Category: Nevin Manimala

J Formos Med Assoc. 2026 Mar 17:S0929-6646(26)00170-1. doi: 10.1016/j.jfma.2026.03.017. Online ahead of print.

ABSTRACT

BACKGROUND: In Taiwan, prolonged mechanical ventilation (PMV) has long imposed a substantial burden on healthcare systems, characterized by high ICU occupancy and escalating costs. To address these challenges, an Integrated Delivery System for PMV patients (PMV-IDS) was implemented in 2000, featuring stepwise care and payment reform. This study aimed to examine longitudinal trends in clinical outcomes and national health indicators associated with the PMV-IDS program.

METHODS: In this retrospective, longitudinal, population-based study, we analyzed aggregate data from patients receiving mechanical ventilation between 2005 and 2023, sourced from the Ministry of Health and Welfare and the National Health Insurance Administration. Patients ventilated for ≥21 consecutive days were defined as PMV; those ventilated for >63 days were considered ventilator-dependent. Trends in weaning success, mortality, ICU resource utilization, and healthcare expenditures were assessed using descriptive statistics and linear regression.

RESULTS: From 2005 to 2022, newly ventilated patients increased by 15%. The proportion receiving prolonged ventilation (>63 days) decreased from 24% to 15%, and mortality declined from 25% to 18%. The weaning success rate within 21 ventilator days reached 70% in 2022. Mean ICU days decreased, and RCC occupancy stabilized after 2015. Home-based ventilator care increased from 3500 in 2013 to 4700 in 2023. Medical expenditures rose from 25.1 to 30.6 billion points.

CONCLUSIONS: This study describes epidemiological trends and associated healthcare utilization among patients receiving long-term mechanical ventilation under Taiwan’s PMV-IDS framework. These findings provide a descriptive benchmark for this population. Given data limitations, future studies are warranted to refine these observations.

PMID:41850921 | DOI:10.1016/j.jfma.2026.03.017

Stat Med. 2026 Mar;45(6-7):e70352. doi: 10.1002/sim.70352.

ABSTRACT

Systematic review and meta-analysis are widely accepted approaches for evaluating treatment effectiveness. Meta-analysis generally addresses statistical aspects of systematic reviews, such as the pooling of treatment effect sizes, assessment of heterogeneity, and statistical inference. To complement treatment effectiveness, cost-effectiveness is often conducted to encompass both clinical and economic perspectives. However, there are few statistical methods proposed for meta-analyses of cost-effectiveness, and none is used widely. In fact, meta-analysis is currently not encouraged for cost-effectiveness due to methodological and statistical complexities. In this paper, we propose simple meta-analytic methods for cost-effectiveness, which may serve as a starting point for future work. We illustrate the methods using two examples from systematic reviews on wound interventions and mental illness.

PMID:41850900 | DOI:10.1002/sim.70352

Low Urin Tract Symptoms. 2026 Mar;18(2):e70055. doi: 10.1111/luts.70055.

ABSTRACT

OBJECTIVES: Urinary incontinence (UI) in the first 3 months after robot-assisted radical prostatectomy (RARP) frequently impairs work performance, yet its quantitative impact on presenteeism remains unclear. This prospective cohort study longitudinally evaluated how early postoperative UI influences presenteeism among employed Japanese men undergoing RARP.

METHODS: We consecutively enrolled 92 employed male patients scheduled for RARP and assessed them preoperatively, at discharge, and at 1- (PS-1) and 3-month (PS-3) post-surgery. Outcomes were the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), WHO Health and Work Performance Questionnaire (HPQ)-Presenteeism Scale, King’s Health Questionnaire (KHQ), and Kessler Psychological Distress Scale (K6).

