Category: Nevin Manimala

Breast. 2026 Jan 27;86:104703. doi: 10.1016/j.breast.2026.104703. Online ahead of print.

ABSTRACT

BACKGROUND: CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) represent the standard of care for hormone receptor-positive, HER2-negative (HR+/HER2-) metastatic breast cancer (MBC) patients. However, no head-to-head randomized trials have directly compared palbociclib, ribociclib, and abemaciclib. Moreover, predictive biomarkers of resistance to CDK4/6i remain largely undefined. This study aimed to evaluate circulating tumor DNA (ctDNA)-based epigenetic and fragmentomic biomarkers as potential predictors of response and resistance in patients receiving CDK4/6i.

METHODS: We conducted a biomarker-driven analysis within the prospective, multicenter MAGNETIC.1 study, enrolling 149 patients with HR+/HER2- MBC treated with first-line endocrine therapy and a CDK4/6 inhibitor. Plasma samples were collected at baseline and during treatment (3 and 6 months). Droplet digital PCR was used to assess ESR1 promoter methylation and ACTB fragmentomic profiles. Progression-free survival (PFS) and overall survival (OS) were evaluated, and molecular dynamics were compared between treatment groups.

RESULTS: After a median follow-up of 34.8 months, no statistically significant differences in PFS or OS were observed between ribociclib and palbociclib treated patients, although ribociclib was associated with numerically longer PFS and higher survival rates. At the molecular level, palbociclib treatment was characterized by transient increases in ESR1 promoter methylation at the first evaluation and a rebound in ACTB_short fragment levels at six months relative to baseline. These dynamic patterns were not observed among patients receiving ribociclib.

CONCLUSIONS: ctDNA-based methylation and fragmentomic profiling revealed exploratory, treatment specific molecular dynamics, highlighting biological differences between CDK4/6 inhibitors. These findings support the feasibility of liquid biopsy-based biomarker studies in this setting, although their potential clinical relevance remains preliminary and requires validation in larger cohorts with earlier and more granular on-treatment timepoints.

PMID:41650543 | DOI:10.1016/j.breast.2026.104703

Res Dev Disabil. 2026 Feb 5;170:105241. doi: 10.1016/j.ridd.2026.105241. Online ahead of print.

ABSTRACT

Hyperfocus-an intense, uncontrollable state of attention-has gained attention for its dual adaptive and maladaptive outcomes and its potential role in gaming experience. Although distinguishing hyperfocus from flow during gameplay may be challenging, their predictive factors (e.g., escapism motivation) and consequences (e.g., burnout, self-efficacy) may differentiate the two constructs. However, the distinction between hyperfocus and flow in gaming contexts – particularly regarding their psychological outcomes and statistical predictors – remains insufficiently understood. The aims of this study were to a) establish possible differences in hyperfocus and flow as potential predictors of negative (cognitive, emotional burnout) and positive (self-efficacy) psychological outcomes among adult video gamers with ADHD traits, and b) compare these outcomes between individuals with a formal ADHD diagnosis and with an ADHD self-diagnosis. Data from 310 participants with ADHD traits were analyzed. First, an exploratory correlation analysis was conducted. Then, the relationships between hyperfocus, flow, escapism motivation, self-efficacy, and burnout were compared between persons with a formal ADHD diagnosis (N = 174) and self-diagnosis (N = 136) using the Mann-Whitney test, network analysis, and two PLS-SEM models. Flow and hyperfocus differed in both predictors and outcomes, with flow associated with greater self-efficacy and hyperfocus predicting higher burnout. Group comparisons indicated complex patterns: self-suppression escapism predicted flow only in the self-diagnosis group, while also predicting hyperfocus in both groups. Hyperfocus and flow emerge as qualitatively distinct states with different predictors and consequences. Furthermore, systematic differences between formally diagnosed and self-diagnosed individuals with ADHD traits underscore the necessity of distinguishing these subgroups in research on ADHD-related experiences.

PMID:41650538 | DOI:10.1016/j.ridd.2026.105241

Biomed Pharmacother. 2026 Feb 5;196:118881. doi: 10.1016/j.biopha.2025.118881. Online ahead of print.

