Nevin Manimala

Prim Health Care Res Dev. 2026 Jun 16;27:e67. doi: 10.1017/S1463423626101327.

ABSTRACT

AIM: We aimed to examine advice interactions among family physicians using social network analysis (SNA) by categorizing advice interaction according to the five advice dimensions.

BACKGROUND: Inter-individual interactions for information exchange is a powerful tool for the pursuit of solutions to issues. These interactions may involve advice-seeking.

METHODS: The whole network approach was adopted and face-to-face research was conducted with 139 family physicians. Data were analysed using social network software, UCINET and visualized using the NETDRAW software. To examine the multidimensional advice networks, the frequency, density, reciprocity (dyad) measures were used. The Quadratic Assignment Procedure was used in UCINET to measure the correlations between the dimensions of advice. The Girvan-Newman algorithm was used to examine clustering in the advice network.

FINDINGS: Density values in the advice dimensions were very low. This indicates that the network was sparse, with limited interactions among family physicians in terms of giving and receiving advice. The strength of the ties in the dimensions was realized through validation, solutions, problem reformulation, meta-information, and legitimization, respectively. The results showed that the relationships between the dimensions were moderately, positively and significantly correlated. The advice network exhibited high modularity. Family physicians tended to seek advice from colleagues at the family health centers where they worked. We presented a visual representation of advice networks in primary healthcare settings. Identifying multidimensional advice networks through social network analysis can provide insight into how information is disseminated among family physicians. Our findings could contribute to decision makers in developing solution-oriented processes.

PMID:42299703 | DOI:10.1017/S1463423626101327

Geospat Health. 2026 Feb 2;21(1). doi: 10.4081/gh.2026.1451. Epub 2026 Jun 16.

ABSTRACT

This study presents the first Knowledge Attitudes, and Practices (KAP) survey on malaria in Djibouti City. It was conducted among 1,344 household heads across nine neighbourhoods in Djibouti City. Composite scores were calculated for each KAP dimension. Analysis of variance and multinomial logistic regression identified socio-demographic predictors and Local Indicators of Spatial Association (LISA) characterised the spatial clustering of the KAP scores. No significant association was found between sociodemographic or economic factors and malaria knowledge. Prevention practices varied notably across neighbourhoods, driven by place of residence, mother tongue, and education-underlining the primacy of spatial determinants. Attitudes were found to be linked to gender and income. Despite high disease awareness, 60% of respondents misidentified transmission routes, nearly two-thirds of respondents failed to adopt effective preventive behaviours, while Long-Lasting Insecticidal Net (LLIN) ownership far exceeded correct use. The gap between awareness and practice suggests that information-deficit approaches have reached their limits; future interventions should target motivational norm-based determinants of behaviour, spatially concentrated in the highest-risk neighbourhoods. Language and cultural barriers require tailored communication strategies beyond standard broadcast campaigns. Strengthened vector control and active surveillance remain essential complements to any behavioural intervention.

PMID:42299701 | DOI:10.4081/gh.2026.1451

J Adolesc. 2026 Jun 16. doi: 10.1002/jad.70206. Online ahead of print.

ABSTRACT

INTRODUCTION: The relationship between psychological distress and problematic mobile phone use (PMPU) is a significant concern for adolescent mental health. However, the longitudinal dynamics of this relationship and the specific cognitive mechanisms driving it remain insufficiently understood. This study aimed to examine the bidirectional relationship between psychological distress and PMPU, and to test the parallel mediating roles of positive and negative metacognitive beliefs.

METHODS: A two-wave longitudinal study was conducted over a 6-month interval in 2023 with 830 Chinese adolescents (48.6% boys; M_age = 15.18, SD = 1.92) in Zhejiang Province, China. Participants completed self-report measures of psychological distress, PMPU, and metacognitive beliefs. A latent cross-lagged panel model (L-CLPM) was used to test for bidirectional effects. The mediating pathways were tested using a longitudinal path model with bootstrapping.

RESULTS: The L-CLPM confirmed a significant bidirectional relationship between psychological distress and PMPU. The mediation analysis revealed that the pathway from T1 psychological distress to T2 PMPU was significantly and simultaneously mediated by both T2 positive and negative metacognitive beliefs. The direct effect was nonsignificant in the presence of the mediators, and the strengths of the two mediation pathways did not statistically differ.

