Tag: nevin manimala

Contracept Reprod Med. 2026 May 7. doi: 10.1186/s40834-026-00455-x. Online ahead of print.

ABSTRACT

BACKGROUND: India is the most populous country in the world, with over 1.4 billion people, facing significant challenges in maternal and reproductive health services. Family planning is a key strategy to prevent unintended pregnancies and optimize spacing between births. Post-placental intrauterine contraceptive device (PPIUCD) insertion is a safe, long-acting, reversible, and cost-effective method of immediate postpartum contraception. This study aimed to compare continuation rates, complications, and expulsion rates of PPIUCD insertion between preterm and term deliveries, and to explore factors influencing outcomes.

SETTINGS AND DESIGN: Hospital-based observational study conducted at VMMC & Safdarjung Hospital, New Delhi.

MATERIALS AND METHODS: Among 2000 antenatal women counseled for immediate postpartum IUCD insertion, 240 (12%) consented and were enrolled. Participants were divided equally into preterm (n = 120) and term (n = 120) groups. CuT 380 A devices were inserted immediately post-placentally. Follow-up was conducted at 3, 6, and 12 months to assess continuation, satisfaction, expulsion, and complications. Counseling was provided antenatally and postnatally using standardized IEC materials, models, and checklists.

STATISTICAL ANALYSIS: Categorical variables were presented as numbers and percentages. Chi-square tests and t-tests were applied where appropriate using SPSS 24.0, with p < 0.05 considered statistically significant.

RESULTS: The mean age of participants was 26.9 ± 3.2 years. Continuation rates at 6 and 12 months were significantly higher in term deliveries (96.6% and 85.0%) than in preterm deliveries (88.3% and 63.3%; p < 0.05). Spontaneous IUCD expulsion was higher in preterm women at 6 months (7.5% vs. 1.6%) and 12 months (15.3% vs. 6.4%; p < 0.05), potentially due to smaller uterine size, underdeveloped uterine cavity, and variations in uterine involution. Satisfaction rates were high and comparable between groups at 12 months (81% preterm vs. 85% term; p > 0.05). Acceptance rates were low overall (12%), highlighting the need for structured counseling, provider training, and peer education to improve uptake.

CONCLUSION: Post-placental IUCD insertion is safe, effective, and cost-efficient in both preterm and term deliveries. Higher expulsion rates in preterm deliveries warrant focused counseling and follow-up. Structured antenatal and postnatal counseling, combined with provider confidence and patient education, is essential to increase acceptance and continuation of PPIUCD, particularly in populations at higher risk of early postpartum fertility.

PMID:42098888 | DOI:10.1186/s40834-026-00455-x

Knee Surg Relat Res. 2026 May 7;38(1):19. doi: 10.1186/s43019-026-00320-w.

ABSTRACT

BACKGROUND: The quadriceps tendon (QT) has emerged as a reliable autograft for anterior cruciate ligament reconstruction (ACLR), but uncertainty remains regarding several key comparative aspects-particularly donor-site morbidity, long-term graft survival, knee stability, and complication rates-when evaluated against hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. High-level evidence restricted to randomized controlled trials directly comparing QT with HT or BPTB remains limited. To compare clinical outcomes, graft failure, donor-site morbidity, and knee stability among QT, HT, and BPTB autografts for primary ACLR using level-I and level-II randomized controlled trials (RCTs).

METHODS: The MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases were searched on 1 September 2025, and repeated 2 weeks later. Only level-I or -II RCTs comparing QT to HT or BPTB in primary ACLR were included. Random-effects meta-analyses were performed for International Knee Documentation Committee (IKDC) and Lysholm scores, instrumented laxity, graft failure, donor-site morbidity, and reoperation. Risk of bias was assessed with RoB 2.0, and small-study effects with funnel and doi plots.

