Nevin Manimala

J Med Internet Res. 2026 Jun 15;28:e95562. doi: 10.2196/95562.

ABSTRACT

BACKGROUND: Refugees frequently face language and access barriers to preventive oral health information. Brief multilingual digital interventions may help reduce such barriers in shelter settings.

OBJECTIVE: This randomized controlled trial evaluated whether a multilingual digital microlearning video improved plaque control and selected self-reported oral health-related behaviors among adults living in refugee shelters.

METHODS: A 2-arm, parallel-group randomized controlled trial was conducted among 86 adults living in 2 municipal refugee shelters in Germany. Participants were randomized (1:1) to receive either a multilingual 4-minute oral hygiene microlearning video or delayed access (control group). Plaque index and gingival index were assessed clinically at baseline and at 2-month follow-up. Secondary outcomes included questionnaire-based measures of oral health literacy-related cognitions and self-reported oral health behaviors. Between-group differences in change scores were analyzed using 2-sided tests; exploratory multivariable regression analyses were conducted to assess potential effect modifiers.

RESULTS: Follow-up was completed by 83 (97%) of 86 participants. Plaque index decreased more in the intervention group than in the control group (mean change -0.21, SD 0.27 vs mean change -0.04, SD 0.17; P=.002). Gingival index decreased in both groups, but the between-group difference was not significant. Among questionnaire-based outcomes, toothbrushing frequency increased substantially, whereas the remaining oral health literacy-related items showed small numerical changes that did not reach statistical significance or remained stable. Approximately three-quarters of participants in the intervention group (32/42, 76%) reported reviewing the video at least once.

CONCLUSIONS: Brief multilingual digital microlearning improved plaque control and self-reported toothbrushing frequency in refugee shelters. Effects on broader oral health literacy-related outcomes were limited and should be interpreted cautiously. Larger, prospectively powered trials with longer follow-up periods and blinded outcome assessment are warranted.

PMID:42296536 | DOI:10.2196/95562

JMIR Res Protoc. 2026 Jun 15;15:e88001. doi: 10.2196/88001.

ABSTRACT

BACKGROUND: As the first peoples of Australia, Aboriginal and Torres Strait Islander peoples have continuing cultures that are essential to wellbeing. Complex sociocultural, health, and wellbeing inequities stemming from colonization, settler-colonialism, and mental health system challenges have led to high rates of negative mental health and wellbeing for Aboriginal and Torres Strait Islander peoples. Improving Aboriginal and Torres Strait Islander mental health and wellbeing outcomes is a national public health priority. Social and emotional wellbeing (SEWB) and the cultural determinants of health (CDH) provide evidence-based approaches for providing culturally centered wellbeing support. There is a need to increase the availability, accessibility, and effectiveness of culturally relevant, holistic, and strengths-based wellbeing supports. It is essential that Aboriginal communities have self-determined opportunities to develop and implement culturally centered wellbeing supports informed by SEWB and the CDH. Aboriginal digital health and wellbeing support research is an emerging field offering potential to help improve wellbeing outcomes. This study aims to explore how virtual reality (VR) could be used to provide SEWB and CDH support for Aboriginal and Torres Strait Islander peoples.

OBJECTIVE: This study protocol outlines a 3-phase mixed-methods approach that will inform the co-design and codevelopment of a VR application that aims to provide SEWB and CDH support. In partnership with Tribal Warrior, an Aboriginal Community Controlled Organization, Studio Gilay, an Aboriginal-led animation and storytelling studio, and Phoria, an Australian immersive storytelling technology company, this study will assess cultural relevance, acceptability, and feasibility of the VR application.

METHODS: Using Indigenist and Participatory Action Research methodologies, purposive sampling will be used to recruit 35 Tribal Warrior staff and Aboriginal community members to participate in each phase of research. Qualitative data collection will occur in each phase through yarning circles. Reflexive thematic analysis will guide qualitative analysis. Phase 3 will involve a quantitative survey, generating cultural relevance, acceptability, and feasibility evidence. Descriptive statistics analysis will be used to report results.

