Nevin Manimala

Child Adolesc Psychiatry Ment Health. 2026 Jul 23;20(1):102. doi: 10.1186/s13034-026-01115-3.

ABSTRACT

BACKGROUND: This German multicenter study aimed to analyze the efficacy of telephone-assisted self-help (TASH) and changes during subsequent adaptive treatment in children with mild-to-moderate ADHD.

METHODS: Participants were children (6;0-11;11 years) with mild-to-moderate ADHD. Study Step 1 comprised a randomized waitlist-controlled trial on the efficacy of three-month, parent-directed TASH. Depending on their response to TASH, in Step 2, children were assigned to booster TASH (full response), behavior therapy (partial response), or pharmacotherapy plus behavior therapy or counseling (non-response) for six months. The primary outcome was the change in blinded-clinician-rated ADHD symptoms; for subsequent changes (Step 2), we considered semi-blinded ratings. The primary analyses were by intention-to-treat.

RESULTS: Of the 163 included children (77.9% boys), 80 were randomized to TASH and 83 to the waitlist control group. Following TASH, 12 children (8.8%) were classified as full responders, 40 (29.2%) as partial responders, and 85 (62.0%) as non-responders. An analysis of covariance did not yield an effect of TASH on the primary outcome (mean between-group difference = 0.00 ± 0.07, 95% CI[- 0.14, 0.13]; p = 0.95; d = -0.01, 95% CI[- 0.37, 0.34]). During Step 2, full responders demonstrated a stable symptom level (piecewise mixed-effects model for repeated measures; d = – 0.07, 95% CI[- 0.61, 0.47], p = 0.80), partial responders a small increase in ADHD symptoms (d = 0.29, 95% CI[0.00, 0.59], p = 0.05), and non-responders a large decrease (d = – 1.00, 95% CI[- 1.27, – 0.73], p < 0.001).

CONCLUSIONS: TASH is not effective in reducing blinded-clinician-rated ADHD symptoms in children with mild-to-moderate ADHD. Based on the changes within the response groups during Step 2, hypotheses are generated for adaptive treatment after TASH. Trial registration German Clinical Trials Register (DRKS): DRKS0000897; URL: https://drks.de/search/de/trial/DRKS00008973/details ; registered on December 18th 2015.

PMID:42571030 | DOI:10.1186/s13034-026-01115-3

BMC Med. 2026 Aug 6;24(1):426. doi: 10.1186/s12916-026-05131-0.

ABSTRACT

BACKGROUND: Pain management is a core ethical principle in emergency medicine, yet gender-related differences in analgesic treatment have been reported. This study examines whether patient and emergency physician gender influence prehospital pain management.

METHODS: This retrospective observational cohort study included all primary helicopter emergency medical service missions conducted by DRF Stiftung Luftrettung in Germany between January 2012 and June 2025. Adult patients (≥ 18 years) with a Glasgow Coma Scale score ≥ 11 and without airway management were analyzed. Pain severity was assessed using the Numeric Rating Scale (NRS). Patient characteristics, analgesic treatment, and emergency physician gender were analyzed using descriptive statistical methods. The study was approved by the Ethics Committee Freiburg (25-1272-S1, August 19th 2025).

RESULTS: A total of 106,888 cases was included, of which 38.5% were female and 61.5% male. Initial pain severity was comparable between genders, with a similar distribution across NRS categories. Despite this, women received analgesic treatment less frequently than men (62.0% vs. 66.9%; p < 0.001), whereas a greater effect is seen when particularly examining the use of opioid analgesics (50.0% vs. 57.1%; p < 0.001). This finding is consistent across all pain severity subgroups. Pain scores at patient handover were similar for women and men, indicating comparable pain levels at the end of prehospital care.

CONCLUSIONS: Despite comparable pain intensity, women received analgesic and opioid treatment less frequently than men in prehospital care, indicating potential gender-based inequalities in pain management. These findings underscore the need for strategies to ensure equitable analgesic treatment.

