Category: Nevin Manimala

Int J Drug Policy. 2026 Jun 7;155:105382. doi: 10.1016/j.drugpo.2026.105382. Online ahead of print.

ABSTRACT

BACKGROUND: The increasing presence of fentanyl in the illicit drug supply has been associated with rising overdose mortality in the United States, but the extent to which it is associated with nonfatal overdose morbidity remains unknown. We examined the association between the proportion of fentanyl reports in illicit drug seizures and state-level rates of nonfatal overdose emergency department (ED) visits.

METHODS: We conducted a longitudinal ecological analysis of 40 US states from 2021 to 2024. Outcomes were annual state-level rates of nonfatal overdose ED visits per 10,000 ED visits, obtained from Drug Overdose Surveillance and Epidemiology Syndromic Surveillance System. The proportion of fentanyl reports among all illicit drug seizure reports was obtained from the National Forensic Laboratory Information System. Annual state-level sociodemographic covariates were obtained from the American Community Survey. Adjusted associations and 95% confidence intervals (CIs) were estimated via linear regression using generalized estimating equations.

RESULTS: After adjusting for covariates, a 10 percentage-point increase in fentanyl seizure proportion was significantly associated with higher nonfatal overdose ED visit rates: opioid-involved (2.18 increase, 95% CI: 0.89, 3.46), fentanyl-involved (0.73 increase, 95% CI: 0.27, 1.18), and cocaine-involved (0.08 increase, 95% CI: 0.01, 0.15). There was no evidence of statistically significant associations with heroin-, stimulant-, methamphetamine-, and benzodiazepine-involved overdose ED visit rates.

CONCLUSIONS: Greater fentanyl penetration in illicit drug seizure reports was significantly associated with higher opioid-, fentanyl-, and cocaine-involved nonfatal overdose ED visit rates across states. These findings suggest that fentanyl saturation is not only a driver of overdose mortality but also contributes to nonfatal overdose burden, with important implications for health system demand and public health preparedness.

PMID:42251803 | DOI:10.1016/j.drugpo.2026.105382

J Environ Manage. 2026 Jun 7;410:130054. doi: 10.1016/j.jenvman.2026.130054. Online ahead of print.

ABSTRACT

European Union’s 2024 mandate for separate collection of bio-waste has catalysed significant changes in organic waste management across Member States, aiming to increase the share of bio-waste collected separately for organic treatment. This study analyses per capita kitchen waste collection in municipalities across Catalonia and Italy. It applies panel regression models for the period 2010-2021 and a cross-sectional analysis for 2021, to assess the impact of geographic, demographic, socio-economic, and waste management variables on separate collection outcomes. Main results show that advanced collection systems, particularly door-to-door schemes, are associated with an increase in kitchen waste capture rates by 12-50 kg per capita and year, with investments in separate collection translating into improvements in collection performance. Municipalities with smaller areas, medium levels of population as well as a higher proportion of older residents were also positively associated with higher per capita collection. Conversely, socio-economic challenges such as high unemployment are linked to reduced participation, while the influence of income appears context dependent. These findings provide robust empirical evidence that kitchen waste collection is shaped by a combination of factors, highlighting the effectiveness of individualised systems and the importance of socio-demographic and local context variables. Future research could explore the role of technological innovations, behavioural responses, and policy interventions related to collection system design, investment and monitoring, as well as the interaction of tourism and seasonal variations with service efficiency, and the influence of income and other socio-economic factors to inform more targeted and adaptable bio-waste management strategies.

PMID:42251795 | DOI:10.1016/j.jenvman.2026.130054

JAMA. 2026 Jun 7. doi: 10.1001/jama.2026.9512. Online ahead of print.

ABSTRACT

IMPORTANCE: The effects of orforglipron, an oral, nonpeptide glucagon-like peptide 1 receptor agonist, added to insulin glargine for treatment of type 2 diabetes have not been described.

OBJECTIVE: To assess efficacy and safety of orforglipron added to titrated insulin glargine in adults with type 2 diabetes and inadequate glycemic control.

DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, phase 3 study conducted at 72 sites across the US, Brazil, China, Japan, and Romania between November 10, 2023, and September 15, 2025, in adults with type 2 diabetes taking insulin glargine with or without metformin and/or sodium-glucose cotransporter 2 inhibitors over 40 weeks.

INTERVENTIONS: Participants were randomized (1:1:1:1) to receive once-daily 3-mg (n = 137), 12-mg (n = 132), or 36-mg (n = 136) dosages of orforglipron or placebo (n = 141), in addition to titrated insulin glargine.

MAIN OUTCOMES AND MEASURES: The primary outcome was mean hemoglobin A1c (HbA1c) change from baseline to week 40 (for the 12-mg once daily and 36-mg once daily dosages of orforglipron). Key secondary outcomes were mean HbA1c change from baseline (for the 3-mg once daily dosage of orforglipron), proportion of participants achieving HbA1c targets of lower than 7.0% and 6.5% or lower, and mean body weight change and percentage change from baseline to week 40.

RESULTS: Among 546 randomized participants (median age, 61.0 [IQR, 26-95] years; 52.9% male; median duration of type 2 diabetes, 14.6 [IQR, 0.1-40.7] years; mean HbA1c, 8.50% [SD, 0.95%]; mean body mass index, 30.8 [SD, 6.1]), 507 (92.9%) completed the trial. At week 40, the mean changes from baseline in HbA1c were -1.58%, -1.88%, and -1.82% with orforglipron, 3 mg, 12 mg, and 36 mg once daily, respectively, vs -0.79% with placebo. Each dosage of orforglipron was superior to placebo (estimated treatment differences: 3 mg once daily, -0.78% [95% CI, -1.02% to -0.55%]; 12 mg once daily, -1.08% [95% CI, -1.33% to -0.83%]; 36 mg once daily, -1.03% [95% CI, -1.28% to -0.77%]; P < .001 for all). All key secondary outcomes demonstrated statistically significant differences in favor of orforglipron compared with placebo. Mean percentage body weight change from baseline was -2.6%, -4.8%, and -5.4% with orforglipron, 3 mg once daily, 12 mg once daily, and 36 mg once daily, respectively, vs 0.2% with placebo. The most frequent adverse events with orforglipron were gastrointestinal (mild to moderate). Orforglipron did not increase the risk of clinically significant hypoglycemia vs placebo.

CONCLUSIONS AND RELEVANCE: In participants with type 2 diabetes inadequately controlled by insulin glargine, addition of oral orforglipron significantly improved glycemic control and body weight, without increasing hypoglycemia risk, compared with placebo.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06109311.

PMID:42251769 | DOI:10.1001/jama.2026.9512

J Sex Med. 2026 Jun 5;23(7):qdag145. doi: 10.1093/jsxmed/qdag145.

ABSTRACT

INTRODUCTION: Several restorative (or regenerative) therapies have been proposed in the past 15 years to reverse the underlying pathophysiology associated with erectile dysfunction.

OBJECTIVES: The aim of this International Society for Sexual Medicine-commissioned review of restorative therapies for erectile dysfunction was to systematically review the literature to determine the safety and efficacy of these therapies.

METHODS: A systematic review of MEDLINE, EMBASE, CINAHL, and the Cochrane CENTRAL database of controlled trials was performed to identify comparative studies published from January 2010 through November 2023. Two reviewers performed study selection and data extraction. Five restorative therapies were assessed: low-intensity extracorporeal shockwave therapy (focused or radial), intracorporal stem cell injections, intracorporal platelet-rich plasma injections, and low-intensity pulsed ultrasound. Outcomes of interest included adverse events and changes in validated erectile function symptom scores. The Cochrane Risk of Bias and ROBINS-I tools were used to evaluate the risk of bias of randomized controlled trials and observational studies, respectively.

