Nevin Manimala

Inquiry. 2026 Jan-Dec;63:469580261448474. doi: 10.1177/00469580261448474. Epub 2026 Aug 19.

ABSTRACT

IntroductionMenopause is a natural life stage often accompanied by persistent symptoms, such as hot flushes, night sweats, and mood changes that can significantly affect quality of life. While symptom experiences vary across cultures, little is known about menopause-related quality of life among Qatari women. The objective of this study was to measure the association between menopause symptoms and the quality of life of Qatari women.MethodsAn online, self-administered cross-sectional survey was distributed to all Qatari women aged 30-64 attending Primary Health Care Corporation Centers in Qatar for any reason.ResultsA total of 512 women completed the Menopause-Specific Quality of Life questionnaire. The mean (SD) age of respondents was 48.8 (7.28) years, with a median of 50 years. Mean (SD) age at menopause was 48.83 (4.93) years. The most frequently experienced symptoms were feeling tired (88.0%), aching muscles/joints (87.0%), lacking energy (86.0%), decreased physical strength (84.0%), low backache (82.0%) and flatulence (80.9%). Menopause status was significantly related to hot flushes (p< 0.001), night sweats (p< 0.001), accomplishing less (p=0.042), aching muscles/joints (p=0.041), aching back/neck/head (p=0.011), decreased physical strength (p=0.028), vaginal dryness during intimacy (p=0.001), and avoiding intimacy (p=0.002). Psychosocial symptoms were reported by 63.2% of respondents, followed by vasomotor symptoms (66.3%), sexual symptoms (66.4%), and physical symptoms (75.9%). There were statistically significant differences in mean scores of vasomotor, physical, and sexual domains across the menopause groups.ConclusionQatari women experience the onset of menopause at a younger age compared to women from other Arab and high income countries and are mostly bothered by symptoms related to physical discomfort and fatigue. Qatari women experience a high quality of life in the psychosocial domain. To improve care, health systems should prioritize menopause awareness and education, develop culturally sensitive strategies, and integrate these into primary care to enhance the wellbeing of aging women.

PMID:42617154 | DOI:10.1177/00469580261448474

Brief Bioinform. 2026 Jul 3;27(4):bbag446. doi: 10.1093/bib/bbag446.

ABSTRACT

Spatial transcriptomics (ST) has enabled direct interrogation of cell-cell communication (CCC) within intact tissues, providing critical spatial context that is lost in single-cell RNA-sequencing-based inference and allowing more accurate identification of physically plausible and spatially organized interactions. A rapidly expanding community of computational tools has emerged to decode CCC from ST data. Here, we provide a comprehensive review of the conceptual evolution and methodological landscape of spatial CCC inference, classifying existing approaches into two major trajectories. One trajectory, spatial pattern-based methods, assumes CCC events manifest as identifiable spatial patterns, such as colocalization, coordinated spatial signals, or higher-order spatial organization captured by deep learning models. The other trajectory, expression modulation-based approaches, assumes that CCC events influence the transcriptomic state of receiver cells. We systematically dissect their biological assumptions, statistical and deep learning frameworks, strengths, and limitations, and highlight emerging challenges in validation, benchmarking, multimodal integration, and tissue-specific modeling. Finally, we outline future directions toward achieving dynamic, multilayered reconstruction of inter- and intracellular communication, de novo signaling, and integrative multi-omics modeling.

PMID:42617152 | DOI:10.1093/bib/bbag446

Brief Bioinform. 2026 Jul 3;27(4):bbag439. doi: 10.1093/bib/bbag439.

ABSTRACT

The rapid expansion of high-throughput omics has created molecular datasets of unprecedented scale and complexity. These data are rich in biological information yet inherently sparse and high-dimensional, often limiting the effectiveness of conventional machine learning techniques. Foundation models (FMs), built on large-scale self-supervised pretraining, offer a robust alternative by learning generalizable representations directly from raw biological data. This review systematically analyzes the emerging landscape of FMs in omics research, spanning sequence modeling, cell state characterization, and multimodal integration. We organize the current literature into three distinct paradigms-sequence-centric, cell-centric, and multi-omics-to clarify a field currently fragmented by diverse tokenization strategies and architectural choices. Beyond methodology, we evaluate the practical utility of these models in tasks ranging from biomarker discovery to perturbation response prediction. We also identify critical barriers to adoption, including high computational costs, interpretability challenges, and the lack of standardized benchmarks. To support reproducible research, we provide a curated catalog of essential datasets and evaluation frameworks. Finally, we propose a roadmap for the next generation of FMs, advocating for architectures that move beyond statistical correlation to incorporate causal reasoning, temporal dynamics, and autonomous experimental validation.

