Tag: nevin manimala

Health Policy. 2026 Apr 18;170:105638. doi: 10.1016/j.healthpol.2026.105638. Online ahead of print.

ABSTRACT

Violence against healthcare workers has prompted policy responses across health systems that often emphasise security measures, legal sanctions, and behavioural interventions. While these approaches are essential to protect healthcare workers, their effectiveness remains limited. This Policy Comment argues that such framing may underemphasise determinants of violence arising at multiple levels of health systems, including broader policy choices (e.g., workforce planning, financing, and service configuration), governance arrangements (e.g., performance monitoring, administrative control, and regulatory standards), and organisational conditions (e.g., staffing shortages, workload, and care pathway bottlenecks), within a context influenced by international policy frameworks and societal factors. Drawing on a multi-level conceptual framework and examples from different countries, we suggest that violence can also be understood as an indicator of systemic strain arising from the persistent gap between healthcare needs and available capacity, reflecting how healthcare systems are organised, governed, and resourced. Rebalancing prevention efforts to address these policy and governance drivers may offer more sustainable solutions.

PMID:42030594 | DOI:10.1016/j.healthpol.2026.105638

J Neurosurg Pediatr. 2026 Apr 24:1-12. doi: 10.3171/2025.12.PEDS25560. Online ahead of print.

ABSTRACT

OBJECTIVE: Several studies have reported that a shorter duration of epilepsy is associated with better surgical seizure outcomes; however, most of these findings have been based on adult populations. Data on children remain limited, and it is still unclear whether the duration of drug-resistant epilepsy (DRE) or the duration of overall epilepsy is more associated with seizure outcomes. The primary research question of this study focused on the association between total epilepsy duration and seizure outcome at the 2-year follow-up, whereas the secondary research question centered on the role of DRE duration.

METHODS: The authors conducted a retrospective analysis of pediatric patients with epilepsy who underwent resective surgery between 2002 and 2022 at a single institution. Seizure outcome data were obtained at the 2-year follow-up after the last surgery. A subgroup analysis of patients with a known time for DRE onset was performed. Predictors of seizure recurrence were assessed using multiple adjusted logistic regression models, accounting for multicollinearity.

RESULTS: A total of 239 patients underwent epilepsy surgery in the study period. Among them, 154 patients (71.0% of those with DRE) had an identifiable time of DRE onset. Compared to those with ongoing seizures, seizure-free patients had a significantly shorter median duration of epilepsy (4.25 vs 5.98 years, p < 0.001) and a shorter median duration of DRE (1.75 vs 3.13 years, p < 0.001). Due to the multicollinearity between time-related variables, epilepsy duration and DRE duration were entered into separate models for adjusted logistic regression. In the epilepsy duration-based models, a longer epilepsy duration was associated with seizure recurrence (OR 1.10, 95% CI 1.03-1.18, p = 0.008). In the DRE-based models, a longer DRE duration was associated with worse outcomes (OR 1.20, 95% CI 1.00-1.43, p = 0.045), while epilepsy duration was not statistically significant.

CONCLUSIONS: In this unselected population-based, pediatric, resective epilepsy surgery cohort, longer epilepsy duration is associated with worse seizure outcomes. Similarly, a prolonged duration of DRE was correlated with worse seizure outcomes. The findings emphasize the importance of early surgical referrals. Future multicenter studies are warranted to further clarify the relative prognostic value of DRE duration versus total epilepsy duration and to guide evidence-based criteria for surgical timing in children with epilepsy.

PMID:42030572 | DOI:10.3171/2025.12.PEDS25560

J Neurosurg. 2026 Apr 24:1-14. doi: 10.3171/2025.12.JNS251883. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate associations between the corpus callosum angle (CCA), corpus callosum splenial angle (CCSA), and resistance to CSF outflow (Rout) with neuropsychological performance in patients who had suspected idiopathic normal pressure hydrocephalus (iNPH), and to assess their predictive value for diagnosis and postoperative cognitive outcomes following ventriculoperitoneal shunt placement.

METHODS: This prospective observational study included 74 patients (39 male, mean age 73.6 years) who were evaluated for iNPH between 2019 and 2022 at a single institution. All patients underwent MRI-based measurement of the CCA and CCSA, the Katzman test for Rout, and a comprehensive neuropsychological battery. Patients were grouped by CCA size (< 90°, 91°-109°, and > 110°), CCSA size (< 60°, 61°-79°, and > 80°), and Rout (≥ 12 mm Hg and < 12 mm Hg). Group comparisons were performed using nonparametric tests, and logistic regression was applied to identify neuropsychological predictors of elevated Rout.

