Tag: nevin manimala

Drug Alcohol Rev. 2026 Jan;45(1):e70087. doi: 10.1111/dar.70087.

ABSTRACT

INTRODUCTION: Driving under the influence of drugs is a major risk factor for road traffic collisions. While increasing harms are observed in relation to polydrug use, evidence is needed about this issue in the context of road safety. We examined polydrug use patterns in drivers providing samples for toxicological analysis in Ireland between 2019 and 2020.

METHODS: A cross-sectional study using LC-MS toxicology results from the Medical Bureau of Road Safety, which is responsible for the chemical testing of intoxicants in all drivers arrested under the Road Traffic Acts 1968-2024 in Ireland. Latent class analysis was performed on all samples with at least one drug detected (N = 4856). Descriptive statistics for age, gender and number of drug groups detected were calculated for each class identified.

RESULTS: We identified six latent classes based on drug detection patterns. The cannabis only class (46.5%) is characterised by the detection of cannabis with no other drug involved, a high proportion of men and young age. The cocaine class (31.1%), which combines cocaine and cannabis use, and the stimulant class (2.5%), characterised by amphetamine/methamphetamine detection, have a similar demographic profile to the cannabis class. The polydrug non-opioid (11.8%), polydrug opioid (5.5%) and heroin (2.6%) classes are older, with lower male:female ratios.

DISCUSSION AND CONCLUSIONS: By identifying profiles of people driving under the influence of drugs, this study contributes to enhancing knowledge of drug and polydrug use in motor vehicle drivers in Ireland. Further work is needed to examine risks and develop interventions to address polydrug driving.

PMID:41391009 | DOI:10.1111/dar.70087

Urol Oncol. 2026 Jan;44(1):63.e13-63.e20. doi: 10.1016/j.urolonc.2025.09.013. Epub 2025 Oct 25.

ABSTRACT

BACKGROUND: Radical cystectomy (RC) with urinary diversion is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer. While continent urinary diversions offer potential quality-of-life benefits, their adoption over time remains poorly defined.

OBJECTIVE: To evaluate national trends in the use of continent versus incontinent urinary diversion following RC and identify demographic and clinical factors associated with diversion type.

METHODS: We analyzed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2008 to 2022. Patients undergoing RC with urinary diversion were identified using CPT codes. Diversion type, temporal trends, and associated demographic and clinical variables were assessed using descriptive statistics and multivariable Firth logistic regression models.

RESULTS: Among 26,587 patients, 85.1% received incontinent diversion and 14.9% received continent diversion. The use of continent diversion declined significantly over time, particularly among males, patients under 75 years old, and White patients. No significant trends were observed among female, Black or Asian patients.

CONCLUSION: Continent urinary diversions have declined over the past decade despite surgical advancements, with notable variation by age, sex, and race. These findings highlight the influence of clinical and sociodemographic factors on diversion selection. The extent to which these findings reflect practice patterns beyond NSQIP remains uncertain.

PMID:41390999 | DOI:10.1016/j.urolonc.2025.09.013

Explore (NY). 2025 Nov-Dec;21(6):103266. doi: 10.1016/j.explore.2025.103266. Epub 2025 Oct 9.

ABSTRACT

OBJECTIVE: This study aimed to assess the efficacy of self-acupressure in alleviating fatigue and enhancing sleep quality among individuals diagnosed with multiple sclerosis.

METHODS: In our randomized controlled study, participants in the intervention group were instructed to administer self-acupressure on two specific sites. Patients were directed to administer the therapy to the specified two sites biweekly in the morning, at least one hour after breakfast, for a duration of 4 weeks, culminating in a total of 8 sessions. No intervention occurred in the control group during this study. Data were gathered utilizing the Patient Introductory Information Form, the Fatigue Severity Scale (FSS), and the Richards-Campbell Sleep Questionnaire (RCSQ).

RESULTS: The study comprised twenty-four individuals with multiple sclerosis in each group, comprising fourteen women in the intervention group and thirteen women in the control group. Subsequent to the intervention, the intervention group demonstrated a statistically significant decrease in total FSS scores compared to the control group (p < 0.001; d = 1.68), although total RCSQ scores revealed a substantial gain (p < 0.001; d = 1.65).

