Category: Nevin Manimala

Cir Cir. 2026;94(2):197-204. doi: 10.24875/CIRU.24000319.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the relationship between kinesiophobia and physical activity levels in patients with end-stage kidney disease (ESKD) undergoing hemodialysis.

METHOD: This cross-sectional study involved 227 ESKD patients undergoing HD treatment. Patients were assessed using the Tampa Scale of Kinesiophobia (TSK), the International Physical Activity Questionnaire-short form, and Beck Depression and Anxiety scales.

RESULTS: Our findings revealed a significant association between kinesiophobia and low physical activity levels in HD patients (r = 0.384, p < 0.001). Patients with high TSK scores were more likely to have reduced physical activity levels. In addition, age (odds ratio [OR] = -31.3, p < 0.001), dialysis duration (OR = -57.2, p = 0.003), and TSK score (OR = 49.9, p < 0.001) emerged as independent predictors of physical activity levels. Notably, older age and longer dialysis duration were associated.

CONCLUSIONS: This study highlights the significant impact of kinesiophobia on physical activity levels in HD patients. More research is needed to figure out how these things work and help doctors decide how to treat ESKD patients so they can be more active.

PMID:42184398 | DOI:10.24875/CIRU.24000319

Cir Cir. 2026;94(2):137-148. doi: 10.24875/CIRU.24000222.

ABSTRACT

OBJECTIVE: This study aimed to investigate the application of MIMICS software in measuring femoral neck fracture (FNF) parameters and its clinical significance.

METHOD: Computed tomography data from 72 patients with FNFs were used to reconstruct three-dimensional (3D) models using MIMICS. The FNFs were divided into valgus and bowing groups based on the coronal femoral head-neck angle. A simulated sphere identified the center of the femoral head, and a 3D coordinate system was established. Statistical analyses were performed.

RESULTS: The valgus group showed more lateral x-axis and upward z-axis displacement (both p < 0.01). The medial x-axis and downward z-axis displacement distances were larger in the bowing group (both p < 0.01). Strong positive correlations were found between the horizontal head tilt angle and head spacing, spatial head-neck angle and y-axis displacement distance (all r_s > 0.89, p < 0.01).

CONCLUSIONS: MIMICS-based FNF parameter measurement accurately describes spatial characteristics post-fracture, providing guidance for FNF treatment and evaluation.

PMID:42184394 | DOI:10.24875/CIRU.24000222

Cir Cir. 2026;94(2):214-224. doi: 10.24875/CIRU.24000480.

ABSTRACT

OBJECTIVE: We implemented and evaluated a novel score called the blunt thoracic trauma score (BTTS) for the triage of chest wall injury (CWI) patients to optimize utilization of the intensive care unit (ICU).

METHOD: Patients who sustained rib fractures after a traumatic injury (2014-2020) were identified in our trauma registry. Demographics and clinical characteristics were summarized by cohorts pre- and post-BTTS implementation in 2017 and BTTS > 6 versus BTTS < 6 using median or frequency. Wilcoxon rank-sum test was used to compare continuous variables, and χ² or Fisher’s exact test for categorical variables. Logistic/negative binomial regression models were used to find predictors for ICU admission and length of stay (LOS).

RESULTS: Six hundred thirty-three patients were included; 407 pre-BTTS/226 post-BTTS. Pre-BTTShigher median ISS (p < 0.001), more rib fractures (p < 0.001). Post-BTTS older (p < 0.001), more comorbidities (coronary artery disease [p = 0.028], hyperlipidemia [p = 0.004], pulmonary disease [p = 0.038]). Post-BTTS cohort had lower rates of ICU admission (p = 0.008), shorter ICU-LOS (p < 0.001), and Hospital-LOS (p < 0.001). Post-BTTS cohort was associated with shorter Hospital-LOS after adjusting for other factors (p = 0.004).

CONCLUSIONS: Implementation of a novel BTTS for triage of CWI was associated with decreased ICU admission rates and shorter ICU-LOS and Hospital-LOS. The decreased Hospital-LOS persisted even after controlling for other factors.

PMID:42184391 | DOI:10.24875/CIRU.24000480

JMIR Med Inform. 2026 May 25;14:e85335. doi: 10.2196/85335.

ABSTRACT

BACKGROUND: Early prediction of gestational diabetes mellitus (GDM) is critical for improving maternal health outcomes. However, predictive models are often challenged by limited early-pregnancy samples, severe class imbalance in datasets, and complex interrelationships among clinical features.

OBJECTIVE: This study aimed to develop and evaluate a unified dual-dimensional enhancement framework integrating data augmentation and feature engineering. By addressing data imbalance and leveraging medical prior knowledge, this framework significantly improves early GDM prediction performance.