RESULTS: As of April 2026, data collection and analysis for phases 1 and 2 are complete. This study will culminate in the development and assessment of a co-designed and codeveloped VR application that aims to provide SEWB and CDH support for Aboriginal peoples. Findings from each phase will be published in academic papers and nonacademic outputs. The VR application will be implemented by Tribal Warrior into existing community programs and supports.

CONCLUSIONS: Findings from this study have potential implications for improving availability and accessibility to culturally centered wellbeing supports for Aboriginal and Torres Strait Islander peoples. Assessing the cultural relevance, acceptability, and feasibility of using VR technology to provide culturally centered wellbeing support will contribute novel evidence to the fields of public health, digital health, and design-based research.

PMID:42296535 | DOI:10.2196/88001

JMIR Med Inform. 2026 Jun 15;14:e85255. doi: 10.2196/85255.

ABSTRACT

BACKGROUND: Laboratory testing is a cornerstone of diagnostic decision-making in emergency departments (EDs), yet its overuse contributes substantially to unnecessary health care costs and inefficiencies. Predictive approaches that leverage electronic health record data may help optimize and guide more appropriate test use.

OBJECTIVE: This study aims to develop and evaluate machine learning models that predict laboratory test use during ED visits by integrating structured clinical data and unstructured text from electronic health records.

METHODS: We analyzed 13,115 adult ED visits from the 2021 National Hospital Ambulatory Medical Care Survey-Emergency Department dataset. Structured predictors included demographics, vital signs, insurance status, and medical history, while unstructured data from chief complaints and injury descriptions were encoded using Bidirectional Encoder Representations from Transformers-based embeddings. Four model configurations were developed: structured-only, unstructured-only, combined structured and unstructured data, and an ensemble (mean probability) approach. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS: The combined model achieved the highest predictive performance (AUC=0.83), outperforming both the structured-only model (AUC=0.78) and the unstructured-only model (AUC=0.74). The ensemble model also performed well but did not exceed the combined model. Key predictors of laboratory testing included older age, ambulance arrival, abnormal vital signs, and chronic comorbidities, whereas injury-related visits were associated with a lower likelihood of testing.

CONCLUSIONS: Integrating structured and unstructured electronic health record data improves the prediction of laboratory test use in ED settings. These findings support the development of data-driven clinical decision support tools aimed at enhancing diagnostic efficiency and reducing unnecessary testing.

PMID:42296534 | DOI:10.2196/85255

J Med Internet Res. 2026 Jun 15;28:e82996. doi: 10.2196/82996.

ABSTRACT

BACKGROUND: Online health communities (OHCs) have emerged as critical platforms for patients with type 1 diabetes (T1D) to exchange informational and emotional support. However, how stakeholder roles and disease duration jointly shape support dynamics and influence formation remains underexplored.

OBJECTIVE: This study aimed to examine network-based social support mechanisms in a large T1D OHC, focusing on how stakeholder diversity and disease duration are associated with social support behaviors, subnetwork structures, and user influence.

METHODS: This retrospective observational study analyzed digital trace data from China’s largest T1D online community (January 1-May 20, 2024), comprising 43,788 posts and 145,423 comments contributed by 1393 users. We manually annotated 2000 randomly sampled posts and fine-tuned a GPT-4o-mini (OpenAI) to classify support type (informational or emotional, and seeking or providing), yielding 20,384 support-related posts and 56,953 comments from 1224 users. We constructed weighted directed informational and emotional interaction networks and modeled predictors of a composite influence metric (Relative Centrality) using a gamma log-link generalized linear model (including demographics, identity, sentiment, disease duration, posting orientation, and cyclical activity time). Analyses were conducted in Python (version 3.11; Python Software Foundation). Statistical significance was set at P<.05.

