Nevin Manimala

Health Econ. 2026 Apr 16. doi: 10.1002/hec.70107. Online ahead of print.

ABSTRACT

Governments frequently adopt austerity policies when facing economic crises, yet their long-term consequences for population health remain incompletely understood. This paper examines the impact of large-scale fiscal austerity on infant mortality by exploiting the Troika-led economic adjustment program implemented in Greece beginning in 2010 as a quasi-experimental shock. Using the synthetic control method, we construct a counterfactual for Greece based on OECD and Union for the Mediterranean countries that did not experience austerity of comparable depth or duration. Relative to this counterfactual, Greece experienced a sharp and persistent increase in infant mortality following the onset of austerity. The divergence emerges immediately after 2010, remains statistically significant throughout the post-intervention period, and shows little evidence of full reversion prior to the COVID-19 pandemic. The estimated effect corresponds to an average 43 percent increase in the infant mortality rate. Mortality effects are larger for boys than for girls and are concentrated in the neonatal period. Accounting explicitly for the fertility decline, we estimate approximately 854 excess infant deaths cumulatively from 2010 to 2020. Extensive robustness checks support the findings. The results identify the total effect of austerity and highlight the importance of protecting early-life health during fiscal consolidation.

PMID:41988926 | DOI:10.1002/hec.70107

J Mol Endocrinol. 2026 Apr 15:JME-25-0224. doi: 10.1530/JME-25-0224. Online ahead of print.

ABSTRACT

The gonadotrophin-releasing hormone (GnRH) pulse generator is a critical neural oscillator that governs reproductive function through the pulsatile release of luteinising hormone (LH) and follicle stimulating hormone (FSH). Early electrophysiological studies, notably by Ernst Knobil, identified multiunit activity (MUA) volleys in the mediobasal hypothalamus that aligned with LH pulses, suggesting a neural basis for GnRH pulsatility. Although GnRH neurons exhibit some intrinsic secretory rhythmicity in vitro, their isolated electrophysiological signatures have proven inconsistent. Recent advances, including GCaMP fibre photometry in freely behaving mice, have revealed a precise correlation between episodic GnRH distal processes and LH pulses. However, it is now well established that a neural oscillator comprising hypothalamic kisspeptin neurones co-expressing neurokinin B and dynorphin, collectively termed the KNDy network, represents the core construct of the GnRH pulse generator. Understanding the dynamics of this network and its modulation by external inputs such as stress, metabolic cues, and circadian rhythms is essential. Computational modelling provides a systematic framework for integrating experimental data with mechanistic and predictive analyses to decode the GnRH pulse generator dynamics.

PMID:41988873 | DOI:10.1530/JME-25-0224

Water Environ Res. 2026 Apr;98(4):e70386. doi: 10.1002/wer.70386.

ABSTRACT

BACKGROUND: Harmful algal blooms (HABs) pose a significant threat to aquatic ecosystems worldwide, with freshwater environments being particularly vulnerable. Among the primary contributors to these blooms is Microcystis aeruginosa, a cyanobacterium known for producing toxins that are harmful to both human health and aquatic life. Given its toxic nature and ecological impact, understanding the factors that influence its growth is crucial. Since M. aeruginosa naturally inhabits sunlit surface waters, it is especially vulnerable to ultraviolet (UV) radiation stress, making this an ecologically and practically relevant area of study. Investigating the effects of UV radiation on M. aeruginosa growth can provide valuable insights into bloom dynamics, ecological consequences, and potential strategies for bloom management and control.

OBJECTIVES: This study aims to examine the effects of UV radiation on the growth dynamics of both toxic and nontoxic strains of M. aeruginosa, specifically PCC 7806 and PCC 7005.

METHODS: M. aeruginosa cultures PCC 7806 and PCC 7005 were exposed to varying levels of UV radiation (80, 60, and 20 mW/cm²). Key parameters such as growth rates, cell concentrations, and the relative UV effects were monitored. Cell counts were determined microscopically and subsequently used to calculate the growth rate.

