Nevin Manimala

Int J Epidemiol. 2026 Apr 17;55(3):dyag045. doi: 10.1093/ije/dyag045.

ABSTRACT

BACKGROUND: Foreign-born residents in high-income countries often outlive the native-born population, but it remains unclear how this advantage varies across countries and socioeconomic groups. We aimed to assess socioeconomic inequalities in the life expectancy advantage of foreign-born populations across 10 European countries.

METHODS: Using national population registers and census, we collected data on mortality by country of birth and educational attainment in 10 European countries from 2010 to 2019. Based on these data, we estimated partial life expectancy between ages 35 and 80 years for native-born and foreign-born populations in each country, both overall and by education. We then decomposed the overall gap between native- and foreign-born populations into differences in education-specific mortality and the educational composition of the population.

RESULTS: Foreign-born populations had higher partial life expectancies than native-born populations in all countries except Sweden and Estonia, especially among individuals with low-level education. Decomposition analyses revealed that the overall longevity advantage of foreign-born populations was largely attributable to their lower mortality in less-educated groups. However, in most countries-except Estonia, Lithuania, and Spain-the overrepresentation of less-educated individuals among the foreign-born partially cancelled out these advantages.

CONCLUSIONS: The longevity advantages among foreign-born populations in European countries may reflect socioeconomic barriers that concentrate relatively healthy, resource-rich immigrants into lower socioeconomic groups. Improving how societies recognize and use the skills and resources of foreign-born populations can help reduce these barriers, benefiting their longevity outcomes and contributing to more inclusive societies.

PMID:41995424 | DOI:10.1093/ije/dyag045

BMC Pregnancy Childbirth. 2026 Apr 17;26(1):427. doi: 10.1186/s12884-025-08325-1.

ABSTRACT

BACKGROUND: Childbirth is a unique and significant experience in every woman’s life. A negative childbirth experience, often due to difficult labor, can adversely affect a mother’s feelings toward her baby and their subsequent relationship. Massage, a non-pharmacological pain relief method involving coordinated manipulation of soft tissues by hand, aims to alleviate pain and enhance comfort. This ancient technique is widely used during labor and has demonstrated effectiveness in reducing both the intensity and duration of labor pain. This study aimed to compare the effects of two massage methods-rotational effleurage massage and connective tissue massage (CTM)-on pain intensity and labor outcomes. The study subjects in the two intervention groups received effleurage massage and connective tissue massage, but the control group did not receive any intervention and only routine labor care was provided to them.

METHODS: This quasi-experimental, multicenter study was conducted on 90 pregnant women (gestational age 38-40 weeks) admitted in labor at three hospitals. Participants were selected through convenience sampling and randomly allocated into three groups of 30 using permuted block randomization within each center. Although random allocation was performed, due to the multicenter design and non-probability sampling, the study is more accurately classified as quasi-experimental. Written informed consent was obtained from all participants. Data collection tools included a demographic and obstetric questionnaire, the McGill Childbirth Satisfaction Questionnaire, a visual analogue scale for pain, and a labor evaluation checklist.

DATA: Statistical analyses were performed using SPSS software version 22 (IBM Corp., Armonk, NY, USA). In this randomized clinical trial, 90 primiparous women were randomly assigned to three groups: effleurage massage, Connective tissue massage, and control. The interventions were performed during the active phase of labor (4-10 cm cervical dilation). Pain intensity was measured using the Visual Analogue Scale at different dilation stages: 3-4 cm, 5-6 cm, 7-8 cm, and 9-10 cm).

RESULTS: Pain intensity significantly decreased in both intervention groups compared to the control group at all stages of the active phase of labor (p < 0.001). At 7-8 cm dilation, the mean pain scores were 6.13 ± 0.94 in the effleurage group, 6.23 ± 0.77 in the connective tissue massage group, and 7.87 ± 0.86 in the control group (p < 0.001). Effleurage massage demonstrated greater efficacy than connective tissue massage in reducing pain during the later stages of active labor (p < 0.05).