RESULTS: Lower CCA values were associated with trends toward poorer performance in imitation apraxia, visual gnosis, and Mini-Mental State Examination (MMSE) scores, although none reached statistical significance after correction for multiple comparisons. Elevated Rout (≥ 12 mm Hg) was significantly associated with better MMSE scores (adjusted p = 0.029), while other domains, including symbolic apraxia, rhythm reproduction, and confrontation naming, showed consistent trends but without statistical significance after correction. A logistic regression model that incorporated MMSE and rhythm reproduction predicted elevated Rout with 93.5% sensitivity and an area under the curve of 0.86. Postoperative cognitive improvements were modest and variable; however, long-term follow-up revealed sustained functional gains in selected patients, particularly those with elevated Rout and preserved preoperative cognitive function.

CONCLUSIONS: CCA and Rout were independently associated with distinct cognitive profiles in patients with suspected iNPH. In particular, Rout demonstrated predictive value for preserved global cognition. Integrating anatomical, physiological, and neuropsychological markers might enhance diagnostic accuracy and improve patient selection for ventriculoperitoneal shunt placement.

PMID:42030562 | DOI:10.3171/2025.12.JNS251883

J Neurosurg. 2026 Apr 24:1-9. doi: 10.3171/2025.12.JNS251835. Online ahead of print.

ABSTRACT

OBJECTIVE: Rathke’s cleft cysts (RCCs) are benign cystic lesions of the sellar and suprasellar regions that may cause hypopituitarism and arginine vasopressin (AVP) deficiency when symptomatic. A recent study with Isl-1 knockout mice identified six molecular markers-KRT8, TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1-as potential indicators of RCC pathogenesis. This study aimed to investigate the expression patterns of these markers in human RCCs and examine their association with clinical manifestations.

METHODS: A retrospective analysis was conducted on 108 histopathologically confirmed RCC cases resected between 2011 and 2023 at three medical centers. Immunofluorescence staining was performed for six markers, and expression profiles were correlated with clinical symptoms (hypopituitarism, AVP deficiency, visual disturbances, and headache), epithelial morphology, and MRI findings. Statistical analysis was conducted using chi-square or Fisher’s exact tests.

RESULTS: KRT8 was expressed in 100% of RCC samples, while the expression rates for TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1 were 90.7%, 75.9%, 76.9%, 55.6%, and 84.3%, respectively. SOX9 expression was significantly associated with single-layered epithelial morphology (p = 0.001). The absence of TUBA1A expression was significantly associated with AVP deficiency (p = 0.042), and FOXJ1 positivity was significantly associated with hypopituitarism (p = 0.040). No other significant associations were found between marker expression and imaging findings or other clinical symptoms.

CONCLUSIONS: This study confirms that the six molecular markers identified in Isl-1 knockout mice are also expressed in human RCCs, with variable expression patterns. KRT8 and FOXA1 staining may aid in distinguishing RCCs from craniopharyngiomas. Moreover, FOXJ1 and TUBA1A expression profiles provide novel insights into the mechanisms underlying hypopituitarism and AVP deficiency, respectively. These findings highlight the potential diagnostic and prognostic utility of molecular markers in RCC management and underscore the need for further studies in asymptomatic and incidental cases.

PMID:42030560 | DOI:10.3171/2025.12.JNS251835

JMIR Aging. 2026 Apr 24;9:e81927. doi: 10.2196/81927.

ABSTRACT

BACKGROUND: Smartphones have become deeply embedded in daily life, supporting a range of social and practical activities. Individuals with dementia can potentially use smartphones to compensate for cognitive decline and maintain independence. However, while smartphones are widely studied in controlled research settings, little is known about how individuals with dementia spontaneously use them in everyday life. Understanding usage patterns and their potential link to social participation could inform strategies to support smartphone use in their social and practical daily activities.

OBJECTIVE: This study aimed to identify factors associated with spontaneous smartphone use, describe usage patterns, and examine whether smartphone use is associated with participation in social activities.

