Category: Nevin Manimala

Am J Public Health. 2026 Mar 26:e1-e4. doi: 10.2105/AJPH.2026.308427. Online ahead of print.

ABSTRACT

Objectives. To provide current prevalence estimates for diagnosed multiple chronic conditions (MCC) among the noninstitutionalized, civilian US adult population. Methods. We analyzed data from the 2024 National Health Interview Survey (n = 32 629) to produce estimates and population counts for adults with 0, 1, or 2 or more conditions by demographic characteristics. Results. In 2024, 51.1% of US adults had at least 1 of 10 selected diagnosed chronic conditions, and 26.4% had MCC. Variations in the prevalence of MCC were observed by sex, race and Hispanic origin, age, health insurance coverage, and urbanization level. Conclusions. The National Health Interview Survey can be used to provide timely estimates on population prevalence of MCC. Prevalence of MCC in 2024 was similar to that of 2010 estimates, and subgroup differences have persisted. Results may inform public health efforts and guide prevention strategies aimed at addressing multiple chronic conditions among adults in the US population. (Am J Public Health. Published online ahead of print March 26, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308427).

PMID:41886700 | DOI:10.2105/AJPH.2026.308427

JCO Oncol Pract. 2026 Mar 26:OP2500950. doi: 10.1200/OP-25-00950. Online ahead of print.

ABSTRACT

PURPOSE: Acute care events (ACEs, emergency department visits and hospitalizations) are burdensome among patients with cancer-many are preventable. Prognostic risk models have not been consistently deployed as a preventive strategy. We convened a Clinical Advisory Panel (CAP) to address this translational bottleneck and develop clinically and statistically valid prognostic models to enable risk-stratified intervention.

METHODS: We identified patients age 21+ years initiating cancer treatment at an academic center or affiliated sites. We extracted sociodemographic and clinical information from the EHR. Data were divided into training (50%), validation (25%), and test (25%) sets. Models were developed using constrained elastic-net logistic regression, with clinically informed coefficient constraints.

RESULTS: In all, 4,697 patients were included, the mean age was 64 years, 71.9% were White, 21.8% had GI cancers, 21.7% had hematologic malignancies, 46.0% were Medicare insured, 77.6% were receiving chemotherapy, and 25.4% were receiving immunotherapy. We developed two models with our CAP, a baseline model predicting risk using a planned anticancer regimen and a follow-up model updating with drug dispensing and clinical changes. ACE in the previous month was the strongest predictor in both models (odds ratio [OR], 1.5, baseline model), with chemotherapy receipt (OR, 1.18), heart failure (OR, 1.22), abnormal international normalized ratio (OR, 1.30), and late-stage cancer (OR, 1.20) contributing. Both had acceptable statistical performance (C-statistic 0.71 and 0.70) and identified patients at the highest risk for ACE.

CONCLUSION: We present a novel approach to ACE prediction among patients receiving cancer treatment using two models to anticipate patients’ risk before treatment starts and then update based on clinical trajectory, facilitated by engagement of a CAP. To prevent ACE, risk-stratified interventions should focus on the factors we observed-optimizing comorbidities, proactively managing symptoms from high-toxicity regimens, or advanced disease.

PMID:41886699 | DOI:10.1200/OP-25-00950

Issues Ment Health Nurs. 2026 Mar 26:1-8. doi: 10.1080/01612840.2026.2645384. Online ahead of print.

ABSTRACT

Evidence-based practice (EBP) is fundamental to high-quality psychiatric nursing care; however, integrating research evidence into routine clinical practice remains a significant challenge. This study aimed to identify perceived barriers to research utilisation (RU) among psychiatric nurses in Türkiye and to examine their associations with selected socio-demographic, professional, and institutional characteristics. A descriptive cross-sectional design was employed. Data were collected between November 2018 and October 2019 from 172 psychiatric nurses working in three tertiary psychiatric hospitals in Istanbul. Data collection tools included a sociodemographic and professional characteristics questionnaire, as well as the Turkish version of the BARRIERS Scale. Descriptive statistics, independent-samples t tests, one-way analysis of variance, correlation analyses, and multiple linear regression were used for data analysis. Nurses reported a moderate level of perceived barriers to RU (mean total score = 67.0, SD = 17.5). The most frequently reported barriers were lack of time to engage with research, limited access to research in the native language, and insufficient availability of synthesised evidence. Setting-related barriers yielded the highest scores on the subscale. Higher perceived barrier levels were associated with employment in university hospitals, having 3-5 years of experience in psychiatric nursing, and infrequent use of research in practice. In contrast, perceived institutional support and clear organisational expectations for EBP were linked to lower barrier scores. These findings suggest that addressing organisational constraints, improving access to usable research evidence, and allocating protected time for research engagement may facilitate EBP integration in psychiatric nursing practice.

