Nevin Manimala

Reprod Health. 2026 May 23. doi: 10.1186/s12978-026-02371-4. Online ahead of print.

ABSTRACT

INTRODUCTION: The immediate postpartum period represents a critical yet underutilized opportunity to prevent unintended and closely spaced pregnancies, particularly in low- and middle-income countries. In Rwanda, despite high rates of facility-based delivery, initiation of contraception before hospital discharge remains suboptimal. Evidence on how sociodemographic characteristics, childbirth-related factors, male partner presence during childbirth, and health provider practices jointly determine immediate postpartum family planning (IPPFP) uptake is limited. This study assessed IPPFP uptake, examined male partner involvement, and identified associated factors.

METHODS: The study was conducted in the maternity units of Muhima District Hospital and King Faisal Hospital in Kigali, Rwanda. Quantitative data were collected from 480 women aged ≥ 18 years within 96 h postpartum. Qualitative in-depth interviews were conducted with five male partners to explore perspectives on postpartum contraceptive decision-making. Immediate postpartum family planning was defined as self-reported initiation of a modern contraceptive method before discharge. Quantitative data were analyzed using descriptive statistics, chi-square tests, and regression analysis, and qualitative data were analyzed thematically to complement quantitative findings.

RESULTS: Overall, 60.6% (291/480) of women initiated a contraceptive method before discharge, with intrauterine devices being the most commonly chosen method (33.7%). Male partners were present during childbirth for 48.3% of women; however, partner presence was not significantly associated with IPPFP uptake (χ² = 1.409, p = 0.262). Qualitative findings from a small exploratory sample suggest that contraceptive decisions were largely made during pregnancy, driven by considerations such as maternal health, parity, and household economic capacity, rather than male partners’ physical presence at childbirth.

CONCLUSIONS: IPPFP uptake in these two urban Rwandan hospitals was moderate. Initiation of contraception before discharge was associated with selected sociodemographic and obstetric characteristics, although these associations were based on unadjusted analyses. Male partner presence during childbirth was not statistically associated with IPPFP uptake, and qualitative findings suggest that contraceptive decisions are often made earlier in pregnancy. Strengthening postpartum counseling and clinical assessment may improve informed decision-making. However, findings should be interpreted in light of the study’s limited scope and design.

PMID:42177551 | DOI:10.1186/s12978-026-02371-4

Trials. 2026 May 23. doi: 10.1186/s13063-026-09812-2. Online ahead of print.

ABSTRACT

BACKGROUND: To facilitate equitable access to novel treatments, cancer trial participants should represent as far as possible those that will receive the treatment in practice. We can identify groups who rarely participate in cancer trials by collecting demographic data from participants. In the UK, there is no standardised practice around demographic data capture, leading to inconsistent collection across trials. A lack of systematically collected and published quantitative data from participants in UK cancer trials may limit our ability to identify underrepresented groups.

METHODS: We reviewed availability and completeness of demographic data recorded from 2235 participants in six bladder and six head and neck cancer trials conducted by the Clinical Trials and Statistics Unit at the Institute of Cancer Research (ICR-CTSU) between 2001 and 2023. To assess the representativeness of trial populations, demographic data from trial participants were compared with published data (NHS Digital) from 260,350 people who were treated for these cancers between 2013 and 2022 in England, using chi-squared goodness-of-fit tests and one-sample tests of proportion. A survey was distributed to 12 clinical trials units conducting similar trials to establish which demographic data are routinely collected across the UK.

RESULTS: Data on ethnicity, postcode, smoking status, and co-morbidity burden were inconsistently captured across ICR-CTSU trials, with missing data. Amongst the overall trial population, people older than 80 (n = 486/2235, 22%), females (n = 466/2235, 21%), people living in the most deprived areas (n = 390/1447, 27%), and ethnic minority groups (n = 5/275, 2%) were underrepresented, with some differences by treatment modality. Responses from UK trial teams showed that aside from age and sex (routinely captured), smoking status was the most consistently captured (13/17 trials).

