Nevin Manimala

JMIR Public Health Surveill. 2026 Apr 1;12:e85875. doi: 10.2196/85875.

ABSTRACT

BACKGROUND: Utilization of the maternal continuum of care (CoC)-comprising adequate antenatal care (ANC), skilled birth attendance, and postnatal care (PNC)-is critical for improving maternal and child health outcomes. However, dropout from the CoC remains substantial in Bangladesh, with women discontinuing services at different stages of pregnancy, delivery, and postpartum care.

OBJECTIVE: This study aimed to quantify maternal dropout at each stage of the CoC and identify socioeconomic and demographic factors associated with discontinuity, comparing two nationally representative survey rounds.

METHODS: Data were drawn from the Bangladesh Demographic and Health Surveys (BDHS) 2017-2018 and 2022. Women aged 15 to 49 years with a live birth in the preceding 2 to 3 years were included. Completion of full CoC was defined as receiving at least 4 ANC visits, delivering with a skilled birth attendant, and obtaining at least 1 PNC contact within 48 hours of delivery. Predisposing (age, education, parity, religion, and division), enabling (wealth index, media exposure, health care access, and residence), and need factors (terminated pregnancy and desired pregnancy status) were identified using the Andersen Behavioral Model. Survey-weighted multivariable logistic regression models were fitted for each CoC component and overall CoC completion, with interaction terms to assess whether associations differed between survey rounds.

RESULTS: Among 8424 mothers, 27.9% (n=2350) failed to complete all components of the maternal CoC. Dropout was highest at the ANC stage (n=4962, 55.7%), followed by PNC (n=3976, 47.2%) and skilled birth attendant-assisted delivery (n=3378, 40.1%). Between survey rounds, overall CoC dropout decreased significantly from 31.9% (BDHS 2017-2018) to 22.4% (BDHS 2022), reflecting modest improvements in service continuity. Factors significantly associated with higher odds of CoC dropout included lower maternal education (adjusted odds ratio [AOR] 2.70, 95% CI 1.94-3.77; P<.001), higher parity (AOR 2.73, 95% CI 2.12-3.50; P<.001), lower wealth quintiles (AOR 4.04, 95% CI 3.02-5.41; P<.001), and rural residence (AOR 1.40, 95% CI 1.18-1.67; P<.001). Protective factors included older maternal age at delivery (AOR 0.56, 95% CI 0.42-0.74; P<.001) and history of ever-terminated pregnancy (AOR 0.74, 95% CI 0.63-0.86; P<.001). Significant temporal interactions (all P<.05) indicated that the strength of associations for education, parity, religion, wealth, media exposure, health care access barriers, residence, and pregnancy desire differed between survey rounds, reflecting changing determinants of CoC engagement amid policy reforms and pandemic disruptions.

CONCLUSIONS: Maternal, socioeconomic, and geographic factors are strongly associated with discontinuity along the maternal health care continuum in Bangladesh. Statistically significant temporal variations underscore the impact of evolving health policies and system disruptions on maternal service utilization patterns. Targeted, area-specific interventions addressing these determinants across all CoC components are essential to improve maternal health care retention and achieve better maternal and child health outcomes.

PMID:41921113 | DOI:10.2196/85875

Acta Orthop. 2026 Apr 1;97:225-231. doi: 10.2340/17453674.2026.45693.

ABSTRACT

BACKGROUND AND PURPOSE: In elastic stable intramedullary nailing (ESIN) for forearm fractures, nail protrusion may cause irritation-related implant removal. The primary aim was to evaluate implant retention after nail impaction, and secondarily to assess secondary procedures, complications, and protrusion as a predictor of removal.

METHODS: We analyzed a retrospective cohort of children with diaphyseal forearm fractures treated with impacted ESIN between 2017 and 2024. Implant retention was defined as no nail removal at record review. Secondary procedures were unplanned operations, while complications were adverse events managed conservatively. Radiographic nail protrusion was measured as extraosseous nail length and evaluated using receiver operating characteristic analysis to predict irritation-related implant removal.

