Nevin Manimala

Eur J Psychotraumatol. 2026 Dec;17(1):2640814. doi: 10.1080/20008066.2026.2640814. Epub 2026 Mar 24.

ABSTRACT

Introduction: In Germany, there is a lack of recent population-based data regarding the prevalence of multiple personality disorder (MPD; ICD-10: F44.81) and the treatment of individuals with this diagnosis. This study aimed to assess the prevalence, psychiatric comorbidities, and treatment of MPD in Germany.Materials and Methods: Based on nationwide claims data, an observational trend study was conducted. For each year from 2012 to 2021, the proportion of persons with at least one coded MPD diagnosis was determined, stratified by sex, age and region. Additionally, psychiatric comorbidity, psychopharmacotherapy, hospital treatment, and outpatient psychotherapy among persons diagnosed with MPD in 2021 were assessed.Results: From 2012 to 2021, the administrative prevalence of MPD increased by 58.5% (from 4.1/100,000 to 6.5/100,000), with a prevalence peak in 17- to 24-year-olds and a female/male ratio of 6:1. In 2021, 86.4% of individuals with a MPD diagnosis had at least one co-occurring psychiatric diagnosis, with 23.9% having five or more. Top comorbidities were anxiety disorders (73.7%), depressive disorders (60.5%), other personality disorders (38.9%), substance use disorders (18.4%), and eating disorders (15.4%). Regarding pharmacotherapy, antidepressants (47.4%), tranquilisers (31.5%), antipsychotics (28.0%), and opioid analgesics (12.8%) were most frequently prescribed. 44.4% of individuals with MPD received psychotherapy, and 14.2% underwent psychiatric hospitalisation (median duration: 7 weeks).Discussion: In this study, we found an administrative prevalence of MPD of 4.1/100,000 in 2012 and 6.5/100,000 in 2021. These figures are considerably lower than those found in epidemiological studies, indicating underdiagnosis of MPD in Germany. The increase in MPD diagnoses was mainly due to a surge in outpatient diagnoses. Individuals with MPD diagnoses had high psychiatric comorbidity, especially depression, anxiety, and personality disorders. Therapeutic measures were in line with current guidelines, with the exception of above-average opioid analgesics prescriptions, which may be related to the high BPD comorbidity.

PMID:41873547 | DOI:10.1080/20008066.2026.2640814

Catheter Cardiovasc Interv. 2026 Mar 24. doi: 10.1002/ccd.70568. Online ahead of print.

ABSTRACT

BACKGROUND: Angina, ischemia, or myocardial infarction without non-obstructive coronary arteries (ANOCA, INOCA, or MINOCA) are common conditions yet often underdiagnosed. Invasive coronary function testing (CFT), which includes coronary thermodilution and coronary reactivity testing, can provide accurate diagnoses and improve patient outcomes.

AIMS: This study describes the diagnostic yield of an invasive CFT program at a single tertiary care center and presents the findings of coronary thermodilution and coronary reactivity testing in the first 104 patients from 2021 to 2025.

METHODS: We conducted a retrospective cohort study of consecutive patients who underwent invasive CFT. Descriptive statistics summarized patient characteristics, diagnostic outcomes, and changes in management following invasive CFT.

RESULTS: One hundred and four patients (mean age 61.6 ± 10.5 years; 48.1% female) included patients tested ad hoc during an index coronary angiogram (n = 23) or during a scheduled functional assessment (n = 81). Testing indications were post-revascularization angina (39%), ANOCA (35%), INOCA (14%), MINOCA (6%), or heart transplant (5%). Invasive CFT consisted of thermodilution-based coronary flow reserve only (35%), coronary reactivity testing only (10%), or both (55%). A definitive diagnosis was achieved in 74 of 104 patients (71.2%). Of these, 28 (27%) were diagnosed with epicardial coronary spasm, 9 (9%) with microvascular spasm, 6 (6%) with endothelial dysfunction, 13 (13%) with CMD, and 18 (17%) with a mixed phenotype. Management changes occurred in 76 of 104 (73%) patients, primarily through the adjustment of antianginal therapy. Nitrates, calcium channel blockers, and β-blockers were modified in 52%, 51%, and 52% of patients, respectively. The association of CFR values derived from PET and by Thermodilution demonstrated a fair overall agreement (k = 0.39, 95% CI 0.09-0.68). Dose-response to acetylcholine (2-200 ucg) showed that diagnostic criteria were achieved with the 100 mcg dose in most participants. Invasive CFT was safe with only two safety events recorded.

