Tag: nevin manimala

Adv Ther. 2026 Jul 30. doi: 10.1007/s12325-026-03734-w. Online ahead of print.

ABSTRACT

INTRODUCTION: To evaluate postpartum depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and identify demographic, obstetric, and neonatal factors associated with EPDS positivity in women without prior psychiatric history.

METHODS: This retrospective, archive-based multicentre study enrolled 763 women aged 20-35 years who delivered at two public hospitals in Turkey (June 2022-June 2025). Variables included educational attainment, employment, pregnancy planning, mode of delivery, abortion/stillbirth history, preeclampsia, birth weight, and neonatal intensive care unit (NICU) admission. Participants were classified as EPDS < 13 or ≥ 13 at the fourth postpartum week; comparisons used univariable and multivariable logistic regression with Bonferroni adjustment.

RESULTS: Of 763 women, 198 (26.0%) scored ≥ 13. After adjustment and Bonferroni correction, history of abortion and preeclampsia remained statistically significant. Working status and history of stillbirth showed nominal associations before correction but did not remain significant after Bonferroni correction. NICU admission was significant in unadjusted analysis but did not remain significant after adjustment (aOR 1.44, 95% CI 0.80-2.60, p = 0.226).

CONCLUSION: Postpartum depressive symptoms affected one in four women. After adjustment and Bonferroni correction, preeclampsia and history of abortion remained associated with EPDS positivity. Targeted psychological screening may be considered for women with high-risk pregnancy or neonatal complications.

PMID:42530824 | DOI:10.1007/s12325-026-03734-w

Int J Cardiovasc Imaging. 2026 Jul 30. doi: 10.1007/s10554-026-03785-8. Online ahead of print.

ABSTRACT

The Coronary Artery Disease Reporting and Data System (CAD-RADS) standardizes coronary CT angiography (CCTA) reporting, but not all reports contain CAD-RADS classifications. We benchmarked 54 large language model (LLM) configurations across 50 distinct models, including recent proprietary and open-weight reasoning models, for zero-shot CAD-RADS classification. We retrospectively analyzed 500 anonymized CCTA reports from four hospitals across three U.S. regions. Expert cardiovascular radiologists provided the reference standard (human inter-rater [Formula: see text]). Fifty-four model configurations (50 distinct LLMs; four configurable models tested in both thinking and non-thinking modes) spanning Llama 2 7B through recent thinking models (DeepCogito v2, Gemini 3 Pro) processed reports using identical zero-shot prompts. Performance was measured with unweighted Cohen’s κ. Two LLMs met both pre-specified non-inferiority criteria ([Formula: see text] margin and entire 95% CI within the human inter-rater agreement band, [Formula: see text]-0.956): Claude 4.6 Opus ([Formula: see text], 95% CI 0.817-0.889) and the open-weight Gemma 4 31B ([Formula: see text], 95% CI 0.810-0.882), which ranked second overall. Both met the criteria at the pre-specified [Formula: see text] margin; at [Formula: see text] no model qualified. On the reports originally dictated without a CAD-RADS statement (n=343), the top models reached [Formula: see text]. Performance declined with longer thinking chains (proxy for case complexity), but thinking-mode outperformed non-thinking mode on matched difficult reports. Gemma 4 31B remained non-inferior at 3-bit quantization and fits on a 24 GB consumer GPU. Current LLMs extract the CAD-RADS stenosis severity category from unstructured CCTA reports with agreement approaching the human inter-rater band, without task-specific training. Our data shows the remarkable rise of open models. A 31B open-weight model matched top proprietary systems and runs on consumer GPUs, enabling privacy-preserving local deployment for clinical data mining.

PMID:42530821 | DOI:10.1007/s10554-026-03785-8

Updates Surg. 2026 Jul 30. doi: 10.1007/s13304-026-02787-4. Online ahead of print.

NO ABSTRACT

PMID:42530818 | DOI:10.1007/s13304-026-02787-4

J Racial Ethn Health Disparities. 2026 Jul 30. doi: 10.1007/s40615-026-03120-w. Online ahead of print.