RESULTS: Support predominantly flowed from longer-duration members (≥ y) to those at earlier stages (≤5 y). Both subnetworks exhibited multicentered, star-like structures; the informational subnetwork had broader participation (density 0.031, diameter 7), while the emotional network was denser (density 0.039, diameter 6). In the influence model, peer supporters had substantially higher influence than patients (exp(β)=34.79, 95% CI 18.94-64.08; P<.001), professionals lower (exp(β)=0.41, 95% CI 0.17-0.99; P=.055), and women higher than men (exp(β)=1.65, 95% CI 1.23-2.23; P=.001). Positive sentiment was associated with higher influence (exp(β)=1.91, 95% CI 1.22-2.97; P=.005), and negative lower (exp(β)=0.54, 95% CI 0.37-0.79; P=.001). Influence followed an inverted U-shaped trajectory over disease duration, peaking at approximately the 116th month (95% CI 43.25-188.91).

CONCLUSIONS: This study suggests that social support patterns and user influence in a T1D OHC vary by stakeholder role and disease duration. Users with shorter disease duration more often sought support, whereas longer-duration users more often provided support, and informational and emotional exchanges formed distinct interaction subnetworks. Peer supporters were the most influential users; influence was also associated with gender, sentiment, activity timing, and a nonlinear (inverted U-shaped) relationship with disease duration. These findings may inform peer-facilitated, stage-tailored community strategies, with professionals engaged in targeted, complementary roles. A patient-centered collaborative care approach integrating peer experience with multidisciplinary clinical input could be explored in future work.

PMID:42296532 | DOI:10.2196/82996

J Aging Health. 2026 Jun 15:8982643261446020. doi: 10.1177/08982643261446020. Online ahead of print.

ABSTRACT

ObjectivesThis study examined the influence of hearing status and loneliness on verbal fluency trajectories in adults aged 60 years and older, assessing their contributions to baseline performance and longitudinal change over time.MethodsData were drawn from 4,929 participants in the Health and Retirement Study (HRS) with objective hearing assessment in 2018 and three waves of semantic verbal fluency and loneliness measured in 2018, 2020, and 2022. Latent growth curve models were estimated to examine longitudinal change.ResultsVerbal fluency showed a small but statistically significant increase over time, whereas loneliness showed a slight decrease over time. Worse hearing status predicted lower baseline verbal fluency and higher baseline loneliness. The association between hearing status and longitudinal change in verbal fluency was observed in partially adjusted models but was attenuated and did not reach statistical significance after full covariate adjustment.DiscussionThese findings support an association between hearing status and baseline levels of verbal fluency and loneliness, while evidence for longitudinal change in verbal fluency was limited to partially adjusted models.

PMID:42296508 | DOI:10.1177/08982643261446020

Am J Phys Med Rehabil. 2026 Jun 11. doi: 10.1097/PHM.0000000000003064. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of an individualized multidisciplinary rehabilitation program for treating individuals with persistent post-concussive symptoms (PPCS), and identify initial symptoms which predict overall symptom burden after rehabilitation.

DESIGN: This retrospective cohort study employed routine assessment data from the Epworth HealthCare Rehabilitation Concussion Clinic. Patients with PPCS (n=528) participated in an individualized outpatient rehabilitation program, and self-reported symptoms and activity levels (using the Oregon Post-Concussion Symptom Checklist) on clinic admission and discharge. Summed checklist scores produced four subscale scores (physical, thinking, emotional and sleep) and a total score.

RESULTS: On Clinic admission, patients self-reported a mean of 10.9 symptoms (SD: 6.0). Fatigue, cognitive impairments and headache were common. There was a statistically significant mean decrease in checklist scores (symptom burden) after rehabilitation (P=<0.001). Patients’ mean daily activity levels also significantly increased between clinic admission (43.1%) and discharge (73.9%) (mean difference: 30.8%, 95% CI: 28.2-33.5, P=<.001). A subset of somatic and vestibular-ocular symptoms cumulatively predicted 31.1% of the total variance in symptom burden on clinic discharge.

CONCLUSION: This study suggested that a multidisciplinary rehabilitation model was effective for treating PPCS. A focus should be on early, tailored intervention to moderate the initial symptom burden and improve patient prognosis.

