Nevin Manimala

J Psychosom Res. 2026 Apr 13;207:112675. doi: 10.1016/j.jpsychores.2026.112675. Online ahead of print.

ABSTRACT

OBJECTIVE: The international cardiovascular guidelines emphasise self-care as a key factor for better health management in patients. Self-care incorporated into patient engagement is considered vital for the patient-provider relationship to alleviate the polipharmacological treatment burden. However, several cardiovascular (CV) patients struggle to adhere to recommendations. The present study aims to address this research gap by exploring the adherence and real-world effectiveness in a CV population. From this perspective, our cohort study attempted to determine self-care ability based on the relevance of self-efficacy and quality of life perception in adults with a CV condition.

METHODS: An observational study design was applied based on cohort analysis. A total of 76 patients at different stages of disease severity participated in the study. Two types of patient data were collected: medical data-drawn from clinical records and psychological data-collected through interviews and the following standardised questionnaires: the EuroQol Visual Analogue, Self-Care of Chronic Illness Inventory, Self-Care Self-Efficacy Scale. All clinical data were recorded during the outpatient scheduled follow-up.

RESULTS: Our results evidenced that patients with hypertension and heart failure need greater engagement actions and education support from providers to achieve the goal of medical treatments modelling health behaviour that prioritises monitoring ability over time. CV risk factors were more regulated in the self-care monitoring group than in the heart failure group; in CV diseases, patients with ischemic heart disease seemed more efficient in self-monitoring than those with heart failure. Relevant results were obtained in self-efficacy perception; the comparison between hypercholesterolaemia and heart failure groups resulted in statistical significance, indicating that patients with hypercholesterolaemia perceive a higher ability to achieve positive outcomes for their own health; other patient groups did not seem to perceive high self-efficacy.

CONCLUSION: In chronic diseases, such as cardiological conditions, monitoring ability seems to be a challenging clinical variable; the ability to check signs and symptoms, and actions associated with the complexity of physical signs and multimorbidity could be impacted over time. Our findings suggest that fostering self-efficacy capacity could induce better physical self-monitoring for enhanced well-being and greater self-confidence regarding the management of health-favouring behaviours and lifestyle-modelled changes.

PMID:41985203 | DOI:10.1016/j.jpsychores.2026.112675

J Low Genit Tract Dis. 2026 Apr 17. doi: 10.1097/LGT.0000000000000953. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess changes in high-risk HPV prevalence among Inuit women in Nunavik following the introduction in 2008 among 12-year-old girls of the quadrivalent HPV vaccine program in Quebec.

METHODS: A total of 169 Inuit women aged 25-65 were recruited in Kuujjuaq, Nunavik, between July 2022 and December 2024. Participants self-collected cervico-vaginal samples under nurse supervision. HPV DNA testing was performed using real-time PCR (Cobas 4800), detecting HPV 16, 18, and 12 other high-risk types. Results were compared with historical data from 473 Inuit women (2002-2007), using the same genotypic categories. Age-stratified prevalence ratios (PR) were calculated to assess differences over time and odds ratios (OR) for HPV 16/18 detection by vaccination status.

RESULTS: Among 148 participants with results, overall high-risk HPV prevalence increased from 15.9% pre-vaccination to 22.3% post-vaccination, driven by a significant rise in other high-risk types among women aged 40+ (from 5.8% to 16.4%; PR=2.80, 95% CI: 1.16-6.75). HPV 16/18 prevalence showed a non-statistically significant decline among the 25-29 age group (6.8%-3.3%). Only one vaccinated participant tested positive for HPV 16/18 (OR=0.29, 95% CI: 0.0062-2.54).

CONCLUSIONS: The quadrivalent HPV vaccine has reduced HPV 16/18 prevalence in the targeted younger population. Continued surveillance is warranted, particularly for nonvaccine high-risk types.

PMID:41985196 | DOI:10.1097/LGT.0000000000000953

Am J Phys Med Rehabil. 2026 Apr 10. doi: 10.1097/PHM.0000000000003007. Online ahead of print.

ABSTRACT

OBJECTIVES: Body weight-supported (BWS) walking therapies, lower body positive pressure (LBPP) treadmills or aquatic pool walking could provide a treatment to reduce pain in individuals with knee osteoarthritis (OA). Our objective was to examine the potential benefits of BWS for individuals with knee OA.

