Nevin Manimala

BMC Med Ethics. 2026 Jun 25. doi: 10.1186/s12910-026-01542-z. Online ahead of print.

ABSTRACT

BACKGROUND: Ethical practice is central to patient trust, safety, and quality healthcare delivery. This study compared healthcare ethics knowledge and practice among doctors and nurses in two Ghanaian hospitals and identified factors associated with ethical practice.

METHODS: An analytical cross-sectional study was conducted among 382 doctors and nurses in two government hospitals in Ghana. Data were collected using a structured questionnaire assessing healthcare ethics knowledge and self-reported practice. Bivariate analysis was conducted using Chi-square tests and T-tests, while Random Forest analysis was applied to identify variables of relative importance to healthcare ethics (HCE) practice.

RESULTS: No statistically significant differences were observed between facilities in mean healthcare ethics knowledge (26.3 ± 2.83; p = 0.98) and practice (23.5 ± 2.94; p = 0.16) scores. Healthcare ethics knowledge was significantly positively associated with practice (p < 0.05). Random Forest analysis identified age, knowledge, education, and gender as the most important predictors of ethical practice based on variable importance rankings, with differences observed in their relative contribution across facilities.

CONCLUSION: Healthcare professionals demonstrated moderate-to-high knowledge and practice of healthcare ethics, with no significant institutional differences. Ethical practice was influenced by demographic and educational factors, highlighting the need for context-specific strategies. Strengthening ethical decision-making may require integrating structured and continuous ethics training into professional development, alongside mentorship approaches that reinforce ethical standards in clinical practice.

PMID:42351140 | DOI:10.1186/s12910-026-01542-z

BMC Nurs. 2026 Jun 26. doi: 10.1186/s12912-026-04868-6. Online ahead of print.

ABSTRACT

BACKGROUND: As healthcare settings become more culturally diverse, nursing and midwifery education needs to prepare students to provide culturally responsive care. Although intercultural sensitivity has received growing attention in health professions education, less is known about how it relates to negative attitudes such as xenophobia. This study examined levels of xenophobia and intercultural sensitivity among nursing and midwifery students and explored their relationships with selected sociodemographic and experiential characteristics.

METHODS: This descriptive cross-sectional study was conducted with 472 nursing and midwifery students enrolled at a state university in Mardin, Türkiye. Data were collected using a sociodemographic questionnaire, the Xenophobia Scale, and the Intercultural Sensitivity Scale. The data were analyzed using descriptive statistics, correlation analysis, and multiple regression analysis.

RESULTS: The students had moderate xenophobia scores and relatively high intercultural sensitivity scores, with mean values of 51.83 ± 12.74 and 88.25 ± 12.63, respectively. No significant relationship was found between total xenophobia and total intercultural sensitivity scores. Weak positive correlations were found between xenophobia and the interaction responsibility (r = 0.105, p = 0.023) and interaction carefulness (r = 0.243, p < 0.001) subdimensions of intercultural sensitivity. Xenophobia scores differed significantly by age, academic year, geographic region, and frequency of intercultural interaction, although the effect sizes were small (η² = 0.02-0.04). In the regression analysis, desire to live abroad remained a significant predictor of higher xenophobia scores (B = 5.834, p < 0.001).

CONCLUSIONS: Xenophobia and intercultural sensitivity do not appear to move together in a straightforward way among nursing and midwifery students. The findings suggest that being sensitive to cultural differences does not necessarily mean being free from xenophobic attitudes. Nursing and midwifery education may therefore benefit from addressing both aspects to better support the development of culturally responsive care.

PMID:42351138 | DOI:10.1186/s12912-026-04868-6

BMC Health Serv Res. 2026 Jun 25. doi: 10.1186/s12913-026-14870-y. Online ahead of print.

ABSTRACT

BACKGROUND: Innovation is increasingly necessary in primary care policy, and healthcare managers play a pivotal role in translating policy ambitions into practice and shaping organisational conditions that foster innovation. The aim of this study was to explore innovation activities and their contextual conditions in Swedish primary care, as perceived by primary care managers.