PMID:41886694 | DOI:10.1080/01612840.2026.2645384

N Z Med J. 2026 Mar 27;139(1632):114-119. doi: 10.26635/6965.7183.

ABSTRACT

AIM: Tamariki (children) in Aotearoa New Zealand suffer high rates of respiratory morbidity. There are also geographic, socio-economic and ethnicity inequities, with tamariki Māori and Pacific children, experiencing the highest rates. Our aim was to survey New Zealand respiratory health services and identify gaps in delivery.

METHODS: We invited health practitioners from all districts to respond to an online survey and separately contacted individuals known to deliver paediatric respiratory care. We included medical, nursing and allied health staff and collated responses.

FINDINGS: There were 23 responses from 17 hospitals. Respiratory- and sleep-specialist senior medical officers (SMOs) were employed in only three major centres. Full time equivalent (FTE) for paediatricians with an interest (PWI) in respiratory care was evenly distributed with low numbers reported in the Northern region, Wellington and Canterbury. Senior nurse FTE was fairly constant across the country, except in the Northern region. Allied health staffing was inconsistent across the country with many districts in the Te Manawa Taki region reporting little or no respiratory physiotherapy staffing. More than half of districts reported limited or no access to videofluoroscopic swallow studies. There is poor access to chest computed tomography (CT) scanning under general anaesthetic in more than half of centres.

CONCLUSION: Despite high levels of respiratory disease and morbidity, with serious disparities, there is inadequate staffing and provision of services. There is an urgent need for better co-ordination of care but a lack of both national and regional frameworks despite respiratory health being a current health target.

PMID:41886692 | DOI:10.26635/6965.7183

N Z Med J. 2026 Mar 27;139(1632):92-100. doi: 10.26635/6965.7147.

ABSTRACT

AIM: Our aim was to determine the incidence of delirium in a tertiary intensive care unit (ICU) in Auckland, New Zealand compared to other Australasian ICUs. To determine the incidence of delirium among different ethnicities and identify risk factors and outcomes of patients experiencing delirium.

METHODS: The design was a retrospective observational study. The setting was a single-centre, 24 bed, tertiary ICU in Auckland, New Zealand. The participants were two hundred and twenty-two patients admitted to the ICU over 10 months in 2019. The main outcome measures were incidence of delirium, identified using the Confusion Assessment Method – ICU (CAM-ICU) screening, antipsychotic prescription, 12-month mortality, and ICU discharge disposition.

RESULTS: Fifty of the 222 (23%) patients had delirium. There was no association between the incidence of delirium and ethnicity (p=0.39). The risk of delirium increased with ICU duration of stay (odds ratio [OR]: 1.003, 95% CI, 1.001-1.005, p=0.004), days on vasopressors (p<0.001) and days on mechanical ventilation (p<0.001). Thirty-three of the 50 (66%) patients received at least one antipsychotic medication. Twelve-month mortality was not associated with delirium (OR: 0.97, 95% CI 0.73-1.22, p=0.81). Delirium was not associated with ICU discharge disposition (p=0.20).

CONCLUSIONS: The incidence of delirium in this single-centre, tertiary Auckland ICU was comparable to other Australasian ICUs. There was no difference in the incidence of delirium between different ethnicities. Positive associations to delirium included length of stay in ICU, number of days on vasopressors and duration of mechanical ventilation. Delirium was not associated with an increased risk of 12-month mortality and was not associated with ICU discharge disposition.

PMID:41886687 | DOI:10.26635/6965.7147

N Z Med J. 2026 Mar 27;139(1632):71-81. doi: 10.26635/6965.7234.

ABSTRACT

AIM: Aotearoa New Zealand has experienced declining eye donation rates despite high levels of corneal disease and strong capacity to perform corneal transplantation. Demand for donor corneal tissue far exceeds supply. This study explored public attitudes toward eye donation, which have not previously been evaluated in New Zealand.

