Nevin Manimala

J Occup Environ Med. 2026 Mar 6. doi: 10.1097/JOM.0000000000003694. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the global burden and trends of ischemic heart disease (IHD) attributable to non-optimal temperature among younger and older populations using Global Burden of Disease 2021 data.

METHODS: We estimated temperature-attributable IHD burden (high, low, non-optimal) from 1990-2021 using deaths, Disability-adjusted life years (DALYs), age-standardized rates, and joinpoint regression, stratified by age, sex, region, and Socio-demographic Index. Decomposition analysis examined demographic contributions.

RESULTS: From 1990-2021, age-standardized mortality and disability rates declined globally, yet absolute numbers of deaths and DALYs, especially in older adults. The burden from low temperatures was disproportionately higher in older adults, with extreme disparities in Central Asia. Sex differences shifted with age, and burdens were consistently higher in lower SDI regions.

CONCLUSIONS: Older adults bear a substantially greater IHD burden attributable to non-optimal temperature, highlighting the need for targeted prevention strategies.

PMID:41801250 | DOI:10.1097/JOM.0000000000003694

West Afr J Med. 2025 Aug 29;42(8):677-686.

ABSTRACT

BACKGROUND AND OBJECTIVES: This study aimed to assess the knowledge and perception of Nigerian paediatricians regarding paediatric sleep disorders and their management. It also assessed the state of their current practice with screening, evaluating and treating sleep disorders in children and the perceived barriers and facilitators to the provision of quality care for sleep disorders for Nigerian children.

METHODS: This descriptive cross-sectional study was conducted among 153 Paediatricians who practice in Nigeria and attended the Annual Scientific Meeting of the Paediatrics Association of Nigeria (PAN) held in January 2023 at Akure, Ondo state, Nigeria. We utilized a pilot-tested, semi-structured questionnaire adapted from the Paediatrics sleep survey questionnaire. Data was analysed with the IBM SPSS software, version 20.

RESULTS: The 153 respondents were from the six geopolitical zones in Nigeria. More than two-thirds (66.7%) had a poor knowledge score (<6). The majority of the respondents rated their confidence in diagnosing sleep disorders as fair (63.4%), while 22.2% rated it as poor. Almost all (98.7%) reported the lack of sleep laboratory in their centre of practice. Also, about two-thirds (68.0%) had no paediatric sleep clinic. The main barriers to the management of paediatric sleep disorders were lack of training (119; 77.3%) and lack of sleep laboratory (102; 66.7%). Having a sleep laboratory in the centre of practice was significantly associated with the knowledge of the paediatricians (p = 0.044).

CONCLUSION: There is a need for interventions to improve the knowledge of Nigerian paediatricians on sleep medicine and the provision of Paediatric sleep laboratory facilities in Nigeria.

PMID:41801239

JAMA Pediatr. 2026 Mar 9. doi: 10.1001/jamapediatrics.2026.0071. Online ahead of print.

ABSTRACT

IMPORTANCE: Whether maternal use of acetaminophen during pregnancy is associated with offspring’s neurodevelopment remains debated.

OBJECTIVE: To evaluate the associations of maternal prenatal prescriptions of acetaminophen with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) among offspring.

DESIGN, SETTING, PARTICIPANTS: This cohort study analyzed 2 092 926 singleton births between 2004 and 2015 in Taiwan, with 1 231 819 having at least 1 sibling. Estimated hazard ratios (HRs) and 95% CIs were examined for offspring ADHD or ASDs according to prenatal acetaminophen prescriptions, adjusting for confounding factors.

EXPOSURE: Prescriptions of acetaminophen were extracted from the National Health Insurance Research Database (NHIRD). Acetaminophen use was defined as having at least 2 dispense records during pregnancy, and the total number of prescriptions and the estimated mean daily dispensed dose were examined.

MAIN OUTCOMES AND MEASURES: The primary outcome was ascertaining diagnoses of ADHD and ASDs from the NHIRD.

