Tag: nevin manimala

Child Care Health Dev. 2026 Mar;52(2):e70260. doi: 10.1111/cch.70260.

ABSTRACT

INTRODUCTION: Although the increased risks of child labour and parental discipline on children’s psychosocial functioning are well-documented in various settings, there is a paucity of data addressing these associations in Laos. This research aims to investigate the prevalence of child labour and parental discipline and their potential associations with psychosocial difficulties among children and adolescents aged 5-14 years.

METHODS: This study employed data from the 2023 Laos Multiple Indicator Cluster Survey (MICS), a nationally representative cross-sectional dataset. Multivariable binary logistic regression analyses were conducted to examine the associations between child labour, child discipline and different categories of psychosocial functioning difficulties. Adjusted odds ratios were estimated controlling for potential confounders, including children’s age, mother’s education, sex, residential area, wealth index and ethnicity.

RESULTS: A considerable proportion of children and adolescents experienced disciplinary practices, with 73.8% exposed to nonviolent forms and 65.6% to violent disciplinary methods. Overall, 15.8% of children were identified as having at least one psychosocial functioning difficulty. Engagement in child labour was significantly associated with five out of 10 psychosocial difficulties (aORs: 1.28-3.75; 95% CIs: 1.05-5.26; p-values < 0.02). Non-violent discipline was significantly associated with seven out of 10 psychosocial functioning difficulties (aORs: 1.72-2.68; 95% CIs: 1.03-4.30; p-values < 0.02). Additionally, exposure to psychological aggression was significantly associated with impairments in seven out of 10 psychosocial domains (aORs: 1.49-2.16; 95% CIs: 1.11-3.06; p-values < 0.02). Moderate physical aggression was significantly associated with four out of 10 psychosocial difficulties (aORs: 1.49-1.83; 95% CIs: 1.12-2.81; p-values < 0.01), while severe physical punishment was significantly associated with severity in four out of 10 domains (aORs: 1.48-1.59; 95% CIs: 1.02-2.29; p-values < 0.02).

CONCLUSIONS: The findings highlight strong associations between exposure to psychological and physical disciplinary practices, as well as child labour, and a wide range of psychosocial functioning difficulties among children and adolescents. These results underscore the urgent need for interventions aimed at reducing harmful disciplinary practices and child labour to support children’s well-being.

PMID:41850791 | DOI:10.1111/cch.70260

BMJ Mil Health. 2026 Mar 18:e003244. doi: 10.1136/military-2025-003244. Online ahead of print.

NO ABSTRACT

PMID:41850789 | DOI:10.1136/military-2025-003244

Thorax. 2026 Mar 18:thorax-2025-224263. doi: 10.1136/thorax-2025-224263. Online ahead of print.

ABSTRACT

BACKGROUND: Ventilator-free days (VFDs), a composite endpoint combining survival and mechanical ventilation duration, are increasingly used in acute respiratory distress syndrome (ARDS) trials to capture patient-centred outcomes beyond mortality. However, its interpretation and analysis are challenged by methodological limitations of conventional statistical methods. This study aims to investigate the interpretability and statistical performance of the hierarchical VFDs compared with the conventional versions for ARDS-related trials.

METHODS: We applied a hierarchical composite endpoint framework, incorporating mortality and ventilation duration prioritised in sequence, to reconstruct VFDs censored at 28 days. Using the win ratio method, we carried out a post hoc analysis based on data from 10 high-quality randomised controlled trials and conducted simulation studies to assess its statistical performance.

RESULTS: Analysis revealed bimodal VFD distributions across trials, with peaks near zero and around 18-20 days. The win ratio method detected all the significant treatment effects that were identified by conventional analyses. Simulation studies suggested that the win ratio demonstrated greater statistical power, particularly when mortality was the primary driver of treatment effect, outperforming traditional methods.

CONCLUSIONS: The hierarchical VFDs endpoint, analysed using win statistics, provides a more sensitive and interpretable approach by distinguishing the contribution of mortality and ventilation duration components to the overall treatment effect in ARDS trials compared to the conventional approach.

