Nevin Manimala

Support Care Cancer. 2026 Feb 13;34(3):195. doi: 10.1007/s00520-026-10458-8.

ABSTRACT

BACKGROUND & AIMS: Post-treatment anxiety and depression are prevalent but often underrecognized among bladder cancer patients. This systematic review and meta-analysis aimed to estimate the pooled prevalence of these symptoms and to evaluate the effectiveness of intensive nursing interventions.

METHODS: A comprehensive search of PubMed, EMBASE, the Cochrane Library, and Web of Science was conducted through October 18, 2025. Eligible studies included those reporting the prevalence or severity of anxiety and/or depression in bladder cancer patients, as well as studies comparing intensive nursing interventions with routine care. Data were synthesized using Stata/MP version 14.0. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I² statistic, and subgroup analyses were performed to explore potential sources of variability.

RESULTS: Sixteen studies involving 1,791 patients were included. The pooled prevalence of anxiety was 25.3% (95% CI: 22.2-28.6%) and that of depression was 29.4% (95% CI: 23.3-35.9%). Higher prevalence rates were observed in non-Western populations and among patients receiving multimodal treatment. Compared with routine care, intensive nursing interventions were associated with significant reductions in anxiety (SMD = -4.52; 95% CI: -6.07 to -2.96) and depression (SMD = -4.51; 95% CI: -5.96 to -3.07) (both P < 0.001). These findings remained robust in sensitivity analyses despite substantial heterogeneity.

CONCLUSION: Anxiety and depression are common among bladder cancer survivors. Intensive nursing interventions are associated with meaningful improvements in psychological outcomes and may be considered for integration into post-treatment supportive care.

TRIAL REGISTRATION: PROSPERO registration number: CRD42024590858.

PMID:41686342 | DOI:10.1007/s00520-026-10458-8

Discov Oncol. 2026 Feb 13. doi: 10.1007/s12672-026-04641-w. Online ahead of print.

ABSTRACT

Alterations in the vaginal microbiota contribute to the pathogenesis of cervical neoplasia. However, the distinctions in microbiota changes related to different human papillomavirus (HPV) subtypes, as well as the variation in gut microbiota, have not been fully explored. In this research, we endeavored to explore the shifts in the vaginal and intestinal microbiota in correlation with the advancement of cervical neoplasia and HPV infection. A total of 578 vaginal and intestinal cross-sectional specimens were collected from 348 subjects and subjected to 16 S rRNA sequencing. Statistical analyses were performed using R language, and Student’s t-test was employed to assess the significance of differences. Both within and between, sample diversity of the vaginal and intestinal microbiota exhibited substantial alterations across cervical intraepithelial neoplasia (CIN) stages and cervical carcinoma. The vaginal genera Lactobacillus, Enterococcus, Peptoniphilus, Atobium, Anerococcus, and Veillonella were associated with different CIN stages and cervical cancer type, whereas Allisonella, Lachnospiracae, Lactobacillus, Staphylococcus, and Sellimonas were associated with varying HPV types. A Random Forest-driven classifier highlighted the predictive potential of differential bacteria in cervical neoplasia and HPV infection, with intestinal bacteria showing higher predictive accuracy in certain instances. Specifically, the accuracy of differentiating CIN I from CIN III was superior for the intestinal bacterial model compared to the vaginal bacterial model (85.52% vs. 83.33%). The model also demonstrated high accuracy in predicting HPV infection, particularly in distinguishing HPV-16 from HPV-18 and HPV-58, with AUC values of 81.61% and 83.07%, respectively, compared to less than 70% for vaginal bacteria. Our findings reveal the intricate interplay among cervical neoplasia, HPV infection, and microbiota, with potential diagnostic and therapeutic implications.

PMID:41686340 | DOI:10.1007/s12672-026-04641-w

Environ Geochem Health. 2026 Feb 13;48(4):158. doi: 10.1007/s10653-026-03020-2.

