Nevin Manimala

Asian J Androl. 2026 Mar 24. doi: 10.4103/aja202584. Online ahead of print.

ABSTRACT

Erectile dysfunction (ED) is increasingly recognized as an early clinical marker of cardiovascular disease (CVD); however, the causal role of familial predisposition to CVD in ED development remains insufficiently defined. This study investigated whether genetic susceptibility associated with a parental history of CVD exerts a causal influence on ED risk, integrating clinical data with Mendelian randomization (MR) analysis. A cohort of 288 men who attended the Department of Andrology of Xiangya Hospital (Changsha, China) between June 2017 and June 2023 were recruited, comprising 223 patients with clinically confirmed ED and 65 controls. Detailed demographic, cardiovascular, and ED severity data were collected. Genetic variants associated with ED and parental CVD history were obtained from genome-wide association study (GWAS) summary statistics, and two-sample MR analyses were conducted to evaluate causal effects. Clinically, men with ED were significantly older, exhibited higher body mass index (BMI), and demonstrated lower testosterone levels compared with controls. A trend toward an association between family history of CVD and ED was observed. MR analyses provided robust evidence of causality, with paternal CVD history increasing ED risk and maternal CVD history exerting an even stronger effect. Sensitivity analyses confirmed the stability of these findings without evidence of pleiotropic bias. Collectively, these results indicate that familial genetic susceptibility to CVD independently contributes to the risk of ED. These findings underscore the clinical importance of incorporating family history into ED risk stratification and highlight the need for early screening and preventive strategies in men with a family history of CVD. Proactive management of this high-risk population may mitigate the future burden of ED and its cardiovascular sequelae.

PMID:41873544 | DOI:10.4103/aja202584

Stroke. 2026 Mar 24. doi: 10.1161/STROKEAHA.125.053989. Online ahead of print.

ABSTRACT

BACKGROUND: Early intensive blood pressure (BP) lowering improves outcomes in acute intracerebral hemorrhage, but its perioperative benefit among patients undergoing surgical hematoma evacuation is uncertain. We evaluated whether earlier achievement of intensive BP targets is associated with improved outcomes in this population.

METHODS: Post hoc secondary analysis of the INTERACT3 (the third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial) pragmatic, international, multicenter, blinded-end point, and stepped-wedge cluster-randomized trial. Among 7036 enrolled intracerebral hemorrhage patients at 121 hospitals, those who underwent surgical hematoma evacuation were included. Patients were categorized by time from hospital arrival to achieving the target systolic BP <140 mm Hg: ≤2 hours versus >2 hours. The primary outcome was 6-month mortality. Key secondary outcomes included death or disability (modified Rankin Scale scores 4-6), modified Rankin Scale score shift, health-related quality-of-life (EuroQol 5-Dimension 3-Level [EQ-5D-3L] domains, visual analog scale, and health utility index), and serious adverse events. Adjusted associations were estimated using Cox, logistic, ordinal logistic, and linear regression models, controlling for age, sex, treatment type, and admission Glasgow Coma Scale.

RESULTS: Of 7036 patients with acute intracerebral hemorrhage, 1506 underwent surgical hematoma evacuation (mean [SD] age, 59.7 [11.8] years; 33.9% women). Overall, there was no statistically significant difference in 6-month mortality between patients who achieved target BP within 2 hours of treatment initiation and those who achieved it after 2 hours (adjusted hazard ratio, 0.81 [95% CI, 0.63-1.04]; P=0.09). Early BP achievement was associated with a lower risk of death or disability (adjusted odds ratio [OR], 0.71 [95% CI, 0.56-0.90]; P=0.01), a favorable shift in the distribution of modified Rankin Scale scores (adjusted common OR, 0.73 [95% CI, 0.60-0.89]; P<0.01), and fewer serious adverse events (adjusted OR, 0.73 [95% CI, 0.57-0.94]; P=0.02). EuroQol 5-Dimension 3-Level outcomes also favored the early group, with significant improvements in mobility (adjusted OR, 0.76 [95% CI, 0.60-0.97]; P=0.03), pain/discomfort (adjusted OR, 0.72 [95% CI, 0.54-0.95]; P=0.02), and usual activities (adjusted OR, 0.79 [95% CI, 0.62-1.00]; P=0.05), as well as higher VAS (mean difference, 0.08 [95% CI, 0.002-0.17]; P=0.04) and health utility scores (mean difference, 0.05 [95% CI, 0.02-0.09]; P<0.01).

