Category: Nevin Manimala

Medwave. 2026 May 22;26(4):e3085. doi: 10.5867/medwave.2026.04.3085.

ABSTRACT

OBJECTIVE: Plantar fasciitis is common and impairs people’s ability to move. Manual therapy is frequently used to treat plantar fasciitis. However, its effects are inconclusive. For this reason, the purpose of this systematic review is to determine the effect of manual therapy on plantar fasciitis.

METHODS: A systematic review of the literature was conducted, following the PRISMA checklist. Five databases (CINAHL, Scopus, PubMed, Web of Science, and OVID) were searched, along with a review of the gray literature and a manual search. Randomized clinical trials from 2014 to 2024 were selected that examined the efficacy of manual therapy in reducing pain intensity and improving function in patients aged 18 to 60 years with a clinical diagnosis of plantar fasciitis. Methodological quality (PEDro scale) and risk of bias (risk of bias scale) were assessed.

RESULTS: Four randomized clinical trials (n = 224) were included, reporting controversial statistical differences in pain and function. In addition, two studies reported clinically relevant changes favoring manual therapy. PEDro scale scores ranged from 4 to 6, and three studies presented a high risk of bias.

CONCLUSIONS: The effects of manual therapy on pain and function in patients with plantar fasciitis are uncertain. The evidence is limited, heterogeneous, and lacking in methodological rigor. A larger number of randomized clinical trials with more consistent, replicable protocols are needed to determine the contributions of manual therapy to improving pain and function in patients with plantar fasciitis. Similarly, the inconsistency and limited evidence on indicators of clinical significance in the selected studies preclude an assessment of the clinical impact of this intervention.

PROSPERO REGISTRATION: CRD42024501550.

PMID:42172644 | DOI:10.5867/medwave.2026.04.3085

JMIR Public Health Surveill. 2026 May 22;12:e80359. doi: 10.2196/80359.

ABSTRACT

BACKGROUND: Sudden death due to cardiorespiratory arrest has a high mortality rate and often occurs outside hospital settings. Prompt initiation of cardiopulmonary resuscitation (CPR) by bystanders, along with the use of an automated external defibrillator (AED), has been shown to double survival rates. Given the challenges of ensuring timely emergency response in rural areas, implementing basic CPR training programs can help improve survival outcomes.

OBJECTIVE: This study aimed to evaluate the effectiveness of online CPR-AED training delivered to participants from a rural area of Camp de Tarragona.

METHODS: This quasi-experimental study consisted of 2 phases: phase 1, evaluation of the effectiveness of online training on CPR-AED knowledge (with pretest and posttest assessments), and phase 2, evaluation of the effectiveness of online training on CPR-AED maneuvers through simulation at 1 month and 6 months after online training. The sample of the study comprised residents in a rural area of Tarragona, Spain. A descriptive statistical analysis of the study population was conducted. For quantitative data with a nonnormal distribution, the median and IQR were presented. Categorical data were described as frequencies and percentages. A bivariate analysis was performed to compare the pretraining and posttraining quantitative variables using the Student 2-tailed t test.

RESULTS: In total, 55 participants were included in the study. Of these, 74.5% (n=55) were women, the mean age was 41.5 (SD 9.1) years, and 94.5% (n=55) were employed. Overall, 52 participants completed the online training. The median time required to complete the course was 261.5 (IQR 935; range 125-327) minutes. In total, 51 participants took part in the first practical simulation, which was conducted 1 month after the theoretical training. The mean score obtained in this first simulation was 7.5 out of 10. Six months after the theoretical training, 46 participants completed a second simulation.

CONCLUSIONS: Online CPR-AED training is effective in improving CPR-AED knowledge and skills in a rural population in the short and medium term.

PMID:42172642 | DOI:10.2196/80359

JMIR Mhealth Uhealth. 2026 May 22;14:e79002. doi: 10.2196/79002.

ABSTRACT

BACKGROUND: Parental oral health education is critical for preventing early childhood caries. However, few interventions are theoretically grounded or use digital approaches.

