Tag: nevin manimala

Environ Health. 2026 Jul 11. doi: 10.1186/s12940-026-01320-9. Online ahead of print.

ABSTRACT

BACKGROUND: Heatwaves increasingly threaten public health in the Mediterranean region, and Greece is among the hardest hit countries. Yet evidence on long-term adaptation, spatial vulnerability, and the contribution of human-induced climate change to heatwave-related mortality in Greece remains limited.

METHODS: We analysed 2,144,957 all-cause deaths in Greece (2000-2019) in people older than 65 years using a time-stratified case-crossover design. We derived population-weighted daily maximum temperatures at NUTS3 level from ERA5 reanalysis and WorldPop. We applied six heatwave definitions (HD1-HD6) varying by duration (≥ 2 or ≥ 3 days) and thresholds (90th, 95th, 99th percentiles). We fitted Bayesian hierarchical Poisson models to estimate heatwave-mortality associations varying by space and time. We additionally adjusted for relative humidity and national holidays. We then combined these estimates with probabilistic climate-attribution methods to quantify the number and proportion of heatwave-related deaths attributable to human-induced climate change.

RESULTS: Heatwaves raised mortality consistently, with relative risks from 1.08 (95% CrI (Credible Interval): 1.07-1.09; HD1) to 1.15 (1.12-1.19; HD6). Risks increased with heatwave intensity and duration, with particularly high risks observed among females and older adults. We did not detect a consistent temporal decline in risk or marked spatial heterogeneity. Human-induced climate change accounted for 46-80% of heatwave-related deaths across definitions. The proportion attributable to climate change rose over time.

CONCLUSIONS: Heatwaves already impose a major mortality burden in Greece, with more than half driven by anthropogenic climate change and little evidence of population-level adaptation. These findings call for rapid emissions reductions and targeted adaptation, including stronger heat-health warning systems and protection of vulnerable groups.

PMID:42436540 | DOI:10.1186/s12940-026-01320-9

BMC Med. 2026 Jul 11. doi: 10.1186/s12916-026-05064-8. Online ahead of print.

ABSTRACT

BACKGROUND: The present study sought to compare the clinical efficacy and safety profiles of radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients who attained complete or partial response (CR/PR) following induction chemotherapy (IC).

METHODS: This multicenter, randomized, open-label, phase 3 noninferiority trial was conducted at 7 Chinese hospitals. Patients with newly diagnosed stage III-IVb NPC who achieved CR/PR after IC were randomly allocated (1:1) to either the RT (IC + RT) group or the CCRT (IC + CCRT) group. The chemotherapy protocol was identical across the two treatment groups. The primary endpoint was progression-free survival (PFS). Secondary endpoints comprised overall survival (OS) and the incidence of adverse events. Statistical analyses were performed using the Kaplan-Meier method and log-rank test.

RESULTS: From December 2016 to May 2023, 220 eligible patients with histologically confirmed nasopharyngeal carcinoma were enrolled. The trial was terminated early due to slow accrual. Of these patients, 109 were assigned to the IC + RT group and 111 to the IC + CCRT group. The median follow-up was 57 months (range, 8-107 months). The IC + RT and IC + CCRT groups showed comparable 5-year progression-free survival rates (87.0% vs. 80.7%, P = 0.21). No significant differences were observed between the two treatment arms with respect to local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, distant metastasis-free survival, or overall survival (all P > 0.05). The IC + RT group had significantly lower incidences of grade 3-4 hematologic and gastrointestinal toxicities than the IC + CCRT group. Additionally, grade 1-2 deafness/otitis and liver dysfunction were also less frequent in the IC + RT group.

CONCLUSIONS: In NPC patients achieving CR/PR after induction chemotherapy, IC + RT demonstrated a favorable safety profile compared with IC+CCRT. Although the observed survival outcomes were numerically comparable, the premature termination of the trial and insufficient statistical power preclude a definitive noninferiority claim. These hypothesis-generating findings warrant validation in future adequately powered trials.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT03015727.

PMID:42436536 | DOI:10.1186/s12916-026-05064-8

Biopsychosoc Med. 2026 Jul 11. doi: 10.1186/s13030-026-00366-y. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Asthma is the most prevalent chronic disease in childhood, and self-efficacy is a key determinant of symptom control, treatment adherence, and prevention of exacerbations. Despite advances in pharmacological management, many children continue to experience barriers that hinder effective self-management. This study aimed to assess the level of self-efficacy and identify its limiting factors among children with asthma aged 8-18 years.

