Nevin Manimala

Rural Remote Health. 2026 Jul;26(3):10953. doi: 10.22605/RRH10953. Epub 2026 Jul 24.

ABSTRACT

INTRODUCTION: Efficient use of health worker time is critical for improving service delivery in low resource and rural settings, where persistent workforce shortages limit progress toward universal health coverage. Ethiopia faces a severe health workforce deficit, yet empirical evidence on how hospital-based professionals utilize their working hours, particularly in rural and remote hospitals, remains limited. This study assessed productive time use among health professionals and examined factors associated with achieving an 8-hour productive workday.

METHODS: A cross sectional time-motion study was conducted in 18 public and private hospitals, including rural facilities across Ethiopia. A total of 180 health professionals representing five cadres were observed over two full working days using a standardized time-motion protocol. Productive activities included direct and indirect patient care and essential administrative functions. Structured interviews assessed workload, workplace conditions, and performance management practices. Descriptive statistics and multivariable logistic regression identified predictors of high productivity.

RESULTS: Health professionals spent a total of 5.55 hours per day on productive activities (69.4% of official working hours). Nearly one-third of time was lost to non-productive activities, primarily waiting for patients and having extended breaks. Productivity was positively associated with postgraduate training, greater experience, higher daily patient load, and receipt of performance appraisal. Patterns were consistent across rural and urban hospitals, though rural facilities reported longer waiting times and greater supply constraints.

CONCLUSION: Despite systemic constraints, health professionals dedicate a substantial share of their time to productive tasks. A portion of non-productive time reflects system-level factors such as patient flow disruptions and supply constraints rather than individual inefficiency, particularly in rural hospitals. Addressing these bottlenecks – alongside strengthening workforce capacity through training, supervision, and performance systems – could improve efficiency within existing resources and support equitable, high-quality care.

PMID:42502183 | DOI:10.22605/RRH10953

BMC Pediatr. 2026 Jul 24;26(1):683. doi: 10.1186/s12887-026-07239-x.

ABSTRACT

OBJECTIVES: Ventilator-associated pneumonia (VAP) is a frequent and serious infection among mechanically ventilated children in pediatric intensive care units (PICUs), with oral colonization playing a key role in its pathogenesis. Effective oral hygiene measures are therefore crucial to reduce VAP incidence and improve clinical outcomes. This study aimed to compare the incidence of VAP in PICU patients receiving routine oral care versus toothbrushing with chlorhexidine, and to evaluate the impact on mechanical ventilation duration, PICU stay, and mortality with secondary outcomes including microbiological colonization, inflammatory markers, and inotropic support requirements.

DESIGN: A parallel-group superiority randomized controlled trial.

METHODS: A randomized controlled trial was conducted on 118 children aged 18 months to 16 years, including PICU patients requiring invasive mechanical ventilation for ≥ 48 h. On admission, patients were randomly allocated into two groups: the intervention group received oral care with toothbrushing plus 0.12% chlorhexidine mouth rinse, while the control group received routine care with 0.12% chlorhexidine rinse only. Both procedures were performed three times daily. VAP was diagnosed according to CDC criteria. Quantitative and qualitative analyses assessed variables distinguishing VAP cases from controls, and multivariate logistic regression identified independent predictors of disease severity.

RESULTS: The results of our study revealed that VAP occurred in 31 patients (52.5%) in the control group and 25 patients (42.3%) in the intervention group, indicating a lower incidence with toothbrushing plus chlorhexidine, although this difference was not statistically significant (p = 0.36). Among all participants, 45.8% died and 54.2% were discharged. Mortality was higher in the control group (53.7%) compared with the intervention group (46.3%), while discharge rates favored the intervention group (53.1% vs. 46.9%); however, these differences did not reach statistical significance (p = 0.46). Positive sputum cultures were more frequent in the control group (55.6%) than in the intervention group (44.4%), whereas negative cultures were more common among intervention patients (54.7% vs. 45.3%), with no significant difference between groups (p = 0.268).

CONCLUSION: Although adding toothbrushing to routine chlorhexidine oral care did not produce a statistically significant reduction in VAP incidence or mortality, a consistent trend toward clinical benefit was observed across multiple outcome measures, including lower rates of positive sputum cultures, reduced inotropic support requirements, and fewer new pulmonary infiltrates. These findings highlight the potential value of enhanced oral hygiene in the PICU and support the need for larger multicenter studies to confirm its effect.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT07287566. Registered on November 20, 2025. Retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT07287566 .

