Category: Nevin Manimala

J Glob Health. 2026 Feb 13;16:04052. doi: 10.7189/jogh.16.04052.

ABSTRACT

BACKGROUND: The continuity and quality of maternal and child health (MCH) services represent significant challenges in low- and middle-income countries (LMICs). Home-based records (HBRs), including the integrated Maternal and Child Health Handbook (MCHHB), may support consistent service usage and improved care quality. We aimed to evaluate the association between HBRs and continued quality MCH care, identifying differences in associations between MCHHBs and the continuum of care and those between other HBR types and the continuum of care.

METHODS: We conducted a pooled analysis of Demographic and Health Surveys (DHS) from 18 LMICs, including women and their youngest eligible children for the health card module. We defined the continuum of quality MCH care using receipt of quality antenatal care (ANC), skilled birth attendance, and quality postnatal care (qPNC), with ANC and PNC measured as composite indicators. We based the HBR ownership on the DHS variable ‘Has health card’. We used multivariable logistic regressions to examine associations between HBR ownership, HBR type, and the continuum of care, adjusting for residence, maternal education, and wealth.

RESULTS: The final analysis included 89 902 samples. Ownership of HBR was associated with significantly higher odds of completing the continuum of quality MCH care compared with not owning HBR. However, no significant differences were observed between owners of MCHHB and those of other HBR types. Based on analysing the subgroups of MCH service components, the MCHHB may facilitate the provision of ANC services, such as urine and blood tests, more effectively than other HBR types.

CONCLUSIONS: Owning HBR was positively associated with greater use of quality MCH services. However, no significant differences were observed for MCHHBs, despite MCHHB ownership being significantly associated with improved uptakes of urine and blood tests. Further research is needed to explore the influence of actual HBR use, provider-related factors, and variations in HBR content and type.

PMID:41678823 | DOI:10.7189/jogh.16.04052

J Glob Health. 2026 Feb 13;16:04055. doi: 10.7189/jogh.16.04055.

ABSTRACT

BACKGROUND: Chikungunya has emerged as a growing global health threat with a new sharp rise in outbreaks across 119 countries. However, its transmission patterns remain poorly characterised. We aimed to describe the global burden and spatiotemporal trends of chikungunya, and identify country-level environmental and socioeconomic factors associated with local transmission.

METHODS: We compiled annual country-level autochthonous chikungunya cases from 2004 to 2024, using data from regional surveillance systems and peer-reviewed sources. We calculated the incidence rates using the number of new cases and the population. We employed a generalised additive model (GAM) to flexibly model nonlinear associations between chikungunya incidence and environmental and socioeconomic factors. We performed subgroup analyses across the six WHO regions and conducted multiple sensitivity analyses addressing data structure, variable selection, and alternative model specifications to assess robustness.

RESULTS: Between 2004 and 2024, the global incidence of chikungunya from autochthonous cases rose from 0.28 to 11.13 per 100 000. In 2024, the Americas bore the heaviest burden (43.9 per 100 000; 431 305 cases), followed by South-East Asia (14.3 per 100 000; 258 854 cases), while Africa, Europe, and the Western Pacific reported few cases. Local outbreaks occurred recurrently in several countries across the Americas, South-East Asia, and Western Pacific, but remained sporadic in temperate regions. Using a GAM, we identified significant nonlinear effects of temperature, urbanisation, and GDP per capita on incidence: incidence rose sharply above 17°C; urban population percentage demonstrated a complex, nonlinear relationship; and GDP showed an inverse association at low to moderate levels. After adjusting for environmental and socioeconomic factors, the temporal trend of incidence generally declined. We identified notable heterogeneity across regions, while our results otherwise remained broadly consistent across the sensitivity analyses.

CONCLUSIONS: Chikungunya burden has expanded globally, shaped by environmental and socioeconomic factors. Strengthened surveillance, integration of climate information into preparedness efforts, and improvements in socioeconomic conditions are needed to reduce disparities and support more effective prevention of future outbreaks.

PMID:41678821 | DOI:10.7189/jogh.16.04055

Neurology. 2026 Mar 24;106(6):e214702. doi: 10.1212/WNL.0000000000214702. Epub 2026 Feb 12.