CONCLUSION: Self-acupressure was proven to reduce fatigue levels and improve sleep quality in adults with multiple sclerosis. In conclusion, self-acupressure is an accessible, cost-effective, and efficacious technique for alleviating fatigue and enhancing sleep quality in patients with multiple sclerosis.

PMID:41390991 | DOI:10.1016/j.explore.2025.103266

Patient Educ Couns. 2026 Jan;142:109397. doi: 10.1016/j.pec.2025.109397. Epub 2025 Oct 20.

ABSTRACT

BACKGROUND: Health literacy plays a crucial role in traditional healthcare access, engagement, and outcomes, yet its impact within newer digital mental health (dMH) services remains unknown. This is a significant knowledge gap given that the digitalisation of mental health care is predicated on the idea of improving access and outcomes for traditionally underserved groups. This study aimed to investigate the prevalence and correlates of limited health literacy among routine care dMH service users.

METHODS: A prospective cohort study was conducted using data from 4578 adults who completed an initial assessment for a large national dMH service between January and June 2024. Limited health literacy was assessed using the Single Item Literacy Screener (SILS) (i.e., scored ≥ 3 out of 5). Analyses examined associations between limited health literacy and user characteristics, treatment enrolment and initiation.

RESULTS: At initial assessment, 11.4 % of participants reported limited health literacy, with these individuals more likely to be younger, have lower educational attainment, less proficiency in English, not be in employment nor married, and identify as Aboriginal and/or Torres Strait Islander (all ps<.001). They also reported more severe symptoms of depression and anxiety, and higher suicide risk (all ps<.001). Limited health literacy was not significantly associated with treatment enrolment nor initiation (ps = 0.322 – 0.985).

DISCUSSION: Findings indicate that a meaningful proportion of routine care dMH service users have limited health literacy, and this does not appear to impede access to the treatments provided by these services. Thus, dMH services may go some of the way to providing mental health treatment for groups who face heightened barriers to accessing healthcare. Further research is needed to ascertain whether limited health literacy impacts on users’ ongoing treatment engagement and outcomes, as well as which aspects of dMH service design and delivery may benefit users with diverse health literacy levels.

PMID:41390986 | DOI:10.1016/j.pec.2025.109397

Clin Transl Sci. 2025 Dec;18(12):e70405. doi: 10.1111/cts.70405.

ABSTRACT

The kidney benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients receiving contrast media remain unclear. This Taiwanese cohort study investigated the short- and long-term effects of SGLT2i on adverse kidney outcomes in patients receiving contrast media between January 1, 2016 and December 31, 2018. Patients who had used SGLT2i in the 90 days prior to receiving contrast media were matched with non-users. Cox proportional hazards regression was used to estimate the hazard ratio (HR) for the composite kidney outcome, which included acute kidney injury (AKI), acute kidney disease (AKD), and a sustained ≥ 30% reduction in estimated glomerular filtration rate (eGFR) confirmed after 3 months. The absolute mean change in eGFR over time was compared using a linear mixed-effects model. The final analysis included 1032 patients (SGLT2i: 344; control: 688). During follow-up, the overall composite adverse kidney event rate was 32.8%. Although the SGLT2i group had a lower event rate (29.94%) than the non-SGLT2i group (34.3%), this difference was not statistically significant (HR, 0.95; 95% CI, 0.75-1.20). Crucially, SGLT2i demonstrated a significant protective effect on long-term kidney function: the hazard for a ≥ 30% eGFR reduction was significantly lower in SGLT2i users (HR, 0.48; 95% CI, 0.29-0.81). Exploratory analyses showed that this benefit-a slower rate of kidney function deterioration-was consistent across subgroups, including men, patients under 65 years, individuals with baseline eGFR < 60 mL/min/1.73 m², and patients with diabetes. While SGLT2i showed no significant short-term protection against AKI or AKD, these findings strongly suggest that SGLT2i confers significant long-term reno-protective benefits for patients receiving contrast media.

