Category: Nevin Manimala

JMIR Res Protoc. 2026 Jan 19;15:e86867. doi: 10.2196/86867.

ABSTRACT

BACKGROUND: End-of-life care is a critical competency for the health care workforce, yet evidence suggests that many health care professionals feel unprepared to engage with death, dying, and bereavement. Death literacy and death competence are emerging frameworks for assessing readiness to provide high-quality, compassionate care. Although validated tools exist, little is known about the preparedness of final-year undergraduate health care students in Australia. Understanding their current levels of death literacy and death competence is essential for informing curriculum design and strengthening workforce capacity.

OBJECTIVE: This study aims to (1) measure death literacy and death competence among final-year students in medicine, nursing, and allied health programs in Australian universities; (2) explore students’ reflections on how undergraduate training has shaped their preparedness for end-of-life care; and (3) identify educational needs and opportunities for curriculum enhancement.

METHODS: A mixed methods design will be used. An online survey (15-20 minutes) will be distributed to final-year students across multiple Australian universities. The survey includes the Death Literacy Index, the Death Competency Scale, and open-ended reflection questions. Quantitative data will be analyzed using descriptive and inferential statistics (in SPSS and Stata), with subgroup comparisons across disciplines and benchmarking against national professional datasets. Qualitative responses will be analyzed thematically. In phase 2, up to 20 students will participate in 2 focus groups (60-90 minutes each). The focus groups will explore survey findings and students’ perceptions of training, preparedness, and gaps. Data will be transcribed, anonymized, and analyzed thematically using NVivo.

RESULTS: Data collection for the national survey is scheduled from September 2025 to December 2025, with an anticipated sample of 60 to 120 final-year students across medicine, nursing, and allied health disciplines. Data analysis will begin in March 2026, and findings are expected to be published in late 2026. The findings will establish baseline measures of death literacy and death competence among final-year health care students and identify strengths and gaps in current curricula. Results will be synthesized to provide actionable insights for educators and to inform future intervention studies.

CONCLUSIONS: By providing the first Australian pilot data on death literacy and death competence among final-year health care students, this study will inform curriculum development and workforce planning. The findings have the potential to enhance educational strategies, improve the preparedness of graduates for delivering end-of-life care, and contribute to the development of a death-literate health system.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/86867.

PMID:41553757 | DOI:10.2196/86867

Microb Genom. 2026 Jan;12(1). doi: 10.1099/mgen.0.001608.

ABSTRACT

Rising antimicrobial resistance (AMR) in Escherichia coli bloodstream infections (BSIs) in high-income settings has typically been dominated by one clone, the sequence type (ST)131. More specifically, ST131 clade C (ST131-C) is associated with fluoroquinolone resistance and extended-spectrum β-lactamases (ESBLs). Even though urinary tract infections (UTIs) are a known common precursor to BSIs, there is currently limited knowledge on the longitudinal prevalence of ST131-C in UTIs and, therefore, the temporal link between the two infection types. Leveraging available genomic and antimicrobial susceptibility test (AST) data for ciprofloxacin, gentamicin and ceftazidime in 2,790 E. coli BSI isolates, we trained Random Forest and extreme gradient boosting (XGBoost) classifiers to predict if an E. coli isolate belongs to ST131-C using only AST data. These models were used to predict the yearly prevalence of ST131-C in 22942 UTI and 24866 BSI isolates from Norway. The XGBoost classifier achieved a prediction F1-score of over 70% on a highly unbalanced dataset where only 4.3% of the genomic BSI isolates belonged to ST131-C. The predicted prevalence of ST131-C in UTIs exhibited a similar annual trend to that of BSIs, with a stable infection burden for 8 years after its rapid expansion, confirming that the persistence of ST131-C in BSIs is largely driven by ST131-C UTIs. However, a higher prevalence of ST131-C in BSIs (~7 %) compared to UTIs (~4 %) suggests a subsequent enrichment of ST131-C. Our study highlights how existing epidemiological knowledge can be supplemented by utilizing extensive data from AMR surveillance efforts without genomic markers.

PMID:41553751 | DOI:10.1099/mgen.0.001608

Br Poult Sci. 2026 Jan 19:1-11. doi: 10.1080/00071668.2025.2601730. Online ahead of print.

