Nevin Manimala

Environ Int. 2026 May 9;212:110286. doi: 10.1016/j.envint.2026.110286. Online ahead of print.

ABSTRACT

BACKGROUND: Climate change threatens global health, particularly among vulnerable populations such as pregnant individuals and their newborns. Evidence linking heat to premature birth is largely based on single-location studies or heterogeneous meta-analyses, leaving important gaps regarding underrepresented regions, preterm subgroups, and the role of maternal and infant characteristics.

OBJECTIVES: To quantify the association between heat and preterm birth (PTB) across multiple countries, assess gestational-age-specific effects, and identify maternal vulnerability factors.

METHODS: We analysed 36.6 million births occurring during the warm season from 250 locations in 13 countries to assess heat effects on PTB. Distributed lag non-linear models (DLNM) with quasi-Poisson regression estimated heat-PTB associations and the fraction of PTB attributable to heat. Gestational-age subcategories (extreme, very, late, and at-term) and socio-economic vulnerability profiles were also examined.

RESULTS: Overall, 1.4% (95% CI: 1.3-1.5) of PTB were attributable to heat (855 PTB per million births), with national burdens from 628 to 1,347 PTB per million. Higher susceptibility was suggested for younger, single, non-primiparous, less-educated, and socio-economically deprived mothers, and among female fetuses. Late PTB showed the largest risk; at-term births also displayed a small but consistent heat-related increase.

CONCLUSIONS: This large analysis of heat-related PTB using harmonized individual-level data indicates that heat increases PTB risk, with variations across countries and climates. It also shows that heat can trigger labour beyond the typical PTB window, affecting pregnancies not usually considered clinically vulnerable. Overall, these findings underscore the need for strategies to mitigate heat-related risks during pregnancy, particularly among socio-economically vulnerable populations.

PMID:42139755 | DOI:10.1016/j.envint.2026.110286

J Neurosurg Pediatr. 2026 May 15:1-9. doi: 10.3171/2025.12.PEDS25317. Online ahead of print.

ABSTRACT

OBJECTIVE: Fetal myelomeningocele repair (FMMR) has shown significant promise in decreasing the incidence of myelomeningocele (MMC)-associated hydrocephalus. In this study, the authors report on the reversal of hindbrain herniation via FMMR. They also describe biometric changes in third ventricle anatomy, which influences the outcome of endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC).

METHODS: At the Arnold Palmer Hospital for Children and Winnie Palmer Hospital for Women & Babies, the maternal and fetal inclusion and exclusion criteria developed by the Management of Myelomeningocele Study (MOMS) were applied to determine eligibility for prenatal MMC repair. Patient charts, prenatal fetal MRI, ultrasonography studies, and postnatal brain MRI for the first 50 FMMRs performed between 2019 and 2024 were retrospectively reviewed for this study. Ventricle size was measured prior to fetal surgery, as was the clivus-supraocciput angle (CSO) on fetal and postnatal images. Neonates were stratified into hydrocephalic and nonhydrocephalic groups for comparative analysis. The hydrocephalic group included patients who had undergone ETV/CPC or insertion of a ventriculoperitoneal shunt (VPS).

RESULTS: A total of 50 women underwent FMMR. One woman did not consent to inclusion in the study, 8 patients remained in utero at the time of analysis, and 3 patients died. Of the 38 patients included in the analysis, 21 (55%) underwent treatment for their symptomatic hydrocephalus; 4 received a VPS, and 17 underwent ETV/CPC. Four ETV/CPC cases did not respond to the treatment and were scheduled for VPS insertion, resulting in an overall ETV/CPC success rate of 70.6% (12/17) in the study. A statistically significant difference in the mean prenatal ventricle size was observed between the nonhydrocephalic (9.61 mm) and hydrocephalic (12.1 mm, p = 0.023) groups. Additionally, a significant difference in the CSO angle in the first month after birth was noted between the groups (67.2° vs 76.7°, p = 0.01).

CONCLUSIONS: There is strong evidence that FMMR decreases MMC-related hydrocephalus by reversing hindbrain herniation and altering the developmental anatomy of the third ventricle. This makes ETV/CPC a safe alternative to CSF shunting because of the newly altered anatomy of the third ventricle and posterior fossa. Larger studies are recommended to further evaluate fetal brain development after FMMR.

