Nevin Manimala

J Appl Res Intellect Disabil. 2026 Mar;39(2):e70213. doi: 10.1111/jar.70213.

ABSTRACT

BACKGROUND: The study is based on the Dual Pathway to Creativity Model and explores the relationship between inhibitory control and creativity in children with mild intellectual disabilities.

METHOD: The sample consisted of 58 children with mild intellectual disabilities. Inhibitory control, fluency, and originality were assessed using the Day-Night Stroop Test and the Alternative Uses Test.

RESULTS: Overall, participants demonstrated moderate fluency (M = 6.55, SD = 3.10), while their originality scores were lower (M = 1.44, SD = 1.32). Correlation analysis indicated that faster responses on the second part of the Stroop test were negatively associated with fluency (r = -0.30, p < 0.05), whereas the association with originality did not reach statistical significance (r = -0.24, p > 0.05).

CONCLUSIONS: Efficient inhibitory control linked to higher fluency supports the Dual Pathway to Creativity Model, emphasizing the balance between inhibition and cognitive flexibility in children with mild intellectual disabilities.

PMID:41822942 | DOI:10.1111/jar.70213

Front Public Health. 2026 Feb 25;14:1753377. doi: 10.3389/fpubh.2026.1753377. eCollection 2026.

ABSTRACT

PURPOSE: This study aimed to characterize the epidemiological features, management, and outcomes of acute poisoning among adolescents in Beijing and surrounding areas to guide targeted prevention and clinical intervention.

METHODS: A retrospective cohort study was conducted among adolescents (aged 11-18 years) admitted for acute poisoning to the emergency or pediatric department of a tertiary toxicological referral center in Beijing between January 2021 and December 2023. Data on demographics, exposure characteristics, toxic agents, treatments, and clinical outcomes were collected and analyzed.

RESULTS: Among the 915 included cases, there was a significant female predominance (72.5%). Intentional self-harm accounted for the vast majority of incidents (94.5%), with oral ingestion being the primary route (99.5%). A high prevalence of preexisting psychiatric disorders was observed (60.1%). Pharmaceutical poisoning was the most common type (78.1%), followed by pesticides (12.5%). Common interventions included gastrointestinal decontamination (55.7%), extracorporeal elimination (22.3%), and antidote administration (3.1%). While most cases resulted in favorable outcomes (98.7%), adverse outcomes occurred in 1.3% of cases and were primarily associated with herbicide exposure. Logistic regression identified younger age, prehospital interventions, preexisting neuropsychiatric disorders, pesticide exposure, multi-agent mixed exposures, industrial chemical poisoning, and intentional self-harm as significant predictors of hospitalization.

CONCLUSION: The findings underscore the critical importance of strengthening mental health support for adolescents and implementing stricter controls on the accessibility of psychotropic medications and highly toxic pesticides.

PMID:41822940 | PMC:PMC12975731 | DOI:10.3389/fpubh.2026.1753377

Front Public Health. 2026 Feb 25;14:1776878. doi: 10.3389/fpubh.2026.1776878. eCollection 2026.

ABSTRACT

BACKGROUND: Early unplanned readmission is a key quality indicator in Diagnosis-Related Groups (DRG)-based payment systems. Despite China’s rapid expansion of DRG reform, evidence on hospital-wide predictors of 30-day readmission using large-scale real-world data from tertiary hospitals remains limited. This study developed and evaluated a DRG-based logistic regression model for predicting 30-day readmission.

METHODS: We conducted a single-center retrospective study using administrative hospitalization data from a high-volume tertiary hospital in Shanghai, China. We extracted 65,215 inpatient episodes from the hospital (January 2023-December 2024). After excluding discharges in December 2024 due to incomplete follow-up (n = 3,109), 62,106 admissions were retained to estimate the overall readmission rate. For multivariable modeling, 21 additional cases with missing DRG variables were removed, yielding 62,085 complete observations. Predictors included age, length of stay, total cost, discharge year, and major DRG categories. Total hospital cost was modeled in its original unit (1 Chinese Yuan) to preserve the raw scale of administrative reporting; however, for interpretation, marginal effects per 1,000 CNY increase were also calculated. Model performance was evaluated using the area under the ROC curve (AUC), Brier score, Hosmer-Lemeshow test, and a decile-based calibration plot.

