Tag: nevin manimala

Int J Soc Determinants Health Health Serv. 2026 Apr 21:27551938261442743. doi: 10.1177/27551938261442743. Online ahead of print.

ABSTRACT

The global refugee crisis has exacerbated health disparities, particularly among middle-aged and older refugees, yet limited research exists on this vulnerable group, especially in low-income countries. This study investigates the predictors of health accessibility among middle-aged and older Afghan refugees in Pakistan in light of the social determinants of health, operationalized across four dimensions: health spending, health provider facilities, health information, and health communication. Using microdata from the 2022 Health Access and Utilization Survey (n = 423) at the household level, the study employed descriptive statistics, chi-square test, and logistic regression to examine the association between sociodemographic factors and health accessibility. The findings revealed discrepancies in gender distribution, literacy levels, and language proficiency. Education was found to be a significant predictor of health providers and health information, while reading ability was negatively associated with health providers and communication, suggesting that basic literacy may not necessarily translate into functional health literacy. The findings underscore the need for inclusive and targeted health policies that extend beyond service provision and address both structural and communication barriers faced by aging refugees. Policy makers and humanitarian organizations should prioritize context-specific, culturally sensitive interventions to promote healthy aging outcomes among vulnerable refugees in Pakistan.

PMID:42012240 | DOI:10.1177/27551938261442743

Geospat Health. 2026 Feb 2;21(1). doi: 10.4081/gh.2026.1426. Epub 2026 Apr 21.

ABSTRACT

This study assessed spatial accessibility to fixed mammography centres across Oklahoma State, USA using the Two-Step Floating Catchment Area (2SFCA) and the Enhanced Two-Step Floating Catchment Area (E2SFCA) methods to identify areas with limited or no access. For this analysis, we used data from the mammography facilities database of the US Food and Drug Administration verified by direct contact with the facility and the U.S. Census block group population and demographics for women aged 40 years and older. Analyses were stratified by urban areas; large rural areas; and small rural areas. Accessibility scores were calculated using the 2SFCA method with 30-minute drive times and the E2SFCA method with drive times of 10, 20 and 30 minutes weighted by distance decay. Block groups were categorized into quartiles based on accessibility scores. Among 940,994 eligible women, 10% lived in areas with no access. Small rural regions faced the greatest barriers. Spatial disparities were linked to racial and socioeconomic differences: non-Hispanic American Indian/Alaska Native and non-Hispanic White populations were more likely to reside in noaccess zones, while Black and Hispanic populations clustered in high-access urban areas. Spatial analysis reveals significant rural disparities in mammography access. Mobile machines should prioritize underserved rural regions to improve equity.

PMID:42012222 | DOI:10.4081/gh.2026.1426

Int J Ment Health Nurs. 2026 Apr;35(2):e70262. doi: 10.1111/inm.70262.

ABSTRACT

Moral courage is a critical attribute for psychiatric and mental health nurses, who routinely navigate complex ethical dilemmas in mental health care settings. Despite its importance, limited research has explored moral courage and its relationship with ethical decision-making confidence among Registered Psychiatric Nurses. The purpose of this study was to examine the relationship between moral courage, ethical decision-making confidence, education level, and years of practice among Registered Psychiatric Nurses in western Canada. A cross-sectional multiple-methods design that adhered to the STROBE Checklist EQUATOR Network was used, involving 80 participants recruited within western Canada. Data was collected using the Nurses’ Moral Courage Scale that utilised open- and close-ended questions as well as the Ethical Decision-Making Confidence scale. Statistical data was analysed using parametric and non-parametric tests to assess group differences. Narrative data was analysed using thematic analysis. The findings revealed a significant positive relationship between moral courage and ethical decision-making confidence. Ethical decision-making confidence scores were higher among nurses with graduate-level education compared to those with diplomas or baccalaureate degrees. However, no significant difference in moral courage scores was observed based on education level or years of practice, and no significant association was found between years of practice and moral courage. Qualitative findings revealed four major themes that included: (1) Advocating; (2) Patient Safety; (3) Reporting Co-Workers; and (4) Standing up to Co-Workers and Superiors. This study highlights the interconnectedness of moral courage and ethical decision-making among psychiatric nurses, while revealing that years of practice alone do not predict moral courage.

