Nevin Manimala

Pediatr Pulmonol. 2026 May;61(5):e71673. doi: 10.1002/ppul.71673.

ABSTRACT

BACKGROUND: Despite asthma being one of the most common chronic conditions among children in the United States, real-world evidence on medication adherence and healthcare utilization in underserved pediatric populations remains limited. Therefore, we aim to evaluate adherence, persistence, and asthma-related healthcare utilization among Medicaid-enrolled children receiving inhaled corticosteroids (ICS) versus ICS-long-acting beta-agonist (ICS-LABA) inhalers.

METHODS: We conducted a retrospective cohort study using Texas Children’s Health Plan claims data from 2016 to 2019. Children aged 4-17 years with asthma diagnoses and ≥1 prescription for an ICS or ICS-LABA were included. Adherence was determined as the proportion of days covered (PDC) of ≥ 50%, and persistence was defined as continuous therapy without a 60-day gap. The PDC ≥ 80% was evaluated in sensitivity analysis. Multivariable logistic regression was used to estimate adherence, asthma-related emergency department (ED) visits, and hospitalizations.

RESULTS: Among 8622 eligible children, 82.4% received ICS and 17.6% received ICS-LABA. In inverse probability of treatment weighting (IPTW) adjusted analyses, compared with ICS, ICS-LABA users had higher adherence rate i.e., 21.08% versus 16.56% achieved PDC ≥ 50% (aOR = 1.35; 95%CI: 1.25-1.45), and 10.82% versus 6.74% achieved PDC ≥ 80% (aOR = 1.61; 95%CI: 1.31-1.97). Refill persistence was also higher with ICS-LABA (36.16% vs. 23.35%, aOR: 1.86, 95%CI: 1.74-1.99). However, despite better adherence, we found ICS-LABA users exhibited greater asthma-related healthcare utilization, i.e., ED visits occurred in 18.69% versus 11.25% (aOR = 1.81; 95%CI: 1.56-2.11) and hospitalizations in 2.53% versus 1.00% (aOR= 2.55; 95%CI: 1.68-3.89), which persisted even after adjusting for adherence.

CONCLUSIONS: We found that adherence was greater in children with asthma who were dispensed an ICS-LABA as compared to those dispensed an ICS-only inhaler; however, adherence rates were low in both groups. Higher hospitalization and ED visit rates among those prescribed ICS-LABA therapy likely reflect higher disease severity in this group. Our findings should be interpreted in light of claims-based adherence measures and potential residual confounding due to unmeasured asthma severity and control.

PMID:42165090 | DOI:10.1002/ppul.71673

Nat Sci Sleep. 2026 May 15;18:591315. doi: 10.2147/NSS.S591315. eCollection 2026.

ABSTRACT

BACKGROUND: The sleep quality of Han Chinese and Tibetan firefighters at high altitude remains poorly understood. This study investigates the prevalence of sleep disturbances in these groups and whether ethnicity affects sleep quality in these two populations.

METHODS: Male firefighters were recruited from China Fire and Rescue stations at high altitude of 500 m, 2570 m, and 4509 m in Southwest China. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality, considering scores >5 as poor sleep quality. Symptoms of anxiety and depression were evaluated using the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9).

RESULTS: As altitude increased, the total PSQI scores of Han Chinese firefighters showed a non-statistically significant rise: 4 (2-5) at 500 m, 4 (3-6.75) at 2570 m, and 5 (2.75-6) at 4509 m. Poor sleep quality prevalence also rose: 23%, 31%, and 44%, respectively. In contrast, the sleep quality of Tibetan firefighters remained relatively stable and was better than that of their Han Chinese counterparts. Furthermore, the GAD-7 and PHQ-9 scores were higher in Han Chinese firefighters compared to Tibetan firefighters. The PSQI score was positively correlated with GAD-7 scores (ρ = 0.454, p < 0.001) and PHQ-9 scores (ρ = 0.380, p < 0.001) but negatively correlated with Tibetan ethnicity (ρ = -0.228, p < 0.001). Logistic regression analysis indicated that, compared to Tibetans, being Han Chinese (odds ratio [OR] = 3.050, 95% confidence interval [CI]: 1.214-7.665) and having higher GAD-7 scores (OR = 1.816, 95% CI: 1.332-2.477) were independently associated factors for poor sleep quality.

CONCLUSION: This study suggests that Han Chinese firefighters in this field sample across these stations are at greater risk of poor sleep quality than Tibetan firefighters, with elevated GAD-7 scores being a potential contributing factor for poor sleep quality.

