Nevin Manimala

Drugs Aging. 2026 Jun 1. doi: 10.1007/s40266-026-01304-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Multi-dose dispensing (MDD) is a medication management system in Sweden that pre-packages regularly used prescription medicines into unit doses. Despite widespread use, there are no recent national estimates of MDD prevalence in Sweden, and little is known about how use evolved through the coronavirus disease 2019 (COVID-19) pandemic or which patient groups account for most MDD utilisation.

OBJECTIVE: The purpose of this study was to describe the prevalence of multi-dose dispensing in older adults in Sweden from 2014 to 2023, spanning the COVID-19 pandemic, and describe trends by patient subgroups.

METHODS: We conducted a repeated cross-sectional study of older adults aged ≥ 70 years old in Sweden, 2014-2023. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level with several other administrative and healthcare registers. The primary outcome was annual period prevalence of MDD, stratified by age, sex, education level, living status, civil status, health status and geography.

RESULTS: Prevalence of MDD amongst adults aged 70 years or older increased by 1.5 percentage points between 2014 and 2023, reaching 12.1% in 2023, and there was no additional increase during the COVID-19 pandemic (2020-2022). In nursing home residents, MDD use approached near-universal levels (from 84.2 to 96.1%). Uptake also increased across other subgroups, most notably amongst people with a dementia diagnosis (+ 45.3 percentage points), those receiving home help services (+ 21.4 percentage points) and those with five or more chronic conditions (+ 15.3 percentage points). Over time, the characteristics of MDD users shifted towards community-dwelling adults receiving home help services, younger older adults (70-79 years old) and individuals with higher education.

CONCLUSIONS: Our nationwide study indicates that MDD has become an established standard of medication management in Swedish nursing homes and is progressively extending into community settings amongst older adults with complex health needs. Prescribing of MDD remained stable during the COVID-19 pandemic. Future studies should quantify risks and benefits of MDD use especially in vulnerable, older, and frail populations.

PMID:42219430 | DOI:10.1007/s40266-026-01304-x

Eur Heart J Cardiovasc Pharmacother. 2026 Jun 1:pvag037. doi: 10.1093/ehjcvp/pvag037. Online ahead of print.

ABSTRACT

Two contemporary randomized trials of β-blocker therapy after myocardial infarction (MI) reached apparently conflicting conclusions. REBOOT, conducted in Spain and Italy, found no reduction in death or major cardiovascular events among patients with preserved ejection fraction. In contrast, the BETAMI-DANBLOCK study, conducted in Scandinavia, reported a modest but statistically significant reduction in a composite endpoint. The prevailing response has been to reconcile this divergence by elevating left ventricular ejection fraction-particularly the 40-49% range-as the decisive explanatory variable. This interpretation offers analytic simplicity but rests on fragile statistical and conceptual grounds. Drawing on Nancy Cartwright’s account of causal capacities and Judea Pearl’s transportability framework, this paper argues that β-blockers exhibit stable physiological effects whose clinical benefits depend on the causal environment. Randomization secures internal validity within trials but cannot homogenize genetic, systemic, or environmental contexts. Meta-analysis, by averaging across heterogeneous environments and individual treatment effects, risks obscuring rather than clarifying dependencies. The divergence between REBOOT and BETAMI-DANBLOCK does not represent a failure of evidence-based medicine but exposes the limits of reductionist interpretation. Rather than seeking universal truths, cardiovascular medicine should map the causal environments in which therapeutic capacities become manifest.

PMID:42219422 | DOI:10.1093/ehjcvp/pvag037

Sci Rep. 2026 Jun 1. doi: 10.1038/s41598-026-54695-7. Online ahead of print.

