Nevin Manimala

Dan Med J. 2026 Apr 17;73(5):A05250419. doi: 10.61409/A05250419.

ABSTRACT

INTRODUCTION: Neovascular age-related macular degeneration (nAMD) affects approximately 8% of the global population. While socioeconomic and geographical disparities have been increasingly studied in Denmark, geographical disparity in best corrected visual acuity (BCVA) at the time of diagnosis in nAMD remains understudied. This study aimed to investigate possible geographical disparity in BCVA at the time of diagnosis in nAMD patients in Region Zealand, Denmark.

METHODS: This was a retrospective study using data from the database “Bedre Oftalmologi for Brugere” from 2011 to 2021. BCVA was extracted for patients at the time of diagnosis with nAMD. Patients were grouped geographically by postal code and municipality. Data were analysed using the Kruskal-Wallis test to investigate geographical disparity and stratified by sex.

RESULTS: A total of 4,266 eyes with nAMD were included. Variations in BCVA at the time of nAMD diagnosis were found between geographical regions in Region Zealand at postal code level and at municipality level. Furthermore, we found a disparity between municipalities among males and females. However, no statistically significant disparity between postal codes was found among males or females.

CONCLUSIONS: There was a significant geographical disparity in BCVA at the time of diagnosis in nAMD patients, inviting further investigation to determine the extent and roots of this disparity.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:42095312 | DOI:10.61409/A05250419

Palliat Support Care. 2026 May 7;24:e135. doi: 10.1017/S1478951526102624.

ABSTRACT

OBJECTIVES: Patients hospitalized with a life-limiting illness, along with their loved ones, frequently experience anxiety, stress, and pain. Legacy building through storytelling and music may alleviate emotional strain and provide comfort. Musical Rounds is a novel music medicine program designed to reduce distress and support legacy building for adult patients receiving palliative care and their loved ones.

METHODS: This multisite, mixed-methods, pre-post feasibility study was conducted across 3 hospitals in California, USA. Participants engaged in live bedside recording sessions in which personal stories were shared with real-time musical improvisation provided by a clinician-musician. Afterward, participants received a personalized edited recording combining voice and improvised music. Pain, stress, anxiety, and comfort were assessed before and after each session using a 0-10 numeric rating scale. Perceived mood changes were assessed through directed qualitative content analysis.

RESULTS: We invited 100 adult patients hospitalized with a life-limiting illness and their loved ones to participate. If patients were unable to respond, loved ones participated on their behalf. Patients (n = 79) demonstrated statistically significant within-group differences between pre- and post-session assessments, including lower pain (-1.58, p < .001), stress (-2.89, p < .001), and anxiety (-2.73, p < .001), and higher comfort (+1.61, p < .001). Loved ones (n = 42) reported lower stress (-3.14, p < .001) and anxiety (-2.86, p < .001), and higher comfort (+1.83, p = .004). Directed content analysis indicated perceived mood improvement in 59% (47/80) of patients and 68% (30/44) of loved ones.

SIGNIFICANCE OF RESULTS: Musical Rounds, a personalized music and storytelling session for hospitalized patients with life-limiting illness and their loved ones, was associated with lower self-reported stress, pain (patients only), and anxiety, and higher comfort and perceived mood across 3 hospitals. Findings demonstrate the feasibility and suggest potential benefits of music medicine-supported legacy building in palliative care. Controlled studies with independent assessors are needed to further evaluate efficacy.

PMID:42095303 | DOI:10.1017/S1478951526102624

Eur Heart J Cardiovasc Pharmacother. 2026 May 7:pvag032. doi: 10.1093/ehjcvp/pvag032. Online ahead of print.

ABSTRACT

AIMS: The absence of stent implantation when using drug-coated balloons (DCB) may decrease the required duration of dual antiplatelet therapy (DAPT). In the light of this, this study aimed to evaluate outcomes for patients with acute coronary syndromes treated with abbreviated versus standard DAPT after DCB-only PCI.