METHOD: Ten semi-structured focus groups were conducted, recorded and transcribed. Participant opinions were analysed using saturation and sentiment approaches. Transcripts were manually coded in NVivo15, with iterative thematic analysis until saturation was achieved.

RESULTS: A total of 44 participants were interviewed. Overall sentiment toward eye donation was positive, with 40 (90%) supporting donation for themselves or family. Barriers to donation included poor awareness (42, 96%), cultural considerations (41, 93%), feelings of disgust (23, 52%) and religious beliefs (13, 30%). Among Māori and Pacific participants (16, 44%), the absence of established tikanga (customary values/practices) around eye donation emerged as a key theme. Baseline knowledge was low: only 13 (30%) had prior awareness, and just two (5%) understood New Zealand’s donation infrastructure.

CONCLUSION: Most focus group participants supported eye donation; however, poor awareness, cultural uncertainty and limited infrastructure remain barriers. New Zealand has the population and capacity to achieve self-sufficiency, but system-level changes are needed to improve eye donation rates.

PMID:41886686 | DOI:10.26635/6965.7234

N Z Med J. 2026 Mar 27;139(1632):44-70. doi: 10.26635/6965.7181.

ABSTRACT

AIM: Gastric cancer incidence and mortality are higher among Māori compared with non-Māori. Here we address a gap in the literature by examining changes in gastric cancer survival over time, and how this varies by socio-demographic factors among Māori and non-Māori over two decades.

METHODS: Records in the New Zealand Cancer Registry (NZCR) for Māori (N=1,452) and non-Māori (N=6,402) diagnosed with gastric cancer between 2002 and 2021 were linked to death and socio-demographic data within Stats NZ Tatauranga Aotearoa’s Integrated Data Infrastructure. Gastric cancer survival was examined among Māori and non-Māori by age, sex, socio-economic deprivation and rurality over the 2002-2017 (gastric cancer-caused mortality) or 2002-2021 (all-cause mortality) period, and by 5-year periods. Clinical characteristics and data missingness by diagnosis year were also documented.

RESULTS: There was ethnic inequity in gastric cancer mortality in all time periods but this disparity appeared smaller in more recent periods, particularly for 1-year age-standardised mortality. Differences in mortality rates by socio-demographic and clinical characteristics were minimal. Higher risk of mortality from gastric cancer for Māori compared with non-Māori was most pronounced for those aged 45-64 years. There were no clear trends in survival across different diagnosis periods for other socio-economic characteristics.

CONCLUSION: Mortality risk was higher for Māori compared with non-Māori with gastric cancer diagnoses between 2002 and 2021. However, age-standardised rate ratios between Māori and non-Māori were lowest in more recent years.

PMID:41886685 | DOI:10.26635/6965.7181

N Z Med J. 2026 Mar 27;139(1632):24-43. doi: 10.26635/6965.7013.

ABSTRACT

AIM: Our aim was to assess the quality of ethnicity data in the Health New Zealand – Te Whatu Ora human resources (HR) databases.

METHODS: This project involved two components. 1) Staff with “not stated” or missing ethnicity in their HR records were identified from Auckland and Waitematā district HR databases on 30 April 2018 and 2 August 2018. They were asked their ethnicity using the Standard questions via an online survey. 2) Staff data were extracted in June 2017 and linked to the National Health Index (NHI) ethnicity data. The concordance of ethnicity data between the two datasets was assessed in three categories: exact match, partial match or total mismatch.

RESULTS: 1) Of the 17,539 staff, the proportions with “not stated” ethnicity were 15.1% at Auckland district and 6.4% at Waitematā district. Among those, 727 Auckland staff and 122 Waitematā staff responded to the survey to update their ethnicity. These respondents most identified as European (64%), followed by Asian (15%) and Pacific and Māori (5% each). 2) Of the 17,539 staff, 86% had matched ethnicity between the HR dataset and the NHI dataset (kappa 0.77, p<0.0001), with the highest agreement level being Asian (93%), followed by European (86%), Pacific (84%) and Māori (83%).

CONCLUSIONS: This project assessed the extent of “not stated” staff ethnicity data and misclassification in two large health districts. Staff with “not stated” on their records were willing to provide their ethnicity data when asked the Standard question. This project suggests the need for quality improvement activities in recording HR ethnicity data to support planning and monitoring workforce diversity.