CONCLUSION: Psychological distress and PMPU showed reciprocal prospective associations in adolescents. The pathway from distress to PMPU was accounted for by parallel positive and negative metacognitive beliefs, which may promote engagement and hinder disengagement. Interventions may therefore need to address both emotional distress and these metacognitive beliefs to disrupt this cycle.

PMID:42299685 | DOI:10.1002/jad.70206

Ethn Health. 2026 Jun 16:1-15. doi: 10.1080/13557858.2026.2688762. Online ahead of print.

ABSTRACT

OBJECTIVE: Black men experience the highest incidence and mortality rates from colorectal cancer (CRC) in Louisiana. Limited awareness of screening guidelines, low perceived risk, and structural barriers to care contribute to delayed detection. This study assessed CRC awareness, risk perceptions, screening intentions, and communication preferences among Black men aged 30-44 in Louisiana to inform targeted intervention strategies.

METHODS: We conducted a statewide cross-sectional survey of English-speaking individuals who identified as male, African American or Black, were aged 30-44 and resided in Louisiana. Measures included CRC awareness, perceived risk, prior screening recommendations, screening intentions, exposure to CRC-related messaging, social media use, and trusted sources of health information. Descriptive statistics were used to summarize responses.

RESULTS: We analyzed a total of 403 responses. Most participants did not perceive CRC as a significant personal health threat. Although 40% reported receiving a physician’s recommendation for screening, only 70% of those individuals completed screening. Fewer than half recalled exposure to CRC-related messages, and message recall was generally low. Social media use was widespread (97%), with 58% reporting regular engagement with influencers. Doctors, teachers, coaches, and pastors were identified as the most trusted sources of health information.

CONCLUSION: Findings highlight low perceived risk of CRC alongside high engagement with digital platforms. These results support the development of culturally tailored, lead-time messaging strategies that increase both perceived severity and susceptibility, leverage trusted messengers, and utilize digital media to promote timely CRC screening among young Black men.

PMID:42299682 | DOI:10.1080/13557858.2026.2688762

Clin Rehabil. 2026 Jun 16:2692155261459227. doi: 10.1177/02692155261459227. Online ahead of print.

ABSTRACT

ObjectiveTo examine the association between increased energy and protein intake through oral nutritional supplements and mortality and hospital admissions in older hip fracture patients at nutritional risk, using a preplanned secondary analysis of a randomised controlled trial.SettingDepartment of Orthopaedic Surgery, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark.ParticipantsHip fracture patients aged ≥65 at nutritional risk.InterventionParticipants were randomised to receive two cans daily of high-energy, high-protein oral nutritional supplements enriched with vitamin D and omega-3 fatty acids for 12 weeks after discharge or standard care.Main MeasuresAll-cause mortality and hospital admissions during a pre-planned 38-week follow-up after discharge, including time to first admission and length of hospital stay.ResultsAll-cause mortality was low, with no difference between intervention and control groups 2 (3%) versus 3 (5%). During follow-up, 31% (n = 19) of intervention participants was admitted to hospital compared with 47% (n = 29) in the control group. The difference approached significance in the intention-to-treat analysis (Risk ratio 0.72, 95% CI 0.51-1.03, p = 0.075) and was statistically significant in the per-protocol analysis (18% vs. 44%; Risk ratio 0.69, 95% CI 0.52-0.92, p = 0.019). No significant differences were observed in admissions frequency, length of hospital stay, or time to first admission.ConclusionPost-discharge oral nutritional supplementation was associated with a trend towards fewer hospital admission, with the strongest effect among adherent participants. No significant effects were observed in mortality, admission frequency, length of hospital stay or time to admission.ClinicalTrials.gov: NCT05556876. Date of registration: 2022-09-23.URL: https://clinicaltrials.gov/study/NCT05556876.

PMID:42299674 | DOI:10.1177/02692155261459227

J Intensive Care Med. 2026 Jun 16:8850666261460825. doi: 10.1177/08850666261460825. Online ahead of print.