PMID:42571028 | DOI:10.1186/s12916-026-05131-0

Cardiovasc Diabetol Endocrinol Rep. 2026 Aug 9;12(1):55. doi: 10.1186/s40842-026-00327-y.

ABSTRACT

BACKGROUND: Atrial fibrillation (Afib) and type 2 DM (T2DM) are common conditions associated with substantial cardiovascular morbidity and mortality. However, data on the burden of Afib among patients with T2DM in sub-Saharan Africa remain limited. This study aimed to determine the prevalence, clinical features, and factors associated with Afib among adults with T2DM at Hoima Regional Referral Hospital (HRRH), western Uganda.

METHODS: A hospital-based cross-sectional study was conducted among 355 adults with T2DM attending HRRH. Participants underwent clinical evaluation, glycated hemoglobin (HbA1c) testing, and 12-lead electrocardiography (ECG) for Afib diagnosis. Logistic regression analysis was used to identify factors associated with Afib, with statistical significance set at p < 0.05.

RESULTS: The prevalence of Afib was 7.9% (28/355). Patients with Afib commonly presented with palpitations, dizziness, fatigue, chest pain, and dyspnea, with tachycardia and irregular pulse frequently observed on examination. In multivariable analysis, hypertension (aOR 3.027, 95% CI 1.419-6.431; p = 0.020), human immunodeficiency virus (HIV) infection (aOR 2.026, 95% CI 1.738-6.538; p = 0.048), body mass index (BMI ≥ 25 kg/m²) (aOR 3.014, 95% CI 1.242-7.930; p = 0.029), and poor glycemic control (HbA1c ≥ 8%) (aOR 3.813, 95% CI 1.762-8.265; p = 0.007) were independently associated with Afib.

CONCLUSION: Afib is relatively common among adults with T2DM in western Uganda, affecting nearly one in ten patients. Hypertension, HIV infection, obesity, and poor glycemic control were significant associated factors. Integrating ECG screening into diabetes care, particularly for high-risk patients may improve early detection and management in resource-limited settings.

PMID:42571021 | DOI:10.1186/s40842-026-00327-y

BMC Pregnancy Childbirth. 2026 Jul 23;26(1):857. doi: 10.1186/s12884-026-09602-3.

ABSTRACT

BACKGROUND: Pregnancy is a period marked by anatomical, physiological, and psychological changes that may be associated with women’s perceptions of risk and their attitudes toward sexuality during pregnancy. Risk perception during pregnancy is a subjective experience shaped by personal, medical, psychological, and cultural factors. Sexuality during pregnancy may also be associated with myths, misconceptions, physiological changes, and concerns about maternal or fetal safety. Although previous studies have examined sexual function, sexual beliefs, and body image during pregnancy, limited evidence is available on the relationship between pregnancy-related risk perception and attitudes toward sexuality during pregnancy. This study aimed to examine this relationship among pregnant women in Türkiye.

METHODS: A descriptive, cross-sectional study was conducted with 306 pregnant women who applied to family health centers in a district in Türkiye. The sample size was determined using statistical power analysis, and data were collected through structured face-to-face interviews. Data collection tools included a Personal Information Form, the Perception of Pregnancy Risk Questionnaire (PPRQ), and the Attitude Scale toward Sexuality during Pregnancy (ASSP). Descriptive statistics, independent samples t-tests, one-way analysis of variance with Bonferroni post-hoc tests, and Pearson correlation analysis were performed using IBM SPSS Statistics version 25. Statistical significance was accepted at p < 0.05.

RESULTS: The mean total PPRQ score was 41.75 +/- 13.97. The mean score for risk perception toward oneself was 42.37 +/- 17.13, and the mean score for risk perception toward the baby was 40.98 +/- 16.58. The mean total ASSP score was 104.99 +/- 23.23, and 23.9% of participants had a positive attitude toward sexuality during pregnancy according to the ASSP cut-off point. A weak positive correlation was found between risk perception toward the baby and approval of sexuality during pregnancy (r = 0.195, p = 0.001), and between risk perception toward the baby and total ASSP score (r = 0.143, p = 0.012). A weak negative correlation was found between risk perception toward oneself and total ASSP score (r = -0.215, p < 0.001). Significant differences in PPRQ and ASSP scores were observed according to several sociodemographic and pregnancy-related characteristics.

