Category: Nevin Manimala

Trials. 2026 Jul 11. doi: 10.1186/s13063-026-09884-0. Online ahead of print.

ABSTRACT

PURPOSE: Most paediatric myopia intervention trials report two primary outcomes: axial length and cycloplegic autorefraction. Having one single primary outcome would increase trial efficiency, reduce participant burden, and may improve trial retention. This article aims to evaluate precision of axial length and cycloplegic autorefraction and to explore eye care professionals’ and young people’s views of cycloplegia.

METHODS: Mixed methods study with meta-analysis of axial length and cycloplegic spherical equivalent measurements reported by paediatric myopia treatment trials; interviews with eye care professionals; engagement/involvement discussion with children and young people.

RESULTS: In the meta-analysis, mean effect size (standard error, SE) was -0.52 (0.12, p < 0.001, 95% confidence interval (CI) -0.76 to -0.29) for axial length and 0.49 (0.11, p < 0.001, CI 0.27 to 0.71) for cycloplegic spherical equivalent refraction. Difference in mean point estimates was 0.033, SE of the difference 0.164 (CI -0.29 to +0.535). With t-statistic (mean difference/SE of mean difference) of 0.20, two-tailed p value was 0.84. Eye care professionals report that children dislike cycloplegia, describing discomfort, distress, and potential refusal to attend follow-up appointments. Children and young people describe pain and discomfort, remember prolonged effects such as blurred vision and light sensitivity, and complain about receiving insufficient information about adverse effects.

CONCLUSIONS: Whilst the precision of axial length and cycloplegic autorefraction spherical equivalent measurements is similar, cycloplegic autorefraction requires longer study visits and inflicts more discomfort. In the design of future trials, researchers, funders, and regulators should consider increasing trial efficiency by selecting axial length as primary outcome and removing cycloplegic refraction from follow-up assessments.

PMID:42436573 | DOI:10.1186/s13063-026-09884-0

BMC Psychol. 2026 Jul 11. doi: 10.1186/s40359-026-05100-5. Online ahead of print.

ABSTRACT

Transitions to a new educational ecosystem result in students’ academic distress, particularly at the university level. Thus, this study aimed to examine academic distress and help-seeking practices among first-year domestic and international university students in the fields of Engineering and Health Sciences. The study mainly focused on academic distress and help- seeking behavior abided by the help-seeking process model and mind sponge mechanism. A quantitative correlational research design was used. A total of 361 students were selectedusing simple random sampling. Standardized questionnaires were used to measure the variables. Descriptive statistics and Multivariate Analysis of Variance (MANOVA) were used to achieve the study objectives. The results revealed that University students had moderate levels of help-seeking behavior and academic distress. Moreover, male students had higher academic help-seeking behavior and lower academic distress than their female counterparts; whereas academic help-seeking behavior and academic distress were lower for female students. Statistically significant sex differences were also noted in academic distress. Based on the mind sponge theory, measures for the prevention of academic distress should be targeted at the optimization of help-seeking behavior with a special focus on female students who manifest a high vulnerability to academic distress. Moreover, ways such as digital-based interventions that assist in addressing a large number of students at once also merit attention.

PMID:42436567 | DOI:10.1186/s40359-026-05100-5

J Neuroeng Rehabil. 2026 Jul 11;23(1):214. doi: 10.1186/s12984-026-02041-3.

ABSTRACT

BACKGROUND: Spike trains from spinal motor neurons contain low-frequency components that modulate muscle force, and higher-frequency components (above 10 Hz) that do not. The functional role of these higher-frequency components in motor control is still debated. We investigated whether mental tasks that modulate the power of cortical oscillations produce corresponding modulations in spinal motor neuron activity above 10 Hz without affecting force output. Such coupling would indicate that some higher-frequency components are not merely arising as a byproduct of force generation nor indirectly contributing to motor control, but simply reflect cortical oscillations propagating to spinal motor neurons. If voluntary power modulations of these higher-frequency oscillations do not affect force output, they could potentially serve as control signals for neural interface applications such as movement augmentation or motor neuroprostheses.

