Nevin Manimala

Int J Equity Health. 2026 Jun 25. doi: 10.1186/s12939-026-02908-w. Online ahead of print.

ABSTRACT

BACKGROUND: Early motherhood remains a major public health and equity challenge in low- and middle-income countries, especially in Latin America. While poverty, education, gender norms, and barriers to sexual and reproductive health are well-established determinants, how household income translates into (or fails to translate into) delayed childbearing remains insufficiently understood-particularly in highly unequal settings marked by informality and fragmented social protection.

OBJECTIVE: To examine the association between household income and early motherhood in Mexico, and to disentangle direct and indirect socioeconomic pathways linking income to early childbearing.

METHODS: We conducted a population-based, multi-method analysis using harmonised municipal microdata from the 2000, 2010, and 2020 Mexican Population and Housing Censuses (n = 3.05 million women aged 12-24 years, representing 30.6 million individuals). Total household income was imputed using Quantile Random Forests trained on nationally representative income-expenditure surveys. Our analytical strategy combined: (1) machine learning models to identify key correlates and non-linear individual-level patterns of early motherhood; (2) Bayesian spatial models (INLA) to quantify subnational clustering and contextual heterogeneity; and (3) dynamic structural equation modelling to assess direct and lagged relationships among income, schooling-related indicators, union formation, and early motherhood outcomes.

RESULTS: Early motherhood prevalence declined modestly from 21.46% (2000) to 19.31% (2020) and remained concentrated in socioeconomically disadvantaged households. In individual-level models, marital status, age, household structure, and dependency ratio were the dominant correlates; income ranked eighth in feature importance. Partial dependence plots indicated a non-linear inverse L-shaped association: predicted risk increased up to approximately Int$ 1,760 (2018 PPP) per adult equivalent, then plateaued and declined slightly. Parity-specific models showed that income’s predictive relevance weakened with higher parity, with U-shaped patterns at the lowest income levels for second and ≥third births. Municipal analyses revealed persistent spatial clustering after adjustment for key predictors, and residual “place” effects consistent with unmeasured contextual constraints shaping early motherhood. In dynamic models, the direct income-early motherhood path was not statistically significant. Overall patterns were consistent with predominantly indirect linkages operating through schooling- and union-related indicators and reinforcing disadvantage dynamics at the municipal level.

CONCLUSIONS: In Mexico, early motherhood remains strongly shaped by intersecting social and territorial inequalities. Income gradients are modest and appear to operate mainly through schooling lag and union-formation pathways rather than as an isolated driver. Equity-oriented strategies are likely to be most effective when they integrate school retention, prevention of early unions, and youth-friendly sexual and reproductive health services, prioritising municipalities with persistently elevated risk.

PMID:42351120 | DOI:10.1186/s12939-026-02908-w

BMC Womens Health. 2026 Jun 25. doi: 10.1186/s12905-026-04622-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the risk factors associated with pathological progression of cervical lesions, specifically focusing on high-risk human papillomavirus (HR-HPV) infection, ThinPrep Cytologic Test (TCT), and PAX1/JAM3 gene methylation in a high-risk colposcopy-referred cohort.

METHODS: A total of 409 patients who underwent colposcopy-directed biopsy at the First Hospital of Hebei Medical University between January, 2023 and April, 2025 due to abnormal TCT results, HR-HPV infection, or positive PAX1/JAM3 gene methylation were analyzed. The sensitivities of different methods were compared, and unordered multivariate logistic regression was used to analyze the risk factors for high-grade cervical lesions and pathological progression.

RESULTS: Univariate analysis demonstrated that age, gravidity, age at first sexual intercourse, number of sexual partners, menopausal status, HR-HPV infection, TCT results, and PAX1/JAM3 methylation were significantly associated with pathological grade (all P < 0.05). In the multinomial regression analysis, compared to the inflammation group, both other high-risk HPV (OR = 3.930) and very-high-risk (16/18) HPV infections (OR = 3.725), as well as non-NILM TCT (OR = 2.435), were significantly associated with an increased risk of LSIL. For the progression to HSIL, very-high-risk HPV (OR = 6.801), non-NILM TCT (OR = 2.399), positive PAX1 methylation (OR = 4.145), and positive JAM3 methylation (OR = 8.215) were identified as strong independent risk factors.

