Nevin Manimala

Child Neuropsychol. 2026 May 6:1-15. doi: 10.1080/09297049.2026.2659058. Online ahead of print.

ABSTRACT

This study aimed to provide a comprehensive comparison of inhibitory control performance among children with Attention-Deficit/Hyperactivity Disorder (ADHD), Specific Learning Disorder (SLD), and comorbid ADHD+SLD, relative to typically developing peers. It sought to clarify whether inhibitory control deficits are generalized across tasks or specific to distinct types of inhibition. A total of 120 children (30 per group; aged 9-11 years) participated. Three tasks assessed different facets of inhibitory control: the Stroop Color-Word Test (interference suppression), the Cued Go/No-Go Task (prepotent response inhibition), and the Stop-Signal Task (cancellation of ongoing responses). Analyses controlled for baseline processing speed. Findings revealed distinct inhibitory profiles. Children with ADHD showed broad deficits across all tasks, most pronounced in the Cued Go/No-Go Task, indicating a core weakness in prepotent response inhibition. The SLD group demonstrated slower reaction times, particularly in the Cued Go/No-Go Task in the initial analysis. Slower responses reflect both processing-speed deficits and potential differences in motor planning and execution. However, after statistically controlling for these general speed effects, the SLD group’s profile revealed a specific and significant deficit only in interference suppression, with no core impairment in prepotent response inhibition or action cancellation. The comorbid ADHD+SLD group exhibited the most severe and pervasive deficits across all measures, exceeding single-diagnosis groups, suggesting a synergistic impairment. These results support the multidimensional nature of inhibitory control and highlight disorder-specific neurocognitive signatures. The findings underscore the need for differentiated assessment and intervention approaches targeting distinct inhibitory processes and processing-speed deficits, particularly in children with comorbid conditions.

PMID:42089258 | DOI:10.1080/09297049.2026.2659058

J Prosthodont. 2026 May 6. doi: 10.1111/jopr.70154. Online ahead of print.

ABSTRACT

PURPOSE: To assess current utilization of the Prosthodontic Diagnostic Index (PDI), identify perceived benefits and limitations, and evaluate support for future updates.

MATERIALS AND METHODS: A survey regarding the use of the PDI was made available through email invitations to 68 US dental school prosthodontic/restorative department chairs (PD), 48 graduate prosthodontic program directors (GP), and 1834 private practice prosthodontists (PP) from the American College of Prosthodontists (ACP) member database. The results of this initial survey were inconclusive due to low response rates. The survey was also administered during the 2024 ACP Annual Session with an improved response rate for educators. Descriptive statistics were used to analyze responses from predoctoral education programs and graduate prosthodontic programs.

RESULTS: Responses were received from 43.8% (n = 21) graduate prosthodontic programs (GP) and 35.3% (n = 24) predoctoral programs (PD). The PDI was taught to graduate prosthodontic residents at 100% (n = 21) of the responding programs and at 58% (n = 14) of responding predoctoral programs. In contrast, the response rate for private practice prosthodontists, 2% (n = 43), was too low for statistical analysis. The PDI was used for new patient screening in 76.2% (n = 16) of GP and 41.7% (n = 10) of PD programs. The PDI was valued for enhancing diagnostic consistency (81.0%, n = 17 GP and 83.3%, n = 21 PD) and objective patient screening (90.5%, n = 19 GP and 87.5%, n = 21 PD). Common themes were observed in open-ended questions regarding the limitations of the PDI, including that the system was cumbersome, complicated, time-consuming to use, issues with calibration across all cohorts, and lacked recognition by general dentists and other dental specialists. The majority of respondents agreed that the PDI needs an update (76.2%, n = 16 GP and 66.7%, n = 16 PD), including the development of an ACP-endorsed classification system for implant-based treatment (81.0%, n = 17 GP and 91.7%, n = 22 PD).

CONCLUSIONS: The PDI is viewed as a beneficial diagnostic and educational tool in academic settings. However, it is complex and has limited alignment with contemporary prosthodontic practice. A revision of the classification system could address current limitations and better support clinical decision-making.

PMID:42089246 | DOI:10.1111/jopr.70154

J Am Heart Assoc. 2026 May 6:e047074. doi: 10.1161/JAHA.125.047074. Online ahead of print.

ABSTRACT

BACKGROUND: Stroke remains a leading cause of mortality and disability worldwide, requiring modifiable risk factors for prevention. Oral health, particularly posterior occlusal contact that supports mastication, may influence systemic vascular outcomes; however, its role in stroke remains unclear. This study investigated whether reduced posterior occlusal contact independently predicts stroke in Japanese adults.