RESULTS: 160 children with diaphyseal forearm fractures were included. At a mean observation time of 5 years, 132/160 children retained their implants (83%, 95% confidence interval [CI] 76-88). Secondary procedures occurred in 30/160 patients (19%, CI 13-26), most commonly irritation-related implant removal (10%, CI 6-16) and refracture (6%, CI 3-10). Complications occurred in 19/160 patients (12%, CI 7-18), including superficial radial nerve symptoms (7/160; 4.4%) and irritation without implant removal (6/160; 3.8%). A protrusion threshold of 3.3 mm predicted irritation-related implant removal (AUC 0.79, CI 0.71-0.86; sensitivity 100%, CI 83-100; specificity 55%, CI 49-61). No irritation-related removals occurred below this threshold.

CONCLUSION: Impacted ESIN was associated with high long-term implant retention, although secondary procedures and complications occurred in about one-third of the patients. A protrusion threshold of 3 mm was linked to irritation-related removal and may guide implant retention.

PMID:41921102 | DOI:10.2340/17453674.2026.45693

Acta Orthop. 2026 Apr 1;97:217-224. doi: 10.2340/17453674.2026.45695.

ABSTRACT

BACKGROUND AND PURPOSE: Denosumab may preserve periprosthetic bone mineral density (pBMD) around uncemented total hip arthroplasty (THA) components. This exploratory analysis of a previously published randomized controlled trial (RCT) aimed to assess the effects of denosumab on BMD 5 years after treatment cessation.

METHODS: 64 non-osteoporotic patients undergoing uncemented THA were enrolled in a randomized, double-blind, placebo-controlled phase-2 trial and received either 2 doses of denosumab or placebo. The primary outcome was pBMD at 12 months, measured by dual-energy X-ray absorptiometry (DEXA). At a mean follow-up of 5.6 years (range 4.3-7.3), 54 patients remained for clinical assessment, DEXA, and plain radiography. The study was registered on ClinicalTrials.gov (NCT01630941).

RESULTS: No differences in pBMD in the acetabular Digas zones or femoral Gruen zones were found between the groups at 5 years. The estimated mean difference in the sum of all zones around the cup was 0.042 g/cm² (95% confidence interval [CI] -0.31 to 0.35; P = 0.8), and for the sum of all Gruen zones -0.06 g/cm² (CI -0.55 to 0.43; P = 0.8). No statistically significant differences were observed in patient-reported outcome measures or the incidence of heterotopic ossification. A gradual decline in pBMD was evident.

CONCLUSION: At 5 years, the adjusted between-group difference and its 95% confidence interval showed no statistically or clinically relevant effect of denosumab. Whether longer treatment duration or a sequential post-denosumab regimen could influence long-term periprosthetic bone preservation is unknown.

PMID:41921101 | DOI:10.2340/17453674.2026.45695

Opt Lett. 2026 Apr 1;51(7):1800-1803. doi: 10.1364/OL.589508.

ABSTRACT

In this Letter, we propose a resilient non-line-of-sight (NLOS) optical camera communication (OCC) system addressing the critical challenges of stochastic data loss and spatial division multiplexing (SDM). It integrates two core innovations: a unified byte-level RaptorQ coding scheme that reconstructs source blocks from fragmented data, obviating the need for repetitive transmissions and increasing throughput by 49% for a data reception ratio (DRR) of 0.82 and a 4-byte payload; and the normalized variance ratio (NVR), a novel, to the best of our knowledge, statistical metric that enables NLOS SDM by adaptively identifying distinct data streams within partially superimposed light patterns. Experimental validation demonstrates the system’s resilience: at 0.8 m, our NVR-enabled NLOS SDM 2-LED system delivers 4.4 kbps throughput while maintaining a bit error rate (BER) below 10^-5. This result offers a substantial reliability advantage over other OCC systems such as ReflexCode, showcasing the system’s potential for practical applications.

