Nevin Manimala

Adv Gerontol. 2026;39(1):55-63. doi: 10.34922/AE.2026.39.1.005.

ABSTRACT

Chronic heart failure (CHF) is the most common pathological condition in geriatric practice. The increasing prevalence of CHF with age is driven by the rapid global rise in non-communicable diseases (NCDs) such as obesity, arterial hypertension, type 2 diabetes mellitus, coronary artery disease (CAD), chronic obstructive pulmonary disease and chronic kidney disease (CKD); their combination is particularly unfavorable. Objective: To investigate the relationship between biomarkers of renal dysfunction and CHF risk factors in middle-aged and elderly individuals with NCDs. This retrospective study included 357 patients (173 men, 184 women) aged 45-74 years. Anthropometric, clinical, laboratory, and instrumental data were analyzed for all patients. The entire cohort was divided into two groups: group 1 – patients with NCDs and LVH (n=136); group 2 – patients with NCDs without LVH (n=221). Results showed that, compared to patients without LVH, those with LVH had significantly higher age, years, systolic blood pressure, prevalence of CAD, cerebrovascular disease, CKD, fibrinogen, cystatin C, creatinine, and proteinuria. Conversely, they had significantly lower hemoglobin levels, red blood cell count, estimated glomerular filtration rate (eGFR), and left ventricular (LV) E/A ratio. In middle-aged and elderly patients with NCDs, statistically significant positive correlations were found between cystatin C levels and blood triglyceride concentration (r=0,163, p<0,05), as well as between cystatin C levels and LV diastolic filling deceleration time (r=0,150, p<0,05). Additionally, eGFR was correlated with LV E/A ratio (r=0,181, p<0,05), LV early diastolic filling deceleration time (r=-0,211, p<0,05), and right ventricular deceleration time (r=-0,166, p<0,05). The findings may serve as cardiorenal markers in implementing a geriatric approach and in developing algorithms for multidisciplinary care for middle-aged and elderly patients with NCDs.

PMID:42150024 | DOI:10.34922/AE.2026.39.1.005

Adv Gerontol. 2026;39(1):36-43. doi: 10.34922/AE.2026.39.1.003.

ABSTRACT

In the article, the authors continue their research into the sector of services for the elderly sector as a segment of the silver economy market. The authors compared two waves of surveys on the demand among elderly citizens of St. Petersburg for innovative services, which were conducted during and after the pandemic. The findings show that basic human needs remain the primary needs at all times (in this case, the delivery of food, essential goods, medicines, etc., as well as assistance in everyday life). In the post-pandemic period, the need to teach older people information technology skills has emerged as a priority in terms of importance (along with the answer «assistance in everyday life and household»). The study highlights the limitations of access to digital social services for older people.

PMID:42150022 | DOI:10.34922/AE.2026.39.1.003

Int J Health Plann Manage. 2026 May 18. doi: 10.1002/hpm.70089. Online ahead of print.

ABSTRACT

COVID-19 crisis has significantly impacted global economic growth. Assessing the economic impacts of various policies is crucial to better public health management (PHM). To incorporate specific PHM policies into a unified framework, prevention and control intensity (PCI) is introduced to quantify the intensity of PHM. Under different PCI, we construct a statistical framework to estimate each economy’s counterfactual output, thereby providing two indicators to assess the effectiveness of PHM adopted by certain economies. Empirical analysis measures the effectiveness of PHM in each of the 137 economies during COVID-19 in 2020. Further analysis is conducted through robustness tests and regression discontinuity design. Aggregated results from 137 economies indicate that COVID-19 may have caused global economic losses far exceeding 5.47 trillion US dollars in 2020. Statistical indicators reveal that 39 economies reduced economic loss through PHM, while 25 economies achieved relatively ideal economic output targets. These findings suggest that moderate prevention and control measures can significantly reduce economic losses and highlight the necessity for most countries to strengthen their PHM strategies to enhance economic resilience and recovery.

