Tag: nevin manimala

Nurs Open. 2026 Jul;13(7):e70666. doi: 10.1002/nop2.70666.

ABSTRACT

BACKGROUND: Decision-making readiness is essential for effective patient participation in treatment decisions, especially for lung cancer patients receiving chemotherapy who face repeated complicated treatment choices. However, existing research investigating their level of decision-making readiness and its associated influencing factors remains inadequate.

AIMS: This study aimed to investigate the level of decision-making readiness among hospitalized lung cancer patients undergoing chemotherapy, and further explore the influencing factors of their decision-making readiness.

MATERIALS AND METHODS: A cross-sectional observational design was adopted. A total of 452 hospitalized lung cancer patients receiving chemotherapy were recruited using convenience sampling. Data were collected via multiple questionnaires: the Chinese Version of the Preparation for Decision Making Scale, Decisional Conflict Scale, Patient Attitude Toward Treatment Decision-Making Scale, Decision Regret Scale, and a self-designed questionnaire covering sociodemographic and clinical characteristics. Descriptive statistics, correlation analysis, and hierarchical multiple linear regression were applied for data analysis.

RESULTS: The median score of participants’ decision-making readiness was 62.00 (56.00, 70.00), representing a moderate overall readiness level. Correlation analysis demonstrated that decision-making readiness was positively associated with patients’ willingness to participate in treatment decision-making and negatively associated with decisional conflict. Hierarchical regression revealed that demographic variables could explain 9.2% of the total variance of decision-making readiness, and the inclusion of decisional conflict and decision participation attitude raised the explanatory power to 31.1%. Economic status, residential location, decisional conflict and participation attitude were identified as significant predictive factors of decision-making readiness.

DISCUSSION: Lung cancer patients undergoing chemotherapy only possess moderate decision-making readiness. Compared with demographic characteristics, psychosocial factors (decisional conflict and decision participation attitude) exert a stronger impact on patients’ decision-making readiness. These findings also support the applicability of the Common Sense Model of Self-Regulation in the field of cancer treatment decision-making research.

CONCLUSION: Targeted nursing decision-support interventions are urgently needed to assess and elevate lung cancer patients’ decision-making readiness, which can further promote the practice of patient-centered treatment decision-making.

PMID:42366843 | DOI:10.1002/nop2.70666

J Med Virol. 2026 Jul;98(7):e71040. doi: 10.1002/jmv.71040.

ABSTRACT

This study estimates the incidence of symptomatic COVID-19 cases, both documented and undocumented, among U.S. Veterans across demographic groups from the beginning of the pandemic to the end of the public health emergency on May 11, 2023. By analyzing a cohort of Veterans alive as of March 1, 2020, we extended a mortality-based estimation approach to measure COVID-19 incidence. We relaxed the assumptions of a constant infection fatality rate (IFR) over time and across age groups and broadened the model from considering only excess respiratory deaths to including excess all-cause deaths. Descriptive analyses were performed to understand differential ascertainment biases among demographic groups. Resulting estimates suggested a significantly higher number of COVID-19 cases among Veterans than those documented in the electronic health record. We also identified varying biases among different demographic groups. These estimates offer a clearer view of COVID-19’s impact on Veterans, accounting for missed cases among those who sought care outside of the VA. Differences between documented and estimated cases were substantial. Policymakers should recognize that actual numbers are likely much higher than documented and that documented rates may not be directly comparable across populations or time periods.

PMID:42366842 | DOI:10.1002/jmv.71040

Health Technol Assess. 2026 Jun;30(53):1-34. doi: 10.3310/GJCB1006.

ABSTRACT

BACKGROUND: Fatigue is common in many long-term medical conditions. Interventions to date have largely been in single conditions.

OBJECTIVE: To conduct a mixed-methods evidence synthesis of the clinical and cost-effectiveness and acceptability of non-pharmacological interventions for fatigue in adults with long-term medical conditions.

METHODS: Randomised controlled trials, cost-effectiveness studies, or qualitative studies of non-pharmacological interventions for fatigue in long-term medical conditions where fatigue was either a criterion for inclusion, the primary target of the intervention, or the primary or coprimary outcome. Studies of post-infectious, post-traumatic, cancer-related or idiopathic fatigue were excluded.

INFORMATION SOURCES: Searches used the MEDical Literature Analysis and Retrieval System, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association PsycInfo^® (American Psychological Association, Washington, DC, USA) databases. We used systematic CLUSTER searching for qualitative studies and Epistemonikos for systematic reviews.

INVOLVEMENT OF PATIENTS: We held three rounds of five focus groups involving people with fatigue in long-term conditions to ensure that assumptions in, and reporting of, the research had validity with the patient population.