RESULTS: A total of 36 studies were included, 30 randomized controlled trials and 6 non-randomized studies. Most of these studies (n = 23) evaluated focused shockwave therapy. Results for focused shockwave therapy compared to sham were mixed. While some sham-controlled trials reported statistically significant improvements in erectile function scores favoring focused shockwave therapy, other trials found no significant difference between groups. Additionally, many studies (78%) did not report or compare the minimal clinically important difference (MCID) in erectile function. Among those that did, further methodological concerns including the use of MCID thresholds with instruments for which no MCID has been validated (ie, IIEF-5) and reporting a combined MCID in cohorts with mixed severity of erectile function limit confidence in the result. Other restorative therapies also report limited and inconsistent evidence.

CONCLUSIONS: The data regarding focused shockwave therapy for erectile dysfunction remains mixed, with some trials showing benefit compared to sham and others showing no difference. The heterogeneity of treatment protocols, methodological limitations across studies, and inconsistent MCID reporting preclude definitive conclusions about clinical efficacy. All restorative therapies, including focused shockwave therapy, require further investigation in well-designed trials with standardized protocols and validated outcome measures before routine clinical use can be recommended.

PMID:42251759 | DOI:10.1093/jsxmed/qdag145

J Eval Clin Pract. 2026 Jun;32(4):e70495. doi: 10.1111/jep.70495.

ABSTRACT

RATIONALE: The National Health Service, UK, has recently implemented a new patient safety strategy, replacing root cause analysis (RCA) incident investigation with systems-based approaches. It is unknown if this change will optimise learning and improve care outcomes.

AIMS OBJECTIVES: We aimed to analyse safety recommendations/actions/improvements/solutions from comprehensive incident investigations by comparing those that adopted root cause analysis with systems-based approaches.

METHOD: The evaluation adopted a sequential multi methods design. Reports were extracted between January 2022 and January 2023. The quality of the incident investigation was graded using a validated tool (Learning Response Review and Improvement Tool). Investigation identified solution types were organised using qualitative content analysis, adopting inductive and deductive orientations. These were then classified into system factors and the effectiveness of the solution scored. Descriptive statistics were computed to investigate differences between incident investigation type.

RESULTS: Grading the quality of reports demonstrated that the expectations set out within the change in safety strategy were mostly being realised in practice. A total of 135 solutions were extracted from systems-based and 57 from RCA reports, where the type of solutions identified were similar between each investigation approach. Organisational system factors were the most frequent for systems-based whilst task system-work factors were most frequent for RCA reports. For both investigation types, most of these solutions were deemed to fall in the least effective category: administrative controls.

CONCLUSION: The evaluation provides important insights into how the shift to systems-based investigations are shaping the quality of investigations and the recommendations that aim to prevent a recurrence of harm. Changing from RCA to systems-based investigations led to more patient/carer/family involvement and systems-focussed solutions, however weaker administrative recommendations remained prominent. Policy, practice and research need to ensure that the change in conceptual thinking and investigative orientation also contributes to improvements in learning and the development of stronger controls or barriers that prevent harm.

PMID:42251746 | DOI:10.1111/jep.70495

Psychiatr Danub. 2026 Apr;38(1):68-79. doi: 10.24869/psyd.2026.68.

ABSTRACT

BACKGROUND: Treatment adherence improves the quality of life and functional outcomes in patients with bipolar disorder (BD) by supporting effective disease management and fostering the development of self-esteem and self-efficacy. This study aimed to determine the effect of Adherence Therapy (AT) on medication adherence (MA), self-efficacy, and self-esteem in patients diagnosed with BD.

SUBJECTS AND METHODS: This randomized controlled study was conducted with patients diagnosed with BD admitted to the psychiatry outpatient clinic of an Application and Research Hospital in Türkiye. The participants were randomly assigned to either an intervention group (n = 31), who received AT individually, or a control group (n = 30), who continued with their routine outpatient clinic follow-up. Data were collected using the Patient Descriptive Questionnaire, the Morisky Medication Adherence Scale (MMAS), the Self-Efficacy Scale (SES), and the Coopersmith Self-Esteem Inventory -Adult Form (CSEI).

