Nevin Manimala

Glob Health Action. 2026 Dec;19(1):2648401. doi: 10.1080/16549716.2026.2648401. Epub 2026 Apr 15.

ABSTRACT

Climate change has become one of the most critical health issues globally in the twenty-first century with children bearing the disproportionate burden of the burden since they are more vulnerable than adults because of their physiological, behavioral, and developmental capacities. It is a systematic review that rates the evidence of the relationship between climatic exposures such as heat, air-pollution, and extreme weather events and pediatric health outcomes. The number of peer-reviewed studies involved was 23 published in 2000-2025, which represented different geographic areas and study designs and assessed acute and chronic health outcomes. The Newcastle-Ottawa Scale and the ROBINS-I tool were used to evaluate the methodological quality, and the majority of the studies had low to moderate risks of bias. The narrative synthesis shows that there are always links between air pollutants especially PM2.5, NO2 and O3 and respiratory morbidity, prevalence of asthma and hospitalization of children. Amplified temperatures as well as heat waves were associated with increased cases of heat illness, dehydration, and febrile state in infants and young children. There were elevated cases of diarrheal and vector-related infections, especially in low-resource settings, which were linked to extreme weather events especially floods. Although the overall results were similar, significant differences in the regions and methods were found, and low-income countries show little evidence. In addition, exposures as analyzed in most studies were usually considered individually, which may have underestimated the cumulative or compound climate risks.

PMID:41983323 | DOI:10.1080/16549716.2026.2648401

Epidemiol Psychiatr Sci. 2026 Apr 15;35:e25. doi: 10.1017/S2045796026100572.

ABSTRACT

AIMS: Prevention of child maltreatment – incorporating physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence – is a clearly defined global policy priority. Global Burden of Disease studies have focused on estimating burden attributable to childhood sexual abuse omitting other forms of child maltreatment. This study aims to estimate burden attributable to child maltreatment using data from the first comprehensive national study, the Australian Child Maltreatment Study (ACMS), accounting for the co-occurrence of multiple forms, the complex impact of multi-type maltreatment and the contribution of interrelated factors.

METHODS: We estimated burden attributable to child maltreatment by age and gender for Australia in 2021. Risk-outcome pairs that met criteria for sufficient evidence for a causal relationship were included. Relative risks were estimated as a function of exposure based on data from the ACMS incorporating increased risk with multi-type maltreatment and adjustment for confounding. Levels of exposure in each of the 32 mutually exclusive combinations or patterns of child maltreatment were estimated based on ACMS data by age and gender. The theoretical minimum risk exposure level was determined as no exposure to child maltreatment in the population and population attributable fractions (PAFs) were calculated. Attributable mortality, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were estimated by multiplying PAFs by the relevant burden of disease estimates by age and gender for Australia in 2021. Sensitivity analyses were conducted to assess the robustness of the results. Uncertainty was propagated into attributable burden estimates using Monte Carlo simulation methods.

RESULTS: Overall, child maltreatment accounted for 6.6% (95% uncertainty interval (UI), 6.2-6.9%) of all DALYs for women and 6.4% (95% UI, 6.0-6.7%) of all DALYs for men in Australia in 2021. An estimated 71.2% of self-harm, 57.1% of anxiety disorders and 49.3% of major depressive disorder (MDD) DALYs in women, and 63.8% of self-harm, 55.9% of anxiety disorders and 42.9% of MDD DALYs in men were attributable to child maltreatment.

CONCLUSIONS: Child maltreatment contributes to a substantial proportion of burden of disease in Australia, equivalent to leading lifestyle-related risk factors such as high body mass index, high blood pressure and smoking. This research significantly advances knowledge of the disease burden attributable to child maltreatment and provides novel methodology for measuring the impact of all five forms of child maltreatment combined on mental health and health risk behaviours nationally and globally.

PMID:41983278 | DOI:10.1017/S2045796026100572

Res Synth Methods. 2026 Apr 15:1-18. doi: 10.1017/rsm.2026.10090. Online ahead of print.