PROTOCOL AND STATISTICAL ANALYSIS PLAN ACCESS: The full study protocol and the statistical analysis plan are included in this document and are available from the corresponding author upon reasonable request.

PMID:42502162 | DOI:10.1186/s12887-026-07239-x

Infect Dis Ther. 2026 Jul 26. doi: 10.1007/s40121-026-01394-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Human Immunodeficiency Virus (HIV) infection has currently become a manageable chronic disease with the prevalence of antiretroviral therapy (ART). The increase in life expectancy and the rising number of people aged more than 50 years among people living with HIV (PLWH) both indicate an increasing risk of chronic non-communicable diseases, especially cardiovascular disease (CVD). Moreover, the contribution of traditional risk factors to CVD far outweighs that of HIV-related factors, which indicates that interventions for reducing CVD risk factors in PLWH are urgent.

METHODS: We designed a multicentre non-randomized controlled trial (nRCT), which incorporated six acquired immunodeficiency syndrome (AIDS)-designated hospitals in Zhejiang Province, and three rounds of surveys were conducted from January 2023 to January 2024. Assessments were performed at baseline, 3 months and 6 months post-intervention, respectively. For the intervention group, PLWH were informed of their 5/10-year CVD risk, on the basis of the assessment in baseline, verbally or online to warn them of the risk of having CVD; at the same time, personalized risky behaviour reinforcement intervention was implemented face-to-face or online for about 15 min. For the control group, PLWH were not informed of the 5/10-year CVD risk and only received routine health education in the clinic without additional intervention. Intervention effects were assessed using 5/10-year CVD risk, health-related behaviours (e.g., smoking, alcohol consumption, physical activities and dietary nutrition), as well as CVD cognitive level. To minimize baseline differences and reduce confounding due to non-treatment factors (e.g., socio-demographic characteristics), propensity score matching (PSM) was applied to construct comparable intervention and control groups, and a generalized estimating equation (GEE) was used to estimate the effect of the intervention. This trial was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500112178) on 11 November 2025.

RESULTS: A total of 948 PLWH were incorporated at baseline, after excluding ineligible participants, including 494 in the intervention group and 454 in the control group. The average age was 42.08 ( ± 11.94) years, with 826 male patients (87.13%). A total of 362 pairs were successfully matched after PSM. After matching, no statistical differences remained between the two groups. After 6 months’ intervention, the intervention group showed significant improvements in CVD cognitive level, with a total increase of 2.30 points compared with 0.41 points in the control group (P = 0.028). Additionally, PLWH who almost never drink and have > 8 h of sedentary time per day, increased and decreased 4.54% and 1.46% respectively, compared with the control group (P < 0.05). The 10-year CVD risk decreased by 0.63% in the intervention group and 0.18% in the control group. Moreover, the smoking rate and drinking rate decreased more in the intervention group compared with the control group, and the physical exercise compliance rate increased more as well, though there was no statistical difference compared with the control group (P > 0.05).

CONCLUSIONS: Risk warning and behavioural intervention effectively improved CVD cognitive level. Although the risk warning and behavioural intervention could not make PLWH completely quit smoking or using alcohol, the intervention led to notable improvements in reducing the frequency of some health risk behaviours.

PMID:42502148 | DOI:10.1007/s40121-026-01394-5

J Thromb Thrombolysis. 2026 Jul 25. doi: 10.1007/s11239-026-03368-3. Online ahead of print.

ABSTRACT

Transcatheter aortic valve replacement (TAVR) has extended its use to low-surgical-risk populations, yet long-term comparative data against surgical aortic valve replacement (SAVR) are still limited, particularly concerning durability and the need for reintervention. We conducted a search of PubMed/MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov through March 2026 for randomized trials comparing TAVR with SAVR in patients with low surgical risk and severe aortic stenosis, specifically those with at least three years of follow-up. Outcomes were pooled as risk ratios (RR) using Mantel-Haenszel random-effects models, and durability and mortality outcomes were analyzed as time-to-event hazard ratios (HR) to accommodate different follow-up durations. Prespecified subgroup analyses by valve platform were performed. Four trials involving 3,014 patients (follow-up ranging from 3 to 10 years) were included. Cardiovascular mortality (HR 1.11, 95% CI 0.86-1.42; P = 0.43) and all-cause stroke (HR 1.09, 95% CI 0.73-1.64; P = 0.67) did not differ significantly between TAVR and SAVR. Aortic valve reintervention was higher with TAVR in risk-ratio analysis (RR 1.58, 95% CI 1.16-2.16) but did not reach statistical significance in the prespecified time-to-event analysis (HR 1.29, 95% CI 0.81-2.05). The excess reintervention risk was confined to the self-expanding valve platform. Permanent pacemaker implantation was significantly more frequent after TAVR (RR 2.08, 95% CI 1.48-2.93; P < 0.0001), with a significant interaction by valve platform (self-expanding RR 2.57 vs balloon-expandable RR 1.40; P = 0.02 for interaction). Bioprosthetic valve failure showed a nonsignificant trend favoring TAVR (HR 0.80, 95% CI 0.54-1.17). The only available 10-year randomized data (NOTION trial) showed significantly less severe structural valve deterioration with TAVR than with SAVR. The results suggest that TAVR and SAVR are equivalent in terms of cardiovascular mortality and stroke outcomes. However, pacemaker implantation rates were higher with TAVR and were strongly dependent on the valve platform used. The observed excess in reinterventions was confined to self-expanding valves and did not show robust support in the time-to-event analysis. The unique 10-year data from the self-expanding platform indicate less severe structural valve deterioration compared to SAVR, suggesting that durability should not be generalized across different device families. These findings advocate for individualized, platform-aware decision-making in clinical practice.

