Nevin Manimala

J Rural Health. 2026 Jun;42(3):e70203. doi: 10.1111/jrh.70203.

ABSTRACT

PURPOSE: Mailed fecal immunochemical test (FIT) and patient navigation for follow-up colonoscopy have been shown to increase colorectal cancer (CRC) screening rates, but implementation barriers exist in rural settings. Partnerships between clinics and Medicaid health plans may address these barriers. In a large pragmatic randomized trial, we conducted a qualitative analysis to identify ways in which practice facilitation supported the implementation of a partnered health plan-clinic intervention of mailed FIT and patient navigation to improve CRC screening among rural Medicaid enrollees.

METHODS: In the SMARTER CRC pragmatic trial, study team practice facilitators supported rural clinics and Medicaid health plans in implementing mailed FIT and patient navigation for follow-up colonoscopy. Qualitative data collected during the first year of implementation included clinic and health plan interviews, clinic contact logs, and monthly periodic reflections with the facilitator team.

FINDINGS: Practice facilitation was needed to support both clinics and health plans in the study. Facilitators supported continued engagement of clinics and health plans, used workflow mapping to align implementation between clinics and health plans, provided technical support for sharing of patient data, and facilitated communication between clinics and health plans. Prior study team experience implementing CRC screening interventions enabled successful facilitation.

CONCLUSIONS: Practice facilitation can successfully support partnered health plan-clinic implementation of mailed FIT and patient navigation in rural clinics. Our findings highlight the importance of assessing support needs across all partnering organizations when implementing multilevel preventive care interventions and underscore the importance of subject matter expertise in practice facilitation.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04890054.

PMID:42572815 | DOI:10.1111/jrh.70203

Aliment Pharmacol Ther. 2026 Aug 10. doi: 10.1111/apt.70906. Online ahead of print.

ABSTRACT

BACKGROUND: Non-Helicobacter pylori (H. pylori), non-nonsteroidal anti-inflammatory drug (NSAID) peptic ulcer disease (PUD) is increasingly recognized as a distinct subgroup, but its proportion across clinical presentations remains unclear.

AIM: We aimed to estimate this proportion.

METHODS: We searched MEDLINE, Embase and CENTRAL from their inception to March 2026 for observational studies. The primary outcome was the proportion of non-H. pylori, non-NSAID PUD among adults with overall, bleeding and perforated PUD. Random-effects meta-analysis of logit-transformed proportions was performed using restricted maximum likelihood. Meta-regression assessed associations with study year, country-level H. pylori prevalence and region. Protocol registered in PROSPERO (CRD420251174202).

RESULTS: Overall, 92 studies (60,816 patients) from 32 countries were included. The pooled proportions of non-H. pylori, non-NSAID PUD cases were 13.0% (95% confidence interval [CI], 10.4-16.2) in overall PUD, 11.3% (95% CI, 8.8-14.4) in bleeding PUD, and 22.0% (95% CI, 13.1%-34.7%) in perforated PUD. In univariable meta-regression, a more recent study year was associated with a higher proportion of bleeding PUD (β = 0.076; 95% CI, 0.031-0.120). This association remained statistically significant after adjustment for country-level H. pylori prevalence (β = 0.070; 95% CI, 0.026-0.113). Lower H. pylori prevalence was also associated with a higher proportion after further adjustment for region (β = -0.025; 95% CI, -0.046 to -0.005).

CONCLUSION: Non-H. pylori, non-NSAID PUD represents a non-negligible but heterogeneous component of PUD. In bleeding PUD, exploratory ecological analyses suggest a temporal increase, potentially reflecting evolving etiologic patterns beyond H. pylori infection and NSAID exposure.

PMID:42572812 | DOI:10.1111/apt.70906

Prehosp Disaster Med. 2026 Aug 10;41(1):e20. doi: 10.1017/S1049023X26109030.

ABSTRACT

INTRODUCTION: Conflict brings excess and changing demands to local civilian health care resources. While conflict-related needs are often easily identifiable, in the aftermath of disaster or conflict, health care systems may struggle to identify changing needs, and humanitarian actors may initiate responses targeted to traumatic injuries while facing different operational realities.

