Category: Nevin Manimala

J Dev Orig Health Dis. 2026 Jul 23;17:e34. doi: 10.1017/S2040174426100658.

ABSTRACT

Public understanding of the Developmental Origins of Health and Disease (DOHaD) remains limited, hindering efforts to shift health behaviours and policy. Arts-based knowledge translation (ABKT) offers a promising approach to engage the public with complex health science. We evaluated the feasibility, acceptability, and impact of a multi-site exhibition co-developed by scientists, artists, and community members to convey DOHaD concepts. The Art of Creation Exhibition, shown in a mid-sized Canadian city in gallery and community settings, featured professional and community-created artworks and interactive activities. Using a parallel convergent mixed methods design, we collected and analysed observational notes, written reflections, analytics from QR codes linked to information about the artworks and DOHaD, and structured activity responses. Quantitative data were analysed using Firth-penalised logistic regression and descriptive statistics. Qualitative data underwent conventional content analysis. Findings were integrated narratively. The Exhibition was successfully installed at all sites, although space and security constraints in community settings required adaptation. 93% of observed individuals at the gallery site engaged with the exhibition, compared to 3%-17% at community sites. Gallery visitors engaged with more artworks for longer. Viewing over half of the artworks was associated with higher odds of endorsing Social Determinants of Health (SDoH) (OR = 6.63, 95% CI [1.22, 68.34]). Written and verbal feedback demonstrated increased awareness, emotional engagement, and interest in further learning. Despite some misinterpretation and low fidelity of interactive activities, the Exhibition was well received and evoked critical reflection. Using ABKT for DOHaD can enhance health literacy, foster dialogue about the SDoH, and support equitable health communication.

PMID:42489013 | DOI:10.1017/S2040174426100658

J Med Internet Res. 2026 Jul 22;28:e90289. doi: 10.2196/90289.

ABSTRACT

BACKGROUND: Chronic low back pain (CLBP) is a major global health challenge. While nonpharmacological therapies are recommended, patient compliance is often hindered by kinesiophobia. Virtual reality (VR) offers an immersive, distraction-based approach, but the comparative effectiveness of different VR modalities remains unclear.

OBJECTIVE: The aim of the study is to compare and rank the efficacy of different VR-based training modalities on pain intensity, disability, and kinesiophobia in patients with CLBP.

METHODS: Systematic searches were conducted in PubMed, Web of Science, Scopus, Embase, CINAHL, and the Cochrane Library from inception until June 2025. Randomized controlled trials (RCTs) assessing the effects of VR-based training on individuals with CLBP were selected. Primary outcomes were pain intensity, disability (Oswestry Disability Index), and kinesiophobia (Tampa Scale of Kinesiophobia). The Cochrane Risk of Bias 2 tool was used for quality assessment. Confidence in Network Meta-Analysis (CINeMA) framework was used to evaluate the credibility of cumulative evidence. A Bayesian network meta-analysis with standardized mean difference (SMD) as effect size was performed to synthesize evidence and rank interventions using surface under the cumulative ranking curve values. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework was adapted to evaluate the quality of evidence.

RESULTS: In total, 25 RCTs with a total of 2610 participants were included in the analysis. For pain intensity, shooting games (SMD -4.40, 95% credible interval [CrI] -6.80 to -2.20) and VR-based equestrian training (SMD -2.00, 95% CrI -3.70 to -0.57) were significantly superior to all types of controls. Surface under the cumulative ranking curve indicated that shooting games had the highest probability (98%) of being the most effective intervention for pain relief. For disability, no intervention demonstrated statistically significant superiority. For kinesiophobia, shooting games (SMD -3.40, 95% CrI -5.60 to -1.10) significantly outperformed traditional exercise controls. The quality of evidence ranged from very low to moderate across outcomes.

CONCLUSIONS: This first network meta-analysis to compare and rank distinct VR modalities for CLBP offers several key innovations and contributions to the field. By moving beyond aggregate VR categorizations, we provide a granular, comparative ranking of specific, actionable VR interventions. Unlike previous reviews that treated VR as a homogeneous group or only compared it to sham, our network meta-analysis directly and indirectly compares 7 distinct VR modalities, revealing that not all VR is equally effective. Our findings suggest that shooting games have the potential to be the most effective VR therapy for relieving pain intensity and kinesiophobia, though evidence for disability remains limited. Unfortunately, due to heterogeneity and low-quality evidence, there is no evidence demonstrating significant improvement in specific outcomes for patients with CLBP. More RCTs are needed to provide robust clinical evidence.

PMID:42489003 | DOI:10.2196/90289

Med J Aust. 2026 Jul;224(7):e70236. doi: 10.5694/mja2.70236.

