworkopen.2026.23617.

ABSTRACT

IMPORTANCE: Expanding access to naloxone is an essential strategy in addressing the overdose crisis in the US. In March 2023, the US Food and Drug Administration approved the first over-the-counter (OTC) naloxone nasal spray, representing a substantial shift in public health policy and pharmacy practice.

OBJECTIVE: To assess the same-day availability of naloxone without a prescription across US retail pharmacies and examine pharmacy and neighborhood factors associated with access following OTC approval.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a secret shopper design to assess availability of naloxone in retail pharmacies in the US from January 15 to April 30, 2024. Participants included a stratified random sample of 1108 pharmacies from the 7 largest corporate pharmacy chains and an eighth stratum incorporating other retail pharmacies.

EXPOSURES: Pharmacy characteristics (chain size, type, and affiliation) and neighborhood sociodemographic indicators (racial and ethnic composition and area deprivation index).

MAIN OUTCOMES AND MEASURES: Same-day naloxone availability without a prescription, location of naloxone within the store, price, and alternative access suggestions.

RESULTS: Among the 1108 pharmacies contacted, an estimated 61.40% (95% CI, 57.34%-65.46%) of those with naloxone in stock reported it was available without a prescription. Naloxone was located at the pharmacy counter (estimate, 58.14% [95% CI, 53.59%-62.68%]), self-service aisles (estimate, 31.74% [95% CI, 27.59%-35.89%]), and front checkout areas (estimate, 8.99% [95% CI, 6.64%-11.34%]). The mean (SE) cost was $52.07 ($1.50) (95% CI, $49.12-$55.02). Among pharmacies without same-day naloxone (estimate, 38.60% [95% CI, 34.54%-42.66%]), respondents equally referred callers to another pharmacy or had no suggestions (estimate, 45.84% [95% CI, 37.77%-53.91%]), 4.46% (95% CI, 0.70%-8.21%) offered other suggestions (hospital, public service agencies, online service, or cannabis dispensary), 3.87% (95% CI, 0.48%-7.25%) suggested the public health department, and 0.06% (95% CI, 0.00%-0.17%) suggested syringe service programs. Pharmacies classified as food and/or mass merchandisers, independent, or medical affiliated had a lower odds ratio of offering same-day naloxone compared with corporate chains. In separate analyses, pharmacies located in areas with higher proportions of White residents were more likely to offer naloxone. Area deprivation index-defined neighborhood disadvantage, which does not include race in its calculation, was not associated with naloxone availability.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of pharmacies across the US, same-day naloxone availability and price remained uneven following OTC approval. As an initial national evaluation of same-day naloxone availability and price after OTC approval, the findings showed differences in implementation across pharmacy types and community demographic features. Although enactment of the OTC policy was necessary, its intended benefits were not realized equally in practice. Expanding pharmacist education and targeting support for independent and medical-affiliated pharmacies may help improve naloxone access, especially in rural and underserved areas.

PMID:42467434 | DOI:10.1001/jamanetworkopen.2026.23617

JAMA Netw Open. 2026 Jul 1;9(7):e2623740. doi: 10.1001/jamanetworkopen.2026.23740.

ABSTRACT

IMPORTANCE: Access to menopausal hormone therapy (MHT) in the US remains low. Understanding whether insurance type is associated with MHT underuse and racial disparities in menopausal care is critical for designing interventions that increase evidence-based and equitable menopause care.

OBJECTIVE: To examine whether Medicaid compared with private insurance is associated with lower MHT use among US women. A secondary objective explored the degree that payer type is associated with observed racial differences in MHT use.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2013-2014, 2015-2016, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify a survey-weighted analytic subset of eligible respondents of a population-based survey of the US civilian, noninstitutionalized population. The study included women aged 45 to 64 years with Medicaid or private insurance coverage who were eligible for MHT. Statistical analyses were performed between March 26, 2024, and December 2, 2025.

EXPOSURE: Insurance type.

MAIN OUTCOMES AND MEASURES: MHT use was the primary outcome. A secondary analysis assessed whether insurance status was associated with observed racial differences in MHT use. Associations were estimated using multivariable logistic regression.

RESULTS: The unweighted sample included 1666 National Health and Nutrition Examination Survey respondents (n = 22 275 545, weighted). Of the weighted final sample, 91.4% had private insurance, and 8.6% had Medicaid. Individuals insured by Medicaid were less likely than those with private insurance to report a history of MHT use (10.7% [95% CI, 6.9%-16.0%] vs 20.7% [95% CI, 18.1%-23.5%]). After adjustment, Medicaid-insured women had lower odds of MHT use than privately insured women (OR, 0.50 [95% CI, 0.28-0.87]). In a secondary analysis, Black participants showed lower odds of MHT than White participants (OR, 0.68 [95% CI, 0.45-0.95]), but this difference was attenuated once insurance status was included in the model (adjusted OR, 0.72 [95% CI, 0.50-1.04]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of women at typical age for menopause, Medicaid coverage was associated with significantly lower MHT use, suggesting that insurance type may play a role in menopausal care disparities. Insurance status may also partially explain previously observed racial gaps in MHT use. These findings highlight the need for policy and clinical interventions to address insurance-related barriers and to promote equitable menopausal care.

PMID:42467433 | DOI:10.1001/jamanetworkopen.2026.23740