ABSTRACT

Meta-analysis is a cornerstone of evidence synthesis, yet challenges arise when studies report heterogeneous summary statistics, such as means and standard deviations (SDs) versus medians, interquartile ranges (IQRs), or other percentiles. Excluding studies that report only medians and IQRs can introduce bias and reduce precision, particularly when outcomes are skewed, which is common in clinical research. Although several methods exist to estimate means and SDs from alternative summaries, many rely on strong normality assumptions, exhibit computational burden, or fail to adequately account for the precision of reported quantiles (e.g., extreme values versus medians). To address these limitations, we propose two flexible weighted estimators for estimating the mean and SD from reported quantiles. The methods leverage inverse-variance and inverse-variance-covariance weighting, respectively, to enhance both accuracy and precision. Additionally, our methods are flexible enough to accommodate any set of reported quantiles and various underlying distributions, and they can be readily implemented using standard statistical software. Simulation studies demonstrate that the weighted estimators provide nearly unbiased estimates of the mean and SD with high precision in most cases, especially for large sample sizes. In a real-world meta-analysis, the estimates obtained using the proposed estimators closely aligned with those derived from true sample statistics. These approaches are particularly valuable for skewed outcomes and offer a practical and user-friendly solution for researchers seeking to integrate heterogeneous data while improving accuracy and precision.

PMID:41983277 | DOI:10.1017/rsm.2026.10090

Bone Jt Open. 2026 Apr 15;7(4):540-548. doi: 10.1302/2633-1462.74.BJO-2025-0322.R1.

ABSTRACT

AIMS: The Reimers migration percentage (MP) is the gold-standard radiological parameter used to aid decision-making regarding surgical management of hip displacement in cerebral palsy (CP). Accurate measurement is important to risk stratify patients and allow timely onward referral from community teams to paediatric orthopaedic services. We performed a study to determine whether experts and novices could use a free smartphone app (HipScreen (HS) app) as a valid method for measuring MP in CP.

METHODS: Using the HS app, two groups measured MP in 20 pelvis radiographs (40 hips) at weeks 0 and 2. The ‘inexperienced’ group included four community physiotherapists with no CP experience. The ‘experienced’ group included four community physiotherapists and two paediatricians with CP experience. All participants watched the tutorial videos on the HS app website. HS app measurements were then compared with gold-standard picture archiving and communication system (PACS) measurements conducted by a senior paediatric orthopaedic surgeon. Modified Pearson correlation (r) was used to determine inter-rater reliability between HS app and PACS measurements. Intraclass correlation coefficient (ICC) was then used to assess intrarater reliability. The mean absolute deviation (MAD) was calculated to compare raters with the gold standard.

RESULTS: HS app measurements in the experienced and inexperienced groups showed highly significant correlation with the gold-standard measurements (p < 0.001). There were no significant differences between intra- or inter-group measurements at weeks 0 and 2 with r > 0.86 and p < 0.001. Both inter- and intra-rater reliability were excellent with ICC > 0.9. There was no statistically significant difference in the MAD within individual measurements and compared with the gold standard.

CONCLUSION: The HS app is accurate in measuring MP in CP when used by non-specialists and specialists. Non-specialists do not require additional supplementary training. These findings suggest app efficacy and safety in regional and national hip surveillance programmes for children with CP.

PMID:41983275 | DOI:10.1302/2633-1462.74.BJO-2025-0322.R1

Acta Oncol. 2026 Apr 15;65:282-288. doi: 10.2340/ao.v65.45593.

ABSTRACT

BACKGROUND AND PURPOSE: We aimed to describe temporal changes in diagnostic work-up, treatment, and prostate cancer (PCa) mortality in locally advanced PCa in 2016-2024 in Sweden. Patient/material and methods: Men registered in the National Prostate Cancer Register of Sweden in 2016-2024 with locally advanced PCa; clinical T stage 3-4, no distant metastases, and prostate-specific antigen < 100 ng/ml were included. We computed the proportion of use of prostate magnetic resonance imaging (MRI) before biopsy, radical prostatectomy, radical radiotherapy, androgen deprivation therapy, and abiraterone, and described the trend in PCa mortality across three calendar periods.

RESULTS: During the 9-year study period 7,484 men with locally advanced PCa were identified. Use of MRI before biopsy increased from 3% in 2016 to 73% in 2024. Concomitantly, radical treatment increased from 35% to 48%, entirely due to increased use of radiotherapy. Abiraterone was not used before 2022 but 31% received this treatment in 2024. The 3-year PCa mortality decreased from 8% (95% confidence interval [CI]: 7-9) in 2016-2018 to 6% (95% CI: 4-8) in 2022-2024.

INTERPRETATION: In this nationwide, population-based study of men with locally advanced PCa, the use of MRI before biopsy, radical radiotherapy, and treatment with abiraterone increased over time. These changes coincided with a modest decrease in 3-year PCa mortality.

PMID:41983270 | DOI:10.2340/ao.v65.45593

Biol Lett. 2026 Apr 15;22(4):20250829. doi: 10.1098/rsbl.2025.0829.