ABSTRACT

INTRODUCTION: Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss in older adults. Intravitreal anti-vascular endothelial growth factor (VEGF) agents-including Aflibercept, Ranibizumab, Bevacizumab, Brolucizumab, and Faricimab-are the mainstay of therapy. However, their comparative efficacy and safety remain uncertain. This study aimed to compare the visual and systemic outcomes of these agents to inform clinical decision-making.

METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science from inception to September 2025 identified randomized controlled trials (RCTs) and observational studies comparing at least two anti-VEGF agents in nAMD. Eligible studies reported outcomes of best-corrected visual acuity (BCVA) change, visual gain ≥ 15 letters, mortality, or arteriothrombotic events. Risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools. A frequentist network meta-analysis estimated mean differences (MD) and odds ratios (OR) with 95 % confidence interval (CI). The protocol was registered in PROSPERO (CRD42025631298).

RESULTS: Sixteen studies involving 6758 participants (follow-up 3-24 months) met the inclusion criteria. For BCVA improvement, Aflibercept had the highest surface under the cumulative ranking curve (SUCRA) ranking (0.80), although all agents showed similar mean differences that were not statistically significant: aflibercept (MD 0.80; 95 % CI -1.20-2.80), Ranibizumab (0.64; -1.87-3.15), Bevacizumab (0.60; -2.02-3.22), Faricimab (2.20; -0.69-5.09), and Brolucizumab (4.20; -5.97-14.36). The larger point estimate for Brolucizumab reflects imprecision rather than superior visual efficacy. Mortality was lowest with Aflibercept (risk ratio (RR) 0.76; 95% CI 0.41-1.55). For arteriothrombotic events, no statistically significant differences were observed between anti-VEGF agents. Comparisons between Aflibercept and Bevacizumab (RR 1.11; 95% CI 0.60-2.07), aflibercept and Ranibizumab (RR 0.77; 95% CI 0.49-1.21), and Bevacizumab and Ranibizumab (RR 0.88; 95% CI 0.60-1.30) showed wide confidence intervals, reflecting substantial imprecision. Certainty of evidence (GRADE) ranged from moderate to low.

CONCLUSION: All anti-VEGF agents stabilize or improve vision in nAMD. Aflibercept may provide the most favorable efficacy-safety balance, Faricimab offers promising durability, and Brolucizumab demonstrates large visual gains with potential safety concerns. Further head-to-head and long-term real-world studies are needed to optimize individualized treatment strategies.

PMID:41650530 | DOI:10.1016/j.biopha.2025.118881

Addict Behav. 2026 Feb 3;176:108632. doi: 10.1016/j.addbeh.2026.108632. Online ahead of print.

ABSTRACT

INTRODUCTION: Motivation-phase smoking treatment can increase treatment reach and abstinence in persons unmotivated to quit smoking. However, Motivation-phase treatment is modestly and inconsistently effective. This research aims to identify factors that may influence the effectiveness of the two intervention components most commonly used in Motivation-phase treatment: nicotine replacement therapy (NRT) and reduction counseling.

METHODS: An exploratory, secondary analysis of a 4-factor, randomized trial enrolled 577 primary care patients who were willing to reduce, but not quit, smoking. Participants were randomized to the following interventions: smoking reduction counseling, nicotine mini-lozenge, behavioral activation counseling, and 5Rs-motivational counseling. Using a precision medicine approach, machine learning analyses determined whether demographic and smoking variables identified persons more likely to benefit from the interventions with regard to 24-hour quit attempts, entry into cessation treatment, and self-reported 7-day point prevalence abstinence at 1 year.

RESULTS: Quitting self-efficacy predicted the likelihood of making a quit attempt and entering cessation treatment. At high levels of self-efficacy (>3.5 out of 5), there were no significant effects of interventions. At low levels of self-efficacy (≤3.5 out of 5), receiving reduction counseling reduced the odds of making a quit attempt (OR = 0.51, p = 0.002), and receiving mini-lozenge reduced the odds of entering cessation treatment (OR = 0.55, p = 0.02). No significant effects were found for smoking abstinence.

CONCLUSIONS: Baseline quitting self-efficacy may identify persons who will not be aided by standard Motivation-phase treatment and thus require a different therapeutic approach. These results raise questions about whom to treat, and how to treat, individuals who decline cessation treatment.

PMID:41650518 | DOI:10.1016/j.addbeh.2026.108632

Nutrition. 2026 Jan 11;145:113110. doi: 10.1016/j.nut.2026.113110. Online ahead of print.