PMID:42139738 | DOI:10.3171/2025.12.PEDS25317

J Neurosurg. 2026 May 15:1-7. doi: 10.3171/2026.1.JNS252444. Online ahead of print.

ABSTRACT

OBJECTIVE: Predicting language lateralization using functional MRI (fMRI) in patients with cerebral vascular malformations close to language areas is essential for treatment decision-making and patient outcomes. Functional MRI-based prediction is challenged because of potential remodeling processes and hemodynamic phenomena. However, there is a lack of possible factors influencing laterality prediction. The authors hypothesized that there might be an impact of lesion type and location on language lateralization.

METHODS: This retrospective study included 24 patients with arteriovenous malformations (AVMs), 11 patients with cavernomas, and 15 healthy controls. Participants performed a subvocal verb-generation task during fMRI. Data analysis in Statistical Parametric Mapping (SPM) 12 involved realignment, coregistration, and smoothing for preprocessing. The authors conducted a whole brain analysis using the general linear model approach at the individual level and calculated the lateralization indices (LIs) using the LI toolbox implemented in SPM independently based on the frontal, temporal, and parietal lobes.

RESULTS: The mean absolute LIs were above 0.2 in all groups. Distribution between groups varied significantly (p = 0.032, f = 0.34). A significant difference was found between patients with AVMs and healthy controls (p = 0.038, r = 0.628). Specifically, patients with frontal AVMs showed significantly lower frontal LIs than did healthy controls (p = 0.032, r = 0.435). In contrast, LIs in cavernoma patients did not differ significantly from controls (p = 0.313). No significant difference was observed between language-adjacent and language-distant lesions (p = 0.14).

CONCLUSIONS: The results of this study suggest that lesion type and location influence language lateralization prediction. Frontal AVMs exhibit significantly lower LIs, requiring caution and experience in interpreting results to ensure patient safety. Cavernomas did not influence LI. Further research with larger cohorts is necessary to understand the underlying causality and neuroplastic changes involved.

PMID:42139736 | DOI:10.3171/2026.1.JNS252444

JMIR Mhealth Uhealth. 2026 May 15;14:e66002. doi: 10.2196/66002.

ABSTRACT

BACKGROUND: Mobile health (mHealth) uses mobile technology as a tool for prevention and health promotion. Research indicates that user engagement is crucial for effective mHealth interventions and improved health outcomes. However, many studies report low adoption rates, rapid decline after initial use, and a lack of acknowledgment of user implications in achieving outcomes. Thus, conceptualizing participation in mHealth is essential to identify key determinants for engaging users.

OBJECTIVE: This scoping review aims to identify and characterize the attributes and definitions of user engagement in mHealth, examine engagement methods, and analyze barriers and facilitators influencing participation.

METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, Scopus, Web of Science, and PubMed databases were searched for publications between 2000 and 2025 with a 2-stage selection process.

RESULTS: Out of 2489 articles identified, 1416 were screened, and 52 met the inclusion criteria. Half were recently published in the last 5 years (2020-2025). Existing literature focused on digital interventions for specific populations and health topics. Analysis revealed four main perspectives on engagement in mHealth: (1) usage metrics, (2) subjective user experiences, (3) a hybrid approach that combines both, and (4) a goal-oriented perspective (behavior change or health outcomes).

CONCLUSIONS: To understand the complexity and multifactorial nature of participation, it is relevant to conceptualize it as a dynamic mechanism enabling users to achieve their objectives. Both quantitative use and subjective user experience should be integrated to reach the optimal intervention dose. Recognizing users’ evolving needs, uniqueness, and their socioenvironmental context interdependence, it is essential to involve users in all stages (design, implementation, and iterative evaluation of mHealth). Findings will inform an e-Delphi study to establish consensus on engagement criteria.

PMID:42139698 | DOI:10.2196/66002

JMIR Form Res. 2026 May 15;10:e83199. doi: 10.2196/83199.

ABSTRACT

BACKGROUND: Cardiac auscultation is an essential component of clinical examination but is often challenging to achieve proficiency in. Self-contained, multisensory learning resources that incorporate simultaneous visual and haptic stimuli offer a unique approach to supporting learners in acquiring this core skill.

