Nevin Manimala

Rural Remote Health. 2026 May;26(2):9803. doi: 10.22605/RRH9803. Epub 2026 May 7.

ABSTRACT

INTRODUCTION: Child malnutrition remains a critical public health challenge in low- and middle-income countries, significantly contributing to morbidity and mortality among children less than age 5 years. In Northern Nigeria, persistent nutritional deficiencies, compounded by socioeconomic disparities and regional variations, demand urgent attention. This study examines trends and determinants of stunting, wasting, and underweight from 2013 to 2018.

METHODS: A cross-sectional research design was used for this study. Household and anthropometric secondary data were extracted from the 2013 and 2018 Nigeria Demographic and Health Surveys, focusing on 39,720 mother-child pairs in Northern Nigeria. Anthropometric measurements were converted into Z-scores, with stunting, wasting, and underweight defined as scores less than &minus;2 standard deviations. Chi-squared analyses were used to assess associations between malnutrition and various factors. Analyses were performed using IBM Statistical Package for the Social Sciences (v28.0), with statistical significance set at p<0.05.

RESULTS: Findings reveal that stunting increased from 39.4% to 44.7% (p<0.001) over the study period, whereas wasting declined markedly from 17.0% to 8.1% (p<0.001) and underweight decreased from 30.0% to 27.5% (p<0.001). Significant disparities emerged across regions, with the North-West exhibiting the highest malnutrition rates, and rural areas showing greater vulnerability than urban settings. Rural children had higher malnutrition rates than urban children. Higher maternal education and greater household wealth were strongly associated with a reduced risk of malnutrition.

CONCLUSION: This study contributes to the literature by showing that regional disparities and conflict-related instability exacerbate child malnutrition in Northern Nigeria. The findings revealed subnational variations that mirrored patterns in other crisis-affected regions, yet with distinct local drivers. The divergent trends in wasting (improved) and stunting (worsened) challenge the assumption that short-term interventions alone can address malnutrition in fragile settings. For practitioners in rural and remote health, these results emphasize the need for localized, multisectoral approaches. Such strategies must combine immediate nutritional support with long-term investments in maternal education, economic empowerment, and health systems adapted to the unique challenges of rural contexts, such as limited infrastructure and access to care.

PMID:42092302 | DOI:10.22605/RRH9803

Am J Surg. 2026 Apr 28;258:117013. doi: 10.1016/j.amjsurg.2026.117013. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative abdominal and shoulder pain, nausea, and vomiting are among the most common complications following laparoscopic surgery, often necessitating increased use of analgesics and antiemetics. This study aimed to compare the effects of nitrous oxide (N₂O) and positional maneuvers on pain intensity, incidence of nausea and vomiting, and analgesic requirements after laparoscopic surgery.

MATERIALS AND METHODS: This double-blind randomized clinical trial was conducted on 126 elective patients scheduled for laparoscopic cholecystectomy. The patients were randomly assigned into three groups of 42 individuals each: one group received N₂O, another received a combination of positional maneuver and pulmonary recruitment, and the third served as the control group. Pain intensity, nausea, vomiting, and time to first analgesic request were assessed at 6, 12, and 24 h postoperatively. Data were analyzed using ANOVA, Chi-square, and Fisher’s exact tests. A p-value of less than 0.05 was considered statistically significant. All analyses were performed using SPSS software, version 24.

RESULTS: The results showed that the N₂O group experienced the lowest intensity of abdominal and shoulder pain at all time points, and the time to first analgesic request was significantly longer in this group than the others (p < 0.05). Additionally, the incidence of nausea and vomiting was lower in the intervention groups than in the control group, and this difference was statistically significant (p < 0.05). Among the demographic variables, gender was the only factor associated with the occurrence of complications; females experienced vomiting more frequently than males.

CONCLUSION: Both nitrous oxide and positional maneuvers effectively reduced postoperative pain and gastrointestinal complications, with N₂O showing greater efficacy in minimizing symptoms and delaying analgesic need.