PMID:42150014 | DOI:10.1002/hpm.70089

Urogynecology (Phila). 2025 Sep 3. doi: 10.1097/SPV.0000000000001725. Online ahead of print.

ABSTRACT

IMPORTANCE: The midurethral sling (MUS) procedure is the gold standard surgical treatment for stress urinary incontinence; however, it can significantly affect symptoms of overactive bladder (OAB).

OBJECTIVES: This study aimed to evaluate the burden of OAB 5 years after MUS insertion by analyzing medication prescriptions, surgical intervention and patient-reported data, with comparisons by sling tensioning technique.

STUDY DESIGN: This prospective cohort study followed participants of the Mid-Urethral Sling Tensioning trial for 5 years post-MUS surgery. Participants completed validated OAB questionnaires before and 5 years post-MUS surgery. Linked administrative health data measured postoperative OAB medication use, and incidence of bladder onabotulinumtoxinA (Botox) procedures.

RESULTS: Of the 318 participants, 260 had complete questionnaire data; among them, 225 (86.9%) had baseline OAB symptoms and at 5 years post-MUS surgery, 211 (81.5%) had symptoms. Approximately 1 in 5 reported clinically significant worsening in OAB symptoms; 19.0% in daily urination, 22.5% in urgency, and 18.1% in urine leakage. Conversely, 38.7%, 40.3%, and 47.6% showed significant improvement in these respective symptoms. In the 5 years after MUS surgery, 21.4% trialed OAB medication with 5.3% persisting at study end, and 2.2% (n=7) underwent a Botox procedure. The Babcock clamp tensioning technique provided less OAB burden compared with Mayo Scissor; however, the study was underpowered to detect statistical significance.

CONCLUSIONS: After MUS surgery, twice the proportion of patients experienced improved OAB symptoms than the proportion reporting worsening. Trials of OAB medications after MUS surgery were common, but most patients discontinued use long term. This study advises surgeons and patients of realistic OAB expectations after MUS surgery.

PMID:42149649 | DOI:10.1097/SPV.0000000000001725

JMIR Aging. 2026 May 18;9:e85074. doi: 10.2196/85074.

ABSTRACT

BACKGROUND: Cognitive decline in older adults is often accompanied by subtle motor alterations. Digital handwriting analysis has emerged as a promising noninvasive approach for detecting these changes, but its usefulness in community-based settings remains unclear.

OBJECTIVE: This study aims to examine the association of handwriting kinematics and physical performance measures with pentagon-copy performance classification in community-dwelling older adults.

METHODS: This cross-sectional study included 174 community-dwelling adults aged 60 years or older (mean age 73.9, SD 6.1 years; 108/174, 62% women). Participants completed 10 digital handwriting tasks and a battery of physical performance tests assessing strength, balance, gait, and cardiorespiratory fitness. Group classification was based on pentagon-copy performance and categorized as normal (93/174, 53% participants) or altered (81/174, 46% participants). Adjusted linear regression models included group as the main predictor and age and sex as covariates. Multiple comparisons were controlled using the Benjamini-Hochberg false discovery rate.

RESULTS: After adjustment for age, sex, and multiple comparisons, selected handwriting variables remained significantly associated with altered pentagon-copy performance, whereas no physical performance variables remained statistically significant. The most consistent differences were observed in cognitive effort and mechanical tasks, where participants with altered pentagon-copy performance showed longer contact time (β=526.8 ms; P<.001) and time on air (β=1111.5 ms; P<.001), together with lower mean writing pressure (β=-2058.8 au; P=.003). Overall, group differences were more consistently detected in handwriting-derived variables than in conventional physical performance outcomes after adjusted analyses.

CONCLUSIONS: Selected digital handwriting variables, particularly temporal measures, were more consistently associated with altered pentagon-copy performance than physical performance outcomes. These findings suggest that digital handwriting analysis may represent a sensitive complementary approach for exploring subtle functional differences in community-based settings.

PMID:42149645 | DOI:10.2196/85074

JMIR Infodemiology. 2026 May 18;6:e72524. doi: 10.2196/72524.