DESIGN: Parallel group randomized clinical trial. Forty-nine (n=49) participants, aged>50 with knee OA, randomly assigned to one of three groups: (1)Control (n=16), (2)Aquatic (n=17), and (3)LBPP (n=16). Interventional groups had two 30-minute walking sessions for eight weeks. The control group received no active treatment. Primary outcome was change in Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain from baseline to 8 weeks. Secondary outcomes included other KOOS subscales, six-minute walk test (6-MWT), joint kinematics, and serum cytokine concentration.

RESULTS: Forty-one participants completed the trial. Changes in KOOS-Pain from baseline to 8 weeks were statistically significant and clinically relevant in the LBPP group (15.3,95% CI 5.0,25.6). Changes in the other groups were not statistically significant (Aquatic 0.9(95% CI -7.8,9.6); and Control -3.3(95% CI -12.3,5.7). Post-hoc analyses indicated improvements were significantly larger with LBPP. This group improved in 6-MWT(58.9m, 95% CI 26.1,91.7) and most KOOS sub-scales. Improvements in KOOS-Pain at 8 weeks in the LBPP group were associated with increased knee flexion(P=0.02). Only the control group had significant increases in IL-1β(P=0.04) and IL-1RA(P=0.02) concentration at 8 weeks.

CONCLUSIONS: This is the first randomized controlled trial of BWS for knee OA and showed benefits of LBPP treadmill walking. Future, larger studies should assess effect size, sustained benefits and cost-effectiveness.

PMID:41985188 | DOI:10.1097/PHM.0000000000003007

J Am Soc Mass Spectrom. 2026 Apr 15. doi: 10.1021/jasms.6c00035. Online ahead of print.

ABSTRACT

Hydrogen/Deuterium Exchange Mass Spectrometry (HDX-MS) is a unique, rapidly evolving technique that has been widely adopted for the characterization of the higher-order structure of proteins. Numerous statistical tools are available in the literature that can be used to identify statistically significant differences in the deuterium uptake values. Biopharmaceutical comparability studies, however, require evidence that two protein samples are highly similar and therefore necessitate a different statistical approach. Hageman et al. recently introduced an innovative HDX-MS equivalence testing method utilizing univariate two one-sided tests (TOST). The acceptance limits were established by the randomized resampling of eight replicate measurements of a reference protein. However, this approach can introduce a non-negligible level of variability in the acceptance limits when the same data set is reanalyzed. In the present study, we enhance this method by replacing the randomized resampling process with the systematic enumeration of all possible combinations of the reference data set, thus eliminating the resampling-induced variation. Because this approach incorporates all measurements, including replicate combinations with markedly elevated variability, it leads to higher acceptance limits. Therefore, we evaluated three strategies: robust outlier detection, a percentile-based method, and a partitioning approach to establish more stringent criteria and reduce patient risk. By applying the enhanced methods to data sets of three approved infliximab biosimilars and a partially deglycosylated NIST mAb used as a mock candidate biosimilar, we demonstrated correct classification of equivalent and nonequivalent samples, making the enhanced evaluation strategy well suited for regulatory comparability assessment.

PMID:41985126 | DOI:10.1021/jasms.6c00035

JCO Glob Oncol. 2026 Apr;12(4):e2500232. doi: 10.1200/GO-25-00232. Epub 2026 Apr 15.

ABSTRACT

PURPOSE: The Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE)2 trial builds on the foundational STAMPEDE trial, which introduced innovative multiarm treatment protocols for metastatic prostate cancer. This survey assessed Nigeria’s readiness for the STAMPEDE2 trial by evaluating current clinical practices, radiotherapy infrastructure, systemic therapy usage, and imaging capabilities across its six geopolitical zones.

MATERIALS AND METHODS: We mapped the radiotherapy centers and machines currently available (commissioned) and in the Nigerian pipeline. A structured questionnaire comprising 31 questions in six sections was disseminated to clinical and radiation oncologists via Google Forms. The survey ran from July to September 2024, gathering data on radiotherapy availability, systemic therapies, advanced imaging, and readiness for clinical trial participation. Descriptive statistical analysis was conducted using Microsoft Excel. Responses were aggregated from 14 cancer centers across Nigeria, encompassing both public and private facilities.

