Nevin Manimala

J Educ Health Promot. 2026 Jun 30;15:250. doi: 10.4103/jehp.jehp_1342_25. eCollection 2026.

ABSTRACT

BACKGROUND: Prolonged QTc interval and reduced heart rate variability (HRV) are independent predictors of postexercise sudden cardiac death (SCD) in apparently healthy individuals. Offspring of hypertensive parents may exhibit early autonomic dysfunction, placing them at higher risk for future cardiovascular disease. This study evaluated the impact of submaximal aerobic exercise on QTc interval and its correlation with HRV in normotensive individuals with and without parental hypertension.

MATERIALS AND METHODS: A cross-sectional study was conducted on 100 healthy medical students (18-25 years), divided into normotensive offspring of hypertensive parents (NOHPs, n = 50) and sex-matched offspring of normotensive parents (NONPs, n = 50). HRV and lead-II ECG were recorded in supine rest and 10 minutes postexercise. Participants underwent a standardized submaximal treadmill test using a modified Bruce protocol, targeting 50% VO₂max to ensure uniform workload. HRV indices (LFnu, HFnu, LF/HF ratio) and QTc (Bazett’s correction) were analyzed with statistical significance set at P < 0.05.

RESULTS: Following exercise, NOHPs exhibited significantly prolonged QTc, higher LFnu, and elevated LF/HF ratio, alongside a reduction in HFnu compared with NONPs, indicating sympathovagal imbalance characterized by sympathetic predominance and vagal withdrawal. Correlation analysis revealed strong positive associations of QTc with LFnu and LF/HF ratio, and a negative association with HFnu in NOHPs during recovery.

CONCLUSION: Submaximal exercise unmasks latent autonomic dysfunction in NOHPs, reflected as impaired vagal reactivation and augmented sympathetic drive, which is closely linked to prolonged QTc during recovery. The study highlights that combined QTc-HRV assessment, particularly after standardized exercise using the modified Bruce protocol, may serve as a sensitive early marker of repolarization instability and elevated arrhythmic risk in young individuals with genetic predisposition to hypertension.

PMID:42491979 | PMC:PMC13378863 | DOI:10.4103/jehp.jehp_1342_25

J Educ Health Promot. 2026 Jun 30;15:241. doi: 10.4103/jehp.jehp_1956_24. eCollection 2026.

ABSTRACT

Clinical training plays a crucial role in the quality of medical education and student satisfaction. This study aimed to evaluate the effectiveness of e-learning in teaching nasogastric intubation skills compared with traditional face-to-face training among medical students. A quasi-experimental study was conducted in 2022 at Islamic Azad University, Najafabad Branch, involving 37 eighth-semester medical students selected through convenience sampling. Participants were divided into two groups: face-to-face training (n = 19) and e-learning (n = 18). Skill acquisition was assessed using a structured checklist, and student satisfaction was measured using a questionnaire. Data were analyzed using SPSS, employing independent and dependent t-tests, the Kolmogorov-Smirnov test, and the Mann-Whitney test. The results showed that the e-learning group achieved significantly higher skill scores compared with the traditional group (P = 0.003). Although satisfaction scores were higher in the e-learning group, the difference was not statistically significant (P = 0.61). These findings suggest that well-designed e-learning can be as effective as traditional methods for clinical skills training, offering a flexible and efficient alternative without reducing student satisfaction.

PMID:42491966 | PMC:PMC13378860 | DOI:10.4103/jehp.jehp_1956_24

J Educ Health Promot. 2026 Jun 30;15:254. doi: 10.4103/jehp.jehp_1585_25. eCollection 2026.

ABSTRACT

BACKGROUND: Telenursing, the application of telecommunications technology to deliver nursing care, is increasingly recognized as a strategy to enhance healthcare access and efficiency. Understanding undergraduate nursing students’ knowledge and perception of telenursing is critical for guiding curriculum development and promoting technology adoption in future practice.

MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 276 undergraduate nursing students at the University of Calabar, selected through stratified random sampling. Data were collected using a structured, self-administered questionnaire and analyzed with descriptive statistics and Chi-square tests. Perception was categorized as “good” when students scored ≥70% on the Likert scale section of the instrument.

RESULTS: Most students (96.0%) were aware of telenursing; however, only 22.8% had direct exposure to telenursing tools, and 13.4% were familiar with applications such as teleconferencing or teleconsultation. Less than half recognized its role in continuing nursing care (47.8%) or its usefulness in managing chronic conditions and surgical patients (34.1%). Overall, 49.3% of students demonstrated good perception, while 50.7% had poor perception. Significant associations were observed between perception and knowledge scores (P < 0.05), as well as between knowledge and students’ year of study and digital literacy levels (P < 0.05).

CONCLUSION: Despite high awareness of telenursing, practical exposure and comprehensive understanding remain limited among undergraduate nursing students in Nigeria. Integrating targeted telenursing training, enhancing digital literacy, and redesigning nursing curricula are recommended to improve readiness for technology-driven healthcare delivery.

PMID:42491963 | PMC:PMC13378809 | DOI:10.4103/jehp.jehp_1585_25

J Educ Health Promot. 2026 Jun 30;15:268. doi: 10.4103/jehp.jehp_257_25. eCollection 2026.

ABSTRACT

BACKGROUND: Empowering healthcare providers is a crucial strategy for enhancing the quality of primary healthcare. This study aimed to investigate the effect of online multimedia psychoeducational interventions on the psychological empowerment of healthcare providers.

MATERIALS AND METHODS: This quasi-experimental study was conducted in 2024 on 80 healthcare providers working in comprehensive health centers in Shiraz City, Iran. Convenience sampling was applied in this study. The intervention group received online multimedia psychoeducational interventions over 2 weeks. These interventions consisted of 14 daily modules. Participants completed the Spreitzer and Mishra Psychological Empowerment Questionnaire before the intervention and again 1 month afterward. Data were analyzed using SPSS version 26 [IBM Corp. Released 2015. IBM SPSS Statistics for Windows, version 23.0. Armonk, NY: IBM Corp.], employing t-test, independent t-test, Chisquare test, and Cohen’s effect size index.

RESULTS: The findings showed a significant difference in the psychological empowerment scores before and after the training program in the intervention group (P < 0.001) compared to the control group (P = 0.20). This result is further supported by a very large Cohen’s effect size (ES = 3.1).

CONCLUSION: The results indicate that online multimedia psychoeducational interventions can be an effective method for training and enhancing psychological empowerment. Psychological empowerment training programs should be integrated into the curriculum for students who will later be employed as healthcare providers in healthcare systems. This study was conducted on urban health centers. Future research should explore the impact of such interventions on healthcare providers working in rural health centers.

PMID:42491961 | PMC:PMC13378822 | DOI:10.4103/jehp.jehp_257_25

J Educ Health Promot. 2026 Jun 30;15:244. doi: 10.4103/jehp.jehp_1131_25. eCollection 2026.

ABSTRACT

BACKGROUND: Sewage treatment is the process of removing contaminants from wastewater, primarily household sewage and produce environmentally safe treated effluent which is done at the sewage treatment plants. International labor organization (ILO) classifies hazards among sewage treatment plant (STP) workers as accidental, physical, chemical, biological, ergonomical, and psychological. Current study was conducted to assess the occupational hazards and the various factors influencing it among the sewage treatment plant workers.

MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 112 sewage treatment plant workers working at 3 sewage treatment plants, in Bangalore, for a period of 2 months from May to June 2017. The data were collected from the subjects after obtaining informed consent using a pretested semistructured questionnaire by interview technique. The results were expressed using descriptive and inferential statistics.