OBJECTIVE: This pilot study of both medical students and clinical educators evaluated the utility of a novel iPhone app, Haptic Heart, which generates haptic vibrations to simulate heart sounds and murmurs. We aimed to explore the perceptions of students and educators when using haptics as a learning resource and the underlying reasons behind these perceptions and to gather lessons that would inform future development of the resource.

METHODS: Clinical-year medical students from the Lincoln Medical School with access to an iPhone were invited to trial Haptic Heart between October 2023 and December 2024. Cardiology specialists involved in clinical education were also invited to take part. After using the app, participants were asked to complete a modified version of the 12-item Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions questionnaire that included additional free-text items. Educators were also asked to comment on the resource’s authenticity and perceived usefulness. Quantitative responses were analyzed using descriptive statistics; free-text responses were analyzed for common themes.

RESULTS: A total of 21 students and 18 educators completed the evaluation. Both cohorts returned positive responses across nearly all questionnaire items, with students showing near universal agreement that the app was of excellent quality (21/21, 100%), supported their learning needs (21/21, 100%), and would change their clinical practice (20/21, 95.2%). Educators similarly rated the resource highly for learning utility (16/18, 88.9%) and authenticity (13/18, 72.2%). Reported technical difficulties were minimal for students (1/21, 4.8%) and educators (2/18, 11.1%). Analysis of free-text responses suggested that learners valued the ability to “feel” murmurs and to vary heart rate. Educators highlighted the resource’s novelty and innovation, although some noted concerns about audio quality when using a stethoscope to auscultate haptic vibrations directly.

CONCLUSIONS: This pilot evaluation demonstrates the potential of smartphone-based haptic technology as a tool for medical education. Haptic Heart was perceived by both students and educators as an innovative educational tool for cardiac auscultation. Further work should focus on expanding the range of haptic patterns provided and exploring the effectiveness of these resources on learning.

PMID:42139690 | DOI:10.2196/83199

JMIR Mhealth Uhealth. 2026 May 15;14:e71251. doi: 10.2196/71251.

ABSTRACT

BACKGROUND: Access to oral health promotion for older adults is globally limited, especially in rural, low- and middle-income settings. Digital research often lacks theoretical foundation and focuses primarily on younger cohorts, yielding few randomized trials evaluating accessible tools for oral health education in older adults.

OBJECTIVE: This study aimed to develop a telehealth reinforcement strategy for oral health promotion to improve knowledge, attitudes, and self-efficacy in community-dwelling older adults.

METHODS: A single-center, parallel-group randomized controlled trial was conducted in 4 municipalities (2 urban and 2 rural) in La Araucanía, Chile. Eligible participants were functionally independent adults aged ≥60 years with smartphone and internet access; those with cognitive impairment, complete edentulism, or inability to use WhatsApp were excluded. Participants were recruited from regional databases and assessed using the Geriatric Dental Specialties Tele-platform, a teledentistry tool for older adults. Participants were randomized (1:1) to face-to-face instruction (comparator) or the same instruction plus 2 weeks of social cognitive theory-informed telehealth reinforcement (4 validated videos via WhatsApp). Clinicians and statistical advisors were blinded. Primary outcomes (oral health knowledge, attitudes, and self-efficacy) were measured via telephone-administered questionnaires at baseline and 6 weeks post intervention. Secondary outcomes included acceptability and self-reported behaviors. Analyses included hypothesis testing, multiple correspondence analysis, and k-means clustering.

