Nevin Manimala

J Community Health. 2026 Jul 8. doi: 10.1007/s10900-026-01594-7. Online ahead of print.

ABSTRACT

Tackle football is the most participated youth sport in the U.S. with leagues beginning as early as age 5. Exposure to cumulative repetitive head impacts (RHI) over years of play is increasingly viewed as a major contributor to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease documented in contact sport athletes. Amid growing awareness of CTE, parents may turn to online information to guide decisions about youth tackle football participation. This cross‑sectional study examined the readability of online CTE information. Using the search term, ‘CTE,’ 68 URLs providing non‑technical information were identified after applying exclusion criteria. Online software was used to generate metrics from six widely-used readability formulas. Grade-level readability scores were categorized as ≤ Grade 8, 9-12, and ≥ 13 and summarized using descriptive statistics; distributions were compared by URL designation using chi-square tests (P < 0.05). Web page publication/revision date and presence of references were recorded. Median readability scores ranged from high school to early college with few pages meeting the recommended ≤ Grade 8 reading level for the general population. Levels were similarly high across non-commercial (.org,.gov,.edu) and commercial (.com) domains. Nearly 40% lacked clear publication or revision dates; fewer than half (47.1%) included references. Commonly accessed online CTE resources exceed recommended reading levels. This digital barrier impairs parents’ functional health literacy and capacity for informed decision-making. As research on CTE and tackle football participation evolves, there is a need for plain‑language, clearly-sourced, updated online resources tailored to this decisional context.

PMID:42418055 | DOI:10.1007/s10900-026-01594-7

Eur J Pediatr. 2026 Jul 8;185(8):559. doi: 10.1007/s00431-026-07234-5.

ABSTRACT

Over the past decade, new evidence has emerged regarding postnatal corticosteroids use in extremely preterm infants, particularly early prophylactic hydrocortisone. In France, national recommendations published in 2010 address late postnatal corticosteroids use only and do not incorporate the most evidence-based data. We aimed to provide a national overview of prescribing practices in French neonatal intensive care units (NICUs), focusing on prophylactic hydrocortisone. A national survey was conducted between 1 June and 13 August 2024 among all 66 French level III NICUs using a structured online questionnaire. One response per center was gathered. Fifty-five of 66 (83%) NICUs responded. Prophylactic hydrocortisone was used in 33 (60%) centers: 16 (29%) systematically and 17 (31%) selectively. Among users, 21 (64%) targeted the same population as the PREMILOC study. Non-users cited concerns about benefit-risk balance, lack of evidence, and absence of national guidelines. Fear of neurodevelopmental risk was more frequent among non-users (9/22 (41%) vs 1/33 (3%), p < 0.001), while perceived spontaneous intestinal perforation risk did not differ.

CONCLUSION: Hydrocortisone use in French NICUs remain heterogeneous due to safety concerns and a possible uncertainty about the strength of evidence. These findings underscore the need for updated national guidelines to support harmonized, evidence-based care for ELGANs.

WHAT IS KNOWN: • Recent evidence supports prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia in extremely preterm infants. • French national recommendations (2010) address late corticosteroid use (beyond 3 weeks) and do not incorporate recent evidence-based data.

WHAT IS NEW: • This national survey provides the first overview of hydrocortisone use in French NICUs, highlighting heterogeneity in prescribing practices. • It identifies discrepancies between evidence and clinical practice, supporting the need for updated guidelines.

PMID:42418052 | DOI:10.1007/s00431-026-07234-5

Eurasian J Med. 2026 Jun 30;58(4):1-5. doi: 10.5152/eurasianjmed.2026.261486.

ABSTRACT

BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency with a highly variable clinical course. Hyperbaric oxygen therapy (HBOT) has been widely used as an adjunctive treatment; however, its efficacy and determinants of treatment response remain incompletely defined. The aim of this study was to evaluate hearing outcomes in patients receiving HBOT and to assess the association between treatmentrelated factors and audiometric recovery.

METHODS: This retrospective study included 65 patients with idiopathic SSNHL. Pure tone audiometry thresholds were evaluated at baseline, post-treatment, and long-term follow-up when available. Changes were analyzed with the Wilcoxon signed-rank and Friedman tests, and correlations with recovery were assessed using Spearman’s analysis.

RESULTS: Complete pre- and post-treatment data were available for 65 patients. A statistically significant improvement in hearing thresholds was observed, decreasing from 41.7 ± 21.9 dB at baseline to 31.9 ± 22.1 dB following HBOT (P < .001). Among 19 patients with long-term follow-up, hearing thresholds further improved to 25.9 ± 17.3 dB. A significant difference was observed between baseline and long-term measurements (P = 0.006), although the overall comparison did not reach statistical significance (P = .209). No significant correlations were identified between hearing improvement and the number of HBOT sessions (r = 0.11, P = .387) or treatment delay (r = -0.06, P = .658). Etiological factors observed in the study population included upper respiratory infection (n = 30), acoustic barotrauma (n = 2), trauma (n = 1), and cases with no identifiable cause (n = 32). When analyzed according to etiology, no statistically significant difference in hearing threshold improvement was observed between groups (Kruskal-Wallis test, P = .151).