ABSTRACT

Racial inequities related to COVID-19 exposure, morbidity, mortality, and access to care in the United States (U.S.) are notable, and COVID-19 vaccine uptake is lower among Black Americans than White Americans. Yet, mechanisms linking healthcare experiences to COVID-19 vaccination behavior among young adults are not well characterized. We analyzed cross-sectional data collected between March and June 2023 from 360 Black young adults (ages 18-29) enrolled in a digital health trial in Georgia, Alabama, and North Carolina (NCT05490329). Discrimination in medical settings and group-based medical mistrust were assessed. COVID-19 vaccination was measured as ever receiving at least one dose. Correlations and a mediation model (PROCESS Model 4; 5,000 bootstrap resamples) tested whether medical mistrust statistically mediated the association between discrimination in medical settings and COVID-19 vaccination, adjusting for age, sex at birth, state, insurance, education, and perceived COVID-19 risk. In mediation analyses, discrimination in medical settings had a significant total effect on COVID-19 vaccination (B=-0.44, SE=0.13, p<.001) and was associated with higher mistrust (B=0.42, SE=0.04, p<.001); higher medical mistrust was associated with lower likelihood of COVID-19 vaccination (B=-0.65, SE=0.24, p=.006). The indirect effect was significant (B=-0.28, SE=0.12, 95% CI [-0.557, – 0.081]). Findings suggest that discriminatory healthcare encounters may reduce COVID-19 vaccination uptake partly through elevated medical mistrust, highlighting the need for trust-building, non-stigmatizing strategies to improve vaccination among Black young adults in the U.S. South.

PMID:42530812 | DOI:10.1007/s40615-026-03120-w

Geroscience. 2026 Jul 30. doi: 10.1007/s11357-026-02399-1. Online ahead of print.

ABSTRACT

Declines in nicotinamide adenine dinucleotide (NAD+) are linked to metabolic stress accompanying aging and disease. While precursor-based approaches elevate systemic NAD, their clinical translation can be constrained by biosynthetic bottlenecks and first-pass metabolism. RENEWAL-NAD+ (ClinicalTrials.gov NCT07336836; retrospectively registered 01/04/2026) was a double-blind, randomized, placebo-controlled Phase 0/1b trial in healthy adults aged 45-75 years (60 randomized; primary analysis n = 50) evaluating 5 days of oral LathMized® NAD+ (LNAD+), a physicochemically modulated formulation that alters the supramolecular organization and solution behavior of NAD+ while preserving its native molecular structure. The primary endpoints were change in intracellular NAD (icNAD), measured in whole blood, and circulating NAD (cirNAD), measured in separated plasma, relative to baseline. LNAD+ produced a rapid and pronounced increase in icNAD, with a 53% elevation versus placebo at Day 6 (p = 5.48e^-14; Hedges’ g = 3.66), while cirNAD was unchanged (p = 0.60), demonstrating compartment-selective augmentation. Plasma NAD catabolites increased substantially (1-methyl-nicotinamide, MeNAM p = 5.39e^-13; N1-methyl-2-pyridone-5-carboxamide, 2PY p = 2.95e^-16), consistent with downstream engagement of NAD metabolic flux. Exploratory analyses identified non-overlapping correlates for the two compartments (cirNAD tracking inflammatory and metabolic markers, icNAD tracking red blood cell indices and NAM). Treatment was very well tolerated: symptom incidence was comparable between groups (p = 0.68), only one mild adverse event (nausea, Grade 1) occurred in the LNAD+ arm, and no secondary clinical, vital-sign, wellbeing, or wearable-derived endpoint survived multiplicity correction. These data demonstrate rapid intracellular NAD augmentation after oral LNAD+ dosing with pharmacodynamic evidence of downstream metabolism, compartment-specific physiological signatures, and a favorable short-term safety profile, with exploratory multi-omic analyses ongoing.

PMID:42530810 | DOI:10.1007/s11357-026-02399-1

Eur Arch Paediatr Dent. 2026 Jul 30. doi: 10.1007/s40368-026-01254-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the 12-month clinical and radiographic success of partial pulpotomy in primary molars using three bioactive materials-MTA, Biodentine, and TheraCal PT-and to assess the influence of final restoration type on treatment outcomes.