METHODS: We recruited 15 human participants and recorded high-density electromyography signals (HD-EMG) from the tibialis anterior muscle, as well as electroencephalography (EEG) signals. The cumulative spike train (CST) was computed from the activity of spinal motor neurons decoded from HD-EMG signals. The participants performed sustained dorsiflexion concurrent with foot motor imagery, hand motor imagery, mental arithmetic, or no specific mental task. We analysed the bandpower correlation between EEG and CST signals as well as evaluated the task discriminability of CST bandpower signals with a linear classifier.

RESULTS: At the intra-muscular coherence peak, we found statistically significant power correlations between CST and EEG in two separate analyses: first, when correlating across individual trials regardless of the mental task, and second, when correlating across the four mental tasks (Kendall’s τ coefficient [Formula: see text], [Formula: see text] respectively; mean ± std. dev.). To evaluate the potential of the CST as a control signal, we classified the mental tasks based on CST bandpower and obtained classification accuracies slightly but significantly above chance level ([Formula: see text]; chance level = 25%).

CONCLUSION: These results show that mental tasks can simultaneously modulate the power of cortical and spinal oscillations. This supports the notion that cortical oscillations not contributing to ongoing force control can propagate to the spinal level. We further demonstrate that mental tasks can be classified from CST bandpower, but classification performance is limited by the low signal-to-noise ratio.

PMID:42436562 | DOI:10.1186/s12984-026-02041-3

J Ovarian Res. 2026 Jul 11. doi: 10.1186/s13048-026-02186-8. Online ahead of print.

ABSTRACT

BACKGROUND: Infertility is associated with significant psychological distress and impaired quality of life (QoL) in women. Polycystic Ovarian Syndrome (PCOS), a common cause of infertility, is frequently associated with metabolic and psychological symptoms. However, limited evidence directly compares psychological symptom burden and QoL between women with PCOS-related infertility and unexplained infertility, including across PCOS phenotypes.

METHODS: This cross-sectional observational study included 240 women aged 18-40 years with infertility due to PCOS or unexplained causes, conducted at a tertiary care center between October 2019 and March 2021. PCOS was diagnosed using revised Rotterdam criteria, and unexplained infertility was defined after exclusion of known causes. Psychological outcomes were assessed using validated screening instruments (PHQ-9, BDI, BAI, and GAD-7), representing symptom severity rather than clinical psychiatric diagnoses. QoL was assessed using WHOQOL-BREF. Statistical analysis included group comparisons using appropriate parametric and non-parametric tests, with p < 0.05 considered statistically significant.

RESULTS: Women with PCOS demonstrated significantly higher screening-based depressive symptom burden (60% vs. 14%, p < 0.001) and anxiety symptom burden (63% vs. 21%, p < 0.001) compared to women with unexplained infertility. QoL scores were significantly lower in the PCOS group (66.8% vs. 85.1%, p < 0.001), particularly in psychological and social domains. Among PCOS phenotypes, hyperandrogenic phenotypes (B and C) showed relatively higher psychological symptom burden and lower QoL scores compared to other phenotypes. The PCOS group also demonstrated higher BMI and androgen levels.

CONCLUSION: Infertility associated with PCOS is linked to higher screening-based psychological symptom burden and reduced quality of life compared to unexplained infertility. Hyperandrogenic PCOS phenotypes appear to be more affected. These findings support the integration of routine psychological screening and multidisciplinary support into infertility care for women with PCOS.

PMID:42436557 | DOI:10.1186/s13048-026-02186-8

BMC Nurs. 2026 Jul 11. doi: 10.1186/s12912-026-05030-y. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitation imposes substantial psychological stress on emergency nurses, potentially impairing clinical performance and patient outcomes. Whether cumulative clinical experience is associated with lower perceived resuscitation stress remains empirically unresolved, and no validated Chinese instrument exists to measure resuscitation-specific perceived stress. This study aimed to translate the Perceived Stress during Resuscitation Scale (PSDRS) into Chinese, psychometrically evaluate its properties, and test its known-groups validity by comparing scores across novice, intermediate, and expert emergency nurses.