PMID:41850776 | DOI:10.1136/thorax-2025-224263

J Epidemiol Community Health. 2026 Mar 18:jech-2025-224810. doi: 10.1136/jech-2025-224810. Online ahead of print.

ABSTRACT

INTRODUCTION: Accumulation of advanced glycation end products, measured by skin autofluorescence (SAF), has been shown to be associated with several chronic non-communicable diseases, particularly cardiovascular diseases (CVDs). The promotion of physical activity (PA) as a strategy for the prevention of CVD by modifying healthy habits has been widely studied.

AIM: To assess the evidence for the association between PA and SAF in the general adult population.

METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Synthesis Without Meta-analysis framework. A search was performed in MEDLINE (via PubMed), Web of Science, Scopus, Cochrane Library and SportDiscuss (via EBSCOhost), from inception to September 2024. Study quality was assessed using the National Heart, Lung and Blood Institute tools and the certainty of evidence was evaluated with Grading of Recommendations, Assessment Development and Evaluation. Vote counting based on the direction of effect was used as the standardised synthesis metric.

RESULTS: In the systematic review, 17 studies were included. The qualitative synthesis showed a predominant consistency in favour of a beneficial association. Specifically, 58.8% of the studies reported a statistically significant inverse association, indicating that higher levels of PA or exercise frequency are correlated with lower SAF levels. The remaining studies (41.2%) reported non-significant results, though several showed favourable trends. No studies reported a positive association between PA and SAF. The quality of the studies was generally fair, and the certainty of evidence low.

CONCLUSIONS: PA is inversely associated with SAF. Therefore, while causality cannot be proven, it is hypothesised that PA may reduce SAF and thus have a positive impact on health.

PMID:41850762 | DOI:10.1136/jech-2025-224810

Orthop Nurs. 2026 Mar-Apr 01;45(2):115-122. doi: 10.1097/NOR.0000000000001198. Epub 2026 Mar 13.

ABSTRACT

The applicability of the phase angle in assessing nutritional status among older women remains unexamined. This study aimed to evaluate the usefulness of the phase angle for nutritional assessment in older women with hip fractures and determine the cutoff value for malnutrition and the minimal detectable change (MDC). In this study, a combined cross-sectional and longitudinal design was employed. A total of 138 older female inpatients with hip fractures admitted to one of three rehabilitation units were included. At admission, nutritional status was assessed using the Geriatric Nutritional Risk Index, and the phase angle was calculated by bioelectrical impedance analysis. At one of the rehabilitation units, the phase angle was also measured 1 month after admission. Data from 90 participants (mean age: 83.11 ± 6.79 years) were analyzed. The cutoff phase angle for identifying malnutrition was 3.975° (sensitivity: 0.882 and specificity: 0.740). The MDC was 0.768°. The phase angle may be useful as a screening tool for nutritional assessment in older women with hip fractures.

PMID:41849773 | DOI:10.1097/NOR.0000000000001198

Orthop Nurs. 2026 Mar-Apr 01;45(2):107-114. doi: 10.1097/NOR.0000000000001197. Epub 2026 Mar 13.

ABSTRACT

BACKGROUND: Upholding a sterile environment in orthopedic surgery is vital to minimize surgical site infections (SSIs). Among personal protective equipment, beard covers for surgical staff with facial hair have been recommended as a measure to prevent contamination. However, their effectiveness in reducing SSIs remains uncertain, especially in orthopedic procedures that often involve high-risk implants and extended exposure of surgical fields. This systematic review assesses the current evidence on the role of beard covers in infection prevention during surgery.

METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for studies investigating facial hair, beard covers, and infection risk. Eligible studies included comparative studies, laboratory experiments, and consensus statements. Quality was assessed using MINORS and CASP tools, while certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations criteria.

