Nevin Manimala

Nurs Crit Care. 2026 Mar;31(2):e70376. doi: 10.1111/nicc.70376.

ABSTRACT

BACKGROUND: Intensive care unit (ICU) nurses frequently encounter ethical dilemmas, patient death and emotional distress, which can shape attitudes towards end-of-life care. Spiritual coping and psychological flexibility may support nurses’ well-being and caregiving behaviour, but the mechanisms by which these factors affect ICU nurses’ attitudes towards end-of-life care remain underexplored, particularly in Eastern cultural contexts.

AIMS: To examine associations between spiritual coping, psychological flexibility and attitudes towards end-of-life care among ICU nurses, and to test whether psychological flexibility mediates the spiritual coping-attitude relationship.

STUDY DESIGN: A cross-sectional study was conducted between November and December 2024 in a large teaching hospital in China. Participants were selected using convenience sampling, and data were collected using the Chinese versions of the Spiritual Coping Questionnaire, Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT) and the End-of-Life Care Attitude Scale for Medical Workers. Descriptive statistics, group comparisons, Pearson correlations, multiple linear regression and PROCESS (Model 4) bootstrap mediation were used.

RESULTS: A total of 244 ICU nurses were included. Psychological flexibility and spiritual coping were positively correlated with attitudes towards end-of-life care (r = 0.635 and r = 0.282, both p < 0.001). In regression, psychological flexibility (p < 0.001), spiritual coping (p = 0.015), death education (p < 0.001), end-of-life care practice (p < 0.001) and educational level (p = 0.036) were significant predictors; the model explained 67.9% of the variance (R² = 0.679). Bootstrap mediation showed a significant indirect effect of spiritual coping on attitudes via psychological flexibility (indirect effect = 0.118, 95% CI 0.064-0.193), accounting for 48.96% of the total effect.

CONCLUSIONS: ICU nurses with greater spiritual coping report more positive end-of-life care attitudes, partly through higher psychological flexibility. Interventions integrating Acceptance and Commitment Therapy-informed flexibility training with culturally sensitive spiritual support and structured death education may strengthen nurses’ preparedness for end-of-life care.

RELEVANCE TO CLINICAL PRACTICE: Incorporating psychological flexibility and spiritual coping into continuing education could enhance ICU nurses’ resilience and improve end-of-life care quality.

PMID:41622496 | DOI:10.1111/nicc.70376

Neural Regen Res. 2026 Jan 27. doi: 10.4103/NRR.NRR-D-25-00498. Online ahead of print.

ABSTRACT

The pathophysiological mechanism of mild traumatic brain injury remains poorly understood. Generalized q-sampling imaging is applicable to a broad spectrum of diffusion imaging data, provides high-resolution depictions of the brain’s structural connectivity, enables tracking neural fibers across brain regions, and shows promise for predicting neurological outcomes. Graph theory, a quantitative method for modeling complex networks, has been widely used to study changes in brain structure and function. This longitudinal observational study involved 34 patients with acute mild traumatic brain injury (12 men and 22 women) and 31 healthy controls (14 men and 17 women). Clinical and cognitive assessments, and magnetic resonance imaging scans were conducted within 72 hours and at 3 months post-injury. Subsequent graph theory and statistical analyses showed that generalized q-sampling imaging-based structural brain networks captured small-worldness in patients with mild traumatic brain injury compared with healthy controls. Patients with mild traumatic brain injury exhibited cognitive deficits, which showed improvement at the 3-month follow-up. The results also indicated changes in betweenness centrality, node efficiency, and node clustering coefficient of the left fusiform gyrus in patients with chronic mild traumatic brain injury, and an increase in connectivity strength between the bilateral anterior cingulate cortices. Preliminary explanations were made based on neural plasticity and compensatory mechanisms. The underlying mechanisms remain to be further explored in our subsequent research.

PMID:41622453 | DOI:10.4103/NRR.NRR-D-25-00498

Nurs Crit Care. 2026 Mar;31(2):e70359. doi: 10.1111/nicc.70359.

ABSTRACT

This study aimed to examine consumer perceptions and priorities for safety and quality in paediatric intensive care units (PICUs) to inform safety measurement and quality improvement efforts. We conducted a cross-sectional, co-designed survey distributed to PICU parents/caregivers across Australia and New Zealand. Quantitative and qualitative data were collected and analysed using descriptive statistics and inductive content analysis. One hundred and seventeen parents/caregivers identified three key safety themes: foundations for safer care delivery, understanding as a foundation for safety, and shared voices, safer choices. The most frequently selected quantitative measurement priorities by respondents were nurse staffing and communication.

