Nevin Manimala

Med Sci Sports Exerc. 2026 Mar 3. doi: 10.1249/MSS.0000000000003967. Online ahead of print.

ABSTRACT

INTRODUCTION: The benefits of exercise for cardiovascular disease prevention are well established, yet most patients fail to adopt regular exercise despite healthcare provider recommendations. While healthcare provider recommendations provide interpersonal support, exercise adoption requires the development of intrapersonal motivation and the presence of a supportive environment. The Exercise is Medicine (EIM) program utilizes healthcare provider referrals to connect patients with a community that fosters the translation of exercise beliefs into behaviors. The purpose of this study was to examine the biopsychosocial and behavioral outcomes of the EIM program.

METHODS: Participants were referred by healthcare providers through electronic medical records. Participants engaged in sixteen group sessions and three one-on-one sessions (two before and one after the group sessions) and completed validated measures to assess the biopsychosocial model of health.

RESULTS: The EIM program demonstrated significant improvements in biological and behavioral markers. Notably, exercise participation increased by an average of 64.7 minutes (95% CI: 46.6 to 82.8). Body mass index decreased by 0.48 units (95% CI: -0.63 to -0.32), while perceived stress scores declined by 1.08 points (95% CI: -1.59 to -0.56). Participants also experienced an improvement in health-related quality of life, with general health scores rising by 5.59 points (95% CI: 4.39 to 6.78). Systolic blood pressure decreased by 2.9 mmHg (95% CI: -3.9 to -1.9). Additionally, there was a 22% reduction in depressive symptoms (p < 0.001) and a 9% reduction in perceived stress (p < 0.001). Increases in exercise time were associated with improvements in key behavioral determinants such as self-efficacy, affective judgment/passion, and tolerance.

CONCLUSIONS: Overall, these findings underscore the program’s positive impact on cardiovascular health and mental well-being in a real-world community setting.

PMID:41791037 | DOI:10.1249/MSS.0000000000003967

Retina. 2026 Mar 3. doi: 10.1097/IAE.0000000000004825. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the outcomes of pars plana vitrectomy combined with epiretinal proliferation (EP) embedding and temporal inverted internal limiting membrane (ILM) flap technique in cases of lamellar macular hole (LMH).

METHODS: This retrospective study included data from 17 consecutive patients who underwent EP embedding combined with the temporal inverted ILM flap technique for LMH. The best-corrected visual acuity (BCVA) and optic coherence tomography data were analyzed at baseline and postoperative period.

RESULTS: Anatomic closure was achieved in 100% of patients. The mean baseline and final BCVA were LogMAR 0.53 ± 0.25 (Snellen 20/67) and 0.18 ± 0.19 (Snellen 20/30), respectively, demonstrating a statistically significant improvement (p < 0.001). Furthermore, final BCVA was significantly higher in patients with a preoperative BCVA better than LogMAR 0.5 (Snellen > 20/63) (p =0.001). The central retinal thickness (CRT) improved considerably from 115.5± 40.8 μm preoperatively to 208.4 ± 51.5 μm (p<0.001) at the final visit.

CONCLUSIONS: The EP embedding surgery combined with the temporal inverted ILM flap technique can provide improved anatomical and functional outcomes in patients with LMH. Our findings highlight that early intervention prior to severe visual loss and outer retinal defect development can be further beneficial in LMH cases.

PMID:41791036 | DOI:10.1097/IAE.0000000000004825

Rev Esc Enferm USP. 2026 Feb 27;60:e20250309. doi: 10.1590/1980-220X-REEUSP-2025-0309en. eCollection 2026.

ABSTRACT

OBJECTIVE: To assess the impact of invasive mechanical ventilation on renal function and to verify the predisposing factors for the development of acute kidney injury in relation to the use of invasive mechanical ventilation in intensive care.

METHOD: An observational, retrospective, quantitative cohort study. The sample was non-probabilistic, of convenience, and consisted of 51 patients. Patient severity was assessed using the Simplified Acute Physiology Score and Sequential Organ Failure Assessment. All tests were two-tailed, and p < 0.05 was considered statistically significant.

RESULTS: Among patients with kidney injury on invasive mechanical ventilation, 41.2% presented with severe kidney injury (stage 3 of the Kidney Disease Initiative Global Outcomes). The duration of mechanical ventilation was longer in patients with acute kidney injury compared to those without renal impairment (19 versus four days).