RESULTS: UV radiation was found to exert a significant influence on the proliferation of both strains of M. aeruginosa, inducing discernible alterations in growth patterns and physiological mechanisms as compared to the control group. A one-way analysis of variance (ANOVA) indicated a significant effect of treatment intensity, with an F statistic of 13.71, p < 0.0001, and an R² value of 0.5950. Pairwise comparisons revealed that the mean difference for the 80 mW/cm² treatment was -4.458 (95% CI: -8.937 to -0.02000, p = 0.0514). Overall, the findings indicate that UV treatment intensity significantly influences growth, with the most pronounced effects observed at 80 mW/cm².

CONCLUSIONS: Our data suggest that the growth of both M. aeruginosa strains, PCC 7806 and PCC 7005, is reduced under high UV radiation during algal blooms. A reduction in dense Microcystis blooms as a result of increased UV exposure could enhance light penetration in water bodies. These findings provide valuable insights for water resource management teams, enabling them to develop strategies to mitigate the public health risks associated with HABs.

PMID:41988826 | DOI:10.1002/wer.70386

Front Public Health. 2026 Mar 31;14:1798507. doi: 10.3389/fpubh.2026.1798507. eCollection 2026.

ABSTRACT

BACKGROUND: Thyroid disorders are common and often under-recognized. Evidence on public thyroid health literacy in Palestine is limited. This study assessed public knowledge of thyroid disorders among adults in the West Bank, Palestine.

METHODS: A cross-sectional online survey was conducted from May 1 to August 1, 2025, among adults (≥18 years) residing in the West Bank. Participants with current or prior health-professional training or employment in healthcare were excluded. Non-probability convenience sampling was used through social media distribution (Facebook, WhatsApp, Telegram). Knowledge was assessed using a 17-item multiple-choice instrument covering risk factors (7 items), clinical manifestations (7 items), and preventive behaviors (3 items). Correct responses were scored as 1 and incorrect/”I don’t know” as 0; knowledge levels were categorized as low (<50%), moderate (50-75%), and high (>75%). Data were analyzed using descriptive statistics, chi-square tests, and ordinal logistic regression.

RESULTS: A total of 1,119 participants were included (71.3% women, 75.0% university-educated). Mean knowledge score was 8.60/17 (50.6%); 56.7% had low knowledge, 26.3% moderate, and 17.1% high. Risk-factor knowledge was lowest (mean 2.97/7; 42.4%), while prevention-related knowledge was comparatively higher (mean 2.03/3; 67.7%). Notable gaps were observed for medication-related risks (amiodarone 9.7%; lithium 11.0%) and pregnancy/postpartum risk (41.7%). In adjusted analyses, higher knowledge was associated with age >50 years (aOR 1.71), while lower knowledge was associated with male sex (aOR 0.70) and no formal education versus university education (aOR 0.26).

CONCLUSION: Public knowledge of thyroid disorders in the West Bank was generally low, with the most pronounced deficits related to pregnancy and the postpartum period and to medication associated thyroid dysfunction. These findings support targeted, low cost health education integrated into routine primary care, maternal and reproductive health services, and community pharmacy counseling, with future studies needed to evaluate effects on timely care seeking and safer medication practices.

PMID:41988568 | PMC:PMC13076517 | DOI:10.3389/fpubh.2026.1798507

Front Physiol. 2026 Mar 31;17:1754825. doi: 10.3389/fphys.2026.1754825. eCollection 2026.

ABSTRACT

BACKGROUND: With the continuous advancement of sports training methodologies, high-intensity interval training (HIIT) and small-sided games (SSG) have emerged as crucial strategies for enhancing players’ physical fitness. However, the comparative effects of these training modalities on various fitness components and their underlying physiological adaptation mechanisms remain insufficiently explored.