PMID:42012195 | DOI:10.1111/inm.70262

Clin Rehabil. 2026 Apr 21:2692155261432011. doi: 10.1177/02692155261432011. Online ahead of print.

ABSTRACT

DesignA cross-sectional study.SettingPatients with burn injuries often present with joint contracture caused by hypertrophic scars. To assess the patient’s degree of disability or outcome to rehabilitation treatment, various objective assessment tools are used, such as a standard goniometer, which is often used for measuring joint range of motion; however, measurements using a handheld goniometer may have a large margin of error depending on the therapist’s experience. Herein, the reliability and validity of a novel marker-based system were investigated for evaluating joint range of motion in patients with burn injuries.ParticipantsIn total, 48 participants with joint contractures in the shoulder, elbow, and wrist owing to hypertrophic scars after thermal injury were enrolled.InterventionUpper extremity joint range of motion was measured using a goniometer and optical motion capture system (Session 1), followed by remeasurement 2 days later (Session 2).Main measuresTwenty-two reflective markers were attached to the upper limbs, and motion analysis was measured using eight infrared cameras.ResultsNo statistical differences were detected between the range of motion values measured using the two methods. The measurements based on the optical motion capture system showed excellent intra-rater reliability.ConclusionsThe findings of this study highlight the value of the motion capture system as a tool to objectively evaluate the joint range of motion in patients with contractures caused by burns.This study was registered at ClinicalTrials.gov (Identifier: NCT05881876).

PMID:42012175 | DOI:10.1177/02692155261432011

Microbiol Spectr. 2026 Apr 21:e0359525. doi: 10.1128/spectrum.03595-25. Online ahead of print.

ABSTRACT

Murine typhus, caused by Rickettsia typhi, is a globally distributed flea-borne disease. Antimicrobial susceptibility data are largely based on reference strains, with little evaluation of variability across clinical isolates. The plaque assay, the gold standard for antibiotic susceptibility testing, requires up to 14 days to complete. Quantitative real-time PCR (qPCR) offers a rapid alternative for determining minimum inhibitory concentrations (MICs). Although qPCR-based susceptibility testing has been described, formal statistical assessment of agreement between methods remains limited. We estimated the MICs for azithromycin, doxycycline, and amoxicillin using qPCR and plaque assay on 24 R. typhi isolates (8 laboratory strains and 16 Lao clinical isolates) cultured in Vero cells. Heat-inactivated R. typhi (56°C, 30 min) served as a control. MIC was defined as the lowest concentration preventing plaque formation (plaque assay) or producing a Ct value greater than or equal to that of the heat-inactivated sample (qPCR). The mean MIC from three independent experiments was taken to represent each isolate. Agreement between methods was assessed using Bland-Altman analysis. Median qPCR MICs (MIC₅₀) of all isolates were 0.130 mg/L (IQR, 0.104-0.240 mg/L) for azithromycin, 0.130 mg/L (IQR, 0.065-0.224 mg/L) for doxycycline, and 256 mg/L (IQR, 234.7-341.3 mg/L) for amoxicillin. Corresponding plaque assay MICs₅₀ were 0.383 mg/L (IQR, 0.194-0.807 mg/L), 0.037 mg/L (IQR, 0.026-0.073 mg/L), and 170.7 mg/L (IQR, 112-256 mg/L), respectively. Bias was -0.3452 (-1.146, 0.4558) for azithromycin, 0.0969 (-0.2297, 0.4235) for doxycycline, and 85.33 (-187.3, 358) for amoxicillin. These findings demonstrate inter-isolate variability and quantitative agreement between methods.IMPORTANCEMurine typhus is a treatable febrile illness caused by Rickettsia typhi, transmitted to humans via fleas. The plaque assay, which detects bacterial-induced host cell death in the presence or absence of antibiotics, is the reference method for testing drug susceptibility. However, the method requires approximately 2 weeks to obtain results. Detection of bacterial nucleic acid provides an alternative laboratory approach that reduces the assay duration to approximately 1 week, thereby improving research efficiency and throughput when testing multiple isolates. Compared with plaque assays, quantitative real-time PCR allows downstream analysis following sample inactivation, reducing prolonged high-containment handling. In this study, we compared the antibiotic susceptibility of 24 R. typhi isolates using both methods. We tested antibiotics commonly used to treat R. typhi infection (doxycycline and azithromycin), along with amoxicillin as a negative control. Both showed comparable results for all antibiotics tested, further supporting nucleic acid detection as a reliable and faster alternative.