CONCLUSIONS: In patients with intracerebral hemorrhage undergoing surgical hematoma evacuation, perioperative intensive BP reduction appears safe. Achieving systolic BP <140 mm Hg within 2 hours was associated with better functional and quality-of-life outcomes, and fewer serious adverse events. These time-sensitive associations support prioritizing ultraearly perioperative BP control; confirmatory prospective analyses are warranted.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03209258.

PMID:41873543 | DOI:10.1161/STROKEAHA.125.053989

Med J Aust. 2026 Mar;224(3):e70172. doi: 10.5694/mja2.70172.

ABSTRACT

Elder abuse can lead to serious physical injuries and long-term psychological consequences, but its recognition and documentation in healthcare settings remain limited. This study used linked data from four Australian states to examine elder abuse coded during emergency department presentations and hospitalisations among 965,986 older people assessed for aged care services between 2010 and 2019. Only 580 people (0.06%) had elder abuse coded during an emergency department presentation or hospitalisation, highlighting substantial under-recognition and under-reporting in hospital settings.

PMID:41873537 | DOI:10.5694/mja2.70172

J Nurs Manag. 2026;2026(1):e3056495. doi: 10.1155/jonm/3056495.

ABSTRACT

AIM: To identify factors associated with usability and adoption of continuous monitoring with deterioration alerting systems (CM-DAS) in non-ICU wards from clinicians’ perspectives.

BACKGROUND: Patient deterioration is a safety concern on general wards; intermittent vital sign checks can miss early decline. CM-DAS can help, but impact depends on usability and clinician adoption, which remain variably achieved.

METHODS: Convergent mixed methods using the unified theory of acceptance and use of technology (UTAUT) model to guide data collection: An online UTAUT-based survey (n = 111 clinicians, 20 countries; April-August 2023) and semistructured interviews (n = 10) were conducted. Quantitative data were analysed with nonparametric tests and composite PLS-SEM (3000 bootstraps); qualitative data underwent thematic analysis; findings were integrated narratively.

RESULTS: Perceived usefulness and ease of use were positively associated with the intention to adopt CM-DAS. In the multivariable PLS-SEM, only intention to use the system (β ˜ 0.29, p ˜ 0.01) and prior CM-DAS experience (β ˜ 0.28, p ˜ 0.01) were associated with routine bedside use; other constructs did not retain independent associations, and variance explained was modest (R²_use≈0.15). Interviews corroborated benefits (patient safety and workflow) and highlighted barriers-false alarms, reliability/connectivity issues, technical language/user interface and gaps in support and training. Peer practices and patient/family responses shaped the climate for adoption.

CONCLUSIONS: This study suggests that ensuring reliable infrastructure (signal stability, hospital Wi-Fi and integration with EHR) is foundational for safe and sustained CM-DAS operation. Routine use was most closely associated with clinicians’ intention to use the system and accumulated experience. Factors such as how easy a system is to use and how individuals perceived its usefulness strengthened an individual’s intention to use the system.

IMPLICATIONS FOR NURSING MANAGEMENT: Management should prioritise reliable infrastructure, implement tiered alarm governance to reduce nonactionable alerts, designate ward super-users supported by vendor service-level agreements and deliver brief, recurring, practice-embedded training so that intention translates into sustained, safe bedside use.

PMID:41873534 | DOI:10.1155/jonm/3056495

J Magn Reson Imaging. 2026 Mar 24. doi: 10.1002/jmri.70302. Online ahead of print.

ABSTRACT

BACKGROUND: Venous pulsatile tinnitus (VPT) is associated with transverse-sigmoid sinus (TSS) anomalies, bone dehiscence (BD), and hemodynamic disturbances. 4D Flow MRI enables comprehensive TSS evaluation, but causal relationships among TSS morphology, hemodynamics, and BD in VPT onset and progression remain unquantified. Reliable imaging predictors for VPT progression and BD’s mediating role are unestablished.

PURPOSE: To construct a directed acyclic graph (DAG) testing whether stenosis-induced hemodynamic abnormalities and bone changes predict VPT occurrence and 6-month progression.

STUDY TYPE: Prospective longitudinal cohort study.

POPULATION: 126 unilateral VPT patients (36 [31-44] years; 73.0% female) and 83 matched non-VPT participants (35 [28-42] years; 71.1% female); all VPT patients completed 6-month symptom follow-up.