ABSTRACT

Warm, dry environments create living conditions that challenge plant growth, reproduction and survival. Plants in these environments have evolved adaptive strategies to enhance water-use efficiency and ensure reproductive success, two of which are annuality and C4 photosynthesis. However, life history variation is rarely included in large-scale studies of plant diversity, and the extent to which these traits coevolve and are jointly selected for is not known. To address this, we used Pagel’s models of independent and correlated evolution for over 4000 species of grasses (Poaceae), while accounting for evolutionary rate heterogeneity and potential type I statistical errors. We found that there are more C4 than C3 annuals and that C4 origins predate evolution of annuality, but no support for correlated evolution between the two traits. Our results indicate that any habitat or trait similarities (e.g. small seeds, fast growth) between annuals and C4 species reflect independent adaptations to similar environmental conditions or are contingent on the two traits themselves, rather than the result of evolutionary or functional links between them. Our results further highlight the importance of appropriate null model specification for testing evolutionary hypotheses across large, old clades.

PMID:41983260 | DOI:10.1098/rsbl.2025.0829

Phytother Res. 2026 Apr 15. doi: 10.1002/ptr.70324. Online ahead of print.

ABSTRACT

Primary dysmenorrhea is defined as recurrent, cramp-like lower abdominal pain occurring during menstruation in the absence of underlying pelvic pathology. A significant proportion of the population opts for natural plant-based remedies due to their perceived lower incidence of adverse effects. This study aims to evaluate the efficacy of plant-based interventions in the management of primary dysmenorrhea. Systematic review and meta-analysis. A comprehensive search was conducted across five databases (PubMed, Web of Science, Medline, Embase, and Scopus) covering the period from 1990 to 2025. Randomized controlled trials (RCTs) investigating the efficacy of plant-based products or herbal medicine for the treatment of primary dysmenorrhea were included. Searches, data extraction, and risk of bias assessment were performed independently by two reviewers. Discrepancies were resolved through consultation with a third reviewer expert in the topic. A total of 47 studies were included in the systematic review, of which 22 were incorporated into the meta-analysis. The findings indicate that herbal medicine can be as effective as conventional pharmacological treatments (n = 1133, MD: 0.12, 95% CI: -0.29 to 0.53, p = 0.58, I² = 95%), such as mefenamic acid or ibuprofen, in managing primary dysmenorrhea. Additionally, a statistically significant difference was observed when compared to placebo (n = 941, MD: -1.83, 95% CI: -2.32 to -1.34, p < 0.00001, I² = 92%). Adverse effects were infrequent, mild in severity, and resolved upon discontinuation of the intervention. Overall, the certainty of evidence is low to very low due to high heterogeneity and moderate risk of bias. Plant-based treatments may reduce pain associated with primary dysmenorrhea and are probably comparable to conventional drug therapies. However, further studies employing more rigorous methodologies are required to establish stronger evidence regarding the efficacy and safety of herbal medicine in addressing this health condition.

PMID:41983255 | DOI:10.1002/ptr.70324

Front Psychiatry. 2026 Mar 30;17:1727227. doi: 10.3389/fpsyt.2026.1727227. eCollection 2026.

ABSTRACT

PURPOSE: To evaluate whether anti-glutamic acid decarboxylase (Anti-GAD) antibodies and selected biochemical parameters are associated with autism spectrum disorder (ASD), symptom severity, and autistic regression in a case-control design. We hypothesized that Anti-GAD titers would be higher in ASD and associated with greater symptom burden.

MATERIALS AND METHODS: Children aged 2-9 years with ASD diagnosed according to DSM-5 criteria and age- and sex-matched healthy controls were included. Laboratory analyses assessed Anti-GAD, ASO, ferritin, iron, vitamin D, vitamin B12, thyroid-stimulating hormone, and folate. Clinical evaluations included the Autism Behavior Checklist (ABC), Modified Checklist for Autism in Toddlers (M-CHAT), and Ankara Developmental Screening Inventory (AGTE). Autistic regression was defined as loss of previously acquired language and/or social communication skills lasting ≥3 months between 15 and 30 months of age.

RESULTS: Ninety children participated (45 with ASD and 45 controls). Anti-GAD antibody levels were higher in the ASD group than in controls (p = 0.003). Although statistically significant, the absolute difference between groups was modest. Among ASD cases, 62% met criteria for regression; this relatively high proportion may reflect the clinic-based sampling and the operational definition applied. Compared with those without regression, children with regression had higher Anti-GAD titers and ABC scores but lower iron and ferritin levels (all p < 0.05). Anti-GAD levels correlated positively with ABC total scores (r = 0.724, p = 0.01). These findings reflect statistical associations and do not imply causality.