RESULTS: Eleven RCTs (mean follow-up, 2-10 years) were included. Pooled IKDC scores averaged 84.8 (95% CI 81.9-87.9) and Lysholm scores averaged 93.1 (95% CI 91.6-94.6), with no significant differences between QT and either comparator (P > 0.05). Side-to-side anterior tibial translation averaged 1.2 mm (95% CI 0.99-1.54 mm) across all grafts, also without significant differences (P > 0.05). Pooled graft failure and ipsilateral reoperation rates were 0.7% (95% CI 0.0-1.9%) and 2.3% (95% CI 0.6-4.7%), respectively, again with no between-graft differences (P > 0.05). Donor-site morbidity did not differ significantly between QT and HT (mean 13.83 [95% CI 9.6-19.83]; P > 0.05).

CONCLUSION: This meta-analysis of level-I/II randomized controlled trials found no statistically significant differences among quadriceps tendon, hamstring tendon, and bone-patellar tendon-bone autografts in patient-reported outcomes, knee stability, graft re-rupture, or additional knee surgery. Donor-site morbidity comparisons were limited by incomplete reporting, particularly for BPTB. These findings suggest that contemporary surgical techniques and rehabilitation protocols may minimize graft-specific differences in mid-term outcomes, although interpretation should consider the limited number of direct comparative trials across all three graft types. Level of evidence Systematic review and meta-analysis; level of evidence, 1 and 2.

PMID:42098886 | DOI:10.1186/s43019-026-00320-w

BMC Psychol. 2026 May 7. doi: 10.1186/s40359-026-04642-y. Online ahead of print.

ABSTRACT

BACKGROUND: Disability poses significant challenges to subjective well-being (SWB), yet many individuals with physical disabilities report unexpectedly high levels of life satisfaction-a phenomenon known as the disability paradox. While quantitative research has identified correlates such as social support and psychological capital, these studies often rely on cross-sectional surveys that capture group trends but fail to illuminate the dynamic, narrative processes through which SWB emerges over the life course, particularly in collectivistic cultures like China where relational and cultural factors may uniquely shape adaptation.

METHODS: This study utilized a mixed-methods approach, employing life tone and life theme analyses within a life story interview framework, supplemented by grounded theory coding procedures. We conducted a qualitative analysis of narratives from 35 Chinese adults with physical disabilities, who also completed psychometric measures of subjective well-being (SWB), social support, and psychological capital. To enhance findings’ robustness, we quantitized narrative indicators and performed triangulation by conducting statistical correlation analyses between these narrative metrics and questionnaire scores within the primary sample (N = 35).

RESULTS: The results indicate: (1) The factors influencing SWB among individuals with physical disabilities primarily consist of four dimensions: family establishment, life experiences, social support, and self-personality; (2) Although the overall emotional tone among Chinese individuals with physical disabilities leans toward negativity, the overall personality tone exhibits a positive orientation, with the frequency of positive emotional words surpassing negative ones starting from mid-adulthood; (3) Life theme analysis demonstrates that relational themes predominate in the narratives, with interpersonal relationships serving as a central pathway for meaning reconstruction and the generation of subjective well-being; and (4) Significant associations were observed between social support, psychological capital, and the emotional and personality features in the narratives, indicating the joint involvement of internal and external resources in shaping SWB among individuals with physical disabilities.

CONCLUSIONS: In summary, this study, grounded in a localized narrative perspective across the full life course, elucidates the factors influencing SWB among Chinese individuals with physical disabilities and their cultural specificity, particularly emphasizing the key role of relational factors in fostering resilience and meaning construction within a collectivistic value framework.

PMID:42098881 | DOI:10.1186/s40359-026-04642-y

BMC Psychol. 2026 May 7. doi: 10.1186/s40359-026-04691-3. Online ahead of print.

ABSTRACT

This study aimed to investigate the associations linking nature connection and pro-environmental behavior (PEB) in adolescents by constructing a chain mediation model, with a focus on the mediating effects of empathy with nature and moral identity. A cross-sectional questionnaire survey was administered to 379 adolescents aged 12-16 from three cities in Yunnan Province, China. The findings revealed that: (1) significant positive correlations were observed among adolescents’ nature connection, empathy with nature, moral identity, and pro-environmental behaviors; (2) moral identity and empathy with nature are consistent with a chain mediating role between adolescents’ nature connections and pro-environmental behaviors. This study suggests cognitive-emotional pathways that are statistically consistent with a link from nature connection to pro-environmental behavior among adolescents, providing a potential theoretical basis and practical guidance for fostering such behavior.