FIELD STRENGTH/SEQUENCE: 3 T multi-shot turbo field echo 4D Flow MRI and fast field echo phase-contrast MR venography (PC MRV).

ASSESSMENT: Three blinded neuroradiologists independently assessed TSS morphology, hemodynamic indices, and petrous BD using PC MRV, 4D Flow MRI, and high-resolution CT multiplanar reconstruction. Interobserver reliability was evaluated with discrepancies resolved by consensus.

STATISTICAL TESTS: Kolmogorov-Smirnov, Chi-Square, Mann-Whitney U test, FDR-corrected correlation analysis, linear/logistic regression, mediation analysis, and ROC curve analysis.

SIGNIFICANCE: p < 0.05.

RESULTS: 74.6% of VPT patients had 6-month progression (increased Tinnitus Handicap Inventory, THI score vs. baseline). Peak flow velocity (38.79 cm/s cut-off) independently predicted 6-month progression (area under the curve, AUC = 0.840; 95% confidence interval, CI: 0.755-0.925). TSS stenosis combined with hemodynamic parameters predicted VPT occurrence (AUC = 0.895, 95% CI: 0.855-0.936). Mediation analysis confirmed BD mediated the effect of wall shear stress on THI. Hierarchical causal pathways among TSS morphology, hemodynamics, BD, and VPT were identified to verify quantifiable DAG.

DATA CONCLUSION: TSS stenosis initiates hemodynamic disturbances and bone changes, which collectively drive VPT occurrence and 6-month progression. Integrating these morphological and hemodynamic parameters yields accurate predictive models.

EVIDENCE LEVEL: 4.

TECHNICAL EFFICACY: Stage 3.

PMID:41873517 | DOI:10.1002/jmri.70302

Res Synth Methods. 2026 Mar 24:1-19. doi: 10.1017/rsm.2026.10081. Online ahead of print.

ABSTRACT

Meta-analytic-predictive (MAP) priors have been proposed as a generic approach to deriving informative prior distributions, where external empirical data are processed to learn about certain parameter distributions. The use of MAP priors is also closely related to shrinkage estimation (also sometimes referred to as dynamic borrowing). A potentially odd situation arises when the external data consist only of a single study. Conceptually, this is not a problem, it only implies that certain prior assumptions gain in importance and need to be specified with particular care. We outline this important, not uncommon special case and demonstrate its implementation and interpretation based on the normal-normal hierarchical model. The approach is illustrated using example applications in clinical medicine.

PMID:41873516 | DOI:10.1017/rsm.2026.10081

Eur J Psychotraumatol. 2026 Dec;17(1):2635919. doi: 10.1080/20008066.2026.2635919. Epub 2026 Mar 24.

ABSTRACT

Background: Evidence on the long-term mental and physical health effects of disaster-related bereavement remains limited.Objective: To compare long-term healthcare utilisation and disease incidence among individuals bereaved in the Sewol ferry disaster with matched controls.Method: This retrospective cohort study used Korean National Health Insurance data to match 388 bereaved individuals with 1,552 controls. Healthcare utilisation and disease incidence were examined over three years pre-disaster and eight years post-disaster using difference-in-differences and Cox proportional hazards models.Results: Psychiatric outpatient utilisation among the bereaved increased from 10% pre-disaster to 38% in year 1, stabilised around 20%, and rose again to 38% in year 8, whereas controls showed a gradual increase to 22%. Difference-in-differences analyses demonstrated significantly higher psychiatric outpatient visits in the bereaved group, with excess visits of 2.87 (95% CI 1.52-4.22) in years 1-3, 1.86 (0.51-3.21) in years 4-6, and 1.56 (0.21-2.91) in years 7-8. Psychiatric admissions also increased significantly across post-disaster periods. Physical outpatient visits showed delayed excess increases in years 4-6 and 7-8. Cox models indicated elevated risks for infectious, benign neoplastic, endocrine, mental, neurological, digestive, dermatological, and musculoskeletal disorders, as well as abnormal findings and injury.Conclusions: Eight years after the disaster, bereaved individuals continued to exhibit persistent mental health problems and greater physical healthcare utilisation. These findings highlight the need for long-term, integrated support addressing both mental and physical health beyond the immediate aftermath of disasters.