CONCLUSIONS: This study provides quantitative data on cancer trial participants examining several demographic factors and indicates potentially underrepresented groups in trials of the disease subtypes investigated. Missing data were likely observed as a result of data cleaning being focused on items directly addressing the research question. Collecting and analysing a broad range of demographic data with a focus on inclusivity can inform researchers of groups who may benefit from tailored interventions to increase accessibility to cancer trials in the future.

PMID:42177546 | DOI:10.1186/s13063-026-09812-2

J Ovarian Res. 2026 May 23. doi: 10.1186/s13048-026-02140-8. Online ahead of print.

ABSTRACT

CONTEXT: Luteinizing hormone (LH) plays an integral role in follicular development. In gonadotropin-releasing hormone (GnRH) antagonist protocols, LH levels have been demonstrated to affect assisted reproductive technology (ART) outcomes. However, the exact nature of this relationship remains unclear, and LH measurements at a single time point may not be sufficient to capture it fully.

METHODS: We conducted a retrospective cohort study on 4,953 infertile women who underwent their first ART cycle with the GnRH antagonist protocol. Four LH measurements (basal status, antagonist administration day and 24 h later, and ovulation trigger day) were obtain for all participants. We used group-based trajectory modeling (GBTM) to characterize the trajectories of LH level changes during antagonist protocol implementation. Factors influencing the different LH trajectories were explored. Associations between LH levels at different time points and their trajectories with the number of obtained oocytes and ART outcomes in embryo transfer (ET) cycles were analyzed.

RESULTS: Based on the statistical criteria, the model with 4 trajectories were selected as the best-fitting model, and the LH change trajectories during antagonist protocol can be grouped into stable (77.0%), rising (11.0%), decreasing (6.2%) and fluctuating (5.8%) types. Different trajectory groups exhibited significant differences in the number of retrieved oocytes. Compared with that in the stable trajectory group, the oocyte yield in the rising trajectory group decreased and that in the fluctuating trajectory group increased. Of these participants, 884 underwent fresh ET cycles, with no significant differences in pregnancy outcomes between the different trajectory groups. On ovulation trigger day, high LH levels predicted better pregnancy outcomes, indicating significant positive associations with the odds of biochemical pregnancy, clinical pregnancy and live birth.

CONCLUSION: Oocyte yield differed significantly among the LH trajectory groups, suggesting that LH dynamics during antagonist controlled ovarian stimulation may be relevant to treatment outcomes. For individuals with risk factors for a rising trajectory (e.g., advanced age, higher body mass index), closer monitoring of LH profiles may be warranted. For fresh ET cycles, trigger-day LH levels may merit heightened clinical attention.

PMID:42177529 | DOI:10.1186/s13048-026-02140-8

BMC Med Educ. 2026 May 23. doi: 10.1186/s12909-026-09494-z. Online ahead of print.

ABSTRACT

BACKGROUND: Ethical climate is an important component of professional development in medical education, yet little is known about how medical students’ perceptions of ethical climate evolve during training or whether these perceptions are associated with career intentions. This study aimed to examine longitudinal changes in perceived and desired ethical climate among medical students and to explore potential associations with intended residency choice.

METHODS: We conducted a follow-up study of a student cohort among medical students enrolled in the Croatian-language medical program at the University of Split School of Medicine. Ethical climate was assessed using the Ethical Climate Questionnaire (ECQ), which evaluates nine ethical climate domains. Data were collected during the third and the sixth year of study. Students completed both perceived and desired versions of the ECQ. Paired analyses were performed for students who participated at both time points, while independent-sample analyses compared third and sixth-year cohorts. Ethical climate domains were also examined in relation to students’ desired residency choice.

RESULTS: A total of 70 third year and 77 sixth-year students participated, with 57 students included in paired analyses. The two dominant climates were Company profit and Laws and professional codes. Perceived ethical climate scores decreased significantly from the third to the sixth year in the Company rules and procedures (p < 0.001), while other domains remained stable. No statistically significant differences were observed in desired ethical climate domains between the third and sixth study years after Bonferroni correction. No associations were found between ethical climate domains and intended residency choice.