RESULTS: Of the 2 092 926 singleton births between 2004 and 2015, 48.3% (n = 1 012 159) were born to mothers with at least 2 acetaminophen prescriptions during pregnancy. In the full cohort ASD dataset (N = 2 092 926), 23 557 children (0.01%) had ASD, and in the full ADHD dataset (N = 2 079 935), 116 387 children (0.06%) had ADHD. In the full cohort, offspring ADHD and ASDs were associated with prenatal prescriptions to acetaminophen, with associations noted for higher frequencies of acetaminophen use or higher mean daily dispensed doses of acetaminophen. In sibling-matched analyses, the associations between prenatal exposures to acetaminophen and ADHD and ASDs among offspring were null. However, a positive association was observed when only the older sibling was exposed (HR, 1.33 [95% CI, 1.17-1.52] for ADHD; HR, 1.75 [95% CI, 1.29-2.36] for ASDs), and a negative association was observed when only the younger sibling was exposed (HR, 0.75 [95% CI, 0.67-0.84] for ADHD; HR, 0.74 [95% CI, 0.57-0.96] for ASDs). The divergence of associations persisted in the bidirectional analyses of higher frequencies of acetaminophen use or higher mean daily doses of acetaminophen.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study in Taiwan suggest that positive associations were observed between maternal prenatal acetaminophen prescriptions and offspring’s ADHD or ASDs in the full cohort but not in the sibling-matched analyses. A substantial divergence in associations in the sibling bidirectional analyses indicates unaddressed sources of bias and prevents firm conclusions from being drawn using the sibling design.

PMID:41801232 | DOI:10.1001/jamapediatrics.2026.0071

JAMA Netw Open. 2026 Mar 2;9(3):e2560058. doi: 10.1001/jamanetworkopen.2025.60058.

ABSTRACT

IMPORTANCE: Increased use of the emergency department (ED) creates strain on the single-payer public health care system in Canada.

OBJECTIVE: To evaluate trends in ED visits and hospital admission rates for urologic conditions in Ontario, Canada, and to determine trends and associated factors for wait times to see a urologist among patients presenting to the ED.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study used health administrative data from all EDs and acute care hospitals in Ontario for all adult patients presenting to the ED with a primary urological diagnosis between January 1, 2007, and December 31, 2022. Analyses were performed from January 2023 to April 2024.

MAIN OUTCOMES AND MEASURES: The main outcome was the rate of ED visits with new urologic diagnoses over time. Crude, age-standardized, and sex-standardized annual rates were estimated for index ED visits and hospital admissions. Wait times to see a urologist after ED visit were also determined.

RESULTS: A total of 2 192 213 unique visits to the ED with a main diagnosis of a urologic disorder were identified (mean [SD] patient age, 52.1 [21.2] years; 66.5% female). Of these, 1 732 356 visits represented a new urologic diagnosis (no visits in the prior 2 years). Age- and sex-standardized ED visit rates rose annually from 2007 (0.91 visits per 100 people) to 2015 (1.0 visits per 100 people) (rate ratio [RR], 1.10; 95% CI, 1.09-1.11), then decreased until 2020 (RR, 0.88; 95% CI, 0.87-0.88), before rising again until 2022 (RR, 0.91; 95% CI, 0.90-0.91). Among people seen in the ED with a urologic diagnosis, 10.0% were admitted to the hospital during the study period. The crude rate of admission rose annually (RR, 1.04; 95% CI, 1.03-1.05; P < .001), from 0.07 (95% CI, 0.07-0.08) admissions per 100 people in 2007 to 0.09 (95% CI, 0.09-0.09) in 2022. Patients with greater continuity of outpatient care had lower odds of being admitted. The mean (SD) wait time to see a urologist after an ED visit increased from 62.5 (80.3) days in 2007 to 84.8 (89.3) days in 2014. It subsequently decreased annually until 2022, to 71.1 (70.6) days. Increased comorbidity was associated with lower risk of outpatient urology visit.

CONCLUSIONS AND RELEVANCE: In this cohort study, the annual ED visit rates for new urologic diagnoses, hospital admissions, and wait times to see urologists significantly increased over the study period. These trends were associated with decreasing continuity of care. This increasing burden of acute urologic disease necessitates investment in health care.

