Category: Nevin Manimala

BJOG. 2026 Mar 13. doi: 10.1111/1471-0528.70217. Online ahead of print.

NO ABSTRACT

PMID:41822966 | DOI:10.1111/1471-0528.70217

Stroke. 2026 Mar 13. doi: 10.1161/STROKEAHA.125.053711. Online ahead of print.

ABSTRACT

BACKGROUND: Timely identification and treatment of acute ischemic stroke (AIS) in the emergency department is imperative. We sought to report the change over time in emergency department-based AIS treatment in a community without an academic medical center through a mixed-methods approach.

METHODS: As part of the longitudinal population-based BASIC (Brain Attack Surveillance in Corpus Christi) project, Nueces County residents 45+ years old with AIS treated in an emergency department were identified, excluding patients with in-hospital events. Logistic regression was used to model changes over time from 2012 to 2022, treating time continuously, for the binary outcomes National Institutes of Health Stroke Scale score documentation, transfer to an out-of-area facility, thrombolytic (tPA/TNK [tissue-type plasminogen activator/tenecteplase]) utilization, and arrival method. Trends for neurology consults and telestroke consults were evaluated from 2015 to 2022 based on data availability. Logistic regression models accounted for subject repeated measures and within-hospital clustering. Rapid qualitative analysis procedures were used to analyze semistructured interviews of emergency medicine (EM) physicians.

RESULTS: A total of 5388 strokes were included. National Institutes of Health Stroke Scale documentation by provider increased by 12.9% (95% CI, 0.057-0.202). The overall proportion of neurology consultation increased by 26% (95% CI, 0.159-0.360). Among these, the proportion of telestroke consults increased by 34.2% (95% CI, 0.218-0.465). Patient transfer to an out-of-area facility saw a peak around 2020 (3.2%) that declined by 2022 (0.0%). tPA/TNK treatment increased by 5.5%, but was not statistically significant (95% CI, -0.006 to 0.116). Arrival to the emergency department by emergency medical services decreased by 9.4% (95% CI, -0.181 to -0.007). Fifty-two practicing emergency medicine physicians in Nueces County were recruited via email between April and October 2024, yielding 18 interviews. Participants described improved organization of stroke care and confidence in treating AIS.

CONCLUSIONS: There have been positive changes in AIS treatment from the emergency medicine perspective, suggesting the success of assertive treatment protocols in this real-world community.

PMID:41822963 | DOI:10.1161/STROKEAHA.125.053711

Int J Gynaecol Obstet. 2026 Mar 13. doi: 10.1002/ijgo.70905. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the impact of potentially life-threatening maternal conditions (PLTCs) on functional disability at 6 months postpartum.

METHODS: This prospective cohort study was done at 10 hospitals in Tigray, northern Ethiopia. A total of 1027 postpartum women (341 with PLTCs and 686 without) were enrolled into the exposed and the unexposed groups, respectively. Disability status was assessed using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Data were collected through interviews and card reviews. Statistical analyses were performed using Pearson’s chi-square and Mann-Whitney for bivariate analyses. Due to the non-parametric distribution of the outcome and the covariate (baseline WHODAS 2.0) data, we used non-parametric analysis of covariance (ANCOVA) to assess WHODAS 2.0 score differences between the groups at 6 months postpartum, adjusting for baseline WHODAS 2.0 scores and other covariates.

RESULTS: Among 1027 participants, 997 (97%) completed the 6-month follow-up. Women with PLTCs had significantly higher median WHODAS 2.0 scores (25.0 vs. 9.4, P < 0.001; effect size = 0.34) and increased disability levels across all domains (P < 0.001). The non-parametric ANCOVA showed that PLTC had a significant independent effect (partial eta-squared (η²p) = 0.043, P < 0.001) after adjusting for confounders (demographic and clinical variables).

CONCLUSION: Women who experienced PLTCs had significantly higher functional disability than those who did not at 6 months postpartum. The effects of PLTCs extend beyond the conventional 6-week postpartum period. Establishing new mechanisms for long-term maternal health follow-up is essential to address ongoing functional disability.

PMID:41822956 | DOI:10.1002/ijgo.70905

HIV Med. 2026 Mar 13. doi: 10.1111/hiv.70221. Online ahead of print.