AIM: This study aims to quantify the immediate changes in, and short-term trends of, Emergency Department (ED) patient profiles following a break in conflict, informing humanitarian intervention and the prioritization of local health care resources in future contexts.

METHODS: A single center, retrospective Interrupted Time Series (ITS) analysis was undertaken comprising of every patient attendance to the Nasser Medical Complex (Gaza Strip) ED from September 1, 2025 through November 30, 2025, inclusive, to evaluate the impact of the ceasefire on October 10, 2025. Binomial and negative binomial regression was used, adjusting for day-of-week confounding, with Newey-West robust standard errors. Coefficients were exponentiated to Incidence Rate Ratios for interpretation as the percentage change in the relevant presentations numbers or trend and were presented with 95% Confidence Intervals (95%CI).

RESULTS: There were 107,631 presentations over the study period, a median of 1,217 (IQR 1,120-1,291) per day prior to, and 1,202 per day (IQR 1,083-1,356) following, the ceasefire. There was no significant step-change in total presentation to the ED following ceasefire, but thereafter, relative to the pre-ceasefire trajectory, attendances experienced a sustained decrease of two percent per day (95%CI, 1.0% to 2.0% reduction; P < 0.001).There were observed changes to the profile of attendances by diagnostic group, with step-change reductions in trauma admissions, gastrointestinal, and pediatric presentations. There were daily trend reductions for multiple diagnostic groups, including traumatic injuries discharged from the ED, respiratory infections, gastrointestinal presentations, and other medical emergencies.

DISCUSSION: This study demonstrates that the implementation of a ceasefire has the potential to change presentation patterns to a civilian ED in a conflict area. While there was no step-change following the ceasefire, there was a reversal of the previous trend of rising daily presentations. It should be noted that most presentations both before and after the ceasefire were for non-traumatic events. These findings highlight the need to continue support and resource for the non-traumatic workload of emergency care during crises, a pattern described in other contexts.

PMID:42572806 | DOI:10.1017/S1049023X26109030

Int J Nephrol Renovasc Dis. 2026 Aug 5;19:602592. doi: 10.2147/IJNRD.S602592. eCollection 2026.

ABSTRACT

PURPOSE: Chronic kidney disease (CKD) is a major public health concern in the United States, with persistently rising incidence and mortality. This study aimed to quantify geographic and demographic disparities in CKD mortality across the United States and to examine the association between CKD mortality and ambient temperature variation.

PATIENTS AND METHODS: CKD deaths and age-adjusted mortality rates (AAMRs) for 1999-2023 were obtained from CDC WONDER and stratified by census region, state, sex, race, age group, and urbanization level. Mortality trends were quantified using joinpoint regression. Primary temperature-mortality analyses used CDC WONDER-linked NLDAS temperature data for 1999-2011, while supplementary descriptive analyses used independently retrieved NLDAS temperature estimates for 2012-2023. Temperature-mortality associations were evaluated using Spearman rank correlations, quasi-Poisson regression models, and distributed lag nonlinear models (DLNMs).

RESULTS: From 1999 to 2023, 628,937 CKD deaths occurred, with national AAMR increasing steadily. Mortality rates were consistently higher in men and nonmetropolitan areas. AAPC rose fastest in the West and Midwest, though recent AAMR declines were noted in the Northeast and South. Winter mortality exceeded summer across regions. In the primary DLNM analysis, cold exposure at the region-specific 5th percentile was associated with higher cumulative CKD mortality risk, with risk ration (RR) ranging from 1.065 in the Northeast to 1.505 in the Midwest; the association reached statistical significance only in the Midwest (RR 1.505, 95% CI: 1.091-2.075), while hot-exposure estimates at the 95th percentile were generally imprecise and not statistically significant.

CONCLUSION: CKD mortality in the United States increased from 1999 to 2023 with marked geographic and demographic disparities. Cold air temperature was associated with higher short-term mortality risk.

PMID:42572783 | PMC:PMC13453418 | DOI:10.2147/IJNRD.S602592

Nat Sci Sleep. 2026 Aug 5;18:604964. doi: 10.2147/NSS.S604964. eCollection 2026.

ABSTRACT

PURPOSE: Post-chemotherapy insomnia is a prevalent complication among breast cancer patients. No relevant sham-controlled studies have employed polysomnography to objectively verify acupuncture treatment effects. This single-blind randomized controlled trial assessed the short-term therapeutic effect and safety of acupuncture for insomnia occurring after breast cancer chemotherapy.