PMID:42098880 | DOI:10.1186/s40359-026-04691-3

J Cardiothorac Surg. 2026 May 7. doi: 10.1186/s13019-026-04251-1. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly being explored in surgical training and clinical knowledge assessment. Although these models have demonstrated promising performance in standardized examinations, their performance in highly specialized fields such as cardiovascular surgery remains insufficiently investigated. This study aimed to evaluate the performance of current large language models in answering and generating board-level cardiovascular surgery questions reflecting guideline-based clinical reasoning.

METHODS: In this cross-sectional evaluation study, three large language models (ChatGPT-5.1, Gemini 3, and DeepSeek v3.2) were evaluated in two stages. In the first stage, the models answered 150 multiple-choice questions developed and validated by five cardiovascular surgery specialists using a Delphi process, designed to reflect the content scope and difficulty level of the American Board of Thoracic Surgery certification examination. Accuracy rates and pairwise comparisons were analyzed using the McNemar test. In the second stage, model-generated questions were evaluated by expert cardiovascular surgeons in terms of medical accuracy, clinical relevance, exam-level appropriateness, error type, and difficulty level. Statistical analyses included Spearman correlation, Wilcoxon signed-rank test, and chi-square analysis.

RESULTS: The models demonstrated comparable accuracy rates (ChatGPT 80.7%; Gemini 78.7%; DeepSeek 82.0%), with no statistically significant differences between them. Question difficulty level was not associated with model accuracy. Error distribution differed significantly between models (χ² = 8.1; p = 0.02), with Gemini demonstrating the highest rate of valid question generation and DeepSeek showing a higher rate of major errors. A significant positive correlation was observed between model- and expert-assigned difficulty levels.

CONCLUSIONS: Current large language models demonstrate strong performance in board-level cardiovascular surgery knowledge assessment. However, the presence of major errors and variability in difficulty calibration, together with known limitations in clinical reasoning, indicate that these systems should be used cautiously as supportive tools in surgical training and knowledge assessment rather than as substitutes for clinical decision-making.

PMID:42098878 | DOI:10.1186/s13019-026-04251-1

Genome Med. 2026 May 7. doi: 10.1186/s13073-026-01665-3. Online ahead of print.

ABSTRACT

BACKGROUND: Compared to European American women, African American women are more likely to be diagnosed with triple-negative breast cancer (TNBC). This difference may be partially due to genetic factors. This study aims to investigate associations of African ancestry and risk variants with TNBC among African American women.

METHODS: We used data from 2,335 TNBC cases, 8,159 estrogen receptor (ER)-positive cases, and 9,814 controls included in the African-ancestry Breast Cancer Genetics (AABCG) Consortium. The proportion of African ancestry (%AFR) and local ancestry were estimated using samples from the 1000 Genomes Project as reference. Logistic regressions were performed for case-control (TNBC vs. control) and case-case (TNBC vs. ER-positive) comparisons, adjusted for age, study, genotype principal components 2-5, body mass index, and reproductive factors. Local ancestry-aware association analyses were conducted in 12 TNBC risk loci to identify ancestry-specific risk variants.

RESULTS: In case-control analyses, no statistically significant association was found between %AFR and TNBC risk after adjustment for potential confounders. However, TNBC cases had a significantly higher mean % AFR (mean = 0.811, standard deviation, SD = 0.104) compared to ER-positive cases (mean = 0.798, SD = 0.110, P < 0.001). Females with %AFR of ≥ 95% had 1.62 times higher odds (95% confidence interval, CI: 1.16-2.25) of having TNBC rather than ER-positive breast cancer, compared to those with %AFR of 55.0-64.9%. Local ancestry-aware association analyses identified seven subtype-informative variants in or near MDM4, RP11-19E11.1, TERT, MRPL36, TCF7L2, C11orf65, and ANKLE1. All of them were significantly associated with TNBC as compared with ER-positive cases, and six of them were also associated with TNBC risk in case-control analyses. Large allelic odds ratios of 1.25 or higher were found in association with TNBC risk or subtype classification. The risk allele frequency for five of them is substantially higher in haplotypes of African ancestry than those of European ancestry.