METHODS: This descriptive cross-sectional study was conducted in 2025 at a pediatric specialty clinic affiliated with a teaching hospital. A total of 100 children with asthma were recruited using convenience sampling. Data were collected using A demographic questionnaire, the Asthma Self-Efficacy Scale, and the Limiting Factors of Self-Efficacy Questionnaire were used to collect the data. The instruments demonstrated acceptable content validity and internal consistency. Data analysis was done with descriptive statistics, Spearman’s correlation, and multiple linear regression in SPSS version 22, with statistical significance set at p < 0.05.

RESULTS: The findings indicated a moderate level of self-efficacy among children with asthma, accompanied by a relatively low-to-moderate level of perceived limiting factors. Spearman’s correlation showed a significant positive association between the frequency of asthma attacks and limiting factor scores (r = 0.197, p = 0.049), suggesting that increased exacerbations were associated with greater perceived barriers to disease management. Multiple linear regression analysis revealed that longer disease duration significantly predicted higher self-efficacy, whereas lower paternal educational level was associated with reduced self-efficacy. The most commonly reported barriers included insufficient disease-related knowledge, concerns about medication side effects, and challenges in treatment follow-up, while family support emerged as a key facilitator of self-efficacy.

CONCLUSION: Children with asthma exhibited moderate self-efficacy in disease management, while cognitive, attitudinal, and family-related barriers undermined sustained self-care behaviors. Strengthening family-centered educational interventions, improving parental health literacy, and implementing targeted nursing programs may contribute to improving self-efficacy and reducing perceived barriers.

PMID:42436530 | DOI:10.1186/s13030-026-00366-y

BMC Sports Sci Med Rehabil. 2026 Jul 11. doi: 10.1186/s13102-026-01878-4. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined whether contralateral-limb balance training, grounded in cross-education theory, enhances gait speed and reconstructed-knee kinematics during early postoperative recovery from anterior cruciate ligament reconstruction (ACLR).

METHODS: A single-blind randomized controlled trial enrolled 40 patients 5-6 weeks post-ACLR, randomized 1:1 to an experimental group (n = 20; contralateral-limb balance training plus conventional rehabilitation) or a control group (n = 20; conventional rehabilitation alone), for 6 weeks (three sessions per week). Lower-limb kinematics during walking were captured using a Vicon three-dimensional motion-capture system, quantifying gait speed and knee-joint range of motion (ROM), peak angular velocity, and peak angular acceleration in the sagittal, coronal, and transverse planes. Data were analyzed using generalized estimating equations (GEE), with analysis of covariance (ANCOVA) examining whether gait-speed changes confounded the kinematic outcomes.

RESULTS: The groups showed no baseline differences (all P > 0.05). Gait speed increased in both (both P < 0.001), with a significant time × group interaction favoring the experimental group (χ² = 11.98, P < 0.001; Hodges-Lehmann estimate 0.08 m/s, 95% CI 0.05-0.11). Sagittal-plane knee ROM likewise improved more in the experimental group (interaction χ² = 9.79, P = 0.002; mean difference 8.97°, 95% CI 5.40-12.54°; d = 1.61). No significant interactions emerged for coronal or transverse ROM, or for peak angular velocity or acceleration in any plane (all P > 0.05). ANCOVA showed that the sagittal-ROM advantage persisted after adjustment for gait-speed change (P = 0.002), indicating an independent benefit, whereas an apparent sagittal peak-angular-velocity advantage disappeared after adjustment (P = 0.165). Against available cross-population minimal clinically important difference (MCID) values (no ACLR-specific standards exist), the gait-speed difference fell below the multi-pathology range (0.10-0.20 m/s), whereas the sagittal-ROM difference exceeded the chronic-stroke reference (8.48°), although its 95% CI lower bound did not.

CONCLUSION: Contralateral-limb balance training, as an adjunct to conventional rehabilitation, yielded greater improvements in gait speed and sagittal-plane knee ROM following ACLR, with the ROM benefit being independent of concurrent gait-speed gains. Kinematic gains were confined to the sagittal plane. Because the between-group differences did not consistently exceed existing MCID thresholds, these findings are statistically robust but of questionable clinical importance, necessitating larger studies and ACLR-specific MCID benchmarks.

TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400087325. Registered on 25 July 2024.

PMID:42436504 | DOI:10.1186/s13102-026-01878-4

Cardiovasc Diabetol. 2026 Jul 11. doi: 10.1186/s12933-026-03284-z. Online ahead of print.

ABSTRACT

BACKGROUND: While metabolic dysfunction-associated steatotic liver disease (MASLD) has been consistently associated with increased cardiovascular risk in the general population, its association with cardiovascular disease (CVD) mortality in adults with established cardiometabolic risk factor (including obesity, hypertension, diabetes mellitus, or dyslipidemia) remains inconsistent. We aimed to determine whether frailty confounds the MASLD-CVD mortality association.

METHODS: We analyzed 10,413 US NHANES III adults with ≥ 1 cardiometabolic risk factor. Frailty was quantified using a 49-item frailty index (FI, ranging from 0 [maximal robustness] to 1 [severe frailty]) and categorized into quartiles. Associations between MASLD and CVD mortality were assessed using multivariable Cox proportional hazards models with and without frailty adjustment. Interaction and mediation analyses were also performed.

RESULTS: Over a mean follow-up of 23.36 years, 1,375 (13.20%) CVD deaths occurred. Frailty was significantly associated with both MASLD and CVD mortality. There was no evidence of interaction between MASLD and frailty, and mediation analysis showed no indirect effect of MASLD on CVD mortality through frailty. In absence of frailty adjustment, MASLD was not associated with CVD mortality (HR = 0.92, 95% CI: 0.78-1.10). After adjustment for frailty, MASLD was independently associated with higher CVD mortality (HR = 1.19, 95% CI: 1.07-1.32). Stratified by FI quartiles, significant associations were observed only in the higher frailty quartiles (Q3: HR = 1.35, 95% CI: 1.03-1.77; Q4: HR = 1.70, 95% CI: 1.07-2.69). The population attributable fraction of MASLD for CVD mortality was 10.1-12.5% after frailty adjustment.

CONCLUSIONS: Frailty may confound the MASLD-CVD mortality relationship in people with cardiometabolic risk factors. The association between MASLD and CVD mortality is detected only when frailty is adjusted for.

PMID:42436502 | DOI:10.1186/s12933-026-03284-z

BMC Pulm Med. 2026 Jul 11. doi: 10.1186/s12890-026-04439-0. Online ahead of print.

ABSTRACT

BACKGROUND: Neonatal acute respiratory distress syndrome (NARDS) can cause respiratory failure in newborns and even pose a threat to their lives, causing a heavy financial burden on families.

AIM: This study aims to explore the potential role of miR-155 as a diagnostic marker and prognostic predictor for NARDS.

METHODS: This study included 100 non-NARDS newborns and 100 NARDS newborns. The plasma miR-155 expression was measured by RT-qPCR. The ROC curve was used to analyze the diagnostic efficacy of miR-155 alone and the combined diagnostic efficacy of PT, APTT, FIB, and CRP. The correlation between clinical indicators and miR-155 expression was analyzed by the chi-square test. The general clinical information of NARDS neonates with different severity degrees and prognosis was compared. Multivariate logistic regression was used to identify the risk factors for NARDS.

RESULTS: The plasma miR-155 level was elevated in NARDS newborns. miR-155 may serve as a promising biomarker in the diagnosis of NARDS. The value of the multi-factor combined diagnosis was significantly improved. 1-minute Apgar score, PT, APTT, and CRP level were statistically related to the miR-155 expression. Abnormal FIB level and the miR-155 expression were independent risk factors for NARDS. The more severe NARDS newborns have poorer coagulation function, stronger inflammatory response, and higher miR-155 level. A higher level of miR-155 was observed in NARDS newborns with a poorer prognosis.

CONCLUSION: The plasma miR-155 level is upregulated in NARDS, and miR-155 may be a potential diagnostic marker for NARDS. NARDS newborns with miR-155 high expression have a poor prognosis.