OBJECTIVE: The objective of this study was to evaluate the effects of a health belief model-based digital intervention on maternal oral health behaviors.

METHODS: This quasi-experimental study enrolled 648 mother-child dyads from 19 community health care centers (CHCs) in Beijing, China. CHCs were allocated to intervention or control groups depending on their voluntary adoption of the dental referral system. Ten CHCs (n=332, 52.6%) were assigned to the intervention group, where mothers received oral health education materials and had access to a dental referral system. The remaining 9 CHCs (n=316, 47.4%) served as the control group, in which mothers continued to receive standard child health care services. The primary outcome was parent-assisted toothbrushing, and the secondary outcome included other oral health behaviors, including night feeding practices, sugar intake, and dental visits. To evaluate the intervention effects on behavioral outcomes, generalized linear mixed models were used, accounting for repeated measures and potential confounding factors.

RESULTS: Compared with the control group, the intervention group demonstrated a significant increase in parent-assisted toothbrushing, with an absolute difference of 10.3 (95% CI 3.0 to 17.6; P=.006) percentage points at 6 months and 1.5 (95% CI -7.2 to 10.1; P=.74) percentage points at 12 months. Additionally, dental visit rates were significantly higher in the intervention group at 12 months (odds ratio 4.65, 95% CI 1.30 to 16.70; P=.02). However, no statistically significant differences were observed between groups in nighttime feeding cessation or sugar intake control at either the 6- or 12-month follow-ups.

CONCLUSIONS: The health belief model-based digital intervention was effective in the short term for enhancing parent-assisted toothbrushing in young children, but its long-term effectiveness remains unproven. Future research should therefore prioritize exploring sustainability strategies.

PMID:42172639 | DOI:10.2196/79002

Int J STD AIDS. 2026 May 22:9564624261449133. doi: 10.1177/09564624261449133. Online ahead of print.

ABSTRACT

BackgroundReports on bladder cancer among people living with HIV (PLWH) are very limited. In this case series, we investigated the clinical characteristics, pathology, treatments, adjuvant therapy, and survival of bladder cancer in PLWH.MethodsThis case series identified all PLWH treated for bladder cancer at our institution between 2013 and 2023 through review of medical records. Clinical data were presented as descriptive statistics. We estimated median and 1-, 3-, and 5-years cancer-specific survival using the Kaplan-Meier method and conducted univariate Cox analyses to evaluate variables associated with cancer-specific survival.ResultsTwenty PLWH underwent treatment for bladder cancer during the study period. All patients were male with a median age of 56 years. Radical cystectomy was performed in four patients (20%) and transurethral resection of bladder tumor in sixteen (80%). Adjuvant immunotherapy (tislelizumab) combined with chemotherapy (gemcitabine and cisplatin) was used in six patients after radical cystectomy. In the Kaplan-Meier analysis, the 1-, 3-, and 5-years cancer-specific survival rates of the cohort were 85%, 65%, and 60%, respectively. In univariate analysis, higher tumor stage (stage >T1 vs T1) was significantly associated with cancer-specific survival.ConclusionsGiven the relatively young age and aggressive pathological features observed in this case series, further research is warranted to determine whether targeted screening in PLWH could be beneficial. Limited data preliminarily suggest that intravesical chemotherapy with pirarubicin and adjuvant immunotherapy combined with chemotherapy may be safe and effective options for PLWH with bladder cancer; however, these observations require validation in larger studies. PLWH with muscle-invasive bladder cancer appear to have poorer cancer-specific survival.

PMID:42172635 | DOI:10.1177/09564624261449133

J Med Internet Res. 2026 May 22;28:e83087. doi: 10.2196/83087.