PMID:41622432 | DOI:10.1111/nicc.70359

J Egypt Natl Canc Inst. 2026 Feb 2;38(1):3. doi: 10.1186/s43046-026-00339-w.

ABSTRACT

BACKGROUND: Luminal breast cancer (LBC) is the most common subtype of breast cancer affecting women worldwide. Although luminal breast cancer typically has a better prognosis, it mostly responds poorly to neoadjuvant chemotherapy. Non-coding RNAs, especially long non-coding RNAs and microRNAs are crucial in regulating biological processes that contribute to breast cancer development. MALAT1, a long non-coding RNA, is pivotal in the progression of breast cancer. Epithelial-mesenchymal transition (EMT) is critical for cell movement during embryonic development. Clarifying this role could pave various avenues for developing innovative strategies for combating this subtype of malignancy. The present study aimed to investigate the expression profiles and clinical relevance of MALAT1 level and EMT-related miRNAs (miR-17-5p, miR-20a-5p, miR-93-5p, miR-135b-5p, and miR-146a-5p) alongside EMT markers (E-cadherin, N-cadherin, vimentin, fibronectin, twist, SNAI1, Slug, ZEB1, and ZEB2) in LBC patients.

METHODS: Fresh tissues were collected from fifty patients and twenty noncancerous controls. Differential expression of the markers was evaluated using qRT-PCR assay. Spearman Rho test assessed the relationship between the expression levels. Linear regression test evaluated the correlation between the parameters and various clinico-pathological features.

RESULTS: Our results revealed an overall upregulation of MALAT1 in breast cancer tissues although this increase did not reach statistical significance. Overexpression of miR-20a-5p, miR-135b, and ZEB2 was reported, whereas miR146a-5p, ZEB1 and Vimentin levels were suppressed. Correlation analysis demonstrated that miR-20a-5p was positively correlated with SNAI1, E-cadherin, N-cadherin and Slug also it was significantly associated with family history and tumor laterality.

CONCLUSIONS: Our findings suggest that miR-20a-5p plays an oncogenic role in luminal breast cancer by promoting EMT, while MALAT1 may contribute to disease progression through indirect regulatory mechanisms. Finally, MALAT1 and miR-20a-5p might serve as potential therapeutic and prognostic targets in LBC.

PMID:41622408 | DOI:10.1186/s43046-026-00339-w

Dev Sci. 2026 Mar;29(2):e70127. doi: 10.1111/desc.70127.

ABSTRACT

Declining youth electoral participation threatens the long-term legitimacy of representative democracy. However, timely cross-national indicators of early disengagement remain scarce. This study draws on data from the IEA International Civic and Citizenship Education Study (ICCS) to examine (a) whether eighth-grade students’ stated voting intentions [are associated with] their cohort’s eventual electoral participation, and (b) which individual-level factors best explain those intentions after controlling for country-level characteristics. First, we align students’ voting intentions from IEA ICCS 2009 and 2016 with [corresponding] official age-specific turnout rates in each cohort’s first national election. The analysis reveals a moderate, statistically significant association, indicating that higher proportions of “likely future voters” in Grade 8 are associated with higher turnout once these cohorts reach voting age. Second, to identify the drivers of voting intentions, we pool microdata from all three IEA ICCS cycles (2009, 2016, 2022; N $\approx$ 316,000 students) and estimate fixed-effects models to account for time-invariant national confounders. Results show that students’ political interest emerges as the strongest predictor, followed by civic knowledge, self-efficacy, trust in the political system and its institutions, and parental political interest. Student background characteristics (e.g., gender or language at home) lose statistical significance once these factors are accounted for. The findings validate adolescent voting intentions as an early warning indicator and highlight malleable psychological levers (i.e., interest, knowledge, efficacy) that civic-education policy can target.

PMID:41622400 | DOI:10.1111/desc.70127

J Clin Psychol Med Settings. 2026 Feb 2. doi: 10.1007/s10880-026-10129-0. Online ahead of print.

