Nevin Manimala

Int J Womens Health. 2026 Apr 2;18:585507. doi: 10.2147/IJWH.S585507. eCollection 2026.

ABSTRACT

BACKGROUND: Approximately two million women globally currently live with untreated obstetric fistula, predominantly in sub-Saharan Africa and South Asia, with Nigeria accounting for 40% of cases. Despite the recognition of multiple healthcare barriers, the causal mechanisms through which these barriers affect treatment-seeking behavior remain poorly understood. We conducted a causal mediation analysis to examine potential pathways in the fistula treatment cascade.

METHODS: We analyzed data from 5,496 women who reported fistula symptoms in the 2024 Nigeria Demographic and Health Survey. Using the counterfactual framework for causal mediation, we decomposed the relationship between fistula knowledge (exposure) and treatment-seeking (outcome) into direct and indirect effects operating through three mediator domains: financial, geographic access, and autonomy barriers. We estimated natural direct and indirect effects using Baron and Kenny regression with product-of-coefficients method, inverse probability weighting, and doubly robust estimation. Bootstrap confidence intervals (1,000 replications) and E-value sensitivity analyses were used to assess the robustness of sampling variability and unmeasured confounding.

RESULTS: Among women with fistula, 65.0% sought treatment, 3.3% received surgical repair, and 6.9% achieved resolution leaving 93.1% with unresolved fistula. The largest cascade gap (61.7%) occurred between treatment-seeking and surgery receipt. Geographic access barriers significantly reduced treatment-seeking (OR=0.73; 95% CI: 0.59-0.88; p=0.002), emerged as the only significant mediating pathway (indirect effect β=-0.19; 95% CI: -0.33 to -0.07). Financial barriers (OR=1.11; 95% CI: 0.95-1.31) and autonomy barriers (OR=0.99; 95% CI: 0.84-1.18) were not independently associated with treatment-seeking in adjusted models. The E-value for geographic access barriers was 2.08, indicating moderate robustness to unmeasured confounding.

CONCLUSION: Geographic access barriers emerged as the dominant pathway associated with reduced treatment engagement, findings consistent with these barriers suggesting a critical pathway under stated causal assumptions. Although knowledge was not directly associated with treatment-seeking, mediation models suggested that geographic access barriers were the only pathway consistently linked to care engagement. Financial and autonomy-related barriers were not statistically significant mediators in this analysis, though this may reflect measurement limitations or operation at different cascade stages rather than true irrelevance. The primary cascade bottleneck is surgical access rather than treatment-seeking, suggesting health system capacity constraints. These findings align with a causal interpretation under the stated identification assumptions of the counterfactual framework, though temporal ordering cannot be definitively established from cross-sectional data. Interventions should prioritize mobile surgical outreach, transportation vouchers, and decentralizing fistula repair services.

PMID:41948705 | PMC:PMC13052275 | DOI:10.2147/IJWH.S585507

OTO Open. 2026 Apr 6;10(2):e70222. doi: 10.1002/oto2.70222. eCollection 2026 Apr-Jun.

ABSTRACT

OBJECTIVE: To evaluate the impact of limited English proficiency (LEP) on the presentation, diagnosis, and management of vestibular schwannoma (VS).

STUDY DESIGN: Retrospective matched cohort study.

SETTING: Single tertiary academic center.

METHODS: A retrospective review of patients diagnosed with VS at a tertiary academic center from 2018 to 2023 identified 29 LEP and 1350 non-LEP patients. LEP patients were matched 1:1 to non-LEP patients using propensity scores based on age, sex, insurance, and zip code-based income. Clinical variables included audiometric data, tumor characteristics, time to diagnosis and treatment, and management outcomes.

RESULTS: No significant differences were found in presenting symptoms, tumor characteristics, or treatment recommendations. LEP patients were significantly less likely to undergo word recognition testing (41% vs 97%, P < .001). Among those tested, bilingual LEP patients performed worse than non-LEP counterparts in word recognition testing (44.5% vs 61.9%, P = .1). LEP patients trended toward larger tumor volumes at diagnosis (6072.5 mm³ vs 2114 mm³, P = .059) and longer delays from symptom onset to diagnosis (4949 vs 2609 days), even after outlier removal. LEP patients also had higher loss to follow-up rates (34% vs 14%, P = .123).

CONCLUSION: Though not statistically significant, several trends suggest LEP patients may face potential barriers to timely diagnosis and follow-up for VS. The relative underrepresentation of LEP patients may also reflect underlying disparities. These findings underscore the need for targeted efforts to improve access and outcomes for LEP patients in neurotologic care.