CONCLUSION: In a high-risk colposcopy-referred cohort, HR-HPV infection, non-NILM TCT results, and positive PAX1/JAM3 gene methylation are independently associated with the presence of high-grade cervical lesions. These biomarkers have the potential to enhance clinical risk stratification and inform decision-making in cervical cancer screening. However, their clinical utility and cost-effectiveness need to be further evaluated through larger, prospective studies to validate their role in routine clinical practice.

PMID:42351112 | DOI:10.1186/s12905-026-04622-9

J Magn Reson Imaging. 2026 Jun 25. doi: 10.1002/jmri.70396. Online ahead of print.

ABSTRACT

BACKGROUND: Alterations in periarticular lipid composition are implicated in musculoskeletal diseases, yet short-term reliability of MRI-based triglyceride composition mapping in the knee is not fully established.

PURPOSE: To evaluate 1-week repeatability of proton-density fat fraction (PDFF) and triglyceride fatty-acid composition-saturated (SFA), monounsaturated (MUFA), and polyunsaturated (PUFA)-in periarticular knee tissues.

STUDY TYPE: Prospective.

POPULATION: Ten healthy adults (5 female, 5 male; age 32 ± 8 years; BMI 23.5 ± 2.4 kg/m²).

FIELD STRENGTH/SEQUENCE: 3T; 12-echo 3D spoiled gradient-echo acquisition for chemical shift-encoded fat quantification and a proton density-weighted SPACE sequence for segmentation (0.6 mm isotropic).

ASSESSMENT: Participants underwent repeated MRI 1 week apart. Femoral and tibial bone marrow, patella, Hoffa’s fat pad, prefemoral fat pad, quadriceps fat pad, posterior fat pad, and subcutaneous adipose tissue were segmented and rigidly aligned. Voxelwise spectral fitting was used to estimate PDFF and fatty acid composition, including SFA, MUFA, and PUFA components. Repeatability metrics included bias, within-subject standard deviation (wSD), within-subject coefficient of variation (wCV%), coefficient of repeatability, and intraclass correlation coefficient (ICC).

STATISTICAL TESTS: Paired t-tests assessed systematic differences (α = 0.05); ICCs used a two-way random-effects, absolute-agreement model (ICC(2,1)).

RESULTS: PDFF showed lowest variability across all regions (wCV: 1.5%-5.9%; ICC: 0.33-0.96). SFA demonstrated similar stability (wCV: 2.4%-12.6%; ICC: 0.19-0.87). MUFA exhibited anatomy-dependent reliability (wCV: 4.1%-21.1%; ICC: 0.17-0.97), with highest repeatability in subcutaneous adipose tissue (ICC: 0.97) and Hoffa’s fat pad (ICC: 0.85). PUFA displayed the greatest variability (wCV: 3.6%-52.8%; ICC: 0.10-0.94), with the greatest instability in periarticular fat pads. No paired comparisons were significant (all p > 0.05; range p = 0.14-0.98). Regional ordering remained consistent across sessions.

DATA CONCLUSION: A 12-echo chemical shift-encoded MRI protocol provides repeatable PDFF and SFA measurements over 1 week. MUFA reliability varies by tissue, while PUFA remains least stable.

EVIDENCE LEVEL: 2 (Prospective cohort).

TECHNICAL EFFICACY STAGE: 2 (Reproducibility/feasibility evaluation).

PMID:42348313 | DOI:10.1002/jmri.70396

Brain Behav. 2026 Jun;16(6):e71560. doi: 10.1002/brb3.71560.

ABSTRACT

BACKGROUND: Anti-CGRP antibodies are effective and safe in real-world migraine management, but guidelines recommend discontinuation after 12-18 months due to limited long-term data and remaining uncertainties regarding optimal treatment duration and sustained safety, highlighting the need for large-scale long-term real-world evidence. This study evaluated their safety and effectiveness in patients treated for ≥2 years.