ABSTRACT

Using a crowdsource model, we developed CycleTrack, a web-based platform that tracks and aggregates medical school application data in real-time. From May 2022 to January 2026, 34,763 users registered on the platform, of whom 20,354 tracked a cumulative 415,837 doctor of medicine (MD), MD-doctor of philosophy (PhD), doctor of osteopathic medicine (DO), and DO-PhD applications. The volume of applications tracked per program strongly correlated with the total number of applications reported in official data from the Association of American Medical Colleges and American Association of Colleges of Osteopathic Medicine (Spearman ρ≥0.91; P<.001); however, statistically significant differences in demographics, grade point average, and Medical College Admission Test (MCAT) scores were observed between CycleTrack users and national averages. Despite this, the CycleTrack database accurately captured the cadence of interview invitations from the Northwestern University and University of Michigan MD programs. Aggregated data from the CycleTrack database offered a glimpse into application cycle dynamics, such as demonstrating the relatively longer DO interview cycle compared to MD and MD-PhD programs. Use data from CycleTrack suggest demand for open and transparent information about statistics and timing of admissions decisions among medical school applicants.

PMID:42172634 | DOI:10.2196/83087

JMIR Form Res. 2026 May 22;10:e79141. doi: 10.2196/79141.

ABSTRACT

BACKGROUND: Population aging is driving a rapid rise in dementia cases worldwide, posing a major challenge for health care systems around the globe, including in the Netherlands. Digital multidomain lifestyle interventions, which target multiple lifestyle domains simultaneously, can protect against cognitive decline in at-risk older adults but struggle to sustain engagement. Addressing stress in these interventions is crucial, as it can directly increase dementia risk and may promote unhealthy behaviors in other domains targeted in these interventions, including physical activity, diet, and sleep.

OBJECTIVE: This study explores the motivators and barriers for Dutch adults aged 60 years and older to use mindfulness apps for stress management within digital multidomain lifestyle interventions. Despite their potential, it remains unclear which stress-related needs would motivate older adults to use mindfulness apps in these interventions and whether these apps effectively address those needs. Moreover, little is known about how older adults practice mindfulness independently in everyday settings alongside other lifestyle priorities.

METHODS: We conducted 15 semistructured interviews with former participants of a 26-week multidomain lifestyle intervention study (the “HELI” [Hersenfuncties na Leefstijlinterventie] study) that included a mindfulness app for stress management. Participants (8 females; age range 61-73 years) were first invited to describe their practices to improve brain health to see whether stress and mindfulness emerged spontaneously. Follow-up questions and scenarios explored experiences with stress and mindfulness before these concepts were explicitly introduced midway through the interview, providing insight into their roles in participants’ lives free from associations with the terms. Data were analyzed using template analysis.

RESULTS: Older adults reported experiencing fewer minor daily stressors than earlier in life and having developed effective coping strategies with age. These strategies often included elements associated with mindfulness, such as acceptance and deliberate attention to the present moment. However, many frequently worried at night about major concerns, including personal health, the well-being of loved ones, and global issues. These findings suggest that older adults may be more motivated to use mindfulness apps to cope with nighttime worry than with minor daily stressors. At the same time, older adults reported barriers to using mindfulness apps, including negative associations with the term “mindfulness” (eg, perceived as too spiritual) and challenges in maintaining focus during exercises.

CONCLUSIONS: We discuss how older adults develop mindfulness skills with age and how these skills help older adults cope with daily stressors but not with nighttime rumination. Specifically, we argue that diminished cognitive resources at night, fewer distractions, and metacognitive patterns may sustain worry before sleep. This study highlights the importance of tailoring multidomain lifestyle interventions to the unique challenges of older adults. We also offer recommendations to present mindfulness in ways that help older adults stay focused during practice.

PMID:42172617 | DOI:10.2196/79141

JMIR Hum Factors. 2026 May 22;13:e77808. doi: 10.2196/77808.

ABSTRACT

BACKGROUND: Support, Monitoring, and Reminder Technology for Mild Dementia (SMART4MD), a customized tablet app, was developed to improve or maintain the quality of life of people with mild cognitive impairment (MCI) and their informal caregivers.