PMID:42617149 | DOI:10.1093/bib/bbag439

Neurology. 2026 Sep 22;107(6):e218375. doi: 10.1212/WNL.0000000000218375. Epub 2026 Aug 19.

ABSTRACT

BACKGROUND AND OBJECTIVES: Evidence remains inconclusive on whether paternal valproate exposure during spermatogenesis is associated with adverse offspring outcomes, with findings lacking beyond Nordic countries. This study aimed to assess the risks of neurodevelopmental disorders (NDDs) and congenital malformations in offspring attributable to paternal exposure to valproate and other antiseizure medications (ASMs) during sperm development.

METHODS: This nationwide birth cohort study used data from the Taiwan National Health Insurance Research Database, including individuals born 2001-2016 who were followed up through 2021. Paternal exposure to valproate or other ASMs was defined during the time of spermatogenesis (3 months before conception). Exposure discordant sibling sets were identified for sibling-comparison analysis to control for shared genetic and lifestyle factors. NDDs-including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), intellectual disability (ID), and tic disorder-and congenital malformations were defined by outpatient and inpatient medical record(s). Relative risks were estimated through Cox proportional hazards models for NDDs (hazard ratios [HRs]) and logistic regression for congenital malformations (odds ratios [ORs]).

RESULTS: In the population cohort of 2,583,503 individuals, 1,701 were exposed to paternal use of valproate and 548 exposure-discordant sibling sets were available for sibling-comparison analysis. In population-based analyses, paternal valproate exposure was not associated with the risk of NDDs (HRs = 0.86 [95% CI 0.61-1.22] for ASD, 1.02 [0.88-1.18] for ADHD, 0.80 [0.53-1.20] for tic disorders, and 0.81 [0.55-1.19] for ID) or congenital malformations (OR = 1.07 [0.83-1.37]) in offspring. These null effects persisted when restricting analyses to children of fathers with epilepsy to control for confounding by indication, and when the sibling-comparison analysis was conducted. For other ASMs, a few associations appeared at nominal significance, but none remained in sibling-comparison analyses.

DISCUSSION: In this large population-based study in Asia, we found no increased risk of NDDs in offspring following paternal exposure to valproate or other ASMs. These findings may contribute to ongoing debates about the management of valproate in men of reproductive age, although additional evidence is needed before drawing conclusions about changes to current practice.

PMID:42617146 | DOI:10.1212/WNL.0000000000218375

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2600038. doi: 10.1200/CCI-26-00038. Epub 2026 Aug 19.

ABSTRACT

PURPOSE: Predictors of optimal or improved health-related quality-of-life (HRQOL) in adult survivors of childhood cancer are understudied.

METHODS: This cohort study used data from 4,755 survivors in the Childhood Cancer Survivor Study who completed baseline (T0) and two follow-up surveys (T1, T2) between 1992 and 2016. HRQOL was assessed using SF-36 Physical and Mental Component Summaries (PCS; MCS), classified as optimal (≥40) or suboptimal (<40), with improvement being suboptimal at T1 to optimal at T2.

RESULTS: At T1, 88.4% and 82.5% had optimal physical and mental HRQOL; among those suboptimal, 51.3% and 63.9% improved by T2. Higher education, physical activity, income, mental health, and absence of chronic conditions predicted optimal or improved HRQOL using multivariable logistic regression with backward selection. Model performance was acceptable for optimal PCS (0.81), MCS (0.72), and improved models (0.69 each).

CONCLUSION: Findings may inform targeted interventions addressing education, lifestyle, mental health, and chronic conditions to enhance well-being in childhood cancer survivors.

PMID:42617134 | DOI:10.1200/CCI-26-00038

JMIR Cancer. 2026 Aug 19;12:e94610. doi: 10.2196/94610.

ABSTRACT

BACKGROUND: Telehealth use expanded rapidly during the COVID-19 pandemic and has since become integrated into routine oncology care. However, clinician experiences and confidence with telehealth may vary across oncology subspecialties, and these differences remain incompletely characterized.

OBJECTIVE: This study aimed to evaluate telehealth perceptions, decision-making factors, and confidence across oncology clinicians from multiple specialties at a single academic cancer center.

METHODS: We conducted a cross-sectional survey of oncology clinicians at the University of California San Diego Moores Cancer Center. A 27-item Qualtrics questionnaire was distributed by email to attending physicians, fellows, and advanced practice providers across surgical, medical, radiation, and palliative oncology. Survey domains included telehealth coordination, technical quality, communication effectiveness, confidence in remote physical examination, and factors influencing visit modality selection. Quantitative responses were summarized descriptively, and open-ended responses underwent thematic analysis.