PMID:41390985 | DOI:10.1111/cts.70405

Rheumatology (Oxford). 2025 Dec 14:keaf680. doi: 10.1093/rheumatology/keaf680. Online ahead of print.

ABSTRACT

OBJECTIVES: We tested the hypotheses that individuals with gout would have distinct circulating inflammatory biomarker patterns compared with non-gout controls and that these differences would be attenuated with highly-effective urate-lowering therapy (ULT).

METHODS: This case-control and longitudinal cohort study utilized longitudinal serum samples from a subset of participants from the STOP Gout study and non-gout controls from an institutional biobank at a single time point. Twenty pre-selected inflammatory and cardiometabolic biomarkers were measured and varimax-rotated principal component analysis (PCA) performed. An inflammatory score was generated using standardized biomarker values representing PCs associated with gout and compared between controls and gout patients, and among gout patients over time. A generalized estimating equation was used to assess interactions between clinical factors and change in inflammatory score over time.

RESULTS: Five PCs statistically differed in gout (n = 278) at baseline vs. controls (n = 275) after accounting for covariates. Mean inflammatory scores of gout cases at all three time points were increased vs. controls (p < 0.001). There was a decrease in inflammatory scores at both 24- (p = 0.01) and 48-weeks (p < 0.001) vs. baseline among gout cases. Higher baseline score and time were associated with reductions in inflammatory score, whereas hypertension and higher baseline serum urate were associated with an increased inflammatory score.

CONCLUSION: Gout is characterized by distinct patterns of circulating inflammatory biomarkers and these appear to change over time with treat-to-target ULT to approximate controls. This study supports the importance of treat-to-target ULT in gout management not only for flare prevention, but also to mitigate systemic inflammation.

PMID:41390970 | DOI:10.1093/rheumatology/keaf680

Gerontologist. 2025 Dec 14:gnaf302. doi: 10.1093/geront/gnaf302. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Compared with people in any other age group, older adults worldwide have more suicidal ideation; however, their suicidal ideation is easily overlooked. Social support is currently one of the most widely researched social resources for preventing suicide. Currently, the impact of social support on suicidal ideation in this population is still uncertain. This study aimed to explore the impact of social support on suicidal ideation in older adults.

RESEARCH DESIGN AND METHODS: A comprehensive literature search was conducted across multiple databases, including the Web of Science, PubMed, EMBASE, CINAHL, Cochrane Library and Scopus databases. Two independent researchers selected the studies, extracted the data and evaluated their quality. Statistical analysis was performed using STATA version 18.0.

RESULTS: This review identified 23 studies, and 14 eligible studies were included in the meta-analyses. High social support was significantly associated with a low risk of suicidal ideation (OR, 0.75; 95% CI, 0.67 to 0.84; I 2 = 93.1%; P < 0.001). Social support is more effective in reducing the risk of SI in women than in men. Social support from families is most effective at reducing suicidal ideation in older adults, and social support can also influence suicidal ideation through mediating factors.

DISCUSSION AND IMPLICATIONS: Social support is significantly correlated with suicidal ideation in older adults. Medical staff or researchers can prioritise social support from families and develop targeted interventions to more effectively reduce the risk of suicidal ideation in older adults.

PMID:41390965 | DOI:10.1093/geront/gnaf302

Gerontologist. 2025 Dec 14:gnaf303. doi: 10.1093/geront/gnaf303. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Population aging underscores the need for a comprehensive understanding of the multi-level factors that support aging in place. Physical environments are closely linked to social environments, and caregivers often observe how these environmental features shape the everyday experience of people with memory problems. This study examines how caregivers’ perceptions of neighborhood built environments are associated with their perceptions of the social inclusion of people with memory problems in communities.

RESEARCH DESIGN AND METHODS: A statewide survey was conducted in Texas, involving 95 caregivers of individuals with memory problems (defined as having significant memory impairment that impacts daily functioning). Descriptive statistics summarized neighborhood characteristics and caregivers’ perception of the community’s social inclusion. Logistic regression predicted two target outcomes of social inclusion for people with memory problems: (1) respect and support and (2) intergenerational exchange (e.g., age-integrated social interactions).