METHODS: A national cross-sectional mixed-methods survey was conducted across Swedish primary care centres. Quantitative data were analysed using descriptive statistics, while qualitative data were analysed using systematic text condensation.

RESULTS: In total, 392 of the 1,028 invited primary care managers responded to the questionnaire. Approximately 80% of primary care managers reported product, process or organisational innovations, reflecting relatively high innovation activity at primary care centres. Innovation ideas predominantly emerged from within the primary care centre, and managers viewed themselves as playing a central role in generating these ideas. Most innovation activities involved internal collaboration between staff groups (86%) and units (62%), with limited external collaboration (6%-12%). Leadership was central in engaging staff with innovation and cultivating an innovation-supportive culture. Managers provided time, space and organisational support for continuous competence development. However, organisational and resource constraints limited staff involvement in innovation, as primary care remains tightly bound to economic and production-related demands.

CONCLUSION: This study offers an overview of the innovation landscape in Swedish primary care from the perspective of primary care managers and contributes empirical knowledge on how innovation is understood and managed across different primary care contexts in Sweden. While Swedish primary care demonstrates strong engagement in innovation, the involvement of and collaboration with external stakeholders remain limited, underscoring the need for system-level strategies and processes to facilitate cross-sector innovation partnerships. Further research is needed on how system-level frameworks for collaboration and innovation can be established across the Swedish healthcare system, including primary care.

PMID:42351137 | DOI:10.1186/s12913-026-14870-y

BMC Vet Res. 2026 Jun 25. doi: 10.1186/s12917-026-05647-w. Online ahead of print.

ABSTRACT

BACKGROUND: Injection-site complications are a poorly recognised problem in small ruminant production in Ghana. The improper injection can lead to tissue damage, abscesses, fibrosis, drug residues, lower meat quality and carcass condemnation, which can cause economic and public health issues. Veterinarians are legally qualified to give injections, but in practice, para-veterinarians and animal herders often do so, as they are in close contact with livestock and are often responsible for immediate animal care. The aim of this study was to evaluate the knowledge, attitudes and practices of animal health providers on injection-site complications in Kumasi, Ghana.

METHODS: A comparative cross-sectional study was carried out among 230 respondents including veterinarians (59), para-veterinarians (18), animal herders (143) and meat handlers (10) with a structured questionnaire. Descriptive statistics and Chi-square tests were used to collect and analyse data on knowledge, attitudes, anatomical injection-site preferences and injection practices. Retrospective abattoir records from January to August 2025 were also reviewed to determine the prevalence and distribution of injection-site lesions in slaughtered small ruminants.

RESULTS: Occupation, age, gender, years of experience, and formal training were significantly associated with the level of knowledge (p < 0.05). Veterinarians had the highest awareness of injection-site complications and correct anatomical injection sites, whereas animal herders had lower awareness, especially about tissue necrosis, contamination-related infections, and improper drug absorption. The neck area was the most common site for intramuscular injection by veterinarians, while the thigh and gluteal muscles were the most common sites for para-veterinarians and animal herders. A total of 100 injection-site lesions were found in 43,483 slaughtered animals during abattoir inspection, with lesions mainly located in the thigh area. There was a significant association between formal training and positive attitudes with good injection practices (p < 0.05).

CONCLUSION: There were significant differences in knowledge and practices about injection-site complications among animal health providers in Kumasi. Injection administration by para-veterinarians and herders, and inappropriate injection-site selection, may be factors in the lesions seen during meat inspection. Injection safety, meat quality and animal welfare can be enhanced through targeted training and inclusive veterinary extension programs that engage all livestock handlers.

PMID:42351133 | DOI:10.1186/s12917-026-05647-w

BMC Med Educ. 2026 Jun 26. doi: 10.1186/s12909-026-09779-3. Online ahead of print.