METHODS: This multicenter retrospective study included patients from 13 headache units who received the same anti-CGRP antibody for ≥24 months, excluding discontinuation periods. Baseline characteristics, monthly headache days (MHD), monthly migraine days (MMD), and adverse events (AEs) were recorded at baseline, 6 months, 1, 2, 3, and 4 years. Descriptive statistics were used to summarize clinical characteristics, and appropriate parametric or non-parametric tests were applied for group comparisons. Multivariate analyses were performed to explore associations between baseline variables and long-term treatment response.

RESULTS: A total of 454 patients (91% female, mean age 48) were analyzed, with follow-up at 2 years (n = 454), 3 years (n = 135), and 4 years (n = 17). Treatments included erenumab (39%), galcanezumab (34%), and fremanezumab (27%). Fifty-seven percent maintained continuous therapy, while 43% restarted after discontinuation. Sustained reductions in MHD and MMD were observed at 2, 3, and 4 years (MHD from 20 to 6, 6, 5/MMD from 14 to 4, 4, and 2). Medication overuse decreased from 78% to 13%, 20%, and 18%. Loss of effectiveness occurred in 4.2% after 2 years. AEs appeared in <20%, mostly mild (>80%), leading to discontinuation in 0.4%. Multivariate analysis showed that shorter disease duration prior to anti-CGRP initiation, earlier anti-CGRP initiation, and greater MHD/MMD reduction at 6 months were associated with better long-term outcomes.

CONCLUSIONS: Anti-CGRP mAbs demonstrate sustained long-term safety and effectiveness, with consistent reduction in headache and migraine days and lower medication overuse. Early initiation and greater initial improvement predict better long-term outcomes. Findings support extending therapy beyond 12-18 months, supporting optimization of clinical protocols.

PMID:42348309 | DOI:10.1002/brb3.71560

Stat Med. 2026 Jul;45(15-17):e70650. doi: 10.1002/sim.70650.

ABSTRACT

Comparing future antibiotic resistance levels resulting from different antibiotic treatments is challenging because some patients may survive only under one of the antibiotic treatments. We embed this problem within a semi-competing risks approach to study the causal effect on resistant infection, treated as a nonterminal event time. We argue that existing principal stratification estimands for such problems exclude patients for whom a causal effect is well-defined and is of clinical interest. Therefore, we present a new principal stratum, the infected-or-survivors ( $ios$ ). The $ios$ is the subpopulation of patients who would have survived or been infected under both antibiotic treatments. This subpopulation is more inclusive than previously defined subpopulations. We target the causal effect among these patients, which we term the feasible-infection causal effect (FICE). We develop large-sample bounds under novel assumptions, and discuss the plausibility of these assumptions in our application. As an alternative, we derive FICE identification using two illness-death models with a bivariate frailty random variable. These two models are connected by a cross-world correlation parameter. Estimation is performed by an expectation-maximization algorithm followed by a Monte Carlo procedure. We apply our methods to detailed clinical data obtained from a hospital setting.

PMID:42348288 | DOI:10.1002/sim.70650

Epidemiology. 2026 Jun 25. doi: 10.1097/EDE.0000000000002016. Online ahead of print.

ABSTRACT

BACKGROUND: Participants in the All of Us research study differ from the U.S. population in myriad characteristics, limiting the generalizability of findings. A statistical reweighting tool to improve generalizability would enhance the scientific value of the data.

METHODS: To account for differences between All of Us and the nationally representative 1999-2018 National Health and Nutrition Examination Survey (NHANES), we generated selection weights using four models incorporating sociodemographic, self-reported health, and clinical characteristics. We assessed covariate balance and compared predictors of all-cause mortality in weighted All of Us to NHANES using the ratio of hazard ratios (RHRs), where an RHR of one indicates unbiased estimates in (weighted) All of Us relative to NHANES.

RESULTS: Weighting improved balance on measured variables between All of Us and NHANES. Among the four weighting models, the most complex model which included sociodemographic, health, and clinical variables and their interactions achieved HRs in All of Us most similar to those in NHANES. For example, the RHR for hypertension for unweighted All of Us vs. NHANES (RHR=1.5; 95% CI=1.4 to 1.7) was reduced to 1.2 (95% CI=0.9 to 1.5) after applying weights from the clinical-interaction model. Even in this model, 17 of 35 HRs evaluated diverged by >20% (RHR <0.8 or >1.2) between weighted All of Us and NHANES.