RESULTS: For neighborhood characteristics, legibility-related environmental features were more commonly present than those related to accessibility or safety. For social inclusion, caregivers perceived positive community respect and support for people with memory problems but limited intergenerational interaction. Legibility of neighborhood environments was positively associated with caregivers’ perceptions of respect and support for people with memory problems, while accessibility was associated with intergenerational exchange.

DISCUSSION AND IMPLICATIONS: The findings underscore the role and potential of neighborhood environments for improving social inclusion for people living with memory problems. They suggest that improving legibility and accessibility of neighborhood environments can foster respect and social support and intergenerational exchanges central to aging in place.

PMID:41390960 | DOI:10.1093/geront/gnaf303

Aliment Pharmacol Ther. 2025 Dec 14. doi: 10.1111/apt.70490. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) reactivation is a serious complication in patients receiving chronic immunosuppression. Anti-CD20 agents such as Rituximab are considered high risk for HBV reactivation (> 10%); therefore, antiviral prophylaxis is recommended for all anti-HBc positive patients. Some studies have suggested that patients with resolved HBV infection and higher hepatitis B surface antibody (anti-HBs) titer have a higher level of protection against reactivation.

AIM: The purpose of this study was to systematically review the role of anti-HBs titer on HBV reactivation in patients on rituximab while not on antiviral therapy/prophylaxis.

METHODS: We systematically reviewed all studies that discussed HBV reactivation in patients on rituximab therapy with resolved HBV infection, defined as HBsAg negative and anti-HBc positive, which discussed anti-HBs titer. The search was conducted in PubMed, Embase via Elsevier, Scopus, and Cochrane CENTRAL inclusive July 2025. We evaluated the incidence of HBV reactivation from cohort studies that described anti-HBs categorically based on anti-HBs titer: ‘negative’ (titer < 10 iU/L), ’10-100 iU/L’, or ‘> 100 iU/L’. Meta-analysis statistics describe the proportion and risk difference for different anti-HBs levels.

RESULTS: The overall reactivation rate was 12.6%. There was a significant difference in HBV reactivation depending on titer: anti-HBs negative 27.3% (51/195) (20.0%-36.0%), titer < 100 iU/L 13.8% (47/379) (8.8%-20.8%), and titer > 100 iU/L 3.5% (8/339) (1.8%-6.9%).

CONCLUSIONS: Those with anti-HBs titer > 100 iU/L can be considered lower risk for HBV reactivation and may not require antiviral therapy, but monitoring with initiation of antiviral therapy if titer falls below 100 iU/L.

PMID:41390946 | DOI:10.1111/apt.70490

Scand J Psychol. 2025 Dec 14. doi: 10.1111/sjop.70060. Online ahead of print.

ABSTRACT

Major depressive disorder (MDD) is associated with reduced quality of life and relapse risk. However, few studies have investigated how quality of life is associated with cognitive deficits following MDD and is affected by cognitive training. This study investigated the long-term effects of computer-based working memory training (CWMT) on health-related quality of life (HRQL) in remitted MDD, and the association between executive functions (EF) and HRQL. Twenty-nine remitted participants (M age 36.21, SD = 10.8) were included in a pre-post pilot study of CWMT with 1- and 2-year follow-up. Twenty participants completed 5 weeks of CWMT, 12 participants were included at the 1-year follow-up, and 10 participants returned for the 2-year follow-up. The 36-item Short-Form Health Survey was used to assess HRQL. Associations between subjective and objective cognitive EF and HRQL were measured by the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) and a neuropsychological test battery of EF. Significant moderate improvements were found in aspects of HRQL after 2 years (d = 0.66). There were negative correlations between HRQL and BRIEF-A pre-intervention (r = 0.47-0.65). However, the study did not find significant associations between improved EF and improved HRQL. Preliminary results indicate long-term improvements in HRQL following CWMT. Subjective EF deficits were associated with poorer HRQL. However, due to limitations including small sample size and multiple statistical comparisons, larger controlled studies are needed to investigate and replicate the potential effects of CWMT on HRQL.

PMID:41390937 | DOI:10.1111/sjop.70060