Nevin Manimala

Aging Ment Health. 2026 Mar 25:1-17. doi: 10.1080/13607863.2026.2642778. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the effects of combined exercise and cognitive interventions with those of exercise alone on cognitive function and quality of life in people with Parkinson’s disease.

METHOD: Six electronic databases were systematically searched for randomized controlled trials (RCTs) published up to January 2025, in strict accordance with the PRISMA guidelines. Two independent reviewers assessed the risk of bias using the Cochrane Risk of Bias 2 tool, and pairwise meta‑analyses were performed to synthesize the extracted data.

RESULTS: Fourteen RCTs were included in this meta-analysis. Combined interventions significantly improved global cognitive function compared with exercise alone. Moreover, combined interventions lasting more than 12 weeks offered significant advantages over exercise‑only regimens in terms of global cognition and executive function. Additionally, combined interventions yielded significant beneficial effects on executive function in individuals with Parkinson’s disease and mild cognitive impairment. No statistically significant between-group differences were observed in the domains of attention, memory, or quality of life.

CONCLUSION: Combined exercise and cognitive interventions are superior to exercise alone for patients with Parkinson’s disease, and their beneficial effects on global cognitive function are not influenced by the specific intervention format.

PMID:41879710 | DOI:10.1080/13607863.2026.2642778

Clin Toxicol (Phila). 2026 Mar 25:1-7. doi: 10.1080/15563650.2026.2639572. Online ahead of print.

ABSTRACT

INTRODUCTION: United Kingdom poison centres handle 40,000 telephone enquiries annually, and of these, follow-up is required for enquiries with a ‘severe’ Poisoning Severity Score or where requested by a clinical toxicologist. We sought to determine the resources required to expand the existing follow-up criteria in our centre to all cases with a Poisoning Severity Score ≥ ‘minor’. We also sought to characterise the follow-up process including comparing the number of follow-up calls and length of time spent per case and assessing these against patient demographics. Our third objective was to survey the experiences of Specialists in Poisons Information during their undertaking of additional follow-up activities.

METHODS: We prospectively followed-up cases from hospitals between 1^st April 2024 and 31^st March 2025. Follow-up calls were made by Specialists in Poisons Information who documented the number of follow-up calls made and the total time spent on follow-up activities for each case. Data were analysed in Microsoft Excel^® and statistical tests performed in Python 3.10.

RESULTS: Our centre received 2,708 enquiries from hospitals, of which 1,352 met the inclusion criteria for enhanced follow-up. In total 3,845 outbound follow-up calls were placed lasting a total of 28,934 minutes, equating to 2.8 follow-ups lasting 21.4 minutes per case. There was a significant difference in both the median number of follow-up calls per case and the total time spent depending on the initial Poisoning Severity Score.

DISCUSSION: Enquiry follow-up is resource intensive, but our findings are broadly similar to those from other poison centres. Substantial improvement in the number of outcomes can be achieved but further work is required to understand whether resourcing pressures can be mitigated through other technologies such as artificial intelligence.

CONCLUSIONS: Specialists in Poisons Information spend in excess of one hour per week each on follow-up activities. The amount of work varies in accordance with case severity, but additional outcome data is considered valuable.

PMID:41879708 | DOI:10.1080/15563650.2026.2639572

Tunis Med. 2025 Dec 27;103(10):1518-1524. doi: 10.62438/tunismed.v103i10.6381.

ABSTRACT

INTRODUCTION: Malnutrition remains a major public health issue in the Democratic Republic of Congo, particularly affecting marginalized indigenous populations. Socioeconomic, cultural, and environmental factors contribute to their vulnerability. This study aims to identify factors associated with malnutrition among Pygmy children under five years of age in the Bafwasende territory.

METHODOLOGY: A cross-sectional descriptive study was conducted among children and their mothers/caregivers in Bafwasende, Tshopo province. Data were collected using KoboCollect and analyzed with SPSS. Nutritional status was assessed using WHO Anthro Z-Scores to evaluate underweight, stunting, and wasting. Descriptive statistics were applied, with absolute and relative frequencies used for categorical variables.

RESULTS: Among 455 children, 28,4% suffer from acute malnutrition(wasting), 69,0% have stunting, and 47,3% have underweight. Children from low-food consumption households, with food expenditures of less than 5,000 CDF, as well as those aged 6 to 11 months, are most at risk. Malnutrition is also more common among children of very young, uneducated, or separated mothers.