ABSTRACT

Indigenous children are seen as an intrinsic, systematic foundation of hope in Aboriginal conceptualisations of hope, yet are grossly overrepresented in Australian suicide statistics. Despite being a target of the Australian Government’s almost 20-year-long Closing the Gap campaign, the numbers are only getting worse. ‘It’s not depression, it’s despair’ are words that echo a sentiment so ghastly for parents of Indigenous children who only hope to bestow them with the gift of exactly that: hope. It is only sensible to counteract this with holistic, culturally empowered, strengths-based well-being programs to both develop Cultural strength while concurrently instilling a sense of Cultural pride and identity.

PMID:42488985 | DOI:10.5694/mja2.70236

JMIR Res Protoc. 2026 Jul 22;15:e92825. doi: 10.2196/92825.

ABSTRACT

BACKGROUND: Cardiovascular disease remains the leading global cause of mortality, driven by interrelated behavioral, biological, and psychosocial risk factors, despite the availability of effective prevention and treatment strategies. Persistent policy inertia, systemic fragmentation, and adverse social and commercial determinants have limited national responses. Addressing these gaps necessitates place-based, systems-oriented approaches that mobilize local assets, engage multisector stakeholders, and incorporate adaptive evaluation. The Springfield Healthy Hearts initiative exemplifies such an approach by positioning Greater Springfield as a “living laboratory” for coordinated cardiovascular health action through a comprehensive data framework, providing a replicable model for other communities.

OBJECTIVE: This protocol outlines the Springfield Healthy Hearts Data Framework, a multicomponent system for dynamically guiding, implementing, and evaluating coordinated action for heart health.

METHODS: The data framework was developed through a structured co-design process involving community members, expert researchers, health professionals, and representatives from local implementation partners. The framework comprises four integrated components: (1) Project evaluation, applying pragmatic frameworks to assess coordinated action projects; (2) Community evaluation, a repeated cross-sectional evaluation of Springfield residents, workers, and regular visitors to capture individual-level behavioral, biological, and psychosocial cardiovascular disease risk factors, as well as engagement with coordinated action projects; (3) City evaluation, ongoing monitoring of suburb- and city-level indicators across 4 domains (sociodemographic characteristics, built environment, food and commercial environment, and health services); and (4) Data synthesis, to utilize data across all levels to inform a continuous learning system. Project evaluations will use both quantitative and qualitative methods, including realist evaluation where appropriate. Community evaluation will be analyzed using descriptive statistics, mixed effects models, and subgroup analyses, with missing data addressed via multiple imputation. City-level data will be analyzed descriptively and dynamically to detect temporal trends and contextual changes.

RESULTS: Initial funding for the Springfield Healthy Hearts Data Framework was secured in June 2025. Co-design workshops were conducted between November 2025 and February 2026 (n=15 participants), informing the design and prioritization of framework components. Community evaluation data collection is scheduled to commence in September 2026 and conclude in August 2027. Data cleaning and preliminary analyses are anticipated in late 2027, with first results expected to be disseminated in early 2028.

CONCLUSIONS: The Springfield Healthy Hearts Data Framework is a replicable model for other communities aiming to implement city-wide, coordinated approaches to heart health action. Findings will be disseminated through peer-reviewed publications, community reports, interactive dashboards, and policy briefs.

PMID:42488978 | DOI:10.2196/92825

J Rehabil Med. 2026 Jul 23;58:jrm46093. doi: 10.2340/jrm.v58.46093.

ABSTRACT

OBJECTIVE: To identify a 5-year medical and psychosocial vulnerability profile among adults living at home 1 year after severe TBI and examine associated early characteristics.

DESIGN: Retrospective secondary analysis of a multicentre longitudinal cohort.

SUBJECTS/PATIENTS: Adults aged 16 years or older with operationally defined severe traumatic brain injury, private residence at 1 year, linked 5-year follow-up, and complete data for 4 profile indicators.

METHODS: Latent class analysis used 5-year rehospitalization, PHQ-9, GAD-7, and Satisfaction With Life Scale scores dichotomized with prespecified clinically interpretable thresholds. External rehabilitation outcomes and early associated factors were examined descriptively and with multivariable logistic regression.

RESULTS: Among 2,835 participants, a 2-class solution identified a lower-vulnerability profile (n = 2,361) and a multidomain vulnerability profile (n = 474). The latter showed more depressive symptoms, anxiety symptoms, low life satisfaction, and rehospitalization, with poorer 5-year functioning, participation, health, productive status, and higher frequency of non-private residence. Better 1-year global outcome was protective; female sex, preinjury illicit drug use, and living alone at 1 year were associated with assignment to this profile.

CONCLUSION: Home return after severe traumatic brain injury should be treated as a transition point for longitudinal rehabilitation surveillance.

