Nevin Manimala

J Glob Health. 2026 Mar 6;16:04079. doi: 10.7189/jogh.16.04079.

ABSTRACT

BACKGROUND: Tuberculosis (TB) remains a major public health challenge in China and worldwide, with smoking being a key modifiable risk factor. Given China’s large population and rising smoking rates, this paper aims to examine the link between smoking and TB incidence.

METHODS: We systematically searched six databases from inception for studies reporting smoking exposure, TB outcomes, and smoker-non-smoker comparisons. Two reviewers independently screened records, extracted data, and assessed bias. We analysed smoking-TB associations using random-effects meta-analysis of odds ratios (ORs) and hazard ratios (HRs).

RESULTS: We included 17 studies reporting ORs and 7 studies reporting HRs in the quantitative synthesis. The pooled OR for TB incidence among smokers compared with non-smokers was 1.77 (95% confidence interval (CI) = 1.29-2.43), indicating a statistically significant increase in risk of TB. For studies reporting hazard ratios, the pooled estimate was 2.39 (95% CI = 1.28-4.45), showing a significant association between smoking and increased TB incidence.

CONCLUSIONS: Both active and passive smoking significantly elevate the risk of TB and worsen its outcomes in China. Our result indicate that COVID-19 pandemic may have indirectly exacerbated smoking-related risks through disruptions to TB services, heightened psychosocial stress, and shifts in smoking behaviours, with potential implications for TB risk and outcomes. Thus, integrating smoking cessation strategies into TB programmes, focusing on heavy smokers in especially high-prevalence areas, and raising public awareness could enhance efforts to prevent and control TB worldwide.

REGISTRATION: PROSPERO: CRD420251070123.

PMID:41789521 | DOI:10.7189/jogh.16.04079

J Glob Health. 2026 Mar 6;16:04078. doi: 10.7189/jogh.16.04078.

ABSTRACT

BACKGROUND: The high incidence and economic burden of coronary heart disease (CHD) represent a major public health challenge in Xinjiang, a region in northwest China. We aimed to assess the effects of a diagnosis-related group (DRG) policy on treatment costs and treatment efficiency in Bortala Mongol Autonomous Prefecture, Kashgar, and Kizilsu Kirghiz Autonomous Prefecture of Xinjiang, China.

METHODS: We retrieved data on CHD inpatients from three prefectures in the Xinjiang medical insurance database. Then, we used interrupted time series analyses to evaluate the effect of the DRG policy on these inpatients. The analysis spanned the period from 1 January 2022 to 31 December 2024, with the policy intervention point for each prefecture defined by its respective DRG implementation date. We divided patients into pre-DRG and post-DRG groups based on the timing of the DRG policy’s implementation. The outcome variables for treatment costs were total cost, drug cost, medical supplies cost, and out-of-pocket (OOP) payments; the outcome variable for treatment efficiency was length of stay (LOS).

RESULTS: Compared to the pre-DRG period, the total cost, drug cost, OOP, and LOS for CHD inpatients in three prefectures all decreased, with a growth rate (GR)<0. In contrast, the medical supplies cost in the Bortala Mongol Autonomous Prefecture and the Kizilsu Kirghiz Autonomous Prefecture increased (GR>0). Following the implementation of the DRG in Xinjiang, CHD inpatients in the Bortala Mongol Autonomous Prefecture saw a significant downward trend in drug cost (β₃ = -26.898; 95% confidence interval (CI) = -45.303, -8.493; P = 0.004), and their LOS decreased significantly in both level (P = 0.001) and trend (P = 0.034). The total cost for CHD inpatients in Kashgar showed a significant downward trend, and drug cost decreased significantly in both level (P = 0.003) and trend (P < 0.001). However, we observed no statistically significant differences in the remaining indicators of the two regions, or for all changes for CHD inpatients in the Kizilsu Kirghiz Autonomous Prefecture (all P > 0.05).

CONCLUSIONS: The DRG policy in Xinjiang has successfully controlled certain treatment costs and improved treatment efficiency for inpatients with CHD in the Bortala Mongol Autonomous Prefecture and in Kashgar. However, the implementation of DRG in the Kizilsu Kirghiz Autonomous Prefecture has not yet shown significant results and thus warrants monitoring and research.

PMID:41789517 | DOI:10.7189/jogh.16.04078

Res Synth Methods. 2026 Mar 6:1-14. doi: 10.1017/rsm.2026.10074. Online ahead of print.