RESULTS: Of the 92 eligible participants, 85 (92.4%) completed the PS-1 and 80 (87.0%) completed the PS-3 assessment. Median ICIQ-SF total scores increased from 0 (IQR 0-2) preoperatively to 9 (6-12) at PS-1, remaining elevated at 7 (4-10) at PS-3 (p < 0.001). Mean HPQ-presenteeism declined from 81.4% ± 13.9% preoperatively to 64.9% ± 18.8% at PS-1, partially recovering to 75.3% ± 16.1% at PS-3 (p < 0.001). At PS-1, UI impact on daily life (ρ = -0.45) and ICIQ-SF total (ρ = -0.43) were moderately associated with lower presenteeism; at PS-3, correlations persisted and extended to multiple KHQ subscales (ρ = -0.41 to -0.53).

CONCLUSIONS: Early postoperative UI after RARP produces a clinically meaningful reduction in work productivity, greatest at PS-1 and still evident at PS-3. Targeted continence care and occupational support during this window may mitigate productivity loss and facilitate sustainable return to work.

PMID:41850893 | DOI:10.1111/luts.70055

J Prosthodont Res. 2026 Mar 18. doi: 10.2186/jpr.JPR_D_25_00209. Online ahead of print.

ABSTRACT

PURPOSE: Commercially pure titanium (CP-Ti) is ideal for removable partial denture (RPD) frameworks owing to its biocompatibility and corrosion resistance; however, conventional casting can introduce defects and dimensional errors. This study compared the shape accuracy, surface roughness, microstructure, and internal pores of CP-Ti RPD frameworks prepared using four CAD-CAM fabrication methods: (1) Ti-resin: casting from a three-dimensional (3D)-printed resin pattern; (2) Ti-wax: casting from a milled wax pattern; (3) Ti-milling: direct milling from a CP-Ti disc; and (4) Ti-SLM: selective laser melting.

METHODS: Forty frameworks were prepared for each group (N = 10). Shape accuracy was assessed using 3D data-inspection software, surface roughness was analyzed using laser microscopy, the microstructure was determined using X-ray diffraction, and internal pores were examined using micro-computed tomography. Nonparametric statistics (Kruskal-Wallis and Steel-Dwass tests) were used (P < 0.05).

RESULTS: Ti-SLM achieved the highest trueness (median: 0.00 mm; IQR: 0.09 mm) and precision (median: 0.01 mm; IQR: 0.02 mm), while Ti-milling yielded the lowest surface roughness (median arithmetic mean height: 0.61 µm; IQR: 0.05 µm). Internal pores were absent in Ti-milling and minimal in Ti-SLM (0-1), whereas Ti-resin and Ti-wax produced 319 and 171 pores (median), respectively. Significant inter-method differences were found in shape accuracy, surface roughness, and pore counts (P < 0.05).

CONCLUSIONS: The fabrication method affected the dimensional accuracy, surface conditions, crystalline features, and internal pores of the CP-Ti frameworks. Ti-milling and Ti-SLM outperformed the casting-based methods (Ti-resin and Ti-wax) in terms of accuracy and defect reduction. These digital approaches may improve the reproducibility and precision of clinical fabrication of CP-Ti RPD frameworks.

PMID:41850866 | DOI:10.2186/jpr.JPR_D_25_00209

J Prosthodont Res. 2026 Mar 18. doi: 10.2186/jpr.JPR_D_25_00115. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the current systematic review was to compare the internal fit of lithium disilicate crowns, fabricated using conventional heat-pressing versus CAD-CAM milling techniques.

STUDY SELECTION: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library up to December 2025, following PRISMA guidelines and registered in the Open Science Framework. Eleven studies met the inclusion criteria (nine in vitro studies and two clinical trials), of which nine were included in the quantitative synthesis.

RESULTS: The random-effects meta-analysis demonstrated no statistically significant difference in internal fit between heat-pressed and CAD-CAM-milled crowns, although substantial heterogeneity was observed (I²=95%). Sensitivity analysis excluding five methodologically heterogeneous studies revealed a statistically significant pooled effect favoring heat-pressed crowns (MD=-18.92 μm; 95% CI: -29.77 to -8.07; P = 0.008), with markedly reduced heterogeneity (I²=19%). Subgroup analysis suggested that elastomeric impressions may be associated with better internal fit compared with digital workflows, although heterogeneity remained high.