CONCLUSION: HBOT demonstrated a positive effect on hearing thresholds in patients with SSNHL, with the observed audiological improvements appearing to be sustained at long-term follow-up Cite this article as: Kuduban O, Özkan R. Shortand long-term hearing outcomes after hyperbaric oxygen therapy in idiopathic sudden sensorineural hearing loss. 2026, 58(4), 1486, doi: 10.5152/ eurasianjmed.2026.261486.

PMID:42417092 | DOI:10.5152/eurasianjmed.2026.261486

Epilepsia. 2026 Jul 8. doi: 10.1002/epi.70378. Online ahead of print.

ABSTRACT

OBJECTIVE: Cerebral cavernous malformations (CCMs) are vascular anomalies frequently associated with drug-resistant epilepsy. Surgical resection is a well-established treatment; however, the optimal strategy to achieve long-term seizure freedom (SF) remains unclear. Intraoperative electrocorticography (ECoG) may enhance seizure outcome by guiding resection extent, yet comparative evidence is limited. To evaluate the efficacy of ECoG-guided resection in patients with CCMs, a single-center comparative retrospective cohort analysis and a meta-analysis were performed.

METHODS: We analyzed 67 adult patients with CCMs who underwent resective surgery with or without ECoG guidance at our institution. The primary outcome of interest was SF. Statistical analysis included univariate analysis, Kaplan-Meier and receiver operating characteristic curves, and uni- and multivariate logistic regression. Additionally, we searched databases to identify studies reporting SF outcomes in patients with CCM-related epilepsy who underwent ECoG-guided surgery. A random-effects model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: Seventeen patients underwent ECoG-tailored resection, and 50 underwent standard microsurgical lesionectomy (non-ECoG). SF rates were higher in the ECoG group at 24-, 30-, and 36-month follow-up (p < .05), although the ECoG group also displayed greater resection volumes (p < .01). After excluding temporal lobectomies, improved seizure outcomes remained significant only in extratemporal ECoG-guided lesionectomies (p < .05). On univariate analysis, ECoG use and postsurgical antiseizure medication were significant predictors of SF. Meta-analysis of seven studies, including our cohort, comprised 241 patients (130 ECoG, and 111 non-ECoG) and demonstrated better seizure outcomes with ECoG-guided resection compared to lesionectomy alone (OR = 6.01, 95% CI = 3.03-11.92, p < .001).

SIGNIFICANCE: ECoG-guided resection is associated with better long-term SF in patients with CCM-related epilepsy. Our evidence shows that ECoG may be a useful adjunct in cases of CCM-related epilepsy surgery, particularly in extratemporal lesions.

PMID:42417083 | DOI:10.1002/epi.70378

J Am Heart Assoc. 2026 Jul 8:e047762. doi: 10.1161/JAHA.125.047762. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer (BC) and atrial fibrillation (AF) represent increasing global health burdens with shared risk factors. However, their coincidence burden and global distribution among older women (≥55 years) remain unclear.

METHODS: This study integrated data from the Global Burden of Disease 2021 database spanning 204 countries and territories, covering incidence rates of BC and AF and exposure rates of 58 risk factors. Using a 4-quartile classification algorithm, we divided the globe into 3 regions (consistent, BC-dominant, and AF-dominant area). Risk factors were screened by using machine learning models (random forest, spatial statistics, and SHAP interpretability framework). Population-attributable fraction and a composite risk index model were generated to evaluate disease burdens and spatial risk localization of BC and AF.

RESULTS: The consistent area (80 countries, 39.60%) exhibited overlapping BC-AF incidence, while BC-dominant (65 countries, 32.18%) and AF-dominant (57 countries, 28.22%) regions highlighted geographic disparities. After screening of machine learning models, 2 shared factors (smoking and alcohol use) and 2 BC-specific factors (high body mass index and low physical activity) were included in the calculation of population-attributable fraction, potentially reducing global BC and AF incidence by 29.05% and 11.75% after shifting these factors to theoretical minimum exposure levels. For most factors, high-risk zones clustered in North and South America, Europe, and Oceania mainly correlate with dietary and lifestyle patterns.

CONCLUSIONS: The spatial coincidence of BC and AF present a significant global health challenge. Addressing both shared and region-specific risk factors can substantially reduce the dual burden of these diseases.