PMID:42502145 | DOI:10.1007/s11239-026-03368-3

J Thromb Thrombolysis. 2026 Jul 25. doi: 10.1007/s11239-026-03366-5. Online ahead of print.

ABSTRACT

Hypercoagulability and platelet activation are central components of COVID-19 pathophysiology. However, despite growing evidence that sex-related biological differences may influence thromboinflammatory responses, studies focusing on sex-based genetic variations in coagulation and platelet indices remain limited. This study includes 324 COVID-19 patients, investigated the sex-specific effects of FGB – 455 G > A (rs1800790) and ITGB3 T1565C (rs5918) polymorphisms. Genotypes were determined using TaqMan-based real-time PCR, and patients were stratified by sex; demographic, hematological, and biochemical data were retrieved and analyzed statistically. The GA genotype of FGB rs1800790 was more frequent in females than males, whereas the TC genotype of ITGB3 (rs5918) was less frequent in females (OR = 1.71, 95% CI: 1.06-2.76, p = 0.028; OR = 0.53, 95% CI: 0.31-0.90, p = 0.020, respectively). In the GG genotype of FGB (rs1800790), females were younger and had lower urea, creatinine, and WBC, with no differences in other parameters (p = 0.026, d = 0.367; p = 0.006, d = 0.485; p = 0.012, d = 0.440; and p = 0.010, d = 0.431 respectively). No sex differences were observed in the GA genotype, whereas aPTT was lower in AA-genotype females (p = 0.045, d = 0.830). For ITGB3 (rs5918), males with the TC genotype were older and had higher PT, ferritin, urea, creatinine, and WBC, but lower eosinophils (p = 0.030, d = 0.584; p = 0.042, d = 0.667; p = 0.001, d = 1.081; p = 0.005, d = 0.803; p = 0.020, d = 0.655; p = 0.020, d = 0.609; and p = 0.012, d = 0.733 respectively); the CC genotype was observed only in three males. These results emphasize the combined influence of sex and coagulation-related genetic variants on thrombo-inflammatory patterns in COVID-19. These findings highlight the potential clinical importance of considering sex-genotype interactions when evaluating thrombo-inflammatory responses and may contribute to more personalized risk assessment and management strategies in patients with COVID-19.

PMID:42502144 | DOI:10.1007/s11239-026-03366-5

Int Urol Nephrol. 2026 Jul 26. doi: 10.1007/s11255-026-05306-x. Online ahead of print.

ABSTRACT

BACKGROUND: Physical inactivity is a significant yet modifiable risk factor for all-cause mortality and falls among peritoneal dialysis (PD) patients; however, their inadequate exercise adherence remains poorly understood. This study aimed to characterize current patterns of exercise adherence in PD patients and identify key determinants influencing adherence behaviors.

METHODS: A multicenter cross-sectional survey was conducted from July 2024 to July 2025 across four tertiary hospitals in Shenzhen, enrolling 207 eligible PD patients. Data were collected using demographic questionnaires, the Exercise Adherence Rating Scale, the Tampa Scale for Kinesiophobia, the Self-Efficacy for Managing Chronic Disease Scale, and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Statistical analyses included multiple linear regression and mediation analysis.

