Nevin Manimala

J Community Psychol. 2026 Jan;54(1):e70076. doi: 10.1002/jcop.70076.

ABSTRACT

Scholars of youth civic development have assessed agency using a wide range of constructs, including motivation, efficacy, empowerment, and sociopolitical control. We propose a multidimensional framework and describe the development and validation of a measure of civic agency, conceptualized as competence, drive, individual power, and collective power. In Study 1, we developed a set of items and employed exploratory factor analysis with a pilot sample of adolescents (N = 295, M_age = 17.1, 65.4% youth of color, 47.9% female, 15.8% nonbinary), which supported our hypothesized four-factor model of civic agency. In Study 2, we conducted confirmatory factor analysis of our final items with a separate adolescent sample (N = 1120, M_age = 16.2, 73.0% youth of color, 55.7% female, 23.3% nonbinary), which demonstrated measurement invariance on race/ethnicity, gender, and age. In Study 3, we validated our scale in a sample of young activists (N = 342, M_age = 19.1, 57.6% youth of color, 72.6% female, 23.0% nonbinary). Confirmatory factor analysis supported a four-dimensional hierarchical structure and we established measurement invariance between adolescents and young adults. Overall, the 16-item Civic Agency Measure consistently demonstrated validity and reliability. We discuss the utility of our work for advancing sociopolitical development theory and supporting adolescents’ efforts for social change.

PMID:41424263 | DOI:10.1002/jcop.70076

Am J Hosp Palliat Care. 2025 Dec 22:10499091251409748. doi: 10.1177/10499091251409748. Online ahead of print.

ABSTRACT

IntroductionCancer is one of the leading causes of global mortality and imposes high costs on healthcare systems. In Brazil, a significant portion of resources is allocated to oncology, especially in the terminal phase. Palliative care has been associated with reduced hospital expenses and improved quality of life. This study aimed to compare direct medical costs in the last week of life of oncology patients receiving usual care (UC) or palliative care (PC).MethodsA retrospective cohort study conducted at Santa Rita Hospital (Porto Alegre, RS), using data from 2021. Patients over 18 years old, hospitalized for ≥7 days, whose death resulted from cancer progression, were included. The sample comprised 58 individuals: 41 in PC and 17 in UC. Direct medical costs included medications, procedures, laboratory and imaging exams, adjusted for inflation and converted to US dollars.ResultsDespite no statistically significant difference in the median of total cost (P = 0.4493), the median cost was lower in the PC group (USD 67.5) compared to the UC group (USD 91.5). Patients receiving palliative care had reduced costs related to procedures, laboratory tests, and imaging exams.ConclusionThe integration of palliative care was associated with reduced specific expenses and greater multidisciplinary support, indicating potential for resource optimization in oncology. These results reinforce the importance of systematic incorporation of this approach in the Brazilian context.

PMID:41424257 | DOI:10.1177/10499091251409748

Epigenomics. 2025 Dec 22:1-10. doi: 10.1080/17501911.2025.2606041. Online ahead of print.

ABSTRACT

AIMS: Environmental factors can alter DNA methylation (DNAm) levels, influence gene expression, and then change fasting glucose (FG) or hemoglobin A1c (HbA1c).

METHODS: Through analyzing DNAm data of 2366 Taiwan Biobank individuals aged between 30 and 70 years, I evaluated the role of DNAm in mediating the associations of seven non-genetic factors (BMI, chronological age, sex, smoking, drinking alcoholic beverages, education, and regular exercise) with FG and HbA1c.

RESULTS: Among 846,232 Cytosine-phosphate-Guanine (CpG) sites, the single-mediator model explored that 21, 15, 10, 3, 3, and 1 CpGs significantly mediated (p < 6.6E-9) the BMI-HbA1c, BMI-FG, sex-FG, age-FG, age-HbA1c, and drinking-HbA1c associations, respectively. The multiple-mediator model considered all significant mediators and selected the model with the smallest Akaike Information Criterion, and identified 8 CpGs that linked exposures (BMI, sex, age, and drinking) to diabetes indicators. Seven out of the 8 CpGs have been reported to be associated with diabetes, FG, HbA1c, or insulin resistance in previous epigenome-wide association studies.

CONCLUSION: Four of the 8 CpGs (cg19693031, cg04816311, cg00574958, and cg11024682) were associated with the expression of genes implicated in diabetes and metabolism, including the TXNIP, GPR146, CPT1A, and SREBF1 genes. These findings highlight the underlying epigenetic mechanism linking non-genetic factors with diabetes.

PMID:41424234 | DOI:10.1080/17501911.2025.2606041

Int J Gynaecol Obstet. 2025 Dec 22. doi: 10.1002/ijgo.70736. Online ahead of print.