PMID:41801205 | DOI:10.1001/jamanetworkopen.2025.60058

JAMA Netw Open. 2026 Mar 2;9(3):e261068. doi: 10.1001/jamanetworkopen.2026.1068.

ABSTRACT

IMPORTANCE: State-level abortion restrictions in the US enforced after the June 2022 Dobbs v Jackson Women’s Health Organization Supreme Court decision have worsened geographic, racial, and socioeconomic inequities in abortion access, warranting investigation of experiences for individuals who travel out of state to seek abortion care.

OBJECTIVES: To highlight the obstacles abortion seekers must overcome to obtain care, to identify common barriers and facilitators of interstate abortion travel, and to offer recommendations for abortion organizations, policymakers, and advocates to expand access for individuals living in states with abortion bans.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study analyzed data obtained from out-of-state participants collected as part of a larger cross-sectional, mixed-methods study. All English- and Spanish-speaking patients from out of state who were at least 16 years of age and medically cleared for research attending 2 abortion clinics in Illinois between September and November 2023 were eligible.

MAIN OUTCOMES AND MEASURES: Participants completed a self-administered survey and a semistructured interview. Directed content analysis was used to identify emergent and crosscutting themes.

RESULTS: In total, 33 individuals (all self-identified as female or a woman) completed the survey and interview. Most participants were between 20 and 24 years of age (n = 12 [36%]) or 30 years or older (n = 12 [36%]), and from southern US states with a total abortion ban (n = 25 [76%]). From the time participants decided to terminate their pregnancy to the day of the abortion appointment, they experienced a median of 14.0 days of delay, with a mean (SD) of 29.6 (36.5) days of delay. Patient journeys of seeking abortion were categorized into 3 phases: information gathering, planning finances and travel, and traveling and completing the appointment. Participants reflected on how restrictive policies in their home states deepened abortion stigma and stifled access to accurate information. Most participants encountered their longest delays in the information-gathering phase, as they had to find legitimate clinics, often without any referrals, and navigate the complex web of laws between states. When patients had personal financial security, strong social support, or were in geographic proximity to a state in which abortion was legal, their journeys were facilitated.

CONCLUSIONS AND RELEVANCE: In this cross-sectional qualitative study of participants traveling across state lines for abortion, the policy landscape and abortion stigma of the home state, information and resource availability, and interpersonal support shaped their journeys in the post-Dobbs landscape. To improve cross-state abortion access for individuals in states with abortion restrictions or bans, policy change should be coupled with increased visibility of accurate information, charitable funding, and abortion stigma reduction. Abortion support organizations and the public should continue to enable access through social support services, such as volunteer drivers and abortion doulas.

PMID:41801198 | DOI:10.1001/jamanetworkopen.2026.1068

JAMA Netw Open. 2026 Mar 2;9(3):e261092. doi: 10.1001/jamanetworkopen.2026.1092.

ABSTRACT

IMPORTANCE: Smartphones are a pervasive feature of adolescents’ daily lives, raising concern about how smartphones are used in contexts such as school that require sustained attention and self-regulation.

OBJECTIVES: To describe youths’ smartphone use during each hour of the school day and examine whether smartphone use during school is associated with poorer cognitive control, a key developmental process underlying academic success.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of youths aged 11 to 18 years from the Southeastern US objectively assessed smartphone use every hour for 14 consecutive days between April 8, 2021, and February 2, 2022 (cohort 1), and February 1, 2023, and December 11, 2024 (cohort 2), providing thousands of data points to capture actual engagement.

MAIN OUTCOMES AND MEASURES: The iPhone iOS (Apple) screen time report captured smartphone use at every hour. Cognitive control was measured in the older cohort using a go/no-go task, with the signal detection metric d’ quantifying inhibitory control.