CONCLUSIONS: An invasive CFT program was safely implemented, demonstrating high diagnostic yield and an association with frequent changes in anti-anginal therapy of patients with non-obstructive coronary artery disease.

PMID:41873546 | DOI:10.1002/ccd.70568

Med J Aust. 2026 Mar;224(3):e70168. doi: 10.5694/mja2.70168.

ABSTRACT

OBJECTIVES: To analyse longitudinal change in motor neuron disease (MND) mortality in Australia from 1986 to 2023.

DESIGN: Australian population-based study of MND mortality.

SETTING: All MND mortality and Australian population data from 1 January 1986 to 31 December 2023 were obtained from the Australian Bureau of Statistics.

MAIN OUTCOME MEASURES: MND mortality records were analysed, and certified deaths were summarised by year of registration. MND mortality rates, 95% confidence intervals (CIs) and Joinpoint regression trends were calculated. Data were further subset by demographic and geographical categories to report Australian MND mortality by age group, sex, state/territory location and remoteness areas classification.

RESULTS: In Australia, the total number of MND deaths more than tripled over the past 37 years, from 238 in 1986 to 781 in 2023. The unadjusted mortality rate in 1986 was 1.49 (95% CI, 1.30-1.69) per 100,000 population and increased to 2.93 (95% CI, 2.73-3.14) per 100,000 population by 2023. After age standardisation, the annual percentage change across 1986-2023 was determined to be 0.47% (95% confidence limit, 0.16-0.86). Joinpoint modelling suggests a more recent reduction in adjusted mortality rates. In 2023, MND accounted for 0.43% of all-cause deaths in Australia, increasing from 0.21% in 1986. The number of MND deaths in Australia peaked at age 70-79 years. MND mortality was higher among men than women (rate ratio, 1.41; 95% CI, 1.33-1.51). MND mortality rates were similar among New South Wales, Victoria and Queensland (2.93, 3.08 and 2.85 per 100,000 population, respectively), with higher rates in South Australia and Tasmania (3.44 and 4.12 per 100,000 population, respectively). MND mortality rates were higher in inner and outer regional areas (3.90 and 3.24 per 100,000 population, respectively) compared with major cities (2.79 per 100,000 population).

CONCLUSIONS: Adjusted MND mortality rates in Australia increased over 37 years.

PMID:41873545 | DOI:10.5694/mja2.70168

Asian J Androl. 2026 Mar 24. doi: 10.4103/aja202584. Online ahead of print.

ABSTRACT

Erectile dysfunction (ED) is increasingly recognized as an early clinical marker of cardiovascular disease (CVD); however, the causal role of familial predisposition to CVD in ED development remains insufficiently defined. This study investigated whether genetic susceptibility associated with a parental history of CVD exerts a causal influence on ED risk, integrating clinical data with Mendelian randomization (MR) analysis. A cohort of 288 men who attended the Department of Andrology of Xiangya Hospital (Changsha, China) between June 2017 and June 2023 were recruited, comprising 223 patients with clinically confirmed ED and 65 controls. Detailed demographic, cardiovascular, and ED severity data were collected. Genetic variants associated with ED and parental CVD history were obtained from genome-wide association study (GWAS) summary statistics, and two-sample MR analyses were conducted to evaluate causal effects. Clinically, men with ED were significantly older, exhibited higher body mass index (BMI), and demonstrated lower testosterone levels compared with controls. A trend toward an association between family history of CVD and ED was observed. MR analyses provided robust evidence of causality, with paternal CVD history increasing ED risk and maternal CVD history exerting an even stronger effect. Sensitivity analyses confirmed the stability of these findings without evidence of pleiotropic bias. Collectively, these results indicate that familial genetic susceptibility to CVD independently contributes to the risk of ED. These findings underscore the clinical importance of incorporating family history into ED risk stratification and highlight the need for early screening and preventive strategies in men with a family history of CVD. Proactive management of this high-risk population may mitigate the future burden of ED and its cardiovascular sequelae.