CONCLUSION: The study highlights an alarming situation, requiring targeted interventions adapted to the cultural and socio-economic realities of indigenous peoples to improve their health and nutrition.

PMID:41879705 | DOI:10.62438/tunismed.v103i10.6381

Tunis Med. 2025 Dec 27;103(10):1511-1517. doi: 10.62438/tunismed.v103i10.5429.

ABSTRACT

AIM: The present study aimed to assess the impact of coronavirus disease (COVID-19) pandemic on the mental health of dental students.

METHODS: The survey was designed as an online cross-sectional study conducted among dental students in Tunisia between May 2020 and January 2022 using a web-based questionnaire. Anxiety, depression, and stress were assessed using three standardized scales (validated French version); the Generalized Anxiety Disorder (GAD-7), the Patient Heath Questionnaire (PHQ-9) depression scale, and the Perceived Stress Scale (PSS-10). The independent t-test and analysis of variance were used to determine the significance of the continuous data. Chi-square and Fisher exact tests were performed for categorical data.

RESULTS: A total of 366 dental students completed the questionnaire, 82.5% (302) were female and 17.5% (64) were male, with a mean age of 21± 6 years. Most participants (96.7%) were Tunisian and 25.7% were in the first grade. The mean scores for anxiety, depression, and stress were 11.48±5, 13.82±5.63, and 8.20±4.72 respectively. Female students were more likely to experience depression than male students ( P <0.05).A statistically significant difference was reported between students mental health status, GAD-7, PHQ-9, and PSS-10 scores ( P <0.05) and a statistically significant difference was found between students under medical care for mental health problems, GAD-7, PHQ-9, and PSS-10 scores (P<0.001).

CONCLUSION: During the pandemic, increased stress and anxiety have been reported among dental students, and some experienced symptoms related to depression.

PMID:41879704 | DOI:10.62438/tunismed.v103i10.5429

Tunis Med. 2025 Dec 27;103(10):1501-1510. doi: 10.62438/tunismed.v103i10.6153.

ABSTRACT

INTRODUCTION: Governments faced efficiency crises in healthcare between the 1980s and 1990s, leading to the adoption of Public-Private Partnerships (PPPs) as innovative solutions. This study explores evaluation methodologies, criteria, and research gaps in the healthcare sector.

METHODS: The study utilized Arksey and O’Malley’s framework to conduct a scoping review of public-private partnerships in the health sector, identifying gaps, suggesting new research directions, and clarifying complex concepts using various databases and dictionaries.

RESULTS: A study screened 21 255 papers for inclusion in an analysis, resulting in 26 studies selected for final review. The aim was to understand the contribution of Public-Private Partnerships (PPPs) to healthcare service quality, operational efficiency, and accessibility. The studies were categorized into four: access to quality care, strengthening health programs, improving communication, information, and awareness, and strengthening leadership and financial management. The studies were conducted in various countries, including Africa, Europe, Asia, North America, and South America.

DISCUSSION: Public-private partnerships (PPPs) play a crucial role in the healthcare sector, improving efficiency and quality. They provide greater access to healthcare, especially for lowincome populations, and reduce financial burdens. However, their success depends on effective governance, accountability, and equitable cost-sharing arrangements. Effective communication and promotion are essential for PPP success. Resilient strategies are needed to overcome service disruptions and ensure transparency.

PMID:41879703 | DOI:10.62438/tunismed.v103i10.6153

Tunis Med. 2025 Dec 27;103(10):1488-1494. doi: 10.62438/tunismed.v103i10.5906.

ABSTRACT

INTRODUCTION: Tunisia is affected by the nutritional and dietary transition.

AIM: To compare dietary habits and nutritional profiles between a rural agricultural area Sidi Ali Ben Aoun and an urban area Grand Tunis.

METHODS: This is a comparative cross-sectional study conducted on a sample of 220 participants, including 110 from Ben Aoun and 110 from Grand Tunis. Data were collected based on a pre-established questionnaire about dietary lifestyle and habits survey. Validated scores were used: Alimentary Diversity of Households (SDAM), the Food Consumption Assessment score (SCAM), MEDI-LITE and IPAQ.