RESULTS: A total of 538 studies were extracted from databases, of which 8 met inclusion criteria. Clinical studies did not demonstrate a statistically significant difference in SSI rates between uncovered bearded surgeons, uncovered clean-shaven surgeons, or with the use of beard covers. Laboratory studies provided mixed results on bacterial shedding associated with facial hair. A consensus statement highlighted insufficient evidence to recommend beard covers as standard practice.

CONCLUSIONS: The current evidence is equivocal when determining the role for beard covers for SSI reduction in orthopedic surgery. Given the lack of evidence-based data, further high-quality research is needed to justify the routine use of beard covers in infection prevention and operating room protocols.

PMID:41849772 | DOI:10.1097/NOR.0000000000001197

Am J Dermatopathol. 2026 Apr 1;48(4):257-266. doi: 10.1097/DAD.0000000000003165. Epub 2025 Nov 13.

ABSTRACT

Secondary syphilis, caused by Treponema pallidum and known as the “the great imitator,” presents with varied manifestations that may mimic other skin conditions. Histopathology is critical when clinical or serologic findings are atypical, and this study analyzed its key features to improve recognition and reduce diagnostic errors. A systematic search was conducted in PubMed, Embase, and Cochrane. Statistical analyses were performed using R, version 4.3.2. A random-effects model was used to determine the proportion with 95% confidence interval (CI). Heterogeneity was assessed using Cochrane Q test and I2 statistics. Eight studies encompassing 384 patients and 460 lesions were included. The mean age was 38.1 years, and approximately 24% of the patients were female. The most common histological features were endothelial swelling, reported by five studies, with a prevalence of 85% (95% CI 0.75-0.96; I2 = 82.6%), and moderate to dense plasma cell infiltration, as reported by six studies, with a prevalence of 83% (95% CI 0.74-0.92; I2 = 90.7%). Acanthosis was observed in six studies, with a prevalence of 66% (95% CI 0.47-0.86; I2 = 96.0%), followed by perivascular inflammatory infiltrate, reported in five studies, with a prevalence of 64% (95% CI 0.37-0.90; I2 = 96.9%). Histopathology reveals consistent features, particularly endothelial swelling and plasma cell-rich infiltrates, in secondary syphilis, reinforcing its diagnostic value when clinical or serologic findings are inconclusive.

PMID:41849752 | DOI:10.1097/DAD.0000000000003165

N Engl J Med. 2026 Mar 18. doi: 10.1056/NEJMoa2513310. Online ahead of print.

ABSTRACT

BACKGROUND: Catheter-based closure of the left atrial appendage is an alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation. The effectiveness of this strategy, as compared with physician-directed best medical care, in patients at high risk for stroke and bleeding is unknown.

METHODS: In this multicenter randomized trial conducted in Germany, we assigned patients with atrial fibrillation and a high risk of stroke and bleeding to undergo left atrial appendage closure or to receive physician-directed best medical care (including direct oral anticoagulants, if eligible). The primary end point, tested for noninferiority, was a composite of stroke (ischemic or hemorrhagic), systemic embolism, major bleeding, or cardiovascular or unexplained death, assessed in a time-to-event analysis. The noninferiority margin was a hazard ratio of 1.3.

RESULTS: A total of 912 adult patients underwent randomization. The primary end-point analysis included 446 patients who were assigned to undergo left atrial appendage closure (device group) and 442 who were assigned to physician-directed best medical care (medical-therapy group). The mean (±SD) age was 77.9±7.1 years; 38.6% of the patients were women, the mean CHA₂DS₂-VASc score was 5.2±1.5 (range, 0 to 9, with higher scores indicating a greater risk of stroke), and the mean HAS-BLED score was 3.0±0.9 (range, 0 to 9, with higher scores indicating higher risk of bleeding). After a median follow-up of 3 years (interquartile range, 1.7 to 4.7), a first primary end-point event had occurred in 155 patients (incidence per 100 patient-years, 16.8) in the device group and in 127 patients (incidence per 100 patient-years, 13.3) in the medical-therapy group (difference in restricted mean survival time, -0.36 years; 95% confidence interval, -0.70 to -0.01; P = 0.44 for noninferiority). Serious adverse events occurred in 368 patients (82.5%) in the device group and 342 (77.4%) in the medical-therapy group.