PMID:41873544 | DOI:10.4103/aja202584

Stroke. 2026 Mar 24. doi: 10.1161/STROKEAHA.125.053989. Online ahead of print.

ABSTRACT

BACKGROUND: Early intensive blood pressure (BP) lowering improves outcomes in acute intracerebral hemorrhage, but its perioperative benefit among patients undergoing surgical hematoma evacuation is uncertain. We evaluated whether earlier achievement of intensive BP targets is associated with improved outcomes in this population.

METHODS: Post hoc secondary analysis of the INTERACT3 (the third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial) pragmatic, international, multicenter, blinded-end point, and stepped-wedge cluster-randomized trial. Among 7036 enrolled intracerebral hemorrhage patients at 121 hospitals, those who underwent surgical hematoma evacuation were included. Patients were categorized by time from hospital arrival to achieving the target systolic BP <140 mm Hg: ≤2 hours versus >2 hours. The primary outcome was 6-month mortality. Key secondary outcomes included death or disability (modified Rankin Scale scores 4-6), modified Rankin Scale score shift, health-related quality-of-life (EuroQol 5-Dimension 3-Level [EQ-5D-3L] domains, visual analog scale, and health utility index), and serious adverse events. Adjusted associations were estimated using Cox, logistic, ordinal logistic, and linear regression models, controlling for age, sex, treatment type, and admission Glasgow Coma Scale.

RESULTS: Of 7036 patients with acute intracerebral hemorrhage, 1506 underwent surgical hematoma evacuation (mean [SD] age, 59.7 [11.8] years; 33.9% women). Overall, there was no statistically significant difference in 6-month mortality between patients who achieved target BP within 2 hours of treatment initiation and those who achieved it after 2 hours (adjusted hazard ratio, 0.81 [95% CI, 0.63-1.04]; P=0.09). Early BP achievement was associated with a lower risk of death or disability (adjusted odds ratio [OR], 0.71 [95% CI, 0.56-0.90]; P=0.01), a favorable shift in the distribution of modified Rankin Scale scores (adjusted common OR, 0.73 [95% CI, 0.60-0.89]; P<0.01), and fewer serious adverse events (adjusted OR, 0.73 [95% CI, 0.57-0.94]; P=0.02). EuroQol 5-Dimension 3-Level outcomes also favored the early group, with significant improvements in mobility (adjusted OR, 0.76 [95% CI, 0.60-0.97]; P=0.03), pain/discomfort (adjusted OR, 0.72 [95% CI, 0.54-0.95]; P=0.02), and usual activities (adjusted OR, 0.79 [95% CI, 0.62-1.00]; P=0.05), as well as higher VAS (mean difference, 0.08 [95% CI, 0.002-0.17]; P=0.04) and health utility scores (mean difference, 0.05 [95% CI, 0.02-0.09]; P<0.01).

CONCLUSIONS: In patients with intracerebral hemorrhage undergoing surgical hematoma evacuation, perioperative intensive BP reduction appears safe. Achieving systolic BP <140 mm Hg within 2 hours was associated with better functional and quality-of-life outcomes, and fewer serious adverse events. These time-sensitive associations support prioritizing ultraearly perioperative BP control; confirmatory prospective analyses are warranted.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03209258.

PMID:41873543 | DOI:10.1161/STROKEAHA.125.053989

Med J Aust. 2026 Mar;224(3):e70172. doi: 10.5694/mja2.70172.