RESULTS: The survey identified 23 operational radiotherapy machines distributed across 12 centers, with 19 additional facilities in the pipeline. These centers were predominantly located in urban areas such as Lagos and Abuja. Prostate cancer treatment modalities are available; however, access to agents such as abiraterone and enzalutamide was reported in 73% of centers. There is one operational positron emission tomography/computed tomography facility in Nigeria. Clinicians expressed strong interest in participating in trials although some gaps in infrastructure, particularly in rural areas, and limited access to advanced treatments like 177Lu-PSMA-617 were noted.

CONCLUSION: The findings underscore Nigeria’s potential readiness for the STAMPEDE2 trial, other clinical trials, and collaborative research, bolstered by an expanding radiotherapy infrastructure and clinician enthusiasm for advanced therapeutic approaches. Initiatives like the Cancer Health Fund and the National Cancer Access Partnership represent significant steps toward equitable cancer care.

PMID:41985120 | DOI:10.1200/GO-25-00232

JCO Glob Oncol. 2026 Apr;12(4):e2500636. doi: 10.1200/GO-25-00636. Epub 2026 Apr 15.

ABSTRACT

PURPOSE: The incidence of breast cancer is rising in Nigeria, with the majority of women presenting at advanced stages. Although mastectomy is the primary surgical treatment, many women fear mastectomy, leading to delayed presentation. Increasing awareness of and access to breast reconstruction after mastectomy is important to mitigate patient fear and encourage earlier presentation. An understanding of institutional and surgical workforce barriers is needed, yet has not been comprehensively studied nationwide. This study assessed barriers to breast reconstruction from the perspective of surgeons practicing in Nigeria.

METHODS: In April 2024, a questionnaire was distributed to breast, general, and plastic surgeons across all six geopolitical zones in Nigeria via an online messaging platform. Demographics, practice patterns, and perceived barriers to breast reconstruction were collected. Plastic surgeons were further asked about microsurgical experience, training, and equipment. Descriptive statistical analysis was performed using R.

RESULTS: Of the 440 invited, 66 (15.0%) surgeons completed the survey. Respondents were predominantly male (81.8%), consultants or fellows (72.7%), and practicing in public teaching hospitals (83.3%). The majority of general and breast surgeons reported performing fewer than five mastectomies per month, while most plastic surgeons had limited or no reconstruction caseloads. Late stage of patient presentation (84%) and poor referral pathways (75%) were the most frequently cited barriers. Additional clinical and institutional constraints were limited access to radiation therapy (62%), inadequate funding (58%), and perceived insufficient technical skill in reconstructive surgery (44%). High interest (90%) in microsurgical training was reported, although equipment access was inconsistent.

CONCLUSION: Findings highlight the need for strengthened referral systems, improved surgical collaboration, and institutional support for training and infrastructure to expand access to breast reconstruction in Nigeria.

PMID:41985118 | DOI:10.1200/GO-25-00636

JCO Glob Oncol. 2026 Apr;12(4):e2500512. doi: 10.1200/GO-25-00512. Epub 2026 Apr 15.

ABSTRACT

PURPOSE: Early integration of palliative care (PC) for children with cancer is vital to improved patient outcomes. Despite this, access to PC services for children in Asia Pacific (AP) is sparce. We aimed to explore potential barriers to PC provision in childhood cancer care across AP.

METHODS: The Assessing Doctors’ Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels.

RESULTS: Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting (P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle-income countries rated these barriers more significantly.

CONCLUSION: Physicians report a discrepancy between ideal and actual timing of PC integration and identify several barriers to PC provision. Study findings will inform capacity building, education, and advocacy initiatives to improve the timing and quality of PC delivery in the region.

PMID:41985116 | DOI:10.1200/GO-25-00512

JMIR Ment Health. 2026 Apr 15;13:e88700. doi: 10.2196/88700.

ABSTRACT

BACKGROUND: Individuals with serious mental illness increasingly use digital devices and the internet to access health information and services but often face challenges when navigating digital tools, which may limit the benefits they receive from online health resources and digital health care services.

OBJECTIVE: The objective of our study was to assess digital health literacy among individuals with serious mental illness and identify factors influencing this literacy.

METHODS: Participants were recruited, using convenience sampling, from 2 psychiatric clinics, 1 day-care center, and 4 halfway houses in Taipei, Taiwan, between May 2024 and February 2025. Self-reported data were collected using a survey that incorporated the eHealth Literacy Scale, the Attitudes Toward Computer/Internet Questionnaire, and the Mobile Device Proficiency Questionnaire. Generalized linear modeling was applied to identify factors associated with digital health literacy.