ABSTRACT

BACKGROUND: Public discourse is significantly impacted by the rapid spread of misinformation on social media platforms. Human moderators, while capable of performing well, face many challenges due to scalability. While large language models (LLMs) show great potential across various language tasks, their capacity for cognitive and contextual analysis, in detecting and interpreting misinformation, remains less evaluated.

OBJECTIVE: This study evaluates the effectiveness of LLMs in detecting and interpreting misinformation compared to human annotators, focusing on tasks requiring cognitive analysis and complex judgment. Additionally, we analyze the influence of different prompt engineering strategies on model performance and discuss ethical considerations for using LLMs in content moderation systems.

METHODS: We evaluated 4 OpenAI models against a panel of human annotators using a subset of posts from the MuMiN dataset. Each model and human annotator responded to structured questions on misinformation, following an established cognitive framework. Both human annotators and LLMs also provided scores indicating how confident they were in their responses. Various prompting strategies were used in this research, including: 0-shot, few-shot, and chain-of-thought, with performance evaluated through precision, recall, F₁-score, and accuracy. We used statistical tests, including the McNemar test, to quantitatively assess differences between LLM and human ratings of misinformation.

RESULTS: GPT-4 Turbo with chain-of-thought prompting achieved the highest performance of all LLMs for detecting misinformation, with an accuracy of 67.2% and an F₁-score of 78.3%, but was outperformed by human annotators, who achieved 70.1% accuracy and an F₁-score of 81%. LLMs performed well in tasks involving logical reasoning and straightforward misinformation detection, but struggled with complex judgments, including detecting sarcasm, understanding misinformation, and analyzing user intent. LLM confidence scores positively correlated with accuracy in simpler tasks (r=0.72, P<.01) but were less reliable in subjective and complex contextual evaluations.

CONCLUSIONS: LLMs show significant potential for automating misinformation detection. Their limitations in understanding and interpreting these posts highlight the current necessity of human oversight. A hybrid framework combining LLMs for preliminary screening with human moderators for more complex evaluation presents a promising future direction. Future research could prioritize the fine-tuning of LLMs using datasets that emphasize cognitive and emotional linguistic features, alongside the development of advanced prompting techniques.

PMID:42149639 | DOI:10.2196/72524

Urogynecology (Phila). 2025 Jul 29. doi: 10.1097/SPV.0000000000001729. Online ahead of print.

ABSTRACT

IMPORTANCE: Despite evidence that intraperitoneal local anesthetics can have a positive effect on patients’ postoperative recovery, such use in urogynecology remains underinvestigated.

OBJECTIVE: The purpose of this study was to evaluate the effects of intraperitoneal bupivacaine without epinephrine on postoperative pain control in patients undergoing surgery for pelvic organ prolapse (POP).

STUDY DESIGN: This double-blind randomized controlled trial compared intraperitoneal bupivacaine versus placebo for postoperative pain control in patients undergoing POP surgery. The primary outcome was pain scores based on a 10-point numeric rating scale and visual analog scale (NRS-VAS) at 4 hours after surgery. Secondary outcomes included pain scores based on the NRS-VAS collected at 8, 12, and 24 hours after surgery, postoperative opiate consumption during inpatient stay, time to first narcotic dose, and hospital length of stay.

RESULTS: Ninety-one participants were randomized into treatment (n = 44) or placebo (n= 47) groups. No differences in demographic or baseline characteristics, surgical time, estimated blood loss, or intraoperative complications were observed between groups. The primary outcome, NRS-VAS pain scores at 4 hours after surgery, showed no statistically significant difference between groups. Similarly, no significant differences were found in NRS-VAS scores at 8, 12, or 24 hours after surgery, total postoperative opiate consumption, time to first narcotic dose during inpatient stay, or hospital length of stay.

CONCLUSIONS: No differences in pain scores, opiate consumption, time to first narcotic dose, or hospital length of stay were observed between the treatment and placebo groups. The routine use of intraperitoneal bupivacaine following POP surgery appears to have limited clinical utility.