PMID:42165074 | PMC:PMC13185950 | DOI:10.2147/NSS.S591315

MedEdPORTAL. 2026 May 19;22:11601. doi: 10.15766/mep_2374-8265.11601. eCollection 2026.

ABSTRACT

INTRODUCTION: Biochemistry is often regarded as conceptually dense yet emotionally disconnected, limiting its relevance to patient care. To bridge this gap, an art-based learning intervention was developed to connect biochemistry of diseases with empathy, perspective-taking, and ethical awareness through visual thinking strategies, structured peer role-play, and guided reflection.

METHODS: This small-group activity was conducted for 150 first-year medical students over a total duration of 180 minutes. Students were divided into 30 groups and each group received a curated artwork and a biochemical role-play case scenario. Evaluation followed Kirkpatrick’s model with a 20-item perception survey and semistructured interviews for level 1 (reaction), postsession assessment, “I used to think, now I think, now I will” reflection, and a 7-item confidence questionnaire for level 2 (learning).

RESULTS: Students reported high levels of engagement across all components, particularly appreciating visual thinking strategies and structured peer role-play. The postsession assessment score was 24.1 (SD = 3.0) out of 30 [P < .001]. Thematic analysis of documented reflections yielded 16 distinct themes representing the shift in learners’ perspectives and their growing commitment to empathic patient care.

DISCUSSION: The integration of art and role-play into early biochemistry teaching effectively supported students in linking molecular mechanism of diseases with human experiences of illness. It also encouraged thoughtful participation and facilitated emotional and ethical awareness. While the approach proved feasible and impactful within this setting, its broader implementation may depend on institutional support and faculty readiness for arts-integrated pedagogy.

PMID:42165068 | PMC:PMC13183865 | DOI:10.15766/mep_2374-8265.11601

Front Psychiatry. 2026 May 5;17:1788310. doi: 10.3389/fpsyt.2026.1788310. eCollection 2026.

ABSTRACT

OBJECTIVE: This meta-analysis evaluated the associations between noise exposure, air pollutants, and attention-deficit/hyperactivity disorder (ADHD) in children, aiming to inform future prevention strategies.

METHODS: Studies were systematically retrieved from CNKI, Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library, covering publications from inception to November 2025. Heterogeneity was assessed using Cochran’s Q test and the I² statistic. Subgroup analyses, meta-regression, and sensitivity analyses were performed to evaluate the robustness of the findings.

RESULTS: Noise exposure was associated with a small increase in ADHD risk (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01-1.05), with stronger associations for childhood exposure, whereas prenatal exposure showed no significant effect. Given the modest effect size, this finding should be interpreted cautiously. Particulate matter (PM_2.5 and PM₁₀) was significantly associated with ADHD in continuous-exposure models-PM_2.5 (OR = 1.32, 95% CI: 1.16-1.50) and PM₁₀ (OR = 1.47, 95% CI: 1.15-1.87). In dichotomous models, PM_2.5 was not significant, while PM₁₀ remained positively associated (OR = 1.58, 95% CI: 1.11-2.26). Elevated nitrogen dioxide (NO₂) exposure was also associated with a modest increase in ADHD risk (OR = 1.11, 95% CI: 1.02-1.20), whereas nitrogen oxides (NO_x), ozone (O₃), and sulfur dioxide (SO₂) did not show significant associations.

CONCLUSIONS: Noise and several air pollutants (PM_2.5, PM₁₀, and NO₂) were significantly associated with increased ADHD risk, particularly during childhood exposure. Other pollutants, including O₃ and SO₂, did not demonstrate significant effects. These findings suggest that environmental noise and several air pollutants may be associated with ADHD; however, some observed associations, particularly for noise and NO₂, were modest in magnitude and should be interpreted cautiously. These results reflect observational associations rather than evidence of a strong or causal effect, while the evidence for some pollutants remains limited or inconclusive. Further research is needed to clarify pollutant-specific associations and the role of exposure timing.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024593274, identifier CRD42024593274; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025632899, identifier CRD42025632899.

PMID:42165060 | PMC:PMC13185364 | DOI:10.3389/fpsyt.2026.1788310

Front Psychiatry. 2026 May 5;17:1813238. doi: 10.3389/fpsyt.2026.1813238. eCollection 2026.

