Category: Nevin Manimala

Psychogeriatrics. 2026 Mar;26(2):e70156. doi: 10.1111/psyg.70156.

ABSTRACT

OBJECTIVES: To estimate the prevalence of extreme behavioural and psychological symptoms of dementia (BPSD) in hospitalised patients in comparison with people with dementia with a long hospital stay but no mental health and behavioural problems related to dementia.

DESIGN: Retrospective analysis using the Admitted Patient Data Collection for people aged ≥ 50 with a diagnosis of dementia who had a long stay (defined as ≥ 42 days) in a public hospital between January 2015 and December 2019.

SETTING: New South Wales (NSW), Australia.

PARTICIPANTS: People with dementia aged ≥ 50 years with long stays in NSW hospitals.

MEASUREMENTS: Characteristics of behaviour-related long stays (BRLS) and non-behaviour-related long stays (NBRLS) cohorts were compared using Welch’s t-test and Fisher’s exact test.

RESULTS: There were 115 people with dementia who had 120 BRLS (range 42-2043 days, median 86 days, IQR 53-151 days) and 6186 people with dementia who had 7523 NBRLS (range 42-5750 days, median 61 days, IQR 49-84 days). Those in the BRLS cohort were younger by a mean of 5.96 years (p < 0.001; Welch’s t-test, 95% CI 4.18-7.74) and more likely to be men (0.0062, p < 0.001, Fisher’s exact test). BRLS occurred predominantly in non-psychiatric public hospitals (92.4%). People with BRLS were more likely to have mental health comorbidities (n = 65, 56.5%) than people with NBRLS (2011, 32.7%).

CONCLUSIONS: BRLS in people with dementia are less common than NBRLS and are more likely to occur in the context of mental health comorbidities and in younger males.

PMID:41797625 | DOI:10.1111/psyg.70156

Stat Med. 2026 Mar;45(6-7):e70469. doi: 10.1002/sim.70469.

ABSTRACT

In multi-site clinical research, diagnostic assessments can vary across sites even when standardized criteria and instruments are used, leading to inconsistent disease classification. This issue is examined in settings with an anchor variable that confidently identifies disease when positive but provides no information when negative. A random effects model is introduced for site-specific sensitivity, along with likelihood-based methods for estimation and hypothesis testing. The approach addresses two objectives: testing whether diagnostic sensitivity varies across sites, and quantifying the magnitude of such variability. Validation data is incorporated to establish parameter identifiability. Laplace approximation and the Expectation-Maximization (EM) algorithm are further engaged to address the computational challenge caused by an intractable integral in the likelihood function. Likelihood ratio and score tests are constructed to account for the boundary constraint that arises when the null hypothesis places the variance component at zero. Simulation studies demonstrate the good performance in finite samples, with accurate parameter estimates and appropriate test size and power. Application to a multi-site Huntington disease cohort for diagnosing mild cognitive impairment reveals differences in diagnostic sensitivity across sites, with tests providing strong evidence of heterogeneity. This framework offers a principled approach for testing and quantifying site-level variability in diagnostic sensitivity, supporting more consistent inference in multi-site studies.

PMID:41797613 | DOI:10.1002/sim.70469

Br J Nutr. 2026 Mar 9:1-26. doi: 10.1017/S0007114526106618. Online ahead of print.

ABSTRACT

This study investigated the relationships of total dietary grain fibre (TGF) and its two subtypes (whole grain fibre (WGF) and refined grain fibre (RGF)) with essential hypertension (EHP) in a large-scale prospective cohort study. The participants were recruited by UK Biobank. Dietary grain fibre was assessed using the baseline touchscreen food-frequency questionnaire. New-onset EHP was defined by International Classification of Disease version 10. Cox proportional hazards model and restricted cubic spline (RCS) analysis were utilized to examine the associations of TGF and its subtypes with EHP. Additionally, mediation analysis was applied to assess whether the triglyceride-glucose (TyG) index and inflammatory index score (INFLA-score) mediated these associations. Among 60,315 participants without prior hypertension, 3,651 (6.05%) developed EHP over a median follow-up of 10.3 years, with an incidence density of 6.08 per 1,000 person-years. The adjusted hazard ratios for Q4 compared with Q1 were 0.828 (95% CI: 0.750, 0.914) for TGF and 0.842 (95% CI: 0.767, 0.936) for WGF. RCS analysis confirmed inverse relationships for TGF and WGF with EHP risk. But RGF showed no significant association with EHP. The TyG index and INFLA-score partially mediated the associations of TGF and WGF with EHP, with mediation proportions of 4.2% and 3.3% for TGF, and 4.9% and 5.2% for WGF, respectively. Jointly, TyG index and INFLA-score together mediated 5.6% between TGF and EHP, and 7.4% between WGF and EHP. In conclusion, higher intake of TGF and WGF reduce EHP risk, and this effect is only partly mediated by TyG index and INFLA-score.