CONCLUSIONS: The current evidence does not demonstrate a consistent difference in internal fit between heat-pressed and CAD-CAM-milled lithium disilicate crowns. Further well-designed, standardized clinical studies are needed to confirm these findings.

PMID:41850865 | DOI:10.2186/jpr.JPR_D_25_00115

J Oral Sci. 2026 Mar 17. doi: 10.2334/josnusd.25-0425. Online ahead of print.

ABSTRACT

PURPOSE: Teachers frequently serve as primary first responders when traumatic dental injuries (TDIs) occur in schools. Immediate management is critical for prognosis, particularly in avulsion cases. This study aimed to assess preschool and primary school teachers’ knowledge of emergency TDI management and their awareness of the ToothSOS mobile application, a resource providing evidence-based guidance.

METHODS: A descriptive cross-sectional study was conducted among 427 preschool and primary school teachers in Turkey between May and June 2025. An online questionnaire, based on international guidelines and validated by expert review, collected data on demographics, TDI management knowledge, and ToothSOS awareness. Statistical analyses were performed using non-parametric tests (P < 0.05).

RESULTS: The median knowledge score was 3 (range: 0-8). Few teachers correctly identified immediate replantation or storage in milk as appropriate actions for avulsed permanent teeth. Although awareness of the ToothSOS was extremely low, over half of the participants expressed willingness to use it. Significantly higher knowledge scores were observed among teachers with prior trauma education.

CONCLUSION: Teachers demonstrated insufficient knowledge of emergency management of TDIs and limited awareness of digital support tools. Incorporating structured trauma education and accessible educational technologies into teacher training may support teachers’ preparedness and decision-making in dental trauma emergencies.

PMID:41850852 | DOI:10.2334/josnusd.25-0425

Child Care Health Dev. 2026 Mar;52(2):e70260. doi: 10.1111/cch.70260.

ABSTRACT

INTRODUCTION: Although the increased risks of child labour and parental discipline on children’s psychosocial functioning are well-documented in various settings, there is a paucity of data addressing these associations in Laos. This research aims to investigate the prevalence of child labour and parental discipline and their potential associations with psychosocial difficulties among children and adolescents aged 5-14 years.

METHODS: This study employed data from the 2023 Laos Multiple Indicator Cluster Survey (MICS), a nationally representative cross-sectional dataset. Multivariable binary logistic regression analyses were conducted to examine the associations between child labour, child discipline and different categories of psychosocial functioning difficulties. Adjusted odds ratios were estimated controlling for potential confounders, including children’s age, mother’s education, sex, residential area, wealth index and ethnicity.

RESULTS: A considerable proportion of children and adolescents experienced disciplinary practices, with 73.8% exposed to nonviolent forms and 65.6% to violent disciplinary methods. Overall, 15.8% of children were identified as having at least one psychosocial functioning difficulty. Engagement in child labour was significantly associated with five out of 10 psychosocial difficulties (aORs: 1.28-3.75; 95% CIs: 1.05-5.26; p-values < 0.02). Non-violent discipline was significantly associated with seven out of 10 psychosocial functioning difficulties (aORs: 1.72-2.68; 95% CIs: 1.03-4.30; p-values < 0.02). Additionally, exposure to psychological aggression was significantly associated with impairments in seven out of 10 psychosocial domains (aORs: 1.49-2.16; 95% CIs: 1.11-3.06; p-values < 0.02). Moderate physical aggression was significantly associated with four out of 10 psychosocial difficulties (aORs: 1.49-1.83; 95% CIs: 1.12-2.81; p-values < 0.01), while severe physical punishment was significantly associated with severity in four out of 10 domains (aORs: 1.48-1.59; 95% CIs: 1.02-2.29; p-values < 0.02).