METHODS AND RESULTS: Patients enrolled in the SWEDEHEART registry between June 2013 and February 2022, treated exclusively with DCBs for ACS, were included. Only patients discharged with ticagrelor as P2Y12-inhibition were included. Patients were categorized by intended DAPT duration at discharge. The primary outcome was net adverse clinical events (NACE) at one year from discharge date, defined as the first occurrence of all-cause death, stroke, myocardial infarction, or major bleeding. The primary analysis used inverse-probability-of-treatment-weighted (IPTW) Cox regression. Among 1,128 patients (141 abbreviated DAPT, 986 standard DAPT), NACE occurred in 25 patients (crude 17.7%; weighted 17.8%) in the abbreviated-DAPT arm and 133 patients (crude 13.5%; weighted 13.8%) in the standard-DAPT arm, corresponding to a weighted hazard ratio of 1.29 (95% CI 0.81-2.03; p=0.28). Results were consistent across pre-specified sensitivity analyses. Due to the small sample size, variance was generally high.

CONCLUSION: In this nationwide registry-based analysis, abbreviated DAPT following DCB-only PCI in ACS was not associated with a statistically significant difference in NACE. However, the confidence intervals were wide and did not exclude clinically meaningful harm. The findings should be regarded as hypothesis-generating and indicate the need for more comprehensive evidence before abbreviated DAPT is routinely adopted in this setting.

PMID:42095276 | DOI:10.1093/ehjcvp/pvag032

ACR Open Rheumatol. 2026 May;8(5):e90051. doi: 10.1002/acr2.90051.

ABSTRACT

OBJECTIVE: Premature mortality burden is an important component of disease burden and can help guide health care and research priorities. However, relying solely on mortality rates may underestimate lupus mortality burden because a substantial proportion of deaths occur at younger ages. Years of potential life lost (YPLL) captures premature mortality by applying a predefined age threshold. We estimated the YPLL from lupus in US women relative to leading causes of death and other autoimmune diseases.

METHODS: Using the US population-based national Multiple Cause-of-Death database, we obtained death counts for 28 diseases, including lupus, the Centers for Disease Control and Prevention’s 15 leading causes of death, and 12 additional autoimmune diseases. We calculated YPLL before age 75 years by summing 75 minus age at death for deaths occurring before age 75. Official cause-of-death rankings were obtained from the Web-based Injury Statistics Query and Reporting System (WISQARS). Sensitivity analyses were repeated in female decedents during 2018 to 2024.

RESULTS: From 2000 to 2015, 304.2 thousand years were lost to lupus in US women aged 15 to 44 years. Lupus-associated YPLL ranked 14th in women aged 15 to 44 years and 9th in women aged 15 to 24, exceeding diabetes mellitus, HIV disease, septicemia, chronic lower respiratory disease, anemias, nephritis, and cerebrovascular disease. Among autoimmune diseases, lupus YPLL ranked first in women aged 15 to 24 years and second in women aged 15 to 44 years.

CONCLUSION: Lupus is a major contributor to premature mortality in young women. Quantifying premature mortality burden through YPLL provides a complementary public health perspective and may inform prioritization of research and public health initiatives.

PMID:42095257 | DOI:10.1002/acr2.90051

Int J Nurs Stud Adv. 2026 Apr 29;10:100544. doi: 10.1016/j.ijnsa.2026.100544. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Scarce or insufficient nursing resources are an important reason that nurses have to ration necessary nursing tasks implicitly. Implicit rationing of nursing care is associated with negative patient and nurse outcomes, such as poor patient safety and low job satisfaction. The frequency at which nursing students implicitly ration nursing tasks during their clinical placements and the prioritisation strategies they use remain unclear.

AIM: To describe the levels of implicit rationing of nursing care, prioritisation strategies used by Swiss and Turkish nursing students during their clinical placements, and characteristics of their nursing work environment.