CONCLUSION: The impact of mechanical ventilation in critically ill patients was evidenced by the higher prevalence of severe acute kidney injury. Invasive ventilatory support was more prevalent among older adults, highlighting the severity of the patients based on the Simplified Acute Physiology Score and Sequential Organ Failure Assessment scores, and consequently a higher risk of death.

PMID:41791003 | DOI:10.1590/1980-220X-REEUSP-2025-0309en

Int J Oral Maxillofac Implants. 2026 Mar 6;0(0):1-24. doi: 10.11607/jomi.11673. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate both the clinical and radiographic effects of adjunctive systemic azithromycin in the non-surgical approach to treating peri-implantitis associated intrabony defects.

MATERIALS AND METHODS: This retrospective analysis included 28 patients (36 implants) presenting peri-implantitis, characterized by peri-implant lesions showing intrabony defects. All of them received non-surgical treatment consisting of submucosal debridement, implant surface decontamination, minor curettage together with submucosal irrigation with 0.12% chlorhexidine digluconate and with the administration of systemic azithromycin (500 mg/day for 3 days). Measurements of clinical and radiographic outcomes were recorded at baseline and after a minimum follow-up period of 12 months.

RESULTS: Mean follow-up of cases was 22.9±13.6 months. At follow-up, the average reduction in probing pocket depth (PPD) was 3.9 ± 1.5 mm. The radiographic intrabony defect depth decreased by 2.2 ± 1.6 mm and bone gain was 2.6 ± 1.7 mm. Baseline PPD and intrabony defect were statistically significant correlated with radiographic bone fill (r=0.499, p=0.002 and r=0.465, p=0.004; respectively). Disease resolution was achieved in 66.7% of treated implants.

CONCLUSIONS: Within the limitations of the study design, non-surgical approach with adjunctive use of systemic azithromycin for the treatment of peri-implantitis associated lesions with intrabony defects may lead to significant clinical and radiographic improvements.

PMID:41790997 | DOI:10.11607/jomi.11673

Epidemiology. 2026 Mar 2. doi: 10.1097/EDE.0000000000001967. Online ahead of print.

ABSTRACT

Air quality regulations and programs are vital for protecting the public from harms caused by air pollution. To support these actions, numerous epidemiological studies have sought to identify the pollutants most responsible for adverse outcomes. These studies often used statistical adjustments for co-pollutants in outcome regression models, a practice also commonly applied to assess interactions between co-pollutants. Here, we highlight possible pitfalls of multi-pollutant analyses. Indiscriminate co-pollutant adjustment can induce noncausal associations through collider adjustment, distorting effect estimates for individual air pollutants. We describe the underlying mechanisms and provide empirical evidence on how such bias may realistically influence the relationships between air pollution and health outcomes from a well-characterized Canadian national cohort alongside a simulation study. Additionally, we discuss strategies to mitigate the impact of this bias. Given the widespread interest in multi-pollutant approaches among the scientific and policy communities, greater caution is needed when conducting and interpreting research on multiple pollutants.

PMID:41790994 | DOI:10.1097/EDE.0000000000001967

J Urol. 2026 Mar 6:101097JU0000000000005027. doi: 10.1097/JU.0000000000005027. Online ahead of print.

ABSTRACT

PURPOSE: We sought to review our experience with the postoperative use of ureteral stents with and without extraction strings in a large series of pediatric patients following robotic pyeloplasty (RALP).

MATERIALS AND METHODS: All RALP at our institution from 2012-present were retrospectively reviewed. Patients with <60 days of follow-up, preoperative nephrostomy tubes, and redo pyeloplasty were excluded. Statistical analysis was performed.

RESULTS: A total of 245 patients underwent RALP: 179 (73%) patients had ureteral stents with extraction strings (SWES) and 66 (27%) had internalized stents. Groups were similar with regards to demographics and perioperative characteristics, except for longer operative times in the internalized stent group (p=0.01).No statistically significant difference in postoperative complications (OR 0.77, 95% CI 0.35-1.68, p=0.5) and urinary tract infections (OR 0.72, 95% CI 0.24-2.20, p=0.6) were observed between SWES compared to internalized stents. No difference in Clavien-Dindo Grade 3 complications were seen between groups (OR 1.78, 95% CI 0.49-6.41, p=0.4). Subgroup analysis did not reveal increased risk for postoperative complications or UTI with female gender, prior UTI history, or circumcision status (p≥0.16). Non-use of antibiotic prophylaxis was associated with increased risk of postoperative UTI in the SWES group (p=0.02). Of patients with SWES, 21 (12%) required stent removal in the office setting, 3 (1.7%) required removal in the operating room under anesthesia, and 153 (86%) were able to remove at home.