CONCLUSIONS: These findings support a significant role of African-ancestry specific genetic factors in determining breast cancer subtypes and highlight the need for future research to uncover possible pathways driving TNBC susceptibility.

PMID:42098873 | DOI:10.1186/s13073-026-01665-3

Subst Abuse Treat Prev Policy. 2026 May 7;21(1):33. doi: 10.1186/s13011-026-00705-w.

ABSTRACT

BACKGROUND: Cardiovascular multimorbidity (CVD MM), defined as two or more cardiovascular conditions, poses a significant public health challenge. Substance use disorders (SUDs) may elevate CVD MM risk, and health insurance disparities could exacerbate this relationship. We examined if insurance type moderates the association between SUDs and CVD MM.

METHODS: We analyzed cross-sectional data from 45,133 US adults in the 2023 National Survey on Drug Use and Health (NSDUH). CVD MM was defined as two or more specific cardiovascular conditions. SUDs included illicit drugs and cannabis, excluding nicotine dependence and alcohol use disorder. Logistic regression models examined the SUDs-CVD MM relationship and tested for an interaction between insurance type and SUDs, adjusting for covariates.

RESULTS: Individuals in the representative sample of US adults were 60.8% privately insured, 17.4% with Medicaid, 9.1% with Medicare, 8.7% uninsured, and 4.0% with other types of insurance. CVD MM (12.7% Uninsured to 47.7% Medicare; p < 0.0001) and SUDs (2.8% Medicare to 8.3% Medicaid; p < 0.0001) prevalence varied significantly by insurance type. In adjusted models, SUDs were not associated with CVD MM; however, Medicaid enrollees had higher odds of CVD MM than those privately insured. In interaction models, insurance type was a statistically significant moderator of the SUDs-CVD MM association (p = 0.0146). Stratified models showed uninsured adults with SUDs had higher odds of CVD MM (aOR:2.25, 95% CI:1.28,3.93) compared to uninsured counterparts without SUDs. No significant association was found among privately insured, Medicaid, or other insured individuals.

CONCLUSIONS: Uninsured individuals with SUDs face an elevated risk of CVD MM. Interventions improving access to care for this vulnerable population are crucial for reducing cardiovascular health disparities.

PMID:42098860 | DOI:10.1186/s13011-026-00705-w

Alzheimers Res Ther. 2026 May 7. doi: 10.1186/s13195-026-02043-2. Online ahead of print.

ABSTRACT

BACKGROUND: Brain endothelial dysfunction is an early pathological feature of Alzheimer disease (AD). We here investigate associations of the brain endothelial glycocalyx protein, syndecan-4 (SDC4), with amyloid and tau pathologies and cognitive impairment in a large longitudinal cohort of AD and controls.

METHODS: The study included n = 1,041 (n = 802 cognitively unimpaired and n = 239 cognitively impaired) participants who underwent biological classification using the NIA-AA “ATN” framework. Cognitive assessments included the Clinical Dementia Rating^®-sum of boxes and the Knight- Preclinical Alzheimer’s Cognitive Composite. Cerebrospinal fluid (CSF) measures of SDC4 and emerging AD biomarkers were obtained using Olink Proteomics. Amyloid-PET (n = 719) and tau-PET (n = 302) scans were performed in subsets of participants. Partial correlations and linear mixed models, respectively, examined cross-sectional and longitudinal associations of CSF SDC4 levels with amyloid-PET and tau-PET burden and cognition. Pseudo-time models estimated CSF biomarker trajectories across the course of AD progression.

