Nevin Manimala

Angiology. 2026 May 21:33197261453467. doi: 10.1177/00033197261453467. Online ahead of print.

ABSTRACT

Continuous-flow left ventricular assist devices (CF-LVADs) are central to advanced heart failure management but are complicated by right ventricular failure (RVF) in up to 40% of patients, increasing morbidity and mortality and underscoring the need for robust prediction tools. We performed a single-center retrospective study of CF-LVAD recipients from March 2009 to May 2024. Of 326 patients, 205 met inclusion criteria; RVF was defined as need for inotropes or right ventricular assist device support. We compared established RVF risk scores (Michigan, Penn/Fitzpatrick, European Registry for Patients with Mechanical Circulatory Support [EUROMACS], Central venous pressure, severe Right ventricular dysfunction, preoperative Intubation, severe Tricuspid regurgitation, Tachycardia [CRITT]) using receiver operating characteristic analysis, logistic regression, and internal validation. Among 205 patients, 81 (39.5%) developed post-LVAD RVF. The EUROMACS score had the highest predictive value (C-statistic 0.670, P < .001), followed by CRITT (0.653, P < .001), Penn (0.616, P = .004), and Michigan (0.606, P = .005). Youden-optimized cutoffs were derived to summarize sensitivity, specificity, positive predictive value, and negative predictive value. Mortality analysis was performed as a secondary exploratory endpoint. Overall, discrimination of existing RVF scores remained modest. EUROMACS performed best but highlighted the need to refine models with contemporary hemodynamic and echocardiographic metrics and to pursue rigorous external validation.

PMID:42165115 | DOI:10.1177/00033197261453467

Glob Health Action. 2026 Dec;19(1):2675098. doi: 10.1080/16549716.2026.2675098. Epub 2026 May 21.

ABSTRACT

BACKGROUND: Timely and consistent digital payment of health workers is crucial for improving the effectiveness of immunization campaigns and achieving the polio eradication goals by 2026. However, evidence on the enablers and barriers to digital payments in sub-Saharan Africa (SSA) is limited.

OBJECTIVE: To explore the enablers and barriers to digital payments for immunization campaign health workers in eight selected SSA countries.

METHODS: An exploratory case study using qualitative methods was conducted in eight SSA countries: four English-speaking (Uganda, Kenya, Nigeria, Ghana) and four French-speaking (Senegal, Ivory Coast, Cameroon, Democratic Republic of the Congo). A scoping review and in-depth interviews were conducted between March and May 2022 in each country. Data were analyzed thematically.

RESULTS: Digital payments are rapidly expanding in SSA, including during large-scale immunization campaigns. Key enablers included supportive regulatory frameworks, increasing mobile phone and digital platform coverage, and the benefits of digital payments. Barriers included inadequate telecom infrastructure, cybercrime, challenges with customer registration, higher transaction costs, and payment delays.

CONCLUSION: This study identifies key enablers of digital payments in eight SSA countries, including supportive regulations, growing mobile phone ownership, and expanding digital platforms. Persistent challenges – such as limited infrastructure, verification constraints, and payment delays – affect implementation. Findings, while context-specific, offer valuable insights for policymakers to strengthen digital payment systems, improve verification, and enhance coordination to optimize health worker payments during immunization and public health campaigns.

PMID:42165113 | DOI:10.1080/16549716.2026.2675098

Glob Health Action. 2026 Dec;19(1):2675808. doi: 10.1080/16549716.2026.2675808. Epub 2026 May 21.

ABSTRACT

BACKGROUND: Retention is especially critical in rural and underserved areas of East Africa, such as Turkana County in Kenya, where resource limitations, harsh conditions, and a lack of professional development opportunities deter nurses from staying. In addition, female nurses face unique challenges shaped by systemic inequities and gendered expectations, influencing their retention.

OBJECTIVE: The aim of this study was to explore factors influencing retention of female nurses in Turkana and to offer new perspectives on the concept of retention from underserved regions in East Africa.

METHODS: This quasi-ethnographic study was conducted in an arid rural setting in Turkana, in 2024. Data were collected through semi-structured interviews with 21 female nurses and 8 local health administrators and through participant observations at 4 health facilities. We used thematic network analysis guided by an abductive approach.

RESULTS: Female nurses in Turkana navigate a paradox of staff shortages alongside high unemployment, leaving many feeling stuck in occupational limbo or permanent liminality, hoping, and working toward better opportunities for themselves and their families. Although the motivation to work as nurses persists, challenging working conditions lead many to aspire to migrate abroad.

CONCLUSION: This study demonstrates the complex interplay of local and global dynamics driving retention of female nurses in Turkana. Perceived workforce stability is largely due to immobility caused by limited alternatives and systemic constraints. This immobility masks dissatisfaction, making the healthcare system in Turkana vulnerable to outmigration. Findings highlight the need for holistic, gender-sensitive policies that enhance rural career pathways for female nurses.