PMID:42092289 | DOI:10.1016/j.amjsurg.2026.117013

Int J Nurs Knowl. 2026 May 6:20473087261443267. doi: 10.1177/20473087261443267. Online ahead of print.

ABSTRACT

IntroductionFrailty among older adults is a critical issue in Japan’s super-aged society. Although potentially reversible, frailty may progress to disability if left unaddressed. Home-visit nursing plays a key role, yet outcome evaluation remains limited. This study examined the effectiveness of care for older adults with frailty using a six-step nursing process based on standardized nursing terminologies NANDA-I, NOC, and NIC.MethodsNine older adults diagnosed with Elder frailty syndrome received individualized home-visit nursing a six-step NNN process over three months. NOC indicators were defined as each participant’s “best possible state” and were evaluated monthly. Data were recorded in Excel and analyzed using EZR. Ethical approval was obtained, and informed consent was independently managed.ResultsAll nine participants completed the study. Most showed improvement in NOC indicators, and some demonstrated resolution of frailty-related symptoms. One participant showed improvement in the initially selected NOC indicators, but new nursing diagnoses emerged and other frailty-related indicators worsened, resulting in no overall improvement in frailty status. Six NOC outcomes showed statistically significant improvement (p < .05), with several demonstrating large effect sizes (Cohen’s d > 0.8). Nurses reported that using NNN helped clarify care focus and promoted team collaboration. In some cases, reassessment shifted the diagnostic framework from Elder frailty syndrome to Readiness for Enhanced Healthy Aging.ConclusionThe NNN-based six-step nursing process may support frailty improvement by visualizing individualized outcomes and guiding targeted care. It may also support collaboration and structured evaluation in home-visit nursing.Practical ImplicationsAlthough preliminary, NNN-based care shows potential for addressing frailty through individualized assessment. Defining NOC outcomes as the “best possible state” may reflect diverse aging trajectories. Visualizing care transitions may promote team knowledge sharing. Future implementation requires standardized documentation and practitioner training.

PMID:42092257 | DOI:10.1177/20473087261443267

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2026 Apr 20;44(4):304-308. doi: 10.3760/cma.j.cn121094-20250828-00342.

ABSTRACT

Objective: To compare and analyze the occupational exposure limits (OELs) specified in China’s “Occupational Exposure Limits for Hazardous Agents in the Workplace-Part 1: Chemical Hazardous Agents” (GBZ 2.1-2019) with the recommended exposure limits (RELs) issued by the National Institute for Occupational Safety and Health (NIOSH) in the United States, aiming to identify chemical hazardous factors requiring optimization of OELs. Methods: In March 2025, using the Chemical Abstracts Service registration number (CAS RN) as the core matching identifier, OELs from GBZ 2.1-2019 and NIOSH RELs in the United States were entered into Excel 2019 to construct a database. The OELs were matched one-to-one according to their classification types. Descriptive statistical methods were employed to analyze the ratio of exposure limits, and content comparisons were conducted to evaluate differences in classification types, legal status, and labeling applications. Results: The types and connotations of limits in China and the United States were basically the same. Among the 272 shared limits, 38.2% (104 items) were consistent, 23.9% (65 items) were basically consistent, and 37.9% (103 items) showed significant differences. There were 51 China standards that were significantly stricter than NIOSH standards in the United States, and 17 China standards that were significantly more lenient than NIOSH standards in the United States. Differences existed between China and the United States limits in terms of legal status and the application of certain labels. Conclusion: Domestic interim standards should be formulated as needed for internationally recognized but unestablished OELs, and OELs that are excessively strict, overly broad or inconsistent with type values should be adjusted. It is recommended to shorten or establish a dynamic OELs update mechanism.

PMID:42092253 | DOI:10.3760/cma.j.cn121094-20250828-00342

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2026 Apr 20;44(4):293-298. doi: 10.3760/cma.j.cn121094-20240722-00332.