CONCLUSIONS: This cross-sectional study found weak correlations between pregnancy risk perception sub-dimensions and attitudes toward sexuality during pregnancy. The findings should be interpreted cautiously because of the weak magnitude of the correlations, the cross-sectional design, the single-district sample, and the use of self-reported data.

PMID:42571019 | DOI:10.1186/s12884-026-09602-3

BMC Biomed Eng. 2026 Aug 8;8(1):15. doi: 10.1186/s42490-026-00118-7.

ABSTRACT

BACKGROUND: Gait speed is a key clinical indicator in neurological and orthopaedic conditions, yet waveform-level adaptations in ground reaction forces (GRF) and multi-muscle electromyography (EMG) remain poorly characterised. Existing approaches often analyse discrete outcomes or individual modalities, leaving limited integration of continuous waveform inference, dimensionality reduction, explainable machine learning, and equivalence testing within a unified multimodal framework.

OBJECTIVE: To compare three-axis GRF and six-muscle EMG between slow (0.5 m/s) and fast (1.0 m/s) treadmill walking using statistical parametric mapping (SPM), functional principal component analysis (fPCA), explainable machine learning, and equivalence testing.

METHODS: Fifty-eight healthy adults were analysed (55 with complete EMG). Paired SPM with cluster-based permutation assessed waveform differences. fPCA-derived features entered a Random Forest with leave-one-subject-out cross-validation and SHAP interpretability. Two one-sided tests (TOST) assessed equivalence of the vertical GRF.

RESULTS: No significant cluster-level SPM differences were found for any GRF component. In contrast, significant EMG clusters were detected in tibialis anterior (ten clusters), gastrocnemius medial and lateral, vastus lateralis, rectus femoris, and semitendinosus. The Random Forest achieved 87.2% accuracy (95% CI: 79.3-92.3%), improving 14.7% points over simple amplitude features, with tibialis anterior PC1 the most important predictor. TOST did not confirm equivalence within ± 0.2 N/kg, though no GRF clusters appeared.

CONCLUSIONS: Moderate speed increases elicited distributed multi-muscle activation changes, whereas GRF waveform differences did not reach cluster-level significance within the present analytical framework. The integrated SPM-fPCA-SHAP-TOST pipeline provides an interpretable signal-processing framework for multimodal gait analysis and could serve as a foundation for future investigations in rehabilitation engineering, digital biomarkers, and wearable sensing, pending validation in clinical populations.

PMID:42571017 | DOI:10.1186/s42490-026-00118-7

BMC Health Serv Res. 2026 Aug 7;26(1):1068. doi: 10.1186/s12913-026-15334-z.

ABSTRACT

OBJECTIVE: This study aimed to assess sociodemographic characteristics, health-seeking behaviors, and breast cancer screening beliefs among women aged 18-69 years attending Family Health Centers (FHCs) in Ankara, Türkiye, and to determine predictors of participation in mammography screening. It is design as a descriptive, cross-sectional study.

METHODS: Between April 2024 and January 2025, data were collected from 718 women using a sociodemographic questionnaire and the Turkish-adapted Breast Cancer Screening Beliefs Scale (originally developed by Kwok et al., validated by Türkoğlu et al.). Descriptive analyses, Chi-square tests, and binary logistic regression were performed with IBM SPSS 25.0. Variables with p < 0.20 in univariate analyses were entered into multivariate modeling, and statistical significance was defined as p < 0.05.