RESULTS: In this study, majority, i.e., 82.0%, of the study subjects were men and the mean age was 36.39 ± 10.81 years. The most common hazards among the STP workers were musculoskeletal injuries (44.6%), lifting of heavy weights (36.6%), awkward working postures, discomfort to bad smells (35.7%), excessive noise (34.8%), and cuts and pricks by sharp tools (20.5%). Among the various factors assessed, work experience was significantly associated with occupational hazard (P < 0.05).

CONCLUSION: Most common occupational hazard among the STP workers was ergonomic related, i.e., musculoskeletal injuries (44.6%), and less work experience was significantly associated with it. Hazards can be reduced using ergonomically designed tools and proper training of the workers.

PMID:42491959 | PMC:PMC13378798 | DOI:10.4103/jehp.jehp_1131_25

J Educ Health Promot. 2026 Jun 30;15:263. doi: 10.4103/jehp.jehp_1720_25. eCollection 2026.

ABSTRACT

BACKGROUND: Opisthorchis viverrini (OV) infection remains a major public health issue in the Mekong Basin and a leading cause of cholangiocarcinoma (CCA). This study identified determinants of OV/CCA preventive behaviors in Champasak Province, Lao People’s Democratic Republic (PDR), using the theory of planned behavior and social support.

MATERIALS AND METHODS: A community-based cross-sectional study was conducted from January to March 2025 among 577 residents aged ≥20 years in one city and nine districts of Champasak Province, southern Lao PDR. Participants were selected using multi-stage random sampling. Data were obtained through a validated structured questionnaire covering demographics, knowledge, perceived behavioral control, social support, and preventive behaviors. Data were analyzed using descriptive statistics, Pearson’s correlation, and multiple linear regression at a significance level of P < 0.05.

RESULTS: Overall, 40.21% of participants had low knowledge, while 81.28% reported moderate preventive behaviors. Preventive behaviors were positively correlated with education, knowledge, perceived behavioral control, and social support, but negatively with age. Regression analysis showed that social support (β =0.36, 95% confidence interval [CI]: 0.28-0.44, P < 0.001), knowledge (β =0.21, 95% CI: 0.12-0.30, P < 0.001), and perceived behavioral control (β =0.18, 95% CI: 0.10-0.26, P < 0.001) were significant predictors. The final model explained 26.00% of the variance in preventive behaviors (adjusted R² =0.26, P < 0.001).

CONCLUSION: Social support, knowledge, and perceived behavioral control significantly influence preventive behaviors against OV/CCA. Strengthening community engagement and behavioral self-efficacy may improve long-term prevention outcomes.

PMID:42491955 | PMC:PMC13378850 | DOI:10.4103/jehp.jehp_1720_25

Cancer Res Commun. 2026 Jul 23. doi: 10.1158/2767-9764.CRC-26-0373. Online ahead of print.

ABSTRACT

As Helicobacter pylori prevalence declines, understanding the contribution of modifiable systemic factors to gastric cancer (GC) risk becomes increasingly important. We evaluated the association of metabolic syndrome (MetS), its individual components, and anatomical subsites with incident GC in 471,540 UK Biobank participants. Multivariable Cox proportional hazards models were used to estimate the risk of overall, cardia, and non-cardia GC, and restricted cubic splines were used for exploratory non-linear analyses. Over a mean follow-up of 6.5 years, 332 incident GC cases were identified. In the fully adjusted model, baseline MetS was associated with increased GC risk (HR = 1.36, 95% CI: 1.08-1.71). A positive trend was observed with the accumulation of metabolic components (P trend = 0.033). Subsite analyses showed a directionally positive association for cardia GC (HR = 1.48, 95% CI: 1.03-2.11) and a non-significant positive association for non-cardia GC (HR = 1.28, 95% CI: 0.95-1.73); however, formal testing found no statistical evidence of subsite heterogeneity (P heterogeneity = 0.547). Exploratory spline analysis suggested a possible non-linear association for systolic blood pressure. Overall, MetS and the accumulation of its components were associated with a moderately increased risk of GC. Waist circumference showed the most consistent component-level signal, and further studies are needed to clarify the role of metabolic health in GC risk assessment.