ABSTRACT

BACKGROUND: Measles is a highly contagious infectious disease. The importance of vaccinating healthcare workers (HCW) and medical students as future HCW is underlined by the numerous measles outbreaks in health institutions. We aimed to assess the factors associated with complete vaccination, and measles serological status in relation to vaccination history among medical students in Catalonia (Spain).

METHODS: A cross-sectional study was conducted among medical students attending four university teaching-units during the 2023-2024 and 2024-2025 academic years. Medical students completed a questionnaire and provided blood samples for measles IgG testing. Associations between positive serology, vaccination status, and independent variables (age, sex, country of birth, degree year, future speciality, vaccination attitudes, and measles vaccination history) were assessed using the odds ratio (OR) and 95% confidence interval (CI).

RESULTS: Of the 255 participants, 79.2% were female, 92.5% were aged ≤ 24 years and 94.9% had received a complete schedule of two doses of measles vaccine. A complete vaccination schedule was associated with being a 5th-year student (aOR 5.26; 95% CI 1.43-20.48). Serological results were positive in 200 students (78.7%), and associated with none of the independent variables. Positive serology was observed in 79.3% and 58.3% of Spanish-born and non-Spanish-born students, respectively (aOR 0.38; 95%CI 0.12-1.27), but the difference was not statistically significant.

CONCLUSIONS: A high proportion of medical students in our sample had received two doses of measles vaccine. In line with public health recommendations, medical students as future HCW should be required to provide documented proof of two doses of measles-containing vaccine prior to starting clinical training.

PMID:42351131 | DOI:10.1186/s12909-026-09779-3

BMC Oral Health. 2026 Jun 26. doi: 10.1186/s12903-026-08896-1. Online ahead of print.

ABSTRACT

BACKGROUND: This prospective CBCT case series evaluated the pattern of maxillary molar movement during sequential distalization with clear aligners and vertical attachments, without adjunctive Class II elastics or skeletal anchorage, and assessed associated orthodontically induced inflammatory root resorption.

METHODOLOGY: Ten maxillary quadrants from seven adult patients with Class II molar relationships were included. All patients were treated using a standardized sequential molar distalization protocol with clear aligners. CBCT scans were obtained at baseline (T0) and immediately after completion of molar distalization (T1). Linear crown and root positional changes, as well as molar root length changes, were assessed using three-dimensional CBCT superimposition. Descriptive statistics and paired t-tests were used, with significance set at P < 0.05.

RESULTS: The maxillary first and second molars demonstrated significant distal displacement at the mesiobuccal cusp tips: 1.24 ± 0.64 mm and 1.02 ± 0.82 mm, respectively. Root apex displacement was limited, suggesting crown-dominant distal movement rather than true bodily distalization. The maxillary central incisors showed significant labial incisal-edge displacement of 1.93 ± 1.27 mm, while root apex position remained stable, indicating partial anterior anchorage loss under the tested protocol. Small but statistically significant reductions in molar root length were detected, ranging from 0.19 ± 0.21 mm to 0.47 ± 0.68 mm.

CONCLUSIONS: Within the limitations of this exploratory prospective case series, sequential maxillary molar distalization with clear aligners and vertical attachments produced modest crown-dominant distal molar movement. Mild anterior anchorage loss was observed under a protocol without adjunctive elastics or skeletal anchorage. Molar root length reductions were small and remained below 1 mm. Larger controlled studies incorporating planned vs. achieved movement analysis are required.

PMID:42351123 | DOI:10.1186/s12903-026-08896-1

J Neuroeng Rehabil. 2026 Jun 25. doi: 10.1186/s12984-026-01952-5. Online ahead of print.

ABSTRACT

BACKGROUND: Transcutaneous auricular vagus nerve stimulation (taVNS) paired with task-specific training has shown promise for improving upper-limb motor recovery after stroke but its effects on gait and balance remain unclear. This study evaluated the feasibility and safety of taVNS paired with task-specific training and explored preliminary effects on walking and balance outcomes in adults with chronic stroke.