RESULTS: Statistically significant differences were found between age groups in terms of marital status, education level, housing situation, presence of chronic disease, general health perception, and history of non-breast cancer screening (p < 0.001). According to the logistic regression analysis, women who are aware of screening programs are 8.50 times more likely to have a mammogram, those who have undergone non-breast cancer screening are 5.52 times more likely, those with chronic diseases are 1.98 times more likely, and those who describe their health perception as “good/very good” are 1.90 times more likely. (Nagelkerke R² = 0.465).

CONCLUSION: Mammography participation is influenced by both structural and personal determinants. Enhancing awareness, strengthening primary-care education, and addressing financial barriers could substantially improve screening uptake and facilitate earlier breast cancer diagnosis among Turkish women.

PMID:42571012 | DOI:10.1186/s12913-026-15334-z

BMC Health Serv Res. 2026 Aug 8;26(1):1067. doi: 10.1186/s12913-026-15289-1.

ABSTRACT

BACKGROUND: Methodological and technical education of nurses is required to address challenges of technology integration in peritoneal dialysis (PD). We analysed the nature of therapy interrupting system errors in automated peritoneal dialysis (APD) cyclers of a German PD reference care centre and provide applicable resolution proposals.

METHODS: We documented therapy interrupting system errors of HomeChoice Pro and HomeChoice Claria cyclers (Baxter, BX, Unterschleißheim, Germany) including the years 2015-2023. We systematically characterise and suggest resolution strategies to these errors based on routinely collected health data and user experience to safely guide nephrology professionals and patients during troubleshooting. The ‘reporting of studies conducted using observational routinely collected health data’ (RECORD)-statement was considered.

RESULTS: We identified 49 different therapy interrupting system errors which were assigned to eight major categories: Errors associated to the pressure chamber (N=18), the Digitalboard/EEPROM (N=18, Electrically Erasable Programmable Read Only Memory), air in set (N=3), opening of the set’s door (N=3), those associated to the energy system (N=3), the heater system (N=3) and a variety of errors resulting in an abrupt termination or non-commencement of the treatment session without clear group assignment (undefined, N=1) or without sufficient documentation. In total, 138 error incidents were documented during the observational timeframe. In frequential order errors were attributed to the pressure chamber (21.74%,), and air in set (19.57%) where specifically error 2240 occurred in 17.39% of total cases, the Digitalboard/EEPROM (17.39%), the energy or battery (16.67%; No. 1032 in 19/23 cases), the set’s door (7.25%) and the heater (4.35%). In 17 cases (12.32%) no error number was documented by the patient or staff. One error cause was registered as undefined (0.72%). Overall, errors were rarely occurring in <0.25% of treatment sessions performed in the observational timeframe.

CONCLUSION: These findings may be useful to guide training purposes for nephrology personnel and persons doing APD. For the manufacturer, the information provided may be helpful to improve error management and information transmission to the persons doing APD with the HomeChoice devices.

PMID:42571003 | DOI:10.1186/s12913-026-15289-1

Ann Surg Oncol. 2026 Aug 8. doi: 10.1245/s10434-026-20381-1. Online ahead of print.

ABSTRACT

BACKGROUND: The 2025 American thyroid association (ATA) guidelines introduced a revised risk stratification system for thyroid cancer incorporating histology-specific models and a four-tier classification framework. However, its clinical performance in patients with papillary thyroid carcinoma (PTC) remains insufficiently validated. This study compared the 2015 and 2025 ATA risk stratification systems for predicting PTC recurrence and evaluated reclassification patterns.

PATIENTS AND METHODS: This retrospective cohort study included 284 patients who underwent surgery for PTC at Samsung Medical Center, Seoul, Korea, between 2019 and 2021. Risk classification was performed according to the 2015 ATA three-tier system (low, intermediate, and high risk) and the 2025 ATA four-tier system (low, low-intermediate, intermediate-high, and high risk). Predictive performance for recurrence was assessed using disease-free survival (DFS) and the integrated area under the receiver operating characteristic curve (iAUC).