CONCLUSIONS: Ureteral stents with extraction strings were not associated with an increased risk of postoperative UTI or complications in our series.

PMID:41790987 | DOI:10.1097/JU.0000000000005027

Lupus. 2026 Mar 6:9612033261432154. doi: 10.1177/09612033261432154. Online ahead of print.

ABSTRACT

ObjectiveType I interferons (IFN) drive systemic lupus erythematosus (SLE) pathogenesis. Some patients develop neutralizing IFN autoantibodies (anti-IFN ab), which theoretically could modify disease activity. We aimed to determine the prevalence of anti-IFN ab in patients with SLE, identify the age and when during the disease course of anti-IFN ab emerge, and assess their association with organ damage.MethodsThis cross-sectional study included 173 SLE patients from the Lund Lupus Cohort. Samples taken at routine outpatient visits were analyzed for anti-IFN ab using ELISA, and positive samples were tested for IFN neutralizing capacity with a gene-reporter assay. Longitudinal samples were analyzed to determine the time-point and age of first positive sample. Demographic and clinical data were obtained from research registries.ResultsEighteen (10.4%) patients were positive for anti-IFN ab by ELISA. Among these, antibodies from nine patients (5.2%) displayed IFN neutralizing capacity. No statistically significant differences were detected between patients positive for neutralizing antibodies and antibody-negative patients with respect to demography, organ damage or ACR classification criteria. The group with neutralizing antibodies were slightly older (median age 59 vs 45 years, p = .14) and had a higher proportion of renal involvement (67% vs 33%, p = .088). Longitudinal analysis of samples from patients with neutralizing anti-IFN ab revealed two age-related patterns: late-onset (≥65 years, n = 4), including one patient positive at diagnosis at age 69, and early-onset (≤40 years, n = 5), with antibodies present at or soon after diagnosis in four cases. Organ damage did not differ between patients with or without neutralizing antibodies (p = .65). At the latest follow-up (2-38 years after anti-IFN ab detection), three of nine patients remained free of organ damage.ConclusionsApproximately 5% of SLE patients have neutralizing anti-IFN antibodies, which may present early in disease or develop later in life. While late-onset antibodies may reflect age-related changes in immune regulation and early-onset antibodies could potentially modulate IFN-driven mechanisms, our data do not support a protective effect against organ damage.

PMID:41790986 | DOI:10.1177/09612033261432154

Biometrics. 2026 Jan 6;82(1):ujag040. doi: 10.1093/biomtc/ujag040.

ABSTRACT

Analyzing multiple outcome variables via regional quantile regression in high-dimensional settings poses significant statistical and computational challenges. In this paper, we propose a new framework that models multivariate quantile varying coefficients using principal component functions, enforcing a low-rank structure on the coefficient matrix to achieve parsimony and interpretability. Our approach augments this representation with a KNN-fused LASSO penalty to capture shared dynamic patterns and identify latent clusters within the principal components. Through comprehensive simulation studies, we demonstrate that our method consistently provides accurate estimates and robust performance under various high-dimensional scenarios. We further illustrate its practical utility with two real-world health datasets, where our approach uncovers complex, quantile-specific associations between predictors and multiple correlated outcomes across a time index.

PMID:41790491 | DOI:10.1093/biomtc/ujag040

JAMA Netw Open. 2026 Mar 2;9(3):e260888. doi: 10.1001/jamanetworkopen.2026.0888.

ABSTRACT

IMPORTANCE: Older adults undergoing major surgery often face increased risks of functional decline, cognitive impairment, and loss of independence. While shared decision-making (SDM) is recommended, there are no standardized guidelines defining its key components for this population.

OBJECTIVE: To identify valid and feasible components of surgical SDM tailored to older adults.

EVIDENCE REVIEW: This qualitative consensus study used a 2-round modified Delphi process with the RAND/UCLA Appropriateness Method between June 1 and September 9, 2023. Forty-one candidate SDM components were developed from existing frameworks and stakeholder input and were rated for validity and feasibility on a scale of 1.0 to 9.0. Ratings were collected via REDCap. Components meeting a median score of 7.0 or greater with statistical agreement were considered valid and/or feasible. Data were analyzed from June 12, 2023, to January 1, 2024.