METHODS: In 2024, we conducted a cross-sectional survey among community-dwelling individuals with mild to moderate dementia from 17 medical facilities in Tokyo. Structured questionnaires were completed by the participants, their families, and attending physicians. Participation in social activities was assessed using the “Spending Time with Others” subscale of the Social Functioning in Dementia (SF-DEM) scale. Factors associated with smartphone use were analyzed using multinomial logistic regression. Associations with participation in social activities were assessed via hierarchical linear regression.

RESULTS: Among 151 participants with a mean age of 82.9 (SD 6.6) years, 43 (29%) participants were regular smartphone users. Smartphone use was negatively associated with older age (odds ratio [OR] 0.41, 95% CI 0.21-0.80) and positively associated with longer education (OR 1.82, 95% CI 1.00-3.30), living alone (OR 3.17, 95% CI 1.08-9.31), and better cognitive function (OR 2.14, 95% CI 1.24-3.69). Common uses included calling, texting, taking photos and videos, and checking the news and weather. Smartphone users reported marginally more frequent participation in social activities than nonusers did (b=1.41, 95% CI -0.01 to 2.83), particularly visiting the homes of friends or family (b=0.43, 95% CI 0.08-0.78) and shopping together (b=0.49, 95% CI 0.15-0.83).

CONCLUSIONS: Despite their limited use at the time of this writing, commercial-based smartphones have the potential to support participation in social activities among individuals with dementia. Targeted support may help bridge the gap between this usage and the broader capabilities of these devices, enhancing their role in sustaining meaningful social participation.

PMID:42030556 | DOI:10.2196/81927

Prim Care Companion CNS Disord. 2026 Apr 23;28(2):25m04149. doi: 10.4088/PCC.25m04149.

ABSTRACT

Objective: Collaborative care models (CoCMs) are modalities for treating mental health conditions in primary care. One such iteration of CoCM, antidepressant monitoring (ADM), is a pharmacologic treatment modality for the management of depression and anxiety. ADM programs have established efficacy, yet little is known about ideal patient selection or approaches related to program retention. The objective of this study was to address this need by examining predictors of referral from a CoCM ADM program to higher levels of psychiatric services.

Methods: A retrospective cohort analysis was conducted on individuals enrolled in the Tampa Veterans’ Affairs ADM program over 18 months (from June 4, 2018, through December 4, 2019). Data collected included information related to referral to a higher level of service, as well as baseline information and covariates of interest. Primary analysis was conducted utilizing a multivariable logistic regression model to evaluate whether baseline characteristics were associated with differences in referral rates to higher-level services.

Results: A total of 757 veterans were included in the analyses, with 131 (17.31%) referred on to a higher level of service for specialty psychiatric care. Multivariable modeling showed the following covariates to be associated with higher rates of referral to specialty psychiatric services: baseline 9-item Patient Health Questionnaire scores, sleep issues at the time of enrollment, alcohol use disorder, and cannabis use disorder.

Conclusions: Results show low rates of referral overall but identify a number of baseline characteristics associated with higher referral rates to specialty psychiatric services. Further research is needed, including prospective work and studies examining proactive interventions to limit required referrals to specialty mental health services.

Prim Care Companion CNS Disord 2026;28(2):25m04149.

Author affiliations are listed at the end of this article.

PMID:42030552 | DOI:10.4088/PCC.25m04149

Neurology. 2026 May 12;106(9):e214803. doi: 10.1212/WNL.0000000000214803. Epub 2026 Apr 24.

ABSTRACT

BACKGROUND AND OBJECTIVES: Cerebral small vessel disease (SVD) is the most common vascular contributor to dementia. SVD markers often coexist, contributing to difficulty assessing their independent contributions to cognitive domains. MRI-visible perivascular spaces (PVSs) are an emerging SVD marker visualized by MRI. We previously showed that basal ganglia PVSs cross-sectionally contribute to worse cognition, independent of other SVD markers. To further characterize the clinical relevance of PVS, we studied its role as a unique SVD marker of longitudinal cognitive decline.