METHODS: A double-blinded, sham-controlled trial was conducted to evaluate active versus sham taVNS paired with task-specific training (15 one-hour sessions over six weeks). Feasibility metrics included recruitment, participant experience, adverse events (AEs), and blinding effectiveness. Clinical outcomes (walking speed, endurance, gait parameters, and balance) were assessed at baseline, post-intervention, and ≥ 30 days post-intervention, supplemented by qualitative interviews.

RESULTS: Twenty-five adults with chronic stroke completed this study (18 males, mean age 64.99 ± 13.45 years; 41.80 ± 38.00 months post-stroke, 14 received active taVNS). Active taVNS was considered feasible and safe, with a 93% consent rate; 96% of participants found the intervention useful/helpful, and 100% found the stimulation acceptable. There were no serious AEs, with 16% of participants reporting mild side effects. Both groups improved across clinical outcomes. No statistically significant between-group differences were observed. Between-group effect sizes were small for gait, balance, disability, and self-efficacy, and small-to-moderate for walking endurance; however, confidence intervals crossed zero for all outcomes.

CONCLUSION: Active taVNS paired with task-specific training was feasible and well tolerated in chronic stroke. No definitive between-group effects were detected. Observed effect sizes should inform the design and sample size calculations of future adequately powered trials using optimised taVNS protocols.

PMID:42351122 | DOI:10.1186/s12984-026-01952-5

BMC Oral Health. 2026 Jun 26. doi: 10.1186/s12903-026-09053-4. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative pain and discomfort following tooth extraction are common complications that may negatively affect patients’ quality of life. The potential association between pre-existing sleep disturbances and postoperative discomfort remains insufficiently explored.

OBJECTIVE: This study aimed to investigate the association between pre-existing sleep disturbances and postoperative pain intensity, emotional impact, and limitations in daily activities in patients undergoing routine tooth extraction.

MATERIALS AND METHODS: This retrospective observational cohort study included 111 adult patients (18-65 years) who underwent tooth extraction at Hacettepe University. Preoperative sleep quality was assessed using the Jenkins Sleep Scale (JSS). Participants were classified into two groups: Group A (patients with sleep disturbances; JSS ≥ 12, n = 48) and Group B (patients without sleep disturbances; JSS < 12, n = 63). Postoperative outcomes were evaluated on postoperative day 1 using the American Pain Society Patient Outcomes Questionnaire-Revised (APS-POQ-R). The null hypothesis stated that there would be no difference in postoperative discomfort between the two groups. Statistical analyses included the Mann-Whitney U test and Chi-square test.

RESULTS: Patients with pre-existing sleep disturbances (Group A) demonstrated significantly higher pain intensity scores (p < 0.001), greater emotional impact (p = 0.030), and increased limitations in daily activities (p = 0.002) compared with Group B. Satisfaction of pain management was significantly lower in Group A (p = 0.016). No statistically significant differences were observed between groups regarding nausea, numbness, itching, or dizziness (p > 0.05).

CONCLUSION: Pre-existing sleep disturbances were significantly associated with increased postoperative discomfort and reduced satisfaction following tooth extraction. The null hypothesis was rejected. However, given the observational design and the lack of predictive analysis, these results should be interpreted cautiously, and further prospective studies are needed before clinical application can be recommended.

PMID:42351121 | DOI:10.1186/s12903-026-09053-4

Int J Equity Health. 2026 Jun 25. doi: 10.1186/s12939-026-02908-w. Online ahead of print.

ABSTRACT

BACKGROUND: Early motherhood remains a major public health and equity challenge in low- and middle-income countries, especially in Latin America. While poverty, education, gender norms, and barriers to sexual and reproductive health are well-established determinants, how household income translates into (or fails to translate into) delayed childbearing remains insufficiently understood-particularly in highly unequal settings marked by informality and fragmented social protection.

OBJECTIVE: To examine the association between household income and early motherhood in Mexico, and to disentangle direct and indirect socioeconomic pathways linking income to early childbearing.