ABSTRACT

The Daxing’anling region possesses China’s best-preserved cold-temperate primary forests, playing a vital role in the ecological security of Northeast China. This study investigates the hydrochemical characteristics, regulatory mechanisms, and potential health risks associated with nitrate in groundwater within the Songling area, aiming to provide scientific basis for sustainable water resource management in the region. By collecting 30 groundwater samples through systematic sampling, this study analyzed the groundwater chemistry characteristics and influencing factors in the study area using methods such as Piper’s three-line diagram, Gibbs diagram, factor analysis, ion ratio coefficients, and the APCS-MLR receptor model. Additionally, a health risk model was employed to assess health risks for different population groups. Results indicate: (1) The average pH value of groundwater in the study area is 7.14, exhibiting the smallest coefficient of variation (CV = 3.61). The average total hardness (TH) was 109.94 mg $·$ L^-1, with 73.33% of samples containing calcium carbonate concentrations below 300 mg $·$ L^-1. The average total dissolved solids (TDS) was 218.16 mg $·$ L^-1, all TDS values < 1 g $·$ L^-1. The average concentration of permanganate index (COD_Mn) was 1.05 mg $·$ L^-1. Iron (Fe) and manganese (Mn) exhibited the highest coefficients of variation ( $CV>370\%$ ), with average values of 1.43 mg $·$ L^-1 and 0.48 mg $·$ L^-1, respectively. The dominant anion and cation components were ${\text{Ca}}^{2+}$ (mean 34.23 mg $·$ L^-1) and ${\text{HCO}}_{\text{3}}^{–}$ (mean 103.52 mg $·$ L^-1), respectively. ${\text{NO}}_{\text{3}}^{–}$ was the primary exceedance factor in groundwater within the study area (exceedance rate 26.67%). (2) The most ion ratios relative to TDS fell within defined ranges, with sampling points highly concentrated in the low-value zone (ratio < 0.5), clearly approaching the rock weathering endpoint. 83.33% of water samples were above the 1:1 line ( ${\text{Na}}^{+}$ / ${\text{Cl}}^{–}$ > 1). The scatter plot fit slope between [(Ca²⁺ + Mg²⁺) – ( ${\text{SO}}_{\text{4}}^{2–}$ + ${\text{HCO}}_{\text{3}}^{–}$ )] and (Na⁺ + K⁺ – Cl^–) is -1.74 (R² = 0.74), approaching the theoretical exchange characteristic value of -1. (3) The KMO value in factor analysis was 0.603, and the Bartlett test showed a significance level of P < 0.001, indicating significant correlations among variables. Three principal factors with eigenvalues greater than 1 were extracted, collectively explaining 87.35% of the variance. APCS-MLR model analysis indicated groundwater chemical composition primarily originated from four principal contributors, including geological sources(F1, 37.24%), agricultural and lifestyle activities(F2, 12.70%), combined natural-human processes(F3, 14.00%), and other unknown sources(F4, 22.93%). (4) The average non-carcinogenic hazard index (HI) for groundwater nitrate exposure in children was 0.5973; The average HI for adult males was 0.3128; the average HI for adult females was 0.3963. The proportion of groundwater nitrate samples exceeding the non-carcinogenic risk (HI) threshold for children reached 23.33%, while the proportion for adults was only 10%. Among adult females, 16.67% of samples had HI values exceeding 0.8, indicating a potential for unacceptable risk. A comprehensive analysis leads to the following conclusions: (1) The groundwater in the study area is predominantly neutral to slightly alkaline, classified as low-hardness freshwater with extremely low levels of organic pollutants, indicating good water quality. Iron and manganese concentrations exhibit regionally inherent geochemical background characteristics. From an ionic composition perspective, groundwater is dominated by Ca²⁺ and ${\text{HCO}}_{\text{3}}^{–}$ , with its hydrochemical types primarily classified as HCO₃-Ca type (1-A type) and HCO₃-Ca $·$ Mg type (2-A type). (2) Groundwater chemical composition in the study area is primarily controlled by rock weathering, cation exchange, and human activities. Among these, the weathering and dissolution of carbonates, silicates, and gypsum jointly dominate the hydrogeochemical processes in this region. Additionally, human activities, particularly nitrate inputs from agricultural and domestic discharges, have become a significant factor altering the groundwater chemical environment. Specifically, ${\text{Ca}}^{2+}$ , ${\text{Mg}}^{2+}$ , and ${\text{HCO}}_{\text{3}}^{–}$ are mainly derived from the dissolution of carbonate and silicate minerals, whereas ${\text{Na}}^{+}$ originates from rock-salt and silicates. ${\text{SO}}_{\text{4}}^{2–}$ is significantly influenced by mining activities and evaporite dissolution, while ${\text{K}}^{+}$ , ${\text{Cl}}^{–}$ , and ${\text{NO}}_{\text{3}}^{–}$ are primarily attributed to domestic sewage and agricultural inputs. (3) Multivariate statistical analysis identified sources influencing groundwater chemistry as geological background sources, agriculture-lifestyle pollution sources, mixed natural-anthropogenic sources, and unknown. These sources exhibit an increasing trend from natural background to anthropogenic disturbance, indicating that geological background and water-rock interactions are the dominant forces shaping hydrochemical characteristics. However, various human activities also exert significant and widespread influence. (4) Nitrate Health Risk Assessment: Drinking water intake constitutes the primary pathway for nitrate-related health risks in humans. Among exposed populations, children face higher health risks than adults, with females exhibiting slightly higher risks than males. Overall, the health risks from nitrate contamination in the study area’s groundwater remain at a low level. Only a very small number of locations directly impacted by human and livestock activities show potential for exceeding concentration thresholds and elevated risks. The following four recommendations are proposed to strengthen water quality management in high-risk areas, promote scientific agricultural fertilization practices, improve wastewater treatment systems, and implement health monitoring and drinking water risk management for susceptible populations.