PMID:42490138 | DOI:10.1158/2767-9764.CRC-26-0373

J Pediatr Orthop. 2026 Jul 24. doi: 10.1097/BPO.0000000000003424. Online ahead of print.

ABSTRACT

INTRODUCTION: STAC3 Disorder (STAC3D) is a rare genetic condition characterized by musculoskeletal abnormalities, myopathic facies, palatal anomalies, micrognathia, short stature, and an increased susceptibility to malignant hyperthermia. It was initially described in the Lumbee Native Americans of North Carolina, though it is now found globally. This study aims to characterize the musculoskeletal phenotype of STAC3D to aid in its diagnosis and clinical management.

METHODS: A retrospective cohort study of STAC3D patients from 2014 to 2025 at a single institution was conducted. Patients diagnosed with STAC3D were included. Data collected included demographics, genetic testing, musculoskeletal conditions, and their management. Descriptive and comparative statistics were utilized, with rates reported as percentages and variables expressed as median and means with standard deviation.

RESULTS: A total of 26 patients met the selection criteria and were included; 23 patients had musculoskeletal data available for analysis. The median age at diagnosis and time of data collection was 22 days and 4 years (25 d to 55 y), respectively (n=26). The median height and weight percentiles are 1%. In all, 83% (n=19/23) of patients had scoliosis, 48% (n=11/23) had hyperkyphosis, 61% (n=14/23) had joint contractures (8 upper extremity, 3 lower extremity, 3 unspecified), and 61% (n=14/23) had a congenital foot deformity (13 clubfoot deformities, 1 bilateral vertical talus). In all, 57% (n=13/23) of all STAC3D patients required at least one orthopaedic procedure, 78% (n=18/23) underwent at least one non-orthopaedic surgery, and 87% (n=20/23) had at least one general anesthesia event.

CONCLUSION: STAC3D is associated with many musculoskeletal problems, including spinal and congenital foot deformities, joint contractures, and other less frequent pathologies. This study is the first to assess the rates of all musculoskeletal conditions in STAC3D patients. Our cohort represents the largest North American cohort and the second largest global cohort of STAC3D patients in the current literature. The results of our study aim to facilitate early diagnosis and expectation management of STAC3D.

LEVEL OF EVIDENCE IV: This is a retrospective cohort study aimed at describing the musculoskeletal conditions associated with STAC3D.

PMID:42490135 | DOI:10.1097/BPO.0000000000003424

JAMA Netw Open. 2026 Jul 1;9(7):e2624772. doi: 10.1001/jamanetworkopen.2026.24772.

ABSTRACT

IMPORTANCE: Despite the goal of utilization management (UM) to facilitate high-value cancer care, concerns about care denials persist. Evaluating justifications for denied claims can clarify the quality of UM decisions.

OBJECTIVE: To examine second-level appeals for denied anticancer medications in Medicare Part D to assess the quality of UM decisions.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a large language model (ChatGPT 5 Mini, OpenAI) to analyze texts of second-level appeals decisions on denied Part D medications, rendered by a Medicare-contracted reviewer. Data were analyzed from March 13, 2025, to May 12, 2026.

MAIN OUTCOMES AND MEASURES: From decision summaries, the reasons for first-level denials (as cited by Part D plans) and the outcomes of second-level appeals (favorable vs unfavorable) were examined. The reasons for unfavorable reviews (clerical vs nonclerical) were also examined.