CONCLUSIONS: Predictors of mortality in All of Us differ from those in the U.S. population both in their distribution and in their associations with mortality. Reweighting can mitigate selection bias, but no model we tested comprehensively achieved generalizability.

PMID:42348262 | DOI:10.1097/EDE.0000000000002016

Ir Med J. 2026 Jun 18;119(6):110.

ABSTRACT

AIMS: This study aimed to explore Irish anaesthesiologists’ attitudes toward environmentally sustainable anaesthesia, including perceptions of safety, efficacy, and policy influences on anaesthetic choice.

METHODS: A cross-sectional online survey was distributed to anaesthesiologists across Ireland between March and June 2025. The questionnaire assessed demographic factors, preferences for intravenous versus inhalational anaesthesia, environmental awareness, and institutional support. Descriptive and comparative statistical analyses were performed.

RESULTS: A total of 98 responses were received. Patient factors and ease of administration were the primary determinants of anaesthetic choice, while cost was less influential. Environmental considerations were common, with 71 (72%) reporting they consider environmental impact when selecting an anaesthetic technique. Most respondents (n=86, 88%) were willing to modify their practice to reduce environmental harm, yet 55 (56%) felt their institution did not provide adequate environmental education or guidance.

DISCUSSION: Irish anaesthesiologists demonstrate strong awareness and willingness to engage in sustainable practice, but institutional training and policy support remain limited. Targeted education and system-level initiatives may enhance environmentally responsible anaesthetic care.

PMID:42348256

J Anat. 2026 Jun 25. doi: 10.1111/joa.70186. Online ahead of print.

ABSTRACT

This study investigates age-related shape changes, morphological integration, and modularity in the human talus-calcaneus complex throughout postnatal development (0-10 years). Geometric morphometric analyses were performed on three-dimensional landmark data from 23 individuals binned into four age groups, considering both the talus and calcaneus. Statistical analyses included Procrustes ANOVA to assess age effects, two-block partial least squares to quantify inter-bone integration, and Covariance Ratio tests to evaluate modular organization within each bone. Trabecular bone architectural parameters from micro-CT scans were analyzed in parallel. Marked age-related shape changes were detected in both the talus and calcaneus, with pronounced morphological transitions observed between the middle age groups (1-3 and 3-6 years). The two bones exhibited strong morphological integration across all age classes, representing the first quantitative assessment of talus-calcaneus integration during ontogeny. Modular organization was confirmed also within each bone. Trabecular bone architectural analysis via micro-CT revealed distinct developmental patterns: the talus exhibited higher initial bone volume fraction with subsequent stabilization and stable trabecular thickness, while the calcaneus showed progressive increases in both bone volume fraction and trabecular thickness, alongside higher anisotropy values, presumably reflecting adaptation to its more direct role in experiencing impact forces during heel strike. The talus-calcaneus complex exhibits highly coordinated ontogenetic timing and strong morphological integration across both external morphology and internal trabecular architecture. These adaptations highlight the sophisticated interplay within this skeletal unit, supporting its function as an integrated biomechanical system critical for understanding human locomotor evolution and foot development.

PMID:42348250 | DOI:10.1111/joa.70186

JAMA Otolaryngol Head Neck Surg. 2026 Jun 25. doi: 10.1001/jamaoto.2026.1584. Online ahead of print.

ABSTRACT

IMPORTANCE: Quality of life (QOL) is considered the second most important outcome after survival in cancer care. In head and neck reconstruction, QOL has long been assumed to stabilize at 1 year, an assumption that guides clinical follow-up and trial design.

OBJECTIVE: To evaluate QOL beyond 1 year after head and neck reconstruction.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study of 315 patients with head and neck disease was conducted from 2015 through 2023 at a high-volume tertiary center in Taiwan. Data were analyzed March to August 2025.

EXPOSURE: Free flap reconstruction.