RESULTS: The 30-day readmission rate was 13.0%. In unadjusted comparisons, patients who were readmitted had shorter median hospital stays (3 vs. 4 days) and lower total costs. After multivariable adjustment, longer length of stay was associated with increased readmission risk (OR 1.016 per day, p < 0.001), while total cost showed a statistically significant but small association (p = 0.003). Age and discharge year were not significant predictors. DRG major categories had a strong overall association (global p < 0.001). The model showed moderate-to-good discrimination (AUC = 0.743) and acceptable overall accuracy (Brier score = 0.098), with visually adequate calibration despite a statistically significant Hosmer-Lemeshow test.

CONCLUSION: Using comprehensive DRG-based real-world data, we developed an interpretable prediction model for 30-day readmission with moderate-to-good discrimination and acceptable calibration. Clinical case-mix captured by DRG categories and patient-level complexity reflected by longer length of stay were key determinants of early readmission. The model may support risk stratification, quality improvement, and performance monitoring in DRG payment environments. The findings may also inform policy discussions on aligning DRG efficiency incentives with patient safety outcomes.

PMID:41822939 | PMC:PMC12975921 | DOI:10.3389/fpubh.2026.1776878

Front Public Health. 2026 Feb 25;14:1777051. doi: 10.3389/fpubh.2026.1777051. eCollection 2026.

ABSTRACT

IMPORTANCE: Global reports suggest declining sperm quality, but data from Asian populations under standardized conditions are limited. Investigating trends in China is critical for understanding modifiable factors affecting male fertility.

OBJECTIVE: To assess decade-long trends in semen quality among healthy Chinese men and evaluate associations with environmental factors. Design, Setting, and Participants: Retrospective cohort analysis of 5,886 semen samples from healthy sperm donors (aged 20-45 years) recruited between 2011 and 2018 at the Beijing Human Sperm Bank. All procedures adhered strictly to WHO 5th Edition laboratory standards. Main Outcomes and Measures: Annual trends in semen volume, sperm concentration (SC), total sperm count (TSC), progressive motility (PR), total motility (PR + NP), and percentage of progressive motility (PPR). Associations between semen parameters and environmental pollutants (SO₂, NO₂, PM10, PM2.5, waterborne PI/AN) were evaluated using Spearman correlation.

RESULTS: From 2011 to 2018, significant improvements occurred across key parameters: SC increased by 12.3% (78-96.5 × 10⁶/mL; p < 0.05 in 2013, 2018); TSC increased by 18.7% (200-283.5 × 10⁶/ejaculate; p < 0.05 from 2014 to 2017); PR and PPR also significantly improved (p < 0.05 in multiple years). Negative correlations were observed between pollutants and semen quality: SO₂, NO₂, and PM10 inversely correlated with TSC (ρ = -0.719 to -0.929; p ≤ 0.045) and PPR (ρ = -0.826 to -0.922; p ≤ 0.011). Water pollutants (PI, AN) similarly correlated with reduced semen volume, TSC, and motility (ρ = -0.735 to -0.878; p ≤ 0.038).

CONCLUSIONS AND RELEVANCE: Contrary to global declines, semen quality significantly improved among healthy Beijing donors from 2011 to 2018. This improvement coincided with aggressive environmental policies (e.g., China’s 2013-2017 Air Pollution Action Plan), suggesting pollution-related sperm damage may be reversible with targeted interventions.

PMID:41822938 | PMC:PMC12975964 | DOI:10.3389/fpubh.2026.1777051

Front Public Health. 2026 Feb 25;14:1763697. doi: 10.3389/fpubh.2026.1763697. eCollection 2026.

ABSTRACT

PURPOSE: This study aimed to examine the level of fall risk and its associations with fall awareness and social support among community-dwelling older adults with functional limitations.

METHODS: A cross-sectional study was conducted from January to October 2025. Using cluster sampling, 825 older adults with functional limitations were recruited from four communities in Chengdu, China. Fall risk was assessed using the Modified Falls Risk for Older People in the Community Assessment (MFROP-com), fall awareness was measured with the Self-awareness of Falls in Elderly Scale (SAFE), and social support was evaluated via the Social Support Rating Scale (SSRS). Data were analyzed using Pearson correlation and multiple linear regression.