PMID:42012166 | DOI:10.1128/spectrum.03595-25

Telemed J E Health. 2026 Apr 21:15305627261444704. doi: 10.1177/15305627261444704. Online ahead of print.

ABSTRACT

BACKGROUND: Telemedicine (TM) is increasingly integrated into health care delivery; however, its safe and effective implementation depends on the competency of the nursing workforce. Although previous research has examined TM utilization among nurses, evidence regarding TM competency levels remains limited.

PURPOSE: To assess TM-related competencies across four domains: awareness, knowledge, attitudes, and skills among nurses in the United Arab Emirates, and identify factors associated with each domain.

METHODS: A cross-sectional survey was conducted among 434 nurses working in governmental health care facilities. TM competencies were measured using a structured online questionnaire incorporating demographic characteristics and the validated TM Awareness, Knowledge, Attitude, and Skills instrument. Descriptive statistics and multiple linear regression analyses were performed to evaluate competency levels and their predictors.

RESULTS: Nurses demonstrated high TM knowledge (81.44 ± 22.27) and positive attitudes (81.42 ± 10.27), with 77.0% and 92.4% of participants scoring high in these domains, respectively. Awareness (55.89 ± 26.17) and skills (57.11 ± 23.01) were more moderate, with only 28.6% and 24.4% of nurses scoring high in these domains, respectively. Interest in TM was a positive predictor of competency across all domains (p < 0.001). Postgraduate education and TM training were associated with higher awareness, while male gender, postgraduate qualification, and higher interest predicted improved skill scores. Regression models explained 8-16% of variance across competency domains.

CONCLUSIONS: Although nurses demonstrated strong knowledge and positive attitudes toward TM, gaps remain in awareness and practical skills. Competency-based, skill-focused TM training is needed to support safe and sustainable integration into nursing practice.

PMID:42012148 | DOI:10.1177/15305627261444704

Med Educ Online. 2026 Dec 31;31(1):2661455. doi: 10.1080/10872981.2026.2661455. Epub 2026 Apr 21.

ABSTRACT

OBJECTIVE: Ageism negatively affects older people’s health, well-being, and quality of care. Identifying ageism and attitudes toward older adults may help identify medical students motivated to work with a growing older population. We conducted a systematic review of interventions to reduce ageism among medical students.

METHODS: We conducted a systematic literature retrieval in Medline, the Cochrane Library, Epistemonikos and PubMed via Ovid, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, from database inception to August 23rd, 2024. We searched for studies examining medical students’ attitudes towards older persons, including interventions to influence these attitudes.

RESULTS: The systematic review included 21 studies. Study samples ranged between 29 and 415, with a pooled total of 3940 medical students, the majority conducted in the USA. The meta-analysis of students’ attitudes before and after all interventions included a total of 2004 students, yielding a non-significant standardized mean difference (SMD) of 0, 12 (95% CI -0, 01 to 0, 26). The meta-analysis of students’ attitudes before and after all interventions (35-37, 39, 41, 45, 48, 50), after removing UCLA-GAS and R-GAS, included a total of 1344 students with a standardized mean difference of 0, 23 (95% CI 0, 06 to 0, 40). Analysis of empathy-based teaching interventions included 1652 students, and showed a statistically significant effect, SMD 0, 18 (95% CI 0, 01 to 0, 34). Analysis of 352 students receiving traditional teaching methods yielded no effect on ageism, with an SMD -0, 13 (95% CI -0, 81 to 0, 54). High heterogeneity (I² 75-85%) affects our confidence in the effect estimates.