RESULTS: A total of 79 participants (mean [SD] age, 15.10 [2.04] years; 41 [51.9%] female) participated in the study. Youths were using their smartphones during every hour of the school day, spending a total of 2.22 hours of the school day on their smartphones. Youths aged 15 to 18 years spent more time on their smartphones during school hours than those aged 11 to 14 years (mean [SD], 23.28 [18.34] vs 11.57 [16.83] min/h; F1,76 = 28.82, P < .001, η2 = 0.28). Youths spent a mean (SD) of 40.14 (39.56) minutes on social media and 13.85 (25.22) minutes on entertainment apps during school hours. Youths checked their smartphones a mean (SD) of 64.46 (32.83) times during school hours. More frequent smartphone checking was associated with lower d’ values (F1,28 = 4.8, P = .04, η2 = 0.15), indicating poorer cognitive control.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that youths use smartphones approximately one-third of the school day; this use was associated with reduced cognitive control. These findings highlight the need for school-level policies and digital literacy programs that address not only overall screen time but also habitual smartphone-checking behaviors that fragment attention.

PMID:41801197 | DOI:10.1001/jamanetworkopen.2026.1092

JAMA Netw Open. 2026 Mar 2;9(3):e261194. doi: 10.1001/jamanetworkopen.2026.1194.

ABSTRACT

IMPORTANCE: Improving mental health through targeting behaviors like sleep and physical activity in treatment has been challenging, in part due to the challenge of measuring these factors in an accurate manner. Mobile technology can enable an understanding of the dynamic, complex associations between physical activity and sleep, but most prior mobile technology studies have had modest sample sizes and utilized cross-sectional, between-person designs, thus limiting their impact.

OBJECTIVE: To investigate the within-person associations between sleep, physical activity, and daily mood among individuals receiving mental health treatment to inform health behavior recommendations.

DESIGN, SETTING, AND PARTICIPANTS: This 12-month cohort study involved patients seeking mental health care at the University of Michigan academic medical center mental health care clinics. All participants were enrolled between May 13, 2020, and December 12, 2022. Data analysis was performed from September 2024 to June 2025.

EXPOSURES: Objective, wrist-based actigraphy measures of sleep (total sleep time, interrupted nighttime sleep, and napping) and physical activity (step count) were obtained.

MAIN OUTCOMES AND MEASURES: The primary outcome was participant-reported daily mood score, on a scale of 1 (worst mood) to 10 (best mood). Linear mixed-effects models were used to estimate associations among sleep, physical activity, and mood scores.

RESULTS: A total of 1476 participants (mean [SD] age, 36.5 [14.2] years; 1062 [72.0%] female) were included in the analysis. Sleep duration was associated with subsequent mood through an inverse U-shaped relationship, with both short and long sleep duration associated with poorer mood (quadratic term b = 0.027; 95% CI, -0.031 to -0.023). Notably, patients varied substantially in their optimal sleep duration (mean [SD], 6.8 [1.9] hours) for peak mood. Physical activity was positively associated with subsequent mood (linear term b = 0.160; 95% CI, 0.149 to 0.162; P < .001; quadratic term b =- 0.022; 95% CI, -0.027 to -0.017; P < .001), with diminishing associations at higher than usual activity for that individual. Conversely, daily mood was associated with subsequent sleep (linear term b = -1.377; 95% CI, -1.877 to -0.877; P < .001; quadratic term b = -0.394; 95% CI, -0.765 to -0.023; P = .037) and step count (linear term b = 0.020; 95% CI, 0.003 to 0.030; P = .02; quadratic term b = -0.010; 95% CI, -0.020 to -0.001; P = .03) in a wavelike manner.

CONCLUSIONS AND RELEVANCE: This cohort study of people seeking mental health care found complex, bidirectional associations between sleep, physical activity, and mood with individual variation in optimal sleep duration for mood scores. The findings advance progress toward effectively targeting health behaviors to improve mental health.

PMID:41801196 | DOI:10.1001/jamanetworkopen.2026.1194

JAMA Neurol. 2026 Mar 9. doi: 10.1001/jamaneurol.2026.0204. Online ahead of print.

ABSTRACT

IMPORTANCE: Psychiatric disturbances are common in epilepsy and are associated with increased risk of premature mortality, lower quality of life, and poor response to antiseizure medications (ASMs).

OBJECTIVE: To evaluate the role of psychiatric disturbances at the time of epilepsy diagnosis in predicting risk of future treatment resistance in focal epilepsy.