RISK OF BIAS: Risk-of-bias assessment of all studies included in the network meta-analysis was undertaken using an adapted version 2 of the Cochrane risk-of-bias tool for randomised controlled trials.

SYNTHESIS OF RESULTS: Clinical effectiveness evaluation used random effects network meta-analyses at three time points. The cost-effectiveness analysis involved a de novo analysis of interventions identified as clinically effective. The qualitative synthesis involved a thematic synthesis of primary studies of interventions and a mega-synthesis of reviews of patient experience of fatigue across different conditions. Focus groups were analysed by thematic analysis, and findings from all work packages were integrated in a final synthesis by the research team.

RESULTS: The clinical effectiveness review included 88 randomised controlled trials, involving 27 interventions, with 6636 participants included at end of treatment, 1849 in the short term and 2322 in the long term.

SYNTHESIS OF RESULTS: Compared to usual care at long-term follow-up, cognitive-behavioural therapy-based interventions and physical activity promotion showed statistically significant reductions in fatigue (standardised mean difference -0.4, 95% credible interval -0.63 to -0.21, 9 studies; and -0.52, -0.86 to -0.18, 2 studies), respectively. Effective interventions provided positive net monetary benefit versus usual care, particularly when delivered in a group format, when valuing a quality-adjusted life-year at £20,000. Individuals vary in their experience of fatigue in ways that are not simply due to their medical condition, indicating that interventions need to be adaptable to individuals’ experiences and capabilities.

DISCUSSION: The evidence base is relatively small, heterogeneous and includes studies at moderate to high risk of bias. More than half of the included trials were in multiple sclerosis.

INTERPRETATION: Interventions for fatigue that support people to increase physical activity or are based on cognitive-behavioural therapy are acceptable and effective in reducing fatigue in people with different long-term medical conditions, with the potential to be cost-effective. Based on the qualitative synthesis, we propose a three-stage component model for interventions.

FUTURE WORK: Future trials should focus on the feasibility and effectiveness of transdiagnostic fatigue services, fatigue interventions in multimorbidity, and investigations of emerging non-invasive stimulation interventions.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR154660.

PMID:42366788 | DOI:10.3310/GJCB1006

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261434121. doi: 10.1177/21501319261434121. Epub 2026 Jun 28.

ABSTRACT

OBJECTIVE: Digital health literacy (DHL) is a critical component for the effective self-management and secondary prevention of hypertension. However, the multi-level determinants of DHL in community settings are not yet fully understood. This study aimed to assess the status of DHL and identify its key sociodemographic, psychosocial, and health system determinants among adults with hypertension in China.

METHODS: A cross-sectional survey was conducted (October 2024-January 2025) across 1 tertiary general hospital and 3 community health service centers in Changzhou, China. Data were collected from 660 hypertensive adults using a structured questionnaire, including the eHealth Literacy Scale (eHEALS), and scales for physician-patient interaction, perceived internet health information quality, and perceived family support. Determinants were analyzed using multivariate logistic regression and a random forest model to rank factor importance.

RESULTS: Nearly half of the participants (49.45%) demonstrated low DHL. Multivariate logistic regression indicated that older age (specifically ≥75 years: OR = 13.33, 95% CI = 1.73-99.88), limited internet use (<1 h/day: OR = 2.50, 95% CI = 1.04-5.88), and concerns regarding data privacy (OR = 3.42, 95% CI = 1.01-11.58) were significant predictors of low DHL. Additionally, higher perceived quality of internet health information (OR = 0.72, 95% CI = 0.67-0.78), better physician-patient interaction (OR = 0.92, 95% CI = 0.86-0.99), and greater family support (OR = 0.37, 95% CI = 0.25-0.55) were associated with lower odds of low DHL. The random forest model identified the perceived quality of internet health information as the most influential predictor, followed by age and data privacy.

CONCLUSION: DHL levels among individuals with hypertension in the community are suboptimal. These findings highlight the potential importance of a multilevel approach to supporting DHL. Efforts to improve the perceived quality of internet health information and strengthen social support systems may be beneficial, and primary care providers could play an important role in guiding patients’ use of digital health resources.

PMID:42366774 | DOI:10.1177/21501319261434121

Spec Care Dentist. 2026 Jul-Aug;46(4):e70197. doi: 10.1111/scd.70197.

ABSTRACT

BACKGROUND: The Katkari tribe in Goa, India, faces significant oral health challenges due to cultural beliefs, poor access to healthcare, and high tobacco consumption. This study aims to assess the oral health status, oral health beliefs, and tobacco habits within this isolated community.

METHODS: A descriptive cross-sectional study was conducted among 101 participants from tribal settlements in North and South Goa between October and December 2023. A structured questionnaire was used to collect data on sociodemographics, oral hygiene practices, myths about oral health, and tobacco use. Participants underwent clinical examination using the WHO Oral Health Assessment Form. Data analysis was performed using IBM SPSS version 20, with descriptive statistics and Chi-Square test and Fisher’s exact test to explore associations between variables.

