Tag: nevin manimala

Pharmacoepidemiol Drug Saf. 2026 Sep;35(9):e70446. doi: 10.1002/pds.70446.

ABSTRACT

PURPOSE: Although antidepressant use during pregnancy has been linked to adverse birth outcomes such as stillbirth and preterm delivery, existing evidence is conflicting and rarely presents absolute risk estimates. We aimed to assess the association between antidepressant use during pregnancy and birth outcomes, alongside estimates of absolute risk to aid clinical interpretation.

METHODS: We conducted a multi-country cohort study using data from the UK Clinical Practice Research Datalink (1996-2018), Norwegian Medical Birth Registry (2009-2020), and Swedish Medical Birth Register (2006-2020). Discordant sibling analyses and paternal negative controls were used to investigate associations with stillbirth, neonatal death, gestational age, size for gestational age, and Apgar score < 7 at 5-min among pregnancies delivered at ≥ 22 weeks’ gestation.

RESULTS: Among 120 209 (4.8%) pregnancies exposed to antidepressants, maternal use was associated with stillbirth (adjusted pooled odds ratio [aOR] 1.16, 95% CI 1.05-1.28), preterm delivery (aOR 1.26, 95% CI 1.23-1.30), and low Apgar score (aOR 1.83, 95% CI 1.75-1.91). Associations persisted in sibling analyses with greater uncertainty. The predicted absolute risk of stillbirth was 0.34% among unexposed pregnancies and 0.40% among exposed. When restricting to mothers with depression or anxiety, the association with stillbirth attenuated (aOR 1.07, 95% CI 0.94-1.21). Paternal antidepressant use was modestly associated with preterm delivery and low Apgar score.

CONCLUSIONS: Maternal antidepressant use during pregnancy may be associated with increased risks of preterm delivery and low Apgar score, though absolute risks remain low. Residual confounding related to parental mental health is likely to explain part of these associations.

PMID:42590906 | DOI:10.1002/pds.70446

United European Gastroenterol J. 2026 Sep;14(7):e70271. doi: 10.1002/ueg2.70271.

ABSTRACT

BACKGROUND: Endoscopy with histopathological assessment of esophageal biopsies is the cornerstone for the diagnosis and phenotypic characterization of eosinophilic esophagitis (EoE).

OBJECTIVE: To evaluate temporal trends in endoscopic assessment and biopsy sampling practices for EoE in a large European cohort and their association with temporal trends in diagnostic delay (DD).

METHODS: A cross-sectional analysis was conducted using multicenter data from the EoE CONNECT registry. Endoscopic findings and biopsy data at diagnosis were analyzed. Temporal trends in biopsy strategies, EREFS implementation, and DD were assessed. Diagnostic sensitivity of individual esophageal segments and their combinations was evaluated in patients undergoing multi-segment sampling. Associations between guideline publication and biopsy practices were analyzed using logistic regression models.

RESULTS: A total of 3298 patients were included. Biopsies were obtained from one esophageal segment in 12.6% of patients, two segments in 63.6%, and three segments in 23.8%. Adherence to guideline-recommended biopsy strategies improved over time, with reduced single-segment sampling and increased use of ≥ 2 segments. Distal esophageal biopsies provided the highest diagnostic sensitivity, and sampling that included the distal segment achieved sensitivity above 97%, particularly when combined with middle esophageal biopsies. EREFS reporting increased from 88-90% to over 98% in recent years. DD decreased significantly over time (approximately 0.7 years per calendar year), accompanied by a shift from mixed/stricturing to inflammatory phenotypes.

CONCLUSION: Increased alignment with international guidelines, reflected by standardized endoscopic reporting and multi-segment biopsy protocols, was associated with improved diagnostic sensitivity, reduced DD, and fewer fibrostricturing presentations.

PMID:42590904 | DOI:10.1002/ueg2.70271

Paediatr Anaesth. 2026 Aug 12. doi: 10.1002/pan.70279. Online ahead of print.

ABSTRACT

BACKGROUND: In pediatric anesthesia, minimum alveolar concentration (MAC) guides inhalational agent dosing but may not accurately reflect anesthetic depth. EEG-guided anesthesia has shown benefits in adults but remains underused in children.

AIMS: This study aims to evaluate the effect of EEG-guided anesthesia with SedLine on emergence delirium (ED) and sevoflurane dose in behaviorally noncompliant children undergoing dental procedures under general anesthesia.

METHODS: In this prospective, randomized controlled trial, 100 children aged 4-10 years were randomized to standard anesthesia guided by MAC and conventional clinical signs (standard group) or EEG-guided anesthesia titrated to SedLine parameters (primary target: PSI 25-50; secondary parameter: SEF 10-15 Hz) (EEG-S group). Primary outcome was ED incidence assessed by the Pediatric Anesthesia Emergence Delirium Scale (PAEDS). Secondary outcomes included mean EtSevo values, postoperative pain, rescue analgesia, nausea/vomiting, recovery time.