ABSTRACT

T. Shokeir, and S. Mousa, “A Randomized, Placebo-Controlled, Double-Blind Study of Hysteroscopic-Guided Pertubal Diluted Bupivacaine Infusion For Endometriosis-Associated Chronic Pelvic Pain,” International Journal of Gynecology & Obstetrics 130, no. 3 (2015): 219-222, 10.1016/j.ijgo.2015.03.043. The above article, published online on 03 June 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; and John Wiley & Sons Ltd. UK. Concerns were raised by a third party regarding the reproducibility of the results reported in Tables 2 and 3, including the p-values stated Table 3. The authors were asked to provide their raw data. However, they did not provide the requested data. Because of the incompatibility of the statistical results presented in the publication and without an adequate explanation by the authors, the editorial team and publisher consider the data and conclusions as unreliable, therefore the article must be retracted.

PMID:41424228 | DOI:10.1002/ijgo.70736

Vasc Endovascular Surg. 2025 Dec 22:15385744251410004. doi: 10.1177/15385744251410004. Online ahead of print.

ABSTRACT

BackgroundVaricose vein surgery increases the risk of venous thromboembolism (VTE). Although pharmacological thromboprophylaxis is commonly used postoperatively, its efficacy and optimal regimen remain unclear. This study systematically reviews the effectiveness and safety of various anticoagulant strategies.MethodsA comprehensive literature search was conducted across PubMed, Embase, EBSCO, and Web of Science databases to identify relevant studies. Eligible studies were screened and selected based on predefined inclusion and exclusion criteria. A network meta-analysis was performed to compare different anticoagulant agents and prophylaxis durations indirectly. Additionally, a random-effects meta-analysis was conducted to calculate the relative risk (RR) and 95% confidence intervals (CI) for VTE and bleeding outcomes.ResultsA total of 11 studies, including 7359 patients who underwent either endovenous or open surgical procedures for varicose veins, met the inclusion criteria. Meta-analysis results indicated that pharmacological thromboprophylaxis was associated with a lower risk of VTE compared to no prophylaxis (RR = 0.49, 95% CI: 0.12-1.99, P < 0.01); however, this difference was not statistically significant. Similarly, there was no significant difference in bleeding risk between patients who received anticoagulant prophylaxis and those who did not (RR = 2.03, 95% CI: 0.82-5.07, P = 0.81). Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.ConclusionsPostoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration.

PMID:41424201 | DOI:10.1177/15385744251410004

Global Spine J. 2025 Dec 22:21925682251407966. doi: 10.1177/21925682251407966. Online ahead of print.

ABSTRACT

Study DesignProspective cohort study.ObjectivePostoperative cerebrospinal fluid leakage (CSFL) is a common complication following thoracic spinal stenosis (TSS) surgery. This study aimed to evaluate the therapeutic effects of different fluid supplementation strategies on intracranial hypotension symptoms (IHS) caused by CSFL.MethodsPatients who developed CSFL after TSS surgery at a single center over a 3-year period were prospectively enrolled. All patients received standardized postural and drainage management. In addition, they were administered either low-sodium or high-sodium solution supplementation alongside standard medications. The incidence and severity of IHS and changes of blood electrolyte levels were compared between the two groups.ResultsThe incidence of IHS in low-sodium group is 57.5%, and in high-sodium group is 40% (P = .117). Although, there was no statistically significant difference in the improvement of IHS between the two fluid supplementation strategies. However, statistical differences in blood electrolyte levels were observed. On postoperative days 2 and 3, serum sodium levels were significantly lower in the low-sodium group (139.9 ± 2.08 vs 141.1 ± 3.1, P = .022; 140.0 ± 3.0 vs 141.25 ± 3.85, P = .034).ConclusionWhile high-sodium fluid supplementation tended to reduce the incidence of IHS following CSFL, the difference compared to low-sodium fluids was not statistically significant. Nonetheless, the observed differences in electrolyte level of sodium suggest a potential physiological impact. Further studies with larger sample sizes are needed to confirm these findings.

PMID:41424188 | DOI:10.1177/21925682251407966

Clin Psychol Psychother. 2025 Nov-Dec;32(6):e70208. doi: 10.1002/cpp.70208.