RESULTS: The mean age of participants was 28.9 years, with 57.4% females. Most participants had low educational levels, and 64.35% reported using toothbrushes for oral hygiene. However, brushing habits were suboptimal, with 64.4% using incorrect brushing techniques. Myths such as “clove oil relieves toothache” (68.3%) and “tobacco relieves toothache” (51.5%) were prevalent. Tobacco use was high, with 66.3% consuming smokeless tobacco, and the most common reasons for use were family influence (37.6%) and peer pressure (28.7%). Education and occupation significantly influenced oral health behavior and tobacco habits.

CONCLUSION: The study highlights the significant oral health challenges faced by the Katkari tribe, including poor hygiene practices, high tobacco use, and widespread myths. These issues are compounded by low education levels and limited healthcare access. Culturally sensitive health education, community-based interventions, and tobacco cessation programs are needed to address these challenges and improve the overall health of the community.

PMID:42366758 | DOI:10.1111/scd.70197

Can Respir J. 2026;2026(1):e3703610. doi: 10.1155/carj/3703610.

ABSTRACT

BACKGROUND: This study primarily analyzed differences in venous thromboembolism (VTE) characteristics across altitudes and their temporal trends during the puerperium. Additionally, it identified independent risk factors for postpartum pulmonary embolism (PE).

METHODS: This retrospective study reviewed all postpartum VTE cases at People’s Hospital of Xizang Autonomous Region between 2015 and 2024.

RESULTS: This cohort study of 172 postpartum women (median age 31 [IQR 26-36]) compared high-altitude (HA, n = 109) and very high-altitude (VHA, n = 63) groups. PE proportion was significantly higher in VHA vs. HA ( p = 0.033). VHA subjects also showed significant elevated preterm delivery (p = 0.033) and ≥ 3 deliveries (p < 0.001). Joinpoint regression (2015-2024) revealed biphasic trends: significant early-phase escalations in VTE (APC = 18.05%) and deep vein thrombosis (DVT) (APC = 19.66%) during 2015-2022 (p < 0.05), followed by clinically relevant (though statistically nonsignificant) late-phase reductions. PE proportion demonstrated a significant overall increase (APC = 18.77%, p < 0.05). In multivariate analysis, four independent predictors significantly increased PE risk: altitude gradient (OR 1.035, p < 0.001), multiparity (OR 2.548, p = 0.004), hypertension or eclampsia (OR 1.797, p = 0.001), and structural heart disease (OR 1.988, p < 0.001).

CONCLUSION: This decade-long analysis (2015-2024) revealed significant altitudinal gradients in postpartum VTE. Clinically significant escalation of postpartum VTE burden in high-altitude populations warrants urgent intervention. Integrated multiparity management and enhanced comorbidity control are critical future initiatives for resolving key perinatal thrombotic risk bottlenecks.

PMID:42366755 | DOI:10.1155/carj/3703610

Pediatr Emerg Care. 2026 Jun 29. doi: 10.1097/PEC.0000000000003645. Online ahead of print.

ABSTRACT

OBJECTIVES: Chest tube thoracostomy is a core skillset within pediatric emergency medicine (PEM); however, few PEM physicians perform this procedure regularly. Site selection is typically performed through landmark identification of the fifth intercostal space (ICS), and incorrect placement can result in serious morbidity. The aims of this study were to evaluate the accuracy of safe thoracostomy site selection among PEM providers, and to identify relationships between provider demographics and experience with performance in this selection process.

METHODS: This was a single-center observational study using a convenience sample of pediatric emergency department (PED) patients. Providers marked the fifth ICS bilaterally using the landmark technique, and the ICS and diaphragm levels were subsequently confirmed using point-of-care ultrasound (POCUS). Descriptive statistics were calculated for patient and provider characteristics. Associations between provider characteristics with location of the ICS mark were evaluated using a generalized estimating equation approach.

RESULTS: Fifteen participating PEM providers performed 120 bilateral landmark-based ICS identifications. Among all identified sites (n=240), only 37.1% (n=89) were accurately confirmed as the fifth ICS, with 12.9% (n=31) being below the fifth ICS. Furthermore, 9.2% (n=22) of all sites were located below the diaphragm during resting breathing. Providers with longer tenure, more PED experience, greater number of chest tubes placed, and greater comfort with identifying the fifth ICS were more likely to mark below the fifth ICS (P=0.004, 0.026, <0.001, <0.001, respectively).