OBJECTIVE: This study conducts an 18-month economic evaluation of the SMART4MD app, in addition to standard care, compared with standard care alone in Sweden and Spain, from a health care provider perspective.

METHODS: In a pragmatic randomized controlled trial, people with MCI and their informal caregivers were randomized to the intervention and control groups. Health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured in 345 Swedish people with MCI and their informal caregivers, and in 347 Spanish people with MCI.

RESULTS: The analysis showed higher incremental costs and lower QALYs for Swedish people with MCI than for controls, whereas higher incremental costs and higher QALYs were observed for Spanish people with MCI. The intervention was not found to be cost-effective for Swedish informal caregivers, with an ICER of €78,000/QALY (€1=US $1.16).

CONCLUSIONS: The differing findings regarding cost-effectiveness for people with MCI in Sweden and Spain highlight the need for further research with extended follow-up, ideally involving a larger sample size and conducted across different national contexts.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.

PMID:42172614 | DOI:10.2196/77808

Interact J Med Res. 2026 May 22;15:e86448. doi: 10.2196/86448.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) and treatment-resistant depression (TRD) are heterogeneous conditions in which key clinical details are split across structured fields and free-text notes in electronic health records (EHRs), constraining population-level insight and timely audit of care quality.

OBJECTIVE: This study aims to present a clinician-oriented, artificial intelligence-supported real-world evidence (RWE) methodology integrating structured and unstructured EHR data to profile MDD and TRD, and report comorbidity patterns from a 2-site pilot. This analysis reports the first objective of the MOOD project, which is to characterize the real‑world clinical and disease severity profile of patients with MDD and treatment‑resistant depression, providing a necessary foundation for subsequent evaluations of treatment patterns and outcomes.

METHODS: We conducted a retrospective study in 2 Belgian hospitals (September 2021-June 2023). Adults (aged ≥18 years) with MDD were identified via DSM-IV (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition]) and ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes or natural language processing-detected note mentions; bipolar depression was excluded. TRD was defined as initiation of a third distinct antidepressant, supplemented by explicit mentions of TRD in notes. Structured data (demographics, diagnoses, medications, and hospitalizations) were harmonized in an Observational Medical Outcomes Partnership warehouse. Free-text notes were processed with a natural language processing pipeline to capture symptoms, psychiatric comorbidities, and contextual events.

RESULTS: We identified 1147 adults with MDD, of which 46% (524/1147) met TRD criteria. Females comprised 62.9% (722/1147) and mean (SD) age was 57.8 (18.4) years. Mortality was 13.3% (152/1147) overall (57/1147, 10.9% TRD vs 95/1147, 15.2% non-TRD). Common medical comorbidities were central nervous system diseases (477/1147, 41.6%) and heart diseases (349/1147, 30.4%). Dementia was more frequent in TRD (42/1147, 8% vs 32/1147, 5.1%), whereas obesity was higher in non-TRD (70/1147, 11.2% vs 46/1147, 8.8%). Anxiety disorder occurred in 35.4% (406/1147) overall and was more prevalent in TRD (229/1147, 43.7% vs 177/1147, 28.4%); personality and panic disorders also trended higher. Severity was sparsely documented (severe MDD 170/1147, 14.8%) and standardized scales were rarely recorded.

CONCLUSIONS: We present a step-by-step artificial intelligence-supported methodology tailored for clinicians, discussing challenges in integrating RWE into psychiatry, and identifying opportunities to enhance data collection with minimal workflow changes, which emphasizes the transformative potential of RWE systems in mental health research.

PMID:42172608 | DOI:10.2196/86448

Interact J Med Res. 2026 May 22;15:e55866. doi: 10.2196/55866.

ABSTRACT

BACKGROUND: Children’s eating habits are formed at an early age, making childhood a crucial period for introducing novel foods, such as pulse-based food products. Pulse Discovery Toolkit (PDTK) intervention was designed to increase familiarity with pulses and to eventually contribute to the consumption of pulse-based foods among preschool children in childcare centers (CCs).