RESULTS: The mean exercise adherence score was 32.06 ±8.28, indicating moderate adherence. Multiple linear regression identified receipt of structured exercise guidance (β= 4.124, p < 0.001), higher self-efficacy (β= 1.392, p < 0.001), and lower kinesiophobia (β= -0.282, p = 0.033) as significant predictors of exercise adherence. Mediation analysis showed indirect associations via self-efficacy [β= 0.136, 95% CI (0.064, 0.220)] and kinesiophobia [β= 0.120, 95% CI (0.046, 0.202)], accounting for 76.2% of the total association.

CONCLUSION: Exercise adherence in PD patients is influenced by multiple factors, with exercise guidance, self-efficacy, and kinesiophobia emerging as critical determinants. Fatigue was indirectly associated with adherence through self-efficacy and kinesiophobia in exploratory analyses. Clinicians may consider prioritizing early identification of at-risk patients and develop and implement theory-driven, multifaceted interventions to enhance adherence.

PMID:42502141 | DOI:10.1007/s11255-026-05306-x

Diabetologia. 2026 Jul 25. doi: 10.1007/s00125-026-06814-2. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Environmental exposures have been adversely associated with the risk of diabetes but their role in the remission and progression of prediabetes (impaired glucose tolerance [IGT] and/or impaired fasting glucose [IFG]), especially different phenotypes, is poorly understood. This study aimed to investigate the relationship between environmental exposures and remission or progression of prediabetes phenotypes.

METHODS: Data were derived from the KORA (Cooperative Health Research in the Region of Augsburg) cohort in Southern Germany (2006-2022). Glucose tolerance status was defined according to the 1999/2006 WHO criteria. We included annual values of particulate matter (PM), light at night (LAN), normalised difference vegetation index (NDVI), imperviousness (IMP) and air temperature variation (T_sd). We fitted complementary log-log regression models for associations between IQR changes in exposures and the incidence of prediabetes phenotypes (isolated impaired fasting glucose [iIFG], isolated impaired glucose tolerance [iIGT], or their combination [IFG+IGT]), remission to normal glucose tolerance (NGT) or progression to type 2 diabetes. We also applied Quantile g-computation regression models for joint association analysis.

RESULTS: During the follow-up, 370/1618 participants developed prediabetes (124 iIFG, 199 iIGT and 47 IFG+IGT). Among participants with prediabetes, 136/367 (without medication) regressed to NGT and 133/420 progressed to type 2 diabetes. We observed consistent associations of air pollutants and the built environment with iIGT or IFG+IGT. For example, an IQR increase in PM_2.5 (aerodynamic diameter ≤2.5 μm) showed an HR of 1.89 (95% CI 1.07, 3.31) for the risk of IFG+IGT and 1.59 (95% CI 1.03, 2.46) with a decrease in NDVI. Co-exposure to environmental mixtures (higher air pollution, T_sd, IMP and LAN, and lower NDVI) was associated with increased risks of iIFG, iIGT and IFG+IGT. Additionally, lower NDVI (HR 0.52 [95% CI 0.28, 0.96]), higher LAN (HR 0.22 [95% CI 0.08, 0.62]) and higher IMP were associated with reduced remission of iIFG but we found no statistically significant associations with the progression to type 2 diabetes.

CONCLUSIONS/INTERPRETATION: The findings indicate potential heterogeneity in environmental exposures and prediabetes phenotypes. Specifically, they are associated with increased incidence of IGT and decreased remission of iIFG.

PMID:42502136 | DOI:10.1007/s00125-026-06814-2

Sports Med. 2026 Jul 26. doi: 10.1007/s40279-026-02483-8. Online ahead of print.

ABSTRACT

BACKGROUND: Musculoskeletal stretching, a low-skill and accessible exercise, may help lower cardiovascular disease (CVD) risk by reducing arterial stiffness (AS). The most well-established measure of AS is pulse wave velocity (PWV).

OBJECTIVES: To determine (1) the effects of acute and longitudinal musculoskeletal stretching interventions on PWV in adults; and (2) whether the pooled effect is moderated by stretching prescription (i.e., frequency, intensity, time, and type [FITT]), study design (e.g., supervision), study quality and risk of bias, and study outcome (e.g., specific PWV segment).

DATA SOURCES: Electronic databases (PubMed, Scopus, Embase, and Web of Science) were searched from 1974 to 2025, using the search terms: stretching AND (arterial stiffness OR pulse wave velocity OR PWV OR vascular stiffness). The reference lists of relevant studies and previous reviews were also screened.

STUDY SELECTION: The eligibility criteria included (1) adults aged 18 years or older; (2) randomized controlled, nonrandomized controlled, or crossover; (3) PWV outcome(s) measured; (4) published in English; (5) published since 1974; and (6) published in peer-reviewed journals.