CONCLUSION: Effleurage massage was more effective than connective tissue massage in reducing pain intensity during active labor. Integrating effleurage into maternity care as a non-pharmacological method may improve maternal comfort and support positive birth experiences.

PMID:41998514 | DOI:10.1186/s12884-025-08325-1

CVIR Endovasc. 2026 Apr 18;9(1):43. doi: 10.1186/s42155-026-00691-x.

ABSTRACT

OBJECTIVE: To compare continuous vs pulsed transarterial embolization techniques with microCT and determine their impact on distal vascular penetration.

MATERIAL AND METHODS: Transarterial embolization was performed in 7 swine using 75-100-micron microspheres. In each subject, 1 kidney was embolized using continuous injection and contralateral with a pulsed injection technique. Histological analysis validated MicroCT findings (50-100 pixels, postprocedural quantification) in 2 subjects (4 kidneys), after which MicroCT alone was used for outcome assessments.

RESULTS: MicroCT imaging demonstrated similar outcomes to histology. Larger number of particles delivered with continuous vs pulsed technique (6806 vs 6174 particles into 223 ml vs 168 ml renal volume respectively). Percentage of the embolized renal cortex at 50 pixels was 1.1% for the continuous technique (0.1 – 2.3%) vs 0.7% pulsed (0.5 – 1.1%) (p = 0.3). Embolized renal cortex at 100 pixels was 2.9% continuous (1.3 – 4.2%) vs 2.3% pulsed (1.3 – 3.2%) (p = 0.3). Average kidney volume in both groups was 78.1 ml (r, 49-138) and 81 ml (r, 46-111), respectively. A slightly larger amount of embolic was delivered using the continuous vs pulsed: 14 ml (r, 12-20) vs 13.1 ml (r, 8-22). Mean embolic/kidney volume ratio was 0.20 for continuous vs 0.16 for pulsed (25% difference, p = 0.2).

CONCLUSION: Continuous embolization technique resulted in a larger absolute concentration of embolic particles within the distal renal cortex and overall volume compared to the pulsed technique, though the difference was not statistically significant. Our findings suggest embolic delivery technique for particle embolics may influence amount and efficacy of distal embolization.

PMID:41998479 | DOI:10.1186/s42155-026-00691-x

J Racial Ethn Health Disparities. 2026 Apr 17. doi: 10.1007/s40615-026-02976-2. Online ahead of print.

NO ABSTRACT

PMID:41998471 | DOI:10.1007/s40615-026-02976-2

High Blood Press Cardiovasc Prev. 2026 Mar 17. doi: 10.1007/s40292-026-00793-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Effective cardiovascular (CV) prevention requires accurate risk estimation and patient engagement, which depends on perceived risk. The Perception of Risk of Heart Disease Scale (PRHDS) is a validated tool, yet clinical thresholds for its brief Italian version are lacking.

AIM: To provide further validation of the Brief Italian version of the PRHDS (PRHDS-BI) in a new cohort, examining convergent and divergent validity, and to establish clinical thresholds and a discrepancy index comparing perceived risk with objective estimates.

METHODS: 285 adults (40-69 years) were involved in this multicentre cross-sectional study (NCT06190743). Participants were without a history of CV disease and completed the PRHDS-BI and the Patient Health Questionnaire-4 (PHQ-4). CV real risk was estimated using the Systematic Coronary Risk Evaluation 2 (SCORE2). Confirmatory Factor Analysis (CFA), correlation analyses, and cut-off definitions were used to validate the scale and analyze risk discrepancies.

RESULTS: The PRHDS-BI showed good internal consistency and strong convergent validity. Clinical thresholds were defined by percentiles: scores 6-12 (low/moderate), 13-17 (high), and 18-24 (very high). A significant mismatch emerged: 63.5% of participants at low/moderate actual risk overestimated their risk, while 80% at very high actual risk underestimated it. This perception-reality gap was statistically confirmed.