RESULTS: There was a significant difference in the MMAS scores, which assess MA, between the intervention and control groups after the AT intervention (p < 0.01). Logistic regression analysis revealed that participants in the intervention group had a significantly lower likelihood of poor MA than those in the control group (OR = 0.060; p < 0.01). An increasing trend was observed in the SES scores of the intervention group; however, this difference was not statistically significant. The CSEI scores increased significantly in the intervention group, but no significant difference was found between the groups.

CONCLUSIONS: The AT administered to patients with BD played a role in increasing patients’ adherence to treatment. The results of this study suggest that it is important for mental health professionals to use evidence-based strategies to improve patients’ MA.

PMID:42251720 | DOI:10.24869/psyd.2026.68

Psychiatr Danub. 2026 Apr;38(1):63-67. doi: 10.24869/psyd.2026.63.

ABSTRACT

OBJECTIVE: To evaluate the level of insight into illness in patients with schizophrenia and its associations with demographic factors, clinical symptoms, executive functions, and selected metabolic parameters.

SUBJECTS AND METHODS: This cross-sectional study included 60 outpatients diagnosed with schizophrenia according to DSMIV criteria. Participants were divided into two groups based on the median score of the Self-Appraisal of Illness Questionnaire (SAIQ): preserved insight (n=30) and impaired insight (n=30). Positive symptoms were assessed with the Positive Symptoms Rating Scale (PSRS), negative symptoms with the Brief Negative Symptom Assessment (BNSA), executive functions with the Wisconsin Card Sorting Test (WCST) and Wechsler-Bellevue Intelligence Scale-II (WB-II) subscales. Metabolic parameters included body mass index (BMI), systolic and diastolic blood pressure, and waist circumference. Statistical analysis was performed using t-tests, ANOVA, Pearson correlation, and multiple linear regression (p<0.05).

RESULTS: Patients with impaired insight exhibited significantly higher positive (PSRS: 28.5±4.2 vs 18.3±3.1; p<0.001) and negative symptoms (BNSA: 35.2±5.6 vs 22.1±4.0; p<0.001), poorer executive performance (WCST total score: 45.6±8.9 vs 68.4±7.2; p<0.001), higher BMI (28.7±3.4 vs 24.5±2.8; p<0.01), and elevated blood pressure values. SAIQ total score negatively correlated with positive (r=-0.62; p<0.001) and negative symptoms (r=-0.58; p<0.001), illness duration (r=-0.45; p<0.01), and positively with years of education (r=0.48; p<0.01) and WCST score (r=0.52; p<0.001). Regression analysis showed that negative symptoms (β=-0.41; p<0.001) and executive dysfunction (β=-0.35; p<0.01) were the strongest independent predictors of poor insight (R²=0.62).

CONCLUSION: Impaired insight in schizophrenia is strongly associated with greater psychopathological burden, neurocognitive deficits (especially executive dysfunction), and metabolic disturbances. These findings support the implementation of integrated therapeutic strategies targeting insight, cognition, and cardiometabolic health to improve long-term outcomes.

PMID:42251719 | DOI:10.24869/psyd.2026.63

Psychiatr Danub. 2026 Apr;38(1):53-62. doi: 10.24869/psyd.2026.53.

ABSTRACT

BACKROUND: The novel coronavirus disease (COVID-19) emerged at the end of 2019 and has since affected Türkiye as well as the rest of the World. The main purpose of this study is to examine the effects of social isolation measures during the COVID-19 epidemic on education perceptions, anxiety levels, sleep quality, and physical activity levels of healthcare students, as well as the relationship between anxiety with sleep quality and physical activity level.

SUBJECTS AND METHODS: The cross-sectional and descriptive study was conducted between May and June 2020. The sample consisted of 457 physiotherapy, nursing, and occupational therapy students aged 18-41. Before to starting the survey, electronic consent was obtained from all participants. The data were collected through the Google Forms web survey platform using the convenience sampling method. The demographic information form, Beck Anxiety Inventory, Pittsburgh Sleep Quality Inventory, and Rapid Assessment of Physical Activity were used to collect data. The data were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows 22 (IBM SPSS Inc., Chicago, IL) at a significance level of 0.05.