PATIENTS AND METHODS: This single-center study recruited 76 patients diagnosed with stage I-III breast cancer. All participants completed chemotherapy treatment, fulfilled ICSD-3 chronic insomnia diagnostic standards, and conformed to the TCM syndrome of Yin deficiency with excessive fire. Subjects were allocated into acupuncture group and sham acupuncture group at a 1:1 ratio with sealed opaque envelope randomization. The research spanned 9 months, including 5 weeks of biweekly intervention with 10 treatment sessions, alongside follow-up visits conducted at one week and one month after treatment termination. Clinical assessments were carried out at baseline, treatment completion, 1-week and 1-month follow-up. The primary outcome was Insomnia Severity Index score. Secondary outcomes contained PSQI, polysomnographic parameters, BAI, BDI, BFI-C and TCMSRS. All 76 randomized participants (38 cases per group) were analyzed based on intention-to-treat approach via MMRM statistical model.

RESULTS: Baseline clinical features showed no statistical difference between two groups (all p > 0.05). Significant group-time interaction was detected in ISI assessment (F = 2.80, p = 0.047). The acupuncture group exhibited more favorable symptom improvement compared with sham group. Between-group mean differences reached -1.61 (95% CI: -2.71 to -0.50, p = 0.005) after treatment, -1.75 (95% CI: -3.15 to -0.35, p = 0.015) at 1-week follow-up, and -1.77 (95% CI: -3.22 to -0.32, p = 0.017) at 1-month follow-up. Remarkable group-time interaction was also observed in PSQI (F = 4.67, p = 0.005), with acupuncture group presenting better sleep improvement at post-treatment, with mean difference of -1.18 (95% CI: -2.01 to -0.36, p = 0.006). Statistically significant interactive results were obtained in BFI-C (F = 4.07, p = 0.010), and acupuncture brought obvious fatigue relief with mean difference of -1.95 (95% CI: -3.22 to -0.68, p = 0.003). TCMSRS also showed notable interaction effect (F = 5.85, p = 0.001), and intergroup difference stood at -1.47 (95% CI: -2.34 to -0.60, p = 0.001) at 1-month follow-up. BDI scores presented significant group-time interaction (F = 3.00, p = 0.039), yet no evident pairwise difference was found in post-hoc comparison. No interactive variation existed in BAI evaluation (F = 1.69, p = 0.176). Polysomnography results demonstrated distinct advantages of acupuncture intervention. Between-group comparisons showed the treatment group obtained elevated sleep efficiency by 10.54% (95% CI: 0.75 to 20.33, p = 0.036) and increased N3 sleep proportion by 8.26% (95% CI: 3.09 to 13.43, p = 0.003). Wake after sleep onset time decreased by 32.00 minutes (95% CI: -57.50 to -0.50, p = 0.046). No severe adverse events emerged throughout the study.

CONCLUSION: Acupuncture improved insomnia severity, sleep quality, PSG-measured sleep architecture (increased sleep efficiency and N3, reduced WASO), fatigue, and TCM pattern symptoms in breast cancer patients with post-chemotherapy insomnia and the Yin deficiency with excessive fire syndrome; however, the between-group difference for the primary outcome did not reach the minimal clinically important difference; therefore, a clinically meaningful advantage over sham cannot be concluded from the current data.

CLINICAL TRIAL REGISTRATION: China Clinical Trial Registry, https://www.chictr.org.cn/; registration number: ChiCTR2400082110.

PMID:42572762 | PMC:PMC13453411 | DOI:10.2147/NSS.S604964

Adv Med Educ Pract. 2026 Aug 4;17:621664. doi: 10.2147/AMEP.S621664. eCollection 2026.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly used as learning resources in medical education, yet their performance and reliability in microbiology, a discipline with a broad, heterogeneous knowledge base, have not been systematically evaluated across multiple platforms.

OBJECTIVE: To benchmark seven publicly available LLMs on microbiology multiple-choice questions (MCQs), assessing overall accuracy, test-retest reliability, topic-specific performance, and the relationship between cognitive complexity and model performance.