ABSTRACT

1. This study investigated the maternal lineage and genetic diversity of indigenous Indonesian chickens using mitochondrial DNA (mtDNA) D-loop sequences to assess population structure and maternal origins.2. Fifty-two samples from eight chicken populations were sequenced for the 1231 bp mtDNA D-loop region. A total of 26 haplotypes were identified, with high diversity observed across all populations (Hd = 0.700-0.933). Most chickens, including Tukong, clustered in haplogroup D1, which suggested a shared maternal lineage common to Southeast Asian domesticated chickens. Two individuals (KUB2 and TK2) were positioned in sub-haplogroup D2, indicating sequence divergence. Merawang and Nunukan chickens were grouped into haplogroups A and B, respectively, consistent with haplotypes shared with Chinese and Japanese chickens, pointing to historical maternal introgression, likely via trade or migration. Analysis of molecular variance (AMOVA) revealed that 28.45% of genetic variation existed among populations (Fst = 0.284, p < 0.001), which indicated a moderate but statistically significant population structure.3. Multiple haplogroups in Indonesian chickens reflect complex maternal origins and past gene flow from outside populations. These findings highlighted the importance of understanding genetic structure to inform the management and characterisation of native breeds. The distinct maternal lineages in Merawang and Nunukan showed historical introductions, while the close relationship among Tukong and Kampung chickens implied interbreeding under extensive rearing systems.

PMID:41553738 | DOI:10.1080/00071668.2025.2601730

Br J Surg. 2025 Dec 24;113(1):znaf282. doi: 10.1093/bjs/znaf282.

ABSTRACT

BACKGROUND: Open excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease, offering low recurrence but notable postoperative pain. Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence. The aim of this trial was to compare the 1-year efficacy of both techniques using validated symptom and quality-of-life scores.

METHODS: A prospective, single-centre, randomized, open-label trial was conducted in patients with grade III haemorrhoids. The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline. Additionally, the predefined, pragmatic composite endpoint-the clinical failure rate (CFR), defined as a ≤50% improvement in both HDSS and SHS-HD-was compared. Secondary outcomes included postoperative pain, time to return to work, complications, and reoperation.

RESULTS: From August 2021 to February 2023, 50 patients were randomized (25 OEH patients and 25 THD patients). Three patients were lost to follow-up (2 THD patients and 1 OEH patient). CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001). Both procedures reduced symptom and quality-of-life scores (P = 0.002 and P < 0.001). OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010).

CONCLUSION: OEH is more effective than THD but is associated with greater early postoperative pain.

REGISTRATION NUMBER: NCT06420986 (http://www.clinicaltrials.gov).

PMID:41553737 | DOI:10.1093/bjs/znaf282

Am J Physiol Heart Circ Physiol. 2026 Jan 19. doi: 10.1152/ajpheart.00950.2025. Online ahead of print.

ABSTRACT

Left ventricular (LV) flow state is associated with unfavorable outcome in patient with severe aortic stenosis. However, there is little information on its impact on long-term prognosis in a population without valvular disease. To examine the impact of LFS on all-cause mortality in multi-ethnic population we analyzed 4398 asymptomatic participants without clinical cardiovascular disease undergoing cardiac magnetic resonance (CMR) in the Multi-Ethnic Study of Atherosclerosis. LV stroke volume index (SVi), LVEF and myocardial contraction fraction (MCF) were measured. LV flow states were classified as normal flow state (NFS, SVi >35 ml/m²), low-flow state (LFS, 30-34 ml/m²) and very low-flow state (VLFS: SVi <30 ml/m²). Clinical data were collected at enrollment. Participants were followed up for a median of 14.2 years. All-cause and cardiovascular disease mortalities were used as primary endpoints. All-cause mortality was 16.2% and cardiovascular disease mortality 3.5%. VLFS and LFS groups had more cardiovascular risk factors and lower cardiac performance than NFS. The relationship between all-cause mortality and SVi was “L-shape with the “breakpoint” at 33.5ml/m2 for a statistical significance (p=0.009). All-cause mortality was significantly associated with LFS after adjusted for age, sex, LVEF, and LV mass index with hazard ratio (HR) 1.81, 95% CI: 1.31-2.49 for VLF and HR: 1.21, 95% CI: 0.95-1.54 for LFS with overall p value 0.001). The highest cardiovascular disease mortality was seen in VLFS.

PMID:41553736 | DOI:10.1152/ajpheart.00950.2025

BJS Open. 2025 Dec 29;10(1):zraf152. doi: 10.1093/bjsopen/zraf152.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery is associated with improved clinical outcomes and cost savings. Comparisons between studies and settings are challenging owing to variable data collection and definitions. The objective of this study was to explore variation in compliance with enhanced recovery after surgery and outcomes across surgery types and countries using a standardized database.

METHODS: This international retrospective cohort study included adult patients who underwent surgical procedures (colorectal, gynaecological, pancreatic, hepatic, breast reconstruction, head and neck, urological, pulmonary), treated with enhanced recovery after surgery recorded in a standardized database between January 2017 and September 2021. The primary outcomes, length of hospital stay and complications, and the exposure variable, compliance with enhanced recovery after surgery, were captured from the standardized database. Patient demographic characteristics and surgical complexity were abstracted and considered as co-variates. Negative binomial and logistic regression analyses were used to model outcomes as a function of enhanced recovery after surgery compliance score.