ABSTRACT

Objective: To explore the mediating role of anxiety and social support between occupational stress and job burnout among locomotive drivers, and the regulatory role of self-requirement. Methods: A total of 1993 front-line drivers from 5 rail transit enterprises were selected as subjects by cluster random sampling method from March to June 2022. The job burnout, occupational stress, anxiety, social support and self-requirement were investigated by using the Marquis Work Burnout Inventory (General Version), Job Stress Survey, Generalized Anxiety Scale, Self-Reported Health Rating Scale and Self-Examination Questionnaire. Bootstrap method was used to examine the mediating effect of anxiety and social support between occupational stress and job burnout, and the regulatory effect of self-requirement. Results: The comprehensive score of job burnout for locomotive drivers was 2.60 (1.95, 3.24) points. There were statistically significant differences in the job burnout scores among drivers with different total working years, current job years, monthly working hours, and smoking status (H=12.12, 22.76, 41.36, 18.20, P<0.05). The mediating effect analysis showed that the partial mediating effect composed of occupational stress-anxiety-job burnout accounted for 30.8% of the total effect (β=0.008, 95%CI: 0.007-0.009), and the partial mediating effect composed of occupational stress-social support-job burnout accounted for 11.5% of the total effect (β=0.003, 95%CI: 0.003-0.004). The analysis of moderated mediating effect showed that the increase of self-requirement could amplify the proportion of the partial mediating effect of anxiety in the total effect (from 21.4% to 44.0%), and reduce the direct effect of work stress on job burnout and the partial mediating effect of social support. Conclusion: The occupational stress of locomotive drivers can indirectly affect job burnout through anxiety and social support. It is suggested to identify the self-requirement level of locomotive drivers and carry out targeted intervention on anxiety and social support to slow down the formation of job burnout.

PMID:42092251 | DOI:10.3760/cma.j.cn121094-20240722-00332

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2026 Apr 20;44(4):288-292. doi: 10.3760/cma.j.cn121094-20241213-00564.

ABSTRACT

Objective: To understand the radiation dose levels and distribution characteristics received by adult examinees during computed tomography (CT) examinations in Tianjin City, so as to provide scientific references for further optimizing CT examination protocols and reducing unnecessary radiation exposure. Methods: From October 2022 to September 2023, a stratified quota sampling method was used to select 15 medical institutions. One CT device was chosen from each institution, and a total of 1803 adult examinees undergoing CT examinations were investigated. Information including scanning region, tube voltage, tube current-time product, scanning length, volume computed tomography dose index (CTDI(vol)), and dose-length product (DLP) were collected and analyzed. The Kruskal-Wallis H test was applied to compare dose parameters among different grades of medical institutions and different scanning regions, with the Bonferroni method used to adjust the significance level for pairwise post hoc comparisons. The Cochran-Armitage trend test was used to analyze the dose trend across different numbers of detector rows. Results: In this survey, the median ages (M) of examinees undergoing cranial, chest, abdominal, and lumbar spine CT examinations were 42, 40, 41, and 43 years old, respectively. The median tube voltages were all 120 kV. The median tube current-time products were 268, 140, 196, and 242 mAs. The 75(th) percentiles (Q(3)) of CTDI(vol) were 60, 14, 20, and 23 mGy, and the Q(3) values of DLP were 844, 480, 758, and 612 mGy·cm. With the exception of abdominal CTDI(vol), CTDI(v)ol and DLP showed a decreasing trend with an increase in the number of CT detector rows, and the differences were statistically significant (P<0.05) . Conclusion: The Q(3) values of CTDI(vol) and DLP for adult CT examinations in Tianjin City were comparable to the national diagnostic reference levels. The Q(3) value of CTDI(vol) ranked at a moderate level among provinces and municipalities, while the Q(3) value of DLP remained at a relatively high level. Therefore, in clinical practice, it is advisable to minimize the scanning field of examinees to reduce radiation dose exposure and safeguard their health and safety.