CONCLUSIONS: Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to physician-directed best medical care with regard to a composite end point of stroke, systemic embolism, major bleeding, or cardiovascular or unexplained death. (Funded by the German Center for Cardiovascular Research; CLOSURE-AF ClinicalTrials.gov number, NCT03463317.).

PMID:41849741 | DOI:10.1056/NEJMoa2513310

JCO Clin Cancer Inform. 2026 Mar;10:e2500276. doi: 10.1200/CCI-25-00276. Epub 2026 Mar 18.

ABSTRACT

PURPOSE: This study assessed the feasibility of developing the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC)-Medicare-linked database infrastructure by integrating tumor registry, electronic health records (EHRs), and Medicare administrative claims data. The database was designed to support research identifying determinants of differences in cancer outcomes among patient populations commonly under-represented in clinical trials (based on the US population with the disease) including older adults.

METHODS: Patients 65 years and older who were diagnosed and/or received their first course of treatment for a primary tumor at UMGCCC from 2018 to 2021 were included in the database. A two-stage data linkage process was used to merge cancer center tumor registry data with EHR and Medicare claims data. We performed data quality and linkage quality checks. Summary statistics were calculated for patient and tumor characteristics.

RESULTS: Of the 3,322 patients identified from the tumor registry, 3,119 patients (94%) were included in the UMGCCC-Medicare database (mean age 73.1 years, 56% male, 31% Black). Lung cancers were the most common (15%) followed by oral cancers (12%) and non-Hodgkin lymphoma (6%).

CONCLUSION: The development of the UMGCCC-Medicare database serves as proof of concept for linking real-world data from different sources. The database is a valuable resource for research requiring detailed patient-level data and follow-up that may generate real-world evidence for older adults living in the United States and treated in routine oncology practice.

PMID:41849726 | DOI:10.1200/CCI-25-00276

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012617. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate how Clove Oil interacts with epithelial cells in human nasal tissue.

METHODS: Tissue samples taken during surgery were immediately submerged in sterile PBS containing antibiotics and transferred to the lab under cold-chain conditions. After several washes to remove residual blood or debris, the samples were centrifuged at 300 g. Before enzymatic digestion with 0.25% trypsin-EDTA at 37 °C, the tissue was deliberately broken down. Complete DMEM/F-12 medium neutralized the enzyme activity. To ensure cell adhesion and viability testing before treatment, 96-well culture plates were used. Clove oil was added to cells at doses of 1, 5, 15, 25, 50, 75, and 100 µL over 24 hours. To assess cell metabolic activity, the MTT colorimetric assay was used.

RESULTS: The inhibitory nature of the dose-response relationship was demonstrated by nonlinear regression analysis. The logIC50 value was 1.616, corresponding to an IC50 of 41.29 µL. There was a strong association between product dose and cytotoxic response, as evidenced by a consistent, reproducible effect and a high coefficient of determination (R2=0.9172).Clove oil treatment resulted in a concentration-dependent reduction in cellular metabolic activity, as assessed by the MTT assay. The treated cells showed a clear decrease in cell viability as the product volume increased, whereas the negative control group maintained 100% cell viability. In addition, statistical analysis showed that all clove oil concentrations significantly reduced cell viability compared with untreated controls. Further evidence of a dose-response relationship was that statistical significance increased with the addition of clove oil.

CONCLUSION: Despite clove oil’s promise in otolaryngology, it is essential to establish a safe therapy window. For conditions in which the function of the mucosal barrier and the health of the epithelial cells are critical, such as allergic rhinitis, rhinosinusitis, or upper respiratory tract infections, it can be administered topically by inhalation, nasal spray, or other nasal drug delivery systems. Further study, including in vivo tests, mucociliary function evaluations, and long-term exposure trials, is needed to establish its safety profile and guide its appropriate use in otorhinolaryngology.

PMID:41849713 | DOI:10.1097/SCS.0000000000012617