ABSTRACT

This study aimed to evaluate the factor structure, internal consistency and concurrent validity of the Italian version of the Metacognitions about Smoking Questionnaire (MSQ), utilizing the framework of the Self-Regulation Executive Function model. A total of 532 smokers completed the Italian-translated version of the MSQ, the Fagerstrom Test for Nicotine Dependence, the Severity Dependence Scale, the Depression Anxiety and Stress Scale-21. To test the factorial structure of the MSQ, a series of confirmatory factor analyses (CFAs) were run; correlational analyses and structural equation modelling (SEMs) approaches were undertaken to evaluate the concurrent validity. The 12-item MSQ with four factors was confirmed: positive metacognitions about cognitive regulation (PM-CR), positive metacognitions about emotional regulation (PM-ER), negative metacognitions about uncontrollability (NM-U) and negative metacognitions about cognitive interference (NM-CI). The MSQ showed an overall satisfactory fit index (TLI = 0.949, CFI = 0.963, RMSEA = 0.082 [0.064-0.101]). Internal consistency was satisfactory. MSQ factors are associated with higher nicotine/cigarette dependence and emotional distress, supporting the concurrent validity of the tool. Specific metacognitions about smoking were associated with different clinical outcomes related to smoking. A higher engagement on PM-CR and on NM-U was positively associated with nicotine/cigarette dependence. A higher engagement on PM-ER and NM-CI was associated with greater emotional distress. The 12-item Italian version of the MSQ could be a promising tool to assess specific metacognitions about smoking in both research and clinical contexts. Metacognitions about smoking may be a suitable therapeutic target to reduce the levels of nicotine/cigarette dependence and emotional distress among smokers.

PMID:41424176 | DOI:10.1002/cpp.70208

BJOG. 2025 Dec 22. doi: 10.1111/1471-0528.70108. Online ahead of print.

ABSTRACT

BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-term contraceptive with high continuation rates, but acne may lead to discontinuation.

OBJECTIVES: To evaluate the incidence of acne among LNG-IUS users.

SEARCH STRATEGY: A systematic search was conducted in PubMed, Embase, and Cochrane Central from inception to September 2024.

SELECTION CRITERIA: Randomised clinical trials (RCTs) analysing patients of any age using LNG-IUS at 52 mg, 19.5 mg, or 13.5 mg, with acne reported as an outcome, were included.

DATA COLLECTION AND ANALYSIS: Statistical analyses were conducted using OpenMeta. Chi-square and Z-tests assessed differences between groups, and study quality was appraised using the ROB-2 tool.

MAIN RESULTS: Of 587 studies identified, nine RCTs met inclusion criteria, comprising 6305 LNG-IUS users. The overall acne incidence was 15.0% (95% CI 9.8%-20.3%). Among 2295 users of LNG-IUS 52 mg, incidence reached 19.5% (95% CI 5.2%-33.7%), whereas in 2322 users of LNG-IUS 13.5 mg it was 13.1% (95% CI 8.3%-17.9%) (p < 0.001). Two trials evaluated the 19.5 mg device but data were insufficient for pooling. Studies enrolling younger women (mean age ~24 years) reported an incidence of 19.3% (95% CI 11.0%-27.5%). Excluding Suhonen et al. yielded pooled proportions of 11.9% (95% CI 1.1%-22.7%) for LNG-IUS 52 mg users, 10.8% (95% CI 6.1%-15.5%) when all dosages were combined, and 9.9% (95% CI 9.0%-10.9%) among young women. Heterogeneity remained substantial in the overall and dosage-specific analyses (I²≈95%-97%); it was eliminated in the young women subgroup (I² = 0%).

CONCLUSIONS: LNG-IUS 52 mg users showed a higher incidence of acne compared with those using LNG-IUS 13.5 mg. Studies enrolling younger women also showed a higher incidence. These findings suggest that device dosage and age influence acne occurrence among LNG-IUS users.

TRIAL REGISTRATION: PROSPERO registration number: CRD42024588771.

PMID:41424156 | DOI:10.1111/1471-0528.70108

Health Technol Assess. 2025 Dec;29(69):1-113. doi: 10.3310/QNDF3325.

ABSTRACT

BACKGROUND: Community-based optometrists, a major provider of primary eye care in the United Kingdom, are the main source of referrals to hospital eye services. The widespread introduction of optical coherence tomography devices in community practices provides community-based optometrists with an opportunity to identify a broader range of treatable diseases. Standard referral pathways do not effectively filter unnecessary referrals, with misclassification of urgency, and erroneous diagnoses.

OBJECTIVES: To assess the effectiveness of a teleophthalmology referral pathway between community-based optometrists and hospital eye services for retinal diseases. To measure the accuracy of an artificial intelligence decision support system for diagnosis and referral management of retinal disease.

DESIGN: A multicentre, superiority cluster randomised controlled trial to assess the effectiveness of a teleophthalmology referral pathway. A prospective, observational diagnostic accuracy study to measure the performance of artificial intelligence decision support system. A comprehensive economic evaluation was conducted.

SETTINGS: United Kingdom-based community optometry practices with an optical coherence tomography device and hospital eye services.

PARTICIPANTS: Adults requiring referral for retinal disease at the opinion of the community-based optometrists.