PMID:42165109 | DOI:10.1080/16549716.2026.2675808

Twin Res Hum Genet. 2026 May 21:1-11. doi: 10.1017/thg.2026.10063. Online ahead of print.

ABSTRACT

Hyperuricemia is a common metabolic disorder and has become a global health concern. This study investigated the association between DNA methylation (DNAm) and serum uric acid (SUA) by conducting an epigenomewide association study (EWAS) in Chinese monozygotic (MZ) twins. Genomewide DNAm of 50 MZ twin pairs was profiled using the Infinium MethylationEPIC v2.0 BeadChip (935K). Generalized estimating equations (GEE) were used to examine the association between DNAm and SUA. Causal relationships between DNAm and SUA were assessed using ICE FALCON approach. Associations between mRNA expression and SUA were further assessed. Finally, candidate genes identified through epigenomewide association study (EWAS), causal inference, and gene expression analyses were validated in a longitudinal twin study. We identified 70 CpGs, mapping to genes such as DOK6 and NGLY1, significantly associated with SUA (Bonferroni correction p < 5.8 × 10^-8). Causal analyses revealed one CpG with a causal effect of DNAm on SUA, 22 CpGs with causal effects of SUA on DNAm, and 33 CpGs showing bidirectional causality. Eleven genes displayed expression levels associated with SUA. DOK6, NGLY1, PKM, and SLC44A1 were selected as candidate genes, all of which showed unidirectional causal effect of SUA on DNAm. In the longitudinal analysis, baseline SUA levels (2012-13) were associated with subsequent DNAm levels in DOK6 and NGLY1 genes (2023-24). In conclusion, we found that SUA levels may influence DNAm variations, particularly at CpG loci within the DOK6 and NGLY1 genes. These findings provide key clues for future investigations into the mechanisms linking SUA with its epigenetic regulatory pathways.

PMID:42165100 | DOI:10.1017/thg.2026.10063

Psychol Med. 2026 May 21;56:e160. doi: 10.1017/S0033291726104541.

ABSTRACT

Prolonged grief disorder (PGD), recently classified in ICD-11 and DSM-5-TR, is characterized by persistent and functionally impairing grief lasting beyond 6-12 months. The COVID-19 pandemic was accompanied by widespread mortality, social isolation, disrupted mourning rituals, and social disconnection, raising concerns about a potentially high burden of PGD during the pandemic period. We conducted a systematic review and meta-analysis, following PRISMA guidelines and PROSPERO registration (CRD42023463720), to estimate PGD prevalence under standardized ICD-11 and DSM-5-TR diagnostic frameworks and to examine potential moderators during the COVID-19 pandemic. PubMed, EMBASE, and the Cochrane Library were searched from inception to October 2024. Eligible studies included adults who experienced bereavement during the pandemic and were assessed using validated PGD instruments (PG-13-R, ICG, BGQ). Random-effects models were applied to pool prevalence estimates, with subgroup and meta-regression analyses. Thirteen studies comprising 5,766 participants were included. The pooled prevalence of PGD during the pandemic period was 24% (95% CI: 13%-36%), with the highest estimates observed in China (43%, 95% CI: 33%-54%). In the overall pooled analysis, studies applying DSM-5-TR criteria yielded lower prevalence estimates than those using ICD-11 criteria (18% vs.26%, p = 0.41). Digital interventions showed no statistically significant pooled effects (Hedges’ g = -0.38, 95% CI: -0.90 to 0.14). The high and geographically heterogeneous prevalence of PGD observed during the COVID-19 pandemic underscores the need to strengthen mental health surveillance, standardized assessment, and service accessibility in large-scale public health emergencies, and provides important evidence to inform population-level interventions and resource allocation strategies.

PMID:42165098 | DOI:10.1017/S0033291726104541

Pediatr Obes. 2026 May;21(5):e70114. doi: 10.1111/ijpo.70114.

ABSTRACT

BACKGROUND: Antihypertensive class medications are prescribed long-term for adolescents, including for conditions other than hypertension. Evidence on weight effects is limited.

OBJECTIVE: To assess the weight effects of commonly prescribed antihypertensive class medications among adolescents, regardless of clinical indication for use.

METHODS: This retrospective study was conducted using electronic health record (EHR) data from a multi-site US research network. The study cohort included adolescents aged 13.0-19.5 years with ≥ 1 antihypertensive class medication order during 2010-2019. Weight and height documented in the EHR were used to calculate BMI z-scores. Inverse probability weighting with marginal structural models was used to account for selection factors and covariates.