ABSTRACT

Elder abuse can lead to serious physical injuries and long-term psychological consequences, but its recognition and documentation in healthcare settings remain limited. This study used linked data from four Australian states to examine elder abuse coded during emergency department presentations and hospitalisations among 965,986 older people assessed for aged care services between 2010 and 2019. Only 580 people (0.06%) had elder abuse coded during an emergency department presentation or hospitalisation, highlighting substantial under-recognition and under-reporting in hospital settings.

PMID:41873537 | DOI:10.5694/mja2.70172

J Nurs Manag. 2026;2026(1):e3056495. doi: 10.1155/jonm/3056495.

ABSTRACT

AIM: To identify factors associated with usability and adoption of continuous monitoring with deterioration alerting systems (CM-DAS) in non-ICU wards from clinicians’ perspectives.

BACKGROUND: Patient deterioration is a safety concern on general wards; intermittent vital sign checks can miss early decline. CM-DAS can help, but impact depends on usability and clinician adoption, which remain variably achieved.

METHODS: Convergent mixed methods using the unified theory of acceptance and use of technology (UTAUT) model to guide data collection: An online UTAUT-based survey (n = 111 clinicians, 20 countries; April-August 2023) and semistructured interviews (n = 10) were conducted. Quantitative data were analysed with nonparametric tests and composite PLS-SEM (3000 bootstraps); qualitative data underwent thematic analysis; findings were integrated narratively.

RESULTS: Perceived usefulness and ease of use were positively associated with the intention to adopt CM-DAS. In the multivariable PLS-SEM, only intention to use the system (β ˜ 0.29, p ˜ 0.01) and prior CM-DAS experience (β ˜ 0.28, p ˜ 0.01) were associated with routine bedside use; other constructs did not retain independent associations, and variance explained was modest (R²_use≈0.15). Interviews corroborated benefits (patient safety and workflow) and highlighted barriers-false alarms, reliability/connectivity issues, technical language/user interface and gaps in support and training. Peer practices and patient/family responses shaped the climate for adoption.

CONCLUSIONS: This study suggests that ensuring reliable infrastructure (signal stability, hospital Wi-Fi and integration with EHR) is foundational for safe and sustained CM-DAS operation. Routine use was most closely associated with clinicians’ intention to use the system and accumulated experience. Factors such as how easy a system is to use and how individuals perceived its usefulness strengthened an individual’s intention to use the system.

IMPLICATIONS FOR NURSING MANAGEMENT: Management should prioritise reliable infrastructure, implement tiered alarm governance to reduce nonactionable alerts, designate ward super-users supported by vendor service-level agreements and deliver brief, recurring, practice-embedded training so that intention translates into sustained, safe bedside use.

PMID:41873534 | DOI:10.1155/jonm/3056495

J Magn Reson Imaging. 2026 Mar 24. doi: 10.1002/jmri.70302. Online ahead of print.

ABSTRACT

BACKGROUND: Venous pulsatile tinnitus (VPT) is associated with transverse-sigmoid sinus (TSS) anomalies, bone dehiscence (BD), and hemodynamic disturbances. 4D Flow MRI enables comprehensive TSS evaluation, but causal relationships among TSS morphology, hemodynamics, and BD in VPT onset and progression remain unquantified. Reliable imaging predictors for VPT progression and BD’s mediating role are unestablished.

PURPOSE: To construct a directed acyclic graph (DAG) testing whether stenosis-induced hemodynamic abnormalities and bone changes predict VPT occurrence and 6-month progression.

STUDY TYPE: Prospective longitudinal cohort study.

POPULATION: 126 unilateral VPT patients (36 [31-44] years; 73.0% female) and 83 matched non-VPT participants (35 [28-42] years; 71.1% female); all VPT patients completed 6-month symptom follow-up.

FIELD STRENGTH/SEQUENCE: 3 T multi-shot turbo field echo 4D Flow MRI and fast field echo phase-contrast MR venography (PC MRV).

ASSESSMENT: Three blinded neuroradiologists independently assessed TSS morphology, hemodynamic indices, and petrous BD using PC MRV, 4D Flow MRI, and high-resolution CT multiplanar reconstruction. Interobserver reliability was evaluated with discrepancies resolved by consensus.

