Category: Nevin Manimala

JMIR Form Res. 2026 Apr 2;10:e76037. doi: 10.2196/76037.

ABSTRACT

BACKGROUND: Individuals with one or more socially stigmatized identities experience extensive health disparities, resulting in poorer health outcomes. However, most studies consider the effects of only individual stigmatized identities.

OBJECTIVE: We aimed to quantitatively estimate the additive and multiplicative effects of stigmatized identities on self-reported overall health.

METHODS: We used survey data from 387,411 participants in the All of Us Research Program, which has assembled a disease-agnostic cohort intended to reflect the US population, to statistically estimate the first- and second-order effects of 47 stigmatized identities on self-reported overall health. We used a linear model to estimate the effects of individual and pairwise stigmas on self-ratings of overall health.

RESULTS: We began by aiming to create cohorts for all 93 stigmatized identities previously found to affect health, of which 47 (51%) could be practicably examined. We first modeled individual stigmas alone to contrast the results with those that included both individual and pairwise stigmas. After using the false discovery rate to adjust for testing multiple hypotheses in the collective model, 29 individual and 116 pairs of stigmas had statistically significant effects on self-reported overall health. All significant individual effects were negative or neutral except for skin cancer. Those with the largest negative effect on self-rated overall health were difficulty walking or climbing stairs, unemployed or unable to work, difficulty with errands, and low educational attainment. Pairs of intersecting stigmas had a mix of negative and positive incremental effects, indicating that some stigmatized identities are negative modifiers, such as depression, and other combinations are less negative than the sum of their individual negative effects, such as having difficulty with multiple types of activities of daily living. The individual stigmas with the largest number of statistically significant stigma pairs were unemployed or unable to work (14/47, 30%); depression and low income (11/47 each, 24%); and difficulty walking or climbing stairs, cognitive difficulties, obesity, and skin cancer (8/47 each, 17%).

CONCLUSIONS: Taken together, numerous pairs of stigmatized identities significantly affect self-reported overall health. While each stigmatization has both direct and indirect effects on health, the relative importance of direct and indirect effects will vary. Many of these are aligned with prior literature, and others warrant further exploration. While the large sample size of this study is a strength, we were unable to model higher-order intersectionality and encourage future research exploring this. The individual and pairwise identities with significant negative effects should be incorporated into research and clinical care by considering the multidimensionality of individuals and how that affects their overall health.

PMID:41926700 | DOI:10.2196/76037

J Clin Gastroenterol. 2026 Apr 3. doi: 10.1097/MCG.0000000000002376. Online ahead of print.

ABSTRACT

INTRODUCTION: Data collection on food insecurity and barriers to a healthy diet is not routinely done in hepatology clinics, although the prevalence of food insecurity is likely high. This is a pilot study to estimate the prevalence of food insecurity and characterize food-insecure patients with cirrhosis who receive routine outpatient care.

METHODS: Prospective survey of outpatients with cirrhosis to screen for food insecurity in the waiting room on the day of their appointment. Responses were linked to electronic medical record data for demographic, comorbidity, and health care utilization data. Descriptive statistics were calculated for patients who were food insecure versus food secure. Univariate and multivariable models were constructed to evaluate the relationships between patient factors and food insecurity.

RESULTS: Of 150 respondents, 25% (n=38) screened positive for food insecurity. In total, 69% (n=104) reported difficulty making the best food choices for their cirrhosis, 89% (n=34) among the food insecure, and 54% (n=60) among the food secure. Compared with food-secure individuals, those with food insecurity were younger (mean age 58.1 vs. 63.5 y, P=0.02), had lower BMI (mean 27.9 vs. 30.9, P=0.03), and were more likely to be Hispanic (15.8% vs. 4.5%, P=0.05) and Medicaid-insured (28.9% vs. 10.7%, P=0.01). Both groups had similar cirrhosis etiologies, co-morbidities, decompensation events, ED visits, and hospital admissions within the past year.