METHODS: We conducted a retrospective cohort study using data collected from April 2016 to March 2022 from a nationwide health insurance database in Japan. Adults aged 40 to 74 years without a history of stroke were included. Posterior occlusal status was categorized as Eichner A (full posterior occlusal contact), B (partial contact), or C (no contact). The primary outcome was stroke incidence, identified using validated insurance claims. Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographics, health behaviors, comorbidities, and tooth counts.

RESULTS: Among 981 543 participants (mean age 49.6±7.0 years; 57.5% male) followed for 2 712 815 person-years, 7086 strokes occurred. In adjusted Cox models, Eichner B was significantly associated with higher stroke risk than Eichner A (HR, 1.26 [95% CI, 1.10-1.44], P<0.001). Eichner C showed elevated risk, although not statistically significant (HR, 1.17 [95% CI, 0.91-1.50], P=0.229). Associations were observed in both sexes and across age groups.

CONCLUSIONS: Reduced posterior occlusal support was associated with higher stroke risk independent of tooth count and conventional vascular risk. These findings highlight that posterior occlusal support may represent a potential marker of cerebrovascular risk and warrant further investigation into its clinical relevance.

PMID:42089190 | DOI:10.1161/JAHA.125.047074

J Am Heart Assoc. 2026 May 6:e049028. doi: 10.1161/JAHA.125.049028. Online ahead of print.

ABSTRACT

BACKGROUND: Inconsistent links between arterial stiffness and cognition may reflect limited cognitive tests and unaccounted diurnal pulse wave velocity variation. To bridge this knowledge gap, we investigated 24-hour ambulatory estimated pulse wave velocity (ePWV) and its association with dementia-related neuroimaging and cognitive function in hypertension.

METHODS: We assessed 893 patients with hypertension aged ≥50 years (mean age, 67.2 years; 52.3% women), including brain magnetic resonance imaging (n=545), global cognitive testing (n=623), and ambulatory ePWV measurements. White matter hyperintensity and hippocampus were quantified via Computational Anatomy Toolbox 12 and Statistical Parametric Maps 12. Cognition was assessed via the Mini-Mental State Examination and Montreal Cognitive Assessment.

RESULTS: Among 623 tested participants, the prevalence of mild cognitive impairment was 10% (Mini-Mental State Examination, n=62) and 18.5% (Montreal Cognitive Assessment, n=115). Cognitive scores decline with higher white matter hyperintensity burden and lower hippocampal volume (P≤0.024). Higher 24-hour ePWV quartiles showed graded associations with higher white matter hyperintensity volume and lower hippocampal volume (both P<0.001) and lower cognitive scores (P≤0.037). Multivariable models showed each 1-SD (+1.2 m/s) increment in 24-hour ePWV were associated with 2.00±1.74 mL greater white matter hyperintensity volume (P=0.004), and 0.54±0.14 mL smaller hippocampal volume (P<0.001), independent of age, systolic blood pressure, and other confounders. These associations persisted after further adjustment for carotid-femoral PWV, which itself showed no independent association (P≥0.18). Results were consistent for daytime and nighttime ePWV and across key subgroups.

CONCLUSIONS: Ambulatory ePWV is an independent risk factor for dementia-related brain pathology. Targeting arterial stiffness represents a promising strategy for dementia prevention.

PMID:42089188 | DOI:10.1161/JAHA.125.049028

Epidemiol Psychiatr Sci. 2026 May 6;35:e30. doi: 10.1017/S2045796026100663.

ABSTRACT

AIMS: Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels.

METHODS: Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990-2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute’s APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010-2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data.

RESULTS: In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17-78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58-23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015-2019 was approximately 60% lower than 2000-2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68-0.78) in the 1980 cohort to 0.90 (95% CI: 0.70-1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010-2019.

CONCLUSIONS: Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.

PMID:42089172 | DOI:10.1017/S2045796026100663

J Am Heart Assoc. 2026 May 6:e044747. doi: 10.1161/JAHA.125.044747. Online ahead of print.

ABSTRACT

BACKGROUND: Guideline-directed medical therapy during the transitional period is crucial for improving outcomes in heart failure with reduced ejection fraction. We investigated whether a simplified transitional care intervention could increase guideline-directed medical therapy adherence in patients with acute heart failure (HF).

METHODS: This multicenter, open-label randomized trial enrolled 982 patients with acute HF. The transitional care intervention included a discharge checklist, HF education, and telephone monitoring. The primary outcome was achievement of high guideline adherence indicator, defined as the prescription of all 3 guideline-directed medical therapy drugs (renin-angiotensin system blockades, beta blockers, and mineralocorticoid receptor antagonists) at 6 months. Both modified intention-to-treat and per-intervention analyses were conducted to evaluate the effectiveness of intervention components.