PMID:42149629 | DOI:10.1097/SPV.0000000000001729

JAMA Netw Open. 2026 May 1;9(5):e2611464. doi: 10.1001/jamanetworkopen.2026.11464.

ABSTRACT

IMPORTANCE: Observational studies have reported associations between pregnancy vitamin D levels and offspring cognition, but no randomized clinical trial (RCT) has investigated the effect of high-dose vitamin D3 supplementation in pregnancy on offspring cognition into middle childhood.

OBJECTIVE: To assess whether high-dose vitamin D3 supplementation during pregnancy is associated with improved offspring cognition at age 10 years.

DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc secondary analysis of the blinded, placebo-controlled Copenhagen Prospective Studies on Asthma in Childhood 2010 RCT conducted from March 4, 2009, to November 17, 2010. The cohort included 700 mother-child pairs from Denmark, of whom 623 were randomized. Exclusion criteria were vitamin D intake above 600 IU/d; endocrine, kidney, or heart disease; and insufficient Danish language proficiency. Cognitive assessments were conducted for the offspring at age 10 years, excluding those born at less than 28 weeks’ gestation and with birth weight less than 1500 g. Participants were unblinded at 3 years of age, while investigators remained unaware of group assignments. The 10-year visits were conducted from February 11, 2019, to December 13, 2021. Statistical analyses were conducted from February to June 2025.

INTERVENTION: High-dose (2800 IU/d) or standard-dose (400 IU/d) vitamin D3 from pregnancy week 24 to 1 week post partum.

MAIN OUTCOME AND MEASURES: The primary outcome was cognitive functioning across 11 functions assessed at age 10 years using a comprehensive neuropsychological test battery as part of the Copenhagen Prospective Study on Neuro-Psychiatric Development (COPSYCH).

RESULTS: The vitamin D3 RCT and the COPSYCH visit were completed by 498 children (mean [SD] age, 10.3 [0.4] years; 258 boys [51.8%]): 247 prenatally exposed to high-dose vitamin D3 and 251 prenatally exposed to standard-dose vitamin D3. Covariate-adjusted analyses of standardized scores (mean [SD], 0 [1]; higher values indicating better performance) showed positive associations of high-dose vitamin D3 with verbal memory (β = 0.17 SD; 95% CI, 0.03-0.32 SD; P = .02), visual memory (β = 0.24 SD; 95% CI, 0.06-0.42 SD; P = .01), and flexibility or set shift (β = 0.19 SD; 95% CI, 0.01-0.37 SD; P = .04); however, high-dose vitamin D3 was no longer associated with flexibility or set shift after multiple test correction.

CONCLUSION AND RELEVANCE: This post hoc analysis of an RCT suggests that high-dose vitamin D3 supplementation in pregnancy is positively associated with visual memory, verbal memory, and flexibility or set shift among offspring measured at age 10 years. These findings strengthen evidence on the association of prenatal vitamin D exposure with childhood cognition.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00856947.

PMID:42149595 | DOI:10.1001/jamanetworkopen.2026.11464

JAMA Netw Open. 2026 May 1;9(5):e2613256. doi: 10.1001/jamanetworkopen.2026.13256.

ABSTRACT

IMPORTANCE: Trauma center designation in the US is determined by state-specific criteria, whereas the optional American College of Surgeons Committee on Trauma (ACS-COT) standards provide a nationally recognized benchmark for optimal trauma care. The number of trauma centers continues to expand, yet access disparities persist. The degree of alignment between state designation criteria and ACS-COT standards as well as its implications for recent patterns of for-profit and nonprofit center expansion remain unexplored.

OBJECTIVE: To quantify the concordance between each state’s trauma center designation criteria and ACS-COT standards, and to evaluate its correlation with expansion of for-profit and nonprofit trauma centers.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Trauma Information Exchange Program database for all designated trauma centers in the 50 states and the District of Columbia from January 1, 2013, to December 31, 2022. Data were analyzed from January to September 2024.