CONCLUSIONS: This study demonstrates a considerable gap in thoracostomy site selection accuracy among PEM physicians. A significant number of chosen sites were found to be below the fifth ICS, and there was a surprising discordance between provider experience and accuracy. These findings highlight a critical gap in performance and the need for ongoing training. Incorporating POCUS into standard practice may improve site selection accuracy and patient outcomes in the PED setting.

PMID:42366752 | DOI:10.1097/PEC.0000000000003645

Risk Anal. 2026 Jul;46(7):e70285. doi: 10.1111/risa.70285.

ABSTRACT

Holidays in the United States can be quite deadly, with more than 500 traffic fatalities on a given holiday. Another uniquely dangerous period is the annual spring break for college students, which starts at the end of February and continues through the first week of April. Although spring break is not a phenomenon across the entire United States, it is especially popular in certain hotspots. In this study, we focus on Florida, the state with the highest number of spring break hotspots in the country. We analyze weekly county-level crash data from the Florida Department of Highway Safety and Motor Vehicles that provides information on all motor vehicle crashes (whether fatal or not) reported to law enforcement. We compare the estimates for fatal and nonfatal traffic injuries during spring break to those during the holiday period between Thanksgiving and New Year’s Day. While both periods are similar in terms of fatalities, the spikes in nonfatal injuries are more pronounced during spring break. Subgroup analyses provide additional insight. Numerous robustness checks and sensitivity analyses confirm the core findings.

PMID:42366744 | DOI:10.1111/risa.70285

Dementia (London). 2026 Jun 28:14713012261463708. doi: 10.1177/14713012261463708. Online ahead of print.

ABSTRACT

Background: Hearing loss is a well-established modifiable risk factor for dementia at the individual level, but less is known about whether hearing loss prevalence aligns with dementia prevalence at the country level across diverse socioeconomic and demographic contexts. This study examined sex-stratified country-level associations between hearing loss prevalence and dementia prevalence, while avoiding causal interpretation of ecological associations. Methods: Country-level sex-specific prevalence estimates for hearing loss and dementia prevalence were obtained from the Global Burden of Disease data resources. Analyses were conducted separately for females and males and included descriptive sample summaries, Pearson and Spearman correlations, principal component analysis, partial correlations used as sequential robustness checks, and theory-informed multivariable linear regression. Variables were log10-transformed for the primary analyses. Models adjusted for economic development, urbanisation, the Henneberg Index, and sex-specific life expectancy at age 60. Formal sex comparison was evaluated using coefficient-comparison testing of the hearing-loss effect from comparable adjusted models. Results: The global bivariate association between hearing loss prevalence and dementia prevalence was strong in females (Pearson r = 0.827; Spearman rho = 0.845; p < 0.001) and males (Pearson r = 0.848; Spearman rho = 0.855; p < 0.001). Principal component analyses indicated that hearing loss prevalence clustered with socioeconomic and demographic indicators in both sexes, explaining more than 70% of total variance. In multivariable regression models, adding hearing loss increased explanatory power in females (R² from 0.661 to 0.827) and males (R² from 0.674 to 0.811). A formal coefficient-comparison test did not indicate a statistically meaningful difference between the female and male hearing-loss coefficients in the fully adjusted models (z = 0.82; p = 0.41). Conclusions: Hearing loss prevalence is strongly associated with dementia prevalence at the country level in both females and males after adjustment for macro-level socioeconomic and demographic covariates. The findings support the population-level relevance of hearing health for dementia surveillance and prevention, while indicating broad convergence rather than clear sex-based divergence in the hearing loss-dementia association.

PMID:42366738 | DOI:10.1177/14713012261463708

Biotechnol Bioeng. 2026 Jun 28. doi: 10.1002/bit.70279. Online ahead of print.

ABSTRACT

CRISPR-Cas9 is a widely used genetic tool with therapeutic potential in molecular biology. CRISPR-Cas9 enables precise genome editing by its ability to target specific DNA sequence. After off-target and on-target regions are identified, CRISPR-Cas9 is applied to these regions based on the match between the guide RNA (gRNA) and target DNA sequence. This study points to the off-target impact of mismatches between the gRNA and target DNA on exon regions of the TP53 gene, which are involved in regulating multiple genes and cellular functions. Off-target positions are typically evaluated using scoring methods. In this study, we have used latent class analysis to reveal subclasses of off-target positions. Thus, we have created the levels of off-target positions and evaluated the effects of mismatching positions within these classes using machine learning classifiers. The results revealed that mismatching positions could be categorized into three levels: low, middle, and high off-target positions. We have improved a computational framework to minimize off-target effects and to identify the PAM sequences in the gRNA design. Thus, carefully designed gRNAs will ensure that desired genetic edits are performed and target variants are achieved. This work will avail the future research aimed at optimizing genome editing by customizing CRISPR-Cas9 to target specific protospacer DNA through gRNA.

PMID:42366734 | DOI:10.1002/bit.70279