RESULTS: Overall, 23 853 adolescents were prescribed an antihypertensive class medication, including clonidine (prescribed to n = 7491), guanfacine (n = 6411), lisinopril (n = 3584), propranolol (n = 3015), spironolactone (n = 1926), and atenolol (n = 1426). At baseline, 13% had a hypertension diagnosis. At 12 months after medication initiation, the estimated population-level BMI z-score was significantly increased for propranolol (BMI z-score 0.19 [95% CI 0.09, 0.29]) and significantly decreased for lisinopril (-0.06 [95% CI -0.10, -0.01]); clonidine, guanfacine, spironolactone, and atenolol were not associated with a significant change in BMI z-score.

CONCLUSIONS: Most antihypertensive class medications were not associated with statistically significant weight gain when prescribed to adolescents.

PMID:42165095 | DOI:10.1111/ijpo.70114

Pediatr Pulmonol. 2026 May;61(5):e71673. doi: 10.1002/ppul.71673.

ABSTRACT

BACKGROUND: Despite asthma being one of the most common chronic conditions among children in the United States, real-world evidence on medication adherence and healthcare utilization in underserved pediatric populations remains limited. Therefore, we aim to evaluate adherence, persistence, and asthma-related healthcare utilization among Medicaid-enrolled children receiving inhaled corticosteroids (ICS) versus ICS-long-acting beta-agonist (ICS-LABA) inhalers.

METHODS: We conducted a retrospective cohort study using Texas Children’s Health Plan claims data from 2016 to 2019. Children aged 4-17 years with asthma diagnoses and ≥1 prescription for an ICS or ICS-LABA were included. Adherence was determined as the proportion of days covered (PDC) of ≥ 50%, and persistence was defined as continuous therapy without a 60-day gap. The PDC ≥ 80% was evaluated in sensitivity analysis. Multivariable logistic regression was used to estimate adherence, asthma-related emergency department (ED) visits, and hospitalizations.

RESULTS: Among 8622 eligible children, 82.4% received ICS and 17.6% received ICS-LABA. In inverse probability of treatment weighting (IPTW) adjusted analyses, compared with ICS, ICS-LABA users had higher adherence rate i.e., 21.08% versus 16.56% achieved PDC ≥ 50% (aOR = 1.35; 95%CI: 1.25-1.45), and 10.82% versus 6.74% achieved PDC ≥ 80% (aOR = 1.61; 95%CI: 1.31-1.97). Refill persistence was also higher with ICS-LABA (36.16% vs. 23.35%, aOR: 1.86, 95%CI: 1.74-1.99). However, despite better adherence, we found ICS-LABA users exhibited greater asthma-related healthcare utilization, i.e., ED visits occurred in 18.69% versus 11.25% (aOR = 1.81; 95%CI: 1.56-2.11) and hospitalizations in 2.53% versus 1.00% (aOR= 2.55; 95%CI: 1.68-3.89), which persisted even after adjusting for adherence.

CONCLUSIONS: We found that adherence was greater in children with asthma who were dispensed an ICS-LABA as compared to those dispensed an ICS-only inhaler; however, adherence rates were low in both groups. Higher hospitalization and ED visit rates among those prescribed ICS-LABA therapy likely reflect higher disease severity in this group. Our findings should be interpreted in light of claims-based adherence measures and potential residual confounding due to unmeasured asthma severity and control.

PMID:42165090 | DOI:10.1002/ppul.71673

Nat Sci Sleep. 2026 May 15;18:591315. doi: 10.2147/NSS.S591315. eCollection 2026.

ABSTRACT

BACKGROUND: The sleep quality of Han Chinese and Tibetan firefighters at high altitude remains poorly understood. This study investigates the prevalence of sleep disturbances in these groups and whether ethnicity affects sleep quality in these two populations.

METHODS: Male firefighters were recruited from China Fire and Rescue stations at high altitude of 500 m, 2570 m, and 4509 m in Southwest China. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality, considering scores >5 as poor sleep quality. Symptoms of anxiety and depression were evaluated using the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9).

RESULTS: As altitude increased, the total PSQI scores of Han Chinese firefighters showed a non-statistically significant rise: 4 (2-5) at 500 m, 4 (3-6.75) at 2570 m, and 5 (2.75-6) at 4509 m. Poor sleep quality prevalence also rose: 23%, 31%, and 44%, respectively. In contrast, the sleep quality of Tibetan firefighters remained relatively stable and was better than that of their Han Chinese counterparts. Furthermore, the GAD-7 and PHQ-9 scores were higher in Han Chinese firefighters compared to Tibetan firefighters. The PSQI score was positively correlated with GAD-7 scores (ρ = 0.454, p < 0.001) and PHQ-9 scores (ρ = 0.380, p < 0.001) but negatively correlated with Tibetan ethnicity (ρ = -0.228, p < 0.001). Logistic regression analysis indicated that, compared to Tibetans, being Han Chinese (odds ratio [OR] = 3.050, 95% confidence interval [CI]: 1.214-7.665) and having higher GAD-7 scores (OR = 1.816, 95% CI: 1.332-2.477) were independently associated factors for poor sleep quality.