RESULTS: Among 982 participants (mean age, 62.4±15.5 years; 64.5% male), there was no statistical difference in the proportion achieving a high guideline adherence indicator between the intervention and control groups (49.6% versus 44.6%; OR, 1.12; 95% CI, 0.86-1.45; P=0.37). No significant differences were observed in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score or clinical outcomes. In the per-intervention analysis, patients who received all components showed significantly higher guideline adherence indicator achievement compared with those who received no components (adjusted odds ratio [OR], 1.56 [95% CI, 1.07-2.27], P=0.02).

CONCLUSIONS: In this randomized trial of patients with acute HF, although the simplified transitional care intervention did not increase high guideline adherence indicator achievement, implementation of all intervention components was associated with improved guideline adherence. Our findings emphasize that implementation fidelity is the key challenge in optimizing transitional care for HF management.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04900584.

PMID:42089166 | DOI:10.1161/JAHA.125.044747

J Korean Med Sci. 2026 May 4;41(17):e133. doi: 10.3346/jkms.2026.41.e133.

ABSTRACT

BACKGROUND: Hypertension is more prevalent among individuals with disabilities than in the general population. This study analyzed long-term trends in disparities in hypertension care quality and the incidence of hypertensive complications among individuals with and without disabilities.

METHODS: This retrospective cohort study followed 52,743 hypertensive patients aged 20 or older with disabilities newly diagnosed in 2010, along with 47,564 age- and sex-matched patients without disabilities, from 2011 to 2019. Hypertension care quality was assessed using indicators of medication adherence and the completion of three complication-monitoring tests at recommended frequency: blood test, urine test, and electrocardiogram (ECG). Hypertensive complications included major cardiovascular and cerebrovascular events, kidney diseases, and all-cause mortality. Logistic regression was repeated annually to assess hypertension care quality, and Cox-proportional model was used to estimate the risk of hypertension-related complications.

RESULTS: Hypertensive patients with disabilities consistently demonstrated lower medication adherence throughout the study period (adjusted odds ratio [aOR], 0.90-0.96, depending on the year), but a higher likelihood of undergoing screenings at recommended frequency (e.g., aOR for blood test, 1.31-1.39, for urine test, 1.24-1.33, and for ECG, 1.30-1.37). The risk of complications remained significantly higher among hypertensive patients with disabilities, even after adjusting for care quality indicators (e.g., adjusted hazard ratio for cardiovascular events: 1.36, 95% confidence interval: 1.31-1.41). Subgroup analyses revealed that the excess risks for complications varied across different sociodemographic groups.

CONCLUSION: These findings underscore the need for comprehensive strategies to enhance medication adherence among hypertensive patients with disabilities. Additionally, other factors beyond medication adherence and monitoring test completion that contribute to the increased risk of complications require further exploration.

PMID:42089135 | DOI:10.3346/jkms.2026.41.e133

J Korean Med Sci. 2026 May 4;41(17):e8. doi: 10.3346/jkms.2026.41.e8.

ABSTRACT

BACKGROUND: Cardiac rehabilitation (CR) is a critical secondary prevention strategy for patients with acute myocardial infarction (AMI). Although CR has been covered by the National Health Insurance in Korea since 2017, real-world participation remains suboptimal. We assessed trends in CR participation over the past 5 years and identified factors associated with non-participation in treatment.

METHODS: This retrospective observational study analyzed data from the National Health Insurance Service claims database between 2018 and 2022. Patients aged ≥ 40 years who were hospitalized for AMI and received acute-phase interventions, such as thrombolysis, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG), were included. CR participation was defined as having at least one claim for education, assessment, or treatment services. Multivariable logistic regression was conducted to identify factors associated with non-participation in CR treatment, focusing on patients who received care at CR-providing institutions, to minimize confounding related to institutional availability.

RESULTS: In total, 109,436 patients were included. Overall participation rates in CR education, assessment, and treatment increased from 2018 to 2022. However, sustained participation in outpatient treatment remained low, with only 5.7% of patients in 2022 completing ≥ 11 treatment sessions. Factors associated with lower treatment participation included the absence of prior education and assessment, lower socioeconomic status, undergoing PCI rather than CABG, and receiving care at non-tertiary hospitals. Regional disparities and inadequate institutional infrastructure further contributed to reduced access to CR services.

CONCLUSION: Although CR participation among patients with AMI in Korea has gradually increased, treatment continuity remains suboptimal. To enhance CR utilization, policy efforts should prioritize reducing patient burden, addressing provider-level barriers, and promoting equitable access through financial support mechanisms and infrastructure expansion.

PMID:42089132 | DOI:10.3346/jkms.2026.41.e8

IDCases. 2026 Apr 17;44:e02570. doi: 10.1016/j.idcr.2026.e02570. eCollection 2026.

