Category: Nevin Manimala

Rev Peru Med Exp Salud Publica. 2026 Jun 22;43(2):160-170. doi: 10.17843/rpmesp.2026.432.15170.

ABSTRACT

OBJECTIVES: To evaluate self-reported adherence to the essential components of tuberculosis preventive treatment (TPT), as an estimate of partial implementation fidelity, and to explore the moderating factors influencing its implementation in two referral services in the Central Department, Paraguay.

MATERIALS AND METHODS: A descriptive observational mixed-methods study with a convergent parallel design (January-May 2023) was conducted in two referral centers for people living with HIV. Partial implementation fidelity was estimated through self-reported adherence to the content and frequency dimensions of TPT implementation according to the National Tuberculosis Guide. Semi-structured interviews were conducted with key stakeholders to identify barriers and facilitators.

RESULTS: 11/13 physicians and 10 key stakeholders participated. Overall TPT fidelity was low (50.0%). Adherence to content was moderate (64.2%), while adherence to frequency was low (31.3%), evidencing a gap between perceived importance and clinical practice. The awareness/education component showed the lowest performance. The main barriers were identified in the internal environment, including organizational fragmentation between TB/HIV programs, limited resources, absence of operational protocols, and communication deficiencies. At the individual level, erroneous beliefs and low self-efficacy were identified. As facilitators, national normative alignment and the willingness of stakeholders to strengthen implementation were observed.

CONCLUSIONS: Low fidelity reflects mainly organizational and process failures, which highlights the need for facilitation strategies, interprogrammatic articulation, and capacity strengthening to achieve sustained implementation.

PMID:42531578 | DOI:10.17843/rpmesp.2026.432.15170

Obstet Gynecol. 2026 Jul 30. doi: 10.1097/AOG.0000000000006389. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate changes in pregnancy-associated drug overdose mortality in the United States from 2018 to 2023 and compare this with drug overdose mortality among reproductive-aged nonpregnant female decedents. Secondarily, to assess types and combinations of drugs that contribute to overdose mortality, regional patterns, and overdose timing.

METHODS: This was a cross-sectional study that used 2018-2023 National Center for Health Statistics death certificate data. Drug overdose deaths were identified using International Classification of Diseases, Tenth Revision codes, and specific drugs involved were identified using T codes. Among all female decedents of reproductive age (15-44 years), pregnancy-associated drug overdose deaths were identified from the pregnancy checkbox. We calculated absolute and relative changes in drug overdose mortality rates for pregnancy-associated deaths and non-pregnancy-associated deaths among reproductive-aged female individuals. The annual pregnancy-associated drug mortality rates were also calculated by drug type and U.S. region (Northeast, Midwest, South, and West).

RESULTS: There were 2,573 pregnancy-associated drug overdose deaths identified. Pregnancy-associated overdose mortality increased from 8.0 per 100,000 live births to 13.0 deaths per 100,000 live births (relative increase: 62.2%). The drug overdose mortality rate among female individuals of reproductive age increased from 16.8 per 100,000 live births to 22.3 per 100,000 live births across the same period (relative increase: 33.0%). The fentanyl-involved pregnancy-associated overdose mortality rate was higher than other drugs. The psychostimulant-involved rate increased across time (from 2.9 deaths/100,000 live births to 7.5 deaths/100,000 live births). Drug overdose mortality rates were highest in the South. Polysubstance-involved overdose deaths were also common, with fentanyl and psychostimulants accounting for 24.8% of deaths.

CONCLUSION: The relative increase in the drug overdose mortality rate among pregnant and postpartum individuals was nearly double that of nonpregnant female individuals of reproductive age, driven by fentanyl, increasing psychostimulant, and polysubstance overdose deaths.