ABSTRACT

BACKGROUND AND OBJECTIVES: The benefit of IV thrombolysis (IVT) with alteplase before endovascular thrombectomy (EVT) compared with EVT alone has been shown to be limited and time dependent. Data on tenecteplase, its recommended alternative, are limited. We aimed to assess the efficacy and safety of IVT with tenecteplase plus mechanical thrombectomy (TNK + EVT) compared with EVT in patients with large vessel occlusion stroke and determine whether its potential benefit decreases with treatment time.

METHODS: We conducted a retrospective pooled analysis of 2 nationwide, real-world registries of patients with anterior circulation large vessel occlusion stroke within 4.5 hours of known symptom onset and with no contraindication to thrombolysis, treated with TNK + EVT (TETRIS) or EVT (ETIS). The efficacy outcome was the 3-month modified Rankin Scale (mRS) score, analyzed in ordinal and dichotomized (mRS score ≤2) approaches. We used propensity score-weighted logistic regression to assess associations between treatment groups and outcomes of interest.

RESULTS: Among 1,890 patients who were analyzed (TNK + EVT: n = 798; EVT: n = 1,092; median age 73 years [interquartile range 61-82]; 49.6% women), the median expected onset-to-thrombolysis time was 146 minutes [interquartile range 119-180]. More than half of patients (n = 1,063; 56.2%) were admitted first to a primary stroke center. All baseline characteristics were balanced between treatment groups after overlap weighting. Overall, TNK + EVT was associated with better 3-month functional outcome over the full mRS (weighted common odds ratio [OR] 1.53 [95% CI 1.29-1.82]; p < 0.001) and regarding functional independence (propensity score overlap weighting [PSOW]-OR 1.50 [95% CI 1.23-1.84]; p < 0.001). This benefit did not differ statistically between patients admitted first to a primary or comprehensive stroke center (p-interaction = 0.12). There was no significant effect of the expected onset-to-thrombolysis time on the association between TNK + EVT and better functional outcome (p-interaction = 0.11). There were no significant differences in parenchymal hematoma (PSOW-OR 1.29 [95% CI 0.94-1.79]; p = 0.12) and symptomatic intracerebral hemorrhage (PSOW-OR 1.13 [95% CI 0.69-1.86]; p = 0.61) rates.

DISCUSSION: Among patients treated within 4.5 hours of symptom onset, TNK + EVT was associated with better functional outcome than EVT, without safety concerns. This benefit does not seem to be time dependent. These findings support the routine use of tenecteplase before EVT in the early time window.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, in patients with stroke due to anterior circulation large vessel occlusion, IV tenecteplase plus thrombectomy is associated with better functional outcomes at 3 months compared with thrombectomy alone.

TRIALS REGISTRATION INFORMATION: NCT03776877 (ETIS registry) and NCT05534360 (TETRIS registry).

PMID:41678809 | DOI:10.1212/WNL.0000000000214702

Obstet Gynecol. 2026 Feb 12. doi: 10.1097/AOG.0000000000006191. Online ahead of print.

ABSTRACT

OBJECTIVE: We sought to evaluate the association between the timing of new-onset hypertensive disorders of pregnancy (HDP) development (ie, antepartum, intrapartum, or postpartum) and the risk of incident hypertension 2-7 years after delivery in nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be) and nuMoM2b-HHS (the nuMoM2b Heart Health Study).

METHODS: This is a secondary analysis of a multisite prospective observational cohort study conducted at eight clinical sites that enrolled nulliparous individuals with singleton pregnancies in their first trimester who were followed during pregnancy and subsequently underwent a cardiovascular screening visit 2-7 years after delivery. For this analysis, we excluded individuals with prepregnancy chronic hypertension in their nuMoM2b pregnancy. We compared rates of stage 1 hypertension (blood pressure 130/80 mm Hg or higher or use of antihypertensive medications) at the 2-7 year postpartum study visit based on the timing of the onset of HDP (categorized as antepartum, intrapartum, postpartum) with no HDP (referent). Multivariable logistic regression models adjusted for baseline covariates (age, insurance, tobacco use, diabetes, and early pregnancy body mass index [BMI]) were used to generate adjusted odds ratios (aOR) and 95% CIs. Interaction analysis was performed to evaluate effect modification by the presence of severe features of HDP. P<.05 was considered statistically significant.