CONCLUSION: One in 4 patients screened during a routine outpatient hepatology visit reported food insecurity. Over 69% of patients reported difficulties with making cirrhosis-specific food choices, most of whom did not screen positive for food insecurity. Our findings underscore an urgent need for tailored screening and for interventions that address the unique barriers faced by cirrhosis patients.

PMID:41926693 | DOI:10.1097/MCG.0000000000002376

JMIR Aging. 2026 Apr 2;9:e84962. doi: 10.2196/84962.

ABSTRACT

BACKGROUND: Being socially connected is essential for health and well-being. Nonetheless, many older adults face social isolation, especially in ethnically diverse societies. Digital technologies offer a pragmatic approach to addressing problems with social connectedness; however, a consolidated understanding of their association with social connectedness among ethnic minority older adults remains unaddressed.

OBJECTIVE: We conducted a systematic review and meta-analysis to investigate the prevalence and utility of digital resources in promoting social connectedness among ethnic minority older adults.

METHODS: This systematic review and meta-analysis was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were retrieved from 4 electronic databases. A random-effects meta-analysis was used to estimate the pooled prevalence along with its 95% CI.

RESULTS: Twelve studies were included. The research approaches used by the included studies were as follows: quantitative (n=5), qualitative (n=5), and mixed methods (n=2). Overall, the estimated prevalence of internet use, which was defined as engaging in online activities through digital devices, was 81.8%. Commonly used digital devices were computers (66.7%), smartphones (63.2%), and tablets (29.3%). Sociodemographic, economic, and health-related factors influenced the adoption and use of digital resources among ethnic minority older adults. These older adults relied on digital resources to build meaningful social connections through social participation, maintaining cultural and religious ties, promoting transnational social networks, and fostering their potential for social connectedness. However, digital resources were not always useful for social connectedness and adversely affected in-person contact.

CONCLUSIONS: Digital resources can promote social connectedness among ethnic minority older adults by enabling them to maintain their cultural and social values. Cities and regions aiming to promote the social connectedness and well-being of ethnic minority older adults should consider intersectional factors that affect access to digital resources and the sustainable adoption of digital resources.

PMID:41926689 | DOI:10.2196/84962

JMIR Hum Factors. 2026 Apr 2;13:e77033. doi: 10.2196/77033.

ABSTRACT

BACKGROUND: Sleep is essential for overall health and well-being, but assessing sleep architecture is often costly and time-consuming, relying primarily on polysomnography (PSG). While wrist-worn wearables offer alternatives, they face limitations regarding user compliance, such as battery charging and physical discomfort. Nearable devices address these burdens, but they regularly lack rigorous validation, especially in real-world settings.

OBJECTIVE: This study evaluates the accuracy and reliability of the Withings Sleep Analyzer (WSA), a contactless sleep monitoring device, compared to PSG in a home setting using a large and diverse cohort of healthy individuals.

METHODS: A total of 117 healthy volunteers (69 women; mean 39.9, SD 11.4 years), prospectively recruited from the general population, underwent home-based PSG and simultaneous WSA recording. The study was conducted under free-living conditions, without constraints on substance intake, prebedtime activity, or forced sleep schedules. The main outcomes were the device’s performance in sleep-wake distinction and sleep stage identification using accuracy, kappa, sensitivity, specificity, and the mean absolute error of sleep measures on the entire population and demographic, clinical, and environmental subgroups.

