Category: Nevin Manimala

Euro Surveill. 2026 Feb;31(5). doi: 10.2807/1560-7917.ES.2026.31.5.2600068.

ABSTRACT

In interim 2025/26 analyses, the Canadian Sentinel Practitioner Surveillance Network estimates influenza vaccine reduced the risk of medically-attended acute respiratory illness due to predominant influenza A(H3N2) viruses, including antigenically distinct subclade K, by about 40% relative to unvaccinated individuals. Vaccine effectiveness was about 30% against A(H1N1)pdm09, with insufficient case numbers for interim influenza B estimation. Meaningful protection against subclade K, despite substantial vaccine mismatch, is interpreted in the context of immuno-epidemiological considerations, including potential viral glycosylation, imprinting, and pre-immunity effects.

PMID:41645799 | DOI:10.2807/1560-7917.ES.2026.31.5.2600068

Arch Ital Urol Androl. 2026 Feb 6:14624. doi: 10.4081/aiua.2026.14624. Online ahead of print.

ABSTRACT

PURPOSE: Venous thromboembolic (VTE) complications contribute substantially to perioperative morbidity and mortality. The decision for mechanical and/or chemo-prophylaxis is currently based on VTE risk assessment models since conventional laboratory assays of coagulation usually fail to detect changes indicating hypercoagulability. Rotational thromboelastometry is a novel assay of coagulation, that it could potentially be used in objectively selecting patients at risk for VTE, who should indisputably undergo prophylaxis. We evaluated the association of conventional and novel assays of coagulation and VTE risk.

METHODS: VTE risk was preoperatively assessed in 45 patients scheduled for endoscopic, open and laparoscopic urologic surgery, including transurethral resection of prostate, transurethral resection of bladder tumor, endoscopic vesical or ureteral stone lithotripsy, open prostatectomy, open cystectomy and urinary diversion, open or laparoscopic radical or partial nephrectomy, between March 2021 and October 2022, using three different risk assessment models (RAMs): the European Association of Urology (EAU) RAM, the American Urological Association (AUA) RAM, and the Caprini model. Patients under antiplatelet or anticoagulation agents were excluded. Patients’ coagulation profile was determined by measuring PT, fibrinogen, aPTT, and rotational thromboelastometry analysis. For rotational thromboelastometry analysis, extrinsic rotational thromboelastometry and fibrinogen rotational thromboelastometry were examined in every patient. Statistical analysis was performed with ANOVA test and χ2 test.

RESULTS: Mean values of all rotational thromboelastometry variables did not vary significantly among different EAU VTE categories. In extrinsic rotational thromboelastometry assessment, a significant difference was observed in the mean values of the Clotting time (CT) between the different risk groups based on AUA RAM. In the comparison between the risk groups defined based on the Caprini score, statistically significant differences were observed in the extrinsic rotational thromboelastometry clot formation time (CFT). In fibrinogen rotational thromboelastometry analysis, significant differences were identified in the clot amplitude after five minutes (A5) and maximum clot firmness (MCF) indices between the AUA risk groups, along with a significant difference in the mean clot formation rate (CFR) value between the risk groups defined based on the Caprini score.

CONCLUSIONS: Rotational thromboelastometry can provide a detailed evaluation of the hemostatic status in patients undergoing urologic surgery that can be used as an adjunct to the VTE risk assessment models and thus, help to offer prophylaxis on a rather personalized basis. Future studies should assess the utility of thromboelastometry in identifying patients at high risk for VTE after major urological procedures.

PMID:41645782 | DOI:10.4081/aiua.2026.14624

Age Ageing. 2026 Feb 1;55(2):afag016. doi: 10.1093/ageing/afag016.

ABSTRACT

BACKGROUND: Primary care services play a key role in dementia care, yet activity may vary between subtypes.

OBJECTIVE: To investigate longitudinal determinants of primary care contact across Alzheimer’s disease (ad), vascular dementia (VD), dementia with Lewy bodies (DLB), and Parkinson’s disease dementia (PDD) 5 years pre-and-post-diagnosis, encompassing clinical, cognitive, functional, and sociodemographic factors.

DESIGN: Retrospective cohort study.