METHODS: Participants without stroke or dementia were included in the Vanderbilt Memory and Aging Project, a longitudinal observational cohort study based in Nashville, TN. Participants completed 3T MRI at study entry to measure SVD burden (PVS volume fraction, white matter hyperintensities volume, lacune counts, and cerebral microbleeds counts). PVS volumes were segmented using a deep learning algorithm. Participants underwent comprehensive serial neuropsychological testing over an 11-year follow-up period (mean follow-up = 4.9 ± 3.1 years). Each SVD marker was related to longitudinal neuropsychological performances using a linear mixed-effects model adjusting for age, sex, race/ethnicity, education, baseline cognitive status, apolipoprotein E-ε4 presence, Framingham Stroke Risk Profile, and intracranial volume. Head-to-head comparisons simultaneously tested multiple statistically significant SVD markers.

RESULTS: Among participants (n = 750, age 68 ± 9 years, 52% female), higher basal ganglia PVS burden at baseline was associated with worse longitudinal performances in Boston Naming Test (β = -29.63; 95% CI -56.66 to -2.60), Animal Naming (β = -33.09; 95% CI -65.66 to -0.51), Wechsler Adult Intelligence Scale IV Coding (β = -86.36; 95% CI -150.9 to -21.82), executive function composite (β = -9.51; 95% CI -14.33 to -4.68), Hooper Visual Organization Test (β = -26.06; 95% CI -50.53 to -1.59), and episodic memory composite (β = -7.05; 95% CI -11.9 to -2.21). In head-to-head comparisons, basal ganglia PVS remained independent associations with executive function composite (β = -7.47; 95% CI -12.84 to -2.10) and Hooper Visual Organization Test (β = -22.11; 95% CI -42.38 to -1.85).

DISCUSSION: Basal ganglia PVS burden independently contributes to worse longitudinal executive function and visuospatial skills independent of other SVD markers, highlighting PVS as an emerging marker of domain-specific cognitive decline in aging. Although causation cannot be established, findings further support PVS as a vascular contributor to deep brain structure damage underlying cognitive decline over time.

PMID:42030516 | DOI:10.1212/WNL.0000000000214803

JMIR Form Res. 2026 Apr 24;10:e77255. doi: 10.2196/77255.

ABSTRACT

BACKGROUND: Breast cancer-related lymphedema is the most prevalent postoperative complication among breast cancer survivors. Although mobile health tools are increasingly used for patient education, evidence supporting their efficacy in lymphedema prevention remains limited.

OBJECTIVE: This study aimed to evaluate the effectiveness of a WeChat-based intervention grounded in the common-sense model (CSM) in improving preventive behaviors, modifying illness perceptions, and reducing lymphedema incidence among breast cancer survivors and to validate the targets of the intervention.

METHODS: This study used a quasi-experimental design. Participants (N=192) were recruited from the breast cancer department of a cancer hospital in Guangzhou, China. The control group (n=98) received routine care. The intervention group (n=94) participated in a 3-month CSM-guided WeChat mini-program (“Nantian e-Care”) delivering tailored educational articles, exercise tutorials, arm circumference monitoring, and real-time nurse consultations. Outcomes, including preventive behaviors, illness perceptions, and lymphedema incidence, were assessed 1, 3, and 6 months post surgery. Generalized estimating equations were used for the analysis.

RESULTS: The intervention group exhibited significant improvements in lifestyle adjustments (Wald χ22=6.9, P=.03) and physical exercise adherence (Wald χ22=6.9, P=.03) compared with the control group. Illness perception, including identity (Wald χ23=8.1, P=.04), timeline cyclical (Wald χ23=8.5, P=.04), personal control (Wald χ23=9.3, P=.03), illness coherence (Wald χ23=29.8, P<.001), and behavioral (Wald χ23=19.5, P<.001) and physical factors (Wald χ23=24.1, P<.001) were markedly enhanced. Mechanistically, skin care improvements were driven by intervention effects, personal control, illness coherence, and behavioral attribution. Lifestyle changes were correlated with intervention and illness coherence. Adherence to physical exercise was not statistically significantly affected by the intervention, although a trend was observed. Critically, the intervention group demonstrated a lower incidence of lymphedema at 6 months (7.50% vs 16.48%, χ21=3.9, P=.048).

CONCLUSIONS: The CSM-guided WeChat intervention effectively promoted preventive behaviors, optimized illness perceptions, and reduced lymphedema risk. These findings underscore the value of integrating theory-driven mobile health tools into postoperative care and highlight scalable strategies for chronic disease management in resource-limited settings.