RESULTS: A total of 120 older adults were randomized (comparator: n=59; telehealth: n=61), with 103 analyzed (comparator: n=51; telehealth: n=52). Both groups showed substantial within-group improvements in oral health knowledge (comparator: Cohen d=0.93, 95% CI 0.52-1.34; P<.001; telehealth: Cohen d=1.07, 95% CI 0.66-1.48; P<.001) and self-efficacy (comparator: r=0.59, 95% CI 0.38-0.74; P<.001; telehealth: r=0.62, 95% CI 0.43-0.77; P<.001). In per-protocol analysis, telehealth improved dental caries knowledge (P=.03) and attitudes (P=.004), with no between-group differences in other domains (P>.05). In intention-to-treat analysis, telehealth showed a significant between-group difference for attitudes only (adjusted mean difference=0.91, 95% CI 0.34-1.48; P=.002), with no differences for overall oral health knowledge (P=.11) or self-efficacy (P=.59). Exploratory analyses indicated only the rural telehealth subgroup showed significant gains in attitudes (P=.003) and flossing (P<.001). Clustering suggested greater improvements among participants with higher baseline needs, predominantly rural, with fewer teeth. Telehealth demonstrated acceptability across multiple indicators (>80% for most measures) with no clinical adverse events; minor video-access issues occurred.

CONCLUSIONS: Telehealth reinforcement provided significant advantages in oral health attitudes compared with face-to-face instruction. The intervention was acceptable and showed benefits among older adults with higher preventive needs, commonly seen in rural settings. By integrating theory-informed strategies into a familiar digital platform, this study adds evidence from rural and urban contexts, extending prior work on mobile oral health. It offers insights to address service gaps in underserved areas and highlights potential for feasible, context-aligned implementation. Future research should evaluate long-term effects, adaptability, and cost-effectiveness.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05917548; https://clinicaltrials.gov/study/NCT05917548.

PMID:42139689 | DOI:10.2196/71251

Prosthet Orthot Int. 2026 May 14. doi: 10.1097/PXR.0000000000000550. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a paucity of knowledge about personality traits of children and adolescents with lower limb differences. This study investigated the following: (1) comparison of personality traits of patients with limb differences to the general population; (2) comparison of male and female personality traits; and (3) comparison of personality traits, based on the five-factor model, between persons who had lower limb amputation at a young age vs. an older age.

METHODS: Thirty participants with unilateral lower limb differences completed Inventory of Children’s Individual Differences (short version) during a routine clinical visit.

RESULTS: Mean raw scores for openness to experience and agreeableness personality traits were statistically higher for participants with amputations compared with published general population. However, only the frequency distributions of T scores of the Inventory of Children’s Individual Differences-Short Version were statistically different for agreeableness personality trait between the 2 groups. There were no significant differences for all personality traits between participants grouped by age at amputation. Male participants scored lower than female participants on all 5 personality traits, but these differences were not statistically significant.

CONCLUSION: The personality traits of children and adolescents with unilateral lower limb differences demonstrate small differences compared with the general population’s personality traits. Although treatment decisions for prosthetic care cannot be made based only on the patient’s personality traits, an appraisal of the patient’s personality may assist the patient’s and clinician’s decisions in developing a personalized rehabilitation treatment plan.

PMID:42139686 | DOI:10.1097/PXR.0000000000000550

Prosthet Orthot Int. 2026 May 14. doi: 10.1097/PXR.0000000000000533. Online ahead of print.

ABSTRACT

BACKGROUND: Adjustable-volume prosthetic sockets are designed to address residual limb volume fluctuations that temporarily alter socket fit. These systems are relatively new to the market and their global use, and the type of patient they work best for, remains unclear.

OBJECTIVE: This study explored global experiences and perspectives on fitting different styles of commercially available adjustable-volume prosthetic sockets.

METHODS: An online survey was distributed globally to prosthetists. The survey asked about experiences with adjustable sockets, including successes, challenges, and barriers faced when fitting, and the impact of amputation level on success. Responses were statistically compared between United States (US) and non-US respondents.

RESULTS: Of 195 valid responses, 66.7% were from the US. Eighty-five percent of respondents had fit an adjustable socket, with those in the US more likely to fit them than those outside of the US (p = 0.001). Reported success rates ranged from 40.0% to 75.1% depending on the socket style, with no significant differences between US and non-US respondents or between amputation levels. Open-ended feedback highlighted the importance of patient selection, the timing of use, and differing views on the implications of prefabricated designs for clinical practice and access to care.

CONCLUSIONS: Globally, prosthetists report moderate success in fitting a variety of lower limb adjustable-volume sockets at different levels of amputation. As the market for adjustable-volume sockets continues to expand, further research is warranted to evaluate long-term outcomes across styles and amputation levels to better inform global prescription practices.