ABSTRACT

BACKGROUND: HIV remains a major global burden, with 2.4 million children and adolescents affected, 84% living in sub-Saharan Africa. As adolescents age, transitioning from paediatric to adult HIV care represents a critical period that may significantly affect antiretroviral therapy (ART) adherence, retention in care and virological suppression. A systematic evaluation of evidence from sub-Saharan Africa is essential to quantify the effects of healthcare transition on virological outcomes, especially viral suppression.

METHODS: We systematically searched three electronic databases: PubMed, Scopus and Embase for studies published between January 1, 2015, and March 5, 2025, using keywords HIV, adolescents, transition to adult care and virological outcome. A narrative synthesis was used to summarize the findings, and meta-analyses were conducted using random-effects models to estimate pooled proportions with corresponding 95% confidence intervals. Heterogeneity between studies was quantified using the I² statistic, and potential sources of variability were explored through subgroup analyses based on study characteristics. The risk of bias for the included studies was assessed according to the study design using the Newcastle-Ottawa Scale. This review was registered with PROSPERO (CRD420251005361).

RESULTS: The systematic search identified 1324 articles, of which 8 met the predefined inclusion criteria and were included in the final analysis. These studies consisted of 13 819 adolescents and young adults aged between 10 and 26 years. The pooled proportions of viral suppression were 75% (95% confidence interval [CI]: 68%-81%, I²: 89.2%, p < 0.0001) before transition and 67% (95% CI: 44%-84%, I²: 95.7%, p < 0.0001) after transition.

CONCLUSION: There is a decline in viral suppression following the transition from paediatric to adult HIV care in sub-Saharan Africa, indicating the need for targeted strategies to sustain suppression post-transition. Future large-scale longitudinal studies should use standardized transition age definitions, consistent follow-up durations and uniform virological suppression thresholds to ensure robust and comparable evidence.

PMID:41822955 | DOI:10.1111/hiv.70221

J Appl Res Intellect Disabil. 2026 Mar;39(2):e70213. doi: 10.1111/jar.70213.

ABSTRACT

BACKGROUND: The study is based on the Dual Pathway to Creativity Model and explores the relationship between inhibitory control and creativity in children with mild intellectual disabilities.

METHOD: The sample consisted of 58 children with mild intellectual disabilities. Inhibitory control, fluency, and originality were assessed using the Day-Night Stroop Test and the Alternative Uses Test.

RESULTS: Overall, participants demonstrated moderate fluency (M = 6.55, SD = 3.10), while their originality scores were lower (M = 1.44, SD = 1.32). Correlation analysis indicated that faster responses on the second part of the Stroop test were negatively associated with fluency (r = -0.30, p < 0.05), whereas the association with originality did not reach statistical significance (r = -0.24, p > 0.05).

CONCLUSIONS: Efficient inhibitory control linked to higher fluency supports the Dual Pathway to Creativity Model, emphasizing the balance between inhibition and cognitive flexibility in children with mild intellectual disabilities.

PMID:41822942 | DOI:10.1111/jar.70213

Front Public Health. 2026 Feb 25;14:1753377. doi: 10.3389/fpubh.2026.1753377. eCollection 2026.

ABSTRACT

PURPOSE: This study aimed to characterize the epidemiological features, management, and outcomes of acute poisoning among adolescents in Beijing and surrounding areas to guide targeted prevention and clinical intervention.

METHODS: A retrospective cohort study was conducted among adolescents (aged 11-18 years) admitted for acute poisoning to the emergency or pediatric department of a tertiary toxicological referral center in Beijing between January 2021 and December 2023. Data on demographics, exposure characteristics, toxic agents, treatments, and clinical outcomes were collected and analyzed.

RESULTS: Among the 915 included cases, there was a significant female predominance (72.5%). Intentional self-harm accounted for the vast majority of incidents (94.5%), with oral ingestion being the primary route (99.5%). A high prevalence of preexisting psychiatric disorders was observed (60.1%). Pharmaceutical poisoning was the most common type (78.1%), followed by pesticides (12.5%). Common interventions included gastrointestinal decontamination (55.7%), extracorporeal elimination (22.3%), and antidote administration (3.1%). While most cases resulted in favorable outcomes (98.7%), adverse outcomes occurred in 1.3% of cases and were primarily associated with herbicide exposure. Logistic regression identified younger age, prehospital interventions, preexisting neuropsychiatric disorders, pesticide exposure, multi-agent mixed exposures, industrial chemical poisoning, and intentional self-harm as significant predictors of hospitalization.