METHODS: Data on 4384 individuals with first dementia diagnoses (2008-2023) were obtained from a South London catchment linking dementia services with primary care records. Linear mixed-effects models were run on 3-month interval counts (up to 40 intervals per individual, 20 pre-and-post-diagnosis). Separate pre-and-post-diagnosis models assessed longitudinal trends, adjusted for age, sex, and antidepressant use, with subgroup analyses by dementia subtype and cognitive status.

RESULT: Service utilisation increased over time, with VD showing a steeper pre-diagnosis rise and PDD moderate post-diagnosis increases compared to ad. Across both periods, worse cognitive impairment and antipsychotic receipt were associated with lower contacts, while older age and Black/British Black ethnicity were associated with higher contact. Pre-diagnosis, agitation, depressed mood, relationship and living conditions problems were linked to lower contact, whereas hallucinations were associated with higher use. Post-diagnosis, hypnotic/anxiolytic use predicted lower contact, while acetylcholinesterase inhibitor receipt, comorbidities, daily living difficulties, and mixed ethnicity were associated with increased utilisation.

CONCLUSION: Person-centred care pathways should anticipate subtype-specific and individual patterns, providing targeted support for those with reduced pre-diagnosis contact who may have unmet needs, while considering early intervention for groups anticipated to require increased service use after diagnosis.

PMID:41645773 | DOI:10.1093/ageing/afag016

Vet Ital. 2026 Feb 6;62(1). doi: 10.12834/VetIt.3932.39205.1.

ABSTRACT

Varroa destructor is the main parasitic threat to Apis mellifera colonies worldwide and represents a major concern for honey bee health and apicultural sustainability. Oxalic acid (OA) is widely used for the control of varroosis; however, its efficacy is strongly influenced by the presence of capped brood. This pilot field study aimed to evaluate the efficacy and safety of a combined treatment protocol based on Api-Bioxal® administered by trickling and sublimation. The study was carried out in a permanent apiary located in the province of Bergamo (Northern Italy) from October 2024 to February 2025 and involved ten A. mellifera colonies housed in Dadant-Blatt hives. The experimental protocol consisted of one OA trickling treatment followed by two OA sublimations and a control treatment with amitraz. Treatment-induced mite fall was recorded daily for 117 days; brood presence, ambient temperature and pollen influx were monitored throughout the study period, and colony strength was assessed at the beginning and end of the trial using the Liebefeld method. Differences between pre- and post-treatment measurements were analysed using the Wilcoxon signed-rank test. An overall mean of 563.6 Varroa mites per colony was recorded as treatment-induced mite fall. The highest efficacy of OA was observed when treatments were applied in broodless conditions, whereas the presence of capped brood markedly reduced acaricidal efficacy. No abnormal honey bee mortality or adverse effects on colony health were observed. Colony strength increased in 8 out of 10 colonies, with statistically significant differences between pre- and post-treatment assessments (p < 0.012). These results indicate that Varroa destructor populations remain susceptible to oxalic acid when treatments are properly timed in relation to brood presence. A combined protocol of OA trickling and sublimation may enhance varroosis control without negative effects on colony health. Further large-scale studies are required to confirm these preliminary findings and to support evidence-based adjustments to national Varroa control guidelines.

PMID:41645768 | DOI:10.12834/VetIt.3932.39205.1

Trials. 2026 Feb 6. doi: 10.1186/s13063-025-09412-6. Online ahead of print.

ABSTRACT

BACKGROUND: Exploring barriers and enablers to participant recruitment into trials is a common discussion point in trial methodology. Participant information leaflets (PIL) can be long, have complexity above the average UK reading age, and may discourage engagement with research. This Study Within a Trial (SWAT) explored whether changing the design of a PIL influences recruitment rate and its value in patient decision-making. It was conducted within a host trial taking place in an emergency setting, where time is at a premium, and decisions on trial participation are needed more quickly than in most non-emergency settings.

METHODS: We have conducted a randomised SWAT, comparing the standard format PIL with one that has been adapted to be visually appealing, with improved readability and reduced word count. Patients considered eligible for the host trial were provided with a randomly allocated PIL type; consent rates were compared. Those consenting to take part in the host trial were asked to complete a questionnaire to explore the value of the PIL in their decision-making to take part in the trial; responses were compared across the two information sheets. The sample size was dictated by host trial recruitment.