CONCLUSIONS: The PRHDS-BI is a valid tool for assessing CV risk perception. Establishing thresholds allows for tailored risk communication and patient-centered interventions, particularly by nursing professionals in primary prevention settings.

PMID:41998465 | DOI:10.1007/s40292-026-00793-6

Support Care Cancer. 2026 Apr 17;34(5):441. doi: 10.1007/s00520-026-10666-2.

ABSTRACT

PURPOSE: The study explored the implementation of integrative nursing (IN) interventions in oncology inpatient care within a dedicated project. As part of an IN consultation service, trained integrative nurses delivered external naturopathic, non-pharmacological interventions. The aim of this study was to characterize patients receiving IN interventions and to describe how these interventions are implemented and applied in oncological inpatient care.

METHODS: This retrospective study analyzed routine project-related data collected at Ulm University Hospital between 2021 and 2023. Recorded variables included patient demographics, clinical characteristics, type and frequency of IN interventions, and immediate patient reaction. Quantitative data were analyzed descriptively, and qualitative data were examined using content analysis.

RESULTS: Healthcare professionals requested an IN consultation for 381 patients, of whom 361 (94.8%) agreed to participate. The majority were female (62.3%; n = 225) and between 60 and 69 years of age (33.5%; n = 121). In total, 1910 IN interventions were carried out, with a median of four IN interventions per patient (M = 5.3 ± 4.6; r = 1-30). Most IN interventions targeted the lower limbs (38.7%; n = 740), most frequently using rhythmic embrocation (70.9%; n = 1355) and solum oil (39.6%; n = 757). Immediately after the IN intervention, the most commonly observed patient reactions were relaxation (67.5%; n = 726) and deeper breathing (37.5%; n = 403).

CONCLUSION: The high level of acceptance and the continuous increase in utilization suggest that IN was well implemented in clinical practice during the project, with positive short-term reactions from patients. Further intervention studies are needed to provide robust evidence of its efficacy and to support its long-term integration into routine hospital care.

PMID:41998445 | DOI:10.1007/s00520-026-10666-2

Eur Radiol. 2026 Apr 17. doi: 10.1007/s00330-026-12544-1. Online ahead of print.

NO ABSTRACT

PMID:41998355 | DOI:10.1007/s00330-026-12544-1

Int Urogynecol J. 2026 Apr 17. doi: 10.1007/s00192-026-06660-1. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: High-quality patient education materials are essential in urogynecology. We hypothesized that patient handouts generated by different large language models (LLMs) would vary in quality and readability and would differ from an established society-produced leaflet.

METHODS: Twelve leaflets on bladder training and pelvic floor muscle therapy from six origins: GPT-4, Gemini-2.5 Pro, Sonnet-4, Llama-4, Perplexity, and The International Urogynecological Association (IUGA), were produced or obtained and standardized into plain text. Three blinded reviewers assessed completeness, information quality (DISCERN), and the Patient Education Materials Assessment Tool (PEMAT-A: actionability; PEMAT-U: understandability). The statistical plan included ordinary least squares fixed-effects per metric with type II analysis of variance for source effects; estimated marginal means with Holm-adjusted pairwise comparisons; a crossed mixed-effects model for topic groups; and inter-rater reliability was measured. Readability and text analyses used standard indices.

RESULTS: Origins varied in completeness (p < 0.001), DISCERN (p < 0.001), and PEMAT-A (p = 0.0018); PEMAT-U showed a trend (p = 0.063). Llama-4 scored significantly lower on completeness and DISCERN, and lower than GPT-4, IUGA, and Perplexity on PEMAT-A; Sonnet4 outperformed Llama-4 on PEMAT-U. No single origin dominated all metrics. Readability varied greatly: GPT-4 had an average Flesch-Kincaid grade level ≈ 6.6, Gemini ≈ 7.4; Sonnet4 ≈ 15; Llama-4 ≈ 17. IUGA leaflets were the longest, with grade levels around 9-10. Bladder-training materials were modestly more complete than pelvic muscle materials (p = 0.045). Inter-rater reliability was high (ICC ≥ 0.87).