PMID:42139685 | DOI:10.1097/PXR.0000000000000533

Knee Surg Sports Traumatol Arthrosc. 2026 May 15. doi: 10.1002/ksa.70425. Online ahead of print.

ABSTRACT

PURPOSE: A growing emphasis on patient-centered care, paired with a steady rise in anterior cruciate ligament reconstructions (ACLRs), has led to greater interest in identifying predictors of patient-reported outcomes (PROs) after ACLR. Patient expectations are one factor previously identified as potentially impacting post-operative PROs in orthopaedic surgery; however, the association between preoperative expectations and PROs after ACLR has not been thoroughly investigated. Therefore, the present study aimed to examine the association between preoperative expectations and PROs 2 years after primary ACLR.

METHODS: Patients who underwent primary ACLR at an academic institution from July 2015 to May 2018 were retrospectively identified from a prospectively enroled registry. Surveys were administered at baseline and 2 years post-operatively. Outcomes included six Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) domains, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner Activity Scale (TAS), Marx Activity Rating Scale of the lower extremity (MARS LE) and numeric pain scale (NPS) of the operative knee and body. Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) preoperative expectations domain assessed patient expectations.

RESULTS: Out of 184 patients, 129 patients (70.1%) with complete preoperative expectations completed 2-year PROs and were included for statistical analysis. The mean preoperative expectations score for our patient population was 88.1. On bivariate analysis, preoperative expectations were not associated with patient sociodemographics. Higher preoperative expectations correlated with improved 2-year surgical satisfaction (p = 0.005), greater 2-year improvement in PROMIS Social Satisfaction (p = 0.023) and improved PROMIS Pain Interference (p = 0.005). On regression analysis, preoperative expectations predicted 2-year PROMIS Pain Interference (p = 0.030) and Met Expectations (p = 0.038). Preoperative expectations were also a predictor of greater improvement in PROMIS Pain Interference (p = 0.014).

CONCLUSION: The current study found that preoperative expectations are predictive of improved 2-year pain-related outcomes and a greater sense that expectations were met after ACLR.

LEVEL OF EVIDENCE: Level IV, a retrospective cohort study.

PMID:42139673 | DOI:10.1002/ksa.70425

Knee Surg Sports Traumatol Arthrosc. 2026 May 15. doi: 10.1002/ksa.70434. Online ahead of print.

ABSTRACT

PURPOSE: Although bone-patellar tendon-bone autograft is widely used for anterior cruciate ligament reconstruction, it is often associated with anterior knee pain resulting from the residual patellar bone defect. Various materials have been proposed to fill this void, yet no consensus exists regarding the optimal choice. This study compared three commonly used patellar harvest site bone void fillers and assessed their impact on the frequency and severity of anterior knee pain. We hypothesised that calcium phosphate cement would result in lower postoperative anterior knee pain compared with autologous bone graft and demineralised bone matrix (DBM) due to its compressive modulus approximating cancellous bone.

METHODS: Skeletally mature patients undergoing primary anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft were enrolled. Exclusion criteria included age under 18, prior anterior cruciate ligament reconstruction, multiligament knee injury, coronal malalignment exceeding three degrees of varus or valgus, or less than 1 year of follow-up. Participants were randomly assigned to one of three groups: (1) autologous bone graft, (2) calcium phosphate cement or (3) DBM. Patient-reported outcomes were collected preoperatively and at 1 week, 6 weeks, 3 months, 6 months, 9 months and 12 months postoperatively. Analysis of variance and chi-square tests were used for statistical analysis.

RESULTS: After applying exclusion criteria, 148 patients were included in the final analysis. No significant differences in visual analog scale pain scores were observed between cohorts at any postoperative interval (12-month, p = 0.598). Similarly, Kujala and Knee injury and Osteoarthritis Outcome scores did not differ significantly among the three cohorts at any time point (12-month, p = 0.878, p = 0.366).

CONCLUSIONS: Filling the patellar harvest site defect with autologous bone graft, calcium phosphate cement, or DBM resulted in similar postoperative anterior knee pain following anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft.

LEVEL OF EVIDENCE: Level I.

PMID:42139669 | DOI:10.1002/ksa.70434