ABSTRACT

College students face a higher risk of depression than their non-college peers. However, the predictors of depressive symptoms among college students and their relative importance remain inconclusive. This study aimed to develop predictive models for depressive symptoms among Chinese undergraduate students using a four-year longitudinal dataset and to explore the importance ranking of predictive factors. A cohort of 1,500 college students from Sichuan University was recruited and followed annually for four years. Computer-based questionnaires were used to collect demographic, behavioral and psychological data. Using a recurrent neural network (RNN), four predictive models were constructed to capture the temporal dynamics of depression risk as students progressed through college. The prevalence of depressive symptoms ranged from 3.60% to 6.27% across the four waves. All RNN models demonstrated strong predictive performance (AUC: 0.921-0.952), with sensitivity improving over longer follow-up periods, outperforming traditional models, such as multilevel linear regression, k-nearest neighbor and support vector machines. Analysis of feature importance revealed that family relationship issues were key predictors of early-stage depressive symptoms. Childhood traumatic experiences and preexisting mental health conditions had lasting impacts, while health-related factors, such as subjective sleep quality, sleep disorders, and self-rated health, were consistent indicators across years. These findings have important practical implications for university mental health programs, suggesting that early identification of high-risk students could enable targeted interventions such as family-based support, trauma-informed counseling, and sleep health education tailored to students’ developmental stages. Such data-driven strategies may improve prevention efforts and promote student well-being.

PMID:42219415 | DOI:10.1038/s41598-026-54695-7

J Hazard Mater. 2026 May 27;513:142544. doi: 10.1016/j.jhazmat.2026.142544. Online ahead of print.

ABSTRACT

Microbial mercury (Hg) methylation and methylmercury (MeHg) demethylation critically govern MeHg production in paddy soils and its accumulation in rice. However, how the decline in microbial diversity under climate change affects these processes remains unclear. Here, we combined stable isotope tracing with a dilution-to-extinction approach to manipulate microbial diversity across paddy soils with Hg contamination gradient (HX: 165 ng/g, GX: 20,707 ng/g and SK: 659,303 ng/g), investigating its effects on Hg methylation and demethylation. Results showed that diversity loss suppressed methylation (to 0.31-0.82 times the original soil) while enhanced demethylation (to 1.33-7.00 times the original soil) in HX and GX soils, reducing net MeHg production. Conversely, in SK soil, it promoted methylation (to 0.31-0.71 times the original soil) and inhibited demethylation (0.14-0.48 times the original soil), increasing MeHg accumulation. Marginal density curves and linear regression analyses indicate that the regulatory effect of microbial diversity on MeHg production depends strongly on Hg levels, with a significant shift in MeHg concentration across a critical threshold of 30,000 ng/g. Nationwide expanded data further confirmed that diversity loss deceases MeHg production below this threshold but elevates it above. This divergence is attributed to Hg-induced shifts in microbial community structure induced. Our findings highlight the crucial role of microbial diversity in regulating net MeHg production in paddy soils, offering important insights for predicting Hg risks under climate change and ensuring food security.

PMID:42218839 | DOI:10.1016/j.jhazmat.2026.142544

J ECT. 2026 May 28. doi: 10.1097/YCT.0000000000001282. Online ahead of print.

ABSTRACT

OBJECTIVE: Evidence about nonvoluntary electroconvulsive therapy (ECT) is limited. Observational studies have suggested that nonvoluntary ECT is equally effective as voluntary ECT in treating psychotic and mood disorders. However, prior studies with short follow-up periods of ∼6 months have been inconclusive regarding long-term clinical outcomes following nonvoluntary ECT, particularly in patients with schizophrenia-spectrum disorders.

METHODS: We conducted a retrospective chart review and included patients who received ECT treatment between 2016 and 2023 at our hospital. The patients were assigned to the nonvoluntary and voluntary groups. We compared the short-term and long-term outcomes between the 2 groups over a 1-year period.

RESULTS: In total, 227 patients were included in this study: 58 in the nonvoluntary group and 169 in the voluntary group. No significant intergroup differences were observed in short-term outcomes, such as the clinical global impressions-improvement scale score, number of discharged patients, and duration of admission. Furthermore, the Cox proportional hazard model found that the nonvoluntary group was not significantly associated with treatment failure 1 year after discharge (hazard ratio: 0.94, 95% CI: 0.55-1.61). However, 6 patients in the nonvoluntary ECT group underwent the procedure again, representing a statistically significant difference.

CONCLUSIONS: Nonvoluntary ECT may be an effective treatment option for patients with life-threatening conditions when no alternative is available. However, further investigation is needed to explore ways to improve patient acceptance of future treatments.