ABSTRACT

PURPOSE: The COVID-19 pandemic disrupted essential services, posing unique challenges for individuals with Autism Spectrum Disorder (ASD) who depend on consistent, specialized support. Service providers faced unique challenges in adapting to remote delivery methods, highlighting the fragility of existing systems during crises. This study explored the experiences of ASD service providers in Qatar during the COVID-19 pandemic.

METHODS: An online survey of 66 ASD service providers in Qatar was conducted. Data were analyzed using descriptive statistics, chi-square, and likelihood ratio tests, with qualitative responses assessed through thematic analysis.

RESULTS: Most service providers (90.9%) worked remotely during the pandemic, with 81.8% engaging in online services. Providers reported significant skill regression in individuals with ASD. Stress levels were notably high (42.4%) and significantly associated with emotional tolls [p = 0.017, LR = 4.887], financial strains [p = 0.008, LR = 4.337], and personal challenges [p = 0.008, LR = 3.203]. Thematic analysis revealed decreased therapy effectiveness and difficulties in balancing work with family responsibilities.

CONCLUSION: These findings suggest the importance of adaptive service delivery systems that maintain continuity of care during crises. Strengthening autism service infrastructure and developing resilient models are essential to safeguard autism support for future emergencies.

PMID:42165059 | PMC:PMC13183810 | DOI:10.3389/fpsyt.2026.1813238

Integr Pharm Res Pract. 2026 May 15;15:583805. doi: 10.2147/IPRP.S583805. eCollection 2026.

ABSTRACT

BACKGROUND: Effective pharmacist-patient communication is essential for modern pharmaceutical services, relying heavily on optimized communication strategies that are essential for ensuring treatment adherence and overcoming the unique challenges of patient care in multilingual regions.

PURPOSE: This study investigates the perceptions, experiences, and strategies used by community pharmacists in Romania to overcome common communication barriers.

METHODS: The research employed an observational, descriptive, cross-sectional study design, utilizing a self-administered online questionnaire. The data was collected through an anonymous online questionnaire (N=150) administered to patients in eastern Romania. Explicit digital informed consent was obtained. Data analysis involved descriptive statistics, t-tests for independent samples, and Spearman correlation coefficient.

RESULTS: Results indicate the perception of significant barriers, notably differences in educational levels, the use of medical terminology, and time constraints. A negative and significant Spearman correlation (ρ = -0.207, p < 0.001) was found between the perceived effectiveness of communication and the need for service improvement, confirming the detrimental impact of these difficulties on the quality of pharmaceutical services. Furthermore, the average self-assessment score of 2.59 for communication training suggests a predominantly negative perception of both university and continuing education in this area.

CONCLUSION: The conclusions highlight an urgent need to integrate culturally and linguistically adapted communication training into the education of community pharmacists. Future research should focus on developing and evaluating pilot educational programs and interventions specifically tailored for bilingual communities.

PMID:42165040 | PMC:PMC13185963 | DOI:10.2147/IPRP.S583805

Front Endocrinol (Lausanne). 2026 May 5;17:1757107. doi: 10.3389/fendo.2026.1757107. eCollection 2026.

ABSTRACT

This study aimed to investigate how levels of serum follicle-stimulating hormone (FSH) on Day 7 of ovarian stimulation are related to the number of oocytes retrieved, and identify any cutoff or threshold point in protocols using gonadotropin-releasing hormone (GnRH) antagonists. We examined data from January 2017 to June 2024, covering 9,969 cycles from 7,981 patients using GnRH antagonists as part of in vitro fertilization processes. We found a complex link between serum FSH and oocyte collection. Lower serum FSH on Day 7 was associated with collection of fewer oocytes (β = -0.531, p < 0.0001), and different levels were associated with changes in the number of oocytes collected. The key point was 9.13mIU/mL. If serum FSH exceeded 9.13 mIU/mL on Day 7, each 1mIU/mL increase reduced the number of oocytes collected by 0.07 (effect β = -0.07, 95% confidence interval [CI] -0.10 to -0.05, P < 0.0001). When serum FSH was below 9.13 mIU/mL, each 1 mIU/mL rise increased the number of oocytes collected by 1.18 (effect β = 1.18, 95% CI 0.95 to 1.41, P < 0.0001). This association suggests that it may be possible to improve ovarian reaction by raising the FSH dose if serum FSH is under 9.13 mIU/mL. However, if serum FSH is already over 10 mIU/mL, it seems likely that other steps may be needed to increase ovarian reaction, although these hypotheses will need to be tested in future studies.