OBJECTIVES: This systematic review and meta-analysis aim to compare the overall impact of HIIT and SSG on players’ physical fitness and examine the moderating effects of different training parameters, including training frequency, intervention duration, players’ training experience, age, and gender. The findings seek to provide theoretical insights for optimising training protocols.

METHODS: A systematic search was conducted in databases including PubMed, Web of Science, Scopus, and EBSCOhost to identify relevant English-language randomised controlled trials that met predefined eligibility criteria. Hedges’ g was used as the effect size metric, and a random-effects model was applied for meta-analyses of power, speed, endurance, and agility. Subgroup analyses were performed to assess the influence of potential moderators.

RESULTS: The meta-analysis revealed that, compared to SSG, HIIT produced a small but statistically significant improvement in speed (ES = 0.564) and a moderate and statistically significant improvement in endurance (ES = 0.706). In contrast, gains in power (ES = -0.144) and agility (ES = -0.159) were trivial in magnitude and not statistically significant. Subgroup analyses indicated that lower training frequency (<3 sessions per week) and shorter intervention duration (<6 weeks) yielded significant improvements. Furthermore, players across different age groups benefited from HIIT, while sex did not exhibit a significant moderating effect.

CONCLUSION: This systematic review and meta-analysis confirm that both HIIT and SSG effectively enhance players’ physical fitness, with HIIT demonstrating a distinct advantage in improving speed and endurance. Although HIIT showed relatively limited improvements in power and agility compared to SSG, both training modalities exert their effects through distinct physiological adaptation mechanisms. Subgroup analysis findings suggest that appropriately balancing training frequency and intervention duration is crucial for achieving optimal training outcomes. Future research should further investigate the long-term effects of these interventions to provide a more robust theoretical foundation for personalised training program design.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42024555633.

PMID:41988503 | PMC:PMC13076140 | DOI:10.3389/fphys.2026.1754825

ACS ES T Water. 2026 Mar 12;6(4):2458-2467. doi: 10.1021/acsestwater.5c01470. eCollection 2026 Apr 10.

ABSTRACT

Evaluating drinking water treatment (DWT) performance requires understanding how dissolved organic matter (DOM) is transformed during treatment and how these transformations drive the formation of disinfection byproducts (DBPs), which remain major concerns in drinking water safety. While current regulations target a limited number of DBP classes, including trihalomethanes (THMs) and haloacetic acids (HAAs), chlorination of DOM produces a much broader pool of largely unregulated DBPs with poorly understood toxicological relevance. In this study, a full-scale conventional drinking water treatment plant was evaluated using an integrated analytical framework combining molecular-level DOM fingerprinting by high-resolution mass spectrometry, targeted DBP quantification by gas chromatography-mass spectrometry, and adsorbable organic halide measurements. This integrated approach enables the assessment of DOM transformation and DBP formation under realistic treatment conditions. Although approximately 60% of dissolved organic carbon (DOC) was removed, molecular fingerprinting revealed a highly selective DOM removal pattern. Aromatic and condensed aromatic compounds were preferentially eliminated, whereas aliphatic and unsaturated fractions persisted and showed a positive statistical association with DBP formation. These results indicate that bulk DOC removal alone is insufficient to mitigate DBP formation and highlight the need for treatment strategies targeting specific reactive DOM fractions to enhance drinking water safety.

PMID:41988169 | PMC:PMC13078287 | DOI:10.1021/acsestwater.5c01470

Ann Ital Chir. 2026 Apr 10;97(4):694-700. doi: 10.62713/aic.4469.

ABSTRACT

AIM: The optimal uterine suturing technique for repeat caesarean section in women with a scarred uterus remains controversial, and evidence comparing novel techniques, such as the breakwater suture, with conventional methods in terms of comprehensive recovery is limited. The objective of this study is to investigate the combined effects of single-layer suturing, double-layer suturing, and breakwater suture techniques on postoperative recovery in patients with scarred uteri undergoing repeat caesarean section.