PMID:42218831 | DOI:10.1097/YCT.0000000000001282

Pharmacogenet Genomics. 2026 Mar 26. doi: 10.1097/FPC.0000000000000599. Online ahead of print.

ABSTRACT

OBJECTIVES: Gastroesophageal reflux disease is primarily treated with proton pump inhibitors (PPIs), which are metabolized by cytochrome P450 2C19 (CYP2C19) in the liver. CYP2C19 polymorphisms affect PPI plasma levels, with rapid (2-27%) and ultra-rapid (<1-5%) metabolizers needing higher doses, while poor (3-15%) and intermediate (27-47%) metabolizers require lower doses for therapeutic effectiveness. Antireflux surgery is recommended for patients refractory to medical therapy or with symptomatic hiatal hernias.

METHODS: This is a multisite retrospective review of adult patients from 2012 to 2023 diagnosed with gastroesophageal reflux disease who underwent hiatal hernia operations and completed CYP2C19 testing. CYP2C19 phenotypes were grouped as poor metabolizer/intermediate metabolizer, normal metabolizers, or rapid metabolizer/ultra-rapid metabolizer. Hiatal hernia size was classified as small, medium, or large based on preoperative and intra-operative findings. Descriptive statistics were used.

RESULTS: Eighty patients [female: 66%, median age: 60.5 (interquartile range 53.3-67.0) years, 90% White, 6% Hispanic] had CYP2C19 testing and underwent a hiatal hernia repair. CYP2C19 phenotypes were poor metabolizer (4%), intermediate metabolizer (24%), normal metabolizers (30%), rapid metabolizer (31%), and ultra-rapid metabolizer (11%). About 28% were grouped as poor metabolizer/intermediate metabolizer and 43% as rapid metabolizer/ultra-rapid metabolizer. Among patients with small (n = 41) and medium (n = 23) hernias, 39% and 57%, respectively, were classified as rapid metabolizer/ultra-rapid metabolizer, suggesting they were resistant to PPIs.

CONCLUSION: The prevalence of rapid metabolizer/ultra-rapid metabolizer CYP2C19 phenotypes in patients undergoing antireflux surgery is higher than generally reported in the general population. These patients could potentially benefit from higher PPI doses or surgical intervention if ineffective. Prospective multisite studies with diverse, representative samples are needed to confirm these findings.

PMID:42218813 | DOI:10.1097/FPC.0000000000000599

Disabil Rehabil Assist Technol. 2026 May 31:1-18. doi: 10.1080/17483107.2026.2680552. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to clarify the selection trends of ATDs by occupational therapists for children with developmental disabilities or developmental concerns in childcare facilities, based on the challenges of inclusive childcare in Japan. We explored variability in ATD selection across cases, the reasoning behind these selections, and alternative devices or strategies considered.

METHODS: An online questionnaire survey was conducted targeting occupational therapists in Japan. Descriptive statistics were used to calculate the selection frequency of ATDs for each case. Correspondence analysis and characteristic word extraction were used to analyse the reasons for ATD selection, and thematic analysis was used to categorise alternative devices and strategies.

RESULTS: Responses were received from 75 occupational therapists, with 72 valid responses. The results showed that ATD selection tended to be relatively consistent for some cases, while it was more varied for others. The reasons for selection were categorised into six categories. Regarding alternatives other than ATDs, various support methods were considered, including adjustments to the human environment and modifications of activities.

CONCLUSION: The results suggest that the variety of support methods available to occupational therapists may influence the variability in ATD selection. The selection of ATDs was based primarily on four factors: support for sensory characteristics, visual support, calming down, and physical function. The findings suggest that occupational therapists comprehensively consider a diverse range of support methods, including ATDs, to achieve inclusion.

PMID:42218785 | DOI:10.1080/17483107.2026.2680552

Breast J. 2026;2026(1):e6589301. doi: 10.1155/tbj/6589301.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy (NACT) is an important component in preparing breast cancer patients for surgery. Its impact on postoperative complications, such as wound infections and bleeding, remains unclear. While most studies show no increase in complication rates, factors such as smoking may elevate risk. Understanding surgeons’ perspectives on bleeding and related influences is therefore essential.