PMID:42436500 | DOI:10.1186/s12890-026-04439-0

BMC Health Serv Res. 2026 Jul 11. doi: 10.1186/s12913-026-15023-x. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare organizations increasingly operate in volatile, uncertain, complex, and ambiguous (VUCA) environments, requiring leadership approaches that facilitate adaptation and resilience. Although digital leadership has gained growing attention, evidence regarding its association with VUCA-related psychological and cognitive dimensions, such as resistance to change, intolerance of uncertainty, cognitive flexibility, and ambiguity tolerance, remains limited among healthcare professionals.

AIM: This study examined the association between digital leadership and perceived VUCA-related psychological and cognitive dimensions among healthcare professionals.

METHOD: A cross-sectional study was conducted among 495 healthcare professionals working in three hospitals in Muğla, Türkiye. Data were collected using validated instruments measuring digital leadership, resistance to change, intolerance of uncertainty, cognitive flexibility, and ambiguity tolerance. Descriptive statistics, Pearson correlation, and linear regression analyses were performed.

RESULTS: Digital leadership was negatively associated with resistance to change (r = – 0.550, p < 0.001) and intolerance of uncertainty (r = – 0.547, p < 0.001). Positive associations were observed between digital leadership and cognitive flexibility (r = 0.466, p < 0.001) as well as ambiguity tolerance (r = 0.500, p < 0.001). Regression analyses showed that digital leadership was significantly associated with all examined VUCA-related psychological and cognitive dimensions.

CONCLUSION: Higher perceptions of digital leadership were associated with lower resistance to change and uncertainty intolerance, and with higher cognitive flexibility and ambiguity tolerance among healthcare professionals. These findings suggest that digital leadership may support adaptive responses in healthcare environments characterized by uncertainty and complexity.

PMID:42436492 | DOI:10.1186/s12913-026-15023-x

BMC Health Serv Res. 2026 Jul 11. doi: 10.1186/s12913-026-15063-3. Online ahead of print.

ABSTRACT

BACKGROUND: A healthcare system’s efficacy is demonstrated by safe motherhood, which is an essential aspect of women’s health. Preconception, pregnancy, labor, and the postoperative phase are all included in this continuum of care. There are still gaps in maternal healthcare awareness, use, and continuity, especially during preconception and the early postnatal stages, even though India has made great strides in lowering maternal mortality through national health programs and better access to institutional deliveries and antenatal care. The purpose of this study was to evaluate Gujarati women’s knowledge, availability, and use of maternal health services, with an emphasis on preconception care, prenatal care, delivery procedures, and postnatal follow-up.

METHODOLOGY: The study used a descriptive cross-sectional methodology and included 318 reproductive-age women from semi-urban, urban, and rural areas using a structured pre-validated questionnaire. Both quantitative information about maternal health practices and experiences were gathered through in-person interviews and Google Forms and analyzed using descriptive statistics including frequencies and percentages in Microsoft Excel.

RESULTS: Among the 318 respondents, 75.5% were aged 18-30 years and 50% resided in rural areas. Awareness regarding preconception health checkups was reported by 71.1% of women, whereas 28.9% lacked such awareness. Antenatal care utilization was high, with 87.1% attending antenatal checkups, the majority receiving tetanus toxoid immunization and iron-folic acid supplementation, and 97.3% undergoing institutional deliveries with skilled birth assistance. However, only 58.2% of women received postnatal care within 48 hours after delivery. Nutritional counseling was reported by 41% of respondents, while 55.2% received breastfeeding counseling. Significant gaps were found in preconception health information, early postnatal follow-up, and emotional support, especially among rural women.

CONCLUSION: The study highlights the need to shift focus from service availability to continuity and quality of maternal care. Strengthening preconception education, ensuring timely postnatal follow-up through community health workers, expanding counseling services, and promoting family engagement are essential to improving maternal and neonatal health outcomes.

PMID:42436490 | DOI:10.1186/s12913-026-15063-3

Int J Equity Health. 2026 Jul 11. doi: 10.1186/s12939-026-02873-4. Online ahead of print.

ABSTRACT

BACKGROUND: Anxiety disorders, depressive disorders, migraine, and rheumatoid arthritis are common chronic conditions that contribute substantially to disability, recurrent care needs, and productivity losses, yet remain comparatively under-prioritised in health policy. In Mexico, these conditions disproportionately affect women, but their economic burden has not been comprehensively quantified from a gender perspective.

OBJECTIVE: To estimate the direct and indirect economic burden of anxiety disorders, depressive disorders, migraine, and rheumatoid arthritis in Mexico among adults aged 20 years and older between 2005 and 2021, from a societal perspective and by gender.