METHODS: A multicenter cross-sectional study was conducted across seven tertiary hospitals in Liaoning Province, China, from June 2025 to February 2026. Following the Brislin translation model, the original PSDRS was translated, back-translated, and culturally adapted through expert panel review and pilot testing. A convenience sample of 434 emergency nurses completed the Chinese PSDRS. Participants were stratified by clinical experience: novice (< 2 years, n = 52), intermediate (2-10 years, n = 202), and expert (≥ 10 years, n = 180). Psychometric evaluation included content validity (S-CVI), construct validity via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on randomly split subsamples, internal consistency reliability (Cronbach’s α), test-retest reliability (ICC), and known-groups validity tested through one-way ANOVA.

RESULTS: The Chinese PSDRS demonstrated robust psychometric properties. Content validity was excellent (S-CVI = 0.926). A randomly split subsample for EFA (n = 210) extracted a seven-factor structure explaining 75.17% of total variance. CFA on the validation subsample (n = 224) confirmed satisfactory model fit (χ²/df = 1.295, RMSEA = 0.036, CFI = 0.958, TLI = 0.951). Internal consistency was satisfactory (Cronbach’s α = 0.815) and test-retest reliability was acceptable (ICC = 0.774). Known-groups validity was supported, with expert nurses reporting lower PSDRS scores (M = 2.31, SD = 0.42) than intermediate (M = 2.48, SD = 0.45) and novice nurses (M = 2.67, SD = 0.49; F = 24.36, P < 0.001, η²=0.102). Post-hoc analyses confirmed all pairwise comparisons were statistically significant (all P < 0.01).

CONCLUSIONS: The Chinese PSDRS is a reliable and valid instrument. A significant dose-response gradient was observed, with greater clinical experience associated with lower perceived resuscitation stress. This pattern is consistent with theoretical perspectives such as the stress-inoculation hypothesis and professional development frameworks; however, these mechanisms were not directly tested, and causal inferences cannot be drawn given the cross-sectional design. This tool can facilitate early identification of at-risk novice nurses and inform experience-tailored stress management interventions.

TRIAL REGISTRATION: Not applicable.

PMID:42436553 | DOI:10.1186/s12912-026-05030-y

BMC Health Serv Res. 2026 Jul 11;26(1):948. doi: 10.1186/s12913-026-15116-7.

ABSTRACT

OBJECTIVE: To explore women’s experiences following polygenic risk score (PRS) testing for breast cancer risk and to assess the knowledge, attitudes, practices (KAP), and implementation perspectives of medical professionals and healthcare decision-makers in Sweden.

METHODS: Convergent mixed-methods study combining quantitative survey data with qualitative thematic analysis of survey open-ended responses and focus group discussion (FGD) notes.

SETTING: Swedish healthcare context.

PARTICIPANTS: 400 women receiving PRS results for a first Participants Feedback Survey; 289 women for the second Participants Feedback Survey, and 6 medical professionals/decision-makers for a KAP survey and FGD. Women completed two sequential online feedback surveys post-PRS result disclosure. Professionals completed a KAP survey and participated in an FGD. Quantitative survey data were analysed using descriptive statistics. Qualitative data from open-ended survey questions and FGD notes were analysed using thematic analysis.

RESULTS: Participants valued participation in PRS testing and receiving PRS-test results, with 87% finding results interesting and 82% finding them valuable. Although most participants found the explanations understandable (approximately 75% in Survey 1 and 82% in Survey 2), qualitative comments indicated that some had difficulty interpreting probabilistic risk information, including participants who self-identified as highly educated or medically trained. Negative emotional impact was generally minimal (85% felt calm), though some women with high PRS risk experienced anxiety. Major unmet needs included clearer explanations, actionable guidance, and better access to follow-up support from healthcare. Professionals were cautiously positive: in the KAP survey, 5 of 6 were familiar with the concept of PRS, but confidence in the health system’s readiness to integrate it was limited. The main barriers raised were the absence of clinical guidelines and the need for evidence of clinical utility.