RESULTS: Among 114 invited clinicians, 57 (50%) complete responses were analyzed. Among 57 respondents, 86% (n=49) were physicians. Specialties included surgical oncology (n=21, 36.8%), medical oncology (n=18, 31.6%), radiation oncology (n=16, 28.1%), and palliative care (n=2, 3.5%). Telehealth coordination was rated easy or very easy by 78.9% (n=45) of clinicians. Audio and video quality were rated good or very good by 71.9% (n=41) and 57.9% (n=33), respectively. Technical issues prompted at least occasional conversion to audio-only visits for 86% (n=49) of respondents, and 17.5% (n=10) of clinicians reported frequent conversion. Communication satisfaction was high (n=48, 84.2%), yet only 50.9% (n=29) reported moderate or high confidence in performing a virtual physical examination. The need for physical examination (n=53, 93%) and patient travel distance (n=45, 78.9%) were the most influential factors in offering telehealth visits. Confidence varied by specialty and clinical phase: moderate or high confidence was reported by surgical oncology clinicians in 52.4% (11/21) of preoperative and 71.4% (15/21) of postoperative responses, by medical oncology clinicians in 77.8% (14/18) of prechemotherapy and 76.5% (13/17) of during chemotherapy responses, and by radiation oncology clinicians in 87.5% (14/16) of preradiation and 93.8% (15/16) of during radiation responses.

CONCLUSIONS: Oncology clinicians reported generally positive experiences with telehealth, although confidence and use patterns varied across specialties and phases of care. Telehealth is viewed as a complementary modality when physical examination is not essential. Improvements in technical reliability and interpreter integration may enhance equitable access and support continued telehealth use in oncology care.

PMID:42617112 | DOI:10.2196/94610

Inquiry. 2026 Jan-Dec;63:469580261479221. doi: 10.1177/00469580261479221. Epub 2026 Aug 19.

ABSTRACT

IntroductionNoncommunicable diseases (NCDs) are associated with a less healthy workforce, higher medical expenditures, and worse on-the-job performance. The allocation of limited health resources between prevention and treatment is therefore critical, as it could influence both NCDs-related mortality risk and on-the-job productivity.MethodsUsing panel data from 38 OECD countries over the period 2000 to 2023, this study applies the system generalized method of moments (GMM) to examine (a) the nexus of prevention-cure-NCDs death probability, and (b) the possible roles of preventive and curative health services on the path of saving the economy’s production loss attributable to the risk of NCDs death for the population aged 30 to 70.ResultsIntegrating preventive and curative health services is associated with improvements in health outcomes and economic productivity. If prevention is maintained at the current level (0.27% of GDP) and curative health spending is continually allocated at a GDP ratio of 10.2%, the probability of dying from NCDs could decrease from the current 13.94% to 13.84%. Annual earnings per worker are estimated to increase from USD 49,036.52 to USD 49,515.49, while GDP per worker is projected to rise from USD 101,727.7 to USD 103,980.ConclusionsGender disparities in NCDs mortality risk persist. The findings underscore the importance of aligning investments in both preventive and curative health interventions to address the burden of noncommunicable diseases.

PMID:42617109 | DOI:10.1177/00469580261479221

J Gastrointestin Liver Dis. 2026 Aug 18. doi: 10.15403/jgld-7414. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Radiofrequency ablation (RFA) is a curative option for early-stage hepatocellular carcinoma (HCC) when liver resection or transplantation is not a suitable option. This study evaluated whether a peri-procedural intravenous lidocaine infusion could reduce neutrophil extracellular trap formation (NETosis), neutrophil-to-lymphocyte ratio (NLR) and improve 1-year outcomes after RFA.

METHODS: In this single-centre, randomized trial, 50 adult HCC patients undergoing RFA were allocated 1:1 to receive propofol-fentanyl sedation alone (PF group, n=25) or combined with intravenous lidocaine (1.5 mg/kg bolus, then 1 mg/kg/h for 24 hours; PF-L group, n=25). Serum citrullinated histone H3 (H3Cit), NLR, and C-reactive protein (CRP) were assessed at baseline and 24 hours post-ablation. The primary endpoint was the change in H3Cit expression. Secondary endpoints included changes in NLR and C-reactive protein (CRP), as well as 1-year overall mortality, disease-free survival, and local recurrence rates.

RESULTS: 24 patients in PF-L group and 25 patients in PF group completed the study. Intra-group H3Cit levels significantly decreased from baseline at 24 hours only in the PF-L group (p=0.031). However, the between-group difference in H3Cit variation levels was not significant (p=0.352). Postoperative NLR changes were also comparable between groups (p=0.354). The overall 1-year mortality rate was 12%, with no significant variance between the two arms.