RESULTS: WSA demonstrates high sensitivity (93%, 95% CI 92%-94%) for sleep detection and moderate sensitivity (73%, 95% CI 69%-77%) for wakefulness, achieving an overall accuracy of 87% (95% CI 86%-87%) for sleep-wake distinction. The device showed consistent performance across various demographic subgroups, including different age, BMI, mattress, and sleep arrangements (with or without bed partner) categories. Challenges were noted in accurately classifying specific sleep stages, particularly in distinguishing between light and deep sleep, with a mean accuracy of 63% (95% CI 62%-65%) and a Cohen κ of 0.49 (95% CI 0.47-0.51). The WSA tended to overestimate total sleep time (20 min, 95% CI 10 min to 31 min) and light sleep (1 h 21 min, 95% CI 1 h 8 min to 1 h 36 min) while underestimating rapid eye movement (-15 min, 95% CI -23 min to -8 min) and deep sleep (-46 min, 95% CI -59 min to -34 min) durations. Disagreements between expert reviewers were mirrored in part by the WSA’s misclassifications. Participants reported altered perceived sleep quality during the night with the PSG, suggesting discomfort during sleep.

CONCLUSIONS: Being contactless and placed under the mattress, the WSA offers a promising approach to long-term sleep monitoring in natural home environments. It shows competitive performance in sleep-wake and sleep stage identification compared to other consumer devices. Progress in wearable and nearable devices is necessary to enhance their accuracy to better support the monitoring of populations with impaired sleep, although limited by an imperfect gold standard. This work also emphasizes the importance of using large, diverse, and challenging datasets, as well as the need for a standardized methodology for accurate sleep stage classification.

PMID:41926681 | DOI:10.2196/77033

Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2026 Apr 2:1-13. doi: 10.1080/19440049.2026.2644495. Online ahead of print.

ABSTRACT

Food dyes enhance natural colour or provide colour to foods. Artificial food dyes are synthetic organic dyes not found in natural sources. Exposure to dyes has been linked to cases of attention deficit hyperactivity disorder (ADHD), rhinitis, urticaria and angioedema. This study used a Food Frequency Questionnaire (FFQ) to assess the exposure to artificial food dyes among the population of Rio Grande do Sul – Brazil through the estimated consumption of foods containing tartrazine (INS 102), sunset yellow (INS 110), amaranth (INS 123), Ponceau 4 R (INS 124), allura red (INS 129) and brilliant blue (INS 133). Exposure estimates were obtained using the maximum limits of usage permitted by Brazilian regulations. Different subpopulations were compared through the Wilcoxon-Mann-Whitney or Kruskal-Wallis tests, followed by the Dunn test; significant differences were found in the latter. The exposure to all dyes was significantly higher among children and adolescents, as was the risk of an intake higher than the Acceptable Daily Intake (ADI). There was also a relationship between lower per capita income and higher exposure to artificial dyes. Amaranth (INS 123) showed a higher risk of intake greater than the ADI (1.56% of survey participants). The exposure to artificial dyes can be considered safe in Rio Grande do Sul, except for amaranth, but and children and adolescents demand special attention.

PMID:41926679 | DOI:10.1080/19440049.2026.2644495

Adv Sci (Weinh). 2026 Apr 2:e20738. doi: 10.1002/advs.202520738. Online ahead of print.

ABSTRACT

We demonstrate that the primary factor determining the external quantum efficiency (EQE) of InGaN-based micro-scale light-emitting diodes (µLEDs) depends on their internal state. A comparative photoluminescence (PL) study shows that the lateral diffusion length of carriers in InGaN red µLEDs is significantly shorter than in InGaN blue µLEDs, primarily due to inhomogeneity in the bulk material. This results in an insignificant change in PL intensity regardless of sidewall conditions. Additionally, examinations of EQE and peak wavelength across various epitaxial designs and sidewall conditions reveal that sidewall-surface recombination does not significantly impact EQE in InGaN red µLEDs. Meanwhile, the peak wavelength, which represents the radiative recombination rate given by the quantum well design of InGaN red µLEDs, is found to dominantly influence the EQE of InGaN red µLEDs. Furthermore, statistical analysis based on the relative standard deviation indicates that the peak wavelength is one of the primary determinants of EQE in InGaN red µLEDs. These findings suggest that addressing internal state is crucial for optimizing EQE of µLEDs.