MAIN OUTCOMES AND MEASURES: The primary outcome was the physical domain of the University of Wisconsin QOL questionnaire. The primary end point was QOL time to deterioration (TTD), which accounts for reversibility and patient response shift, and to identify modifiable risk factors for deterioration, defined in TTD as a decline of 5 or more points without subsequent recovery of 5 or more points. For Cox proportional hazards models, statistical analysis included hazard ratios (HRs) with 95% CIs. The secondary end point was a composite of TTD or death.

RESULTS: Among 315 patients (mean [SD] age, 53.7 [11.8] years; 283 [89.8%] male; median follow-up, 1155 [95% CI, 1056 to 1254] days), baseline Cox models identified Charlson Comorbidity Index as associated with QOL deterioration (HR, 1.46; 95% CI, 1.22 to 1.74). In 12-month landmark models (N = 272), Charlson Comorbidity Index (HR, 1.70; 95% CI, 1.43 to 2.06), chemotherapy (HR, 1.60; 95% CI, 1.03 to 2.48), and complications (HR 2.01; 1.21 to 3.34) were associated with QOL deterioration. The composite end point showed similar results. QOL remained dynamic beyond 1 year, with 115 of 192 patients (59.9%) having clinically meaningful score changes between years 1 and 2 (58 of 192 [30.2%] improved, 57 of 192 [29.7%] deteriorated) despite stable cohort mean scores. Findings were consistent in analyses restricted to patients with malignant disease (n = 246). Exploratory baseline and 12-month risk scores demonstrated the feasibility of predicting dynamic QOL changes beyond 1 year.

CONCLUSIONS AND RELEVANCE: Results of this cohort study question the assumption that QOL stabilizes at 1 year after head and neck reconstruction. More than half of patients continued to experience clinically meaningful changes, with complications at 1 year representing the strongest modifiable risk factor for deterioration. Prognostic QOL risk scores provide an approach for targeting survivorship interventions to patients at highest risk for deterioration, shifting the focus from survival alone to preservation of QOL.

PMID:42348233 | DOI:10.1001/jamaoto.2026.1584

Environ Toxicol Chem. 2026 Jun 25:vgag174. doi: 10.1093/etojnl/vgag174. Online ahead of print.

ABSTRACT

Plastic pollution is one of the most persistent threats to aquatic ecosystems, yet studies in low-disturbed mountain aquatic environments remain scarce. This study examined the presence of macro- and microplastics in three rivers in the Montesinho Natural Park and adjacent areas, Portugal. It investigated how intrapopulational ecological traits of the signal crayfish (Pacifastacus leniusculus), a non-native species widely distributed across Europe, may influence contaminant accumulation. Sampling was conducted at five sites along an invasion gradient (front-core), where macroplastics along the margins and signal crayfish were collected, followed by laboratory analyses for the morphological and polymeric characterization of the plastics. Chemical identification was performed using Fourier-transform infrared spectroscopy with attenuated total reflectance (FTIR-ATR) and Raman spectroscopy. Behavioural assays of boldness and aggressiveness were carried out on 100 captured signal crayfish individuals. Macroplastics were detected in all sampling sites. Microplastic abundance was higher at the invasion front, and the digestive tract contained significantly more particles than the gills, suggesting that the digestive tract is the primary route of exposure. No differences were detected between sex or individual size. Fibers were the dominant form, mainly in blue and black colors, and polymers such as polyethylene terephthalate (PET), polyethylene (PE), and polypropylene (PP) prevailed. Although personality traits differed between the invasion front and the core, with generally bolder and more aggressive individuals at the front, behavioural responses also showed sex-related patterns, with females tending to leave the shelter faster and males showing higher aggressiveness. However, no statistically significant correlations were found between animal personality and microplastic accumulation. Overall, our results indicate that plastic contamination depends on multiple factors arising from interactions between local environmental factors, including hydromorphological processes, and intrapopulational ecological traits (i.e., diet). This study highlights the importance of integrating behavioural analyses to better understand differential exposure to contaminants and their potential environmental implications for non-native species and possible legacy for native communities.

PMID:42348218 | DOI:10.1093/etojnl/vgag174