ABSTRACT

Network meta-analysis (NMA) is a vital methodology for synthesizing evidence across multiple treatments and informing medical decision-making. However, effective visualization and interpretation of results from large networks of interventions remain challenging, particularly for non-specialists. NMAstudio 2.0 is an innovative, interactive web application designed to address these difficulties by streamlining NMA workflows and enhancing result visualization. Developed using Python and R, NMAstudio 2.0 seamlessly integrates with established NMA frameworks. Our exemplar application of NMAstudio 2.0 using a Cochrane Review comparing several treatments for chronic plaque psoriasis demonstrates its capacity to facilitate all crucial steps of an NMA. The application features an intuitive interface for uploading data, automating analyses, generating interactive visualizations such as network diagrams, forest plots, ranking plots, and producing unique outputs like boxplots for transitivity checks and bidimensional forest plots. Most outputs are dynamically linked with the network diagram, enabling users to interactively explore evidence networks, apply advanced filtering, and highlight specific features by selecting nodes or edges within the diagram. While NMAstudio 2.0 aims to simplify NMAs, it also incorporates steps during the data upload process to mitigate the risk of producing poorly reported NMAs. NMAstudio 2.0 represents a significant step forward in improving the usability and accessibility of NMA, offering researchers a robust, versatile platform for evidence synthesis. Its integration of advanced features with an emphasis on user experience positions it as a valuable resource for enhancing decision-making and promoting evidence-based practice across diverse contexts.

PMID:41789459 | DOI:10.1017/rsm.2026.10074

Hypertension. 2026 Mar 6. doi: 10.1161/HYPERTENSIONAHA.125.26397. Online ahead of print.

ABSTRACT

BACKGROUND: Contemporary hypertension guidelines emphasize individualized blood pressure (BP) management, often incorporating age; yet chronological age alone may be insufficient to guide optimal treatment. The frailty index offers a multidimensional measure of biological aging and may better guide BP management.

METHODS: We pooled participant-level data from SPRINT (Systolic Blood Pressure Intervention Trial) and ACCORD (Action to Control Cardiovascular Risk in Diabetes). The frailty index was calculated using a 31-item Rockwood cumulative-deficit model, with frailty defined as a frailty index >0.21. Participants were also categorized by age (<65 versus ≥65 years). Systolic BP (SBP) time in target range (TTR) was calculated using linear interpolation across 10 mm Hg intervals. Restricted cubic splines and stratified Cox models were used to assess the association between TTR within predefined SBP targets and major adverse cardiovascular events.

RESULTS: A total of 19 230 participants were included in the analysis (mean age, 65.2 years; 49.0% women; 68.2% classified as frail). Restricted cubic spline analyses showed a J-shaped relationship between average SBP and major adverse cardiovascular events, with clearer separation by frailty than by age. Among frail individuals, greater time spent within SBP intervals between 110 and 140 mm Hg was associated with lower major adverse cardiovascular event risk (hazard ratios per 10% increase in TTR, 0.92-0.94), whereas among nonfrail individuals, greater time spent below 130 mm Hg was associated with lower risk (hazard ratios per 10% increase in TTR, 0.89-0.98). Age demonstrated limited discrimination. Findings were consistent in separate analyses of SPRINT and ACCORD.

CONCLUSIONS: The frailty index, rather than chronological age, more accurately discriminates optimal SBP targets in hypertensive patients, whereas chronological age may remain a more practical tool in resource-limited settings.

PMID:41789453 | DOI:10.1161/HYPERTENSIONAHA.125.26397

F1000Res. 2026 Feb 3;15:176. doi: 10.12688/f1000research.177011.1. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate the association between Fusobacterium nucleatum and c-Myc expression in Oral Potentially Malignant Disorders (OPMDs) and Oral Squamous Cell Carcinoma (OSCC) and to explore its potential role in oral carcinogenesis.

MATERIALS AND METHODS: A total of 32 histopathologically confirmed cases (18 OPMDs and 14 OSCC) were analyzed. Anaerobic cultures and polymerase chain reaction (PCR) were used to detect F. nucleatum. Immunohistochemistry (IHC) was performed to assess c-Myc expression. Statistical analysis was conducted using Mann-Whitney and Chi-square tests, with p < 0.05 considered significant.

RESULTS: F. nucleatum was detected in eight OSCC and two OPMD cases, with higher colony counts in OSCC. All samples were positive for c-Myc, but their expression levels varied. In OPMDs, positivity was mainly observed in the basal and suprabasal epithelial layers, whereas OSCC showed both peripheral and central tumor cell localization. F. nucleatum-positive OSCC cases demonstrated strong nuclear c-Myc staining (50-75% positive cells). Tobacco habits, particularly combined smoking and smokeless use, were more common in F. nucleatum-positive OSCC cases.