METHODS: We conducted a cost-of-illness analysis from a societal perspective. Direct costs were estimated by combining condition-specific prevalence from the Global Burden of Disease Study 2021 (GBD 2021) with normative per-case treatment costs derived from national clinical guidelines and official cost sources. Indirect costs were valued using three complementary approaches: the Human Capital Approach (HCA), based on predicted annual labour income from nationally representative employment surveys; a GDP-per-capita benchmark (1 DALY = 1 GDP per capita); and a willingness-to-pay approach using the value of a statistical life year (VSLY) transferred to Mexico following OECD methods. All costs were expressed in 2021 international dollars (Int$).

RESULTS: Between 2005 and 2021, the four disorders accounted for 28.8 million DALYs lost. Migraine was the most prevalent condition, but depressive disorders generated the highest direct costs (Int$310.5 billion) and the largest share of indirect costs (41.1%). Indirect costs totalled Int$106.8 billion under the HCA, Int$582.2 billion under the GDP-per-capita valuation, and Int$2.9 trillion under the willingness-to-pay approach. Under the GDP-per-capita benchmark, the combined economic burden of the four disorders reached approximately Int$1.2 trillion over the study period. Women consistently bore a greater burden than men across all four conditions and under all valuation methods; total indirect costs borne by women were 2.0 times higher for anxiety disorders, 2.1 times higher for depressive disorders, 2.2 times higher for migraine, and 3.8 times higher for rheumatoid arthritis.

CONCLUSIONS: Anxiety disorders, depressive disorders, migraine, and rheumatoid arthritis impose a substantial and unequally distributed economic burden in Mexico. The persistent excess burden among women indicates that these high-disability chronic disorders should be understood not only as a public health problem, but also as a health equity concern. More gender-responsive priority setting, stronger continuity of care, and better financial protection may help reduce both disability and its downstream economic consequences in Mexico and other LMICs with segmented health systems.

PMID:42436481 | DOI:10.1186/s12939-026-02873-4

BMC Oral Health. 2026 Jul 11. doi: 10.1186/s12903-026-09186-6. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the increasing use of bleach-shade composite resins in recent years, studies examining the optical properties of these materials remain limited. Furthermore, there are insufficient data on the effectiveness of surface treatments for removing stains from these materials. This study evaluated the effects of different surface treatment protocols on the color stability, whiteness index, and surface roughness of bleach-shade composite resins after coffee immersion.

METHODS: A total of 300 specimens were prepared from four bleach-shade composite resins (Estelite Asteria BL, Brilliant EverGlow BL Translucent, G-aenial A’chord BW, and Opallis E-Bleach L) and one multi-shade (Filtek Z250 A2) composite resin (n = 60 per material). The specimens were randomly allocated to six groups (n = 10): Group 1 (one-step polishing, OptraGloss), Group 2 (two-step polishing, Nova Twist), Group 3 (bleaching, Whiteness HP), Group 4 (bleaching + one-step polishing), Group 5 (bleaching + two-step polishing), and Group 6 (control). All specimens were immersed in a coffee solution for 12 days. Measurements (color and roughness [Ra]) were performed at baseline (t₀), after staining (t₁), and after the surface treatments (t₂). Color differences were calculated using the CIEDE2000 formula (∆E₀₀), and whiteness index (WI_D) values were determined using the CIELAB-based WI_D formula. Statistical analyses were performed using the Kruskal-Wallis, Dunn, and robust ANOVA tests (p < 0.05).

RESULTS: At the t₁ time point, all specimens exhibited clinically unacceptable ΔE₀₀ values and decreased WI_D values. The Asteria group exhibited the highest color stability at t₁, while the Brilliant and A’chord groups exhibited the highest WI_D values (p < 0.05). At the t₂ time point, while Ra increased in the bleaching groups, the lowest Ra values were found in the one-step polishing group (p < 0.05).

CONCLUSIONS: Coffee exposure adversely affected the optical and surface properties of bleach-shade composite resins. Bleaching alone showed limited effectiveness, whereas polishing improved the esthetic outcomes and maintained clinically acceptable surface characteristics. Material-dependent differences were observed among the tested composites.

PMID:42436480 | DOI:10.1186/s12903-026-09186-6