PMID:42531570 | DOI:10.1097/AOG.0000000000006389

J Speech Lang Hear Res. 2026 Jul 30:1-33. doi: 10.1044/2026_JSLHR-25-00953. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to test the impact of modifying resistive load and time under tension (TUT) on respiratory excursion, submental excitation, and ratings of perceived exertion/effort (RPE) during expiratory muscle strength training (EMST). Task specificity between EMST, cough, and swallowing was also explored.

METHOD: Participants were outfitted with respiratory bands, submental surface electromyography, and a microphone. Tasks included maximal expiratory pressure (MEP) testing, voluntary and reflex cough testing, cup sips, and EMST. EMST included three sets of 10 repetitions in four conditions: short (0.2 s) at 50% MEP, long (1 s) at 50% MEP, short at 75% MEP, and long at 75% MEP (L75). Outcomes were respiratory kinematics, cough airflow, submental excitation, and RPE. Multilevel models and pairwise comparisons were used for statistical analysis.

RESULTS: Twenty healthy adults (M_age = 27 ± 5 years) participated. There were significant effects between EMST conditions where rib cage excursion ranged from 5% to 24% (of maximum), abdominal excursion ranged from 6% to 19%, submental excitation ranged from 40% to 57%, and RPE varied (p < .05). Several pairwise contrasts during cough and swallowing showed no significant differences with EMST conditions. Submental excitation during L75 was higher than the swallowing condition (p = .03).

CONCLUSIONS: Exercise parameters including resistive load and TUT that impacted the acute physiologic responses to EMST should be considered during exercise prescription to maximize physiologic adaptations and training specificity. Future research will examine the longitudinal impacts of modifying EMST exercise parameters on coughing and swallowing outcomes.

PMID:42531563 | DOI:10.1044/2026_JSLHR-25-00953

Can Urol Assoc J. 2026 Aug;20(8):241-247. doi: 10.5489/cuaj.9856.

ABSTRACT

INTRODUCTION: Peer review underpins academic publishing and represents a core scholarly competency; however, most trainees receive little structured or mentored instruction in conducting high-quality reviews. As the demand for rigorous peer review grows, journals must also cultivate the next generation of reviewers. For a society journal such as the Canadian Urological Association Journal (CUAJ), this cultivation also supports strengthening scholarly capacity within its Canadian urology community. We therefore developed and piloted the CUAJ Trainee Peer-Reviewer Training Program.

METHODS: We designed and implemented a one-year, structured, and mentored trainee peer-reviewer training program for Canadian urology residents and fellows. The program included: 1) a didactic seminar introducing principles of peer review, ethical considerations, and best practices; 2) a structured mock peer-review exercise with facilitated group feedback; and 3) completion of three mentored manuscript peer reviews under the supervision of editorial board members, with individualized feedback. Participants completed baseline and exit surveys assessing self-reported knowledge, confidence, and peer-review competencies, as well as providing feedback on the initiative using 10-point Likert scales.

RESULTS: Nine trainees completed the program. Participants reported increased familiarity with the peer-review process (median 7, interquartile range [IQR] 4-8 before vs. 9, IQR 8-10 after, p=0.02) and confidence in conducting peer review (5, IQR 4-8 before vs. 9, IQR 8-9 after, p=0.01). Improvements were also observed across multiple domains of critical appraisal and peer-review skills, including evaluation of study design, statistical methods, interpretation of results, and provision of constructive feedback. Participants reported a high likelihood of continuing to engage in peer review after the program (median 9, IQR 8-10). All participants indicated they would recommend the initiative to other trainees, and overall satisfaction with the program was high (median 9, IQR 8-10).

CONCLUSIONS: The CUAJ Trainee Peer-Reviewer Training Program was feasible and well-received by trainees. In its pilot year, the program provided structured exposure to the peer-review process and was associated with improvements in trainees’ self-reported familiarity, confidence, and comfort with evaluating key components of scientific manuscripts. This trainee-focused peer-review initiative may represent a practical and sustainable strategy to strengthen the Canadian urology reviewer pipeline while equitably introducing trainees to the principles of critical appraisal and scholarly publishing.