PMID:42092250 | DOI:10.3760/cma.j.cn121094-20241213-00564

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2026 Apr 20;44(4):241-246. doi: 10.3760/cma.j.cn121094-20250704-00267.

ABSTRACT

Objective: To evaluate the causal association between serum albumin and carpal tunnel syndrome (CTS) and to investigate the mediating role of leptin in this relationship. Methods: In April 2025, data on serum albumin, leptin (adjusted for body mass index), and CTS from Genome-Wide Association Studies (GWAS) and FinnGen public databases were collected for a two-way, two-sample Mendelian randomization (MR) analysis. Causal analyses were performed using inverse variance weighted (IVW), weighted median estimator, MR-Egger, simple mode, and weighted mode methods. The robustness of the results was tested using Cochran’s Q statistic, MR-Egger intercept test, Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test. A two-step approach was used to analyze the mediating effect of leptin between serum albumin and CTS. Results: The IVW analysis showed that elevated serum albumin levels significantly increased the risk of CTS (OR=1.18, 95%CI: 1.00-1.38, P=0.045), and the results from the weighted median estimator and weighted mode method were consistent with the IVW direction and the differences were statistically significant (P<0.05). Mediation analysis revealed a significant negative causal effect between serum albumin and leptin (OR=0.44, 95%CI: 0.28-0.68, P<0.001), and elevated leptin levels significantly reduced the risk of CTS (OR=0.79, 95%CI: 0.68-0.94, P=0.006). Leptin played a key mediating role in the path of serum albumin affecting CTS (β(indirect)=0.190, P=0.027), with a mediation proportion of 118%. Reverse MR analysis showed that the causal effect of CTS on serum albumin was not statistically significant (OR=1.00, 95% CI: 0.97-1.04, P=0.889). There were no statistically significant differences in the heterogeneity test (Cochran’s Q=20.68, P=0.079) and multi-effect test (MR-Egger intercept value -0.004, P=0.684; MR-PRESSO global P=0.067) . Conclusion: There is a positive causal relationship between serum albumin level and the risk of CTS, and leptin level plays an important mediating role in this pathway, suggesting that albumin may indirectly increase the risk of CTS through the modulation of leptin, and provide new genetic clues for the identification of people at high risk of CTS.

PMID:42092244 | DOI:10.3760/cma.j.cn121094-20250704-00267

Biochem Biophys Res Commun. 2026 Apr 29;821:153785. doi: 10.1016/j.bbrc.2026.153785. Online ahead of print.

ABSTRACT

BACKGROUND: Inhibiting hepatic stellate cells (HSCs) activation, which represents the initial step of liver fibrosis, is a key strategy for fibrosis treatment. Sorafenib has been repurposed as an antifibrotic agent; however, its reported effects largely rely on cytotoxic mechanisms. The antifibrotic mechanisms induced by minimally cytotoxic sorafenib remain unclear. We aimed to elucidate the dynamic changes in gene expression and lipid metabolites that occur during HSC inactivation using low-concentration sorafenib.

METHODS: Human HSCs (LX-2) were activated by treatment with transforming growth factor (TGF)-β to create a fibrotic environment. The activated cells were treated with sorafenib and then subjected to transcriptomic and lipidomic analyses. In the transcriptomic analysis, statistical significance was assessed using adjusted P-values based on the Benjamini-Hochberg method, whereas significance in the lipidomic analysis was evaluated using MetaboAnalyst.

RESULTS: During fibrogenesis, we observed upregulation of extracellular matrix-related genes (COL1A1 (P < .001), FN1 (P < .001), THBS1 (P < .001), P4HA3 (P < .01)) and CXCL12 (P < .01), which is an upstream regulator of the Raf/MEK/ERK and PI3K/AKT signaling pathways. Meanwhile, dihydroceramide (dhCer) and dihydrosphingomyelin (dhSM) levels decreased (both P < .001). In contrast, sorafenib-induced antifibrotic conditions significantly reversed these molecular and lipidomic trends (all P < .01).