CONCLUSION: The findings underscore the critical importance of strengthening mental health support for adolescents and implementing stricter controls on the accessibility of psychotropic medications and highly toxic pesticides.

PMID:41822940 | PMC:PMC12975731 | DOI:10.3389/fpubh.2026.1753377

Front Public Health. 2026 Feb 25;14:1776878. doi: 10.3389/fpubh.2026.1776878. eCollection 2026.

ABSTRACT

BACKGROUND: Early unplanned readmission is a key quality indicator in Diagnosis-Related Groups (DRG)-based payment systems. Despite China’s rapid expansion of DRG reform, evidence on hospital-wide predictors of 30-day readmission using large-scale real-world data from tertiary hospitals remains limited. This study developed and evaluated a DRG-based logistic regression model for predicting 30-day readmission.

METHODS: We conducted a single-center retrospective study using administrative hospitalization data from a high-volume tertiary hospital in Shanghai, China. We extracted 65,215 inpatient episodes from the hospital (January 2023-December 2024). After excluding discharges in December 2024 due to incomplete follow-up (n = 3,109), 62,106 admissions were retained to estimate the overall readmission rate. For multivariable modeling, 21 additional cases with missing DRG variables were removed, yielding 62,085 complete observations. Predictors included age, length of stay, total cost, discharge year, and major DRG categories. Total hospital cost was modeled in its original unit (1 Chinese Yuan) to preserve the raw scale of administrative reporting; however, for interpretation, marginal effects per 1,000 CNY increase were also calculated. Model performance was evaluated using the area under the ROC curve (AUC), Brier score, Hosmer-Lemeshow test, and a decile-based calibration plot.

RESULTS: The 30-day readmission rate was 13.0%. In unadjusted comparisons, patients who were readmitted had shorter median hospital stays (3 vs. 4 days) and lower total costs. After multivariable adjustment, longer length of stay was associated with increased readmission risk (OR 1.016 per day, p < 0.001), while total cost showed a statistically significant but small association (p = 0.003). Age and discharge year were not significant predictors. DRG major categories had a strong overall association (global p < 0.001). The model showed moderate-to-good discrimination (AUC = 0.743) and acceptable overall accuracy (Brier score = 0.098), with visually adequate calibration despite a statistically significant Hosmer-Lemeshow test.

CONCLUSION: Using comprehensive DRG-based real-world data, we developed an interpretable prediction model for 30-day readmission with moderate-to-good discrimination and acceptable calibration. Clinical case-mix captured by DRG categories and patient-level complexity reflected by longer length of stay were key determinants of early readmission. The model may support risk stratification, quality improvement, and performance monitoring in DRG payment environments. The findings may also inform policy discussions on aligning DRG efficiency incentives with patient safety outcomes.

PMID:41822939 | PMC:PMC12975921 | DOI:10.3389/fpubh.2026.1776878

Front Public Health. 2026 Feb 25;14:1777051. doi: 10.3389/fpubh.2026.1777051. eCollection 2026.

ABSTRACT

IMPORTANCE: Global reports suggest declining sperm quality, but data from Asian populations under standardized conditions are limited. Investigating trends in China is critical for understanding modifiable factors affecting male fertility.

OBJECTIVE: To assess decade-long trends in semen quality among healthy Chinese men and evaluate associations with environmental factors. Design, Setting, and Participants: Retrospective cohort analysis of 5,886 semen samples from healthy sperm donors (aged 20-45 years) recruited between 2011 and 2018 at the Beijing Human Sperm Bank. All procedures adhered strictly to WHO 5th Edition laboratory standards. Main Outcomes and Measures: Annual trends in semen volume, sperm concentration (SC), total sperm count (TSC), progressive motility (PR), total motility (PR + NP), and percentage of progressive motility (PPR). Associations between semen parameters and environmental pollutants (SO₂, NO₂, PM10, PM2.5, waterborne PI/AN) were evaluated using Spearman correlation.