PMID:42296468 | DOI:10.1097/PHM.0000000000003064

QJM. 2026 Jun 15:hcag157. doi: 10.1093/qjmed/hcag157. Online ahead of print.

NO ABSTRACT

PMID:42295867 | DOI:10.1093/qjmed/hcag157

Physiol Int. 2026 Jun 15:2060.2026.00920. doi: 10.1556/2060.2026.00920. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate circulating levels of heat shock protein 27 (HSPB1, Hsp27), heat shock protein 60 (HSPD1, Hsp60) and heat shock protein 90 (HSPC1, Hsp90) in a large cohort of healthy non-pregnant and pregnant women, as well as in patients with preeclampsia. In addition, we investigated whether serum levels of these heat shock proteins are associated with clinical characteristics and routine laboratory parameters of the study population.

METHODS: The study included 60 women with preeclampsia, 60 healthy pregnant women with uncomplicated pregnancies and 59 healthy non-pregnant controls. Serum concentrations of Hsp27, Hsp60 and Hsp90 were measured with ELISA. Standard clinical chemistry parameters were assessed on an automated analyzer. Statistical analyses were performed using nonparametric methods.

RESULTS: Serum levels of Hsp27, Hsp60 and Hsp90 were significantly higher in healthy pregnant women compared with healthy non-pregnant controls. Moreover, preeclamptic patients exhibited significantly elevated levels of all three heat shock proteins compared with both control groups. In the preeclamptic group, serum Hsp27 levels showed significant positive correlations with serum bilirubin and lactate dehydrogenase activity. Hsp60 levels were positively correlated with blood urea nitrogen, creatinine, aspartate aminotransferase activity and lactate dehydrogenase activity. Hsp90 levels showed a significant positive correlation with aspartate aminotransferase activity.

CONCLUSIONS: Moderately increased circulating levels of Hsp27, Hsp60 and Hsp90 in otherwise healthy pregnancies may reflect adaptive physiological responses. In contrast, markedly elevated levels observed in preeclampsia may be associated with placental ischemia and oxidative stress, as well as maternal systemic inflammation, endothelial dysfunction, and tissue injury in both placental and maternal organs.

PMID:42295854 | DOI:10.1556/2060.2026.00920

JAMA Intern Med. 2026 Jun 15. doi: 10.1001/jamainternmed.2026.1929. Online ahead of print.

ABSTRACT

IMPORTANCE: COVID-19 vaccines were previously shown to reduce risk of major adverse cardiovascular events (MACEs). Whether the 2024-2025 COVID-19 vaccine continues to reduce COVID-19-associated MACEs in the context of evolving variants and widespread population immunity is unknown.

OBJECTIVE: To determine whether the 2024-2025 COVID-19 vaccine is associated with reduced risk of COVID-19-associated MACE.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a target-trial emulation using US Department of Veterans Affairs (VA) electronic health records. Participants were veterans with vaccination encounters between September 3, 2024, and December 31, 2024.

EXPOSURES: Same-day coadministration of the 2024-2025 COVID-19 and influenza vaccines vs influenza vaccine alone.

MAIN OUTCOMES AND MEASURES: Composite end point of COVID-19-associated MACE, defined as COVID-19-associated cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. Secondary outcomes included all-cause MACE, hospitalization, and death. Vaccine effectiveness (VE), calculated as 1 minus the risk ratio, and risk difference were estimated at 8 months using inverse probability weighting.

RESULTS: Among 1 039 659 participants who received influenza vaccine (mean [SD] age, 70.1 [12.4] years; 954 341 [91.8%] men), 349 085 received COVID-19 vaccine and 690 574 did not. At 8 months, the COVID-19 vaccine was associated with lower risk of COVID-19-associated MACE (VE, 37.7% [95% CI, 18.2%-54.9%]; risk difference per 10 000 persons, 2.0 [95% CI, 0.9-3.7]). VE for COVID-19-associated MACE was statistically significant only in individuals older than 75 years (VE, 50.7% [95% CI, 31.8%-65.6%]), a group that also experienced the largest absolute risk reduction (5.5 fewer events per 10 000 individuals). No statistically significant vaccine effectiveness was observed among those younger than 65 years or aged 65 to 75 years. While VE for COVID-19-associated MACE on the relative scale was statistically significant across subgroups of participants with and without comorbid health conditions, the absolute benefit was consistently and substantially greater for individuals with the comorbid health condition. Secondary analyses of all-cause MACE, all-cause hospitalization, and all-cause death suggested substantially larger absolute risk reductions (risk difference for all-cause MACE, 23.7 [95% CI, 14.1 to 34.7]).