RESULTS: CSF SDC4 levels were elevated in even the earliest preclinical stages of AD compared to controls and were closely associated with other CSF and imaging biomarkers of AD. Higher CSF SDC4 levels correlated with higher global and regional amyloid-PET and tau-PET burden and worse baseline cognition. Higher baseline CSF SDC4 levels predicted more rapid progression of brain amyloid and tau, and faster decline in global cognition, episodic memory, language, and executive functions over follow-up (mean, 8 years). CSF SDC4 associations with cognition were mainly mediated by global tau-PET burden. Importantly, our pseudo-time models estimate that SDC4 upregulation begins very early in AD pathogenesis near the point of amyloid-positivity and increases more robustly following the point of tau-positivity. SDC4 was among the top 10 most important proteins in predicting the pseudo-time models of AD progression and predicted these models to a potentially better extent than other emerging AD biomarkers.

CONCLUSION: Findings from this large longitudinal study suggest that CSF SDC4 levels are increased in the earliest preclinical stages of AD and are closely associated with the progression of amyloid and tau pathologies and future rates of cognitive decline. We propose that SDC4 upregulation is an important early event in AD pathogenesis which predicts cognitive and pathological disease trajectories.

PMID:42098850 | DOI:10.1186/s13195-026-02043-2

J Anesth Analg Crit Care. 2026 May 8. doi: 10.1186/s44158-026-00401-y. Online ahead of print.

ABSTRACT

BACKGROUND: Intensive care unit (ICU) professionals face high levels of stress, burnout, and work-related psychological strain. However, comprehensive multinational assessments of their well-being-particularly those exploring gender differences and work-life dynamics-are scarce.

METHODS: A cross-sectional survey was conducted by the International Women in Intensive and Critical Care Network (iWIN) between October 2023 and June 2024. The 113-item questionnaire assessed well-being using the WHO-5 Well-Being Index and other validated instruments across eight domains. ICU professionals were recruited via email, professional meetings, and the iWIN website. Descriptive statistics, T-tests, chi-square, and Mann-Whitney U tests were used for analysis.

RESULTS: One hundred fifty-eight ICU professionals from diverse roles responded (62% female, 37% male, 1% other). The median WHO-5 score was 68 (IQR 52-80); males reported significantly higher scores than females (72 vs. 60; p = 0.0051). Respondents reported high workload, moderate job autonomy, and frequent stress. Temporary employment was common, with 41.1% considering job transfers. Despite generally positive diversity ratings, gender disparities remained in perceptions of hiring, promotion, and career advancement fairness.

CONCLUSIONS: This exploratory survey found generally positive well-being among ICU professionals, with a gender difference observed in WHO-5 scores. Concerns related to workload, job insecurity, and career development were also reported. Findings should be interpreted with caution and warrant further investigation.

PMID:42098838 | DOI:10.1186/s44158-026-00401-y

BMC Nurs. 2026 May 7. doi: 10.1186/s12912-026-04705-w. Online ahead of print.

ABSTRACT

BACKGROUND: Self-regulatory fatigue is an emerging concern within nursing education, with implications for professional competence, emotional resilience, and long-term career development. To assess the level of self-regulatory fatigue among nursing interns and explore its related influencing factors.

METHODS: A total of 340 nursing interns participated in this survey. Data were collected from March to December 2024 using an online survey comprising a general information questionnaire, the Perceived Stress Scale (PSS), the Adolescent Mental Health Literacy Assessment Questionnaire (AMHLAQ), and the Psychological Detachment Scale. Descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficients, and multiple linear regression analyses were conducted.

RESULTS: Perceived stress (β = 0.47, p < 0.001), mental health literacy (β = -0.13, p = 0.008), psychological detachment (β = -0.10, p = 0.025), academic performance (β = 0.15, p < 0.001), length of clinical placement (β = -0.11, p = 0.016) and left-behind experience (β = -0.10, p = 0.032) were significant predictors of self-regulatory fatigue. The model explained 39.1% of the variance in self-regulatory fatigue.

CONCLUSIONS: Nursing interns showed a moderate level of self-regulatory fatigue. Three psychological factors, namely, perceived stress, mental health literacy, and psychological detachment, along with academic performance, clinical placement duration, and left-behind experience, were significantly associated factors of self-regulatory fatigue. These findings suggest that targeted strategies should be developed to mitigate interns’ fatigue and promote their holistic health.

PMID:42098828 | DOI:10.1186/s12912-026-04705-w