METHODS: We proposed a framework combining Generative Adversarial Network (GAN)-based data augmentation with large language model-inspired feature engineering. GAN sampling was used to generate clinically plausible synthetic minority class samples to mitigate data imbalance. The large language model was guided to organize features into domains (eg, basic demographics, metabolic syndrome, and core liver biomarkers) and generate higher-order composite features, integrating medical prior knowledge. Machine learning models were subsequently developed, and interpretability analyses were performed using Shapley additive explanations to identify key predictors.

RESULTS: This study used a final analytical cohort of 8214 pregnant women, divided into dataset A comprising 966 out of 5251 (18.4%) participants with GDM, and dataset B comprising 598 out of 2963 (20.2%) participants with GDM. The random forest model enhanced by Tabular Variational Autoencoder-based feature augmentation demonstrated the best performance. On the test dataset, it achieved a recall of 0.7559, an accuracy of 0.8444, and an area under the receiver operating characteristic curve (AUROC) of 0.8873. Statistical evaluation confirmed that the Tabular Variational Autoencoder method significantly outperformed the baseline (Cohen d=2.894; P<.001) and the Conditional Tabular Generative Adversarial Network method (Cohen d=1.637; P=.02) in recall enhancement. Shapley additive explanations analysis identified the following 5 features as the most influential predictors: fasting blood glucose, the composite feature (fasting blood glucose+triglycerides)×prepregnancy BMI, activated partial thromboplastin time, leukocyte count, and neutrophil count.

CONCLUSIONS: The proposed dual-dimensional enhancement framework effectively alleviates data limitations and captures complex feature interactions in early GDM prediction. This strategy not only improves model performance, particularly in recall, but also provides interpretable biological evidence to support rapid clinical screening, stratified management, and early intervention in pregnancy.

PMID:42184375 | DOI:10.2196/85335

JMIR Public Health Surveill. 2026 May 25;12:e87537. doi: 10.2196/87537.

ABSTRACT

BACKGROUND: In South Korea, where plain packaging has not been adopted, tobacco packaging continues to function as a key marketing tool for the tobacco industry, using texts, colors, and imagery to attract consumers. Among these, flavor cues are especially important as they enhance product appeal. Cigarette sticks also serve marketing functions through design features such as colors and capsule indicators.

OBJECTIVE: This study aimed to examine flavor-related cues on cigarettes and heated tobacco products (HTPs) packaging and stick design and to assess the presence of flavor additives in these products.

METHODS: This surveillance study was conducted in November 2024. Tobacco products were purchased from convenience stores located in Seoul, supplemented by cross-referencing with national market monitoring data. Of 353 identified products, 214 products (150 cigarettes and 64 HTPs) were collected. Flavor cues were categorized by pack and stick design features, and additives were identified through sensory analysis of product components.

RESULTS: Among the collected products, 63.1% (54% for cigarettes and 84.4% for HTPs) had both flavor cues and flavor additives, while 20.6% (27.3% for cigarettes and 4.7% for HTPs) had neither. Flavor cues were found in 67.3% of cigarettes and 95.3% of HTPs (P<.001), and flavor additives in 59.3% of cigarettes and 84.4% of HTPs (P<.001). Pack color was the most common cue, and additives were most often delivered through crushable capsules. HTPs used a wider range of flavoring methods, including flavoring in tobacco leaves and inner wrappers.

CONCLUSIONS: Tobacco packaging and stick design in South Korea remain important marketing tools for the tobacco industry. Flavor cues and additives are widely used in tobacco products, particularly in HTPs. These findings highlight the need for plain packaging policies and bans on flavor additives in tobacco products.

PMID:42184364 | DOI:10.2196/87537

West J Nurs Res. 2026 May 25:1939459261442459. doi: 10.1177/01939459261442459. Online ahead of print.

ABSTRACT

BACKGROUND: Family caregivers often struggle to track daily caregiving tasks (eg, managing medications, appointments). To address this, our team developed CareMobi, a mobile app designed to make caregiving more organized, collaborative, and manageable.

OBJECTIVE: We sought to evaluate early user satisfaction, real-world utility, and perceived value of CareMobi among informal caregivers.

METHODS: A cross-sectional survey was administered between October 2023 and January 2024 to CareMobi users. The survey included Likert-scale items assessing satisfaction and usability, and open-ended prompts exploring use cases and improvement suggestions. Descriptive statistics summarized quantitative data, and open-ended responses were analyzed using inductive content analysis.