DESIGN, SETTING, AND PARTICIPANTS: The Human Epilepsy Project (HEP) is a prospective, observational, international, and multicenter cohort study with follow-up for up to 6 years. Participants with newly diagnosed focal epilepsy, enrolled within 4 months of initiating ASM treatment, between the ages 18 and 60 years, and without significant other comorbidities were recruited during the open period of 2012 to 2020. Data analysis was performed from January to September 2025.

EXPOSURE: Presence of a psychiatric diagnosis.

MAIN OUTCOMES AND MEASURES: Presence of psychiatric diagnosis (mood/anxiety disorders) measured by Mini International Neuropsychiatric Interview (MINI) and/or suicidality measured by Columbia-Suicide Severity Rating Scale (C-SSRS) at enrollment. Treatment response included the following outcomes: treatment resistant (TR), defined as failure of first 2 adequate ASM trials (ongoing seizures at/above therapeutic doses); treatment sensitive (TS), defined by a minimum period of seizure freedom on first 2 adequate ASM trials (12 months/3-fold greatest pretreatment seizure-free interval, whichever is longer); and indeterminate (neither TR/TS).

RESULTS: Of 376 enrolled adults, 347 (median [IQR] age at seizure onset, 33 [23-44] years; 209 female [60.2%]) completed the MINI and C-SSRS at enrollment. Of these individuals, 191 (55%) were TS, 83 (24%) TR, and 73 (21%) indeterminate. The rate of psychiatric disturbance (mood/anxiety disorder; suicidality) at epilepsy diagnosis was 38% (n = 133). Fifty-seven (16%) had mood/anxiety disorder(s) without suicidality, and 75 (22%) expressed suicidality with or without a psychiatric disorder. Suicidality at epilepsy diagnosis was associated with greater than 2-fold risk of developing TR (relative risk [RR], 2.02; 95% CI, 1.32-3.09; P = .001). There were no significant overall associations between mood/anxiety disorders and TR. Suicidality alone significantly increased TR probability from 16.3% (95% CI, 11.3%-21.3%) in those with no psychiatric disturbance to 47.1% (RR, 2.89; 95% CI, 1.65-5.05; P < .001). Anxiety disorder alone increased TR probability to 32.9% (RR, 2.02; 95% CI, 1.10-3.71; P = .02), although this was not statistically significant after correcting for multiple comparisons. There was no significant change in TR probability when mood disorder alone was present; however, presence of mood disorder with suicidality increased TR probability to 39.6% (RR, 2.43; 95% CI, 1.26-4.68; P = .008).

CONCLUSIONS AND RELEVANCE: Results of this cohort study reveal that suicidality at the time of focal epilepsy diagnosis was associated with future drug resistance and may be a marker of more severe neuropathology. Psychiatric screening at time of diagnosis may facilitate early identification of patients at risk for treatment refractory epilepsy syndromes.

PMID:41801192 | DOI:10.1001/jamaneurol.2026.0204

West Afr J Med. 2025 Aug 29;42(8):668-676.

ABSTRACT

BACKGROUND: Kidney transplantation in Nigeria has witnessed remarkable advancements. Availability of suitable and willing living donors is one of the major factors leading to its success. The aim of this study was to identify and analyze the reasons for exclusion of potential living kidney donors in a transplant program at a tertiary hospital in Southeast Nigeria. This is important in order to improve donor screening, maximize the living donor pool and ensure donor safety.

METHODS: This was a retrospective study of kidney transplant register and medical records at the transplant clinic of Federal Medical Center Umuahia, Southeast Nigeria. Relevant clinical data of potential living kidney donors who presented for pre-donation evaluation over a period of 8 years were collated in excel sheet and analyzed using SPSS version 23.0. Tables, charts and graphs were used to illustrate some data.

RESULTS: Pre-donation evaluation records of sixty four potential living donors were retrieved. Median age was 23 (IQR=19-39) years There were 62 males and 2 females with M:F ratio of 31:1. Majority were unskilled workers (83%) and unrelated to prospective recipients (61%). Among those related to the patients (39%), there were more second-degree relatives (22%) than first degree relatives (17%). Out of the 64 potential kidney donors, 13 (20%) eventually donated while 51(80%) did not. Factors that prevented eventual kidney donation included immunological incompatibility (32.8%), albuminuria (11%), hypertension (9%), financial motivation (9%), nephrolithiasis (4.7%), donor withdrawal from donation process (4.7%), Hepatitis B infection (3%), prediabetes (3%) and abnormal cardiac function (1.5%).