RESULTS: Of 4,342 individuals included in this analysis (mean age 27.0 years [SD 5.6 years]), 23.2%% (n=1,007) had new-onset HDP. Among those with HDP, 53.6% (n=540) were diagnosed antepartum, 42.4% (n=427) were diagnosed intrapartum, and 4.0% (n=40) were diagnosed postpartum. At a mean follow-up of 3.2±0.9 years after delivery, the frequency of incident hypertension was elevated regardless of whether HDP occurred antepartum (37.6%, n=203), intrapartum (26.0%, n=111), or postpartum (40.0%, n=16) (compared with no HDP [16.5%, n=550]). After adjustment for maternal age, insurance type, tobacco use, prepregnancy diabetes, and early pregnancy BMI, the risk of chronic hypertension remained elevated regardless of when HDP was diagnosed, although the risk was higher when it developed antepartum (aOR 2.40, 95% CI, 1.95-2.95) or postpartum (aOR 2.90, 95% CI, 1.49-5.64) compared with when it developed intrapartum (aOR 1.55, 95% CI, 1.21-1.97; referent no HDP, P<.01 for all).

CONCLUSION: New-onset HDP, regardless of whether it is diagnosed antepartum, intrapartum, or postpartum, is associated with an increased risk of incident hypertension 2-7 years after delivery, compared with individuals without HDP during their first birth. Greater awareness of cardiovascular disease risk after HDP-even when HDP is diagnosed during labor or postpartum-is needed to appropriately risk stratify and help prevent hypertension after delivery.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02231398.

PMID:41678805 | DOI:10.1097/AOG.0000000000006191

JMIR Res Protoc. 2026 Feb 12;15:e71620. doi: 10.2196/71620.

ABSTRACT

BACKGROUND: Pediatric patients with end-stage kidney disease require kidney transplants (KTs) throughout their lifetime. Long-term graft survival is dependent on multiple factors, which are broadly categorized as donor- and recipient-related factors. Advances in transplant care and changes in donor population demographics necessitate an updated analysis on donor risk factors to guide clinical decision-making.

OBJECTIVE: In this systematic review and meta-analysis, we will focus on the impact of donor factors on graft survival in pediatric KT, excluding transplants from donation after circulatory death as the latter are less common in children.

METHODS: This review encompasses studies reporting donor-related risk factors for graft survival in pediatric KT, including age, size, comorbidities, and ethnicity for living and deceased donors, as well as the cause of death and length of hospitalization for deceased donors. The literature search will use the following databases: PubMed, Scopus, Web of Science, Embase, and Cochrane. Two independent reviewers will select studies and assess their quality. Pooled estimates of relevant factors will be computed via a random-effects model using the Stata/BE (version 19) software. Depending on data availability, subgroup analyses will be conducted based on donor type (living vs deceased). The reporting of findings will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS: The search and screening for the systematic literature review are anticipated to be finished in June 2026. Data extraction, quality appraisal, and subsequent data synthesis will begin in July 2026. The review is expected to be completed by October 2026, and the study results will be published in 2027.

CONCLUSIONS: Our review will provide a comprehensive synthesis of the available evidence on kidney donor risk factors impacting graft survival in pediatric KT. The results of this review could provide valuable insights for clinical decisions, policy development, and ongoing efforts to improve outcomes for children with end-stage kidney disease requiring KT.

PMID:41678799 | DOI:10.2196/71620

JMIR Cancer. 2026 Feb 12;12:e84788. doi: 10.2196/84788.

ABSTRACT

Our study describes the characteristics of remote patient monitoring use among commercially insured patients with cancer from 2019 to 2023.

PMID:41678798 | DOI:10.2196/84788

JMIR Pediatr Parent. 2026 Feb 12;9:e71367. doi: 10.2196/71367.

ABSTRACT

BACKGROUND: The population of young individuals not in employment, education, or training (NEET) is highly diverse, but a common problem appears to be their mental health. NEETs due to illness or disability are of particular concern for social exclusion, but little is known of how young individuals who are NEET with and without disability make use of, and gain from, employment interventions. There is also a scarcity of research on psychological interventions and mental health outcomes among young NEETs. Acceptance and commitment therapy (ACT) has shown promising results in psychological outcomes in young adults.