METHODS: This randomised controlled trial was conducted in a university postgraduate dental clinic setting and included 120 children aged 4-7 years with cariously exposed, restorable primary molars diagnosed with reversible pulpitis. Teeth were randomised to one of three pulp-capping materials (MTA, Biodentine, or TheraCal PT) and restored with either a preformed metal crown (PMC) or glass ionomer cement (GIC), forming six subgroups. Clinical and radiographic outcomes were assessed at regular intervals using modified Zurn and Seale criteria. Outcome assessment was performed by two blinded evaluators. Cox regression analysis and Kaplan-Meier survival curve were used.

RESULTS: A total of 120 participants (20 per subgroup) were included in the intention-to-treat analysis. No statistically significant differences were observed amongst the groups (p > 0.05). Overall success rates across the six subgroups ranged from 65 to 90% at 12 months. Cox regression showed no significant effect of capping material (Biodentine: HR = 1.06; TheraCal PT: HR = 1.75; overall p > 0.05) or restoration type (GI vs PMC: HR = 1.79; 95% CI 0.82-3.92; p = 0.145) on treatment survival. No material-related adverse events were reported.

CONCLUSIONS: Partial pulpotomy using MTA, Biodentine, or TheraCal PT demonstrated comparable clinical and radiographic outcomes at 12 months. No statistically significant differences were observed between the evaluated materials or final restoration types.

CLINICAL REGISTRY: ClinicalTrials.gov, NCT06227390, submission date: 22 December 2023.

PMID:42530796 | DOI:10.1007/s40368-026-01254-3

Nurs Crit Care. 2026 Sep;31(5):e70611. doi: 10.1111/nicc.70611.

ABSTRACT

BACKGROUND: Hyperglycaemia is common among intensive care unit (ICU) patients and is associated with increased mortality. However, whether intensive or liberal glucose control is more beneficial remains controversial.

AIM: To compare the benefits and risks of intensive versus liberal glucose control in ICU patients.

STUDY DESIGN: A Meta analysis of randomized controlled trials.

METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to October 30, 2024. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were independently screened and extracted by four reviewers. Relative risks (RRs) were pooled using a random effects model, and trial sequential analysis was performed for the primary outcome.

RESULTS: Seventy RCTs were included, comprising 36 502 patients, of which 64 RCTs (32 491 patients, 89%) were conducted in adults and 6 RCTs (4011 patients, 11%) in children. The RR of all-cause mortality after intensive and liberal glucose control was 0.99 (95% CI, 0.93-1.05) in adults. Comparable findings were observed for all-cause mortality in children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycaemia in both children (RR 5.70; 95% CI 2.60-12.51) and adults (RR 3.55; 95% CI 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR 0.83; 95% CI 0.70-0.98) and adults (RR 0.78; 95% CI 0.63-0.97). In the subgroup analysis of adults, a lower risk of infection was observed in all surgical groups, but not in the medical group. There was no statistically significant difference in other complications, including sepsis, acute renal injury, new need for dialysis and need for blood transfusion.

CONCLUSIONS: Intensive and liberal glucose control had similar effects on all-cause mortality in adults and children, though paediatric data are limited and should be interpreted cautiously. Intensive glucose control reduced infection risk, especially in surgical ICUs, but increased the risk of severe hypoglycaemia.

RELEVANCE TO CLINICAL PRACTICE: These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased hypoglycaemia risk, although it may reduce infection risk, particularly in surgical ICU patients.

PMID:42529895 | DOI:10.1111/nicc.70611

Pers Soc Psychol Bull. 2026 Jul 30:1461672261468870. doi: 10.1177/01461672261468870. Online ahead of print.