PMID:41920627 | DOI:10.1364/OL.589508

JMIR Cancer. 2026 Apr 1;12:e72647. doi: 10.2196/72647.

ABSTRACT

BACKGROUND: People with cancer often experience unmet needs during treatment and survivorship, which can impact their ability to carry out daily tasks, reduce their quality of life, and limit their participation in work and social activities. Cancer Coach by CancerAid (now known as Osara Health) is a digital health intervention designed to address these needs through a combination of synchronous telehealth coaching and an asynchronous mobile app that supports behavior change and emotional well-being.

OBJECTIVE: This study aimed to evaluate the impact of Cancer Coach by CancerAid on the mental and physical health of people with cancer using patient-reported outcomes.

METHODS: Participants were referred to the program via insurers and hospital clinics. Health coaches administered the Patient-Reported Outcomes Measurement Information System 10-item Global Health Short Form via telephone at both the beginning and end of the intervention. This tool measures global physical health (GPH) and global mental health (GMH). Pre- and postintervention scores were analyzed using Wilcoxon signed rank tests. Independent 2-tailed t tests assessed whether changes in GPH and GMH scores were associated with the use of health coaching alone or in combination with the mobile app.

RESULTS: Statistically significant improvements were observed in both GPH (z=-4.97; P<.001; r=0.37) and GMH (z=-4.53; P<.001; r=0.34), indicating moderate effect sizes in the 89 participants. The average T score point changes of 4.43 for GPH and 4.58 for GMH represented a minimal important change for participants. The improvement in the group GMH T score was reflected in the move from “good” to “very good” mental health status. Participants who engaged with both health coaching and the mobile app showed greater improvements in physical health, whereas those who received health coaching alone exhibited higher gains in mental health. This suggests that the mode of support may influence specific health outcomes.

CONCLUSIONS: The use of the Patient-Reported Outcomes Measurement Information System 10-item Global Health Short Form showed that participants had significant improvements in physical and mental health after participating in the Cancer Coach by CancerAid️ intervention. The integration of telehealth coaching with app-based support may enhance overall well-being and address holistic needs during cancer treatment and survivorship.

PMID:41920589 | DOI:10.2196/72647

JMIR Form Res. 2026 Apr 1;10:e87094. doi: 10.2196/87094.

ABSTRACT

BACKGROUND: Artificial intelligence (AI)-enabled digital health kiosks are increasingly used in workplaces and communities to promote health awareness, especially in low- and middle-income countries. However, evidence on their real-world use, user acceptability, and immediate behavioral responses remains limited, especially outside formal clinical care.

OBJECTIVE: This study evaluated the implementation experience, user acceptability, and immediate self-reported actions associated with the use of an AI-enabled workplace health kiosk among public school teachers in an urban, low-resource setting in the Philippines.

METHODS: We conducted a study involving 384 teachers who used an AI health kiosk during wellness activities. The kiosk provided informational health indicators. Postuse surveys assessed usability; trust; privacy concerns; and self-reported actions, such as health consultations and sharing results. Analyses were descriptive and exploratory. The study did not evaluate diagnostic accuracy, clinical validity, disease prevalence, or health outcomes.

RESULTS: Most participants (162/189, 85.7%) rated the kiosk experience as good or excellent, and 93.1% (176/189) found it easy to use. Overall, trust in kiosk results was high, although 31.7% (60/189) of the participants expressed privacy concerns. After using the kiosk, 70.9% (134/189) of the participants consulted a health care professional, and 66.7% (126/189) made lifestyle changes. A small percentage (32/189, 16.9%) reported no follow-up actions, mainly due to uncertainty about the next steps. User feedback highlighted convenience and accessibility but also noted operational issues such as queuing and connectivity problems.