ABSTRACT

BACKGROUND: Poor dietary intake has been linked to depression during pregnancy, but little research has examined this in Hispanic populations.

OBJECTIVE: We examined third-trimester associations of study-derived dietary patterns with odds of prenatal depression and depressive symptoms in pregnant, low-income Hispanic women.

METHODS: Participants (N = 587) were drawn from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort in Los Angeles, CA. Diet was assessed using a 24-h recall tool. Women were assigned quartile rankings based on adherence to two previously derived dietary patterns: vegetables, oils, and fruit (VOF; healthier) and solid fats, refined grains, and cheese (SRC; less healthy). Depressive symptoms were defined using the Center for Epidemiological Studies-Depression Scale score, and a dichotomized depression outcome was defined as Center for Epidemiological Studies-Depression Scale scores ≥16.

RESULTS: Eighteen percent of participants were classified as depressed at the third-trimester visit. Women with the greatest adherence to the healthier dietary pattern (VOF) had 59% lower odds of depression (OR = 0.41, 95% CI: 0.19, 0.86) relative to women with the lowest adherence to this dietary pattern, after adjustment for covariates. Additionally, women with moderately high (third quartile) adherence to the VOF dietary pattern had 16.9% lower depressive symptoms (95% CI: -30.5%, -0.8%) compared with women with the lowest VOF adherence. Women with the highest VOF adherence had similar, non-statistically significant lower depressive symptoms (Beta = -10.4%, 95% CI: -25.7%, 8.1%).

CONCLUSION: Our results indicate that there are important relationships between a healthy diet and lower depression in late pregnancy, and suggest that nutritional counseling and improved neighborhood access to healthy food may be important for maternal mental health.

PMID:41650492 | DOI:10.1016/j.nut.2026.113110

JMIR Diabetes. 2026 Feb 6;11:e83448. doi: 10.2196/83448.

ABSTRACT

BACKGROUND: Older adults with diabetes frequently access their electronic health record (EHR) notes but often report difficulty understanding medical jargon and nonspecific self-care instructions. To address this communication gap, we developed Support-Engage-Empower-Diabetes (SEE-Diabetes), a patient-centered, EHR-integrated diabetes self-management support tool designed to embed tailored educational statements within the assessment and plan section of clinical notes.

OBJECTIVE: This study aimed to validate the clarity, relevance, and alignment of SEE-Diabetes content with the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework from the perspectives of older adults and clinicians.

METHODS: An interdisciplinary team conducted expert reviews and qualitative interviews with 11 older adults with diabetes and 8 clinicians practicing in primary care (family medicine) and specialty diabetes care settings at a Midwestern academic health center. Patients evaluated the readability and relevance of the content, while clinicians assessed clarity, sufficiency, and potential clinical utility. Interview data were analyzed using inductive thematic analysis, and descriptive statistics were used to summarize participant characteristics.

RESULTS: Patients (mean age 72, SD 4.9 y; mean diabetes duration 26, SD 15 y) reported that the SEE-Diabetes statements were clear, relevant, and written in plain language that supported understanding of self-care recommendations. Clinicians (mean 13, SD 9.5 y of diabetes care experience) viewed the content as concise, clinically appropriate, and well aligned with patient self-management goals and the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework. Both groups identified the tool’s potential to enhance patient engagement and patient-clinician communication, while noting opportunities to improve the specificity of language, particularly within medication-related content.

CONCLUSIONS: SEE-Diabetes demonstrated content validity as a practical, patient-centered digital health tool for supporting diabetes self-management communication within EHR clinical notes. The findings support its use as a complementary approach to reinforce self-care communication in routine clinical practice and highlight areas for refinement to enhance personalization.

PMID:41650468 | DOI:10.2196/83448

JMIR Form Res. 2026 Feb 6;10:e80783. doi: 10.2196/80783.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) vaccination is a proven and effective tool for preventing several types of cancers, yet vaccination rates among young adults remain suboptimal, particularly among those not enrolled in 4-year colleges. This population can be more difficult to reach due to fewer established institutional touchpoints, limited engagement with campus-based health services, and greater variability in access to preventive care. At the same time, social media has become a dominant source of information for young adults, with TikTok (ByteDance) emerging as one of the most widely used platforms. Approximately 41% of TikTok’s users are between the ages of 16 and 24 years, making it a potentially important channel for public health communication. However, little is known about how noncollege young adults perceive HPV-related content on TikTok, or how influencers themselves view their role in communicating about vaccination.