PMID:42488972 | DOI:10.2340/jrm.v58.46093

Drug Metab Pers Ther. 2026 Jul 24. doi: 10.1515/dmpt-2025-0087. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of the TNF-α promoter SNP -308G/A on therapeutic response, serum drug levels, and immunogenicity of TNF inhibitors in chronic inflammatory rheumatic diseases.

METHODS: This cross-sectional, multicentric study included 73 patients: 32 with rheumatoid arthritis (RA) and 41 with spondyloarthritis (SpA). Serum drug levels (SDL) and anti-drug antibodies (ADA) were quantified by ELISA (Promonitor^®). Genotyping for SNP -308 was performed via PCR-RFLP. Therapeutic response was assessed at 6 months using delta DAS28 and EULAR response in RA and delta BASDAI, BASDAI20 and BASDAI50 responses in SpA patients.

RESULTS: In RA, the heterozygous G/A genotype was significantly associated with a greater reduction in median DAS28 compared to G/G (p=0.039) and a higher proportion of good EULAR responders (p=0.154). In SpA, G/A carriers showed larger decreases in BASDAI scores though differences were not statistically significant. Across both diseases, the G/A genotype was associated with significantly higher median serum drug levels (p=0.032). No association was observed between SNP -308G/A and ADA positivity.

CONCLUSIONS: The TNF-α -308G/A polymorphism may be a predictive marker of TNF inhibitor efficacy in RA, potentially influencing serum drug levels while immunogenicity appears unaffected. Larger prospective studies are needed to confirm these findings and explore additional determinants of TNF inhibitor response.

PMID:42488961 | DOI:10.1515/dmpt-2025-0087

Stroke. 2026 Jul 23. doi: 10.1161/STROKEAHA.126.055939. Online ahead of print.

ABSTRACT

BACKGROUND: Health-related quality of life is a key secondary end point in stroke trials. Differential item functioning (DIF) occurs when individuals with the same underlying health-related quality of life interpret and respond differently to questionnaire items, potentially biasing treatment comparisons. This study evaluates DIF in the patient-reported 5-level EuroQOL questionnaire among patients with acute ischemic stroke across age, sex, and treatment groups.

METHODS: Data were from the AcT trial (Alteplase Compared to Tenecteplase), a registry-based randomized comparison of alteplase and tenecteplase conducted at 22 stroke centers across Canada (December 2019-January 2022). Patients with acute ischemic stroke presenting within 4.5 hours of symptom onset and eligible for thrombolysis completed the 5-level EuroQOL questionnaire at 90 days poststroke. DIF was assessed using multigroup graded response models with the Wald-based sweep procedure, which accounts for between-group differences in latent trait distributions. We quantified effect sizes using signed weighted area between curves (sWABC); |sWABC| <0.10=negligible.

RESULTS: Of 1577 patients enrolled in the trial, 1264 survived to 90 days with complete 5-level EuroQOL questionnaire data (51.2% tenecteplase; 46.5% female; 30.1% aged ≥80). Omnibus testing revealed significant DIF only for age (χ²=86.9, P<0.001); neither sex (χ²=31.7, P=0.063) nor treatment (χ²=22.4, P=0.379) showed evidence of DIF. Four items flagged for age-related DIF: self-care, usual activities, pain/discomfort, and anxiety/depression. However, only self-care (sWABC=-0.46) and usual activities (sWABC=-0.34) showed moderate effects, while pain/discomfort (sWABC=-0.002) and anxiety/depression (sWABC=0.09) were negligible. Importantly, factor scores from models with and without DIF adjustment correlated (correlation coefficient=0.98).

CONCLUSIONS: The 5-level EuroQOL questionnaire appears to function equivalently across sex and treatment groups in this stroke population. Age-related DIF, though statistically detectable in physical functioning items, had little practical consequence for individual scores, supporting the instrument’s use for health-related quality of life comparisons in stroke trials.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.

PMID:42488952 | DOI:10.1161/STROKEAHA.126.055939

Western Pac Surveill Response J. 2026 Jun 30;17(2):1-6. doi: 10.5365/wpsar.2026.17.2.1223. eCollection 2026 Apr-Jun.

ABSTRACT

OBJECTIVE: On 18 October 2022, diarrhoeal cases among the Sama Badjao indigenous community in the Philippines were reported from a tertiary hospital in Lucena City, Quezon Province. An investigation was conducted to confirm the outbreak, profile cases, identify the source of infection, and recommend prevention and control measures.

METHODS: Suspected cases were identified through medical records review, active case finding and key informant interviews. Identified cases were interviewed using a structured questionnaire to collect demographic, clinical and exposure information. Rectal swabs and environmental water samples were collected for bacterial isolation and confirmation.

RESULTS: A total of 75 cases were identified, with 40 (53.3%) hospitalized and four fatalities (case fatality rate: 5.3%). Ages ranged from 2 months to 20 years (median: 4 years). Nine of the 15 rectal swabs were positive for Vibrio cholerae Ogawa biotype El Tor. The community practised open defecation, and only 24.7% of households had basic sanitation. Although V. cholerae was not found in water samples, faecal contamination was noted in a community well, and Aeromonas species were isolated, indicating the presence of multiple gastrointestinal pathogens.