CONCLUSIONS: In this workplace setting, an AI health kiosk was feasible, acceptable, and linked to immediate self-reported health actions. Findings are preliminary and context specific. Formal validation, follow-up studies, and further evaluation are needed before use in diagnostic, population health, or policy contexts.

PMID:41920576 | DOI:10.2196/87094

JAMA Netw Open. 2026 Apr 1;9(4):e263419. doi: 10.1001/jamanetworkopen.2026.3419.

ABSTRACT

IMPORTANCE: While numerous states have enacted laws to reduce access to firearms among high-risk individuals, the evidence regarding the associated outcome of reducing firearm suicide has been mixed, in part due to methodological limitations.

OBJECTIVE: To examine the association between state firearm laws and firearm-related suicide deaths across all 50 US states during the period from 1976 to 2024.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted in December 2025, used a difference-in-differences fixed-effects panel regression with Prais-Winsten correction applied to annual state-level data on firearm-related suicides from all 50 US states from January 1976 through December 2024. Sample data were obtained from the Centers for Disease Control and Prevention-maintained Web-based Injury Statistics Query and Reporting System.

EXPOSURES: Six firearm laws with prior evidence or theoretical plausibility of affecting risk of suicide: (1) required permits to purchase handguns; (2) waiting periods for firearm purchases; (3) laws requiring permits for concealed carry; (4) minimum age requirements; (5) extreme risk protection order laws; and (6) state permit requirements for gun dealers. Laws were modeled with a 2-year lag.

MAIN OUTCOMES AND MEASURES: The primary outcome was annual, age-adjusted, state-specific firearm suicide rate, and the negative control outcome was nonfirearm suicide rate. Models accounted for serial autocorrelation and heteroskedasticity in the data and adjusted for a range of sociodemographic covariates.

RESULTS: Across the study period, 2450 observations were collected. The mean overall suicide rate was 13.7 deaths per 100 000 with 7.9 deaths per 100 000 for firearm-related suicide and 5.8 deaths per 100 000 for non-firearm-related suicide. Firearm suicide rates varied 8-fold across states in 2024 (1.8 deaths per 100 000 in New York vs 15.1 deaths per 100 000 in Wyoming). Handgun permit laws (-6.7%; 95% CI, -9.7% to -3.7%), waiting periods (-12.5%; 95% CI, -22.1% to -1.7%), and requirements for a license for concealed carry (-8.9%; 95% CI, -13.1% to -4.8%) were significantly associated with decreases in firearm suicide rates but not with nonfirearm suicide rates. States with 1 (-8.1%; 95% CI, -11.4% to -4.7%), 2 (-12.5%; 95% CI, -16.3% to -8.5%), or all 3 (-25.3%; 95% CI, -34.2% to -15.2%) of these laws (handgun permit requirements, waiting periods, and concealed carry permits) had progressively lower firearm suicide rates.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study analyzing data from 49 years and 50 states, permit-to-purchase requirements for handguns, waiting periods, and the requirement for a license for concealed carry were each independently and cumulatively associated with significantly lower firearm suicide rates.

PMID:41920544 | DOI:10.1001/jamanetworkopen.2026.3419

JAMA Netw Open. 2026 Apr 1;9(4):e264098. doi: 10.1001/jamanetworkopen.2026.4098.

ABSTRACT

IMPORTANCE: External beam radiation therapy (EBRT) for left-sided breast cancer historically increased the risk of cardiovascular disease (CVD). Advances in EBRT have reduced mean heart dose, but contemporary population-level data on long-term cardiovascular outcomes remain limited.

OBJECTIVE: To examine whether contemporary left-sided EBRT is associated with different long-term CVD risk than right-sided EBRT among women with breast cancer.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study used linked administrative health databases in Ontario, Canada, to identify women who received EBRT after a diagnosis of unilateral breast cancer between April 1, 2002, and December 31, 2017. Patients were followed up through February 28, 2025, for most outcomes and December 31, 2022, for cause-specific mortality. Data analysis was completed in August 2023 (with revisions in August 2025).