PMID:42030512 | DOI:10.2196/77255

JCO Oncol Pract. 2026 Apr 24:OP2501161. doi: 10.1200/OP-25-01161. Online ahead of print.

ABSTRACT

PURPOSE: 177Lu-PSMA-617 (LuPSMA) is an approved prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical therapy for men with metastatic castration-resistant prostate cancer (mCRPC). Older patients, particularly octogenarians, represent a substantial proportion of men with mCRPC but have been traditionally underrepresented in key registrational trials of LuPSMA.

METHODS: This retrospective multi-institutional study evaluated patients age 80 years and older with mCRPC after chemotherapy treated with ≥1 cycle of LuPSMA from August 2022 to December 2024. Clinical and demographic data were abstracted from electronic medical records. Outcomes included prostate specific antigen (PSA) response (PSA50 and PSA90), progression-free survival (PFS), overall survival (OS), and toxicities. Kaplan-Meier methods estimated PFS/OS; descriptive statistics summarized baseline and safety data.

RESULTS: Ninety-five patients (median age, 83 years) were included, of whom 36 (38%) and 21 (22%) had a history of cardiac disease or chronic kidney disease, respectively. Median follow-up was 24.1 months (IQR, 6.7-28.1). Patients received a median of five cycles of LuPSMA. Fifty-two (57%) and 21 (23%) patients achieved a PSA50 and PSA90, respectively. Median PFS and OS were 7.3 months (95% CI, 6.4 to 8.7) and 13.5 months (95% CI, 9.7 to 18.8), respectively. Grade ≥3 hematologic toxicities included anemia (n = 19; 20%) and thrombocytopenia (n = 4, 4%); grade ≥3 acute kidney injury occurred in one patient. Fourteen (15%) patients had dose delays, seven (7%) required reductions, and 10 (11%) discontinued therapy due to toxicity. Thirty-seven patients (39%) were hospitalized during therapy, with intensive care unit-level care required in two patients (2%), and there was one treatment-related death.

CONCLUSION: LuPSMA had comparable outcomes in octogenarians with mCRPC to patients on registrational trials, although 2/5 of patients required hospitalization during therapy. These findings support the feasibility and efficacy of LuPSMA in well-selected older men with mCRPC and suggest a role for closer monitoring of older patients.

PMID:42030508 | DOI:10.1200/OP-25-01161

JMIR Med Inform. 2026 Apr 24;14:e83127. doi: 10.2196/83127.

ABSTRACT

BACKGROUND: Artificial intelligence-augmented electrocardiogram (AI-ECG) models for detecting left ventricular systolic dysfunction (LVSD) often exhibit degraded performance in patients with comorbidities.

OBJECTIVE: This study aimed to introduce and validate a recalibration method using longitudinal patient data to enhance prediction accuracy and simulate its clinical utility for ongoing monitoring.

METHODS: We conducted a multicenter, retrospective cohort study using data from 2 hospitals in Korea. A dataset of paired transthoracic echocardiograms (TTEs) and electrocardiograms (ECGs) matched within a 2-week interval was constructed, separating pairs into baseline (first for each patient) and follow-up assessments. In addition to conventional supervised learning, we developed a patient-wise recalibration strategy that incorporated historical left ventricular ejection fraction measurements and prior AI-ECG outputs to adjust for future predictions, thus empirically mitigating confounding effects. Pretraining was also implemented to enhance the model’s performance.

RESULTS: The recalibrated 12-lead DeepECG LVSD model achieved an area under the receiver operating curve of 0.956 (95% CI 0.946-0.965) for internal validation and 0.940 (95% CI 0.936-0.945) for external validation of follow-up TTE-ECG pairs. The uncalibrated 12-lead DeepECG LVSD model also showed modest performance, with an area under the receiver operating curve of 0.953 (95% CI 0.941-0.965) in the internal validation and 0.947 (95% CI 0.943-0.951) in the external validation when tested on baseline TTE-ECG pairs. Recalibration yielded statistically significant improvements in the 12-lead DeepECG LVSD models (P<.001), with enhanced and more balanced performance across all clinical subgroups.

CONCLUSIONS: Patient-wise recalibration improved accuracy and consistency across various comorbidities by mitigating performance degradation and bias. This broadens the application of AI-ECG for LVSD detection from low-risk screening to high-risk longitudinal monitoring.

PMID:42030497 | DOI:10.2196/83127