INTERVENTIONS: Community optometry practices were randomised 1 : 1 to standard care or teleophthalmology. Referrals sent via the teleophthalmology platform were remotely reviewed by human experts based at the corresponding hospital eye services. A referral decision was provided within 48 hours. Suitable optical coherence tomography scans were solely processed by artificial intelligence decision support system (the ‘Octane’ model).

MAIN OUTCOME MEASURES: Cluster randomised controlled trial’s primary outcome was the proportion of false-positive referrals (not required or not urgent) per arm in overall participants and in referred-only participants against an independent reference standard. Secondary outcomes included the proportion of wrong diagnosis, wrong referral urgency, false-negative referrals, safely triaged referrals for rare diseases, time from referral to consultation and treatment and cost-effectiveness of teleophthalmology. Primary outcome for the artificial intelligence study was the sensitivity and specificity of artificial intelligence referral decisions against the reference standard.

RESULTS: Teleophthalmology significantly reduces the proportion of false-positive urgent referrals by 59% compared to standard care in referred participants. Due to the observed low event rate for false positive referrals, teleophthalmology’s role for reducing false positives overall was inconclusive. No significant difference between arms for safety of referral decisions (false negatives) was found. After accounting for external factors, the time to consultation demonstrated both clinically and statistically significant benefits for the teleophthalmology arm. The time to treatment showed a clinically significant benefit. Of 396 recruited participants, the Octane artificial intelligence model processed images contributed by 204 participants (51.5%). For referral decisions, the model showed comparable sensitivity and specificity against its own preset referral rules (rule-based reference standard) (post hoc analysis), but it showed inferior sensitivity and specificity when compared to human expert assessors making these referral decisions (clinical reference standard) (primary AI analysis). The artificial intelligence model presented challenges relating to its generalisability in a real-world evaluation context.

LIMITATIONS: Technical limitations in optometry practices, lack of ethnicity data.

CONCLUSIONS: Asynchronous teleophthalmology reduces the number of unnecessary urgent referrals, the main drivers of increasing hospital capacity pressures, provides more appropriate referral-to-treatment times and is more cost-effective compared to standard care. The Octane artificial intelligence model could not process images from 48.5% of study participants. Compared to hospital-based experts for referral decisions, Octane was less accurate at making routine and urgent referral decisions and of similar accuracy to community optometrists.

FUTURE WORK: Applied health research, human-artificial intelligence interaction and artificial intelligence clinical trial design.

TRIAL REGISTRATION: This trial is registered as ISRCTN18106677.

FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127773) and is published in full in Health Technology Assessment; Vol. 29, No. 69. See the NIHR Funding and Awards website for further award information.

PMID:41424155 | DOI:10.3310/QNDF3325

Ann Med. 2026 Dec;58(1):2604391. doi: 10.1080/07853890.2025.2604391. Epub 2025 Dec 22.

ABSTRACT

BACKGROUND: Recent reports suggest that the COVID-19 pandemic and associated lockdowns may have influenced the epidemiology of osteoporotic fractures, but results vary across regions and fracture types. The aim of this study was to provide evidence-based insights into the impact of the pandemic on osteoporotic fracture incidence.

METHODS: We searched four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to August 2025 for observational or retrospective studies comparing osteoporotic fracture incidence during the COVID-19 pandemic (2020) with the pre-pandemic period (2019). The primary outcome of interest was the change in fracture incidence, analysed using risk ratios (RR) with 95% confidence intervals (CI) in Review Manager 5.4. Subgroup analyses were performed by sex, geographic region, and fracture type.

RESULTS: Nine studies meeting the inclusion criteria were analysed. Overall, “all types” of osteoporotic fractures showed a significant decrease during the pandemic (RR = 0.85, 95% CI 0.80-0.91, p < 0.0001). Specifically, forearm fractures decreased significantly (RR = 0.87, 95% CI 0.79-0.96, p = 0.002). However, for the most clinically significant fractures, no statistically significant global change was found for hip fractures (RR = 0.93, 95% CI 0.76-1.15, p = 0.14) or vertebral fractures (RR = 1.35, 95% CI 0.85-2.15, p = 0.20). In regional subgroup analysis, hip fracture incidence decreased significantly in South America (RR = 0.79, p = 0.0004) and in both males and females, but no significant change was observed in Europe (RR = 0.92, 95% CI 0.81-1.04, p = 0.17).

CONCLUSION: During the COVID-19 pandemic, there was a decrease in the incidence of minor fractures, such as those of the forearm, likely due to reduced outdoor activity. However, the incidence of major osteoporotic fractures (hip and vertebral) remained stable globally, with significant reductions observed only in specific regions like South America.

PMID:41424145 | DOI:10.1080/07853890.2025.2604391