ABSTRACT

INTRODUCTION: Strongyloidiasis is a neglected soil-transmitted helminthiasis caused by Strongyloides stercoralis, affecting an estimated 300-600 million people worldwide. Due to its ability to cause autoinfection, the parasite may persist lifelong and lead to severe complications. While gastrointestinal symptoms are common, presentation as gastric outlet obstruction (GOO) is rare and can mimic malignancy.

CASE PRESENTATION: A 42-year-old male presented with several months of non-projectile vomiting, epigastric pain, indigestion, anorexia, and significant weight loss. Examination revealed dehydration, hypotension, and tachycardia. Laboratory tests showed mild microcytic anemia and mild hyponatremia, with normal eosinophil counts. Abdominal ultrasonography suggested gastric outlet obstruction. Upper gastrointestinal endoscopy demonstrated a circumferential ulcerated duodenal lesion with pyloric deformity, initially suspicious for malignancy. Histopathological examination of duodenal biopsies revealed S. stercoralis. After correction of hypovolemia and electrolyte imbalance, the patient was treated with ivermectin, resulting in complete resolution of symptoms.

DISCUSSION: Strongyloidiasis has a broad clinical spectrum, ranging from asymptomatic infection to disseminated disease. Gastric outlet obstruction is an uncommon manifestation and poses diagnostic challenges, particularly in endemic regions. Endoscopy with histopathological confirmation is essential for diagnosis when clinical and laboratory findings are non-specific. Prompt treatment with ivermectin is highly effective and prevents serious complications.

CONCLUSION: Strongyloidiasis should be considered in the differential diagnosis of gastric outlet obstruction, especially in endemic areas. Early diagnosis and timely antiparasitic treatment are crucial to reduce morbidity and prevent life-threatening complications.

PMID:42089110 | PMC:PMC13138174 | DOI:10.1016/j.idcr.2026.e02570

Int J Clin Health Psychol. 2026 Jan-Mar;26(1):100687. doi: 10.1016/j.ijchp.2026.100687. Epub 2026 Apr 27.

ABSTRACT

BACKGROUND: Adolescents with overweight/obesity have an elevated risk of mental health and behavioral difficulties. Exercise has been shown to impart psychological benefits to these individuals; however, whether the effects of moderate-to-vigorous physical activity (MVPA) delivery differ between weekdays and weekends is limited. Therefore, this study aimed to examine the effects of weekday and weekend MVPA at age 14 on internalizing and externalizing problems at age 17 among adolescents with overweight/obesity.

METHODS: We analyzed data from two assessment waves of the UK Millennium Cohort Study (MSC): MCS6 (2015-2016; age ∼14) and MCS7 (2018-2019; age ∼17). Data were restricted to adolescents classified as overweight/obesity at MCS6 using the UK90 thresholds. Weekday and weekend MVPA were measured at age 14 using the wrist-worn GENEActiv accelerometer, including one pre-specified weekday and one weekend day. Outcomes at age 17 were parent-reported Strengths and Difficulties Questionnaire (SDQ) internalizing (emotional + peer problems) and externalizing (conduct + hyperactivity/inattention) composites. We estimated average treatment effects (ATEs) and conditional average treatment effect (CATEs, heterogeneous effects) using a causal forest framework (EconML) and adjusted for pre-exposure covariates (age, sex, body mass index, ethnicity, cognitive decision-making, household income, parental education, and parental mental health). Missing data were treated via K-Nearest Neighbors imputation.

RESULTS: The analytic sample included 1,238 adolescents (mean age 14.25 years). Mean MVPA was higher on weekdays than weekends (135.74 ± 62.08 vs 113.80 ± 64.37 min/day). Covariate-adjusted average treatment effects (ATEs; per 1 min/day MVPA) were small and not statistically significant for internalizing or externalizing problems. Weekday MVPA ATEs were -0.0025 (95% CI -0.0062 to 0.0012) for internalizing and 0.0003 (-0.0027 to 0.0033) for externalizing; weekend MVPA ATEs were -0.0008 (-0.0051 to 0.0035) and 0.0005 (-0.0026 to 0.0037), respectively. Heterogeneity was evident only for weekday MVPA effects on internalizing (22.98% with significant individual effects), with height as the strongest moderator (β = 0.0002; p < 0.001; R² = 0.519) and more negative CATEs among shorter adolescents (Q1 -0.004994 vs Q4 -0.001903; ANOVA F = 106.741, p < 0.001).

CONCLUSIONS: In adolescents with overweight/obesity, estimated average effects of weekday and weekend MVPA at the age of 14 on parent-reported internalizing and externalizing problems at age 17 were close to zero under a selection-on-observables framework. Any potential benefits may be subgroup-specific and context-dependent; the observed weekday-specific heterogeneity warrants replication with more reliable exposure measurement and a richer set of contextual covariates.

PMID:42089085 | PMC:PMC13137140 | DOI:10.1016/j.ijchp.2026.100687