RESULTS: Among 255 participants included in the analysis, 83.5% (n=213) reported owning at least 1 digital device. Digital health literacy was significantly lower among individuals who reported greater perceived difficulty in using digital tools (B=-1.533, 95% CI -2.350 to -0.717; P<.001) and higher distrust in online information (B=-0.986, 95% CI -1.916 to -0.056; P=.04). By contrast, greater mobile device proficiency (B=0.144, 95% CI 0.008-0.281; P=.04) and self-efficacy (B=1.777, 95% CI 0.376-3.177; P=.01) were positively associated with digital health literacy.

CONCLUSIONS: Despite widespread device ownership, digital health literacy was varied and generally suboptimal among patients with serious mental illness. Perceived difficulty and distrust emerged as major barriers; proficiency and self-efficacy facilitated higher literacy. These findings highlight the need for mental health professionals to integrate tailored digital skills training, confidence-building strategies, and ongoing support into digital health interventions for individuals with serious mental illnesses.

PMID:41985096 | DOI:10.2196/88700

JMIR Rehabil Assist Technol. 2026 Apr 15;13:e80971. doi: 10.2196/80971.

ABSTRACT

BACKGROUND: Mobile apps and biofeedback using motion analysis have both been used separately to increase compliance with exercise programs. We developed a mobile app, Osteoarthritis-Rehabilitation Assistant (O-RA), that uses motion analysis technology in the mobile app to assist older adults with performing a knee exercise program.

OBJECTIVE: This study aimed to evaluate the effects of the O-RA app on the compliance and correctness of the exercise program by older adults.

METHODS: We conducted an assessor-blind, parallel-design, randomized controlled trial with 40 older adults (aged 60 years or older) who had no symptoms and no diagnosis of knee osteoarthritis. Participants were divided into 2 groups: O-RA app (intervention) group and standard treatment (control) group. Both groups were taught 4 types of exercise programs by a physical therapist for 15 minutes and were instructed to do exercises at home every day for 1 week. The number of exercises, the percentage between observed and prescribed exercises, the correctness of exercises, and overall pain during the program were assessed in both groups.

RESULTS: The control group had significantly higher compliance with the exercise program than the intervention group (t38=3.5044, P=.001). There was no statistically significant difference in the correctness of the exercise program between the intervention and control groups. The difficulty of use and satisfaction were 47 and 59, respectively, out of the full score of 100. The main problems were the instability and the difficulty using the app.

CONCLUSIONS: In older adults without knee osteoarthritis symptoms or diagnosis, the O-RA app was not a facilitator but a barrier to the lower extremity exercise program. An updated version, aiming to increase the stability and make it more user-friendly, should be developed; however, more comprehensive data, including qualitative user feedback and standardized usability metrics, will be needed to effectively guide its design.

PMID:41985075 | DOI:10.2196/80971

Clin Exp Dent Res. 2026 Apr;12(2):e70357. doi: 10.1002/cre2.70357.

ABSTRACT

OBJECTIVES: Hormonal changes during pregnancy can increase susceptibility to plaque-induced gingivitis, and at the same time, dental care visits during pregnancy have been reported to be low. This study evaluated the effect of an oral health education program on knowledge, attitude, and clinical indices of oral health in pregnant women.

METHODS: This nonrandomized controlled intervention study was conducted at Kowsar Hospital, Urmia. Allocation to groups was based on the day of visit (even/odd days). In addition to routine prenatal care, the intervention group received an individual education session of approximately 60 min with a brochure, and the control group received routine care only. Knowledge, attitude, plaque index (PI), gingival index (GI), and decayed, missing, and filled teeth (DMFT) indices were measured at baseline and 3 months later. Statistical analysis was performed in Statistical Package for the Social Sciences.

RESULTS: Of 240 enrolled participants, 200 (100 per group) provided complete follow-up data. Baseline characteristics and oral health indices were comparable between groups. At 3 months, the intervention group demonstrated improved knowledge and attitude, lower PI, and modest improvement in GI. In the control group, knowledge and attitude changed little, GI worsened, and PI remained largely unchanged. DMFT increased in both groups over the 3-month period.

CONCLUSIONS: Short-term, structured oral health education with a brochure can improve knowledge and attitude of pregnant women in the short term and improve plaque and gingivitis.

PMID:41985064 | DOI:10.1002/cre2.70357