PMID:41926672 | DOI:10.1002/advs.202520738

Int J Audiol. 2026 Apr 2:1-13. doi: 10.1080/14992027.2026.2650507. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effectiveness of the integrated digit-in-noise test (iDIN), which uses digit sequences of varying lengths as test materials, in assessing speech-in-noise recognition among non-native Cantonese speakers with normal hearing.

DESIGN: A cross-sectional observational study was conducted involving native Mandarin speakers with Cantonese as a second language. Participants completed Cantonese and Mandarin versions of iDIN and the Cantonese Speech in Noise Test (HINT). In the iDIN, only the 2-, 3-, and 5-digit forward recall, as well as the 3-digit backward recall conditions, were administered. Data on language experience, proficiency, and exposure were collected through questionnaires.

STUDY SAMPLE: Forty-seven participants (mean age 29.13 years) with normal hearing and Cantonese as a second language were recruited in Hong Kong. All had varying durations of Cantonese exposure, from <1 year to over 10 years.

RESULTS: Statistically significant differences were observed between Cantonese and Mandarin speech reception thresholds (SRTs) for the 3-digit, 5-digit forward recall, and 3-digit backward recall conditions, but not for the 2-digit forward recall. Longer Cantonese exposure correlated with improved (lower) SRTs in Cantonese iDIN, with performance becoming comparable to native speakers after ∼2 years of exposure.

CONCLUSIONS: iDIN may have potential as a tool for assessing speech-in-noise recognition in non-native Cantonese speakers with normal hearing, particularly after two years of exposure, though further validation in clinical populations is needed.

PMID:41926650 | DOI:10.1080/14992027.2026.2650507

J Med Internet Res. 2026 Apr 2;28:e76432. doi: 10.2196/76432.

ABSTRACT

BACKGROUND: Digital biomarkers are increasingly being used to support depression assessment by providing objective, continuous, and real-time physiological and behavioral data. However, most existing studies have focused on individual biomarkers, such as sleep or cardiac parameters, while integrative evaluations that capture the multidimensional nature of depression remain limited.

OBJECTIVE: This systematic review evaluated digital biomarkers for depression and synthesized evidence on differences between individuals with depression and controls.

METHODS: Eligible studies included observational or interventional studies examining digital biomarkers for depression with validated outcome measures. We searched major international and Korean databases, including MEDLINE, PsycINFO, CINAHL, IEEE Xplore, Web of Science, Cochrane Library, KISS, RISS, KMbase, and KoreaMed, from inception to December 28, 2025. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Scottish Intercollegiate Guidelines Network checklist. Meta-analyses were conducted using random-effects models with the Hartung-Knapp-Sidik-Jonkman method, and other outcomes were narratively summarized.

RESULTS: The search yielded 39,617 records, of which 132 studies involving 57,852 participants met the inclusion criteria. These studies encompassed various digital biomarkers, including sleep, physical activity, cardiac measures, smartphone-derived data, speech, GPS data, and circadian rhythms. A meta-analysis of 22 studies (6947 participants) revealed that individuals with depression had significantly longer sleep onset latency (5 studies; n=292; +4.75 min, 95% CI 2.46-7.04; P=.005; 95% prediction interval [PI] 0.01-10.27) and time in bed (3 studies; n=236; +31.81 min, 95% CI 18.22-45.39; P=.01; 95% PI 2.28-55.16). Physical activity counts were also significantly lower (5 studies; n=462; standardized mean difference -0.71, 95% CI -1.33 to -0.09; P=.03; 95% PI -2.18 to 0.71). Although individuals with depression showed a lower sleep efficiency, higher mean heart rate, and lower SD of normal-to-normal intervals, these differences were not statistically significant. Other digital markers yielded inconsistent results. Overall, these findings indicate that no single digital biomarker sufficiently captures depression-related changes. Instead, the results support the superiority of personalized, multimodal approaches. However, the generalizability of these findings is limited by the lack of standardized data collection protocols and high clinical heterogeneity across studies, as reflected in wide PIs.