PMID:41948694 | PMC:PMC13052497 | DOI:10.1002/oto2.70222

World J Otorhinolaryngol Head Neck Surg. 2025 Aug 18;12(2):159-167. doi: 10.1002/wjo2.70042. eCollection 2026 Apr.

ABSTRACT

OBJECTIVE: To investigate the influence of hearing loss on the efficacy of personalized and customized music therapy in patients with chronic tinnitus.

METHODS: A total of 147 patients with chronic tinnitus were included in the research; according to the pure-tone average (PTA) test results (PTA at 0.5, 1.0, 2.0, and 4.0 kHz), the patients were classified into three groups: PTA ≤ 25 dB (normal hearing), 25 < PTA ≤ 60 dB (mild to moderate hearing loss), and PTA > 60 dB (severe hearing loss); all patients have received personalized and customized music therapy for 3 months. Electronic questionnaires of Hospital Anxiety and Depression Scale (HADS-A, HADS-D), Tinnitus Handicap Inventory (THI), Insomnia Severity Index Scale (ISI), and Visual Analog Scale (VAS) in the complete follow-up system were used to evaluate the therapeutic effects on the efficacy of music therapy.

RESULTS: The results showed that HADS-A, HADS-D, THI, ISI, and VAS scores after 3 months of therapy were lower than those before treatment in the PTA ≤ 25 dB group (p < 0.001). While HADS-A, THI, ISI, and VAS scores were decreased after 3 months of therapy in the 25 < PTA ≤ 60 dB group (p < 0.001). However, there was no statistically significant difference in HADS-A, HADS-D, THI, ISI, and VAS scores between before and after therapy within 3 months in the PTA > 60 dB group (p > 0.05). Besides, the more severe the hearing loss, the less improvement in tinnitus-related symptoms after music therapy for 3 months.

CONCLUSIONS: Personalized and customized music therapy is effective for chronic tinnitus patients with normal hearing or mild to moderate hearing loss. Hearing loss levels exerted an impact on the efficacy of personalized music therapy; the efficacy of patients with severe hearing loss is worse than that of patients with normal hearing or mild to moderate hearing loss. Appropriate hearing remedial therapy is essential to improve the efficacy of personalized, customized music therapy before receiving music therapy.

PMID:41948685 | PMC:PMC13052217 | DOI:10.1002/wjo2.70042

World J Otorhinolaryngol Head Neck Surg. 2025 Jul 2;12(2):218-227. doi: 10.1002/wjo2.70032. eCollection 2026 Apr.

ABSTRACT

OBJECTIVES: To determine the effect of COVID-19 on voice by evaluating acoustic, aerodynamic, auditory-perceptual, and patient-reported measurements for COVID-19 patients compared to controls.

DATA SOURCES: A systematic review was conducted using PubMed and Embase.

REVIEW METHODS: Studies were reviewed for acoustic, aerodynamic, auditory-perceptual, and patient-reported outcomes.

RESULTS: Seven studies met criteria. There were 790 patients diagnosed with COVID-19 and 484 controls. Acoustic measurements revealed that COVID-19 patients had an increased harmonic-to-noise ratio (HNR) (27.14 vs. 41.37 dB), and increased fundamental frequency (177.66 vs. 172.81 Hz), jitter (0.73 vs. 0.31), and shimmer (4.43 vs. 3.42). Auditory-perceptual measurements indicated that COVID-19 patients had an increased Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) score (11.46 vs. 2.15). COVID-19 patients also had an increased Voice Handicap Index (VHI-10) score (4.89 vs. 1.59). Finally, COVID-19 patients had a statistically significant decrease in maximum phonation time compared to controls (9.94 s vs. 16.32 s, p = 0.01).

CONCLUSIONS: Although maximum phonation time was the only statistically significant measurement, other measurements were worse for COVID-19 patients. The current research suggests negative effects of COVID-19 on the voice; however, this is the first systematic review to summarize its effects with measurable outcomes. More studies with vocal measurements taken at different time points following infection are needed to understand the full long-term effect of COVID-19 on the voice. Additionally, studies evaluating voice quality for mild cases of COVID-19 with comparison to healthy controls are needed to understand its prevalence and effect as the severity of COVID-19 decreases.

PMID:41948684 | PMC:PMC13051893 | DOI:10.1002/wjo2.70032

Health Sci Rep. 2026 Apr 2;9(4):e72268. doi: 10.1002/hsr2.72268. eCollection 2026 Apr.

ABSTRACT

BACKGROUND AND AIMS: Computer vision syndrome (CVS) is a recognised health concern characterized by eye and vision-related symptoms resulting from prolonged use of digital devices. Approximately 60 million people worldwide are affected by CVS, with almost one million new cases reported annually.