APPRAISAL AND SYNTHESIS METHODS: Initially, 242 studies were identified. After screening, six studies on acute stretching and six studies on longitudinal stretching were included. Effect sizes were calculated as standardized mean differences (SMD). Data were pooled using a 3-level model with restricted maximum likelihood estimation, and the magnitude of the effect was adjudicated as trivial (< 0.2), small (0.2), moderate (0.5), or large (0.8).

RESULTS: Acute stretching led to a small, nonsignificant reduction (beneficial) in PWV (SMD = – 0.22, p = 0.258), whereas longitudinal stretching resulted in a large and statistically significant reduction in PWV (SMD = – 1.02, p = 0.012). The pooled effect size was significantly greater (more beneficial) when each stretch was repeated three or more times (versus less than three times, SMD contrast = – 1.46, p < 0.001). Larger (beneficial) pooled effect sizes were also observed when stretching was prescribed for 5-7 days/week (versus 3-4 days/week, SMD contrast = – 1.05, p = 0.149), when stretching sessions lasted at least 30 min (versus less than 30 min, SMD contrast = – 0.79, p = 0.169), and when sessions were supervised (versus unsupervised, SMD contrast = – 1.11, p = 0.130); however, these differences did not reach statistical significance.

CONCLUSIONS: A single bout of stretching resulted in a small acute decrease in PWV (SMD = – 0.22, 95% CI – 0.62 to 0.17). There was a large decrease in PWV (SMD = – 1.02, 95% CI – 1.79 to – 0.25) following a 4- to 12-week intervention. We recommend stretching each major muscle-tendon group three or more times. These findings may be used to help design a future intervention to test the efficacy and biological plausibility of stretching exercises to reduce arterial stiffness and possibly CVD risk.

PMID:42502132 | DOI:10.1007/s40279-026-02483-8

J Community Health. 2026 Jul 25. doi: 10.1007/s10900-026-01603-9. Online ahead of print.

ABSTRACT

Earthquakes have caused devastating impacts throughout history, highlighting the growing importance of pre-disaster risk management. With the increasing use of digital technologies, social media platforms such as YouTube have become widely used sources of information on earthquake preparedness. However, the quality and reliability of such content remain questionable. This study aimed to evaluate the quality, reliability, and content of YouTube videos related to earthquake preparedness. In this cross-sectional study, the top 100 most-viewed videos for the keywords “earthquake preparedness” and “earthquake safety information” were analyzed on January 19, 2026. After applying eligibility criteria, 72 videos were included. Video quality and reliability were assessed using the Global Quality Scale (GQS) and modified DISCERN (mDISCERN), while popularity was measured through view rate and the Video Power Index (VPI). Content analysis and non-parametric statistical tests were performed. The findings showed that the overall quality and reliability of videos were low to moderate. Longer videos tended to have higher quality and reliability scores, whereas engagement metrics did not reflect content quality. These results indicate a need to improve the availability of accurate, evidence-based, and practical earthquake preparedness information on digital platforms.

PMID:42502127 | DOI:10.1007/s10900-026-01603-9

Mol Psychiatry. 2026 Jul 25. doi: 10.1038/s41380-026-03772-4. Online ahead of print.

ABSTRACT

Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental disorder with complex molecular etiology. Since genetic causes account for less than 50% of ASD cases, novel approaches are required to overcome the challenges of characterizing genes and molecular pathways linking risk alleles to phenotype. Here we use RNA-sequencing, 3-dimensional protein-centric chromatin conformation (Hi-ChIP), and whole genome DNA methylation sequencing approaches to investigate hippocampal tissue from an ASD mouse model (Cntnap2 knockout [Cntnap2 KO]) to determine if multi-omic data integration improves the resolution of key molecular pathways contributing to the complex ASD phenotype. Each -omic dataset individually identified disruptions in numerous genes and pathways, providing broad ASD-related insights, such as 1) 699 downregulated genes with an enrichment of neuronal ontological terms; 2) unique chromatin interactions in Cntnap2 KO mice; and 3) that most differentially methylated genes (1220/1659) have a neuronal function. The multi-omic data integration reduced the heterogeneity and refined the data to 43 genes with links to ASD (e.g., Zbtb18, Cttnbp2, Gabbr2). A pathways analysis of these 43 genes identified one gene ontological term: regulation of neuronal synaptic plasticity. These findings are consistent with large scale gene expression studies of human ASD postmortem brain tissue, suggesting that multi-omic data integration can be used to achieve a greater resolution of the heterogeneous ASD molecular etiology.

PMID:42502111 | DOI:10.1038/s41380-026-03772-4