METHODS: This descriptive, cross-sectional observational study included 506 Swiss and 750 Turkish eligible students from four universities, with a final sample size of 81 and 205 students, respectively. Implicit rationing of nursing care was measured using the Basel Extent of Rationing of Nursing Care-Revised (BERNCA-R) version on a scale of 0 (‘never’) to 3 (‘often’). The prioritisation strategies were assessed with a single item. In addition, data on workplace characteristics and demographics were collected. Data were analysed using descriptive statistical methods.

RESULTS: Among the 23 BERNCA-R items compared in this study, the reported rationing levels in the Swiss sample ranged from 0.52 (‘change of wound dressings’) to 1.83 (’emotional and psychological support’), and in the Turkish sample, the levels ranged from 0.74 (‘necessary disinfection measures’) to 1.63 (‘sponge bath’). The Swiss students prioritised nursing tasks primarily based on ‘their necessity’ and/or ‘associated consequences for patient safety’, whereas the Turkish students prioritised them mainly based on ‘their necessity’. The Swiss students rated the staffing and resource adequacy, overall quality of the work environment, quality of care, and patient safety at their most recent clinical placement workplace slightly higher than that rated by the Turkish students.

CONCLUSIONS: This study demonstrates the importance of teaching resource scarcity management and care prioritisation strategies to reduce students’ implicit care rationing during clinical placements.

TWEETABLE ABSTRACT: Implicit rationing and associated factors from the perspective of nursing students: a cross-sectional and cross-cultural comparative observational study, from Switzerland and Türkiye.

PMID:42095233 | PMC:PMC13141541 | DOI:10.1016/j.ijnsa.2026.100544

Front Nutr. 2026 Apr 21;13:1807288. doi: 10.3389/fnut.2026.1807288. eCollection 2026.

ABSTRACT

BACKGROUND: The triglyceride-cholesterol-body weight index (TCBI) has been proposed as a composite indicator of nutritional-metabolic status, yet evidence regarding its association with incident CVD in general aging populations and across different modeling strategies remains limited.

METHODS: We analyzed harmonized data from the China Health and Retirement Longitudinal Study (CHARLS: 2011-2018) and the English Longitudinal Study of Aging (ELSA: 2002-2018). Community-dwelling adults aged 45 years and older and free of CVD at baseline were included. Baseline TCBI was calculated as triglycerides × total cholesterol × body weight /1,000 and primarily analyzed as a log-transformed continuous variable. Incident CVD was defined as physician-diagnosed heart disease or stroke during follow-up. Cox proportional hazards models, restricted cubic spline analyses, and prespecified subgroup analyses were conducted separately in each cohort.

RESULTS: A total of 6,013 participants (CHARLS: 3,741; ELSA: 2,272) were included. In the fully adjusted model, higher baseline TCBI was significantly associated with incident CVD in both cohorts (CHARLS: HR = 1.216, 95% CI (1.092, 1.352); P < 0.001; ELSA: HR = 1.195, 95% CI (1.022, 1.396); P = 0.025) when modeled as a continuous variable. Quartile-based analyses were broadly consistent, although the pattern was not entirely monotonic, particularly in ELSA. Restricted cubic spline analyses showed a significant overall association without evidence of non-linearity in CHARLS, whereas neither the overall nor the non-linear association was statistically significant in ELSA. The results remained robust in lag analyses. However, the incremental predictive value of TCBI beyond conventional risk factors was minimal, with no significant improvement in discrimination or reclassification in either cohort.

CONCLUSIONS: Higher baseline TCBI was associated with incident CVD in two large aging cohorts, especially when modeled as a continuous exposure. However, its incremental predictive value beyond conventional cardiovascular risk factors was minimal. TCBI may therefore serve as a complementary metabolic and nutritional indicator rather than a stand-alone predictive tool.