EXPOSURE: Tumor laterality (left vs right).

MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalization with a most responsible diagnosis of CVD. Secondary outcomes included all-cause mortality, cardiovascular mortality, hospitalizations for specific CVD diagnoses, coronary revascularization, and new diagnoses of ischemic heart disease, heart failure, and atrial fibrillation. Cumulative incidence functions estimated the 15-year risk of outcomes accounting for the competing risk of death; event rates per 100 person-years captured recurrent events.

RESULTS: Among 76 586 women (mean [SD] age, 59 [12] years; 38 427 [50.2%] with left-sided tumors) followed up for a median (IQR) of 10.9 (7.7-15.2) years, the 15-year cumulative incidence of first CVD hospitalization did not differ by laterality (left: 13.8% [95% CI, 13.4%-14.2%]; right: 13.5% [95% CI, 13.1%-13.9%]; P = .43). In women with preexisting CVD, new diagnoses of heart failure (10.2% [95% CI, 9.9%-10.6%] vs 9.6% [95% CI, 9.2%-10.0%]; P = .01) and ischemic heart disease (13.6% [95% CI, 13.2%-14.0%] vs 12.8% [95% CI, 12.4%-13.2%]; P = .03) were slightly more frequent after left-sided EBRT. The rate of CVD hospitalizations when including recurrent events was modestly higher for left-sided disease (1.72 vs 1.63 per 100 person-years; P = .006). Among women with preexisting CVD, there were no differences in all-cause mortality or recurrent CVD hospitalizations.

CONCLUSIONS AND RELEVANCE: In this cohort study of women treated with EBRT for breast cancer in the past 2 decades, left-sided breast cancer radiation therapy was associated with minimal increases in long-term cardiovascular risk. These findings suggest that contemporary photon-based EBRT techniques have substantially reduced the cardiovascular risk historically associated with left-sided breast cancer radiation therapy.

PMID:41920543 | DOI:10.1001/jamanetworkopen.2026.4098

JAMA Netw Open. 2026 Apr 1;9(4):e264122. doi: 10.1001/jamanetworkopen.2026.4122.

ABSTRACT

IMPORTANCE: During early months of the COVID-19 pandemic, presentations for acute myocardial infarction (AMI) declined significantly, and outcomes worsened. However, the full extent and long-term sequelae of changes in AMI epidemiology during the pandemic remain uncertain, as does whether these patterns differed by rurality.

OBJECTIVE: To describe the epidemiology of AMI-related hospitalizations, interventions, and outcomes among Medicare beneficiaries throughout the COVID-19 pandemic, focusing on differences in urban and rural populations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included all Medicare fee-for-service beneficiaries with AMI between January 1, 2018, and December 31, 2023, in the analysis. Data were analyzed from March 19 to July 9, 2025.

EXPOSURES: Time period (prepandemic [January 1, 2018, to December 31, 2019], pandemic [January 1, 2020, to December 31, 2021], and postpandemic [January 1, 2022, to December 31, 2023]) and beneficiary-level rurality.

MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital death, defined as death within 1 day of discharge from the index episode of AMI. Secondary outcomes included death within 90 days of the index admission date and postdischarge outcomes. AMI episodes were defined as any emergency department (ED), observational, or inpatient stay with a primary ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) diagnosis or a primary cardiogenic shock and secondary STEMI or NSTEMI diagnosis. Generalized estimating equations clustering on hospitals were used to compare pandemic and postpandemic outcomes with the prepandemic period, adjusting for beneficiary characteristics.