RESULTS: The cohort included 12 134 patients (from Canada, the Netherlands, and Switzerland) who had median age of 63 years and underwent colorectal (59%) or gynaecological (19%) surgery. The median compliance with enhanced recovery after surgery differed by country (Canada 78.6%, the Netherlands 67.7%, Switzerland 80.0%). Each 1-unit increase in enhanced recovery after surgery compliance score corresponded to reduced length of hospital stay across all operations, by 0.94 (95% confidence interval (c.i.) 0.85 to 1.04) days in Canada, 1.03 (0.85 to 1.20) days in the Netherlands, and 1.55 (1.12 to 1.97) days in Switzerland. Each 1-unit increase in enhanced recovery after surgery compliance score corresponded to a 29 (95% c.i. 25 to 33)% reduction in odds of experiencing a severe complication across all operations in Canada, a 22 (14 to 31)% reduction in the Netherlands, and a 5 (2 to 8)% reduction in Switzerland.

CONCLUSION: Using a standardized database, this study confirmed that enhanced recovery after surgery compliance is associated with reduced length of hospital stay and complications in an international multisurgical cohort.

PMID:41553734 | DOI:10.1093/bjsopen/zraf152

Public Health Rep. 2026 Jan 19:333549251404847. doi: 10.1177/00333549251404847. Online ahead of print.

ABSTRACT

OBJECTIVE: Most people in the United States are unaware that alcohol causes cancer and increases heart disease risk. Warning labels on alcohol containers can increase knowledge about these harms. Yet, it is unclear if Americans support this policy. We assessed attitudes toward cancer and heart disease warning labels on alcohol containers.

METHODS: In May 2024, we surveyed 1095 adults (aged ≥18 y) participating in AmeriSpeak, a nationally representative panel of the US noninstitutionalized civilian adult population. We analyzed support for warning labels overall and by sociodemographic characteristics by using descriptive statistics weighted to represent the US population.

RESULTS: Overall, 4 in 10 respondents supported cancer or heart disease warning labels on alcohol containers. Fewer than 10% opposed warning labels; many were neutral. More young adults (aged 18-29 y; 57.9% [95% CI, 44.6%-70.0%]) than older adults (aged ≥60 y; 36.0% [95% CI, 30.3%-42.1%]) supported cancer warning labels (P = .04). More women (50.8%; 95% CI, 45.0%-56.6%) than men (40.5%; 95% CI, 34.1%-47.2%) supported heart disease warning labels (P = .03).

CONCLUSIONS: Most people in the United States are neutral about or support cancer and heart disease warning labels on alcohol containers. Leveraging warning labels is a cost-effective way to inform the public about alcohol’s link to cancer and heart disease.

PMID:41553719 | DOI:10.1177/00333549251404847

Minerva Endocrinol (Torino). 2026 Jan 19. doi: 10.23736/S2724-6507.25.04276-9. Online ahead of print.

ABSTRACT

BACKGROUND: Prenatal exposure to dioxin, a known endocrine disruptor, after the Seveso accident of 1976 has been associated with thyroid dysfunction, metabolic syndrome and semen quality reduction. Experimental exposure to dioxin in utero produced epigenetic endocrine modifications associated with reduction of semen quality, while in men epigenetic effects are not known. Our objective was to study, by a case control approach, the long-term epigenetic effects of prenatal dioxin exposure in 38 men whose mothers had been exposed to high doses of dioxin, serum median 52.0 ppt at exposure, and therefore who were exposed in utero, median 24.7 ppt at pregnancy, vs. 41 unexposed men.

METHODS: Bisulfite-converted DNA was hybridized onto illumina Infinium Methylation EPIC BeadChip and methylation differences were studied at both individual probe (DMPs) and gene region (DMRs) levels.

RESULTS: We identified hypomethylation of the SPAG1 gene region and a slightly hypermethylated region containing genes of the HOXA family associated with thyroid and skeletal development. An elevated level of epigenetic drift was noted in the exposed group potentially contributing to disease risk. Epigenetic age acceleration did not show significant association with in-utero dioxin exposure. Additionally, we found heightened neutrophils and diminished natural killer cells in blood of dioxin exposed men.

CONCLUSIONS: These observations are the first in the literature and align with the long-term semen quality reduction and alteration of thyroid homeostasic mechanisms reported in children exposed in utero to dioxin in Seveso. The actual dioxin background serum levels, 1.0-2.0 ppt, are much lower than those associated to these effects.

