Nevin Manimala

Womens Health (Lond). 2026 Jan-Dec;22:17455057261418776. doi: 10.1177/17455057261418776. Epub 2026 Feb 22.

ABSTRACT

BACKGROUND: There is growing evidence that doulas may buffer poor birth outcomes for marginalized groups by providing social support, health education and advocacy between patients and their medical team.

OBJECTIVE: This study aims to examine the current environment and scope of work for doulas serving immigrants and refugees.

DESIGN: This study is an extension of the on-going mixed methods, community-engaged Georgia Doula Study. From June to November 2022, researchers conducted in-depth interviews with 22 doulas serving immigrants and refugees in and outside of Metropolitan Atlanta.

METHODS: Semi-structured in-depth interviews were conducted. Interviews were recorded and transcribed. Two research assistants independently coded the interviews using Dedoose. Data were examined using thematic analysis.

RESULTS: Four themes emerged for immigrant-serving doulas including: doulas fill the gap of care and societal navigation, doulas are asked to integrate themselves into their client’s communities, the relationship between doulas and their clients is mutually empowering, and the landscape included both doula-centered and systems-centered frictions. Doulas reported a high level of desire for their services among immigrants, with positive experiences for both clients and them. However, doulas were frequently the only source of support for immigrant clients and were tasked with navigating the complexities of both new arrival experiences and the complex U.S. healthcare system.

CONCLUSION: Doulas provide critical support in the navigation of immigrant experiences in the United States-including and beyond pregnancy. Their work with immigrant communities enriches the lives of their clients and improves maternal and child health outcomes. However, revised policies and programming for more holistic perinatal services are needed to facilitate their expansive scope of work.

PMID:41723593 | DOI:10.1177/17455057261418776

J Perioper Pract. 2026 Feb 22:17504589261421004. doi: 10.1177/17504589261421004. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative delirium is a common and serious complication in surgical patients, often leading to prolonged hospitalisation and increased morbidity. Intranasal insulin has shown promising results in preventing postoperative delirium and protecting cognitive function. However, its use has not been standardised and is not part of treatment protocols. We performed a systematic review and meta-analysis on the effect of intranasal insulin in reducing postoperative delirium.

METHODS: PubMed, EMBASE, Cochrane Central, and Web of Science databases were searched from inception to October 2025 for randomised controlled trials investigating intranasal insulin for postoperative delirium prevention in patients undergoing surgery. Risk ratios with 95% confidence intervals were computed using a random-effects model. Heterogeneity was assessed with I² statistics. We performed subgroup analyses of orthopaedics, gastrointestinal, and cardiac surgeries.

RESULTS: A total of 1039 patients from nine randomised controlled trials were included, of whom 574 (55.2%) received treatment with intranasal insulin. The overall incidence of delirium was significantly lower in patients treated with intranasal insulin (risk ratio = 0.36; 95% confidence interval = 0.28-0.46; p < 0.001). Subgroup analyses also demonstrated significant reductions in delirium following orthopaedic surgeries (p < 0.001), gastrointestinal surgeries (p < 0.001), and cardiac surgeries (p = 0.013).

CONCLUSIONS: Perioperative intranasal insulin significantly reduced the incidence of postoperative delirium in patients undergoing surgery.

PMID:41723589 | DOI:10.1177/17504589261421004

J Perioper Pract. 2026 Feb 22:17504589261418823. doi: 10.1177/17504589261418823. Online ahead of print.

ABSTRACT

BACKGROUND: This quality improvement study was undertaken in the ophthalmology theatres at the Western Eye Hospital, Imperial College Healthcare NHS Trust, to address reduced capped theatre utilisation during the COVID-19 recovery period. Baseline utilisation was 75.8%, below the national Getting It Right First Time target of 85% for theatre touchtime utilisation by 2024/25. The aim was to identify the causes of underperformance and implement targeted interventions to improve theatre efficiency.

METHODS: A Lean Six Sigma DMAIC (Define, Measure, Analyse, Improve, Control) framework was used as the study design. Targeted interventions included increasing pre-assessment capacity to reduce under-booking, improving scheduling processes, reducing early finishes, and carrying out structured daily reviews of implant and equipment availability to minimise on-the-day cancellations. Multiple regression, factorial Design of Experiments, process capability analysis, Plan-Do-Study-Act cycles, and Statistical Process Control were used to analyse variation, test changes, and monitor performance.

RESULTS: The Analyse phase showed that early finishes, under-booking, and limited pre-assessment capacity were the main drivers of low utilisation, rather than commonly assumed factors such as late starts. Following the introduction of targeted interventions, capped theatre utilisation improved from 75.8% to 81%. Continuous monitoring through Plan-Do-Study-Act cycles and Statistical Process Control supported stability and informed further refinements.

CONCLUSIONS: This project shows that combining Lean Six Sigma methodology with advanced statistical analysis can deliver measurable improvements in theatre utilisation. The findings challenged long-held assumptions about the causes of inefficiency and highlight the importance of optimising scheduling processes and pre-assessment capacity. The model offers a transferable, scalable approach for other units aiming to enhance theatre efficiency and achieve sustainable operational improvements.