PMID:41686319 | DOI:10.1007/s10653-026-03020-2

Alzheimers Dement. 2026 Feb;22(2):e70992. doi: 10.1002/alz.70992.

ABSTRACT

INTRODUCTION: Vascular cognitive impairment (VCI), a major cause of cognitive impairment, remains underdiagnosed due to varying non-amnestic manifestations. It is important to detect VCI at the mild cognitive impairment (MCI) stage or earlier. We aimed to develop and validate ReCOGnAIze, a tablet-based, gamified, and interpretable app to detect VCI and MCI.

METHODS: A multi-phase, cross sectional study in an Asian community cohort with development phase (n = 200) and validation with 235 independent participants having comprehensive neuroimaging and neuropsychological data.

RESULTS: In differentiating VCI, ReCOGnAIze achieved strong performance (n = 154, AUC = 0.85), identifying digital features: processing speed and response time variability, consistent with known VCI impairments of executive functioning. Additionally, a generalizable ReCOGnAIze composite score distinguished MCI from cognitively healthy (CH) (n = 235, AUC = 0.90), outperforming the Montreal Cognitive Assessment (MoCA) (AUC = 0.70).

DISCUSSION: ReCOGnAIze is a scalable, explainable artificial intelligence (AI) tool that accurately detects VCI and MCI, with gamified, tablet-based, interpretable tasks.

HIGHLIGHTS: Non-significant differences on Montreal Cognitive Assessment (MoCA) for vascular cognitive impairment (VCI). ReCOGnAIze artificial intelligence (AI) models identify VCI with area under the curve (AUC) of 0.85. ReCOGnAIze games detect mild cognitive impairment (MCI) with AUC of 0.90, outperforming MoCA (AUC = 0.7). Processing speed and response time variability are key VCI markers.

PMID:41685533 | DOI:10.1002/alz.70992

J Med Virol. 2026 Feb;98(2):e70834. doi: 10.1002/jmv.70834.

ABSTRACT

BACKGROUND: Biliary atresia (BA) is a severe infantile hepatobiliary disorder of unknown etiology. Perinatal rotavirus (RV) infection has been implicated in animal models of BA; however, supporting human data remains limited. The study investigated the serological evidence of recent RV infection in infants with BA using RV-specific immunoglobulin (Ig)-A, a marker of primary infection unaffected by maternal antibodies.

METHODS: Serum samples from 17 infants with BA and 30 age-matched controls without gastrointestinal symptoms or prior RV vaccination were retrospectively analyzed. Anti-RV-IgA titers were measured by enzyme-linked immunosorbent assay using purified WA-strain virions. Cytomegalovirus (CMV)-IgM and Epstein-Barr virus (EBV)-viral capsid antigen (VCA)-IgM levels were assessed using commercial enzyme immunoassays.

RESULTS: RV-IgA was detected in 70.6% (12/17) of the patients with BA versus 3.4% (1/29) of the controls (p < 0.001). RV-IgA titers were significantly higher in the BA group (median: interquartile range 2^8.0:2^6.0-2^10.0) than in the control group (2^3.5:2^2.0-2^4.8) (p = 0.004). Among patients diagnosed with BA after 14 days of age, 84.6% (11/13) were RV-IgA-positive. CMV-IgM was detected in three patients in the BA group and one individual in the control group, while EBV-VCA-IgM was negative in BA patients and positive in two controls; neither difference was statistically significant.

CONCLUSIONS: The study findings support the potential association between RV infection and BA pathogenesis. However, the lack of an epidemiological reduction in BA following the introduction of the RV vaccine warrants caution in other studies. Further prospective multicenter studies are required to elucidate the causal role of RV infection in BA development.

PMID:41685501 | DOI:10.1002/jmv.70834

Stud Health Technol Inform. 2026 Feb 12;334:127-128. doi: 10.3233/SHTI260033.

ABSTRACT

Refugee populations in Canada experience disproportionately high rates of trauma-related mental health conditions. We conducted 15 semi-structured interviews across six stakeholder groups to explore mental healthcare gaps. Findings reveal three major barriers: fragmented regulatory frameworks; unsustainable funding models; and failure to integrate end-user needs.

PMID:41685489 | DOI:10.3233/SHTI260033

Stud Health Technol Inform. 2026 Feb 12;334:83-87. doi: 10.3233/SHTI260021.