METHODS: In this retrospective cohort study, 300 pregnant women with scarred uteri undergoing repeat caesarean section at The Maternal and Child Health Care Hospital of Tong Xiang between January 2022 and December 2024 were included. The sample was divided into three groups based on the type of suture used: single-layer suture group (n = 108), double-layer suture group (n = 103), and breakwater suture group (n = 89). Primary outcomes comprised postoperative recovery time, complications, uterine healing status, psychological state, and sleep quality.

RESULTS: There were no significant differences in baseline characteristics among the three groups (p > 0.05). Regarding postoperative recovery, the breakwater suture group demonstrated significantly shorter time to anal flatus, time to first ambulation, and postoperative hospital stay compared with both the single-layer and the double-layer suture groups (p < 0.05). Postoperative ultrasound revealed significantly greater uterine segment myometrial thickness in the breakwater suture group compared to the other two groups (p < 0.001). At six months postoperatively, the incidence of uterine diverticulum in the breakwater suture group (4.5%) was significantly lower than that in the single-layer suture group (15.7%); the overall difference among the three groups was statistically significant (p = 0.041). Furthermore, patients in the breakwater suture group demonstrated significantly better postoperative outcomes on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Edinburgh Postnatal Depression Scale (EPDS), and Pittsburgh Sleep Quality Index (PSQI) compared with the other groups (p < 0.001).

CONCLUSIONS: In repeat caesarean sections in women with scarred uteri, the breakwater suture technique comprehensively promotes postoperative recovery and may be recommended as a suturing method.

PMID:41987623 | DOI:10.62713/aic.4469

Zhongguo Zhen Jiu. 2026 Apr 12;46(4):547-552. doi: 10.13703/j.0255-2930.20250221-k0003. Epub 2026 Feb 4.

ABSTRACT

OBJECTIVE: To observe the effect of electroacupuncture (EA) on intestinal function after laparoscopic colorectal cancer surgery.

METHODS: A total of 72 patients with malignant tumors of the sigmoid colon or rectum scheduled for laparoscopic surgery were randomly divided into an observation group (36 cases) and a control group (36 cases, 1 case discontinued). The observation group received EA starting from the first postoperative day. Acupoints used included Zhongwan (CV12), Qihai (CV6), and bilateral Quchi (LI11), Tianshu (ST25), Zusanli (ST36), Shangjuxu (ST37), and Xiajuxu (ST39). EA apparatus was connected between bilateral Tianshu (ST25), as well as ipsilateral Zusanli (ST36) and Shangjuxu (ST37), using continuous wave at a frequency of 2 Hz, current intensity of 2 to 3 mA, adjusted to patient tolerance. The control group received sham EA using the same acupoints. For sham EA, the needle tips were inserted into adhesive pads without touching the skin surface, and the EA apparatus was specially modified to be non-conductive, thus preventing any effective current circuit. Both groups were treated once daily for 30 min each time, for five consecutive days. The time to first anal exhaust, time to first defecation, number of postoperative administrations of the analgesic flurbiprofen axetil, and postoperative hospital stay were recorded in the two groups. Numerical rating scale (NRS) score was assessed from postoperative day 1 to 5, and the incidence of postoperative intestinal obstruction within 14 days was also recorded in the two groups.

RESULTS: The time to first defecation in the observation group was shorter than that in the control group (P<0.01). Among patients aged ≥65 years, the time to first anal exhaust and the time to first defecation in the observation group were earlier than those in the control group (P<0.05, P<0.01). A positive correlation was found between age and time to first exhaust and defecation (r=0.472, r=0.604, P<0.01). The NRS scores on postoperative day 4 and 5 in the observation group were lower than those in the control group (P<0.01, P<0.05). There were no statistically significant differences between the two groups in terms of the number of flurbiprofen axetil administrations or length of hospital stay (P>0.05). No cases of intestinal obstruction occurred in either group within 14 days postoperatively.

CONCLUSION: EA can accelerate the recovery of bowel function after laparoscopic colorectal cancer surgery, which might have greater clinical value for patients aged 65 years or older.