RESULTS: Between September 2019 and September 2022, with a brief pause during the COVID19 pandemic, 271 participants were randomised to receive either the optimised PIL (n = 138) or the conventional PIL (n = 133). The recruitment rates were 47.1% (65/138) in the optimised PIL group and 48.9% (65/133) in the conventional PIL group; this difference was not statistically significant (p = 0.771). There were no significant differences in responses from participants recruited to the host trial who completed the Decision-Making Questionnaire.

CONCLUSION: Improving the readability and visual presentation of the participant information sheet provided to participants had no effect on recruitment rate, and did not appear to impact decision-making of recruited participants.

PMID:41645217 | DOI:10.1186/s13063-025-09412-6

J Orthop Surg Res. 2026 Feb 5. doi: 10.1186/s13018-026-06721-7. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to comprehensively examine the distal femoral valgus cut angle (VCA) utilized during total knee arthroplasty (TKA) in the Turkish population and identify the radiological and demographic factors influencing this critical surgical parameter.

METHODS: A retrospective analysis was performed on 193 lower extremity orthoradiographs from 120 patients diagnosed with end-stage knee osteoarthritis between January 2020 and December 2023. Key radiological variables assessed included VCA, mechanical femorotibial angle (MTFA), neck-shaft angle (NSA), medial offset (MO), and lateral distal femoral angle (LDFA).

RESULTS: The mean VCA was 6.48 ± 0.83 degrees, with no statistically significant differences observed between genders (p = 0.755). A moderate negative correlation was identified between VCA and NSA (r = – 0.423, p < 0.001), while weak to moderate positive correlations were observed between VCA and both MO (r = 0.337, p < 0.001) and LDFA (r = 0.307, p = 0.002). No significant associations were found between VCA and the other evaluated parameters.

CONCLUSIONS: The results highlight the necessity of personalized assessment of VCA during TKA to optimize radiological outcomes, as opposed to a standardized approach. In the Turkish population, VCA is primarily influenced by NSA, MO, and LDFA, with coronal plane deformities showing no significant effect. This study emphasizes the importance of considering patient-specific anatomical variations during preoperative planning.

PMID:41645210 | DOI:10.1186/s13018-026-06721-7

Harm Reduct J. 2026 Feb 5. doi: 10.1186/s12954-026-01408-y. Online ahead of print.

ABSTRACT

BACKGROUND: The rate of hepatitis C virus (HCV) treatment initiation and cure is suboptimal among people experiencing homelessness. A recent randomized controlled trial conducted by our study team compared peer-assisted telemedicine for HCV (TeleHCV) to peer-assisted referral to local providers (enhanced usual care [EUC]) in a rural population in Oregon. We hypothesized that the TeleHCV treatment model is more effective than EUC among those with unstable housing.

METHODS: In this secondary analysis of the Oregon TeleHCV randomized controlled trial in adults with HCV and injection drug use (n = 203), we explored the role of unstable housing as an effect modifier of the TeleHCV intervention using a Poisson regression analysis. Randomized arm, frequency of peer contacts, and medication lockers were exposures of interest. HCV cure, defined as undetectable HCV RNA 12 weeks after treatment initiation, is the primary outcome.

RESULTS: Overall, attaining HCV cure was less likely for those with unstable housing (RR = 0.68, 0.49-0.96, p = 0.026). However, unstably housed participants assigned to the TeleHCV arm were more than 6 times more likely to achieve HCV cure compared to unstably housed EUC participants (RR = 6.47, 3.12-13.43, p < 0.001) with a statistically significant interaction between treatment assignment and housing status (p = 0.022). The impact of TeleHCV on HCV cure was also identified among stably housed participants, but with a smaller effect size (RR = 2.15, 1.19-3.89, p = 0.012). Among participants with unstable housing, greater peer engagement was associated with an increased likelihood of both treatment initiation (RR = 1.24, p < 0.001) and HCV cure (RR 1.26; p < 0.001).

CONCLUSIONS: The peer-assisted TeleHCV intervention was substantially more effective for achieving HCV cure among participants with unstable housing at baseline compared to those unstably housed who received EUC. The treatment model should be broadly disseminated to target populations with HCV and high rates of homelessness to achieve HCV elimination goals.