ABSTRACT

Chronic pain (CP) and hazardous/harmful drinking (HD) commonly co-occur. HD contributes to the onset and severity of CP, while CP severity predicts alcohol use disorder relapse. Integrated treatments for CP and HD are needed in rural areas, where CP and alcohol-related consequences occur at higher rates and treatment accessibility is lower. This study assessed the acceptability and feasibility of an app-based cognitive-behavioral intervention for CP and HD. Participants (n = 32) were rural residents reporting CP and HD (mean age = 49.81, SD = 8.79). Participants were randomized to intervention or assessment-only control. Self-report questionnaires at baseline and 12-week follow-up assessed program acceptability, pain, alcohol involvement, and functioning. Timely recruitment and low attrition (3.2%) supported procedure feasibility, while app engagement suggested intervention feasibility and acceptability. Descriptive statistics suggest reductions in pain (37% reduction in median pain in intervention group vs. 10% in control group). Changes in alcohol-related behavior were not consistent across outcomes and warrant further study (e.g., no change in median heavy drinking episodes in intervention, with 77% reduction in control; 60% reduction in alcohol consequences in intervention vs. 27% in control). This mobile intervention is feasible and acceptable for rural residents and may help address CP and functioning among those who engage in HD.

PMID:41622395 | DOI:10.1007/s10880-026-10129-0

J Bone Miner Metab. 2026 Feb 1. doi: 10.1007/s00774-025-01682-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Though low serum magnesium (Mg) levels are associated with adverse outcomes in patients on haemodialysis, the interaction with calcimimetics remains uncertain. We hypothesized a potential interaction between serum Mg levels and calcimimetic use in cardiovascular events (CVEs), all-cause mortality, and new fractures during follow-up in patients on haemodialysis.

MATERIALS AND METHODS: This single-centre retrospective cohort included 399 Japanese adults on maintenance haemodialysis, followed for ≤ 5 years. Cox models with time-dependent serum Mg levels and calcimimetic usage interaction adjusted for clinicodemographic and biochemical covariates.

RESULTS: At baseline, 205 patients (51.4%) were prescribed calcimimetics (median serum Mg, 2.5 mg/dL). The mean observational period was 40.6 months, and 122 CVEs, 159 all-cause mortality, and 69 new fractures occurred (incidence rates: 0.09, 0.10-, and 0.05 per patient-year), respectively. The time-dependent model showed serum Mg < 2.4 mg/dL was associated with a markedly higher risk for new fractures in calcimimetic-naïve patients. Serum Mg levels were not significantly associated with CVEs and all-cause mortality, regardless of calcimimetic usage. The restricted cubic spline curve demonstrated linear inverse trends of serum Mg levels with all-cause mortality and new fractures in calcimimetic-naïve patients. However, no significant interaction between Mg and calcimimetic use was observed for any outcome.

CONCLUSION: We did not detect a statistically significant interaction between serum Mg levels and calcimimetic use. Nonetheless, low serum Mg (< 2.4 mg/dL) was associated with a higher risk of fractures, particularly among calcimimetic-naïve patients. Thus, low serum Mg is a potentially modifiable risk marker associated with fracture risk, particularly in calcimimetic-naïve patients.

PMID:41622380 | DOI:10.1007/s00774-025-01682-z

Arch Womens Ment Health. 2026 Feb 2;29(1):30. doi: 10.1007/s00737-025-01666-y.

ABSTRACT

PURPOSE: This study investigates how different forms and intensities of intimate partner violence (IPV)-particularly emotional abuse and coercive control control-are associated with symptoms of depression and anxiety among women in Nepal.

METHODS: We analyzed the 2022 Nepal Demographic and Health Survey, focusing on 4377 ever-partnered women aged 15-49 years. IPV was categorised into four domains: physical, sexual, emotional, and coercive control. Depression and anxiety were assessed using Nepali versions of the PHQ-9 and GAD-7. Multivariable logistic regression and marginal effects models were applied to estimate associations and explore dose-response patterns.

RESULTS: Emotional IPV (aOR = 3.8) and coercive control (aOR = 1.8) were independently associated with moderate-to-severe depressive symptoms. Similar associations were observed for anxiety (emotional IPV aOR = 2.9; coercive control aOR = 1.6). Male partner alcohol use independently increased the risk of both IPV and common mental disorders (CMDs). Predicted probabilities of CMD symptoms were 5.45% with neither IPV nor alcohol use, 7.82% with alcohol use only, 11.64% with IPV only, and 17.95% with both exposures. Marginal effects analysis showed a clear dose-response pattern: each additional act of emotional, physical, or sexual IPV significantly increased CMD risk.