PMID:42095219 | PMC:PMC13138991 | DOI:10.3389/fnut.2026.1807288

Front Nutr. 2026 Apr 21;13:1786580. doi: 10.3389/fnut.2026.1786580. eCollection 2026.

ABSTRACT

BACKGROUND: Both intermittent enteral nutrition (IEN) and continuous enteral nutrition (CEN) are used to provide nutritional support to critically ill patients. However, their comparative effects on gastrointestinal tolerance and clinical outcomes remain uncertain.

OBJECTIVES: We conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of IEN versus CEN in critically ill patients.

METHODS: We performed a comprehensive literature search of PubMed, Embase, Scopus, and the Cochrane Library from inception through December 10, 2025, to identify RCTs comparing IEN and CEN in critically ill adults. The primary outcome was all-cause mortality in the intensive care unit (ICU). Secondary outcomes included gastrointestinal complications, length of ICU stay, and achievement of nutritional goals. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models as appropriate. Subgroup analyses were performed according to mechanical ventilation status.

RESULTS: Twenty-two RCTs comprising 1,662 critically ill patients (IEN, n = 816; CEN, n = 846) were included. Compared with CEN, IEN was associated with a significantly higher incidence of diarrhea (RR 1.56, 95% CI 1.23 to 1.98, I ² = 19%) and abdominal distension (RR 1.68, 95% CI 1.10 to 2.57, I ² = 18%), as well as prolonged ICU length of stay (MD 0.91, 95% CI 0.41 to 1.41, I ² = 0%). Conversely, IEN was associated with a lower incidence of constipation (RR 0.74, 95% CI 0.57 to 0.97, I ² = 0%). These effects were more pronounced in mechanically ventilated patients, whereas no statistically significant differences were observed in non-ventilated patients. No significant differences were identified between the two strategies regarding ICU mortality, vomiting, gastric retention, aspiration pneumonia, or achievement of nutritional goals.

CONCLUSION: This updated meta-analysis demonstrates that IEN is associated with increased rates of diarrhea and abdominal distension and prolonged ICU length of stay compared with CEN, particularly among mechanically ventilated patients. Although IEN reduces the incidence of constipation, CEN may be the preferable feeding strategy for most critically ill patients. Individualized approaches considering patient-specific factors and clinical context are warranted. Further high-quality trials are needed to identify patient subgroups who might benefit from IEN.

SYSTEMATIC REVIEW REGISTRATION: https://osf.io/krs8v.

PMID:42095216 | PMC:PMC13139002 | DOI:10.3389/fnut.2026.1786580

Front Sports Act Living. 2026 Apr 21;8:1793910. doi: 10.3389/fspor.2026.1793910. eCollection 2026.

ABSTRACT

INTRODUCTION: The Modified Maddocks Questions Tool (MMQT) is part of the Concussion Recognition Protocol used for sideline assessment of suspected concussion. Although widely used in English-speaking populations, it has not been validated in Spanish-speaking children. This study aimed to evaluate comprehension and response accuracy of a Spanish-adapted MMQT in soccer players aged 4-8 years.

METHODS: We conducted a cross-sectional observational study in Montevideo, Uruguay, between July and October 2024. Eighty-eight male soccer players aged 4-8 years were assessed at halftime using a Spanish-adapted version of the MMQT. Comprehension was evaluated by asking participants to reformulate each question. Associations between age, comprehension, and response accuracy were analyzed using chi-square or Fisher’s exact tests and logistic regression models.

RESULTS: No statistically significant association was found between age and either comprehension or accuracy. Overall comprehension exceeded 96%. However, Question 4 (“Which team won the last match?”) consistently showed a lower correct response rate across all ages. Our findings reinforce previous observations showing that questions assessing recall of past events can be challenging for younger children and suggest caution when evaluating MMQT responses in this age group.