PMID:41723588 | DOI:10.1177/17504589261418823

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261425544. doi: 10.1177/21501319261425544. Epub 2026 Feb 22.

ABSTRACT

INTRODUCTION: Patient-provider trust is essential for effective healthcare delivery, influencing care engagement, disclosure, and adherence. Mistrust can delay diagnoses, reduce care utilization, and worsen outcomes. While cultural competence trainings aim to improve provider awareness, few studies examine how community health workers (CHWs) perceive and support trust-building in clinical care.

PURPOSE: To explore strategies for building and maintaining patient-provider trust from the perspectives of CHWs.

METHODS: Using a Community-Based Participatory Research approach, 39 CHWs from 3 rural-serving health centers in California participated in semi-structured focus groups. English and Spanish sessions were co-led by University researchers and trained CHW partners. Deductive thematic analysis was conducted in Dedoose, and descriptive statistics were generated using Stata 17.

RESULTS: CHWs identified 3 factors that shape patient-provider trust: (1) Power dynamics, such as provider-dominated conversations and time constraints, limit trust-building; (2) Communication that fosters emotional safety, including provider attentiveness and respectful verbal and nonverbal behaviors; and (3) Cultural respect and competence, emphasizing the importance of recognizing patients’ beliefs and providing language-concordant care.

DISCUSSION: CHWs offer community-informed insights on trust-building that can inform culturally responsive and equity-oriented interventions, particularly in rural and underserved regions. Future efforts should explore co-developing training modules with CHWs to strengthen patient-provider trust.

PMID:41723587 | DOI:10.1177/21501319261425544

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261422872. doi: 10.1177/21501319261422872. Epub 2026 Feb 22.

ABSTRACT

OBJECTIVE: Using State-level surveillance records we assessed disparities in premature mortality among people with HIV (PWH) in Florida during pre- (2019) and early COVID-19 pandemic (2020).

METHODS: We calculated age-standardized rates of years of potential life lost per 100 persons (aYPLL) stratified by sex, race and ethnicity, rural/urban residence, and social vulnerability index (SVI).

RESULTS: PWH in Florida during 2020 experienced a significant increase in aYPLL (2019: 29.0, 95% CI [28.1, 30.0]; 2020: 32.8, 95% CI [31.8, 33.9]). HIV/AIDS contributed the most aYPLL in 2020 (13.4, 95% CI [12.4, 14.4]), especially among females (15.8, 95% CI [15.2, 16.4]), rural communities (14.5, 95% CI [12.7, 17.6]), and high SVI communities (12.5, 95% CI [11.9, 13.2]). aYPLL due to external causes increased significantly from 2019 to 2020 (4.1, 95% CI [4.0, 4.3] vs 5.4, 95% CI [5.2, 5.5]), especially for females (3.6, 95% CI [3.3, 3.9] vs 7.8, 95% CI [7.4, 8.3]) and those living in low SVI communities (3.1, 95% CI [2.7, 3.8] vs 7.1, 95% CI [6.5, 8.1]). aYPLL due to COVID-19 was greatest for females (2.3, 95% CI [2.1, 2.6]) and residents of high SVI communities (2.0, 95% CI [1.9, 2.1]).

CONCLUSIONS: PWH experienced increased individual- and neighborhood-level disparities in premature mortality from HIV/AIDS from 2019 to 2020, especially among females and those in rural and socially vulnerable communities. External causes and COVID-19 were also associated with an increased premature mortality during this time frame, with disparities noted by sex and community social vulnerability. Pandemic planning should include targeted outreach programs which prepare for vulnerable populations’ healthcare needs and mitigate mortality.

PMID:41723585 | DOI:10.1177/21501319261422872

Med Sci Monit. 2026 Feb 22;32:e949520. doi: 10.12659/MSM.949520.

ABSTRACT

Statistics from 2024 have shown that 50% of young women use contraception. Nowadays, it is not only used to prevent pregnancy. Positive effects of this treatment can be seen in cases of acne vulgaris, hirsutism, and painful menstruation. A controversial topic is the use of combined oral contraception (COC) in women with migraine with aura – it is contraindicated, but for headaches associated with the menstrual cycle, there is a chance of improvement, especially with the 28/0 regimen. This review assessed differences in the effects of substances contained in COC. Tablets containing ethinylestradiol in combination with drospirenone, levonorgestrel, desogestrel, chlormadinone acetate, dienogest, or lynestrenol were compared. The effects of different drug doses on body mass index (BMI), blood pressure, and the severity of adverse effects in women were considered. An individualized approach to patients is important to select COCs appropriate for the condition and at the same time minimize adverse effects, thereby improving quality of life. The progress in the development of newer COCs, such as an estetrol-containing pill with drospirenone, is promising as well.