RESULTS: The majority of students expressed concerns regarding the insufficiency of distance education (82.5%). Over half (53.39%) of the study participants reported experiencing mild, moderate, and severe anxiety. In addition, students exhibited poor sleep quality (67.5%) and low levels of physical activity (61.1%). A statistically significant positive correlation was found between the total scores of the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index (r = 0.425, p < 0.001).

CONCLUSION: Healthcare students were concerned about distance education during the first wave of the pandemic. Universities should provide all students with guidance on mental health and encourage them to perform more physical activity. Moreover, different methods and techniques should be developed for applied science during distance education.

PMID:42251718 | DOI:10.24869/psyd.2026.53

Psychiatr Danub. 2026 Apr;38(1):23-32. doi: 10.24869/psyd.2026.23.

ABSTRACT

OBJECTIVE: The aim of this study was to compare eating disorders (EDs) symptoms, traumatic experiences, family functioning and emotional regulation between Croatian and German bulimia nervosa (BN) female patients.

METHODS: The study included a total of 192 participants; 50 Croatian BN female patients ranging from 15 to 25 years old, treated at University Hospital Center Zagreb, and 55 German BN female patients between 20 and 45 years old, treated at University Hospital Ulm. Croatian control group consisted of 50 subjects, and German control group consisted of 37 subjects that are matched with participants of clinical groups by to the essential characteristics. Participants were asked to fill out EDI-2, ETISR-SF, FAD and DERS.

RESULTS: We obtained differences between Croatian and German BN female patients in age range and in multiple clinical scales. After controlling for the age variable, we found no statistically significant difference between groups in ED symptoms on EDI-2, nor in family functioning with respect to FAD. The Croatian participants showed more traumatic experiences on the ETISR-SF (General trauma, Physical punishment) and German participants showed more difficulties with emotional regulation on DERS (Awareness), whereas higher levels of exposure to General trauma (OR=.25; 95% CI =.09-.70; p<.01) and Physical punishment (OR=.06; 95% CI=.01-.37; p<.01) increased the odds for participant to be categorized as part of the Croatian group, while lack of emotional Awareness (OR=7.07; 95% CI=1.33-37.05; p<.05) increases the odds for participant to belong to the German group.

CONCLUSIONS: The Croatian group exhibited more traumatic experiences, whereas German participants demonstrated greater lack of emotional awareness. On the whole, we found no statistically significant difference between Croatian and German BN female patients in ED symptoms as neither in family functioning.

PMID:42251713 | DOI:10.24869/psyd.2026.23

Aging Ment Health. 2026 Jun 7:1-16. doi: 10.1080/13607863.2026.2678989. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence linking residential environments to Alzheimer’s disease (AD) and mild cognitive impairment (MCI) remains limited.

METHODS: We followed 426,220 dementia-free UK Biobank participants for a median 13.6 years. Cox models evaluated associations between green, blue spaces, and natural environment (300 and 1000 m buffers) and AD/MCI risk, alongside exploratory mediation and gene-environment interactions.

RESULTS: Incident cases included 3513 AD and 864 MCI. For AD, higher green space, blue space, and natural environment within 300 m lowered risk (decreases of 5.8, 0.8, and 5.7% per IQR, respectively). At 1000 m, only green space (6.7%) and natural environment (5.7%) remained inversely associated. Blue space exhibited a non-linear AD association. For MCI, green and natural spaces consistently lowered risk across both buffers (14.9-22.2% reductions); blue space was non-significant. Analyses showed limited mediation by air pollutants and selective additive gene-environment synergy.

CONCLUSION: Higher residential green space and natural environment are observationally associated with reduced AD and MCI risks, whereas blue space associations with MCI remain inconclusive. Underlying mechanisms and exploratory gene-environment synergies require further validation.

PMID:42251690 | DOI:10.1080/13607863.2026.2678989