CONCLUSION: This study suggests that Han Chinese firefighters in this field sample across these stations are at greater risk of poor sleep quality than Tibetan firefighters, with elevated GAD-7 scores being a potential contributing factor for poor sleep quality.

PMID:42165074 | PMC:PMC13185950 | DOI:10.2147/NSS.S591315

MedEdPORTAL. 2026 May 19;22:11601. doi: 10.15766/mep_2374-8265.11601. eCollection 2026.

ABSTRACT

INTRODUCTION: Biochemistry is often regarded as conceptually dense yet emotionally disconnected, limiting its relevance to patient care. To bridge this gap, an art-based learning intervention was developed to connect biochemistry of diseases with empathy, perspective-taking, and ethical awareness through visual thinking strategies, structured peer role-play, and guided reflection.

METHODS: This small-group activity was conducted for 150 first-year medical students over a total duration of 180 minutes. Students were divided into 30 groups and each group received a curated artwork and a biochemical role-play case scenario. Evaluation followed Kirkpatrick’s model with a 20-item perception survey and semistructured interviews for level 1 (reaction), postsession assessment, “I used to think, now I think, now I will” reflection, and a 7-item confidence questionnaire for level 2 (learning).

RESULTS: Students reported high levels of engagement across all components, particularly appreciating visual thinking strategies and structured peer role-play. The postsession assessment score was 24.1 (SD = 3.0) out of 30 [P < .001]. Thematic analysis of documented reflections yielded 16 distinct themes representing the shift in learners’ perspectives and their growing commitment to empathic patient care.

DISCUSSION: The integration of art and role-play into early biochemistry teaching effectively supported students in linking molecular mechanism of diseases with human experiences of illness. It also encouraged thoughtful participation and facilitated emotional and ethical awareness. While the approach proved feasible and impactful within this setting, its broader implementation may depend on institutional support and faculty readiness for arts-integrated pedagogy.

PMID:42165068 | PMC:PMC13183865 | DOI:10.15766/mep_2374-8265.11601

Front Psychiatry. 2026 May 5;17:1788310. doi: 10.3389/fpsyt.2026.1788310. eCollection 2026.

ABSTRACT

OBJECTIVE: This meta-analysis evaluated the associations between noise exposure, air pollutants, and attention-deficit/hyperactivity disorder (ADHD) in children, aiming to inform future prevention strategies.

METHODS: Studies were systematically retrieved from CNKI, Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library, covering publications from inception to November 2025. Heterogeneity was assessed using Cochran’s Q test and the I² statistic. Subgroup analyses, meta-regression, and sensitivity analyses were performed to evaluate the robustness of the findings.

RESULTS: Noise exposure was associated with a small increase in ADHD risk (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01-1.05), with stronger associations for childhood exposure, whereas prenatal exposure showed no significant effect. Given the modest effect size, this finding should be interpreted cautiously. Particulate matter (PM_2.5 and PM₁₀) was significantly associated with ADHD in continuous-exposure models-PM_2.5 (OR = 1.32, 95% CI: 1.16-1.50) and PM₁₀ (OR = 1.47, 95% CI: 1.15-1.87). In dichotomous models, PM_2.5 was not significant, while PM₁₀ remained positively associated (OR = 1.58, 95% CI: 1.11-2.26). Elevated nitrogen dioxide (NO₂) exposure was also associated with a modest increase in ADHD risk (OR = 1.11, 95% CI: 1.02-1.20), whereas nitrogen oxides (NO_x), ozone (O₃), and sulfur dioxide (SO₂) did not show significant associations.

CONCLUSIONS: Noise and several air pollutants (PM_2.5, PM₁₀, and NO₂) were significantly associated with increased ADHD risk, particularly during childhood exposure. Other pollutants, including O₃ and SO₂, did not demonstrate significant effects. These findings suggest that environmental noise and several air pollutants may be associated with ADHD; however, some observed associations, particularly for noise and NO₂, were modest in magnitude and should be interpreted cautiously. These results reflect observational associations rather than evidence of a strong or causal effect, while the evidence for some pollutants remains limited or inconclusive. Further research is needed to clarify pollutant-specific associations and the role of exposure timing.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024593274, identifier CRD42024593274; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025632899, identifier CRD42025632899.

PMID:42165060 | PMC:PMC13185364 | DOI:10.3389/fpsyt.2026.1788310