ABSTRACT

It is unclear whether Healthy Neuroticism is beneficial for health, potentially due to mismatches between how Healthy Neuroticism is often conceptualized and operationalized. The present study uses data from 212 to 672 Dutch adults (54.17% female, mean age = 62.46) to examine how 3 operationalizations of Healthy Neuroticism (at the domain, facet, and characteristic adaptation levels) are associated with preventive disease screenings. Using a series of hurdle models, we found that individuals who were higher on Neuroticism domain, facets (Anxiety, Depression), and characteristic adaptations (Disease Concern) were more likely to engage in preventive disease screenings. However, Healthy Neuroticism (operationalized as interactions between domain, facet, and characteristic adaptations with Conscientiousness) was largely not associated with the likelihood or count of disease screenings, though these results should be interpreted with caution until further replication due to limits on statistical power. We discuss the theoretical implications for the Healthy Neuroticism literature and practical implications for improving health.

PMID:42529892 | DOI:10.1177/01461672261468870

Disaster Med Public Health Prep. 2026 Jul 30;20:e138. doi: 10.1017/dmp.2026.10414.

ABSTRACT

OBJECTIVES: Children are disproportionately affected by disasters and represent a vulnerable population in such settings. However, no internationally recognized core competencies exist to guide health care providers in caring for children impacted by disasters (particularly non-pediatricians). This study aimed to establish consensus-based core competencies for pediatric disaster response through international expert agreement across disciplines.

METHODS: A three-round modified Delphi study was conducted following CREDES criteria, using competency statements generated via a comprehensive scoping review of pediatric disaster literature. International disaster medicine experts rated competency statements on a 7-point linear scale (1 = disagree, 7 = agree). Consensus was defined a priori as standard deviation (SD) ≤ 1.0. Data were collected and analyzed using the STAT59 online platform.

RESULTS: 57 competencies met consensus criteria across three Delphi rounds, with mean scores ranging from 5.4 to 6.6. The highest-ranked competencies (mean = 6.6) were pediatric vulnerabilities recognition, pediatric transport management, child identification and tracking, and child-parent reunification. Decontamination initiation was also highly ranked (mean = 6.5).

CONCLUSIONS: The 57 consensus-based core competencies for pediatric disaster medicine response, spanning 16 practice domains, provide a foundation to further develop standardized curricula, guide preparedness and response efforts, and define minimum training expectations for health care providers caring for children impacted by disasters.

PMID:42529878 | DOI:10.1017/dmp.2026.10414

Prim Health Care Res Dev. 2026 Jul 30;27:e81. doi: 10.1017/S146342362610142X.

ABSTRACT

BACKGROUND: Out-of-hours primary care (OOH-PC) has been introduced in many health systems to reduce non-urgent emergency department (ED) use. While prior studies suggest potential efficiency gains, economic evaluations rarely stratify outcomes by patient risk, limiting policy relevance. This study assesses the cost-effectiveness of diverting low-risk patients from ED to OOH-PC.

AIM: Compare direct medical costs, time spent at the facility, and hospitalization probability across risk and care setting subgroups from a societal perspective.

METHODS: We analysed data from a cluster-randomized trial conducted in Belgium that examined a nurse-led triage system. Under the study trial’s extended Manchester Triage System (eMTS) protocol, patients eligible for primary care were assigned to OOH-PC and are referred to in our study as low-risk, while those assigned to the ED are defined as high-risk. To complement previous work, we stratified costs and effects by risk group. Mixed-effects regression models estimated costs, time at the facility, and hospitalization, with bootstrap confidence intervals. We also calculated the incremental net monetary benefit (INMB).

RESULTS: Treating low-risk patients at the OOH-PC instead of at the ED reduced costs by €24 (€14-€39) per patient, shortened the time spent at the facility by 69 (52-94) minutes. From a societal perspective, the average INMB was €49.5 per low-risk patient. Aggregately, we estimated that the 37 intervention weekends in 2019 led to an average saving of €14,136 in direct medical costs and cumulative time savings of 28 days.

CONCLUSION: Diverting low-risk patients from the ED to OOH-PC resulted in cost- and time-savings for low-risk patients at the study site. These findings highlight the potential to improve out-of-hours healthcare delivery to maximize benefits for patients and healthcare systems, although confirmation in other healthcare settings is required before wider implementation.

PMID:42529876 | DOI:10.1017/S146342362610142X