PMID:42165020 | PMC:PMC13183537 | DOI:10.3389/fendo.2026.1757107

Int Dent J. 2026 May 20;76(4):109636. doi: 10.1016/j.identj.2026.109636. Online ahead of print.

ABSTRACT

PURPOSE: The integration of artificial intelligence (AI) into prosthodontics represents a paradigm shift in the design and fabrication of removable partial dentures (RPDs). This study evaluates the current AI technologies, including large language models such as ChatGPT, Copilot, Gemini, and DeepSeek, for designing RPDs.

METHODS: Standardized prompts were submitted to four AI-assisted systems (ChatGPT, Copilot, Gemini, and DeepSeek) to generate RPD designs for 25 partially edentulous clinical scenarios based on Kennedy classifications. The outputs were compared with reference models (AiDENTAL), a validated retention prediction model, and evaluations by six blinded experts. Statistical comparisons were performed using a mixed-effects ordinal regression model (p < 0.05).

RESULTS: Compared with the reference standards, Copilot and Gemini produced the most consistent and accurate RPD designs, whereas DeepSeek showed the greatest deviation, despite achieving the highest predicted retention scores. Expert evaluations confirmed that AiDENTAL achieved the highest overall design quality, followed by Copilot, whereas ChatGPT and DeepSeek demonstrated lower and more variable performances.

CONCLUSIONS: The design of RPDs using different large language models, including ChatGPT, Copilot, Gemini, and DeepSeek, resulted in notable variations in the design output. AiDENTAL achieved the highest overall RPD design quality, whereas Copilot and Gemini produced the most consistent and accurate designs across all the evaluated criteria.

PMID:42160812 | DOI:10.1016/j.identj.2026.109636

J Craniomaxillofac Surg. 2026 May 20;54(8):104587. doi: 10.1016/j.jcms.2026.104587. Online ahead of print.

ABSTRACT

Anterior disc displacement without reduction of the temporomandibular joint is a prevalent condition associated with pain and functional limitation, and minimally invasive arthroscopic approaches are increasingly favored over open surgery due to lower morbidity. This study compared three arthroscopic interventions: classical myotomy (CM), minimally invasive anterior arthroscopic myotomy (MIAAM), and posterior ligament electrocoagulation (PLE). A total of 86 patients were included: 24 (27.9%) underwent CM, 30 (34.8%) underwent MIAAM, and 32 (37.2%) underwent PLE. Outcomes were assessed using visual analog scale (VAS) pain, maximum mouth opening (MMO), and joint function at baseline and at 1 and 6 months postoperatively. Pain improved significantly over time in all groups (F = 5.02; df = 2; p < 0.05), with no significant differences between techniques. Maximum interincisal opening (MIO) and mandibular protrusion also improved significantly (F = 14.6; df = 2; p < 0.05 and F = 8.949; df = 2; p < 0.05, respectively), again without inter-group differences. MIAAM was associated with faster pain relief at 1 month and slightly better 12-month outcomes, although these differences were not statistically significant. Overall, PLE showed comparatively less favorable results, suggesting MIAAM may represent a balanced option in terms of efficacy and safety.

PMID:42160800 | DOI:10.1016/j.jcms.2026.104587

Clinics (Sao Paulo). 2026 May 20;81:100939. doi: 10.1016/j.clinsp.2026.100939. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the association between lipid profile, statin use, metabolic syndrome, and clinic. Prostate Enlargement (PE) in adult men attending a urology outpatient clinic.

METHODS: A cross-sectional study was conducted among 1117 men aged 40-years or older. Prostate volume was measured by ultrasonography; a volume ≥ 40 mL was considered the threshold for enlargement. Independent variables included lipid fractions, prescription-based statin use, and components of metabolic syndrome. Multivariate logistic regression models were applied, adjusted for age, hypertension, and medication exposure.

RESULTS: The median age was 63-years (IQR: 55-71), and the median prostate volume was 34.0 mL (IQR: 26.0-48.0). Statin use was identified in 36.5% of the sample, and the prevalence of PE was 38.9%. Age was the only factor independently associated with PE (OR = 1.07; 95% CI: 1.05-1.09; p < 0.001). Metabolic syndrome was associated with PE in crude analysis; however, this association lost statistical significance after adjustment for potential confounders.

CONCLUSION: Age was the only independent determinant of prostate enlargement in this metabolically controlled cohort. Lipid parameters and prescription-based statin use showed no adjusted association with prostate volume; however, the lack of detailed statin exposure data warrants cautious interpretation of these findings.

PMID:42160783 | DOI:10.1016/j.clinsp.2026.100939