RESULTS: A total of 1 152 851 AMI episodes among 1 032 212 beneficiaries were identified between 2018 and 2023, of which 75.6% were NSTEMI. Most AMI episodes were among male (57.6%) beneficiaries aged 65 to 80 years (56.8%). The unadjusted quarterly incidence of AMI decreased from 17.2 to 13.0 episodes per million beneficiary days at risk (quarter 1 of 2018 to quarter 4 of 2023). In-hospital (adjusted odds ratio [AOR], 1.09; 95% CI, 1.07-1.11]) and 90-day mortality (AOR, 1.10; 95% CI, 1.09-1.12) increased during the pandemic and then returned to baseline or lower (AORs, 0.99 [95% CI, 0.97-1.01] and 0.96 [95% CI, 0.95-0.98], respectively). After the pandemic, beneficiaries were less likely to discharge to a skilled nursing facility (AOR, 0.67; 95% CI, 0.66-0.68), utilize the ED (adjusted incidence rate ratio [AIRR], 0.93; 95% CI, 0.92-0.94), or experience readmission (AIRR, 0.90; 95% CI, 0.90-0.92) within 90 days of their index episode of AMI. Patterns were largely similar by rurality.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of fee-for-service Medicare beneficiaries, the incidence of AMI decreased during and after the pandemic. Beneficiaries experienced greater in-hospital and 90-day mortality during the pandemic. After the pandemic, in-hospital and 90-day mortality returned to baseline among micropolitan and rural beneficiaries and was lower than baseline among urban beneficiaries.

PMID:41920542 | DOI:10.1001/jamanetworkopen.2026.4122

JAMA Netw Open. 2026 Apr 1;9(4):e264340. doi: 10.1001/jamanetworkopen.2026.4340.

ABSTRACT

IMPORTANCE: Police pursuits account for approximately 1% of motor vehicle fatalities and expose suspects, officers, and bystanders to preventable harm. Contemporary population-based estimates of fatality trends and context-specific risk remain limited.

OBJECTIVE: To evaluate the characteristics of and trends in fatal vehicle crashes involving police pursuit in the US between 2009 and 2023 and the factors associated with these crashes.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used National Highway Traffic Safety Administration Fatality Analysis Reporting System (FARS) data between January 2009 and December 2023. These nationwide, population-based data included individuals involved in fatal motor vehicle crashes involving police pursuits. The data analysis was performed between August 2025 and February 2026.

EXPOSURES: Police motor vehicle pursuits, as documented in the FARS database.

MAIN OUTCOMES AND MEASURES: The primary outcomes were pursuit-related motor vehicle crash fatalities per year and associated factors, including urban vs rural settings, interstate vs noninterstate roads, US census regions, time of day, and day of the week. A negative binomial regression was used to model fatality rates controlling for population and crash frequency.

RESULTS: Between 2009 and 2023, there were 5425 fatal police pursuit-related crashes involving 8307 vehicles and 14 497 persons, resulting in 6352 deaths (mean [SD], 423 [84] deaths per year). Fatal crashes occurred most often in urban settings (3069 [57%]), at night (3794 [70%]), on noninterstate roads (4825 [89%]), and with documented speeding (4183 [77%]). Nonmotor vehicle occupants represented 270 fatalities (4%). When controlling for population and crashes, fatalities increased by 2% (95% CI, 1%-3%; P < .001) annually. Compared with the Northeast, fatalities were significantly higher in the South (difference, 336% [95% CI, 284%-395%]; P < .001), the Midwest (difference, 110% [95% CI, 84%-140%]; P < .001), and the West (difference, 95% [95% CI, 70%-123%]; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of the FARS database from 2009 to 2023, police pursuit-related fatalities increased over 15 years. Higher rates of fatal crashes were concentrated in identifiable settings including nighttime hours, urban corridors, noninterstate roadways, and southern states. The findings support risk-based restrictions, mandatory national pursuit reporting, and investment in nonpursuit alternatives among US police.

PMID:41920540 | DOI:10.1001/jamanetworkopen.2026.4340