OBJECTIVE: This study aimed to expand the knowledge on the effects of an app-based intervention built on ACT on NEETs with and without disabilities.

METHODS: A 2-arm randomized controlled trial was conducted in 2021, including 151 young NEETs aged 16-24 years. Participants were recruited mainly via social media platforms and through organizations working with young NEETs. The intervention group (n=77) used an app for psychological well-being with the possibility for digital group meetings for 6 weeks, and the control group (n=74) received film clips once a week. Outcomes were self-assessed through questionnaires. Statistical analyses were made using chi-square, Mann-Whitney U test, general linear model, and logistic regression.

RESULTS: No differences in effects on mental health were seen between the intervention and control group, neither overall nor between young NEETs with or without disability. Usage data show that 68.8% (53/77) of the participants in the intervention group downloaded the app, and 24.7% (19/77) completed all 6 modules. Effects on employment and education levels were only seen within the intervention group, where those who had completed one or more modules had a higher likelihood of being active in terms of employment and education compared to those who did not complete modules. No significant effects were seen in employment and education levels in relation to disability status. A high proportion of the participants had a disability, few were in contact with a youth employment center, and there was an overrepresentation of young women in general. Participants with disabilities had lower self-esteem, had less frequently completed high school, had less work experience, and a larger proportion had been in the NEET situation for over a year. A higher dropout were seen among participants in the intervention group and among young men.

CONCLUSIONS: No effects of the app-based intervention were seen for psychological well-being between young NEETs with disabilities and those without, but the results showed potential effects on employment and education levels related to engagement in the intervention. NEETs with disabilities are of particular concern and might need additional efforts or other types of interventions than the one investigated in this study. Findings can be considered weak due to the low adherence and high attrition.

TRIAL REGISTRATION: ISRCTN Registry ISRCTN46697028; https://www.isrctn.com/ISRCTN46697028.

PMID:41678795 | DOI:10.2196/71367

J Med Internet Res. 2026 Feb 12;28:e82322. doi: 10.2196/82322.

ABSTRACT

BACKGROUND: Although cancer screening is essential for early detection and an improved prognosis, screening beyond the recommended guidelines may increase the risk of false-positive results. Consequently, educating individuals about the potential harm of non-guideline-based cancer screening is essential; however, effective communication methods remain unclear.

OBJECTIVE: This study aimed to evaluate the effectiveness of different types of educational videos in encouraging preferences for guideline-based cancer screening.

METHODS: This 3-arm pseudorandomized controlled trial was conducted in June 2025 using a Japanese online survey platform. Eligible respondents were working adults aged 30 to 60 years with no history of major cancer. Respondents were assigned to 1 of the following 3 video conditions: video A, which provided a logical explanation of false-positive risks; video B, which presented the narrative of a woman who received a false-positive result from breast cancer screening; and video C, which depicted a man who underwent unnecessary follow-up testing after tumor marker screening. The primary outcome was the preference for guideline-based cancer screening after watching the videos. The secondary outcomes included 7 self-reported video evaluation items, such as perceived relevance and clarity, assessed using a 5-point Likert scale. Differences in the primary outcome between video groups were analyzed using multivariable logistic regression with adjustment for covariates. Means and 95% CIs were calculated for each secondary outcome according to sex and video group. In addition, before-and-after changes in screening preferences were assessed using McNemar test, with a significance level of .05.

RESULTS: In total, 1200 respondents (400 per group) completed the survey. No statistically significant differences in the primary outcome were observed among the video groups. With reference to video A, the adjusted odds ratios for preferring guideline-based screening were 0.89 (95% CI 0.59-1.32) for video B and 0.98 (95% CI 0.65-1.46) for video C. Regarding secondary outcomes, male respondents rated video B less favorably than female respondents in terms of relevance and willingness to undergo guideline-based screening. The before-and-after comparison showed a significant change in preference for guideline-based screening (P=.04). These videos appeared to be more effective for individuals with an annual history of colorectal cancer screening than for those without such a history.

CONCLUSIONS: Educational videos have the potential to influence cancer screening preferences; however, no single video format has demonstrated clear superiority. These findings underscore the importance of tailoring educational materials to the target audience characteristics. Further research is required to develop effective strategies for encouraging guideline-based cancer screening.

TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry UMIN000060549; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000066119.

PMID:41678792 | DOI:10.2196/82322

J Am Acad Orthop Surg Glob Res Rev. 2026 Feb 11;10(2). doi: 10.5435/JAAOSGlobal-D-25-00178. eCollection 2026 Feb 1.

ABSTRACT

PURPOSE: The purpose of this study was to analyze national trends in knee and shoulder arthroscopy to identify seasonal and annual variability using the Healthcare Cost and Utilization Project-Nationwide Ambulatory Surgery Sample (HCUP-NASS) dataset.

METHODS: Estimated national rates of ambulatory knee and shoulder arthroscopy were analyzed using HCUP-NASS data from 2016 to 2021. Time trend plots were generated to identify potential seasonal trends in these procedures.

RESULTS: There was a decreasing trend in the number of procedures (shoulder arthroscopy, rotator cuff repair [RCR], knee arthroscopy, meniscal repair [MR]/meniscectomy, and anterior cruciate ligament reconstruction [ACLR]) done from 2016 to 2021. There were an estimated 264,987 (95% confidence interval [CI] = 251,205 to 276,770) patients who underwent shoulder arthroscopy and 381,125 (95% CI = 362,555 to 399,696) patients who underwent knee arthroscopy in 2021, as compared with 345,892 (95% CI = 326,224 to 365,559) patients who underwent shoulder arthroscopy and 521,912 (95% CI = 496,905 to 546,919) patients who underwent knee arthroscopy in 2016. Male patients showed markedly higher rates of shoulder arthroscopy, RCR, knee arthroscopy, MR, and ACLR procedures as compared with female patients, whereas female patients showed markedly higher rates of knee arthroscopy done without MR and ACLR. Shoulder and knee arthroscopy rates peaked in the 55 to 75-year-old age group. In addition, both procedures were most frequently done in December and had the lowest utilization in the month of July.

CONCLUSION: There was a nonlinear decrease in the estimates of shoulder arthroscopy, RCR, MR/meniscectomy, knee arthroscopy, and anterior cruciate ligament reconstruction procedures from 2016 to 2021, with peaks in 2016 and 2019, and a low point in 2020. There are notable variations in rates of knee and shoulder arthroscopy procedures by age and sex.

CLINICAL RELEVANCE: Recent data on commonly done ambulatory orthopaedic arthroscopies are important for policy makers and for understanding utilization trends.

PMID:41678780 | DOI:10.5435/JAAOSGlobal-D-25-00178

N Z Med J. 2026 Feb 13;139(1629):49-58. doi: 10.26635/6965.7173.

ABSTRACT

BACKGROUND: Burnout is a chronic syndrome that compromises physician wellbeing and patient care. This study aimed to quantify burnout among New Zealand ophthalmologists and identify key demographic and practice-related factors associated with increased risk, as well as to assess lifetime burnout experiences, time off taken and barriers to seeking help.

METHODS: A cross-sectional study of 171 New Zealand ophthalmologists used a modified Mini Z 2.0 Burnout Survey to assess workplace satisfaction, stress and burnout, while additional questions gathered demographic and practice characteristics, as well as retrospective data on burnout frequency, time off taken, help sought and perceived barriers.

RESULTS: Out of 161 delivered surveys, 84 responses were received (52% response rate). Overall burnout was 20%, with a significantly higher rate in the public sector (p<0.05). Burnt-out respondents reported notably lower job satisfaction, team effectiveness and workload control. No significant associations were found with other demographic or practice factors. Sixty-three percent had experienced burnout at least once, and 40% reported multiple episodes, yet only 15.5% took time off. Among those who sought help (51%), family members were the most common source of support, while 43% did not seek help, primarily due to time constraints.

CONCLUSION: This study shows that burnout affects one in five New Zealand ophthalmologists. Findings underscore the importance of reducing stigma and cultivating supportive environments that encourage help-seeking without fear of repercussions. Reducing administrative tasks and expanding mental health resources, especially in the public sector, may mitigate burnout and strengthen workforce recruitment and retention.

PMID:41678759 | DOI:10.26635/6965.7173