CONCLUSIONS: Breast cancer PRS testing holds potential for enhancing risk assessment in Sweden. Key challenges for clinical integration include clinician readiness, the development of clear guidelines, and improved participant comprehension and communication. PRS tests should be accompanied with clinical decision support both for patients as well for medical professionals. Addressing these will require person-centered communication tools, robust evidence of clinical utility, well-defined clinical pathways, investments in provider education, and equitable implementation strategies within the Swedish healthcare system.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42436550 | DOI:10.1186/s12913-026-15116-7

Patient Saf Surg. 2026 Jul 11. doi: 10.1186/s13037-026-00501-2. Online ahead of print.

ABSTRACT

BACKGROUND: Post-thyroidectomy complications including hypocalcemia, recurrent laryngeal nerve injury, and cervical hematoma remain important safety concerns. Although the harmonic scalpel improves operative efficiency, evidence regarding its impact on patient safety outcomes remains limited.

METHODS: In this prospective observational cohort study, 60 patients undergoing open thyroidectomy were allocated to harmonic scalpel (n = 30) or clamp and tie (n = 30) groups. The primary endpoints were safety outcomes, including hypocalcemia, recurrent laryngeal nerve injury, postoperative hematoma, surgical site infection, and composite complication rates. Secondary endpoints included operative time, intraoperative blood loss, drain output, postoperative pain, and length of hospital stay. Statistical significance was defined as p < 0.05.

RESULTS: Use of the harmonic scalpel was associated with a significant reduction in overall complications compared with the conventional technique (13.3% vs. 33.3%, p = 0.04). Transient hypocalcemia occurred less frequently in the harmonic scalpel group, accompanied by significantly higher postoperative calcium levels at 24 and 48 h. No recurrent laryngeal nerve injury or postoperative hematoma was observed in the harmonic scalpel group, although differences were not statistically significant. In addition to improved safety outcomes, harmonic scalpel use resulted in shorter operative duration, substantially reduced intraoperative blood loss, lower postoperative drain volumes, decreased pain scores, and reduced length of hospital stay.

CONCLUSION: The harmonic scalpel was associated with improved operative efficiency and a lower overall complication burden without increasing major safety-related complications. Larger randomized multicenter studies are required to confirm these findings.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42436548 | DOI:10.1186/s13037-026-00501-2

Environ Health. 2026 Jul 11. doi: 10.1186/s12940-026-01320-9. Online ahead of print.

ABSTRACT

BACKGROUND: Heatwaves increasingly threaten public health in the Mediterranean region, and Greece is among the hardest hit countries. Yet evidence on long-term adaptation, spatial vulnerability, and the contribution of human-induced climate change to heatwave-related mortality in Greece remains limited.

METHODS: We analysed 2,144,957 all-cause deaths in Greece (2000-2019) in people older than 65 years using a time-stratified case-crossover design. We derived population-weighted daily maximum temperatures at NUTS3 level from ERA5 reanalysis and WorldPop. We applied six heatwave definitions (HD1-HD6) varying by duration (≥ 2 or ≥ 3 days) and thresholds (90th, 95th, 99th percentiles). We fitted Bayesian hierarchical Poisson models to estimate heatwave-mortality associations varying by space and time. We additionally adjusted for relative humidity and national holidays. We then combined these estimates with probabilistic climate-attribution methods to quantify the number and proportion of heatwave-related deaths attributable to human-induced climate change.

RESULTS: Heatwaves raised mortality consistently, with relative risks from 1.08 (95% CrI (Credible Interval): 1.07-1.09; HD1) to 1.15 (1.12-1.19; HD6). Risks increased with heatwave intensity and duration, with particularly high risks observed among females and older adults. We did not detect a consistent temporal decline in risk or marked spatial heterogeneity. Human-induced climate change accounted for 46-80% of heatwave-related deaths across definitions. The proportion attributable to climate change rose over time.

CONCLUSIONS: Heatwaves already impose a major mortality burden in Greece, with more than half driven by anthropogenic climate change and little evidence of population-level adaptation. These findings call for rapid emissions reductions and targeted adaptation, including stronger heat-health warning systems and protection of vulnerable groups.

PMID:42436540 | DOI:10.1186/s12940-026-01320-9

BMC Med. 2026 Jul 11. doi: 10.1186/s12916-026-05064-8. Online ahead of print.