PMID:41987441 | DOI:10.13703/j.0255-2930.20250221-k0003

J Nurs Manag. 2026;2026(1):e9157658. doi: 10.1155/jonm/9157658.

ABSTRACT

BACKGROUND: Burnout among emergency healthcare providers, including physicians, nurses, and paramedics, is a growing global concern, particularly in developing countries where prevalence rates can reach 70%-80%. Burnout negatively impacts healthcare systems and patient outcomes. However, limited studies compare burnout rates across these professions or focus on the Middle Eastern context, including Jordan. This study aims to assess burnout prevalence among emergency physicians, nurses, and paramedics in Jordan and identify associated demographic and work-related factors.

METHODS: A cross-sectional descriptive study was conducted using a paper-based, self-administered questionnaire incorporating the Copenhagen Burnout Inventory (CBI). Participants were drawn from emergency departments in 15 hospitals and 13 ambulance stations. Data were analyzed using SPSS Version 25, employing descriptive statistics, ANOVA, and logistic regression to identify burnout predictors.

RESULTS: A total of 560 participants completed the survey (response rate: 70%). The prevalence rates for personal, work-related, and patient-related burnout were 83.7%, 79.2%, and 64.0%, respectively, with overall high burnout rates (75.6%). Sleep deprivation (p ≤ 0.002), poor supervisor relationships (p ≤ 0.01), and attempts to change workplaces (p ≤ 0.03) were associated with all burnout dimensions. Female participants and those with one to three children showed higher burnout odds (p = 0.004, p = 0.045, respectively). No significant differences in burnout rates were observed among professions.

CONCLUSIONS: This study highlights alarmingly high burnout prevalence rates among emergency healthcare providers in Jordan, stressing the need for tailored strategies to mitigate burnout and improve the resilience of the healthcare system. Future research should explore the long-term impacts of systemic factors and post-COVID-19 dynamics.

PMID:41986944 | DOI:10.1155/jonm/9157658

J Anat. 2026 Apr 15. doi: 10.1111/joa.70153. Online ahead of print.

ABSTRACT

The domestic dog (Canis lupus familiaris), a species characterized by remarkable phenotypic diversity resulting from selective breeding, is among the several mammals that may exhibit an anatomical perforation of the humeral condyle, designated as the supratrochlear foramen (STF). The prevalence of the STF varies considerably across mammalian species and has been proposed to reflect functional adaptations linked to evolutionary and biomechanical factors, particularly in the human humerus. To the best of our knowledge, comprehensive studies on STF variation within present-day canine populations remain scarce. This study aimed to determine the prevalence and morphology of the STF in extant dogs, and to compare these findings with those from Roman Imperial Period dogs, and Iberian wolves (Canis lupus signatus), a subspecies considered representative of the dog’s wild ancestor, in order to explore evolutionary changes within Canis lupus subspecies. We analyzed 269 humeri (123 extant dogs, 76 ancient dogs, 70 Iberian wolves) using osteometric measurements and statistical analysis. Our results demonstrate that the STF was observed in 73.17% of extant dogs, compared to 82.89% in ancient dogs and 98.57% in Iberian wolves, suggesting a reduction in its prevalence over time in domestic lineages that may be linked to human-driven selection processes. In all studied groups, the STF was consistently located closer to the lateral humeral epicondyle, and its predominantly transversely elongated shape reveals a common morphological pattern across Canis lupus subspecies. Despite differences in humeral size among groups, STF dimensions showed a positive correlation with overall humeral measurements, with larger humeri exhibiting proportionally larger and more frequent STFs. Extant dogs displayed the smallest STF dimensions, followed by ancient dogs, with Iberian wolves having the largest. Considering the potential impact of the STF on the biomechanical properties of the distal humerus, this study provides new insights into its anatomical variability in dogs, emphasizing its clinical relevance for orthopedic diagnostic accuracy and surgical treatments in veterinary medicine.

PMID:41986904 | DOI:10.1111/joa.70153