METHODS: This study used a questionnaire on bleeding and wound healing. After ethical approval in Vienna and Burgenland, 33 surgeons were recruited. Data were collected between July and December 2022 through interviews or self-administered questionnaires and analyzed descriptively.

RESULTS: Overall, 63.6% of surgeons reported recognizing NACT-treated patients intraoperatively. Perceptions of blood loss varied, with some noting no difference and others reporting increased bleeding. The influence of tumor size and smoking was debated, with no clear consensus. Most surgeons did not observe prolonged operative times. Challenges in axillary dissection and sentinel lymph node identification were reported, particularly after NACT.

CONCLUSION: Surgeons’ views on the impact of NACT in breast surgery vary considerably. These findings highlight the complexity of integrating NACT into surgical practice and the need for further research to improve training, patient counseling, and evidence-based guidelines.

PMID:42218781 | DOI:10.1155/tbj/6589301

Scand J Clin Lab Invest. 2026 May 31:1-14. doi: 10.1080/00365513.2026.2681040. Online ahead of print.

ABSTRACT

In large datasets, conventional t-tests may identify statistically significant but practically trivial differences because statistical significance increases with sample size. A log-adjusted t-statistic, defined as an empirical sample-size-aware modification of the classical t-statistic, was evaluated to reduce this oversensitivity. Performance was assessed by Monte Carlo simulations of two-sample comparisons across sample sizes from 10 to 50,000 and effect sizes from δ = 0 to 1.0, and by application to a real clinical laboratory dataset comprising 464,145 participants. In simulations, the ${\text{log}}_{10}\left(\text{Df}\right)$-adjusted statistic showed null rejection rates close to 0.05 across sample sizes, whereas the classical t-test became increasingly oversized at very large n. The adjustment was more conservative for small effects (δ = 0.2-0.4) while high rejection rates were retained for larger effects (δ = 0.6-1.0). In the real-data analysis, several sex differences that were highly significant by the classical t-test had small effect sizes and yielded reference p-values above the conventional 0.05 threshold after adjustment; platelet count (Cohen’s d = 0.13) changed from p < 10^-300 to reference p = 0.052, and potassium (d = 0.05) from p = 10-51 to reference p = 0.104. In contrast, larger effects such as hematocrit (d = 0.83) and HDL cholesterol (d = 0.77) continued to yield reference p-values below that threshold. These reference p-values were compared with the conventional α = 0.05 threshold for illustrative purposes only and were not intended to imply formal Type I error control. These findings suggest that the log-adjusted t-statistic may serve as a useful empirical decision aid for interpreting large clinical laboratory datasets by attenuating sample-size-driven significance while preserving detection of substantively meaningful effects.

PMID:42218778 | DOI:10.1080/00365513.2026.2681040

J Sports Sci. 2026 May 31:1-12. doi: 10.1080/02640414.2026.2673237. Online ahead of print.

ABSTRACT

The shared genetic architecture linking physical activity, sedentary behavior, and osteoporosis risk remains unclear. We investigated the genetic basis, pleiotropic effects, and causal relationships between moderate-to-vigorous physical activity (MVPA), leisure screen time (LST), and heel estimated bone mineral density (eBMD). Leveraging summary statistics from genome-wide association studies of European individuals (MVPA: N = 606,820; LST: N = 526,725; eBMD: N = 426,824), we conducted a genome-wide cross-trait analysis. A significant global genetic correlation was observed for MVPA and eBMD ($r_g$ = 0.13, P = 7.97 × 10^-11), but not for LST and eBMD ($r_g$ = $–$ 0.02, P = 0.34). Two specific genomic regions showed evidence of local genetic correlation. Cross-trait meta-analysis identified 90 pleiotropic loci, of which 20 were novel. Transcriptome-wide association studies revealed 42 shared genes. Mendelian randomization suggested a causal relationship between genetically predicted MVPA and eBMD (beta = 0.07, 95%CIs = 0.01-0.14, P = 0.03), but not for LST (beta = 0.01, 95%CIs = $–$ 0.04-0.05, P = 0.81). Our findings demonstrate a shared genetic basis and pleiotropic effects between MVPA and eBMD, highlighting their intrinsic link and supporting MVPA’s role in osteoporosis prevention.

PMID:42218761 | DOI:10.1080/02640414.2026.2673237