RESULTS: Among respondents (N = 51), 82% reported being satisfied or very satisfied with the app, and 76% found it easy or very easy to use. Highly valued features included appointment/calendar tracking (32 selections), health progress monitoring (30 selections), and file storage (20 selections). Caregivers use CareMobi across diverse contexts, from elder care to self-management, to coordinate care among multiple individuals and streamline information access. Open-ended responses revealed 3 primary areas of impact: improved communication, centralized information management, and support for symptom and medication tracking. Users requested enhancements to support care team coordination, emphasizing the importance of simple, functional tools for daily caregiving.

CONCLUSION: Preliminary findings, based on a small, self-selected sample, suggest CareMobi is a user-friendly tool that supports informal caregivers and facilitates care coordination. Results highlight the importance of caregiver-centered app design and indicate the need for further evaluation through longitudinal, mixed-methods research to assess long-term outcomes and integration into care routines.

PMID:42184363 | DOI:10.1177/01939459261442459

J Med Internet Res. 2026 May 25;28:e88276. doi: 10.2196/88276.

ABSTRACT

BACKGROUND: Wearable devices are increasingly adopted for personal health monitoring, but evidence on their long-term associations with health-related lifestyle behaviors in real-world population settings remains limited.

OBJECTIVE: This study examined the longitudinal association between wearable device adoption and engagement in health-related lifestyle behaviors using a nationally representative panel dataset from South Korea.

METHODS: We analyzed data from the 2016 and 2022 waves of the Korea Media Panel survey. Health-related lifestyle behaviors in the physical, social, and cultural domains were operationalized as estimated annual activity counts based on self-reported frequency measures. We used a difference-in-differences framework with generalized estimating equations to compare changes in these behaviors between new wearable adopters and nonadopters adjusting for demographic and socioeconomic characteristics. Relative changes were estimated using Poisson models with a log link, and subgroup analyses were conducted to explore variation across sociodemographic groups. As a sensitivity analysis, inverse probability of treatment weighting was additionally applied to assess the robustness of the findings to observed baseline imbalance.

RESULTS: Wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time. In the difference-in-differences model, adopters showed greater relative increases in total activity (rate ratio [RR] 1.24, 95% CI 1.08-1.35), physical activity (RR 1.36, 95% CI 1.12-1.64), and cultural activity (RR 1.78, 95% CI 1.31-2.42) than nonadopters. Subgroup analyses showed limited evidence of consistent heterogeneity and should be interpreted cautiously. Sensitivity analyses using inverse probability of treatment weighting showed overall patterns broadly similar to those of the primary analyses.

CONCLUSIONS: In this nationally representative panel study, wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time, whereas no clear association was observed for social activity. These findings should be interpreted as associative rather than causal given the observational design and the inability to directly assess parallel trends.

PMID:42184361 | DOI:10.2196/88276

JMIR Form Res. 2026 May 25;10:e83018. doi: 10.2196/83018.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death in the United States, and state policies can be effective tools to prevent suicide. State legislators are increasingly active on social media, communicating about their legislative priorities and signaling information about their knowledge and attitudes about issues.

OBJECTIVE: This study aimed to characterize US state legislators’ social media posts mentioning suicide on X (formerly Twitter) and explore differences in how Democrat and Republican legislators communicate about suicide.

METHODS: We used Quorum, a public affairs database, to identify all state legislator X posts mentioning suicide (N=1049) between December 1, 2023, and November 30, 2024. We developed a codebook and used content analysis to characterize posts and document the frequency of communication about suicide and themes related to causes, solutions, and consequences of suicide. We assessed concordance between the social media post language used and guidelines for reporting about suicide. We conducted univariate analysis and chi-square tests to assess differences in the content of posts between Democrat and Republican legislators. Differences in the frequency of posts about suicide were analyzed using 2-tailed t tests.

RESULTS: Of 1049 posts identified, 849 (80.9%) were included in the final sample. The annual suicide post rate per 10,000 posts was 13.2 (0.1% of all posts) among Democrats and 7.4 (0.1% of all posts) among Republicans (P=.09). Suicide related to a specific population was identified in 52.2% (443/849) of posts, with youth, veterans, firearm owners, and the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and more) population being identified most frequently. Causes of suicide were identified in 37.1% (315/849) of posts, with no significant difference between Democrats and Republicans. However, the types of causes identified varied, with Democrats more likely to identify lethal means (eg, firearms) as a cause of suicide than Republicans (115/573, 20.1% vs 20/172, 7.5%; P<.001). About two-thirds (558/849, 65.7%) of posts identified at least one solution to prevent suicide, with Democrats more likely to identify a solution than Republicans (443/573, 77.3% vs 114/268, 42.5%; P<.001). General awareness was the most frequent solution, while policy-specific solutions were present in only 23.3% (198/849) of posts. Collateral consequences of suicide were infrequently mentioned.