CONCLUSION: Empathy-based interventions seem to improve medical students’ attitudes towards older persons. Traditional teaching methods may increase negative attitudes. Considering the high heterogeneity, the results should be interpreted cautiously. Adding empathy-based components to medical curricula could combat ageism. More studies are needed to examine whether the results of studies from North America are valid globally.

PMID:42012144 | DOI:10.1080/10872981.2026.2661455

Diagnosis (Berl). 2026 Apr 16. doi: 10.1515/dx-2026-0001. Online ahead of print.

ABSTRACT

OBJECTIVES: Traditional diagnostic accuracy metrics – sensitivity, specificity, predictive values, likelihood ratios, and global indices such as Youden’s J and the diagnostic odds ratio – describe important statistical properties of diagnostic tests but do not express benefit-harm balance in a single, prevalence-sensitive measure. The Diagnostic Efficiency Ratio (DER) is introduced as a composite metric designed to quantify diagnostic discriminative efficiency.

METHODS: DER is defined as the ratio of the number needed to misdiagnose (NNM) to the number needed to diagnose (NND), where NND=1/(Sn + Sp – 1) and NNM=1/[(1 – Sp) + Pr × (Sp – Sn)]. Closed-form derivation was performed analytically and verified using independent algebraic tools. Hypothetical scenarios spanning plausible ranges of sensitivity, specificity, and prevalence were constructed to illustrate DER behavior, and an empirical illustration using published neonatal sepsis biomarker studies was conducted.

RESULTS: Across hypothetical scenarios, DER demonstrated mathematically coherent and clinically intuitive behavior. High DER values occurred only when sensitivity and specificity were jointly strong and balanced. DER declined as specificity decreased or prevalence increased, with small values indicating contexts in which misdiagnoses consume a larger share of testing effort. In the empirical neonatal sepsis examples, DER differentiated biomarkers and settings in a manner consistent with its structural formulation, highlighting context-dependent diagnostic efficiency.

CONCLUSIONS: DER provides a prevalence-sensitive, frequency-based representation of diagnostic benefit relative to harm, reframing diagnostic accuracy in efficiency-oriented terms by expressing how effectively testing effort is converted into discriminative gain beyond chance relative to misclassification burden. This conceptual and illustrative evaluation supports DER’s coherence and potential stewardship utility as a complement to traditional diagnostic accuracy metrics. Ultimately, the DER helps to recast diagnostic performance as an efficiency problem, aligning it with modern value-based healthcare and stewardship priorities.

PMID:42012142 | DOI:10.1515/dx-2026-0001

J R Soc Med. 2026 Apr 21:1410768261438374. doi: 10.1177/01410768261438374. Online ahead of print.

NO ABSTRACT

PMID:42012125 | DOI:10.1177/01410768261438374

Trauma Violence Abuse. 2026 Apr 21:15248380261433012. doi: 10.1177/15248380261433012. Online ahead of print.

ABSTRACT

This systematic review aims to synthesize what protective factors have been identified to promote resilience in adults who have experienced potentially traumatic events (PTEs). APA PsychInfo and PubMed were searched to identify literature published between 2014 and 2024 that studied resilience in trauma-exposed adults. Studies were included if: the PTEs experienced by participants met Criterion A for events preceding posttraumatic stress disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-V TR); the study measured modifiable protective factors; and the study included a measure of resilience. Two independent reviewers used standardized data extraction forms and assessed risk of bias with the Mixed Methods Appraisal Tool. Of 991 unique references, 13 articles met inclusion after full-text review. A social-ecological framework guided the synthesis and categorization of factors bolstering resilience. At the interpersonal level, protective factors identified included social support and religious attendance. At the institutional or organizational level, employment, length of employment, and workplace belongingness were identified as promoting resilience. At the community level, access to social resources to help meet basic needs was found to strengthen resilience. Finally, at the public policy level, employee assistance supported resilience. This review identified critical gaps in current resilience literature. Future research should define the type, timing, and duration of PTEs exposure, as well as specify the time lapsed between data collection and the PTEs exposure. Resilience conceptualizations and interventions should focus on tracing resilience across time and on multisystemic resilience-oriented interventions that include the individual, interpersonal, institutional/organizational, community, and public policy levels.

PMID:42012092 | DOI:10.1177/15248380261433012