ABSTRACT

ObjectiveTo compare the efficacy and safety of etomidate versus ketamine as induction agents for rapid sequence intubation in critically ill adults, focusing on 28-day mortality and post-intubation hypotension.Data SourcesPubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2026. Reference lists of included studies were also manually screened.Study SelectionWe included randomized controlled trials (RCTs) comparing single-dose intravenous ketamine versus etomidate for emergency rapid sequence intubation in critically ill adults (≥ 18 years) in non-operating room settings (eg, intensive care unit or emergency department).Data ExtractionTwo investigators independently screened records, extracted data using a standardized form and assessed the risk of bias using the RoB 2 tool. The certainty of evidence was evaluated using the GRADE framework.Data SynthesisSix RCTs comprising 4108 randomized patients (2046 assigned to ketamine and 2062 to etomidate) were included. For the primary outcome, the pooled analysis evaluated 4102 patients and showed no statistically significant difference in 28-day mortality between the ketamine and etomidate groups (28.7% vs 29.9%; relative risk [RR] 0.96; 95% CI, 0.87-1.05; I² = 13.8%). In a prespecified subgroup analysis of patients with sepsis (n = 1546), mortality also did not differ significantly (RR 1.04; 95% CI, 0.91-1.19). However, ketamine was associated with a statistically significant increase in the incidence of post-intubation hypotension (14.2% vs 11.3%; RR 1.25; 95% CI, 1.01-1.53; I² = 0%). Conversely, ketamine significantly reduced the risk of adrenal suppression compared to etomidate (5.3% vs 14.7%; RR 0.36; 95% CI, 0.17-0.75). No significant differences were observed regarding peri-intubation cardiac arrest or first-attempt intubation success.ConclusionsFor emergency intubation in critically ill adults, including those with sepsis, 28-day mortality is similar between etomidate and ketamine. However, ketamine may increase post-intubation hypotension, whereas etomidate may increase adrenal suppression.

PMID:42299661 | DOI:10.1177/08850666261460825

J Int Assoc Provid AIDS Care. 2026 Jan-Dec;25:23259582261460521. doi: 10.1177/23259582261460521. Epub 2026 Jun 16.

ABSTRACT

BackgroundCervical cancer remains a major global health challenge, disproportionately affecting low- and middle-income countries. Women living with HIV are at increased risk due to weakened immunity. This study assessed cervical cancer screening utilization and associated factors among HIV-positive women attending antiretroviral therapy (ART) clinics in Gondar town, Northwest Ethiopia.MethodsA multicenter institution-based cross-sectional study was conducted from November 1 to 30, 2025, using systematic random sampling. Data were collected through structured interviewer-administered questionnaires and analyzed using STATA 14. Bivariable and multivariable logistic regression analyses were performed, with P < .05 considered statistically significant.ResultsScreening utilization was 30.2%. Good knowledge (AOR = 3.44; 95% CI: 2.22-5.16), favorable attitude (AOR = 2.81; 95% CI: 2.28-6.61), and history of sexually transmitted infections (AOR = 2.22; 95% CI: 1.83-4.13) were significantly associated.ConclusionScreening utilization was low. Strengthening health education, improving ART counseling, and integrating screening into routine HIV care are recommended.

PMID:42299655 | DOI:10.1177/23259582261460521

Eur Heart J Cardiovasc Pharmacother. 2026 Jun 16:pvag040. doi: 10.1093/ehjcvp/pvag040. Online ahead of print.

ABSTRACT

AIMS: Current guidelines recommend considering long-term oral anticoagulation in patients with new-onset postoperative atrial fibrillation (POAF) after cardiac surgery, balancing stroke and bleeding risk. However, no specific approach to bleeding risk assessment is provided. We explored in a proof-of-concept study whether a bleeding risk score can identify patients with POAF after coronary artery bypass grafting (CABG) with increased risk of post-discharge major bleeding.

METHODS AND RESULTS: This observational cohort study included 4436 patients with POAF after CABG in 2009-2020 without oral anticoagulation. The four-item PRECISE-DAPT score (based on age, creatinine clearance, preoperative hemoglobin concentration, and previous bleeding) was calculated for all patients. Bleeding risk was defined as high (≥25 points), medium (16-24 points), or low (≤15 points). Associations between bleeding risk and major bleeding events during the first postoperative year were assessed by Cox regression. Discrimination was evaluated with C-statistics, and calibration by comparing expected and observed bleeding rates. Major bleeding occurred in 2.1% of patients during the first year. The score classified 36.0% of patients as high bleeding risk. The hazard ratio for high versus low bleeding risk was 4.81 (95% CI 2.59-8.96). The area under the receiver operating characteristic curve was 0.68 (95% CI 0.63-0.73). Calibration showed good agreement between expected and observed bleeding events in patients with an annual bleeding risk up to 7%.

CONCLUSIONS: A bleeding risk score can be used to stratify patients with POAF after CABG into groups with different post-discharge bleeding risk. Further studies are necessary to identify the optimal risk score and its role in OAC decision pathway to improve clinical outcomes.