PMID:41873512 | DOI:10.1080/20008066.2026.2635919

J Nurs Manag. 2026;2026(1):e3543130. doi: 10.1155/jonm/3543130.

ABSTRACT

BACKGROUND: Problematic mobile phone use is an emerging public health issue, the prevalence of which has increased among nurses.

AIM: To synthesize and describe knowledge on problematic mobile phone use by nurses, its consequences, and strategies for addressing this phenomenon.

DESIGN: A systematic review was conducted following the checklist Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. This systematic review has been registered in PROSPERO (CRD420251052591).

METHODS: Four electronic databases were systematically searched from their inception to September 2025. The article’s reference lists were also manually searched. The study selection was carried out in three stages, with two reviewers independently analyzing the data and resolving disagreements. The quality assessment utilized the Mixed Method Appraisal Tool, considering the criteria established for each study design.

RESULTS: Sixteen studies from four online databases were selected, the majority of which were cross-sectional and descriptive. The risk factors for problematic mobile phone use, the negative consequences for mental and physical health, and the clinical work of nurses were highlighted, such as a combination of strategies to prevent and mitigate problematic mobile phone use in the clinical setting.

CONCLUSION: The problematic mobile phone use of nurses negatively affects their mental and physical health, as well as their performance in the clinical setting.

IMPLICATION FOR NURSING MANAGEMENT: The findings of this study may inform the need for nursing managers to develop and implement strategies to prevent and mitigate the problematic use of these devices among nurses and ensure the appropriate use of mobile phones in the clinical setting.

PMID:41873504 | DOI:10.1155/jonm/3543130

Hum Vaccin Immunother. 2026 Dec;22(1):2633892. doi: 10.1080/21645515.2026.2633892. Epub 2026 Mar 24.

ABSTRACT

As life expectancy increases, age-related diseases become more frequent and severe, making vaccination a key strategy for disease prevention. To assess the knowledge and attitudes toward herpes zoster and to determine associations with acceptability of vaccination among patients and dermatologists, a descriptive and quantitative analytic cross-sectional survey-based study was conducted among patients aged ≥50 y in a tertiary hospital, and dermatologists in the Philippines. Majority of dermatologists had good knowledge (97.5%) and attitudes (99.7%) toward vaccination. Reported barriers were vaccine cost, procurement, and storage. Only 32.8% of patients were aware of herpes zoster, of which 61.7% had good knowledge and 99.2% had positive attitudes toward vaccination. Majority (87.0%) were willing to be vaccinated. Fear of side effects and unwillingness to pay limited acceptance. Knowledge did not impact vaccine acceptance, but favorable attitudes were associated with acceptance in both groups. Recall and social desirability bias cannot be ruled out, and sampling of patients was limited to a single outpatient clinic. Overall, Filipino dermatologists exhibit high levels of knowledge, positive attitudes, and vaccine acceptability. While patient awareness was limited, vaccine acceptability is high, particularly when recommended by a physician, highlighting their critical role in primary care.

PMID:41873494 | DOI:10.1080/21645515.2026.2633892

Future Microbiol. 2026 Mar 24:1-7. doi: 10.1080/17460913.2026.2645506. Online ahead of print.

ABSTRACT

Vaccination programs have averted millions of childhood deaths, yet vaccine-preventable diseases (VPDs) continue to resurge as coverage declines and pathogen evolution undermines previously successful vaccines. Anticipating resurgence is a public health priority. We review theoretical and empirical advances in the study of early warning signals (EWS) of epidemic transitions, with a focus on critical slowing down (CSD) – a phenomenon in which recovery from perturbations becomes slower near the epidemic threshold. We summarize the mechanisms that generate CSD, indicators that can be extracted from surveillance data, and the conditions under which signals may be detectable. We then examine case studies to illustrate the opportunities and challenges of applying EWS to VPD resurgence. Theory and computer simulations show that CSD can precede both elimination and resurgence, with increases in variance and autocorrelation calculated from disease surveillance reports emerging as consistent indicators. Empirical evidence supports this potential, though performance depends on noise structure, seasonality, spatial clustering, and outbreak responses. Case studies highlight both successful applications and contexts where signals were weak or absent. EWS offer a promising framework for anticipating VPD resurgence, but further research is required to refine methods, integrate mechanistic and social-behavioral drivers, and evaluate applicability across pathogens and settings.

PMID:41873479 | DOI:10.1080/17460913.2026.2645506