CONCLUSIONS: Adding intravenous lidocaine to sedation resulted in an intra-group reduction in H3Cit expression following RFA but did not produce a statistically significant reduction compared to standard propofol-fentanyl sedation alone. 1-year survival and local recurrence rates did not differ between groups. However, our preliminary findings justify the need for larger, baseline-balanced trials to evaluate periprocedural NETosis modulation by sedation regimen.

PMID:42617103 | DOI:10.15403/jgld-7414

Clin Infect Dis. 2026 Aug 19:ciag491. doi: 10.1093/cid/ciag491. Online ahead of print.

ABSTRACT

BACKGROUND: The increasing heterogeneity in people with HIV makes it necessary to evaluate new follow-up strategies tailored to clinical/social complexity.

METHODS: Prospective, single-center, randomized, non-inferiority clinical-trial comparing two follow-up strategies – semi-annual standard care (SoC) or annual visits for 24 months- in virologically suppressed people with HIVand low-complexity profile, according to the GeSIDA “HIV Patient Stratification System”. The primary endpoint was non-inferiority (prespecified lower margin: -4%) in virological control (viral load <50 copies/mL; FDA snapshot). Secondary outcomes included adherence, quality of life, satisfaction, and healthcare costs.

RESULTS: Of 394 eligible candidates, 71 declined participation (48% preferring to maintain SoC) and 321 were randomized (162 SoC, 159 Annual). Participants were predominantly male (89%), MSM (78%), Spanish (63%), median age of 45 years and 13 years of HIV follow-up, without baseline differences between groups. Overall, 283 (88%) completed the study; 25 switched to long-acting therapy and 10 were lost or transferred. Virological control was similar in SoC and Annual arms: 86.42% vs 86.79% (ITT) and 98.29% vs 97.87% (PP), although non-inferiority was not statistically demonstrated. During the study, the increment from baseline in the proportion of highly satisfied participants was significant in the Annual arm (p=0.001). Reductions in HIV-related direct costs (-25.3%; p<0.001) were greater in the Annual group.

CONCLUSIONS: Among people with HIV and low complexity, annual follow-up achieved virological outcomes clinically comparable to semi-annual care, despite not meeting the formal non-inferiority threshold. Annual follow-up was associated with significant increment in patient satisfaction and lower HIV direct-related costs.

PMID:42617095 | DOI:10.1093/cid/ciag491

JMIR Med Educ. 2026 Aug 19;12:e93148. doi: 10.2196/93148.

ABSTRACT

BACKGROUND: Simulation-based medical education is essential for improving patient safety. In virtual reality (VR)-based simulation, immersion is primarily generated through visual and auditory cues, while other sensory modalities are typically absent. This sensory limitation may reduce the emergence of authentic safety-relevant behaviors. Olfaction plays an important role in clinical reasoning, risk perception, and self-protective behavior and is closely linked to memory and emotion. Although olfactory cues have been shown to influence hand hygiene behavior in real or simulated environments, their targeted integration into fully immersive VR-based medical simulation has not been systematically examined.

OBJECTIVE: This study aimed to investigate whether adding a real olfactory cue (disinfectant scent) to a fully virtual clinical simulation increases patient safety-relevant behavior, specifically hand hygiene compliance (hand disinfection and glove usage).

METHODS: In a controlled study at the University of Münster (during the winter term 2025-2026), 95 medical students participated in a VR-based clinical simulation. Study rooms were preassigned to either an olfactory intervention or a control condition, and participants selected their room without knowledge of the assigned condition (quasi-random allocation by room). Hand hygiene and glove use were automatically tracked as outcomes. Odds ratios (ORs) were calculated to assess the effect of the intervention on these behaviors.

RESULTS: The olfactory intervention nearly tripled the odds of hand disinfection (8/43, 18.6% vs 20/52, 38.5%; an absolute risk increase of 19.9 percentage points; OR=2.73, 95% CI 1.09-7.40; P=.04; number needed to treat=5), while no significant difference was observed for glove use (OR=1.44, 95% CI 0.62-3.45; P=.40).

CONCLUSIONS: The integration of a real olfactory cue into a fully immersive VR medical simulation significantly increased hand disinfection behavior, particularly after patient contact, but did not affect glove use. These findings suggest that olfactory augmentation can selectively reinforce safety-relevant behaviors in digital training environments. Incorporating real-world sensory cues into VR may represent a simple yet effective design strategy to enhance behavioral authenticity and patient safety outcomes in simulation-based medical education.

PMID:42617058 | DOI:10.2196/93148