CONCLUSIONS: Patient education quality varies substantially across AI tools and compared with society materials. AI-generated content can meet readability targets but requires expert review to ensure completeness and reliability before clinical use.

PMID:41998329 | DOI:10.1007/s00192-026-06660-1

Behav Res Methods. 2026 Apr 17;58(5):126. doi: 10.3758/s13428-026-02998-y.

ABSTRACT

Deficits in spatial and navigation abilities are among the earliest signs of dementia. Yet, traditional neuropsychological tests primarily target memory and attention. The Spatial Performance Assessment for Cognitive Evaluation (SPACE) is a novel gamified digital assessment for iPads that uses various spatial tasks to detect early deficits in spatial navigation abilities indicative of cognitive impairment. In this study, 348 participants aged 21-76 completed the Montreal Cognitive Assessment (MoCA), SPACE, and a sociodemographic and health questionnaire. We investigated whether SPACE could predict scores on the MoCA beyond known risk factors for cognitive impairment. Using a factor analysis, we then assessed whether SPACE could complement the MoCA by capturing latent variables independent of MoCA scores that represent additional spatial aspects of cognitive functioning. Results from a hierarchical regression revealed that the pointing and perspective-taking tasks in SPACE significantly predicted MoCA scores beyond age and gender. Surprisingly, none of the risk factors predicted MoCA scores. The factor analysis revealed that the MoCA and perspective-taking contributed to a separate factor from the other navigation tasks in SPACE. We also provide normative data on age and gender for each task in SPACE, which can serve as benchmarks for future studies to identify individuals at risk.

PMID:41998313 | DOI:10.3758/s13428-026-02998-y

J Gen Intern Med. 2026 Apr 17. doi: 10.1007/s11606-026-10444-0. Online ahead of print.

ABSTRACT

IMPORTANCE: Health care workers (HCWs), particularly those identifying as female or Black, face disproportionate mental health strain. Digital mental health platforms have grown in popularity and, for health systems, may offer scalable solutions, but their differential impact across demographic groups remains understudied.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of a randomized controlled trial enrolled 1275 HCWs from an urban academic health system between January and May 2022. Participants were randomized to usual care or proactive digital engagement via the Cobalt platform. Female and Black HCWs were oversampled to assess subgroup effects.

INTERVENTION: Monthly digital outreach, including mental health symptom screening and linkage to resources via the Cobalt platform, compared with usual care.

MAIN OUTCOMES AND MEASURES: Primary outcomes were changes in depression (PHQ-9) and anxiety (GAD-7) scores at 6 and 9 months. Secondary outcomes included well-being (WHO-5, WBI-9) and work productivity (LEAPS). Generalized linear models assessed HTE by gender and race.

RESULTS: Of 1275 randomized participants (mean age 38.6 years; 83.4% female; 25.1% Black), both intervention and control groups showed significant reductions in anxiety and depression scores over time. No significant HTE was observed by gender or race for primary outcomes. Female HCWs receiving the intervention reported significantly greater improvement in work productivity at 6 months (LEAPS score difference: 1.70; p = 0.03). Black HCWs in the intervention arm showed a sustained improvement in depression scores at 9 months (- 2.21; p < 0.001), though adjusted models did not confirm statistical significance.

CONCLUSIONS AND RELEVANCE: A proactive digital mental health strategy coupled with a well-being platform improved mental health outcomes across HCWs, with modest differential effects in productivity and depression among female and Black participants. These findings support the scalability of digital interventions and highlight the need for culturally tailored approaches to enhance equity and impact.

PMID:41998267 | DOI:10.1007/s11606-026-10444-0