CONCLUSIONS AND RELEVANCE: In this cohort study, receipt of the 2024-2025 COVID-19 vaccine was associated with reduced risk of COVID-19-associated MACE, with reductions most prominent in those 75 years or older and those with comorbidities. While the reduction in COVID-19-associated MACE was modest, the substantially larger reduction in all-cause MACE suggests that the vaccine’s protective association extends to the hidden burden of undetected SARS-CoV-2 and its sequelae.

PMID:42295793 | DOI:10.1001/jamainternmed.2026.1929

JAMA Neurol. 2026 Jun 15. doi: 10.1001/jamaneurol.2026.1542. Online ahead of print.

ABSTRACT

IMPORTANCE: Middle meningeal artery embolization (MMAE) is a minimally invasive adjunctive treatment for chronic subdural hematoma (cSDH). The TRUFILL n-butyl cyanoacrylate (n-BCA) liquid embolic system is indicated for embolization of cerebral arteriovenous malformations for presurgical devascularization and may be appropriate for MMAE in patients with cSDH.

OBJECTIVE: To evaluate safety and effectiveness of the study device for MMAE plus standard of care vs standard of care alone in patients with cSDH.

DESIGN, SETTING, AND PARTICIPANTS: The Middle Meningeal Artery Embolization for the Treatment of Subdural Hematomas With TRUFILL n-BCA (MEMBRANE) trial was a prospective, multicenter, open-label, randomized clinical trial conducted from May 27, 2021, to February 6, 2024, at 30 hospitals (28 in the United States and 2 in China). Participants aged 18 to 90 years with symptomatic cSDH and a modified Rankin Scale score of 3 or less were enrolled.

INTERVENTIONS: Site physicians determined whether each patient required surgical or nonsurgical management. Participants in the surgical and nonsurgical cohorts were then randomized 1:1 to receive MMAE plus standard of care or standard of care alone.

MAIN OUTCOMES AND MEASURES: The primary effectiveness end point was residual or re-accumulation of hematoma (>10 mm; assessed by an independent core laboratory) at 6 months or requiring a surgical procedure on the cSDH within 6 months (conducted as an intention-to-treat analysis). The primary safety end point was incidence of adverse events through 6 months (conducted as an as-treated analysis).

RESULTS: A total of 376 participants (188 in MMAE plus standard of care and 188 in standard of care alone) were included. In the MMAE plus standard of care and standard of care alone groups, the mean (SD) age was 70.9 (10.6) and 70.3 (12.1) years, and 45 (23.9%) and 49 (26.1%) were female, respectively. Primary effectiveness end point events occurred in 17 of 146 participants receiving MMAE plus standard of care (11.6%) and 29 of 131 receiving standard of care alone (22.1%) (final estimate of common odds ratio: 0.53 [90% CI, 0.31-0.91]; P = .04), indicating statistically significant benefit for MMAE plus standard of care vs standard of care alone. Adverse events occurred in 130 of 181 participants in the MMAE plus standard of care group (71.8%) and 124 of 190 in the standard of care alone group (65.3%) through 6 months. MMAE plus standard of care treatment was noninferior to standard of care alone based on analysis of good functional outcome at 3 months, as assessed by the modified Rankin Scale.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, MMAE plus standard of care significantly reduced rates of recurrence and reoperation vs standard of care alone, without a significant increase in adverse events.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT04816591.

PMID:42295790 | DOI:10.1001/jamaneurol.2026.1542