METHODS: This cross-sectional study was conducted from September 1 to October 15, 2024, among medical students. A paper questionnaire was distributed to students across all academic years at both public and private universities in Syria. The data were analyzed using descriptive statistics, with categorical variables shown as frequencies and percentages. A Chi-square test was used to explore the association between CVS incidence among medical students in Syrian universities and other relevant factors.

RESULTS: The study included 2,636 medical students from Syrian universities, with a majority (74.54%) enrolled in public institutions. The prevalence of CVS among these students was 47%. The most used electronic devices were smartphones (96%), followed by laptops (32%). The primary reasons for computer use included social media (90%), studying (83%), and watching movies (44%). The most frequently employed preventive measure was taking breaks during usage (60%), while adherence to the 20-20-20 rule was minimal (7%).

CONCLUSION: The prevalence of CVS among medical students is 47%, with 90% of the sample using digital devices for social media and 83% for studying. A significant association exists between the occurrence of CVS and factors such as gender, daily computer usage time, the distance from the screen, sitting posture, and whether the individual wears corrective lenses or glasses. This study underscores the need to educate computer and smartphone users about proper ergonomics, posture, and eye exercises.

PMID:41948655 | PMC:PMC13051820 | DOI:10.1002/hsr2.72268

BMC Womens Health. 2026 Apr 7. doi: 10.1186/s12905-026-04425-y. Online ahead of print.

NO ABSTRACT

PMID:41947129 | DOI:10.1186/s12905-026-04425-y

BMC Public Health. 2026 Apr 7. doi: 10.1186/s12889-026-27266-8. Online ahead of print.

NO ABSTRACT

PMID:41947126 | DOI:10.1186/s12889-026-27266-8

BMC Public Health. 2026 Apr 7. doi: 10.1186/s12889-026-27235-1. Online ahead of print.

NO ABSTRACT

PMID:41947107 | DOI:10.1186/s12889-026-27235-1

BMC Infect Dis. 2026 Apr 7. doi: 10.1186/s12879-026-13273-y. Online ahead of print.

ABSTRACT

BACKGROUND: Data describing HIV prevalence, ART use and virological suppression, in older adults in urban or rural South Africa, are limited. We aimed to address this evidence gap.

METHODS: In a population-based cross-sectional study, using age- and sex-stratified random sampling of adults aged ≥ 40 years, a researcher-administered questionnaire collected socio-demographic, and clinical data (03/2022-04/2024). HIV was confirmed using two point-of-care tests (discrepancies resolved by ELISA). The age- and sex-specific study prevalence was applied to the KwaZulu Natal (KZN) province population structure to provide an illustrative projection of HIV prevalence in KZN. Achievement of UNAIDS 95-95-95 targets was calculated in 10-year age bands. People living with HIV (PLHIV) were categorised as virologically suppressed (< 50copies/mL) vs. unsuppressed, and younger (40-49years) vs. older (≥ 50years). Logistic regression determined associations with HIV and virological suppression.

RESULTS: 1,916 adults were recruited; 713 (37.2%) living with HIV, 36.7% men and 37.7% women. HIV prevalence was 68.1% among 40-49-year-olds, 49.4% among 50-59-year-olds, 26.0% among 60-69-year-olds and 9.8% age ≥ 70 years. In older adults (≥ 50 years), the prevalence was 27.9%. The overall projected standardised HIV prevalence in adults ≥ 40 years in KZN was 47.4% (44.8% men; 49.3% women). In our sample, 98% of PLHIV were aware of their status, 97.6% on ART, and 77.7% virologically suppressed. Men ≥ 70 years achieved highest virological suppression (88.2%). Overall, being female vs. male (57.8% vs. 42.2%; OR 1.6 [95%CI 1.1, 2.4]; p = 0.008), having HIV ≥ 3 years vs. < 3 years (62.2% vs. 55.1%; OR 3.0 [95%CI 1.6, 5.7]; p = 0.001), rural vs. urban living (50.9% vs. 49.1%; OR 1.5 [95%CI 1.0, 2.1]; p = 0.044) were associated with virological suppression. Older PLHIV (≥ 50years) vs. younger (40-49years) reported hypertension (51.0% vs. 30.0%), diabetes (10.0% vs. 5.0%), and polypharmacy (≥ 5 drugs) (13.2% vs. 6.3%).

CONCLUSION: In KZN, the overall study prevalence of HIV in adults age ≥ 50 years was 27.9% in both urban and rural populations, the UNAIDS 95-95-95 targets were met for known status and being on treatment, but not virological suppression.

PMID:41947066 | DOI:10.1186/s12879-026-13273-y

BMC Emerg Med. 2026 Apr 7. doi: 10.1186/s12873-026-01574-z. Online ahead of print.

NO ABSTRACT

PMID:41947057 | DOI:10.1186/s12873-026-01574-z