METHODS: Seven LLMs (Claude 4.6 Sonnet, Gemini 3.0, ChatGPT-5.2, Grok 4, Copilot, DeepSeek V3, and Kimi K2) completed 200 MCQs distributed across 20 microbiology topics and five Bloom’s taxonomy levels in three independent sessions separated by 24-hour intervals. A total of 4200 responses were analyzed. Statistical analysis included one-way ANOVA with Tukey’s HSD post hoc tests, repeated-measures ANOVA, intraclass correlation coefficients (ICCs), and Pearson correlations.

RESULTS: The collective mean accuracy was 86.18%. Six of seven systems exceeded the 80% high-competency threshold; Claude (89.83%), Grok (89.50%), and GPT (88.83%) led the group. Gemini (72.33%) was the only underperforming system. Test-retest reliability varied dramatically: Claude achieved excellent ICC (0.966), while Gemini exhibited poor reliability (ICC = 0.290), with session-to-session fluctuations of up to 100 percentage points on individual topics. Microbial Cell (100%) was the easiest topic; Viral Genomics (61.9%) was the most challenging across all systems. A uniform decline at Bloom’s Level 4 (Analyze) was observed across all LLMs, with no model exceeding 78%.

CONCLUSION: Contemporary LLMs demonstrate substantial knowledge of microbiology but differ markedly in reliability. Response consistency, alongside accuracy, should be a primary criterion for educational deployment. These findings are specific to microbiology MCQ performance and may not generalize to open-ended clinical reasoning.

PMID:42572759 | PMC:PMC13453379 | DOI:10.2147/AMEP.S621664

Int J Gen Med. 2026 Aug 4;19:620724. doi: 10.2147/IJGM.S620724. eCollection 2026.

ABSTRACT

PURPOSE: This study aims to investigate the prevalence of ocular features, particularly refractive errors and amblyopia risk factors (ARFs), in children diagnosed with Autism Spectrum Disorder (ASD). Additionally, it seeks to explore their associations with selected prenatal factors.

METHODS: This cross-sectional study included 436 children diagnosed with ASD and 508 typically developing controls, all aged between 2 and 9 years from the Tianjin region. Refractive status was measured using the Spot Vision Screener, while ARFs were determined following the guidelines set by the American Academy of Pediatric Ophthalmology and Strabismus. Information on prenatal variables, such as the mode of delivery, maternal weight gain, and self-reported maternal emotional symptoms was gathered via parental surveys. The data were analyzed statistically using SPSS version 27.0.

RESULTS: The results showed that 42.7% of children with ASD presented refractive errors, a rate notably higher than the 36.8% observed in the control group, with hyperopia and astigmatism being the most prevalent conditions. 15.4% of children with ASD were identified as having ARFs, compared to 8.3% in the control group (P <0.05). Notably, 90% of the children with ASD had refractive errors that required correction but were left uncorrected. Prenatal factors, including cesarean delivery (OR = 2.298, P < 0.05) and self-reported maternal emotional symptoms (OR = 5.150, P < 0.05), were found to be significantly associated with both ASD and the presence of refractive errors and amblyopia in this cross-sectional analysis.

CONCLUSION: Children with ASD exhibit a higher incidence of refractive errors and ARFs, with prenatal influences playing a significant role. Additionally, the high rate of uncorrected refractive errors in this population highlights a critical gap in visual care. Early diagnosis and treatment, along with targeted management of prenatal risk factors, are critical for improving both visual health and overall developmental outcomes in this group.

TRIAL REGISTRATION: Registration number: ClinicalTrials.gov ID NCT06122519. Registration date: October 2023.

PMID:42572738 | PMC:PMC13453352 | DOI:10.2147/IJGM.S620724

Front Pharmacol. 2026 Jul 27;17:1904931. doi: 10.3389/fphar.2026.1904931. eCollection 2026.