PMID:41886684 | DOI:10.26635/6965.7013

JMIR Form Res. 2026 Mar 26;10:e68318. doi: 10.2196/68318.

ABSTRACT

BACKGROUND: Internet use is rapidly increasing in Sri Lanka. Excessive use can lead to addiction with significant consequences, particularly among adolescents. While internet addiction has been documented worldwide, data from Sri Lanka remain limited. A validated local tool is required to assess the prevalence and associated factors in this population.

OBJECTIVE: This study aimed to translate and validate the Young Internet Addiction Test (IAT) into Sinhala, assess the prevalence of internet addiction among school-going adolescents aged 15 to 19 years in the Western Province of Sri Lanka, and identify demographic and behavioral characteristics associated with internet addiction.

METHODS: We conducted a 2-phase cross-sectional analytical study in Colombo and Gampaha districts. Phase 1 involved translation and validation of the Sinhala IAT using confirmatory factor analysis (n=200) and test-retest reliability assessment (n=40). Phase 2 involved multistage stratified cluster sampling to recruit 2835 students. Participants completed self-administered questionnaires assessing demographics, internet use patterns, and internet addiction.

RESULTS: The Sinhala IAT demonstrated excellent internal consistency (Cronbach α=0.98) and strong test-retest reliability (r=0.95; P<.001). Among 2835 students with complete data, 1803 (63.6%) were current internet users. The overall prevalence of internet addiction among internet users was 12.6% (227/1803; 95% CI 11.2%-14.0%), including mild addiction at 8.2% (147/1803; 95% CI 6.9%-9.5%), moderate addiction at 3.5% (64/1803; 95% CI 2.7%-4.5%), and severe addiction at 0.9% (16/1803; 95% CI 0.4%-1.4%). No significant associations were found with sex (male and female; odds ratio 1.13, 95% CI 0.86-1.49; P=.14), age group (P=.23), or parental education (P=.34). The most common online activities were entertainment (1522/1803, 84.4%), gaming (1251/1803, 69.4%), and social media use (1127/1803, 62.5%). Mean daily use was 2.1 (SD 1.8) hours, with 10.0% (180/1803) reporting single sessions of ≥6 hours.

CONCLUSIONS: This study provides the first systematic evidence of internet addiction in adolescents in Sri Lanka. The predominance of mild to moderate severity suggests an opportunity for early intervention.

PMID:41886680 | DOI:10.2196/68318

Cochrane Database Syst Rev. 2026 Mar 26;3:CD015468. doi: 10.1002/14651858.CD015468.pub2.

ABSTRACT

RATIONALE: Malnutrition affects 35% to 64% of hospitalised older people, and is associated with adverse health outcomes such as disease complications and hospital readmission. Identifying effective nutritional interventions is essential to improve clinical outcomes and reduce healthcare costs in this population.

OBJECTIVES: To evaluate the effects of various nutritional interventions, compared with either a control group (standard care or placebo) or each other, on patient-relevant outcomes in hospitalised older people at risk of or with established malnutrition, and to rank the effects of these different interventions using network meta-analysis (NMA) based on individual participant data (IPD).

SEARCH METHODS: We searched CENTRAL, MEDLINE, five other databases, and two trial registries to 2 July 2024, and checked the reference lists of included studies and relevant systematic reviews.

ELIGIBILITY CRITERIA: We included older people (≥ 65 years) hospitalised for different acute conditions at risk of or with malnutrition enrolled in randomised controlled trials (RCTs) comparing oral nutritional interventions with control or each other. For RCTs that met our inclusion criteria, either fully or partially, we requested IPD from the study authors. If we did not receive a response or IPD were unavailable, we used published aggregated data. We excluded RCTs that only partially met the eligibility criteria if neither IPD nor sufficient aggregated data were obtainable.

OUTCOMES: Critical outcomes were all-cause mortality, serious adverse events (SAEs), and functional status (e.g. activities of daily living). Important outcomes were health-related quality of life (HRQoL), length of hospital stay (LOS), body weight, and fat-free mass. The main outcome assessment time point was at hospital discharge or 30 days after randomisation.

RISK OF BIAS: We used the Cochrane risk of bias 2 (RoB 2) tool.

SYNTHESIS METHODS: For each outcome, we first analysed IPD within each study. Second, we pooled results in an NMA which also included the aggregated data from RCTs without available IPD. We performed random-effects NMAs based on the frequentist approach and ranked treatments by P-scores. We rated the certainty of evidence using the GRADE approach.