PMID:41797603 | DOI:10.1017/S0007114526106618

Glob Health Action. 2026 Dec;19(1):2640684. doi: 10.1080/16549716.2026.2640684. Epub 2026 Mar 9.

ABSTRACT

BACKGROUND: Women with disabilities face heightened vulnerability to domestic violence and often encounter multiple barriers to seeking help. However, empirical evidence on help-seeking behaviour among this group in low-resource settings remains limited.

OBJECTIVE: The study assessed factors associated with help-seeking among women with disabilities following exposure to domestic violence in Uganda using nationally representative data.

METHODS: We analysed data from 2006, 2011, and 2016 Uganda Demographic and Health Surveys. Disability status was determined using Washington Group Short Set of Questions on functional difficulties. The sample comprised women with disabilities aged 15-49 who reported experiencing domestic violence. Descriptive statistics and logistic regression models estimated associations between socio-demographic characteristics and help-seeking, accounting for sampling weights, clustering, and stratification.

RESULTS: Help-seeking among women with disabilities remained low over time. In 2016, only about two in five women (43%) who experienced domestic violence reported seeking help. Employment and age were strongly associated with help-seeking. Employed women with disabilities were six times more likely to seek help than their unemployed peers (AOR = 6.68; 95% CI: 1.53-29.23). Younger women were less likely to seek help than older women. No significant associations were observed for education, wealth, or place of residence.

CONCLUSIONS: Employment and older age emerged as important enablers of help-seeking among women with disabilities who are experiencing domestic violence. Strengthening and implementing age-appropriate and inclusive labour policies that promote economic participation and awareness of support services for women with disabilities may enhance their access to domestic violence services in Uganda and similar low-resource settings.

PMID:41797601 | DOI:10.1080/16549716.2026.2640684

J Invest Surg. 2026 Dec;39(1):2586017. doi: 10.1080/08941939.2025.2586017. Epub 2026 Mar 9.

ABSTRACT

BACKGROUND: Postoperative sore throat (POST) is an distressing complication following endotracheal intubation, particularly with double-lumen tube (DLT) intubation. Study evaluated the effects of two local anesthetic techniques on hemodynamic responses and POST in DLT-intubated patients.

METHODS: A randomized controlled study was conducted with 60 patients scheduled for elective thoracic surgery. Participants were randomized into three groups: TrachoSpray group (2 mL of 10% lidocaine), Manual spray group (10% lidocaine) and, Control group (0.9% saline). Hemodynamic parameters, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were monitored preoperatively, intraoperatively, and postoperatively. POST was assessed using a visual analog scale at 2, 6, 12, and 24 h post-extubation.

RESULTS: Both lidocaine groups demonstrated significant reductions in SBP, DBP, and MAP at key time points compared to control group. Post-extubation, MAP was significantly higher in TrachoSpray group than lidocaine group (p = 0.04). No statistically significant differences in POST scores were observed between groups.

CONCLUSIONS: TrachoSpray device and manual lidocaine spray improved hemodynamic stability in DLT-intubated patients; however, neither method resulted in a significant reduction in POST scores. Further research is needed to confirm these hemodynamic benefits and to explore potential effects on long-term outcomes.

PMID:41797600 | DOI:10.1080/08941939.2025.2586017

Indian J Cancer. 2025 Oct 1;62(4):541-547. doi: 10.4103/ijc.ijc_643_23. Epub 2026 Mar 7.

ABSTRACT

BACKGROUND: CDK4/6 inhibitors have become the standard of care for the treatment of HR+ metastatic breast cancer (MBC) based on clinical trials. However, real-world experience and efficacy in various subgroups are still lacking. Therefore, we conducted a study to analyze the use of CDK4/6 inhibitors in the treatment of HR-positive MBC and assess the related outcomes.

METHODS: A total of 120 patients who received CDK4/6 inhibitors from 2015 to 2021 were analyzed. Detailed clinical, demographic information and tumor-related factors were obtained for each patient. Progression-free survival (PFS), toxicity profile, and tolerance to CDK4/6i were analyzed and correlated.