RESULTS: We included 4952 second-level appeals from 2020 to 2024 by beneficiaries with hematological (n = 1155 [23.3%]), prostate (n = 876 [17.7%]), digestive (n = 650 [13.1%]), breast (n = 613 [12.%]), and lung, bronchus, and respiratory (n = 430 [8.7%]) cancers. Most appeals were for targeted therapy (n = 2889 [58.9%]) or hormonal therapy (n = 959 [19.4%]). The most common reasons for initial denial or appeals were “non-medically acceptable” indications (ie, off-label use; 3410 [68.9%]), formulary exceptions (545 [11.0%]), and failure to meet preapproval coverage criteria (mostly on-label prescribing; 463 [9.3%]). Overall, 19.5% (95% CI, 18.4%-20.6%) received favorable reviews, and 55.2% (95% CI, 53.8%-56.6%) and 25.3% (95% CI, 24.1%-26.5%) received unfavorable reviews due to clerical and nonclerical issues, respectively. Favorable reviews were more prevalent among appeals for drugs initially failing to meet preapproval coverage criteria (61.1% [95% CI, 56.7%-65.6%]), but less so among appeals for off-label therapies (16.5% [95% CI, 15.2%-17.8%]). More than 87.9% (95% CI, 86.1%-89.6%) of successfully appealed off-label therapies were for medically acceptable indications supported by Medicare-approved clinical compendia and/or peer-reviewed literature.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of second-level appeals for denied anticancer medications in Medicare Part D, a considerable number of successfully appealed claims (especially for therapies prescribed on label) were found, which suggests potentially inappropriate UM decisions by Part D plans. However, the appeal outcomes varied substantially by the nature of the denials. Streamlining the preapproval process for on-label therapies and establishing accessible, transparent criteria for off-label prescribing may optimize UM processes for anticancer medications.

PMID:42490111 | DOI:10.1001/jamanetworkopen.2026.24772

JAMA Netw Open. 2026 Jul 1;9(7):e2624972. doi: 10.1001/jamanetworkopen.2026.24972.

ABSTRACT

IMPORTANCE: The transition from child restraint systems (CRSs) to seat belts (SBs) is often based on fixed age or height thresholds. However, the association between height and injury patterns among injured children remains insufficiently characterized within clinical trauma settings.

OBJECTIVES: To examine the association between height and regional injury patterns among children involved in motor vehicle crashes evaluated at trauma centers and to assess how these patterns vary between CRS and SB users.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of children 6 to 11 years old who were involved in motor vehicle crashes evaluated at trauma centers used inverse probability of treatment weighting with gradient boosting machine-derived propensity scores and restricted cubic spline modeling to evaluate height-dependent associations between protective device and injury pattern. Data from the American College of Surgeons-Trauma Quality Improvement Program (2017-2020) were used. Statistical analyses were conducted between June 1, and August 31, 2025.

MAIN OUTCOMES AND MEASURES: Prevalence of severe regional injuries (Abbreviated Injury Scale score ≥3).

RESULTS: A total of 6503 children aged 6 to 11 years (mean [SD] age, 8.48 [1.69] years; 3251 male [50.0%], 3252 female [50.0%]) were identified from the database; 1066 (16.4%) had used a CRS. After weighting, CRS use was associated with a higher prevalence of severe head and neck injury (13.9% vs 10.5%; odds ratio, 1.41; 95% CI, 1.06-1.88, P = .02) and severe spinal cord injury (2.9% vs 1.8%; odds ratio, 1.70; 95% CI, 1.02-2.84, P = .04) compared with SB use. Height-dependent analysis revealed a nonlinear association between restraint type and injury patterns. Among children measuring 110 to 140 cm, CRS use was associated with a higher prevalence of severe spinal and thoracic injuries, whereas the prevalence of abdominal injury was lower within the same height range.

CONCLUSIONS AND RELEVANCE: In this cohort study, the association between protective devices and injury patterns was height dependent and nonlinear. A shift in regional injury anatomy was observed across the 110- to 140-cm spectrum, suggesting that a uniform threshold may not adequately characterize growth-specific vulnerabilities.

PMID:42490109 | DOI:10.1001/jamanetworkopen.2026.24972