STATISTICAL TESTS: Kolmogorov-Smirnov, Chi-Square, Mann-Whitney U test, FDR-corrected correlation analysis, linear/logistic regression, mediation analysis, and ROC curve analysis.

SIGNIFICANCE: p < 0.05.

RESULTS: 74.6% of VPT patients had 6-month progression (increased Tinnitus Handicap Inventory, THI score vs. baseline). Peak flow velocity (38.79 cm/s cut-off) independently predicted 6-month progression (area under the curve, AUC = 0.840; 95% confidence interval, CI: 0.755-0.925). TSS stenosis combined with hemodynamic parameters predicted VPT occurrence (AUC = 0.895, 95% CI: 0.855-0.936). Mediation analysis confirmed BD mediated the effect of wall shear stress on THI. Hierarchical causal pathways among TSS morphology, hemodynamics, BD, and VPT were identified to verify quantifiable DAG.

DATA CONCLUSION: TSS stenosis initiates hemodynamic disturbances and bone changes, which collectively drive VPT occurrence and 6-month progression. Integrating these morphological and hemodynamic parameters yields accurate predictive models.

EVIDENCE LEVEL: 4.

TECHNICAL EFFICACY: Stage 3.

PMID:41873517 | DOI:10.1002/jmri.70302

Res Synth Methods. 2026 Mar 24:1-19. doi: 10.1017/rsm.2026.10081. Online ahead of print.

ABSTRACT

Meta-analytic-predictive (MAP) priors have been proposed as a generic approach to deriving informative prior distributions, where external empirical data are processed to learn about certain parameter distributions. The use of MAP priors is also closely related to shrinkage estimation (also sometimes referred to as dynamic borrowing). A potentially odd situation arises when the external data consist only of a single study. Conceptually, this is not a problem, it only implies that certain prior assumptions gain in importance and need to be specified with particular care. We outline this important, not uncommon special case and demonstrate its implementation and interpretation based on the normal-normal hierarchical model. The approach is illustrated using example applications in clinical medicine.

PMID:41873516 | DOI:10.1017/rsm.2026.10081

Eur J Psychotraumatol. 2026 Dec;17(1):2635919. doi: 10.1080/20008066.2026.2635919. Epub 2026 Mar 24.

ABSTRACT

Background: Evidence on the long-term mental and physical health effects of disaster-related bereavement remains limited.Objective: To compare long-term healthcare utilisation and disease incidence among individuals bereaved in the Sewol ferry disaster with matched controls.Method: This retrospective cohort study used Korean National Health Insurance data to match 388 bereaved individuals with 1,552 controls. Healthcare utilisation and disease incidence were examined over three years pre-disaster and eight years post-disaster using difference-in-differences and Cox proportional hazards models.Results: Psychiatric outpatient utilisation among the bereaved increased from 10% pre-disaster to 38% in year 1, stabilised around 20%, and rose again to 38% in year 8, whereas controls showed a gradual increase to 22%. Difference-in-differences analyses demonstrated significantly higher psychiatric outpatient visits in the bereaved group, with excess visits of 2.87 (95% CI 1.52-4.22) in years 1-3, 1.86 (0.51-3.21) in years 4-6, and 1.56 (0.21-2.91) in years 7-8. Psychiatric admissions also increased significantly across post-disaster periods. Physical outpatient visits showed delayed excess increases in years 4-6 and 7-8. Cox models indicated elevated risks for infectious, benign neoplastic, endocrine, mental, neurological, digestive, dermatological, and musculoskeletal disorders, as well as abnormal findings and injury.Conclusions: Eight years after the disaster, bereaved individuals continued to exhibit persistent mental health problems and greater physical healthcare utilisation. These findings highlight the need for long-term, integrated support addressing both mental and physical health beyond the immediate aftermath of disasters.

PMID:41873512 | DOI:10.1080/20008066.2026.2635919