RESULTS: Participants exhibited a high fall risk (mean score 26.51 ± 10.95). The regression model explained a significant proportion of variance in fall risk (Adjusted R ² = 0.536, p < 0.001). Higher fall awareness (B = -0.463, β = -0.565, p < 0.001) and greater social support (B = -0.422, β = -0.190, p < 0.001) were independent predictors of lower fall risk. Advanced age, unmarried, living alone, and having sleep disorders were associated with increased risk (p < 0.05).

CONCLUSION: Fall awareness and social support were identified as key modifiable factors associated with reduced fall risk among community-dwelling older adults with functional limitations. Fall prevention programs should focus on enhancing risk perception and strengthening social support networks for this population.

PMID:41822936 | PMC:PMC12975942 | DOI:10.3389/fpubh.2026.1763697

Front Public Health. 2026 Feb 25;14:1773690. doi: 10.3389/fpubh.2026.1773690. eCollection 2026.

ABSTRACT

Sex workers experience disproportionately high rates of depression, anxiety, PTSD, suicidality, dissociation, and substance use across global contexts. Sex work refers to the consensual exchange of sexual services, performances, or content for compensation; debates persist regarding the impact of coercion and constraint within sex work, particularly in relation to structural and economic pressures. This mini-review synthesizes research on the structural, social, and occupational determinants of sex workers’ mental health, emphasizing how legal frameworks, work venues, stigma, and interpersonal dynamics shape psychological outcomes. Sex work occurs across indoor, outdoor, and digital settings, with workers often moving fluidly between contexts; mental health risk consistently increases in criminalized environments and in settings characterized by reduced safety and autonomy. Drawing on Goffman’s stigma framework, the review examines external and internalized stigma as central mechanisms linking criminalization, discrimination, and healthcare avoidance to psychological distress, with compounded effects for LGBTQIA+ and BIPOC sex workers. Particular attention is given to masculine sexual entitlement as a proximal interpersonal stressor strongly predictive of PTSD symptoms. Across studies, violence exposure, poverty, early entry into sex work, and low workplace control are associated with elevated mental health burden, whereas peer and community networks function as robust protective factors that enhance safety, autonomy, and access to care. Implications include sex work-affirming, trauma-informed clinical care and community-partnered research.

PMID:41822935 | PMC:PMC12978257 | DOI:10.3389/fpubh.2026.1773690

Front Public Health. 2026 Feb 25;14:1772045. doi: 10.3389/fpubh.2026.1772045. eCollection 2026.

ABSTRACT

BACKGROUND: This study employed a three-product agent-based model (ABM) to evaluate the potential population-level effects of granting market authorization for on! ^® nicotine pouches, an oral tobacco-derived nicotine product. Previous research has typically relied on simplified two-product models comparing cigarette use in a “Base Case” with a “Modified Case” scenario, limiting the ability to reflect real-world multi-product tobacco use patterns. To address this, the ABM in this study incorporated cigarettes and smokeless tobacco (ST) products in the Base Case and added the on! ^® nicotine pouches as the Test Product in the Modified Case.

METHODS: Developed in MATLAB^® version 9.2, the model consisted of a transition sub-model, which simulated annual changes in product use based on national survey data and Test Product-specific studies, and a mortality sub-model, which linked survival outcomes to product transitions using an excess relative risk estimate of 5% for the Test Product relative to cigarettes. The simulation ran over an 80-year time horizon, predicting individual-level agent dynamics and annual transitions.

RESULTS: Model outputs indicated that introducing the Test Product could prevent approximately 476,000 premature deaths, reduce cigarette prevalence by 0.6 percentage points, and ST product use by 0.3 percentage points, while increasing Test Product use by 1.6 percentage points.

CONCLUSION: These findings suggest that regulatory authorization of on! ^® nicotine pouches could yield a net public health benefit by lowering all-cause mortality and reducing the prevalence of use of tobacco products associated with greater health risks.

PMID:41822933 | PMC:PMC12975934 | DOI:10.3389/fpubh.2026.1772045

Clin Otolaryngol. 2026 Mar 12. doi: 10.1111/coa.70098. Online ahead of print.