RESULTS: Among the 120 patients analyzed, 100 received palbociclib, while ribociclib, and abemaciclib were given to ten patients each. The median age of the population was 57 years. With a median follow-up of 28 months, the median PFS and overall survival (OS) were 25 and 54 months, respectively. The PFS did not significantly differ among different anti-hormonal agents used in combination with CDK4/6 inhibitors. Patients who were resistant to endocrine therapy had a shorter PFS compared to treatment-naive MBC patients (22 versus 40 months). Patients with strong hormonal receptor expression had a significantly better PFS compared to those with weak expression (25 versus 14 months). Her2Neu-negative patients responded better than those with low positive expression (P = 0.039). Visceral metastatic disease was associated with a significantly shorter PFS (17 months) compared to skeletal metastasis (32 months). There was no statistical significance when CDK4/6 inhibitors were used in different lines of treatment or with dose reduction.

CONCLUSION: CDK4/6 inhibitors demonstrate similar responses and better tolerance in real-world evidence. Further studies are necessary to identify other predictive and resistance factors for the use of CDK4/6 inhibitors.

PMID:41797591 | DOI:10.4103/ijc.ijc_643_23

Indian J Cancer. 2025 Oct 1;62(4):528-534. doi: 10.4103/ijc.ijc_96_25. Epub 2026 Mar 7.

ABSTRACT

BACKGROUND: Epithelial malignancies, which constitute the majority of adult cancers, are relatively rare in the pediatric population, accounting for only 2% of all childhood tumors. In contrast to common childhood cancers-which typically arise from embryonal or mesenchymal tissues-epithelial malignancies originate from the epithelial lining of glands and include carcinomas of the lung, breast, colon, and genitourinary tract. Understanding the occurrence, behavior, and treatment outcomes of adult-type epithelial malignancies in children is essential for developing age-appropriate management strategies and improving long-term survival. This emerging subset of pediatric cancers warrants further investigation and collaborative efforts to establish optimal diagnostic criteria, staging systems, and therapeutic approaches tailored to younger patients. We undertook a 5-year retrospective analysis of children diagnosed with adult-type epithelial malignancies at our center.

METHODS: Study Design: This is a retrospective data analysis conducted at MVR Cancer Centre and Research Institute (MVRCCRI), focusing on pediatric patients below 18 years of age who presented between the years January 2019 and December 2024. Inclusion criteria: All children under 18 years of age who presented to MVRCCRI provided they had an adult-type neoplasm of epithelial origin were included in this study. Statistical analysis was performed. The mean, intervals and percentages in each group were calculated. Institutional ethical committee approval was obtained for this retrospective review.

RESULTS: A total of 69 children who were younger than 18 years were included in the study. There were 18 males and 51 females in the study giving a male to female ratio of 1:2.8. Three children had a family history of malignancy: one had a history of consanguinity was diagnosed with CMMRD on genetic evaluation, and the other had a mother with breast cancer and a pathological variant in the ATM gene. The third child with adrenocortical carcinoma had a pathological variant in TP53 diagnosed in mother. The children were analyzed based on the primary diagnosis. The largest group of epithelial malignancies in our cohort was thyroid malignancy, and the second largest group was carcinoma of the salivary glands. Children who presented with early stages of disease fared well in all the groups.

CONCLUSION: Adult-type epithelial neoplasms in children and adolescents are distinct entities, characterized by unique biological behaviors and genetic signatures. Treatment approaches should integrate principles from adult oncology and collaborative studies are essential to define the epidemiology, for staging and prognostic markers, and also to develop pediatric-specific treatment protocols for these malignancies.

PMID:41797589 | DOI:10.4103/ijc.ijc_96_25

Br J Psychiatry. 2026 Mar 9:1-10. doi: 10.1192/bjp.2026.10561. Online ahead of print.

ABSTRACT

BACKGROUND: People with psychosis have a life expectancy that is reduced by 15 years, mainly owing to preventable physical illnesses of which obesity is a precursor. Obesity is three times more common in individuals with psychosis, and antipsychotics are an important cause. Prediction could individualise obesity treatment, but current models are not fully actionable for individuals.

AIMS: To test whether antipsychotic-induced weight increase at 1 year is causally mediated by weight change in the first 12 weeks of treatment, and then develop and internally validate a causal actionable prediction pathway to prevent antipsychotic-induced obesity.