ABSTRACT

Healthcare systems have invested heavily in interoperability, yet adoption by clinicians has been inconsistent. Despite the availability of mature technical standards, many providers continue to rely on fax and other low-tech methods for information exchange. This paper explores whether the barriers to adoption are primarily technical or economic in nature. Using e-prescribing as a comparative case, we examine three jurisdictions that adopted similar technologies but experienced very different outcomes: Canada, the United States, and Denmark. Canada pursued a voluntary model and saw limited uptake. The United States initially struggled but achieved significant adoption once penalties were tied to Medicare Part D. Denmark achieved near-universal adoption by mandating use nationwide. These contrasting outcomes suggest that interoperability adoption hinges on how costs and benefits are distributed among stakeholders, rather than on technology alone. Drawing on economic theories of transaction costs, externalities, Coase’s theorem, and information asymmetry, we offer an early framework for interpreting adoption outcomes. While our analysis is limited to e-prescribing and related cases, the findings suggest that economic design principles may be critical for sustainable interoperability. Future work should extend this framework to other domains of health data exchange.

PMID:41685478 | DOI:10.3233/SHTI260021

Stud Health Technol Inform. 2026 Feb 12;334:73-77. doi: 10.3233/SHTI260019.

ABSTRACT

This environmental scan examined commercially available AI clinical decision support solutions (AI-CDSS) across three domains: knowledge base, AI methodology, and privacy. Over half of vendors disclosed some information on their knowledge base, yet few demonstrated rigorous appraisal or alignment with Quality Standards or other evidence-based guidelines. Transparency on AI methods was limited as most cited proprietary algorithms but rarely described training data. Privacy information was more commonly reported but often high-level, with limited detail on compliance, storage location, or restrictions on secondary use. These gaps reveal the obstacles facing decision makers: without standardized, transparent information, organizations and governments cannot reliably evaluate AI-CDSS or provide the support clinicians need for responsible and informed implementation.

PMID:41685476 | DOI:10.3233/SHTI260019

Stud Health Technol Inform. 2026 Feb 12;334:35-41. doi: 10.3233/SHTI260011.

ABSTRACT

Challenges in access to specialty care in Canada lead to long wait times and poorer outcomes. The eConsult Centre of Excellence at The Ottawa Hospital (TOH) developed Triaging Referrals to eConsult (TReC), embedding specialist advice into routine referral workflows within health information systems (HIS). Following a successful proof-of-concept, TReC expanded to Women’s College Hospital (WCH) in 2023 and the Children’s Hospital of Eastern Ontario (CHEO) in 2025. We applied the RE-AIM framework to evaluate implementation across study the three study sites. Reach was assessed by utilization; effectiveness by response times and surveys; adoption by specialist participation; implementation by delivery and cost; maintenance by ongoing use. Data sources included administrative data and surveys of patients and providers. Specialist participation included 160 at TOH, 22 at WCH, and 26 at CHEO. Since launch, >10,000 eConsults were completed at TOH, >880 at WCH, and >360 at CHEO, spanning 15, 8, and 10 clinical areas, respectively. Median response times ranged from 2-8 days across sites, versus Ontario’s 23-week average for in-person care. Median cost per TReC case was $37 CAD (10 minutes spent per case), substantially lower than in-person visits. Surveys showed high acceptability: 84% of referring providers at TOH and 91% at WCH found advice actionable; 70% of TOH patients felt concerns were addressed; and 91% of TOH specialists perceived TReC to improve access. TReC scaled successfully across three hospitals and improved timely access. High acceptability supports expansion and potential to improve equitable access across Ontario. Future evaluation will assess post-TReC healthcare utilization.

PMID:41685469 | DOI:10.3233/SHTI260011

J Adolesc. 2026 Feb 13. doi: 10.1002/jad.70119. Online ahead of print.

ABSTRACT

INTRODUCTION: Parental education has been linked to childhood health and wellbeing outcomes. Intergenerational transfer of parental education into childhood health and wellbeing outcomes operates through multiple pathways, however the mediating influence of neighbourhood conditions remains understudied.

METHODS: Drawing on data from the Longitudinal Study of Australian Children (LSAC) (n = 6432, 51% male, ages 14-15 years) we conduct a causal mediation analysis using a Regression-with-Residuals (RWR) approach to examine the mediating effect of neighbourhood social environment, neighbourhood built environment, and neighbourhood socio-economic advantage in the relationship between parental education and children’s health and wellbeing at age 14 years.

RESULTS: The results show neighbourhood quality, in particular neighbourhood social environment and neighbourhood advantage, mediates a small but statistically significant proportion of the association between parental education and child health and wellbeing.

CONCLUSIONS: Our findings suggest that spatial stratification during childhood is likely to play an important role in the intergenerational reproduction of socio-economic gradients in health.

PMID:41685451 | DOI:10.1002/jad.70119