CONCLUSIONS: This study found differences between Democrats and Republicans in their X posts about suicide and areas of misalignment with research evidence. When considered within the context of research on the epidemiology of suicide and evidence supporting suicide prevention policies, the study highlights the need to improve communication about suicide with state legislators and to encourage further collaboration with suicide prevention organizations and experts. Furthermore, given the differences observed, study findings suggest potential value in tailoring messages about suicide for legislators based on their political party.

PMID:42184359 | DOI:10.2196/83018

SICOT J. 2026;12:33. doi: 10.1051/sicotj/2026030. Epub 2026 May 26.

ABSTRACT

BACKGROUND: Distal femur fractures represent a small but clinically significant proportion of femoral injuries and are associated with high rates of complications, including non-union and revision surgery. Intramedullary nailing is a commonly employed fixation strategy, with both antegrade and retrograde approaches widely used in current practice. However, controversy persists regarding the optimal nail entry technique, particularly with respect to fracture healing, revision rates, and complications. This systematic review and meta-analysis aimed to compare clinical and radiological outcomes of antegrade versus retrograde intramedullary nailing for femoral shaft and distal femur fractures.

METHODS: This review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251274011). MEDLINE, EMBASE, and Cochrane databases were systematically searched for comparative studies evaluating antegrade and retrograde intramedullary nailing. Retrospective and prospective human studies reporting outcomes of union, revision, refracture, malunion, delayed union, operative time, and complications were included. Data extraction and quality assessment were independently performed, with risk of bias evaluated using the ROBINS-I tool. Meta-analysis was conducted using odds ratios (ORs) and weighted mean differences with 95% confidence intervals.

RESULTS: Five studies encompassing 1,479 patients were included, of whom 894 underwent antegrade nailing, and 585 underwent retrograde nailing. Antegrade nailing demonstrated a significantly lower rate of refracture following primary fixation compared with retrograde nailing (OR 31.41; 95% CI 4.45-221.80; p < 0.001). Revision rates were also significantly lower in the antegrade group (OR 1.76; 95% CI 1.21-2.58; p = 0.003). Retrograde nailing showed a higher overall union rate, although this did not reach statistical significance (p = 0.10). Rates of malunion, delayed union, non-union, operative time, and overall complications were comparable between groups, with moderate to substantial heterogeneity observed for several outcomes.

CONCLUSION: Both antegrade and retrograde intramedullary nailing provide effective fixation for femoral shaft and distal femur fractures. Antegrade nailing is associated with significantly lower rates of refracture and revision, while retrograde nailing demonstrates comparable union outcomes. These findings suggest that antegrade nailing may offer advantages in selected patient populations, particularly elderly individuals, although the surgical approach should ultimately be guided by fracture pattern, patient factors, and surgeon expertise.

PMID:42184353 | DOI:10.1051/sicotj/2026030

J Med Internet Res. 2026 May 25;28:e84228. doi: 10.2196/84228.

ABSTRACT

BACKGROUND: The number of cancer survivors in Switzerland is increasing. Many individuals face challenges in dealing with health-related information and navigating the health care system. Digitalization offers new care and support opportunities, but its effective use requires digital and navigational health literacy (HL) and self-management skills.

OBJECTIVE: This study aimed to assess the competencies of cancer survivors in Switzerland, compare them with those of the general population, and identify vulnerable subgroups.

METHODS: A cross-sectional online survey was conducted using validated scales from the Health Literacy Survey 2019-2021 (HLS19), measuring digital HL, interaction with digital devices, frequency of use of digital resources, and navigational HL. Self-management skills were assessed with the Health Education Impact Questionnaire (heiQ). HLS19 scores were compared to data from the general Swiss population and a subpopulation with chronic diseases provided by the Federal Office of Public Health, using Mann-Whitney U tests, chi-square tests, and independent t tests. Regression analyses identified associations of sociodemographic and clinical factors with digital and navigational HL and self-management skills.

RESULTS: A total of 131 cancer survivors (74.8% female, 41% with breast cancer) completed the survey. Only 30% reported high digital HL, while self-management skills were generally high, particularly in “health service navigation” (median 3.6, IQR 0.8 on a 4-point Likert scale) and “constructive attitudes” (median 3.6, IQR 1). Compared to the general population, cancer survivors had significantly higher scores in digital interaction and digital resource use (P≤.002), while no differences were observed in digital or navigational HL. Digital and navigational HL, as well as self-management, were consistently associated with education level, social support, and financial deprivation.

CONCLUSIONS: Cancer survivors in Switzerland report low digital and navigational HL, comparable to the general population, while self-management skills were strong overall. Support strategies should simultaneously target individual and systemic factors to improve cancer survivors’ ability to access and use digital health resources. Future research should include a more representative sample to validate these findings.

PMID:42184350 | DOI:10.2196/84228