METHODS: We conducted a population-based, multi-method analysis using harmonised municipal microdata from the 2000, 2010, and 2020 Mexican Population and Housing Censuses (n = 3.05 million women aged 12-24 years, representing 30.6 million individuals). Total household income was imputed using Quantile Random Forests trained on nationally representative income-expenditure surveys. Our analytical strategy combined: (1) machine learning models to identify key correlates and non-linear individual-level patterns of early motherhood; (2) Bayesian spatial models (INLA) to quantify subnational clustering and contextual heterogeneity; and (3) dynamic structural equation modelling to assess direct and lagged relationships among income, schooling-related indicators, union formation, and early motherhood outcomes.

RESULTS: Early motherhood prevalence declined modestly from 21.46% (2000) to 19.31% (2020) and remained concentrated in socioeconomically disadvantaged households. In individual-level models, marital status, age, household structure, and dependency ratio were the dominant correlates; income ranked eighth in feature importance. Partial dependence plots indicated a non-linear inverse L-shaped association: predicted risk increased up to approximately Int$ 1,760 (2018 PPP) per adult equivalent, then plateaued and declined slightly. Parity-specific models showed that income’s predictive relevance weakened with higher parity, with U-shaped patterns at the lowest income levels for second and ≥third births. Municipal analyses revealed persistent spatial clustering after adjustment for key predictors, and residual “place” effects consistent with unmeasured contextual constraints shaping early motherhood. In dynamic models, the direct income-early motherhood path was not statistically significant. Overall patterns were consistent with predominantly indirect linkages operating through schooling- and union-related indicators and reinforcing disadvantage dynamics at the municipal level.

CONCLUSIONS: In Mexico, early motherhood remains strongly shaped by intersecting social and territorial inequalities. Income gradients are modest and appear to operate mainly through schooling lag and union-formation pathways rather than as an isolated driver. Equity-oriented strategies are likely to be most effective when they integrate school retention, prevention of early unions, and youth-friendly sexual and reproductive health services, prioritising municipalities with persistently elevated risk.

PMID:42351120 | DOI:10.1186/s12939-026-02908-w

BMC Womens Health. 2026 Jun 25. doi: 10.1186/s12905-026-04622-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the risk factors associated with pathological progression of cervical lesions, specifically focusing on high-risk human papillomavirus (HR-HPV) infection, ThinPrep Cytologic Test (TCT), and PAX1/JAM3 gene methylation in a high-risk colposcopy-referred cohort.

METHODS: A total of 409 patients who underwent colposcopy-directed biopsy at the First Hospital of Hebei Medical University between January, 2023 and April, 2025 due to abnormal TCT results, HR-HPV infection, or positive PAX1/JAM3 gene methylation were analyzed. The sensitivities of different methods were compared, and unordered multivariate logistic regression was used to analyze the risk factors for high-grade cervical lesions and pathological progression.

RESULTS: Univariate analysis demonstrated that age, gravidity, age at first sexual intercourse, number of sexual partners, menopausal status, HR-HPV infection, TCT results, and PAX1/JAM3 methylation were significantly associated with pathological grade (all P < 0.05). In the multinomial regression analysis, compared to the inflammation group, both other high-risk HPV (OR = 3.930) and very-high-risk (16/18) HPV infections (OR = 3.725), as well as non-NILM TCT (OR = 2.435), were significantly associated with an increased risk of LSIL. For the progression to HSIL, very-high-risk HPV (OR = 6.801), non-NILM TCT (OR = 2.399), positive PAX1 methylation (OR = 4.145), and positive JAM3 methylation (OR = 8.215) were identified as strong independent risk factors.

CONCLUSION: In a high-risk colposcopy-referred cohort, HR-HPV infection, non-NILM TCT results, and positive PAX1/JAM3 gene methylation are independently associated with the presence of high-grade cervical lesions. These biomarkers have the potential to enhance clinical risk stratification and inform decision-making in cervical cancer screening. However, their clinical utility and cost-effectiveness need to be further evaluated through larger, prospective studies to validate their role in routine clinical practice.

PMID:42351112 | DOI:10.1186/s12905-026-04622-9