RESULTS: The mean age was 37.2±15.3 years for the urban population versus 38.7±13.8 years for the rural population (p=0.43). In the rural population, males were 54.5% vs 48.2%; p=0.34. The occurrence of non-communicable diseases was lower in Ben Aoun (p<0.001). The adopted diet in the region of Ben Aoun aligned with the principles of the Mediterranean diet (MEDI-LITE score was 13.2±1.76 versus 7.35±2.65 in Grand Tunis, p<0.001). Both studied regions had a similar level of food security as assessed by the SDAM (p=0.006). However, household dietary diversity was more present in the rural region: the average SCAM was 11.4±0.79 in the rural group compared to 10±1.31 in the urban group (p<0.001).

CONCLUSION: The rural region (Sidi Ali Ben Aoun) was characterized by a healthier and more diverse diet compared to the urban region (Grand Tunis).

PMID:41879701 | DOI:10.62438/tunismed.v103i10.5906

Tunis Med. 2025 Dec 27;103(10):1474-1479. doi: 10.62438/tunismed.v103i10.5657.

ABSTRACT

INTRODUCTION: The establishment and preservation of optimal oral health in children are largely contingent upon the active participation of their parents and caregivers. These primary figures are instrumental in shaping children’s preventive practices and facilitating necessary treatment, highlighting a critical interface for health interventions. The aim of the study was to evaluate the knowledge of parents in Monastir city, Tunisia, toward their children’s oral health care and prevention of tooth decay and to determine the influence of parental socio-demographic variables on knowledge.

METHODS: A cross-sectional study was conducted in the pediatrician’s waiting room in Monastir, Tunisia. Ethical Clearance was obtained. The sample was made up of 195 parents. The questionnaire was completed to obtain information regarding demographic and education variables, knowledge about oral health prevention, parents’, children’s oral hygiene habits, and risk behaviors. The data collected were subjected to statistical analysis using the Pearson chi-square test and the ANOVA test.

RESULTS: Sixty-three percent of parents who participated in the study had an insufficient knowledge score (score<50%). The mean knowledge score among mothers was slightly greater than fathers. The parents having fewer than three children have better knowledge, and the parents with one child have better scores. Similar results with a higher educational level were statistically significant. The majority of parents recognized many preventive dental aspects like the number of daily brushings, the nature of toothbrush of the child’s dental, effective brushing time, and caries as an infectious disease. However, it was revealed that there was limited knowledge among parents about the importance of early oral health prevention.

CONCLUSION: The oral health knowledge among the participants was relatively low. Parents should get better education in oral health knowledge in order to influence their children to gain better oral health.

PMID:41879699 | DOI:10.62438/tunismed.v103i10.5657

Cardiol Young. 2026 Mar 25:1-7. doi: 10.1017/S1047951126111913. Online ahead of print.

ABSTRACT

BACKGROUND: Non-code dose boluses of epinephrine are utilised in critically ill paediatric patients during periods of hemodynamic deterioration, often with the hopes of preventing a cardiac arrest. Data regarding the physiologic effects of these administrations are limited. The primary aim of this study was to use high-fidelity physiologic data to characterise the effects of intravenous non-code dose bolus epinephrine.

METHODS: Paediatric patients in the cardiac ICU who received non-code dose bolus epinephrine were identified. Those who received fluid boluses or chest compressions within 2 minutes of bolus epinephrine were excluded. Autoregressive integrated moving average analyses with exogenous variables were conducted to characterise the time-dependent changes in hemodynamic indices. Cluster analyses were then conducted to determine patterns in hemodynamic changes associated with bolus epinephrine.

RESULTS: A total of 71 non-code dose bolus epinephrine administrations were included in the final analyses. Heart rate, blood pressure, and renal near infrared spectroscopy all demonstrated statistically significant changes after bolus epinephrine administration. Peak change in each was 40%, 52%, and 9%, respectively, with peaks occurring between 60 seconds and 120 seconds after administration. Three response-based clusters were identified.

CONCLUSION: Non-code dose bolus epinephrine is associated with a significant increase in heart rate, blood pressure, and systemic oxygen delivery. Cluster analysis using the peak change identified distinct clinical clusters.

PMID:41878889 | DOI:10.1017/S1047951126111913

Cancer Control. 2026 Jan-Dec;33:10732748261433284. doi: 10.1177/10732748261433284. Epub 2026 Mar 25.