RESULTS: During follow-up, structural recurrence occurred in 23 patients (8.1%). Under the 2015 system, recurrence occurred in 0/119 low-risk, 8/106 intermediate-risk, and 15/59 high-risk patients. Under the 2025 system, recurrence occurred in 0/86 low-risk, 1/56 low-intermediate-risk, 2/53 intermediate-high-risk, and 20/89 high-risk patients, with recurrence events predominantly concentrated in the high-risk group. The 2025 ATA system resulted in substantial reclassification, particularly among patients initially classified as intermediate risk. The iAUC for predicting DFS was 0.873 for the 2015 system and 0.852 for the 2025 system.

CONCLUSIONS: The 2025 ATA risk stratification system demonstrated predictive performance comparable to the 2015 system while concentrating recurrence events predominantly within the high-risk group, suggesting improved risk discrimination in patients with PTC.

PMID:42570987 | DOI:10.1245/s10434-026-20381-1

Environ Sci Pollut Res Int. 2026 Aug 8. doi: 10.1007/s11356-026-38086-z. Online ahead of print.

ABSTRACT

Industrial oily wastewater and oil spills pose serious environmental threats, demanding efficient and scalable separation materials. In this work, a hydrophobic/oleophilic ZIF-8/polyurethane sponge (ZIF-8/PUS) composite was fabricated via a simple dip-coating and drying process at room temperature. The composite was characterized by X-ray diffraction, FTIR, scanning electron microscopy (SEM), Brunauer-Emmett-Teller (BET) surface area analysis, and Barrett-Joyner-Halenda (BJH) pore size distribution, confirming successful ZIF-8 deposition and a well-developed porous architecture. The water contact angle increased from 96.8 to 148.4°, while the oil contact angle remained 0°. The sponge achieved an oil absorption capacity of 36.1 g g⁻¹ for 15W-40 oil and a water flux of 107 L m⁻² h⁻¹. Temperature-dependent separation tests (25-85 °C) yielded COD removal efficiencies of 99.24-97.55% and oil and grease removal of 99.20-97.74%. Statistics on triple experiments validated these results’ robustness: One-way ANOVA showed significant differences in COD and oil/grease removal among experimental groups (p < 0.0001), and Tukey’s HSD test showed that optimally adjusted samples outperformed controls (p < 0.05). The sponge retained performance after ten absorption-squeezing cycles. Application to real drilling rig wastewater (RIG-69 Fath unit) achieved 94.97% COD removal (6689 to 67 mg L⁻¹) and 99.07% oil and grease removal, demonstrating practical potential for industrial oily wastewater treatment.

PMID:42570976 | DOI:10.1007/s11356-026-38086-z

Sci Rep. 2026 Aug 8;16(1):24542. doi: 10.1038/s41598-026-64405-y.

ABSTRACT

Cognitive-behavioral therapy (CBT) is the first-line treatment for obsessive-compulsive disorder (OCD), yet a significant number of patients do not achieve remission or substantial symptom relief. This study aims to enhance the prediction of CBT outcomes in OCD by integrating demographic, clinical, and neuroimaging data using machine learning (ML) models. We conduct a comprehensive analysis on a well-characterized clinical sample, employing a rigorous validation scheme to avoid data leakage, and comparing multiple ML algorithms to minimize bias. Out of four different ML models trained on demographic and clinical data, structural MRI, and resting-state MRI functional connectivity data, no model was able to predict CBT success significantly above chance level in the present sample. Although clinical and demographic data enabled 64%-66% accuracy for predicting remission, this did not reach statistical significance after permutation testing. Pre-treatment symptom severity emerged numerically as the most promising predictor of remission, aligning with previous studies, but did not pass the significance threshold in the present study. Despite efforts to identify neuroimaging predictors, neither functional nor structural MRI features significantly contributed to the prediction models. These findings suggest that robust, individualized brain-based predictions for mental health outcomes remain challenging with the available data and sample size.

PMID:42570963 | DOI:10.1038/s41598-026-64405-y