PMID:41553716 | DOI:10.23736/S2724-6507.25.04276-9

Adv Ther. 2026 Jan 19. doi: 10.1007/s12325-025-03447-6. Online ahead of print.

ABSTRACT

INTRODUCTION: While the therapeutic options for Crohn’s disease (CD) have broadened swiftly, direct comparative evidence on treatment efficacy remains limited. This study explored the relative efficacy and safety of available treatments based on current evidence.

METHODS: A network meta-analysis (frequentist random-effect model) evaluated comparative efficacy of licensed advanced therapies for CD using data on efficacy of maintenance therapy from fully published, randomised, controlled phase 3/3b studies with 48-64-week follow-up periods and placebo or active comparator controls, identified through a systematic literature review (PROSPERO number CRD42023413752). Intravenous (IV) and subcutaneous (SC) infliximab, SC adalimumab, IV and SC vedolizumab, SC ustekinumab, SC risankizumab, and oral upadacitinib were included. Clinical remission and endoscopic response rates attained through maintenance regimens were assessed according to line of use (e.g., first-line and second-or-later line). Safety (serious adverse event rates) was also compared.

RESULTS: Data from nine randomised controlled trials were analysed. SC infliximab 120 mg every 2 weeks (q.2.w.) exhibited the highest risk difference (95% confidence interval) vs. placebo in both first-line and second-or-later-line maintenance treatment for achieving clinical remission (0.38 [0.23-0.53] and 0.51 [0.19-0.83], respectively; 14 and 12 comparator arms, respectively), and endoscopic response (0.39 [0.29-0.49] and 0.35 [0.07-0.63], respectively; 5 comparator arms) compared with other treatments. Differences between therapies did not reach statistical difference. Safety was comparable among treatments in terms of rates of serious adverse events.

CONCLUSIONS: The current NMA integrating recently updated phase 3 data in CD indicated that no single treatment significantly outperformed others in achieving clinical remission and endoscopic response, although SC infliximab 120 mg q.2.w exhibited highest numerical efficacy as both a first-line and second-or-later-line maintenance treatment in adult patients with moderate-to-severe CD.

PMID:41553714 | DOI:10.1007/s12325-025-03447-6

Adv Ther. 2026 Jan 19. doi: 10.1007/s12325-025-03470-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Three previous publications have reported real-world comparative effectiveness of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) and budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FORM) in patients with chronic obstructive pulmonary disease (COPD) in the USA. This subgroup analysis assessed treatment with FF/UMEC/VI and BUG/GLY/FORM in patients with COPD who stepped up from dual therapy, stratified by number of prior exacerbations and class of prior dual therapy.

METHODS: Propensity score (PS)-weighted patients identified within healthcare claims from the Komodo Research database were used to compare annualized rates and time to first moderate-severe COPD exacerbation between FF/UMEC/VI and BUD/GLY/FORM initiators stepping up from dual therapy, stratified by the type of dual therapy (long-acting muscarinic antagonist plus long-acting β₂-agonist [LAMA/LABA] or inhaled corticosteroid [ICS] plus LABA) and by prior (none or ≥ 1) COPD exacerbation. Results are presented as events per patient year (PPY) and rate ratio (RR) with 95% confidence intervals (CIs).

RESULTS: Approximately 14,000 patients contributed to this analysis, 10,093 FF/UMEC/VI and 3926 BUD/GLY/FORM initiators. Baseline characteristics were well balanced following PS weighting. Step-up to FF/UMEC/VI was associated with a statistically significant reduction in moderate-severe exacerbations compared with step-up to BUD/GLY/FORM irrespective of exacerbation history: no prior exacerbation, n = 7235, 0.48 vs 0.56 PPY, RR [95% CI] 0.86 [0.77, 0.95], P = 0.003; ≥ 1 prior exacerbation, n = 6784, 1.14 vs 1.41 PPY, RR [95% CI] 0.81 [0.74, 0.87], P < 0.001. Step-up to FF/UMEC/VI was also associated with a statistically significant reduction in moderate-severe exacerbations compared with step-up to BUD/GLY/FORM across both subgroups of prior dual therapy: LAMA/LABA, n = 5717, 0.71 vs 0.95 PPY; RR [95% CI] 0.75 [0.67, 0.83], P < 0.001; ICS/LABA, n = 8302, 0.85 vs 0.99 PPY; RR [95% CI] 0.86 [0.79, 0.93], P < 0.001.

CONCLUSION: Patients newly initiating FF/UMEC/VI following prior treatment with ICS/LABA or LAMA/LABA experienced a significantly lower rate of moderate-severe COPD exacerbations than those newly initiating BUD/GLY/FORM irrespective of number of prior exacerbations or prior dual therapy class.

PMID:41553713 | DOI:10.1007/s12325-025-03470-7