CONCLUSION: Psychological IPV-including emotional abuse and coercive control-has a strong, cumulative effect on women’s mental health and remains underrecognized in clinical protocol and public health policies. Male partner alcohol use further amplifies this risk. Integrated IPV-mental health-alcohol interventions, grounded in syndemic and trauma-informed frameworks, are urgently needed in Nepal’s primary health care systems.

PMID:41622374 | DOI:10.1007/s00737-025-01666-y

Psychopharmacology (Berl). 2026 Feb 2. doi: 10.1007/s00213-026-07016-9. Online ahead of print.

ABSTRACT

RATIONALE/OBJECTIVES: Major Depressive Disorder is a common and disabling psychiatric illness whose pharmacological treatment options have historically been characterized by relatively low response rates. “Treatment-resistant depression” has emerged to describe patients whose depressive symptoms fail to respond to multiple courses of oral antidepressant medications. In 2019, the FDA approved intranasal esketamine as augmentation to an oral antidepressant in patients with treatment-resistant depression (TRD). While intranasal esketamine’s efficacy was demonstrated in Janssen pharmaceutical’s drug development program, publications on its real-world use have shown varying degrees of effectiveness. We aim to assess intranasal esketamine’s effectiveness in a real-world clinical setting in Hartford, Connecticut, and are among the first to do so in an American sample using the Montgomery-Asberg Depression Rating Scale (MADRS), the same outcome measure used in the clinical trials where efficacy was established.

METHODS: In this analysis, a sample of 50 patients were enrolled in an intranasal esketamine treatment program at the Institute of Living (IOL) in Hartford, Connecticut. Information for these patients was obtained through retrospective analysis of the electronic health record. Descriptive statistics were used to analyze symptom severity and outcomes, using the Montgomery-Asberg Depression Rating Scale (MADRS) score at baseline and over 16 weeks of treatment.

RESULTS: Assessment showed that moderate to severe baseline symptoms of depression were reduced to the mild range after 4 weeks and this effect was sustained over 16 weeks of treatment. Adverse effects were transient and generally mild (dissociation and sedation being the most common), with no safety events, and very few discontinuations related to tolerability.

CONCLUSION: Results of this analysis demonstrate real-world effectiveness of intranasal esketamine as augmentation therapy in treatment resistant depression. The medication was well tolerated, with no safety events, misuse or dependence. While results demonstrating the efficacy of intranasal esketamine in patients with TRD were observed in the clinical trial studies, this analysis shows intranasal esketamine treatment to be safe and effective in a real-world clinical setting.

PMID:41622351 | DOI:10.1007/s00213-026-07016-9

Neurol Sci. 2026 Feb 2;47(2):216. doi: 10.1007/s10072-026-08826-7.

ABSTRACT

BACKGROUND: Manganese (Mn) is an essential but neurotoxic trace element implicated in neurodegenerative disorders. Its association with amyotrophic lateral sclerosis (ALS) remains uncertain. We conducted a systematic review and meta-analysis to evaluate whether Mn concentrations differ between ALS patients and healthy controls.

METHODS: We systematically searched PubMed, EMBASE, Web of Science, and Scopus for observational studies comparing Mn concentrations between ALS patients and healthy controls. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with the I² statistic, and publication bias was evaluated by Egger’s test.

RESULTS: Twelve studies (446 ALS cases, 652 controls) measuring Mn in blood, serum, cerebrospinal fluid (CSF), hair, urine, toenail, plasma, or tissue were included. The pooled SMD was 0.05 (95% CI: – 0.20 to 0.30; p = 0.68; I² = 71.7%), indicating no significant difference in Mn concentrations. Subgroup analyses by biological matrix and analytical method showed no consistent pattern; meta-regression identified analytical method as a significant source of heterogeneity.

CONCLUSION: No publication bias was detected (Egger’s p = 0.53). Peripheral Mn concentrations do not differ significantly between ALS patients and controls. Future research should employ longitudinal and CNS-targeted approaches, incorporating occupational exposure assessment and standardized analytical protocols.

PMID:41622338 | DOI:10.1007/s10072-026-08826-7