PMID:42531553 | DOI:10.5489/cuaj.9856

Global Spine J. 2026 Jul 30:21925682261474420. doi: 10.1177/21925682261474420. Online ahead of print.

ABSTRACT

Study DesignSystematic review and meta-analysis.ObjectivesWe sought to evaluate the association between pre-treatment symptom duration and outcomes in patients undergoing radiotherapy (RT)/surgery for metastatic epidural spinal cord compression (MESCC).MethodsA systematic review included publications evaluating the association between pre-treatment symptom duration and outcomes after RT/surgery in adults with MESCC. Primary exposure was pre-treatment symptom duration. Outcomes were motor-recovery, ambulation, survival and local control. Pooled-effect-estimates were calculated.Results Of 4639 studies, 37 met the inclusion criteria (26-RT,11-surgery). RT: All studies defined symptom duration as time from motor-weakness onset to RT. Longer symptom duration was associated with improved motor-recovery (Pooled-effect-estimate=2.08, 95%CI:1.68-2.58,p<0.001) and decreased mortality-risk (improved-survival)((Pooled-effect-estimate=0.72, 95%CI:0.69-0.76,p<0.001). Although longer symptom duration was consistently associated with better ambulation and lower local recurrence, few studies precluded meta-analysis. Surgery: Symptom duration was defined as time from neurological-deficit onset to surgery in 7/11 studies; three-studies used ambulatory status, and one-study used both. Longer symptom duration was associated with increased risk-of-death (worse-survival)(Pooled-effect-estimate=1.28, 95%CI:0.54-3.03,p=0.575), though statistically insignificantly. Meta-analysis for motor-recovery wasn’t feasible, but most studies found longer symptom duration worsened motor-recovery, while ambulation findings were inconsistent.ConclusionSymptom duration was associated with differing outcome patterns by treatment modality. In RT cohorts, longer symptom duration was associated with improved survival and motor recovery. In surgical cohorts, it trended toward worse survival, though this did not reach statistical significance. Most surgical studies suggested an inverse association between symptom duration and motor recovery. These findings are exploratory, and should be interpreted in context of treatment selection-bias and between-cohort heterogeneity.

PMID:42531551 | DOI:10.1177/21925682261474420

Am J Public Health. 2026 Jul 30:e1-e11. doi: 10.2105/AJPH.2026.308563. Online ahead of print.

ABSTRACT

Objectives. To assess differences in social determinants of health identified through International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision (ICD-10-CM) codes between lesbian, gay, bisexual, and other nonheterosexual (“sexual minority”) veterans and heterosexual veterans who utilize primary care services in the US Veterans Health Administration. Methods. We used the Veterans Health Administration Survey of Healthcare Experiences of Patients, weighted descriptive statistics, and multivariable logistic regression to examine differences in sociodemographic characteristics and social determinants of health-related ICD-9-CM and ICD-10-CM code domains by sexual orientation (sexual minority vs heterosexual). Results. Of the 455 165 veterans surveyed, roughly 3% (n = 14 065) identified as sexual minority. Compared with heterosexual veterans, sexual minority veterans were often younger and more likely to be racially/ethnically diverse, live in urban areas, and identify as female. All sexual minority groups had a greater risk of issues related to housing, economic circumstances, and other psychosocial circumstances than heterosexual veterans. Conclusions. Sexual minority veterans had increased vulnerabilities across various social determinants of health ICD-9-CM and ICD-10-CM code domains associated with health and well-being. Future research should continue to explore this relationship and develop evidence-based interventions to support sexual minority veterans effectively. (Am J Public Health. Published online ahead of print July 30, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308563).

PMID:42531544 | DOI:10.2105/AJPH.2026.308563

Int J Health Plann Manage. 2026 Jul 30. doi: 10.1002/hpm.70115. Online ahead of print.