INCLUDED STUDIES: We included 21 RCTs (72 reports; 12 RCTs with IPD) with 3309 older participants (mean age ranged from 75 to 85 years; 1863 participants with IPD) with different acute conditions. Interventions included the provision of additional protein (three studies), energy supplements (two studies), oral nutritional supplements (ONS; eight studies), individualised feeding support (two studies), and comprehensive individualised nutritional care (eight studies). In all but two RCTs, interventions were compared to control (standard care with or without a placebo). We judged 16.1% of outcome assessments to be at low risk of bias and 16.8% at high risk.

SYNTHESIS OF RESULTS: ONS may reduce all-cause mortality (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.25 to 0.84; absolute risk difference 57 fewer deaths per 1000 people, 95% CI 79 fewer to 17 fewer; low-certainty evidence) compared to control, while comprehensive individualised nutritional care may show little to no effect (RR 0.98, 95% CI 0.55 to 1.73; 1 fewer per 1000 people, 95% CI 26 fewer to 46 more; low-certainty evidence). For all other treatment comparisons, the evidence is very uncertain (NMA with 13 RCTs, 2728 participants; Q between designs: not applicable (NA)). ONS may reduce SAEs compared to control (RR 0.56, 95% CI 0.32 to 0.95; 84 fewer SAEs per 1000 people, 95% CI 131 fewer to 10 fewer; Q between designs: Q 1.95, df 2, P = 0.3772; low-certainty evidence). For all other treatment comparisons, the evidence is very uncertain (NMA with 14 RCTs, 2184 participants). Comprehensive individualised nutritional care may make little to no difference in activities of daily living compared to control (standardised mean difference (SMD) 0.06, 95% CI -0.08 to 0.20; low-certainty evidence) and ONS compared to energy supplements (SMD -0.15, 95% CI -0.53 to 0.23; low-certainty evidence). For all other treatment comparisons, the evidence is very uncertain (NMA with 5 RCTs, 1128 participants; Q between designs: NA). Energy supplements probably make little to no difference in HRQoL compared with ONS (mean difference (MD) 0.01, 95% CI -0.06 to 0.08; Q between designs: NA; moderate-certainty evidence). All other comparisons of different nutritional interventions may make little to no difference to HRQoL (NMA with 3 RCTs, 1513 participants). The provision of additional protein, energy supplements, ONS, and comprehensive individualised nutritional care may make little to no difference in LOS compared to control (18 RCTs, 3013 participants; Q between designs: Q 2.86, df 3, P = 0.4145). Body weight (16 RCTs, 2114 participants; Q between designs: Q 2.03, df 3, P = 0.5655) may increase with ONS when compared to control (MD 0.9 kg, 95% CI 0.37 to 1.42) or comprehensive individualised nutritional care (MD 1.00 kg, 95% CI 0.12 to 1.87), but the evidence is very uncertain. Energy supplements and ONS probably have similar effects on body weight (MD 0.11 kg, 95% CI -0.85 to 0.63; moderate-certainty evidence). For fat-free mass, no meta-analysis was possible. One RCT (102 participants) compared ONS with energy supplements and found little or no difference between groups (MD 0.13 kg, 95% CI -0.63 to 0.90; low-certainty evidence), while evidence regarding the effects of additional protein compared with control was very uncertain (1 RCT, 19 participants). Rankings of treatments by P-scores were not consistent across outcomes.

AUTHORS’ CONCLUSIONS: In older hospitalised people at risk of or with malnutrition, oral nutritional supplements may reduce mortality and SAEs compared to control 30 days after randomisation. For other outcomes, there may be little or no differences in results. Overall, the evidence was of low to very low certainty, primarily due to a limited number of studies and participants per comparison. The comparison of treatment effects across outcomes was constrained by variations in network structure. When interpreting the results, the heterogeneity of the population in terms of acute and chronic conditions needs to be considered. To improve certainty, adequately powered studies with robust methodologies should compare interventions with controls as well as against each other.

FUNDING: The German Federal Ministry of Education and Research funded this work (grant number: 01KG2102).

REGISTRATION: Protocol (2022) doi.org/10.1002/14651858.CD015468.

PMID:41886673 | DOI:10.1002/14651858.CD015468.pub2