OBJECTIVE: This study explored the perspectives of young adults and TikTok influencers regarding the dissemination and reception of HPV vaccine information on TikTok. The goal was to assess the potential of leveraging influencers as trusted messengers for this hard-to-reach population.

METHODS: Researchers conducted 5 focus groups with noncollege young adults, stratified by gender and vaccination status. Each group included 5-8 participants, resulting in a total of 34 individuals. Participants who reported being extremely hesitant about the HPV vaccine were excluded to focus on those more receptive to information. In parallel, researchers recruited 9 TikTok influencers who reached audiences aged 18-25 years and conducted in-depth individual interviews. Influencers represented a diverse mix of identities, follower counts, and content genres, providing varied perspectives on engagement with health-related topics.

RESULTS: Across the focus groups, young adults described regularly encountering or actively seeking health-related information online, with TikTok emerging as a primary or supplementary source for some. However, very few participants reported seeing content specifically related to HPV vaccination. Despite this gap, most expressed openness to such content if it was delivered in a relatable, authentic manner and included concise, relevant facts. Influencers echoed the importance of authenticity, emphasizing that their credibility is grounded in genuine connections with their audiences. Many described frequent, meaningful exchanges with followers about sensitive issues, suggesting comfort in addressing health topics. Influencers noted that they would be willing to share HPV-related content under certain conditions, including alignment with existing content, personal relevance, or participation in a structured campaign or partnership.

CONCLUSIONS: Findings suggest that TikTok may be a promising platform to engage noncollege young adults in HPV vaccination messaging. The strong parasocial relationships influencers maintain with their audiences could position them as effective messengers on sensitive health topics. Strategic collaborations with influencers, coupled with carefully crafted, authentic content, may help bridge communication gaps and support increased awareness of HPV vaccination in this underserved population.

PMID:41650455 | DOI:10.2196/80783

J Neurosurg. 2026 Feb 6:1-7. doi: 10.3171/2025.9.JNS25902. Online ahead of print.

ABSTRACT

OBJECTIVE: Stroke care disparities related to race and ethnicity have been well-documented, with African American populations experiencing higher stroke incidence and receiving less timely treatments like intravenous tissue plasminogen activator (tPA). Telemedicine, particularly telestroke, has emerged as a potential solution to address geographic and racial disparities in acute stroke care, yet some studies have reported persistent racial differences in treatment. This retrospective study was conducted to analyze data from a telestroke network consisting of a hub hospital and 38 spoke centers in Pennsylvania.

METHODS: Patients who had presented with acute ischemic stroke and required a virtual consult with a neurovascular specialist were included in the study. The data collected from electronic medical records included baseline characteristics, stroke-related variables, treatment details, and outcomes. Descriptive statistics, chi-square tests, and a Kruskal-Wallis test were used to analyze the data. In addition, univariate and multivariable logistic regression analyses were performed to evaluate the association between race and key outcomes.

RESULTS: A total of 4256 patients were included, of whom 2925 were White and 1122 were African American. On multivariable logistic regression, African American patients, as compared to White patients, were less likely to undergo mechanical thrombectomy (OR 0.58, 95% CI 0.35-0.96, p = 0.03) and were more likely to be discharged to rehabilitation (OR 1.39, 95% CI 1.06-1.84, p = 0.01), with no significant differences in tPA administration or death between the two racial groups.

CONCLUSIONS: The study results suggest that African American patients are significantly less likely to undergo mechanical thrombectomy and more likely to be discharged to rehabilitation compared with their White counterparts, despite similar rates of tPA administration and death. These findings highlight persistent disparities in advanced stroke interventions and postacute care, emphasizing the need to address structural and socioeconomic barriers to ensure equitable treatment and recovery for all patients.

PMID:41650447 | DOI:10.3171/2025.9.JNS25902

JMIR Public Health Surveill. 2026 Feb 6;12:e87800. doi: 10.2196/87800.

ABSTRACT

BACKGROUND: Alcohol is a widely used psychoactive substance, and its use constitutes a major public health challenge due to its immediate and long-term adverse effects on various health-related outcomes. Adolescence has been identified as a particularly vulnerable phase regarding alcohol use. Although consumption rates in this age group have declined in Germany over the past decades, a plateau has been reached, and there is a continued need for interventions to further reduce consumption rates.