CLINICAL TRIALS REGISTRATION: NCT04798521.

PMID:41645194 | DOI:10.1186/s12954-026-01408-y

BMC Public Health. 2026 Feb 6. doi: 10.1186/s12889-026-26535-w. Online ahead of print.

NO ABSTRACT

PMID:41645167 | DOI:10.1186/s12889-026-26535-w

BMC Psychiatry. 2026 Feb 5. doi: 10.1186/s12888-026-07878-5. Online ahead of print.

ABSTRACT

BACKGROUND: The period immediately following psychiatric inpatient care is recognized as a time of elevated risk of suicide, yet little is known about factors that influence how soon suicide occurs after discharge.

AIM: To examine the timing of suicide among persons after psychiatric discharge and identify sociodemographic and clinical factors associated with a shorter time to death by suicide.

METHODS: We included all adults in Sweden who died by suicide in 2015 and who had been discharged from psychiatric inpatient care during the last three months of life (n = 140). Sociodemographic and clinical variables were extracted from electronic medical records, including contextual factors from the last hospitalization (involuntary care, documented suicide risk, unplanned discharge). Time to suicide was modelled using stratified Cox proportional hazards regression.

RESULTS: The median time from discharge to death was 32 days. Older age was the only background factor independently associated with a shorter time to suicide; each additional 10 years of age was associated with shorter time to suicide, as indicated by an increased unadjusted hazard ratio (uHR) of 1.26 (95% CI: 1.12-14.2, p < .001). A diagnosed neurotic, stress-related and somatoform disorder (ICD-10 code F40-F49) was associated with a longer time to suicide (uHR = 0.68 (0.47-0.98), p = .036), although this association was not statistically significant when adjusting for age (aHR 0.82, 0.56-1.20, p = .310). Previous suicide attempts, sex, substance use disorder and depressive disorders were not associated with time to suicide. Neither involuntary care nor the presence or absence of a formal suicide risk assessment during inpatient stay predicted earlier suicide. Unplanned discharges were likewise unrelated to the time to suicide.

CONCLUSIONS: Among people who died by suicide within three months of psychiatric discharge, only older age independently predicted a shorter time to suicide. The absence of clear signals-particularly from routinely collected risk assessments-suggests that timely, universal follow-up may be more appropriate than attempts to target aftercare on the basis of standard risk markers.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41645161 | DOI:10.1186/s12888-026-07878-5

BMC Health Serv Res. 2026 Feb 5. doi: 10.1186/s12913-026-14093-1. Online ahead of print.

ABSTRACT

BACKGROUND: This study explores the “wave-off” mechanism in healthcare, in which physicians implicitly discourage patient revisits to manage high workloads. Understanding this mechanism is critical for balancing workload management and patient-centered care, as it highlights how physician discretion shapes patient behavior and operational efficiency.

METHODS: We analyze 200,426 outpatient records from a cardiology department to investigate the relationship between physician workload and the likelihood of patient revisits. We introduce a novel metric, Sample Entropy, to quantify patient “stickiness,” or the propensity to revisit. We examine physician behaviors-such as referrals for diagnostic examinations and medication prescribing-to identify strategies used to modulate patient flow. Statistical analyses assess the impact of workload on revisit patterns and the mechanisms driving the wave-off effect.

RESULTS: Higher physician workloads are significantly associated with reduced short-term patient revisits. Physicians manage workload by prescribing more medications and referring fewer diagnostic examinations, laboratory tests, particularly for patients with higher stickiness as measured by Sample Entropy. These behaviors alleviate short-term workload pressure but risk long-term inefficiencies, potentially reflecting bounded rationality in clinical decision-making.

CONCLUSIONS: The wave-off mechanism illustrates a trade-off between immediate workload relief and long-term operational performance. While it helps physicians address short-term capacity constraints, it may undermine optimal long-term patient care and system efficiency. This study highlights the operational and behavioral implications of physician-driven demand modulation, including the subtle yet consequential phenomenon of physician-reduced demand, in which patients are implicitly discouraged from revisiting due to workload-driven adjustments in care delivery.

PMID:41645147 | DOI:10.1186/s12913-026-14093-1