CONCLUSION: The potential living donors evaluated were mostly young males that were unrelated to their potential recipients. Immunologic incompatibility was the leading cause of failure to donate a kidney; mainly from donor-recipient significant HLA mismatches.

PMID:41801162

Public Health Res (Southampt). 2026 Mar;14(3):1-120. doi: 10.3310/GJSR2325.

ABSTRACT

METHODS: This study employed an interdisciplinary approach to assess the impact of agricultural production modifications and dietary changes on ammonia emissions, health outcomes and health inequalities. Statistical and econometric methods were applied to analyse agricultural emission trends and dietary patterns. Spatial data analysis and numerical modelling techniques were used to simulate the dispersion and transformation of atmospheric pollutants. Health impact modelling estimated mortality and morbidity outcomes under various policy scenarios, while cost-effectiveness and cost-benefit analyses supported decision-making. A participatory approach involving multistakeholder engagement was utilised to enhance policy relevance and implementation feasibility. A systematic scoping review of academic studies on agricultural-derived air pollution and clinically coded outcomes revealed very limited research on this topic, which presents an inconsistent picture as to whether agricultural-derived particulate matter affects health.

RESULTS: Key findings indicate that dietary modifications have greater potential health benefits than direct reductions in particulate matter exposure from ammonia emissions. Small reductions in meat and dairy consumption, supported by taxation and subsidies, could help achieve environmental and health targets. A 20% meat and dairy tax, coupled with a 20% subsidy on fruits and vegetables, could reduce meat consumption by 21.5% and increase fruit and vegetable intake by up to 13.5%. These dietary shifts also significantly lower greenhouse gas emissions and water use. While ammonia’s environmental effects are well documented, its direct health impacts remain uncertain. Epidemiological studies suggest a possible association between ammonium-derived particulate matter and increased mortality and cardiorespiratory diseases, though findings are inconsistent. Toxicological assessments indicate limited intrinsic toxicity of ammonium nitrate and sulfate. A ‘high-ambition mitigation’ scenario integrating ammonia reduction measures with dietary shifts could prevent 67,000 premature deaths and 270,000 cases of respiratory diseases over 30 years. Notably, older adults and lower-income populations would experience the greatest health benefits. Most farm-based ammonia reduction strategies demonstrated net economic benefits, with only a few measures having limited abatement potential. Additionally, reduced greenhouse gas emissions further amplified the benefits of each scenario.

LIMITATIONS: Despite robust modelling techniques and multistakeholder engagement, several limitations exist. The direct health effects of ammonia-derived particulate matter remain an area of uncertainty, necessitating further epidemiological research. Additionally, while economic and environmental benefits were quantified, behavioural responses to policy interventions – such as consumer acceptance of dietary changes – require further exploration. The study primarily focused on UK-specific data, limiting generalisability to other regions with different agricultural practices and policy landscapes. Finally, unintended consequences of dietary shifts on food security and cultural preferences were not fully explored, indicating the need for future research to refine policy recommendations. The Assessing Mitigation Pathways to Realise Public Health Benefits of Air Pollutant Emission Reductions from Agriculture project provides a comprehensive, interdisciplinary framework for evaluating integrated policy measures. It underscores the importance of sustainable agricultural and dietary transitions in achieving cobenefits for public health and environmental sustainability, while emphasising the need for continued research to address remaining uncertainties.

FUTURE WORK: More detailed spatial and temporal analyses are required to fully understand the potential importance of significant local sources on human health in specific areas/times of year. There is a need to better align evidence of studies, such as Assessing Mitigation Pathways to Realise Public Health Benefits of Air Pollutant Emission Reductions from Agriculture, with toxicological studies which suggest that (pure) ammonium nitrate and sulfate have only very modest toxicity.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42020172116.

FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129440) and is published in full in Public Health Research; Vol. 14, No. 3. See the NIHR Funding and Awards website for further award information.

PMID:41801161 | DOI:10.3310/GJSR2325