CONCLUSION: Higher Anti-GAD antibody levels were statistically associated with ASD, autistic regression, and greater behavioral symptom severity in this sample. These results suggest possible immune-related contributions to ASD heterogeneity; however, larger longitudinal studies are needed before clinical or biomarker implications can be established.

PMID:41983249 | PMC:PMC13071506 | DOI:10.3389/fpsyt.2026.1727227

Front Psychiatry. 2026 Mar 30;17:1753003. doi: 10.3389/fpsyt.2026.1753003. eCollection 2026.

ABSTRACT

BACKGROUND: Sleep is essential for optimal health; however, the prevalence of poor sleep, characterized by disrupted patterns and qualities, adversely affects psychological well-being and cognitive function. This issue is prevalent, yet it is frequently underdiagnosed and inadequately managed. Current therapeutic options exhibit notable limitations. The Stellate Ganglion Block (SGB) may alleviate sleep disturbances through various physiological mechanisms; however, its safety and efficacy remain subjects of ongoing debate. This meta-analysis systematically evaluates the efficacy of SGB using objective metrics to provide high-quality clinical evidence and to inform future research directions.

METHODS: Literature searches were conducted in PubMed, Web of Science, Embase, the Cochrane Library, OVID, and Google Scholar from database inception to June 2025. Analyses were performed with RevMan 5.4 software, and the study was registered on PROSPERO (CRD420251040732) .

RESULTS: Seven studies met the inclusion criteria. In comparison to the control group, patients who received the SGB demonstrated a statistically significant increase in total sleep time (WMD: 60.86; 95% CI, 38.05 to 83.66; P < 0.001). Additionally, these patients exhibited lower scores on the Pittsburgh Sleep Quality Index (PSQI) (WMD: -1.22; 95% CI, -1.80 to -0.65; P < 0.001), reduced sleep onset latency (WMD: -1.59; 95% CI, -2.48 to -0.69; P < 0.001), and enhanced deep sleep quality, as indicated by lower scores on the deep sleep quality assessment (WMD: -1.42; 95% CI, -1.95 to -0.89; P < 0.001).

CONCLUSION: The SGB shows promise in alleviating sleep problems. However, a lack of high-quality studies, insufficient long-term follow-up, and incomplete participant demographic data limit the existing evidence. There is a pressing need for extended follow-up and multicenter randomized controlled trials (RCTs). Future research should explore the potential synergies between stellate ganglion block and cognitive behavioral therapy (CBT-I) for sleep disorder to assess the sustainability of its efficacy and to expand the population that may benefit from this intervention.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251040732.

PMID:41983247 | PMC:PMC13071040 | DOI:10.3389/fpsyt.2026.1753003

J Pharm Policy Pract. 2026 Apr 13;19(1):2650578. doi: 10.1080/20523211.2026.2650578. eCollection 2026.

ABSTRACT

BACKGROUND: The digitalisation of healthcare requires nurses to possess strong Digital Health Literacy (DHL) to ensure patient safety. This study aimed to evaluate the relationship between DHL and perceptions of PSC among registered nurses in Jordan and to identify the demographic and professional factors associated with varying levels of DHL.

METHODS: A multi-center, cross-sectional survey was conducted from July to September 2025 across five public, private, and university-affiliated hospitals in Jordan. A sample of 500 registered nurses was recruited using stratified random sampling. Data were collected using a validated, seven-part composite questionnaire. Data were analyzed using descriptive statistics, reliability analysis (Cronbach’s alpha), and structural equation modelling.

RESULTS: The results confirmed the study’s primary hypothesis, revealing a significant and strong positive predictive relationship between DHL and PSC (β = 0.42, p < 0.001), with DHL explaining 28.1% of the variance in PSC. Nurses reported moderately high DHL overall (M = 3.28), with strengths in operational skills but lower confidence in evaluating information reliability. Perceptions of patient safety culture were positive (M = 3.71), with Teamwork Climate rated highest (M = 4.21) and Perceptions of Management lowest (M = 3.34). Significant disparities in DHL were found; higher levels of education (p < .001) and working in a university-affiliated hospital (p = 0.001) were associated with higher competency. Notably, no significant differences were observed based on age or years of experience. Lack of adequate training and insufficient time were identified as the primary organisational barriers to technology use.

CONCLUSION: Digital health literacy was significantly associated with better patient safety culture among Jordanian nurses, driven more by organisational and educational factors than generational stereotypes. To realise the safety benefits of digital health investments, institutions should strengthen nurses’ digital and critical appraisal skills and remove organisational barriers.

PMID:41983241 | PMC:PMC13072690 | DOI:10.1080/20523211.2026.2650578