ABSTRACT

BACKGROUND: Current management of hemostatic consumables is challenged by inefficient inventory control, substantial wastage, and recurrent operational adverse events. The SPD model offers an integrated supply chain approach with strong potential to optimize medical logistics. This study aims to evaluate the impact of the SPD model on cost control and management efficiency in hemostatic consumables.

METHODS: This retrospective study was conducted at a tertiary (Grade A) cancer hospital. Hemostatic consumables managed under the traditional model (January-December 2023) were compared with those under the SPD model (January-December 2024). The SPD model integrated an information technology platform, IoT-enabled smart cabinets, barcode scanning, and a pay-on-consumption settlement mechanism. T-tests and chi-square tests were used to compare the two groups in cost control metrics, management efficiency scores, staff satisfaction, and the incidence of operational adverse events.

RESULTS: In terms of cost control, the SPD model demonstrated statistically significant reductions in monthly average hemostatic material expenditure, requisition frequency, expiration loss rate, and reported loss rate (all p < 0.05). Regarding management efficiency, the SPD model showed significantly higher scores in timely delivery, work efficiency, standardization, supply traceability, waste recovery, delivery satisfaction, and demand forecasting, while achieving significantly lower scores in item issues and operating costs (all p < 0.05). Staff satisfaction surveys revealed significant improvements in operational convenience, clinical reliability, system usability, and overall satisfaction under the SPD model (all p < 0.05). Furthermore, the incidence of all documented operational adverse events was significantly reduced under the SPD model (all p < 0.05).

CONCLUSION: The SPD model facilitates precise, low-loss, and highly efficient control of hemostatic consumables, representing an effective optimization strategy with considerable clinical benefits and significant potential for widespread adoption. Despite limitations including single-center design and a one-year observation period, future multi-center and longitudinal studies are warranted to validate these findings and assess long-term sustainability.

PMID:42531520 | DOI:10.1002/hpm.70115

Am J Physiol Heart Circ Physiol. 2026 Jul 30. doi: 10.1152/ajpheart.00036.2026. Online ahead of print.

ABSTRACT

Background: Arterial waveforms are altered in left ventricular systolic dysfunction. We aimed to investigate the diagnostic implications of automatically analyzed pressure waveforms and their changes over time in patients with reduced ejection fraction. Methods: Arterial waveforms were recorded non-invasively using applanation tonometry in patients with heart failure with reduced ejection fraction (HFrEF) and in matched controls. Waveform parameters were analyzed with respect to the left ventricular ejection time index (LVETi), the characteristics of antegrade and reflected waves, their interaction as quantified by the Augmentation Index (AIx), and wave intensity, expressed as the ratio of the S and D peak intensities (SDR). Results: Overall, 78 HFrEF patients (ejection fraction (EF) 28+/-9%) and 78 controls (EF 66+/-8%), matched for sex, age, presence of hypertension and diabetes, systolic and diastolic blood pressure, and heart rate were included. All waveform parameters were statistically different between patients and controls. In ROC analysis, HFrEF patients and controls could be separated best using LVETi (AUC 0.897, p<0.0001) and SDR (AUC 0.911, p<0.0001). In newly diagnosed and treated HFrEF patients, the AUC for discrimination between HFrEF patients from controls was almost ideal (0.978, p<0.0001), when a combination of LVETi and SDR was used. Finally, in 46 HFrEF patients with available follow up data, concordance analysis showed a high agreement of up to 0.8 between changes in the cardiac function (eg., using EF) and changes in several waveform parameters. Conclusions: Pulse waveform parameters may be useful for screening and follow-up of patients with HFrEF.

PMID:42531502 | DOI:10.1152/ajpheart.00036.2026

JMIR AI. 2026 Jul 30;5:e90590. doi: 10.2196/90590.

ABSTRACT

BACKGROUND: Synthetic electronic health record generation is limited not only by statistical fidelity but also by clinical validity. Records that appear statistically plausible may still violate hard structural, physiological, or relational constraints.

OBJECTIVE: This study evaluated best-of-N constraint-minimizing selection as an inference-time strategy for improving clinical validity and characterized when such selection succeeds or fails as a function of the generator’s valid support mass (pvalid).