EXPOSURE: State-specific trauma center designation criteria.

MAIN OUTCOMES AND MEASURES: The primary outcome was concordance, defined as the proportion of ACS-COT standards reflected in each state’s trauma center designation criteria. Correlations (Spearman rank [rs]) of concordance with the expansion of for-profit and nonprofit trauma centers from 2013 to 2022 were calculated.

RESULTS: The study cohort comprised 464 trauma centers (389 nonprofit [83.8%] and 75 for-profit [16.2%]) that gained designation between 2013 and 2022. State trauma center designation criteria concordance with ACS-COT standards varied between 31.1% and 100%. Overall mean (SD) concordance was highest for level I trauma centers with the highest resource capacity (92.5% [15.6%]) and lowest for level IV trauma centers with low resource capacity (78.5% [28.2%]). Among the 464 trauma centers, 380 (81.9%) were level III or IV centers with lower resource capacity. States with lower concordance between their designation criteria and ACS-COT standards had a statistically significant correlation with expansion of for-profit trauma centers (rs = -0.39; P = .004) but not with expansion of nonprofit trauma centers.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of state trauma center designation criteria and their alignment with ACS-COT standards, states’ designation criteria and trauma center expansion patterns varied widely. Lower concordance between state designation criteria and ACS-COT standards was correlated with for-profit trauma centers, whereas this pattern was not observed for nonprofit trauma centers. These findings highlight the importance of understanding how regulatory environments may shape trauma system development.

PMID:42149591 | DOI:10.1001/jamanetworkopen.2026.13256

JAMA Netw Open. 2026 May 1;9(5):e2613308. doi: 10.1001/jamanetworkopen.2026.13308.

ABSTRACT

IMPORTANCE: Breastfeeding improves health outcomes in neonates. However, infants’ oral anatomy may alter latch and sucking mechanics, hampering breastfeeding. The role of maxillary frenulum (upper lip-tie) has remained controversial.

OBJECTIVE: To investigate the association between upper lip-tie clinical findings, such as thickness, attachment, and upper lip mobility, and early breastfeeding problems.

DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study (Lingual Frenulum in Newborn Infants substudy), consecutive mother-infant dyads were studied from August 2, 2023, to January 31, 2024, in the mother-child unit of Oulu University Hospital, Oulu, Finland. After 6 months, parents were asked about breastfeeding success.

MAIN OUTCOMES AND MEASURES: Main outcomes were the association of various maxillary frenulum clinical findings with breastfeeding problems and possible treatment indications. Study physicians assessed frenulum thickness, tissue type, attachment point, upper lip mobility and skin paleness when stretched, sucking pad, mother’s need to fix the upper lip position, and the need of early tongue-tie treatment. The validated maternal breastfeeding experience scores were recorded. Follow-up information was inquired via emails.

RESULTS: Of the 264 studied mother-infant dyads (151 [57.2%] male infants; mean [SD] gestational age, 39.5 [1.2] weeks), 228 mothers (86.4%) reported early breastfeeding problems in maternal breastfeeding experience scoring. Baseline data were similar between the breastfeeding problem group vs controls. No associations between distinct maxillary frenulum findings and breastfeeding problems were found. Mothers without breastfeeding problems had more often previous breastfeeding experience than mothers who reported breastfeeding problems (28 [77.8%] vs 116 [50.9%], P = .003). Of the mothers with infants treated early for tongue-tie, 17 (43.6%) vs 46 (20.8%) of the nontreated patients’ mothers reported a need to fix the upper lip position during breastfeeding (P = .003). The upper lip-ties of 4 infants (1.5%) had been operated on during the 6-month follow-up period.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study, an isolated, harmful upper lip-tie was rare in newborn infants. Maternal inexperience, rather than infant’s upper lip-tie anatomy, was associated with breastfeeding problems; no operative treatment indications for maxillary frenulum were confirmed.

PMID:42149590 | DOI:10.1001/jamanetworkopen.2026.13308