CONCLUSIONS: Medical students’ perceptions of institutional ethical climate change during undergraduate training, particularly regarding organizational structure, while ethical ideals remain largely stable. Ethical climate perceptions do not appear associated with residency choice, suggesting that ethical development and career decision-making may follow distinct trajectories. These findings highlight the importance of addressing the hidden curriculum and supporting structured reflection on ethical tensions encountered during clinical training.

PMID:42177514 | DOI:10.1186/s12909-026-09494-z

BMC Med Educ. 2026 May 23. doi: 10.1186/s12909-026-09520-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore the effects of the Simroid dental training robot on the training of undergraduate dental students in patient interviews and clinical examinations.

METHODS: Undergraduate students who participated in internship rotations in the Department of Endodontics at Tianjin Stomatological Hospital from July 2023 to June 2025 were enrolled as the research participants. This study adopted a non-randomized controlled design, dividing students from different academic years into two groups: the control group received conventional training, while the experimental group utilized the Simroid patient robot for patient interview and clinical examination training. The effectiveness of the training was evaluated using the Mini Clinical Exercise Evaluation (Mini-CEX) and a learning satisfaction questionnaire. Statistical analyses were conducted through independent samples t-test and repeated measures ANOVA.

RESULTS: The experimental group achieved significantly higher assessment scores in both clinical examination and doctor-patient communication compared to the control group (P < 0.05). Additionally, the experimental group reported higher levels of learning satisfaction.

CONCLUSION: This study demonstrated that incorporating the Simroid dental training robot into patient interview and clinical examination training significantly enhanced undergraduate students’ clinical examination skills and doctor-patient communication abilities. By enabling students to proficiently master patient interview process and experience realistic doctor-patient communication scenarios during preclinical training, this approach effectively prepared them for subsequent clinical internships.

PMID:42177505 | DOI:10.1186/s12909-026-09520-0

BMC Public Health. 2026 May 23. doi: 10.1186/s12889-026-27803-5. Online ahead of print.

ABSTRACT

BACKGROUND: As more household assets are allocated to the stock market, the health externalities of stock market returns have become a focal point of interdisciplinary research. However, prior evidence has largely focused on medium to long term associations with healthcare-seeking activities, leaving the immediate healthcare seeking response in emerging economies underexplored. Leveraging data on both regular outpatient visits for hypertension (ROV) and major illness outpatient visits for hypertension (MOV), this study examines the immediate association between stock market returns and such visits.

METHODS: The sample for ROV and MOV is constructed from 30,715,658 regular outpatient records and 94,370 major illness outpatient records from a major city in East China. Using daily data, this paper first quantifies the association between stock market returns and outpatient visits for hypertension. Second, it employs a regression discontinuity in time (RDiT) design to strengthen credibility. Third, it applies a monthly nonlinear model to examine how extreme negative returns are associated with MOV. Separate estimations are conducted for ROV and MOV.

RESULTS: We find that outpatient visits for hypertension are significantly higher on days when the stock market declines. This association is especially strong among seniors and those with poorer baseline health. Ambient temperature is weakly associated with ROV but explains more variation in MOV. Using monthly data, we also observe a significant negative association between stock market returns and MOV, particularly during extreme market declines (e.g., crashes).

CONCLUSIONS: These findings indicate a strong association between stock market returns, particularly price declines, and outpatient visits for hypertension. The association is immediate and transient, offering insights into the broader public health implications of economic shocks and filling a gap in the literature on emerging economies and healthcare seeking behavior.

PMID:42177504 | DOI:10.1186/s12889-026-27803-5

BMC Surg. 2026 May 23;26(1):335. doi: 10.1186/s12893-026-03710-9.

ABSTRACT

BACKGROUND: This research examines the impact of bariatric procedures on male sex hormones and semen parameters in infertile men with obesity. Obesity adversely affects male fertility by causing hormonal imbalances and worsening semen quality. Metabolic and bariatric surgery (MBS) offers sustained weight loss and potential reversal of these abnormalities.