PMID:42417071 | DOI:10.1161/JAHA.125.047762

Clin Teach. 2026 Aug;23(4):e70476. doi: 10.1111/tct.70476.

ABSTRACT

BACKGROUND: Spiritual care has been shown to be an important component of holistic patient care. However, students have reported it missing from current Australian medical school curricula. The aim of this study was to evaluate the impact of a three-hour spiritual care workshop designed to enable final year medical students to take a spiritual history from their patients.

METHODS: We used a prospective pilot study design to evaluate a novel half-day workshop designed to equip final year medical students to assess the spiritual wellbeing of their patients. The impact of the spiritual care workshop was evaluated using video analysis of a formative objective structured clinical examination (OSCE) of a spiritual consultation using a standardised patient prior to and after the teaching episode. Students self-assessed confidence scales pre- and post-workshop. Student characteristics that might facilitate learning in this domain were assessed.

RESULTS: Thirty-two final year medical students from four universities participated at two training sites. Video analysis by four independent assessors showed satisfactory inter-rater reliability and demonstrated a statistically significant increase (p < 0.001) in the use of spirituality questions. The students’ self-assessed confidence scales pre- and post-workshop demonstrated statistically significant increases in assessing all domains except empathic responsiveness; the greatest improvement was in the spiritual domain.

CONCLUSION: Whilst this study was confined to medical students, we believe that the objective and subjective effectiveness demonstrated in this spiritual care workshop will be readily translatable into multidisciplinary holistic communication skills training.

PMID:42417069 | DOI:10.1111/tct.70476

Stroke. 2026 Jul 8. doi: 10.1161/STROKEAHA.125.054810. Online ahead of print.

ABSTRACT

BACKGROUND: Changes in ischemic white matter hyperintensity (WMH) volume on magnetic resonance imaging over time are associated with cognitive decline. We investigated whether changes in WMH volume over time exhibit threshold effects of normalized WMH volume on declining cognitive performance and whether these effects on cognition differ between deep WMHs (DWMHs) and periventricular WMHs (PVWMHs).

METHODS: We followed 339 participants longitudinally from GeneSTAR (Genetic Study of Atherosclerosis Risk) with brain magnetic resonance imaging and neuropsychological testing at baseline (2009-2013) and at 13-year follow-up (2023 to present; 62% female, and 33% Black; mean baseline age, 49.7±9.6 years). WMHs were classified as PVWMH (within 2 mm of ventricles) or DWMH. Two-segment linear spline regression models using adjusted mixed linear regression identified test-specific thresholds longitudinally beyond which cognitive decline accelerated. Cognitive scores from both timepoints were treated as repeated measures, with WMH included as a time-varying predictor.

RESULTS: Declines in motor function and processing speed accelerated beyond thresholds of changing PVWMH and DWMH volumes. For Grooved Pegboard tests, changes in volume were associated with minimal effects below a threshold of changing volume (log-transformed ratio of lesion volume to intracranial volume for PVWMH from -9.42 to -9.29 and DWMH from -11.8 to -11.7). Substantial declines in cognitive performance were observed above thresholds of increases in volume (slope differences: PVWMH: 14.5-15.1 seconds per log-unit; P<0.001; and DWMH: 9.54-10.9; P<0.001). The digit symbol substitution test demonstrated paradoxical positive associations below changing volume thresholds (PVWMH: β=6.68; P=0.001; and DWMH: β=6.98; P<0.001), reversing to decline above thresholds of increase in volume for PVWMH (Δβ=-11.2; P<0.001) and DWMH (Δβ=-9.77; P<0.001).

CONCLUSIONS: Changes in WMH volume exhibit nonlinear threshold effects on changes in cognitive performance over time and differ by anatomic region. Minimal cognitive impact occurred below thresholds, with accelerated declines above. PVWMHs demonstrate larger effects on declining cognitive function than DWMH, particularly for motor and processing speed functions, and progress at a faster rate.

PMID:42417040 | DOI:10.1161/STROKEAHA.125.054810

J Womens Health (Larchmt). 2026 Jul 8:15409996261467343. doi: 10.1177/15409996261467343. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: What is the current lifetime prevalence of infertility in the U.S., and how do U.S. adults view access to in vitro fertilization (IVF) and state-mandated insurance coverage?

DESIGN: Cross-sectional data were analyzed from a nationally weighted online survey of 1,000 U.S. adults in November 2024. Survey-weighted descriptive statistics estimated lifetime infertility prevalence and support for the right to access IVF and for state-mandated IVF insurance coverage. Survey-adjusted chi-square tests assessed differences in support across sociodemographic groups.