DISCUSSION: A cholera outbreak was confirmed among the Sama Badjao community in Lucena City. Environmental assessment indicated that poor sanitation, open defecation and unsafe water sources likely contributed to the outbreak. The high case fatality rate (5.3%) was influenced by delayed care and limited health-care access. These findings emphasize the need for interventions to improve water, sanitation and hygiene practices and provide culturally appropriate public health programmes to reduce cholera risk among vulnerable communities.

PMID:42488931 | PMC:PMC13389470 | DOI:10.5365/wpsar.2026.17.2.1223

Res Rep Urol. 2026 Jul 15;18:597883. doi: 10.2147/RRU.S597883. eCollection 2026.

ABSTRACT

PURPOSE: Benign Prostatic Hyperplasia (BPH) is a common non-malignant prostate enlargement that contributes to bladder outlet obstruction and lower urinary tract symptoms in men as they age.

PATIENTS AND METHODS: In this 90-day study, ninety-five men aged 45-80 years with clinically and radiologically confirmed moderate BPH [International Prostate Symptom Score (IPSS) between 8-19] were randomly allocated (1:1) to receive either Undaria pinnatifida fucoidan (UPF) or placebo. Prostate health was evaluated using the validated IPSS (total and composite sub-scores) on days 30, 60 and 90. Potential clinically meaningful IPSS reductions were assessed as Minimum Clinically Important Difference (MCID). Urinary flow rate, post-void residual volume (PVR) and prostate-specific antigen were also assessed.

RESULTS: By day 60, the UPF group showed significant improvement in total IPSS score compared to placebo (p=0.0234), with further improvements by day 90 (p=0.0015). The mean reduction in total IPSS score from baseline to day 90 was -3.40 in the UPF group versus -0.93 in the placebo group. Voiding (p=0.0006) and storage (p=0.0150), sub-scores improved significantly by day 90 in the UPF group. Quality of life related to urinary symptoms improved continuously by day 60 and 90 (both p<0.05 vs placebo). A higher proportion of UPF-treated participants achieved MCID ≥2 (60.0%) and ≥3 points (51.1%) compared to placebo (42.2% and 28.9%), with statistical significance for ≥3 points (p=0.0314) at day 90. Urinary flow rate improved and PVR decreased in both groups; however, between-group differences, including PSA, were not statistically significant. Importantly, UPF was well tolerated.

CONCLUSION: UPF supplementation was associated with statistically and clinically significant IPSS improvement, including voiding and storage composite scores, and enhanced prostate-related quality of life when compared to placebo. Secondary outcomes did not differ significantly between groups, and the duration (90 days) limits long-term interpretation. UPF appears safe and potentially beneficial for managing moderate BPH symptoms.

PMID:42488927 | PMC:PMC13389963 | DOI:10.2147/RRU.S597883

Plast Reconstr Surg Glob Open. 2026 Jul 22;14(7):e7907. doi: 10.1097/GOX.0000000000007907. eCollection 2026 Jul.

ABSTRACT

SUMMARY: Dercum’s disease is a rare, incurable condition characterized by painful lipomas distributed throughout the body for which there is no standard care protocol. Current treatment focuses on pain control through medication and surgical intervention. However, available management options only provide temporary relief. This practical review aims to condense the available therapeutic approaches for Dercum’s disease.

METHODS: A literature review was conducted on multiple online databases to identify articles published between 1976 and 2025. Keywords included “Dercum’s disease,” “adiposis dolorosa,” and “treatment.” This search yielded 5 novel therapies to treat symptoms of Dercum’s disease.

RESULTS: Infliximab, which is traditionally used as an autoimmune medication targeting tumor necrosis factor alpha showed a visual reduction in lipoma size, as well as an improvement in subjective pain grading. Deoxycholic acid (DCA) is a bile acid found naturally in the body that helps to emulsify fat in the intestines. Subcutaneous injection of DCA resulted in both an objective lowering of pain and decreased size of lipomas. CBL-514 is a first-in-class small-molecule inhibitor that induces apoptosis in adipose tissue. It is currently in phase 2 clinical trials and has yielded statistically significant reduction in lipoma size resulting in it receiving Fast Track distinction from the Food & Drug Administration.

CONCLUSIONS: Current management of Dercum’s disease revolves around medications and surgical intervention, which provide transient results and can be limited in certain populations. Novel studies are looking into off-target therapy options with the goal of presenting long-term treatment choices for clinicians to enhance management of this debilitating disease.

PMID:42488923 | PMC:PMC13391129 | DOI:10.1097/GOX.0000000000007907