PMID:42299626 | DOI:10.1093/ehjcvp/pvag040

Medicine (Baltimore). 2026 Jun 12;105(24):e49308. doi: 10.1097/MD.0000000000049308.

ABSTRACT

Diabetic nephropathy (DN) is a common, life-threatening complication of diabetes, contributing to the global disease burden. With the advent of video platforms, health information is being more widely disseminated. However, the quality of such content varies widely, which may influence the public’s perception. This study aimed to evaluate the upload sources, content, and characteristics of DN-related videos on TikTok and Bilibili and to explore descriptive associations between video quality scores and selected video characteristics. This cross-sectional content analysis included 166 DN-related videos. Video quality was assessed using the Global Quality Scale (GQS), modified DISCERN (mDISCERN), and Journal of the American Medical Association (JAMA) benchmark criteria. Descriptive subgroup and correlation analyses were performed to examine cross-sectional associations between video quality scores and selected video attributes. No multivariable adjustment was performed. In unadjusted cross-sectional comparisons, TikTok videos showed higher observed engagement counts at the time of data collection than Bilibili videos, whereas no statistically significant differences were observed in video duration or quality indicators after correction for multiple comparisons. In unadjusted descriptive subgroup comparisons, videos uploaded by experts showed more favorable results in selected quality-related measures, particularly GQS and JAMA, than videos uploaded by individual users. No clear association was observed between video quality and snapshot engagement metrics recorded at the time of retrieval. This study identified descriptive differences in the presentation and dissemination patterns of DN-related health information across TikTok and Bilibili. Because the analyses were observational, cross-sectional, and unadjusted for potential confounders such as video length and content type, the observed differences between platforms and uploader types should be interpreted as descriptive associations only rather than independent effects.

PMID:42299601 | DOI:10.1097/MD.0000000000049308

Medicine (Baltimore). 2026 Jun 12;105(24):e49278. doi: 10.1097/MD.0000000000049278.

ABSTRACT

Insulin resistance is closely associated with mild cognitive impairment (MCI) and sarcopenia. The predictive utility of the metabolic score for insulin resistance (METS-IR) for MCI across different sarcopenia strata and its potential as a substitute for life’s essential 8 (LE-8) remains unclear. This prospective cohort study used data from the China Health and Retirement Longitudinal Study. Participants aged ≥45 years without baseline MCI or memory-related disease and with biomarker and cognitive data were included. METS-IR was calculated from fasting blood glucose, triglycerides, high-density lipoprotein cholesterol, and body mass index. LE-8 was scored using an adapted American Heart Association framework. Associations between METS-IR and incident MCI stratified by sarcopenia status were assessed using Cox proportional hazards models and restricted cubic splines. Machine-learning analyses using 11 classifiers and stratified 10-fold cross-validation evaluated the incremental and substitutional value of METS-IR within LE-8-based prediction models. A total of 4980 participants were included. Higher METS-IR was associated with a less favorable cardiometabolic profile. In multivariable-adjusted Cox models, compared with the lowest quartile of METS-IR, hazard ratios for incident MCI were 0.94 (95% confidence interval [CI]: 0.79-1.11) for quartile 2, 0.65 (95% CI: 0.53-0.78) for quartile 3, and 0.72 (95% CI: 0.59-0.87) for quartile 4. Restricted cubic spline analyses showed a significant nonlinear association between METS-IR and incident MCI in the overall sample (P for overall < .001, P for nonlinear = .017). A significant overall association was also observed in the possible sarcopenia subgroup, although nonlinearity was not statistically significant. No significant nonlinear or overall association was observed in the nonsarcopenia or confirmed sarcopenia subgroups. In prediction analyses, LE-8-based models achieved moderate discrimination (area under curve, AUC: 0.525-0.696). Adding METS-IR yielded a modest but statistically significant improvement only in AdaBoost (ΔAUC = +0.00487, P < .05). When selected biochemical LE-8 components were substituted by METS-IR, discrimination improved in several algorithms in multiple models, particularly in multilayer perceptron (P < .01). METS-IR showed a significant nonlinear association with incident MCI, with the lowest risk observed at intermediate-to-higher METS-IR levels. The incremental and substitutional value beyond LE-8 was limited, model-dependent, and requires external validation.

PMID:42299594 | DOI:10.1097/MD.0000000000049278