OBJECTIVE: To determine PDTK’s impact on knowledge, acceptability, and consumption of pulse-based foods among preschool children attending CCs, and to assess its feasibility and acceptability by early childhood educators (ECE) and cooks. The nutrient contents and food group servings of pulse-based intervention recipes in the PDTK were also compared with regular CC recipes.

METHODS: The PDTK intervention was delivered over a 3-month period in 2 CCs in Saskatoon (50 children, 8 staff). The intervention, which integrated taste exposure and nutrition education, consisted of 12 child-friendly weekly lessons, a food service guide for cooks, 15 recipes for pulse-based foods, 4 intervention recipes incorporated in the CC menu, and 4 parent newsletters. Mixed methods were used with pre- and postintervention knowledge tests, plate waste measurement, sensory evaluation, ECE and cook’s perspective, and nutrient content comparison of the intervention and control foods from the regular childcare menu to evaluate the intervention’s impact.

Improvements in correct identification of chickpeas (2/21 [10%] at preintervention to 7/21 [33%] at postintervention, P=.074), beans (8/21 [38%] to 11/21 [52%], P=.68), and peas (6/21 [27%] to 8/21 [38%], P=.61) were not statistically significant. Children consumed higher amounts of the regular recipes (293.54, SD 27.65; 178.46, SD 24.33) than the intervention recipes (211.56, SD 25.61; 108.83, SD 21.97) at both times, respectively. However, at the end of the intervention, significant differences were only observed in the amount of total food consumption (P=.049) and the protein content (P=.04) when consumption proportion was examined, with both being higher for the control recipes in comparison to the intervention recipes. The majority (92% and 72%) of the children rated the refried bean wrap and lentil smoothie, “yummy,” respectively. Most of the intervention recipes have lower energy, fat, and sodium content compared with the regular CC recipes. Findings from ECE semistructured interviews and the lesson plan evaluations revealed that the ECEs reacted favorably to the curriculum. The cooks from the participating CCs did not report any barriers to cooking pulses in their facility. However, the need for modification to make the recipes easier to cook in CCs was noted in our study.

CONCLUSIONS: With a few modifications to make some of the lessons more age-appropriate and some of the recipes easier to cook, it is feasible to implement the PDTK in CCs in order to promote regular consumption of pulses.

PMID:42172607 | DOI:10.2196/55866

Integr Environ Assess Manag. 2026 May 22:vjag086. doi: 10.1093/inteam/vjag086. Online ahead of print.

ABSTRACT

This study illustrates results of an ecological survey performed on a former quarry area, morphologically reshaped from late ’90 s, through the use of red gypsum obtained as a by-product from the production cycle of a facility in Italy. After emplacement of the red gypsum in the former quarry, the area underwent spontaneous revegetation. To evaluate the ongoing restoration process and to document existing ecological values, a geopedological survey, a preliminary vegetation survey and preparation of a wildlife checklist were conducted in autumn 2023; additionally, desktop studies were carried out to identify the expected vegetation series and habitats for the area. A preliminary assessment was also carried out to identify the main Ecosystem Services currently provided by the subject area. The investigations showed that, although of its recent origin and the modest rate of pedological evolution, the area currently presents elements of high ecological value: the observed vegetation is consistent with the successional series expected for the area and the observed ecological features (in terms of vegetational structures, outcropping soils and more arid microclimatic conditions) introduce elements of habitat diversity with respect to the surrounding area (a dense wood), favoring therefore the presence of animal species adapted to habitats that are limiting for many. Specifically, the southern portion of the area displays a complex assemblage of different native plant species, while the northern part of the area is characterized by the presence of a dense bramble bush, species is of ecological value for wildlife since offering food/ refuge/ habitat/ pollination. Overall results thus indicate that the approach adopted in the restoration of the former quarry allowed a functional restoration of the area; on the basis of this work, key suggestions were provided to optimize the management of the restored area, meanwhile monitoring its temporal evolution.

PMID:42172597 | DOI:10.1093/inteam/vjag086