CONCLUSION: F. nucleatum colonization correlates with increased c-Myc expression in OPMDs and OSCC, supporting its possible role in microbially driven oral carcinogenesis. These findings suggest its potential as a prognostic biomarker and a therapeutic target.

PMID:41789431 | PMC:PMC12959620 | DOI:10.12688/f1000research.177011.1

Transp Policy (Oxf). 2026 Feb;176:103920. doi: 10.1016/j.tranpol.2025.103920. Epub 2025 Nov 24.

ABSTRACT

This study explores the complex relationships among metropolitan- and neighborhood-level racial segregation, transportation, and tract-level employment outcomes using data from over 28,000 census tracts in 95 Metropolitan Statistical Areas (MSAs) in the United States. Results from a series of multilevel models indicate that the availability of private (but not public) transportation is positively related to employment rate at the census-tract level. We also find census tracts with higher shares of Hispanics and African Americans have higher unemployment rates, but MSA-level dissimilarity is not significantly related to tract-level unemployment. We also determine that there is no moderating effect of MSA-level racial segregation on the relationship between transportation and employment outcomes. Findings reveal the critical role of automobiles in connecting employees to jobs. They further highlight that a reduction in racial segregation at the neighborhood level might benefit employment outcomes at the census tract level.

PMID:41789421 | PMC:PMC12959454 | DOI:10.1016/j.tranpol.2025.103920

Stat Probab Lett. 2026 Jun;233:110662. doi: 10.1016/j.spl.2026.110662. Epub 2026 Feb 2.

ABSTRACT

Directional replicability addresses the question of whether an effect studied across $n$ independent studies is present with the same direction in at least $r$ of them, for $r\ge 2$ . When the expected direction of the effect is not specified in advance, the state of the art recommends assessing replicability separately by combining one-sided $p$ -values for both directions (left and right), and then doubling the smaller of the two resulting combined $p$ -values to account for multiple testing. In this work, we show that this multiplicative correction is not always necessary, and give a sufficient and necessary condition under which it can be safely omitted.

PMID:41789419 | PMC:PMC12959485 | DOI:10.1016/j.spl.2026.110662

Commun Earth Environ. 2026;7(1):208. doi: 10.1038/s43247-026-03226-3. Epub 2026 Jan 29.

ABSTRACT

Outcrops and cores are primary sources of information about the Earth’s past. Quantitative analyses rely on geochronologies that take into account highly variable sedimentation and erosion rates as well as gaps from missing strata. Using 23 geochronologies from the Holocene, Quaternary, Phanerozoic and Precambrian, we apply Haar fluctuation analysis to statistically characterize the number of measurements per unit time – the measurement densities. The analysis determines the densities’ (multifractal) scaling regimes and exponents; collectively, the analyses span over nine orders of magnitude in time scale. The measurement density is a new paleoindicator that we show is typically correlated with the primary paleoindicator, biasing and complicating its statistical interpretation. We also analyze the distribution of gaps linking the latter’s (probability) scaling with series incompleteness and the length Sadler effect. The density characteristics are needed to unbias spectra and other statistical characterizations.

PMID:41789418 | PMC:PMC12956591 | DOI:10.1038/s43247-026-03226-3

Lancet Reg Health West Pac. 2026 Jan 15;67:101790. doi: 10.1016/j.lanwpc.2025.101790. eCollection 2026 Feb.

ABSTRACT

BACKGROUND: Social prescribing supports individual well-being and community engagement by linking people to local resources. In Cambodia, members of the existing Village Health Support Groups have been trained as link workers to deliver social prescribing activities by leveraging existing resources in a limited-resource setting. However, the nature and functioning of social prescribing in limited-resource settings remain poorly understood. This study aims to describe the implementation of social prescribing in Cambodia and examine how a social prescribing intervention for older adults was associated with improved access to healthcare, greater community support, and reduced loneliness, providing initial insights to inform future implementation research.

METHODS: A cross-sectional study was conducted across ten Cambodian provinces among 1200 older adults aged 60 and above between 1 December 2024 and 31 January 2025. We interviewed older adults in each of the following groups using a structured questionnaire: Group 1 (n = 400, received social prescribing), Group 2 (n = 400, did not receive but lived in areas with trained link workers), and Group 3 (n = 400, lived in areas without trained link workers). Descriptive analyses were conducted to summarise the demographic and contextual characteristics of participants across the three groups. Additional descriptive analyses were conducted for Group 1 to summarise the characteristics of social prescribing activities, and qualitative responses were thematically analysed. Logistic regression analyses were conducted to examine associations between social prescribing exposure and key outcomes. The primary outcomes were overall health status and loneliness. Secondary outcomes included consultation opportunities, healthcare access, unmet needs, and health status. Two comparisons were made: recipients versus non-recipients within trained areas (Group 1 vs Group 2) and non-recipients in trained versus non-trained areas (Group 2 vs Group 3). Models were adjusted for age, sex, marital status, education, household size, and IDPoor Equity Card status-a government measure of household poverty.