CONCLUSIONS: The findings highlight strong associations between exposure to psychological and physical disciplinary practices, as well as child labour, and a wide range of psychosocial functioning difficulties among children and adolescents. These results underscore the urgent need for interventions aimed at reducing harmful disciplinary practices and child labour to support children’s well-being.

PMID:41850791 | DOI:10.1111/cch.70260

BMJ Mil Health. 2026 Mar 18:e003244. doi: 10.1136/military-2025-003244. Online ahead of print.

NO ABSTRACT

PMID:41850789 | DOI:10.1136/military-2025-003244

Thorax. 2026 Mar 18:thorax-2025-224263. doi: 10.1136/thorax-2025-224263. Online ahead of print.

ABSTRACT

BACKGROUND: Ventilator-free days (VFDs), a composite endpoint combining survival and mechanical ventilation duration, are increasingly used in acute respiratory distress syndrome (ARDS) trials to capture patient-centred outcomes beyond mortality. However, its interpretation and analysis are challenged by methodological limitations of conventional statistical methods. This study aims to investigate the interpretability and statistical performance of the hierarchical VFDs compared with the conventional versions for ARDS-related trials.

METHODS: We applied a hierarchical composite endpoint framework, incorporating mortality and ventilation duration prioritised in sequence, to reconstruct VFDs censored at 28 days. Using the win ratio method, we carried out a post hoc analysis based on data from 10 high-quality randomised controlled trials and conducted simulation studies to assess its statistical performance.

RESULTS: Analysis revealed bimodal VFD distributions across trials, with peaks near zero and around 18-20 days. The win ratio method detected all the significant treatment effects that were identified by conventional analyses. Simulation studies suggested that the win ratio demonstrated greater statistical power, particularly when mortality was the primary driver of treatment effect, outperforming traditional methods.

CONCLUSIONS: The hierarchical VFDs endpoint, analysed using win statistics, provides a more sensitive and interpretable approach by distinguishing the contribution of mortality and ventilation duration components to the overall treatment effect in ARDS trials compared to the conventional approach.

PMID:41850776 | DOI:10.1136/thorax-2025-224263

J Epidemiol Community Health. 2026 Mar 18:jech-2025-224810. doi: 10.1136/jech-2025-224810. Online ahead of print.

ABSTRACT

INTRODUCTION: Accumulation of advanced glycation end products, measured by skin autofluorescence (SAF), has been shown to be associated with several chronic non-communicable diseases, particularly cardiovascular diseases (CVDs). The promotion of physical activity (PA) as a strategy for the prevention of CVD by modifying healthy habits has been widely studied.

AIM: To assess the evidence for the association between PA and SAF in the general adult population.

METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Synthesis Without Meta-analysis framework. A search was performed in MEDLINE (via PubMed), Web of Science, Scopus, Cochrane Library and SportDiscuss (via EBSCOhost), from inception to September 2024. Study quality was assessed using the National Heart, Lung and Blood Institute tools and the certainty of evidence was evaluated with Grading of Recommendations, Assessment Development and Evaluation. Vote counting based on the direction of effect was used as the standardised synthesis metric.

RESULTS: In the systematic review, 17 studies were included. The qualitative synthesis showed a predominant consistency in favour of a beneficial association. Specifically, 58.8% of the studies reported a statistically significant inverse association, indicating that higher levels of PA or exercise frequency are correlated with lower SAF levels. The remaining studies (41.2%) reported non-significant results, though several showed favourable trends. No studies reported a positive association between PA and SAF. The quality of the studies was generally fair, and the certainty of evidence low.

CONCLUSIONS: PA is inversely associated with SAF. Therefore, while causality cannot be proven, it is hypothesised that PA may reduce SAF and thus have a positive impact on health.

PMID:41850762 | DOI:10.1136/jech-2025-224810