PMID:41723577 | DOI:10.12659/MSM.949520

J Anesth Analg Crit Care. 2026 Feb 21. doi: 10.1186/s44158-026-00361-3. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical effectiveness of high-flow nasal therapy (HFNT) over conventional oxygen therapy (COT) in patients with mild COVID-19-related acute hypoxaemic respiratory failure (AHRF) remains uncertain. The COVID-HIGH trial did not demonstrate statistically significant benefits of HFNT over COT. However, the trial was slightly underpowered, and the event rate lower-than-expected. Bayesian methods provide deeper insight by incorporating prior knowledge and quantifying uncertainty intuitively. This analysis aimed to quantify the probability of benefit or harm associated with HFNT, adopting a Bayesian approach.

METHODS: We performed a Bayesian reanalysis of the COVID-HIGH trial (NCT, which randomised 364 patients with PaO₂/FiO₂ between 200-300 mmHg to receive HFNT or COT. The primary outcome was escalation of respiratory support (continuous positive airway pressure, noninvasive ventilation or invasive mechanical ventilation) within 28 days. A key secondary outcome was clinical recovery at day 14. Bayesian logistic models with noninformative and informative priors were used to estimate the posterior probability of treatment effects.

RESULTS: Escalation of respiratory support occurred in 23.6% (HFNT) versus 30.2% (COT) (risk difference – 6.6%, 95% CI – 15.1 to 2.1; p = 0.14). Across a wide range of priors, the posterior probability mass on the beneficial side remained high, generally > 70%, while the proportion on the harm side remained consistently low at ≤ 6% for all models, underscoring a favourable benefit-risk profile. The acute respiratory failure meta-analysis model (OR 0.76, 95% CrI 0.60-0.97), the COVID-19 randomised evidence model (OR 0.76, 95% CrI 0.60-0.97), the COVID-19 observational evidence model (OR 0.60, 95% CrI 0.45-0.80), and the COVID-19 Bayesian meta-analysis mixed evidence model (OR 0.66, 95% CrI 0.52-0.86) showed posterior probability mass on the beneficial side of 70%-94%. Clinical recovery at day 14 occurred in 61.5% (HFNT) versus 53.3% (COT), with 61-73% of posterior probability mass on the clinical benefit side.

CONCLUSIONS: This Bayesian re-analysis of the COVID-HIGH trial suggests that HFNT likely reduces escalation of respiratory support and improves clinical recovery in patients with COVID-19 pneumonia and mild hypoxaemia, although the magnitude of benefit remains uncertain and sensitive to prior assumptions.

TRIAL REGISTRATION: The trial was prospectively registered in ClinicalTrials.gov on December 7, 2020 (NCT04655638).

PMID:41723547 | DOI:10.1186/s44158-026-00361-3

Eur J Med Res. 2026 Feb 21. doi: 10.1186/s40001-026-04085-6. Online ahead of print.

ABSTRACT

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease marked by chronic inflammation, affecting the joints and increasing the risk of cardiovascular disease (CVD). The link between different polyunsaturated fatty acids (PUFAs) consumption and CVD in individuals with RA remains unclear. This study investigates the association between PUFAs intake and CVD prevalence among individuals with RA, using 2007-2018 National Health and Nutrition Examination Survey (NHANES) data.

METHODS: A cross-sectional analysis included 1,394 individuals with RA, and their PUFA intake was evaluated through 24-h dietary recall interviews. Logistic regression models evaluated the relationship between PUFA intake and CVD, adjusting for various covariates. Subgroup analyses and dose-response relationships were also explored.

RESULTS: In models adjusted for age, gender and race, higher eicosapentaenoic acid (EPA) intake showed an inverse association with CVD prevalence. However, this association was attenuated and did not remain statistically significant after further adjustment for socioeconomic, lifestyle and clinical factors. A higher intake of linoleic acid (LA) and n-6 PUFAs was linked to an increased prevalence of CVD. In contrast, no significant association was found between other n-3 PUFAs and CVD prevalence. An “L”-shaped dose-response pattern was observed in analyses adjusted for age, gender, and race, with a turning point at 64 mg/day, but this pattern was not observed in fully adjusted models. No significant nonlinear relationships were observed for LA, other n-3 PUFAs or n-6 PUFAs.

CONCLUSIONS: A higher intake of LA and n-6 PUFAs is positively associated with CVD prevalence. These findings suggest a potential link between specific dietary fatty acid composition and cardiovascular disease in RA, warranting further investigation to inform tailored nutritional recommendations.

PMID:41723518 | DOI:10.1186/s40001-026-04085-6

Int J Equity Health. 2026 Feb 21. doi: 10.1186/s12939-026-02791-5. Online ahead of print.

NO ABSTRACT

PMID:41723499 | DOI:10.1186/s12939-026-02791-5

BMC Med Educ. 2026 Feb 21. doi: 10.1186/s12909-026-08842-3. Online ahead of print.

NO ABSTRACT

PMID:41723488 | DOI:10.1186/s12909-026-08842-3