FINDINGS: Among those who received social prescribing, information was most commonly provided by Village Health Support Groups (82.7%) and village leaders (76.9%) and were most often delivered at home (55.2%). Referrals were mainly to health facilities (84.3%) and community activities (77.2%), and also included counselling at pagoda (20.6%), mental health support (21.4%), and daily life assistance (17.0%). 98.9% of participants reported that social prescribing was helpful. Enhanced health literacy, practical support, and improved psychosocial well-being emerged as themes from the qualitative analysis of the semi-structured interviews, health literacy, practical support, and improved psychosocial well-being emerged as themes from the qualitative analysis of the semi-structured interviews. Compared to Group 2, Group 1 was significantly associated with greater opportunities to consult with community supporters (multivariable-adjusted OR (aOR) 1.65, 95% CI 1.24-2.20, p = 0.00054), which remained statistically significant after Bonferroni correction. In contrast to Group 2, Group 1 was less likely to report poor healthcare availability (aOR = 0.73, 95% CI: 0.53-1.00, p = 0.048) and loneliness (aOR = 0.60, 95% CI: 0.37-0.97, p = 0.039), although these associations were not significant after Bonferroni correction.

INTERPRETATION: Social prescribing in Cambodia, delivered through existing Village Health Support Groups, appeared feasible and was perceived as highly helpful by older adults. Descriptive findings suggest that trained link workers may enhance community support in limited-resource settings. These insights offer an initial understanding of how social prescribing functions in low-resource contexts and can inform future implementation research.

FUNDING: World Health Organization Regional Office for the Western Pacific.

PMID:41789408 | PMC:PMC12958073 | DOI:10.1016/j.lanwpc.2025.101790

Lancet Reg Health West Pac. 2026 Feb 11;67:101804. doi: 10.1016/j.lanwpc.2026.101804. eCollection 2026 Feb.

ABSTRACT

BACKGROUND: The estimated effectiveness of SMS (short message service) reminders for improving childhood vaccine coverage and timeliness has varied in previous studies. The observed heterogeneity in effectiveness may be explained in part by variation in reminder content or timing of the reminder relative to the vaccine schedule date. We sought to evaluate the effectiveness of a range of SMS reminders of varied content and timing for improving on-time childhood vaccination.

METHODS: AuTOMATIC was a multi-centre Bayesian adaptive factorial randomised trial comparing four alternative SMS message framings at three alternative message timings versus a no reminder control strategy. Participants were parents of children registered with one of 20 primary care clinics Australia-wide and randomly assigned to one of 12 SMS reminder arms or to control. Reminders varied by framing of content (neutral, positive, risk-based or social benefit) and timing (14 days prior to the due date, on the due date, or 7 days afterwards). The primary endpoint was on-time vaccination, i.e. within 28 days of its scheduled date. Allocation probabilities were updated and stopping rules implemented over the trial according to pre-specified rules based on the posterior probability of effectiveness of each arm evaluated at interim analyses. Trial procedures were largely digitally automated. This trial was registered on Australian New Zealand Clinical Trials Registry (ACTRN12618000789268).

FINDINGS: Between January 14, 2021 and February 26, 2024, 9993 parents were randomised and all were included in the primary analysis; between 380 and 1110 were assigned to each of the 12 SMS reminder arms and 637 to control. The adjusted odds ratio (aOR) of on-time vaccination for each of the 12 SMS arms compared to control ranged from 1.02 [95% CrI 0.76-1.34] to 1.53 [1.22, 1.92] with a pooled effect aOR of 1.29 [1.06, 1.55]. This pooled effect corresponded to a standardised difference of 6% [2%, 11%] in the proportion of on-time vaccinations.

INTERPRETATION: On average, SMS reminders were associated with a modest increase in on-time vaccination compared to no reminder. There was evidence that neutral SMS reminders were less effective than persuasive reminders, but we were unable to identify a single best combination of reminder content framing and timing.

FUNDING: Ramaciotti Foundations, Royal Australasian College of Physicians, and the Western Australia Department of Health.

PMID:41789401 | PMC:PMC12958076 | DOI:10.1016/j.lanwpc.2026.101804