METHOD: This was a post hoc analysis of a clinical trial of olanzapine versus haloperidol which recruited 263 participants with first-episode psychosis. We conducted two distinct analyses: causal mediation and prediction modelling, within which there were two sequential models (a baseline model to predict 12-week outcome and a 12-week model to predict 1-year outcome), followed by counterfactual prediction. In the first analysis, we used parallel causal mediation analysis to determine the natural direct and indirect and total effects of antipsychotic choice on weight in 97 participants, considering two mediators: weight change from 0 to 12 weeks, and weight change from 12 to 52 weeks. In the second analysis, we first developed a baseline causal actionable prediction model to predict weight gain at 12 weeks in 172 participants and then a 12-week model to predict obesity at 1 year in 97 of the participants. Finally, we demonstrated counterfactual prediction.

RESULTS: Antipsychotic-induced weight gain at 1 year appeared to be causally mediated by weight change during the first 12 weeks of treatment (indirect effect 5.70; 95% CI 2.83 to 8.66). At internal validation, the discrimination c-statistic for the baseline causal actionable prediction model was 0.728 (95% CI 0.661 to 0.801), and the calibration slope was 0.768 (95% CI 0.436 to 1.21). For the 12-week model, the c-statistic was 0.904 (95% CI 0.820 to 0.961), and the calibration slope was 0.601 (95% CI -0.0633 to 1.21). We used the models to predict the counterfactual outcomes of antipsychotic choice and 12-week weight change.

CONCLUSIONS: Our results show that it may be early rather than later weight change that causally mediates antipsychotic-induced weight gain at 1 year. They also demonstrate the potential for causal actionable prediction of counterfactuals for true precision medicine, although this is tempered by the feasibility scope of this study and small sample size. Our results are hypothesis-generating and not yet clinically deployable.

PMID:41797581 | DOI:10.1192/bjp.2026.10561

BJPsych Bull. 2026 Mar 9:1-8. doi: 10.1192/bjb.2026.10219. Online ahead of print.

ABSTRACT

AIMS AND METHOD: Prolonged armed conflict profoundly impacts children’s mental health. This study investigated elevated rates of post-traumatic stress disorder (PTSD) symptoms among displaced Palestinian youth residing in Qatar. A cross-sectional study included 350 Palestinian children and adolescents aged 8–18 years displaced from Gaza. The Child PTSD Symptom Scale – Self-Report Version for DSM-5 (CPSS-5) and a Demographic and Resilience Questionnaire were used. Descriptive statistics and multiple linear regression identified factors associated with PTSD symptoms.

RESULTS: It was found that 54.9% of participants met the threshold for probable PTSD (CPSS-5 score ≥31). Intrusion and arousal symptoms had the highest average severity scores. Factors associated with higher PTSD severity included formal education, physical injury during the war and witnessing death, particularly that of close relatives.

CLINICAL IMPLICATIONS: The findings emphasise the urgent need for accessible, culturally appropriate and sustained mental health interventions. Longitudinal research is needed to understand long-term trajectories and inform comprehensive support systems.

PMID:41797574 | DOI:10.1192/bjb.2026.10219

J Biosoc Sci. 2026 Mar 9:1-21. doi: 10.1017/S0021932026100522. Online ahead of print.

ABSTRACT

Globally, child marriage is a persistent issue, adversely affecting the rights and well-being of girls. With a special focus on religious affiliation, this study explores the contributing factors leading to child marriage, such as cultural norms, religious beliefs, and socioeconomic conditions. From the Census of India 2011 data, percentage distributions of child marriage were used to assess the trends and magnitude of child marriage over the years. From NFHS-5 data, bivariate and multivariate analyses were conducted to assess factors like education and wealth index. Spatial analysis techniques, including Moran’s I statistics, helped identify the geographic distribution of child marriage. Findings reveal a history of relatively high child marriage rates among Muslims and their faster decline over the last decades. In 2011, under-14 marriages among Hindus exceeded 1.03% more than that of Muslims, with a 0.33% higher incidence of under-18 marriages among Muslims. The sample-based NFHS-5 study highlights significant disparities in child marriage based on the sample populations’ religious affiliations, regions, social categories, education, and wealth. In conclusion, the issue transcends religious boundaries, is rooted in broader social and economic contexts, and advocates for multidimensional interventions.

PMID:41797567 | DOI:10.1017/S0021932026100522