OBJECTIVE: This study aimed to assess problematic alcohol use among adolescents in Germany and explore associations with sociodemographic and psychosocial characteristics, particularly with health literacy, to inform future interventions tailored to the specific needs of this target group.

METHODS: In a cross-sectional quota-based survey, 2006 adolescents (aged 12-17 years) completed an online survey (n=1406) or face-to-face interview (n=600) assessing the frequency of weekly alcohol use, the presence of problematic alcohol use (German version of the Car-, Relax-, Alone-, Forget-, Friends-, Trouble- questionnaire [CRAFFT-d]), sociodemographic information, and health literacy (European Health Literacy Survey instrument [HLS-EU-Q16]). Based on their CRAFFT-d and HLS-EU-Q16 scores, participants were identified as exhibiting problematic alcohol use (vs no problematic alcohol use) and inadequate or problematic health literacy levels (vs adequate health literacy levels), respectively. Chi-square tests were computed to analyze differences between different groups (as defined by the sociodemographic factors, weekly alcohol consumption frequency, and health literacy) in terms of problematic alcohol use (binary CRAFFT-d outcome).

RESULTS: Approximately 20% (390/2006) of the participants reported consuming alcohol on at least 1 day per week, and 12.7% (255/2006) of the sample met the CRAFFT-d screening criterion for problematic alcohol use. Problematic alcohol use was significantly associated with gender (χ²₁=20.96, V=0.10; P<.001), age (χ²₂=85.88, V=0.21; P<.001), subjective social status (χ²₂=8.23, V=0.06; P=.02), and migration background (χ²₁=5.60, V=0.05; P=.02), but there were no significant associations with level of education (χ²₁=3.43, V=0.04; P=.06), and health literacy (χ²₁=1.54, V=0.03; P=.21). In addition, participants who reported more frequent alcohol consumption per week, also met the screening criterion for problematic alcohol consumption more frequently (χ²₇=698.65, V=0.59; P<.001).

CONCLUSIONS: The findings demonstrate that problematic alcohol use is more common in boys than girls, in older vs younger adolescents, in those with high or low (vs intermediate) social status, in individuals with (vs without) a migration background, and in those who drink alcohol more frequently. These results emphasize the necessity of implementing targeted prevention strategies that address the specific risk profiles of adolescents concerning alcohol consumption.

PMID:41650444 | DOI:10.2196/87800

J Acquir Immune Defic Syndr. 2026 Feb 6. doi: 10.1097/QAI.0000000000003845. Online ahead of print.

ABSTRACT

BACKGROUND: F/TAF was shown to be non-inferior to F/TDF as pre-exposure prophylaxis (PrEP) in men, but approval was not extended to cisgender women. We report the results of PrEPVacc, in which a predominantly female population was randomly allocated to receive daily oral F/TDF or F/TAF for ∼6 months within a HIV-1 prophylactic vaccine trial.

SETTING: Five study sites in three African countries (Uganda, Tanzania, South Africa).

METHODS: The two regimens were compared by the averted infections ratio (AIR) – the proportion of infections averted by F/TAF relative to F/TDF. The counterfactual HIV incidence, an essential component of this metric, was derived from a preceding registration cohort. Dried blood spots (DBS) were collected at regular timepoints for later assessment of tenofovir diphosphate levels in selected sub-populations.

RESULTS: 1380 participants (697 F/TDF, 683 F/TAF) were included in the primary analysis (total follow-up 709.2 person-years); 87% were cisgender women. Three HIV infections (0.86/100 person-years) occurred in the F/TAF group versus two in the F/TDF group (0.56/100 person-years). The counterfactual HIV incidence was estimated to be 2.59/100 person-years (90% CI 1.86-3.52), giving an AIR of 0.85 (90% CI 0.31-1.66). Based on the week 8 DBS sample , only an estimated 14% of participants were classified as taking 2-3 tablets per week and 9% ≥4 tablets per week.

CONCLUSIONS: Despite similar HIV incidence rates, the non-inferiority of F/TAF was not demonstrated, probably due to low statistical power primarily driven by low adherence. However, there is compelling evidence from multiple studies supporting the efficacy of F/TAF as PrEP regardless of sex.

PMID:41650395 | DOI:10.1097/QAI.0000000000003845