ABSTRACT

IntroductionThis study investigates the cumulative association between adverse childhood experiences and lung cancer risk and analyzes whether a healthy lifestyle could modify this association.MethodsUsing the UK Biobank, we analyzed 156,798 participants who completed a baseline Mental Health Questionnaire. Lung cancer risk from age 30 was recorded, classifying childhood adversity severity using cumulative categories (none, mild [1-2 types], and severe [≥3 types]). We used multi-variable Cox regression and competing risk models to estimate hazard ratios (HR) between childhood adversity and lung cancer risk. Mediation analyses assessed the role of smoking.ResultsDuring a median follow-up of 41 years from age 30, 677 participants were diagnosed with lung cancer, and 401 died. Lung cancer risk increased progressively with increasing childhood adversity severity. Compared with individuals without childhood adversity, those who experienced any adversity had a 37% higher risk of lung cancer (HR 1.37, 95% CI 1.15-1.63), while those with severe adversity had an 82% higher risk (HR 1.82, 95% CI 1.27-2.62), demonstrating a clear summative effect. Participants who experienced any form of adversity had a 18% increased risk of dying from lung cancer (HR 1.18 [1.05-1.32]). Smoking severity was higher among participants with childhood adversity and accounted for approximately 40% of the observed association. Timely smoking cessation was associated with a substantially lower risk of lung cancer (approximately 75%). However, in the severe adversity group, smoking cessation did not provide a protective effect (HR 0.47 [0.20-1.09]). Smoking cessation significantly reduced lung cancer mortality regardless of adversity level.ConclusionChildhood adversity was associated with a higher risk of lung cancer in a cumulative manner, even after accounting for non-cancer death. Smoking accounted for a substantial proportion of the association between childhood adversity and lung cancer risk, and smoking cessation was associated with lower lung cancer risk across adversity levels. The association between childhood adversity and lung cancer remained robust, warranting further research to explore additional mediating pathways.

PMID:41878887 | DOI:10.1177/10732748261433284

J Am Heart Assoc. 2026 Mar 25:e045411. doi: 10.1161/JAHA.125.045411. Online ahead of print.

ABSTRACT

BACKGROUND: Mortality in adults with congenital heart disease (CHD) is strongly driven by disease complexity. Social determinants of health (SDOH) influence adult CHD (ACHD) health outcomes but their impact on mortality is unclear. This study examined the influence of clinical factors and SDOH on all-cause mortality in patients with ACHD.

METHODS: Single-center retrospective cohort study of patients with ACHD in the Mayo ACHD Registry who had a verifiable residential address between January 1, 2004 and December 31, 2023. Clinical and SDOH indicators were extracted, including insurance type, language, rural-urban commuting area code, and a housing-based socioeconomic index, an individual-level measure of socioeconomic status derived from 4 objective housing characteristics and categorized into quartiles (Q1-Q4). Cox proportional-hazards models were fitted to evaluate associations with mortality, incorporating CHD severity, arrhythmias, SDOH indicators, and other comorbidities. County of residence was included as a random effect, and model discrimination was assessed using the concordance statistic.

RESULTS: Among 6134 patients with ACHD, the mean age was 38±16 years; 51% were male; 78.7% were White and 44.9% had rural residence. Independent predictors of mortality included cyanotic CHD (adjusted hazard ratio [aHR], 5.70 [95% CI, 2.90-11.23]), Fontan palliation (aHR, 4.98 [95% CI, 2.56-9.70]), ventricular tachycardia (aHR, 1.71 [95% CI, 1.16-2.52]), older age at first visit (aHR, 1.05 per year [95% CI, 1.04-1.05]), male sex (aHR, 1.19 [95% CI, 1.03-1.39]), public insurance (aHR, 1.60 [95% CI, 1.35-1.90]), rural residence (aHR, 1.25 [95%, CI 1.06-1.47]), and non-English language (aHR 1.75 [95% CI 1.38-2.23]). The housing-based socioeconomic index quartile was not associated with mortality. The final model achieved a concordance statistic of 0.77.

CONCLUSIONS: Mortality in patients with ACHD is strongly influenced by both clinical factors and SDOH, independent of socioeconomic status. Addressing barriers to care such as language, insurance, and geography is essential for improving ACHD survival particularly in those at increased mortality risk.

PMID:41878868 | DOI:10.1161/JAHA.125.045411