ABSTRACT

BACKGROUND: The present study sought to compare the clinical efficacy and safety profiles of radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients who attained complete or partial response (CR/PR) following induction chemotherapy (IC).

METHODS: This multicenter, randomized, open-label, phase 3 noninferiority trial was conducted at 7 Chinese hospitals. Patients with newly diagnosed stage III-IVb NPC who achieved CR/PR after IC were randomly allocated (1:1) to either the RT (IC + RT) group or the CCRT (IC + CCRT) group. The chemotherapy protocol was identical across the two treatment groups. The primary endpoint was progression-free survival (PFS). Secondary endpoints comprised overall survival (OS) and the incidence of adverse events. Statistical analyses were performed using the Kaplan-Meier method and log-rank test.

RESULTS: From December 2016 to May 2023, 220 eligible patients with histologically confirmed nasopharyngeal carcinoma were enrolled. The trial was terminated early due to slow accrual. Of these patients, 109 were assigned to the IC + RT group and 111 to the IC + CCRT group. The median follow-up was 57 months (range, 8-107 months). The IC + RT and IC + CCRT groups showed comparable 5-year progression-free survival rates (87.0% vs. 80.7%, P = 0.21). No significant differences were observed between the two treatment arms with respect to local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, distant metastasis-free survival, or overall survival (all P > 0.05). The IC + RT group had significantly lower incidences of grade 3-4 hematologic and gastrointestinal toxicities than the IC + CCRT group. Additionally, grade 1-2 deafness/otitis and liver dysfunction were also less frequent in the IC + RT group.

CONCLUSIONS: In NPC patients achieving CR/PR after induction chemotherapy, IC + RT demonstrated a favorable safety profile compared with IC+CCRT. Although the observed survival outcomes were numerically comparable, the premature termination of the trial and insufficient statistical power preclude a definitive noninferiority claim. These hypothesis-generating findings warrant validation in future adequately powered trials.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT03015727.

PMID:42436536 | DOI:10.1186/s12916-026-05064-8

Biopsychosoc Med. 2026 Jul 11. doi: 10.1186/s13030-026-00366-y. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Asthma is the most prevalent chronic disease in childhood, and self-efficacy is a key determinant of symptom control, treatment adherence, and prevention of exacerbations. Despite advances in pharmacological management, many children continue to experience barriers that hinder effective self-management. This study aimed to assess the level of self-efficacy and identify its limiting factors among children with asthma aged 8-18 years.

METHODS: This descriptive cross-sectional study was conducted in 2025 at a pediatric specialty clinic affiliated with a teaching hospital. A total of 100 children with asthma were recruited using convenience sampling. Data were collected using A demographic questionnaire, the Asthma Self-Efficacy Scale, and the Limiting Factors of Self-Efficacy Questionnaire were used to collect the data. The instruments demonstrated acceptable content validity and internal consistency. Data analysis was done with descriptive statistics, Spearman’s correlation, and multiple linear regression in SPSS version 22, with statistical significance set at p < 0.05.

RESULTS: The findings indicated a moderate level of self-efficacy among children with asthma, accompanied by a relatively low-to-moderate level of perceived limiting factors. Spearman’s correlation showed a significant positive association between the frequency of asthma attacks and limiting factor scores (r = 0.197, p = 0.049), suggesting that increased exacerbations were associated with greater perceived barriers to disease management. Multiple linear regression analysis revealed that longer disease duration significantly predicted higher self-efficacy, whereas lower paternal educational level was associated with reduced self-efficacy. The most commonly reported barriers included insufficient disease-related knowledge, concerns about medication side effects, and challenges in treatment follow-up, while family support emerged as a key facilitator of self-efficacy.

CONCLUSION: Children with asthma exhibited moderate self-efficacy in disease management, while cognitive, attitudinal, and family-related barriers undermined sustained self-care behaviors. Strengthening family-centered educational interventions, improving parental health literacy, and implementing targeted nursing programs may contribute to improving self-efficacy and reducing perceived barriers.

PMID:42436530 | DOI:10.1186/s13030-026-00366-y