CONCLUSIONS: The Spanish-adapted MMQT demonstrates high comprehension and may be suitable for sideline concussion screening in children aged 5-8 years. However, Question 4 appears less reliable and should be reconsidered in future versions. A conservative approach is recommended, whereby any incorrect response warrants removal from play for further evaluation.

PMID:42095200 | PMC:PMC13139062 | DOI:10.3389/fspor.2026.1793910

Public Health Chall. 2026 May 5;5:e70269. doi: 10.1002/puh2.70269. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: In low- and middle-income countries, meat consumption is often associated with health risks due to limited awareness of zoonotic disease transmission. Burkina Faso is not exempt from these public health threats. This study aimed to assess knowledge and practices related to meat-borne zoonotic risks among meat consumers in Burkina Faso.

METHODS: A cross-sectional descriptive and analytical survey was conducted from August to November 2022, including 849 participants. Data were collected using a structured questionnaire administered through face-to-face interviews. Scores were attributed to assess levels of knowledge and practices regarding zoonotic risks associated with meat handling and consumption. Statistical analysis was performed using descriptive statistics and chi-square and Fisher’s exact tests.

RESULTS: According to findings, although 90.22% acknowledged that meat could transmit zoonotic diseases to humans, only 31.22% could name at least one zoonotic disease. Poor hygiene in meat sale outlets was reported by 50.77% of respondents. Good practices, such as proper meat storage, were inconsistently reported, as 66.90% reportedly stored meat exposed to open air, and 46.29% used the same utensils for meat preparation and meal service in households. Overall, level of education, professional occupation, religion and position held in the household were significantly associated with both knowledge and practices (p < 0.05), and participants having better knowledge were more likely to adopt safer practices (p < 0.05).

CONCLUSION: Despite a general awareness of meat-related health risks, including zoonotic diseases, knowledge gaps and unsafe practices remain prevalent among consumers. Reducing meat-borne zoonotic diseases requires shifting from general awareness to actionable, behaviour-oriented interventions. By combining community education, improved market hygiene and multi-sectoral collaboration, public health authorities can substantially reduce preventable exposure to zoonotic pathogens while preserving the nutritional benefits of meat consumption.

PMID:42095195 | PMC:PMC13142224 | DOI:10.1002/puh2.70269

Health Sci Rep. 2026 May 4;9(5):e72021. doi: 10.1002/hsr2.72021. eCollection 2026 May.

ABSTRACT

BACKGROUND AND AIMS: Shoulder impingement syndrome (SIS) is a common cause of shoulder pain and dysfunction. This study explored the association between coracoacromial ligament (CAL) thickness and SIS using magnetic resonance imaging (MRI).

METHODS: This cross-sectional MRI-based observational study involved 47 patients aged 18-70 years with shoulder pain. T2 fat-saturated sagittal MRI views were used to measure CAL thickness at proximal and distal portions by two radiologists. Statistical analyses included t-tests, χ ² tests, and Pearson’s correlation, with significance set at p < 0.05.

RESULTS: Mean proximal CAL thickness was 1.24 mm (SD = 0.44 mm), and distal thickness was 1.50 mm (SD = 0.72 mm). Patients with SIS had significantly greater thickness at proximal (1.36 mm vs. 1.05 mm, p = 0.002, d = 0.82) and distal (1.78 mm vs. 1.12 mm, p = 0.001, d = 0.92, 95% CI: 0.39-0.93). Males showed greater distal thickness (1.62 mm) than females (1.34 mm, p = 0.04, d = 0.45). Age did not correlate with thickness (p > 0.71). Subacromial bursitis (70.21%, p < 0.001) and acromioclavicular (AC) joint osteophytes (68.09%, p = 0.003) were prevalent and associated with SIS.

CONCLUSION: CAL thickness, particularly at the distal portion, was strongly associated with SIS, independent of age but varying by gender. Measuring CAL thickness may aid SIS diagnosis.

PMID:42095187 | PMC:PMC13139633 | DOI:10.1002/hsr2.72021