ABSTRACT

Smoking behavior is influenced not only by nicotine dependence but also by behavioral rituals and psychological factors. The motor routines associated with smoking, such as holding and manipulating the cigarette, may represent an important behavioral component of tobacco addiction. However, the relationship between smoking-related gestures, psychological distress, and smoking behavior has received limited empirical attention. This cross-sectional study analyzed data from 787 treatment-seeking smokers undergoing clinical evaluation for tobacco dependence. Smoking behavior was assessed through the number of cigarettes smoked per day and the Fagerström Test for Nicotine Dependence (FTND). Psychological distress was evaluated using the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). Smoking-related gesturality was measured through a clinical item assessing the perceived importance of smoking gestures. Associations were examined using Spearman correlations, non-parametric group comparisons, and multivariate logistic regression. Gesturality showed a weak but statistically significant association with anxiety (ρ = -0.12, p = 0.001) and depressive symptoms (ρ = -0.13, p < 0.001). Higher gestural involvement was also associated with greater cigarette consumption (ρ = 0.10, p = 0.01). In multivariate analysis, the number of cigarettes smoked per day emerged as the only independent predictor of high gesturality (OR = 1.03, p = 0.02), while anxiety and depressive symptoms showed non-significant trends. Smoking-related gestures appear to reflect a behavioral dimension of tobacco use that is primarily associated with smoking intensity and habitual motor routines, while showing only weak inverse associations with anxiety and depressive symptoms.

PMID:42572714 | PMC:PMC13453294 | DOI:10.3389/fphar.2026.1904931

J Inflamm Res. 2026 Aug 5;19:590431. doi: 10.2147/JIR.S590431. eCollection 2026.

ABSTRACT

BACKGROUND: Macrophage-driven inflammation in adipose tissue contributes to chronic intermittent hypoxia (CIH)-induced metabolic disorders, but the underlying mechanisms remain unclear. Adiponectin (Ad), an abundant adipokine secreted by adipocytes, plays a crucial role in insulin sensitivity. We tested the hypothesis that CIH-induced macrophage inflammation requires adipocyte-derived paracrine signals and that Ad attenuates this process.

METHODS: Using a co-culture approach, we investigated the roles of adipocytes and Ad in CIH-induced macrophage inflammation. Direct co-culture involved physical interaction between iBMDM macrophages and 3T3-L1 adipocytes, while indirect co-culture used adipocyte-conditioned media. After CIH and Ad treatment, inflammatory factor levels in conditioned media were quantified. Statistical significance was set at P < 0.05.

RESULTS: CIH did not directly trigger inflammatory factor release from individually cultured iBMDM cells or 3T3-L1 adipocytes. However, CIH significantly increased inflammatory factor release in co-cultured cells. Ad alleviated the pro-inflammatory effect of adipocytes on macrophages under CIH conditions.

CONCLUSION: CIH disrupts adipocyte function and promotes macrophage inflammation via paracrine mechanisms.

PMID:42572695 | PMC:PMC13453351 | DOI:10.2147/JIR.S590431

PeerJ. 2026 Aug 6;14:e21595. doi: 10.7717/peerj.21595. eCollection 2026.

ABSTRACT

BACKGROUND: This study investigated the impact of single sessions of resistance exercise with varying training intensities and doses on serum brain-derived neurotrophic factor (BDNF) levels in older adults.

METHODS: Nine older women aged ≥65 years were recruited for a study employing a balanced-order research design, which allowed for more robust comparisons of different resistance training modalities. All the participants completed four resistance training modalities: low-set high-intensity (LsHi), high-set high-intensity (HsHi), low-set high-repetition (LsHr), and high-set high-repetition (HsHr).

RESULTS: Serum BDNF levels were measured pre- and post-exercise for each modality. While the comparison of change rates (△BDNF) across the four exercise modalities did not reach statistical significance, serum BDNF levels were significantly elevated within-group following the LsHr modality. Notably, the LsHr modality showed a trend toward greater increases in serum BDNF, with average post-exercise levels increasing by more than 30%.

CONCLUSION: Although no statistically significant differences in △BDNF were observed between the four modalities, these findings provide preliminary evidence that a muscular endurance-focused resistance training protocol (LsHr) may be effective in eliciting acute BDNF elevations in older adults. These results suggest that the interplay between training volume and intensity warrants further investigation. Given the exploratory nature of this study, our findings indicate that while LsHr shows potential, further research with larger cohorts is necessary to definitively establish whether training dose or specific modality configuration is the primary driver of BDNF modulation.

PMID:42572691 | PMC:PMC13453137 | DOI:10.7717/peerj.21595