CONCLUSIONS: Certain digital biomarkers, particularly sleep onset latency and physical activity counts, showed consistent average differences between the depression and control groups. However, wide PIs indicate substantial variability across settings, suggesting that no single marker is sufficient for reliable detection. This study advances the field by providing a comprehensive meta-analysis of multidimensional digital biomarkers, establishing a quantitative foundation for objective depression screening and monitoring. These findings support the use of personalized, multimodal digital phenotyping approaches and highlight the need for standardized, clinically interpretable frameworks for real-world depression monitoring.

PMID:41926632 | DOI:10.2196/76432

J Wound Care. 2026 Apr;35(Sup4a):S28-S36. doi: 10.12968/jowc.2025.0340. Epub 2026 Apr 2.

ABSTRACT

OBJECTIVE: To determine the composite cut-off value and diagnostic accuracy of C-reactive protein (CRP) for diabetic foot osteomyelitis (DFO).

METHOD: A retrospective study of patients was combined with a meta-analysis. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity and area under the curve (AUC) were calculated via forest plots and summary receiver operating characteristic curves. A composite cut-off model was developed using R 4.4.3 (R Foundation for Statistical Computing, Austria).

RESULTS: The experimental cohort comprised 265 patients (204 with DFO and 61 without). The meta-analysis comprised 12 studies, including a total of 1828 patients. The retrospective cohort demonstrated that CRP achieved an AUC of 0.63 (95% confidence interval (CI): 0.55, 0.71) for diagnosing DFO, with an optimal cut-off value of 9.57mg/l (sensitivity 74%, specificity 53%). Meta-analysis revealed pooled sensitivity of 74% (63-83%) and specificity of 73% (65-79%) (AUC=0.79; 95%CI: 0.75, 0.82). The composite model suggested a CRP cut-off of 15.20mg/l (sensitivity 80%, specificity 53%).

CONCLUSION: In this study, CRP demonstrated moderate diagnostic utility for DFO and could function as a screening adjunct.

PMID:41926570 | DOI:10.12968/jowc.2025.0340

J Cardiovasc Pharmacol. 2026 Apr 1;87(4):209-218. doi: 10.1097/FJC.0000000000001801.

ABSTRACT

Aspirin (ASA) is the cornerstone of the acute coronary syndrome primary and secondary prevention. Still, its role is debated in some high bleeding risk patients or cases that underwent second-generation drug-eluting stents with a better scaffold. This study compared the efficacy and safety of aspirin-free versus aspirin-based strategies in patients with ACS undergoing PCI. We systematically searched PubMed, Embase, Scopus, and ScienceDirect for studies comparing aspirin-based versus aspirin-free strategies in patients with ACS undergoing PCI. Pooled relative risk (RR) with 95% CI was calculated using a fixed effects model or a random effects model if heterogeneity was present. Significance was set at P < 0.05. Thirty studies including 207,938 patients (N = 104,062 in the ASA arm, and 103,876 in the ASA-free arm) were included in this study. There was a statistically significant reduction in risk of all-cause mortality [RR 0.93, 95% CI, 0.87-0.99, P-value = 0.024, I2 = 0%], BARC 2-5 [RR = 0.68, 95% CI, 0.58-0.81, P-value = <0.01, I2 = 0%], BARC 3 or 5 [RR= 0.71, 95% CI, 0.60-0.82, P-value= <0.01, I2 = 0%], TIMI major bleeding [RR = 0.66, 95% CI, 0.50-0.86, P-value= 0.02, I2 = 0%], TIMI minor or major bleeding [RR= 0.61, 95% CI, 0.52-0.72, P-value= <0.01, I2 = 0%], and ISTH major bleeding with aspirin-free strategy [RR= 0.52, 95% CI, 0.42-0.64, P-value= <0.001, I2= 0%]. Other secondary outcomes showed statistically nonsignificant results. The aspirin-free strategy showed lower all-cause mortality and bleeding, supporting its efficacy and safety in high bleeding risk patients.

PMID:41926558 | DOI:10.1097/FJC.0000000000001801