METHODS: This prospective case series included 43 infertile men with severe obesity who underwent sleeve gastrectomy, One-anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass. All participants had a BMI ≥ 35 kg/m² and a history of infertility for over one year. Semen analysis and hormonal profiling (FSH, LH, total testosterone, estradiol [E2], and prolactin) were conducted preoperatively and at 3, 6, and 12 months postoperatively.

RESULTS: Significant weight loss was observed at all follow-up points (p ≤ 0.003). Improvements were noted in semen motility, progressive motility, vitality, and abnormal forms (all p ≤ 0.003). Serum testosterone levels increased, while estradiol levels decreased significantly (p ≤ 0.003). Changes in FSH, LH, and prolactin were statistically insignificant.

CONCLUSIONS: Metabolic and bariatric surgery (MBS) is associated with marked improvements in semen quality and serum testosterone levels, supporting its role as an effective therapeutic strategy for obesity-related male infertility. No pregnancies were recorded during the 12-month follow-up.

TRIAL REGISTRATION: Not applicable.

PMID:42177498 | DOI:10.1186/s12893-026-03710-9

Environ Health. 2026 May 23. doi: 10.1186/s12940-026-01309-4. Online ahead of print.

ABSTRACT

BACKGROUND: Taiwan is one of the fastest-warming regions globally. As climate change intensifies, understanding how vulnerability influences health outcomes critical. This study aimed to identify regional vulnerability factors for temperature-related respiratory mortality and effective region-specific adaptation policies.

METHODS: A two-stage time-series study was conducted using daily respiratory mortality counts aggregated by county and day. This study employed a distributed lag non-linear model to estimate the temperature-attributable mortality burden from respiratory diseases across all counties and cities in Taiwan. A two-stage meta-analysis was conducted to estimate temperature-mortality associations and quantify cold- and heat-related mortality burdens by county. Meta-regression was used to identify regional vulnerability factors modifying temperature-related mortality risk, and geographically weighted regression (GWR) was applied to characterize the spatial heterogeneity of these effects across counties.

RESULTS: Cold exposure was linked to a higher burden of respiratory disease mortality (attributable fraction [AF]: 2.03%, 95% CI: 1.10-2.95) than heat exposure (AF: 1.02%, 95% CI: 0.65-1.40). For cold-related AFs, higher proportions of Indigenous populations (3.27, 0.79-5.75), low-income populations (2.11, 0.67-3.55), greater population density (2.21, 0.46-3.96), and children (0.98, 0.35-1.61) were significantly associated with increased risk, suggesting vulnerability factors. GWR further showed that hospital bed availability had statistically significant protective effects against cold-related AF in 10 of 19 counties (β = – 5.24 to – 6.78), most pronounced in remote mountainous counties (Hualien, Taitung, Kaohsiung).

CONCLUSION: Higher proportions of Indigenous populations, low-income population, and children amplify cold-related respiratory mortality. Hospital bed availability confers the strongest protection against cold-related mortality in remote, mountainous counties. Climate adaptation policies for cold-related respiratory health should therefore be tailored to local vulnerability profiles, prioritizing healthcare expansion in geographically remote counties rather than applying uniform investment across all regions.

PMID:42177497 | DOI:10.1186/s12940-026-01309-4

Fluids Barriers CNS. 2026 May 23. doi: 10.1186/s12987-026-00819-0. Online ahead of print.

ABSTRACT

BACKGROUND: Endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) offers an alternative to shunt placement for infant hydrocephalus, avoiding shunt-related complications when successful. However, approximately 40% of procedures fail, with 30% ultimately requiring shunt placement. Current risk stratification relies primarily on age and prior interventions, limiting ability to optimize treatment selection. Therefore, this study aimed to determine whether preoperative cerebrospinal fluid volume (CSFV) measurements independently predict shunt-dependence following ETV/CPC in infant hydrocephalus.