CONCLUSIONS: In light of the observed trends, we propose that activating the dhSM synthesis pathway may play a regulatory role in fibrosis. Collectively, our study provides novel lipid-based insights into the molecular mechanisms underlying antifibrotic responses.

PMID:42092220 | DOI:10.1016/j.bbrc.2026.153785

J Infect Public Health. 2026 Apr 29;19(6):103236. doi: 10.1016/j.jiph.2026.103236. Online ahead of print.

ABSTRACT

BACKGROUND: Despite significant progress in tuberculosis (TB) prevention, China remains the third-highest TB burdened country globally, with ongoing concerns about drug-resistant tuberculosis (DR-TB) and HIV/TB co-infection.

METHOD: The study utilized data from the Global Burden of Disease (GBD) 2021, applying the Age-Period-Cohort (APC) model to analyze age, period, and cohort effects on the incidence and mortality of TB, DR-TB, and HIV/TB co-infection. The Bayesian Age-Period-Cohort (BAPC) model projected future trends from 2022 to 2035.

RESULT: Age effects indicated an increased incidence and mortality risk for TB and DR-TB with age, while younger and middle-aged groups were more affected by HIV/TB co-infection. Period effects demonstrated decreasing risks for TB and DR-TB, but an increasing trend for HIV/TB co-infection. Cohort effects similarly indicated a decline for TB and DR-TB, with a slight rise for HIV/TB co-infection among individuals born between 1990 and 2006. BAPC projections indicate that by 2035, the age-standardized incidence rate (ASIR) for TB, DR-TB, and HIV/TB co-infection will be 21.86, 1.04, and 1.21 per 100,000 person-years, respectively, while the age-standardized mortality rate (ASMR) will be 0.90, 0.09, and 0.12 per 100,000 person-years, respectively. None of these projections fulfill the End TB targets.

CONCLUSION: Current strategies are unlikely to meet the End TB targets by 2035 in China, suggesting a need for preventive treatment for latent tuberculosis infection (LTBI) and improved screening for HIV and TB in high-risk populations.

PMID:42092213 | DOI:10.1016/j.jiph.2026.103236

Int J Hyg Environ Health. 2026 May 5;275:114811. doi: 10.1016/j.ijheh.2026.114811. Online ahead of print.

ABSTRACT

Knowledge of infectious agents, modes of transmission, and routes of spread play a central role in planning and performing infection prevention and control (IPC) procedures. The European Hygeia survey involved an online questionnaire that was administered from March 2025 to August 2025 to nurses from acute Hospitals and long-term facilities in Italy, Spain, Sweden and Turkey, to monitor their training on hygiene and related topics, in order to provide them up-to-date, reliable and easily accessible professional education and training to strengthen their knowledge on IPC procedures. A total of 438 nurses were included in the study; their median age was 42 years and 368 (84%) were women and 66 (15%) men; 4 (1%) not stated. Most nurses attended at least one hygiene course (321, 75%), 364 (84%) nurses were interested in attending a hygiene course. There were a few statistically significant differences in education level, in particular, nurses with university degree had a greater self-perceived knowledge in hygiene and prevention with adjusted Odds Ratios (aOR) = 3.77, CI: 1.38-10.30, p = 0.010 and infections (aOR = 2.96, CI: 1.09-8.01, p = 0.033) than nurses with diploma. Our study showed most nurses had a good self-perceived knowledge in hygiene prevention and protection measures and were willing to take part in future courses on this subject. Greatest knowledge deficiencies were related to disinfection and sterilization and infection control fields, future education courses should aim to address this issue.

PMID:42092211 | DOI:10.1016/j.ijheh.2026.114811