ABSTRACT

OBJECTIVE: Nasal septal deviation (NSD) is a common cause of chronic upper airway obstruction (UAO), and surgical correction via nasal septoplasty results in improvements in airflow. Multiple studies have been conducted to assess possible relationships between chronic UAO (including due to NSD) and cardiorespiratory function (such as pulmonary artery pressures). The objective of this scoping review is to identify and examine the current evidence on the potential relationship between nasal septal deviation, estimated mean pulmonary artery pressure (mPAP), and estimated pulmonary artery systolic pressure (ePASP) in patients who undergo nasal septoplasty.

DATA SOURCES: PubMed, EMBASE, Ovid.

METHODS: A scoping review was performed in accordance with the PRISMA Extension for Scoping Reviews guidelines.

RESULTS: Two independent reviewers screened 411 articles; 9 before-after studies met eligibility criteria for review inclusion. There was a total of 458 study participants, of which 395 underwent septoplasty and 63 were matched controls. All studies reported a statistically significant decrease between the pre-operative and post-operative estimated mPAP (p < 0.05) and/or ePASP (p < 0.001) in subjects who underwent nasal septoplasty. Two studies included control participants and reported a statistically significant difference between the pre-operative estimated mPAP of patients with NSD and controls (p < 0.001).

CONCLUSION: This scoping review highlights the current evidence on the potential relationship between NSD, estimated mPAP, and ePASP in patients who undergo nasal septoplasty for NSD. Further studies of higher statistical and methodological quality are required to assess for cause-and-effect relationships and examine the potential link between chronic UAO and cardiorespiratory function.

PMID:41820243 | DOI:10.1111/coa.70098

HIV Med. 2026 Mar 12. doi: 10.1111/hiv.70217. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine temporal changes in late diagnosis of HIV (LD) among migrant and non-migrant people with HIV in Sweden 2003-2023 and to assess demographic and socioeconomic risk factors for LD in these two populations.

METHODS: People with HIV diagnosed with HIV-1 in Sweden 2003-2023 were included (n = 6278). LD was defined as a first CD4+ T-cell count <350 cells/μL or an AIDS-defining event within 3 months of diagnosis. People with HIV with evidence of recent infection were reclassified as non-late. Temporal changes in LD were examined using descriptive statistics and regression analyses. To assess risk factors for LD, modified Poisson regression was employed. Risk factor analyses were restricted to 2010-2020 when complete sociodemographic data were available (n = 2778). Data were obtained from Swedish national registries.

RESULTS: The absolute incidence of total and late HIV diagnoses decreased over the study period, whereas the annual proportion of LD varied between 46% and 60% and trended upwards. LD occurred in 41% of non-migrant people with HIV and 58% of migrant people with HIV. Among non-migrant people with HIV, having an upper secondary education or less was associated with LD compared to post-secondary education, as was male sex with heterosexual HIV acquisition and higher age. For migrant people with HIV, neither lower education nor income was statistically significantly associated with LD. Instead, higher age, certain birth regions, heterosexual acquisition and male sex with acquisition through injection drug use were associated with LD.

CONCLUSIONS: LD declined in absolute terms yet constituted a high and increasing proportion of new HIV cases in Sweden 2003-2023, with differing sociodemographic determinants by migrant status.

PMID:41820237 | DOI:10.1111/hiv.70217

Stat Med. 2026 Mar;45(6-7):e70488. doi: 10.1002/sim.70488.

ABSTRACT

In the design of clinical trials, it is essential to assess the design operating characteristics (e.g., power and the type I error rate). Common practice for the evaluation of operating characteristics in clinical trials that employ Bayesian analysis and decision procedures relies on estimating the sampling distribution of posterior summaries via Monte Carlo simulation. It is computationally intensive to repeat this estimation process for each design configuration considered, particularly for clustered data that are analyzed using complex, high-dimensional models. In this paper, we propose an efficient method to assess operating characteristics and determine sample sizes for Bayesian trials with clustered data. We prove theoretical results that enable posterior probabilities to be modeled as a function of the number of clusters. Using these functions, we assess operating characteristics at a range of sample sizes given simulations conducted at only two values for the number of clusters. These theoretical results are also leveraged to quantify the impact of simulation variability on our sample size recommendations. The applicability of our methodology is illustrated using an example Bayesian cluster-randomized clinical trial.

PMID:41820232 | DOI:10.1002/sim.70488