METHODS: This retrospective cohort study was conducted from 2008 to 2024, with follow-up through 2024 and statistical analysis performed in January 2025. Infants who underwent ETV/CPC as the primary treatment for hydrocephalus and had magnetic resonance imaging within two weeks before surgery were included. The primary outcome was shunt-dependence, defined as progressive ventriculomegaly requiring shunt placement after ETV/CPC. Imaging measures included traditional frontal-occipital horn ratio (FOHR) and novel volumetric assessments: CSFV and CSFV/intracranial volume (ICV) ratio estimated using deep learning-based segmentation methods and the corresponding z-scores using age- and sex- adjusted normative curves. Cox proportional hazards regression identified independent predictors of shunt-dependence.

RESULTS: A total of 188 infants (median age at surgery 60 days, 42.5% female) were included. Sixty-six (35.8%) patients became shunt-dependent over a median follow-up of 3.8 years as of January 2025. In multivariable analysis adjusting for age and prior temporary CSF diversion, both CSFV z-score (HR 1.10, 95%CI 1.02-1.20, p = 0.02) and CSFV/ICV ratio z-score (HR 1.07, 95%CI 1.01-1.13, p = 0.02) independently predicted shunt-dependence, while FOHR did not achieve statistical significance in adjusted models. Younger infants with higher CSFV z-scores demonstrated elevated failure rates.

CONCLUSIONS: Preoperative CSF volume measurements provide superior risk stratification compared to traditional linear assessments for predicting shunt-dependence in infant hydrocephalus. These findings support integration of volumetric brain imaging analysis into clinical decision-making to optimize treatment selection and improve outcomes through more precise identification of candidates most likely to benefit from ETV/CPC versus primary shunt placement.

PMID:42177495 | DOI:10.1186/s12987-026-00819-0

BMC Med Educ. 2026 May 23. doi: 10.1186/s12909-026-09525-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Anatomy teaching in preclinical medical education has become increasingly compressed, making it more difficult for students to integrate foundational anatomical knowledge with clinical reasoning. Upper limb nerve lesions are particularly challenging to learn because they require spatial understanding and application of structure-function relationships, yet students often struggle to translate two-dimensional instructional materials into clinical reasoning. This study presents a preliminary evaluation of a medical student-developed, three-dimensional (3D) interactive simulation designed to model upper limb nerve lesions and their associated motor, sensory, and reflex deficits.

METHODS: First-year medical students who had completed the standard anatomy curriculum participated in a single-session pilot study with room-level random allocation comparing a traditional PowerPoint-based review (2D Review Group) with an interactive simulation (3D Simulation Group). Both groups completed identical worksheets and a five-item multiple-choice pre- and post-test assessing clinical application of anatomy knowledge. Post-session surveys evaluated perceived clarity, clinical relevance, and educational value. Knowledge gains were compared using Mann-Whitney U tests with effect size calculations, and open-ended survey responses were analyzed using Reflexive Thematic Analysis (RTA) following Braun and Clarke.

RESULTS: A total of 35 students participated, with 33 included in the knowledge gain analysis. Both instructional groups showed improvement on the post-test. Although differences in change scores were not statistically significant (U = 165.00, p = .274), the 3D Simulation Group showed a larger median gain and reached similar post-test scores to the 2D Review Group despite lower baseline performance. Survey responses did not differ significantly between groups. Qualitative feedback suggested differing learner priorities across instructional modalities, with participants in the 3D Simulation Group emphasizing visual-spatial support and interactivity, and participants in the 2D Review Group emphasizing structured review and practice questions.

DISCUSSION: Given the single-session design, these findings should be interpreted as exploratory. However, they suggest that interactive 3D simulation may support conceptual understanding and application of anatomical knowledge, particularly for learners with lower baseline knowledge.

CONCLUSION: This study supports the feasibility of a student-led, AI-assisted approach to developing adaptable educational tools within a medical curriculum. Although quantitative differences were modest, qualitative feedback suggests that learners valued the tool’s support for clinical reasoning and spatial understanding. Further longitudinal and multi-session research is needed to evaluate retention, scalability, and educational impact.

PMID:42177489 | DOI:10.1186/s12909-026-09525-9