METHODS: We evaluated Wasserstein generative adversarial network with gradient penalty (WGAN-GP) and conditional tabular generative adversarial network (CTGAN) on 3 public clinical tabular datasets: stroke prediction (n=5110), diabetes health indicators (n=100,000), and cardiovascular disease (n=68,599). For each generator, we compared random sampling, naive clipping, and best-of-N selection (N ∈ {8, 16, 128}). Validity was assessed via dataset-specific rule violations; fidelity via Kolmogorov-Smirnov (KS) statistics and correlation preservation; utility via TSTR (train-on-synthetic-test-on-real) AUC (area under the receiver operating characteristic curve); and privacy via membership inference attack (MIA) AUC and distance to closest record (DCR).

RESULTS: Best-of-N effectiveness was governed by the base generator’s valid support mass. In stroke, WGAN-GP had pvalid=0, and all selection strategies, including strict rejection across 5000 draws, produced 500/500 (100%) invalid samples. In cardiovascular data, WGAN-GP had pvalid=0.12; best-of-16 reduced violations from 441/500 (88.2%) to 65/500 (13.0%), and best-of-128 eliminated them entirely (0/500), matching theoretical predictions exactly. In diabetes, WGAN-GP random sampling was already fully valid (0/500 violations), and best-of-N primarily shifted utility. Across all 3 datasets, CTGAN+best-of-16 achieved 0/500 violations with strong fidelity (mean KS≤0.12) and utility (TSTR AUC up to 0.81). MIA AUC remained near-random guessing (approximately 0.50) throughout, though DCR-based proximity concentration increased markedly under CTGAN selection (reaching 22.6% on stroke and 100% on cardiovascular data).

CONCLUSIONS: Best-of-N functions as a bounded-budget feasibility filter rather than a universal repair mechanism. Its effectiveness depends critically on the generator’s valid support mass. CTGAN+best-of-16 offered the strongest overall trade-off across clinical validity, fidelity, utility, and privacy in our experiments.

PMID:42531495 | DOI:10.2196/90590

Womens Health (Lond). 2026 Jan-Dec;22:17455057261474450. doi: 10.1177/17455057261474450. Epub 2026 Jul 30.

ABSTRACT

IntroductionRepeated induced abortion is an important public health concern globally. While its burden spans both developed and developing contexts, complications are disproportionately higher in low-resource settings.ObjectiveTo assess the prevalence and associated factors of repeated induced abortion among women seeking abortion care services in public hospitals in Northwest Ethiopia.Study DesignAn Institutional based cross-sectional study was employed.MethodsThe study was conducted among 406 systematically selected women seeking abortion care between April 10 and June 15, 2022. Data were collected using interviewer-administered questionnaires via EpiCollect. Analysis was performed using SPSS version 25. Binary logistic regression was utilized to identify potential factors influencing the outcome variable. Odds ratios with their 95% confidence intervals were used to determine the strength of association and variables with a p-value below 0.05 were considered statistically significant factors for the outcome variable. Reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology statement.ResultsOf the 406 participants 21.9% (95% CI: 18.1-26.1) reported repeated induced abortion. Age ≥ 30 years (adjusted odds ratio (AOR) = 5.505; 95% CI: 1.279-23.696), having multiple sexual partner (AOR = 5.148; 95% CI: 2.410-10.997), and alcohol consumption (AOR = 2.535; 95% CI: 1.033-6.218) were the significant factors associated with repeated induced abortion.ConclusionApproximately one in five women seeking abortion care reported a lifetime history of repeat induced abortion. Rather than relying on uniform approaches, it is crucial to implement tailored counseling and behavioral assessments that focus specifically on older women, those with multiple sexual partners, and women who consume alcohol, as these subgroups exhibit significantly higher odds of repeat induced abortion.

PMID:42531481 | DOI:10.1177/17455057261474450