FINDINGS: The 11 panelists included 8 clinicians (from the fields of surgery, geriatrics, palliative care, ethics, and social work) and 3 patient representatives. Seven panelists (63.6%) were female. Clinicians practiced in an urban, academic setting with a mean clinical experience of 13.8 (range, 1-35) years; the mean patient age was 67.6 (range, 52-84) years. In round 1, all 41 candidate components were rated valid; 33 (80.5%) were rated feasible and 8 (19.5%) were rated as having uncertain feasibility. After panel discussion and revisions, round 2 concluded that 39 components (95.1%) were feasible, while 2 (4.9%) were rated as unfeasible and removed. Four new components were added and rated valid and feasible for a total of 43 components. Barriers to implementation included knowledge and/or skills (55 of 164 [33.5%]), time (43 of 164 [26.2%]), and cultural factors (30 of 164 [18.3%]). Specific challenges involved assessing cognitive function and decisional capacity and counseling on long-term functional outcomes after surgery.

CONCLUSIONS AND RELEVANCE: Through a structured consensus process, 43 components were identified as valid and feasible for surgical SDM with older adults. These components provide a framework to guide preoperative communication, inform quality measurement, and support the development of interventions to improve SDM. Addressing barriers such as time, knowledge, and cultural constraints will be essential for implementation.

PMID:41790475 | DOI:10.1001/jamanetworkopen.2026.0888

JAMA Netw Open. 2026 Mar 2;9(3):e260277. doi: 10.1001/jamanetworkopen.2026.0277.

ABSTRACT

IMPORTANCE: The language used to describe health equity efforts has become increasingly contested. Understanding how language influences public attitudes is essential to effectively communicate equity-focused concepts across ideological groups.

OBJECTIVE: To assess the association of language and framing with public receptiveness to health equity concepts, including alignment of definitions with shared values, reactions to common terms, and preferences for public health framing statements.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional online survey of 1000 US adults was conducted between April 9 and April 25, 2025, using an international public opinion research firm that recruited from a nonprobability-based online panel with matching and weighting to national benchmarks. Participants were stratified by age, sex, race and ethnicity, self-reported political ideology, and geographic region to approximate national demographics.

EXPOSURES: The survey included 3 modules: (1) random assignment to a definition of health equity or health equality with values-alignment questions; (2) evaluative reactions to 10 common health equity terms; and (3) preferences for 4 pairs of equivalent public health statements differing only in framing.

MAIN OUTCOMES AND MEASURES: Primary outcomes included participant ratings of values alignment (including personal values and values core to national identity, the latter of which were termed American values in the survey), evaluative reactions to equity-related terms (negative to nonnegative), and framing preferences across ideology groups. Descriptive statistics assessed values alignment, reactions to terms, and framing preferences.

RESULTS: Among 1000 US adults (weighted number, 513.2 [51.3%] female; 105.8 [10.6%] very liberal, 164.0 [16.4%] liberal, 344.0 [34.4%] moderate, 205.9 [20.6%] conservative, 98.7 [9.9%] very conservative, and 81.5 [8.2%] not sure), respondents represented a broad range of ages, racial and ethnic backgrounds, and educational attainment. Respondents assigned to the health equity definition reported higher alignment with personal values (42.9%-87.4% across groups) than those assigned to health equality (28.5%-79.0% across groups), with endorsement of either concept increasing progressively from very conservative to very liberal respondents (P < .001 in both cases). When assessing perceived core American values, health equity (47.0% [95% CI, 33.1%-60.8%]) was more frequently endorsed than health equality (21.1% [95% CI, 9.6%-32.5%]) among those identifying as very conservative. Four terms-accessible health care, health care investment, population health, and community health-were broadly well received (<10% negative responses in most groups), whereas the terms marginalized communities and inclusive health elicited more divergent reactions across ideologies (P < .01 in both cases). Collectivist (our health vs your health) and affirming (start, support, and increase) framings were consistently preferred across groups.

CONCLUSIONS AND RELEVANCE: In this national online survey of 1000 US adults, respondents showed both ideological differences and areas of convergence in responses to health equity language and framing. These findings suggest that strategic use of broadly resonant terms and collective, affirming framings may foster understanding of and support for health initiatives across political ideologies.

PMID:41790470 | DOI:10.1001/jamanetworkopen.2026.0277