RESULTS: The sample included adults aged 18-87 years (median age 51 years). Lifetime infertility prevalence was 8.9% (95% CI: 7.2-11.0). Most respondents supported IVF access for infertility patients (74.2%; 95% CI: 70.9-77.2), and approximately two-thirds supported state-mandated IVF insurance coverage (64.6%; 95% CI: 61.2-67.7). Support for IVF access varied significantly by age (p = 0.04), education (p < 0.01), income (p < 0.01), race/ethnicity (p = 0.01), political leaning (p < 0.01), and infertility experience (p < 0.01). Lower support was observed among adults ages 18-29 and 30-49, those with lower income or educational attainment, Black respondents, Independents/Independent-leaning respondents, and individuals without personal or secondhand infertility experience. Support for state-mandated IVF insurance coverage varied by education (p < 0.01), income (p < 0.01), political leaning (p < 0.01), and infertility experience (p < 0.01), with the lowest support among respondents with lower income or education, Republican/Republican-leaning respondents, and those without infertility experience.

CONCLUSIONS: Approximately 1 in 11 U.S. adults has experienced infertility. Although support varied across demographic and political groups, most Americans support IVF access and insurance mandates.

PMID:42417028 | DOI:10.1177/15409996261467343

Womens Health (Lond). 2026 Jan-Dec;22:17455057261467280. doi: 10.1177/17455057261467280. Epub 2026 Jul 8.

ABSTRACT

BackgroundDepression is a widespread mental health disorder that disproportionately affects women of reproductive age due to a combination of biological, social, and environmental factors. It significantly impacts productivity, increases morbidity and disability, and poses challenges to the global economy. In Bangladesh, there have been few studies addressing this issue using modern analytical methods, despite its importance for public health.ObjectivesThe study aims to develop the best predictive model for depression risk factor analysis and to assess the PHQ-9 scale.DesignThis study extracted data from the cross-sectional survey.MethodsWe utilized data from the BDHS 2022, which gathered information on depression using the Patient Health Questionnaire (PHQ-9). The study included 13,113 ever-married women aged 15-49 years. To develop the predictive model, several machine learning algorithms were used. The performance of each model was assessed using metrics such as accuracy, precision, recall, and specificity. SHapley Additive exPlanations (SHAP) analysis was conducted to interpret and rank each feature’s contribution to the model’s output.ResultsApproximately 4.54% of women experienced moderate to severe depression. The Boruta algorithm identified 21 significant risk factors from a total of 25 variables, spanning demographic, socioeconomic, household, and reproductive domains, for predicting depressive symptoms. The Random Forest (RF) and Decision Tree models showed good performance across different performance metrics, achieving sensitivity of (0.068, 95% CI:0.064-0.072) and (0.409, 95% CI:0.395-0.423), specificity of (0.946, 95% CI:0.945-0.948) and (0.640, 95% CI: 0.629-0.651), and accuracy of (0.906, 95% CI:0.905-0.907), and (0.630, 95% CI:0.620-0.641). Whereas, boosting models also showed comparable performance. SHAP analysis revealed that household size, number of children under 5 in the household, and number of women in the household were the most influential predictors.ConclusionThe study demonstrated the effectiveness of the RF and decision tree model in detecting depression among Bangladeshi women, proving to be a valuable tool for identifying and predicting risk factors related to women’s mental health. The findings indicate that combining machine learning with the PHQ-9 would help screen for depressive symptoms in large-scale public health settings while accounting for different covariate effects.

PMID:42417027 | DOI:10.1177/17455057261467280

NeuroRehabilitation. 2026 Jul 8:10538135261426535. doi: 10.1177/10538135261426535. Online ahead of print.

ABSTRACT

ObjectivesTraumatic brain injury (TBI) is a leading cause of long-term disability. This study aimed to evaluate the effectiveness of a Post-Acute Care (PAC) program for patients with TBI in Taiwan and to identify the independent predictors associated with the magnitude of their functional recovery.MethodsThis retrospective cohort study included 168 patients with TBI admitted to a PAC program from a tertiary medical center. The primary outcome was the change score in the Barthel Index (BI)(ADL). The Wilcoxon Signed-Rank Test was used to assess changes in functional scores (BI(ADL), IADL, and EQ-5D) from admission to discharge.ResultsPatients demonstrated statistically significant improvements across all functional measures after the PAC intervention, including the BI(ADL), IADL, and EQ-5D (all p < .001). After adjusting for all covariates, length of stay was the sole significant independent predictor of the BI(ADL) change score (B = 0.309, p < .001), indicating that for each additional day of PAC, a patient’s BI score was expected to improve by 0.309 points.ConclusionPost-Acute Care is a highly effective intervention for improving functional outcomes in patients with TBI. These findings provide a strong evidence base for clinicians to advocate for sufficient rehabilitation time and for policymakers.

PMID:42417023 | DOI:10.1177/10538135261426535