RESULTS: From 2011 to 2018, significant improvements occurred across key parameters: SC increased by 12.3% (78-96.5 × 10⁶/mL; p < 0.05 in 2013, 2018); TSC increased by 18.7% (200-283.5 × 10⁶/ejaculate; p < 0.05 from 2014 to 2017); PR and PPR also significantly improved (p < 0.05 in multiple years). Negative correlations were observed between pollutants and semen quality: SO₂, NO₂, and PM10 inversely correlated with TSC (ρ = -0.719 to -0.929; p ≤ 0.045) and PPR (ρ = -0.826 to -0.922; p ≤ 0.011). Water pollutants (PI, AN) similarly correlated with reduced semen volume, TSC, and motility (ρ = -0.735 to -0.878; p ≤ 0.038).

CONCLUSIONS AND RELEVANCE: Contrary to global declines, semen quality significantly improved among healthy Beijing donors from 2011 to 2018. This improvement coincided with aggressive environmental policies (e.g., China’s 2013-2017 Air Pollution Action Plan), suggesting pollution-related sperm damage may be reversible with targeted interventions.

PMID:41822938 | PMC:PMC12975964 | DOI:10.3389/fpubh.2026.1777051

Front Public Health. 2026 Feb 25;14:1763697. doi: 10.3389/fpubh.2026.1763697. eCollection 2026.

ABSTRACT

PURPOSE: This study aimed to examine the level of fall risk and its associations with fall awareness and social support among community-dwelling older adults with functional limitations.

METHODS: A cross-sectional study was conducted from January to October 2025. Using cluster sampling, 825 older adults with functional limitations were recruited from four communities in Chengdu, China. Fall risk was assessed using the Modified Falls Risk for Older People in the Community Assessment (MFROP-com), fall awareness was measured with the Self-awareness of Falls in Elderly Scale (SAFE), and social support was evaluated via the Social Support Rating Scale (SSRS). Data were analyzed using Pearson correlation and multiple linear regression.

RESULTS: Participants exhibited a high fall risk (mean score 26.51 ± 10.95). The regression model explained a significant proportion of variance in fall risk (Adjusted R ² = 0.536, p < 0.001). Higher fall awareness (B = -0.463, β = -0.565, p < 0.001) and greater social support (B = -0.422, β = -0.190, p < 0.001) were independent predictors of lower fall risk. Advanced age, unmarried, living alone, and having sleep disorders were associated with increased risk (p < 0.05).

CONCLUSION: Fall awareness and social support were identified as key modifiable factors associated with reduced fall risk among community-dwelling older adults with functional limitations. Fall prevention programs should focus on enhancing risk perception and strengthening social support networks for this population.

PMID:41822936 | PMC:PMC12975942 | DOI:10.3389/fpubh.2026.1763697

Front Public Health. 2026 Feb 25;14:1773690. doi: 10.3389/fpubh.2026.1773690. eCollection 2026.

ABSTRACT

Sex workers experience disproportionately high rates of depression, anxiety, PTSD, suicidality, dissociation, and substance use across global contexts. Sex work refers to the consensual exchange of sexual services, performances, or content for compensation; debates persist regarding the impact of coercion and constraint within sex work, particularly in relation to structural and economic pressures. This mini-review synthesizes research on the structural, social, and occupational determinants of sex workers’ mental health, emphasizing how legal frameworks, work venues, stigma, and interpersonal dynamics shape psychological outcomes. Sex work occurs across indoor, outdoor, and digital settings, with workers often moving fluidly between contexts; mental health risk consistently increases in criminalized environments and in settings characterized by reduced safety and autonomy. Drawing on Goffman’s stigma framework, the review examines external and internalized stigma as central mechanisms linking criminalization, discrimination, and healthcare avoidance to psychological distress, with compounded effects for LGBTQIA+ and BIPOC sex workers. Particular attention is given to masculine sexual entitlement as a proximal interpersonal stressor strongly predictive of PTSD symptoms. Across studies, violence exposure, poverty, early entry into sex work, and low workplace control are associated with elevated mental health burden, whereas peer and community networks function as robust protective factors that enhance safety, autonomy, and access to care. Implications include sex work-affirming, trauma-informed clinical care and community-partnered research.

PMID:41822935 | PMC:PMC12978257 | DOI:10.3389/fpubh.2026.1773690