RESULTS: Median PAEDS scores during the first 120 min postoperatively were significantly lower in the EEG-S group compared with the Standard group (e.g., upon arrival to PACU: 4 [IQR 4] vs. 8 [IQR 4.5]). In addition, the incidence of ED upon arrival in the recovery room was significantly lower in the EEG-S group (17% vs. 43%) and at 10 min postoperatively (17% vs. 37%). The mean end-tidal sevoflurane concentration was statistically lower in the EEG-S group (maintenance EtSevo 1.88 ± 0.25 vs. 1.98 ± 0.20; mean difference = 0.10, 95% confidence interval: 0.006-0.190; p = 0.036). Postoperative FLACC pain scores were also lower in the EEG-S group, representing a potential confounding factor for ED outcomes.

CONCLUSION: EEG-guided anesthesia was associated with lower PAEDS scores and reduced sevoflurane consumption compared with standard management. However, given small EEG-derived differences and potential confounding by postoperative pain, these findings should be interpreted cautiously. Within the applied target ranges, EEG-derived parameters were not independently associated with ED, and specific EEG targets predictive of ED could not be identified.

TRIAL REGISTRATION: This study was registered (Protocol Registration Receipt NCT06400706/OKocaturk/May 02 2024) at http://www.

CLINICALTRIAL: gov.

PMID:42590887 | DOI:10.1002/pan.70279

J Nurs Manag. 2026;2026(1):e9937065. doi: 10.1155/jonm/9937065.

ABSTRACT

AIM: To assess levels of quantum leadership, organizational transparency, and organizational readiness for change among staff nurses and to examine whether organizational transparency statistically mediates the association between quantum leadership and organizational readiness for change.

DESIGN: A cross-sectional descriptive study was reported in accordance with STROBE guidelines.

METHODS: A census sampling approach was used to recruit 350 staff nurses from Shoubrakhit General Hospital. Data were collected using the Quantum Leadership Survey, the Organizational Transparency Instrument, and the Organizational Readiness for Implementing Change Scale.

RESULTS: Most nurses reported high levels of quantum leadership (77.1%), organizational transparency (66.3%), and readiness for change (85.4%). Correlation analysis showed positive associations among the three main variables. The statistical mediation model indicated that quantum leadership was directly associated with organizational readiness for change and showed a small positive indirect association through organizational transparency. The model demonstrated acceptable overall fit.

CONCLUSION: Quantum leadership was positively associated with organizational readiness for change, with organizational transparency showing a small statistical mediating role. Given the cross-sectional, self-report, single-hospital design, the findings should be interpreted cautiously as associations rather than evidence of causal processes.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and nursing leaders should strengthen transparent communication channels, involve nurses meaningfully in committees and change-related discussions, support accountable decision-making, and assess staff readiness before major organizational initiatives.

PMID:42590874 | DOI:10.1155/jonm/9937065

J Psychiatr Ment Health Nurs. 2026 Aug 12. doi: 10.1111/jpm.70187. Online ahead of print.

ABSTRACT

INTRODUCTION: Workplace stress is prevalent in psychiatric nursing, with compassion fatigue significantly challenging nurses’ well-being and care quality. Effective prevention requires identifying at-risk nurses using validated assessment frameworks. The contemporary approach to workforce mental health emphasises proactive, targeted interventions tailored to individual risk profiles. Nurses play a central role in sustaining therapeutic environments, and their psychological resources are critical to this process. However, the heterogeneity of compassion fatigue among psychiatric nurses remains underexplored.

AIM: To empirically identify distinct subtypes of compassion fatigue among psychiatric nurses and examine their key predictors: METHODS: Using convenience sampling, 297 psychiatric nurses were selected from five Chinese hospitals to participate in a cross-sectional online survey. Measures of sociodemographic traits, occupational stress, social support, psychological resilience, coping methods, and compassion fatigue (as measured by the Professional Quality of Life Scale) were all filled out by the participants. Standardised scores for burnout, secondary traumatic stress, and compassion satisfaction were used as indicators in latent profile analysis. To find the ideal number of profiles, model fit indices such as the Lo-Mendell-Rubin likelihood ratio test, entropy, Bayesian information criterion, and Akaike information criterion were compared. Subsequent multivariate logistic regression examined predictors of profile membership. Data analysis was conducted using statistical methods, and the STROBE guideline was followed in reporting.

RESULTS: Three distinct compassion fatigue profiles were identified among psychiatric nurses: Mild Fatigue-Traumatic Stress (18.5%, n = 55), Moderate Fatigue-Low Burnout (64.0%, n = 190), and Severe Fatigue (17.5%, n = 52). Multivariate logistic regression revealed that older age, higher work stress, and greater use of negative coping were significant risk factors for more severe profiles, whereas not working night shifts, higher social support, greater positive coping, and higher psychological resilience were associated with reduced risk. The Severe Fatigue group exhibited the most adverse profile-highest work stress, lowest resilience and support, and greatest reliance on negative coping. Conversely, the group with the highest levels of resilience and social support was Mild Fatigue-Traumatic Stress.

CONCLUSION: There are different subgroups of psychiatric nurses who feel compassion fatigue, each with unique risk and protective characteristics. These results highlight the necessity of profile-specific, focused treatments that address organisational and personal issues. Early career nurses and those working night shifts may benefit from priority support to mitigate occupational psychological burden and enhance workforce well-being.

PMID:42590873 | DOI:10.1111/jpm.70187

J Hum Lact. 2026 Aug 12:8903344261470652. doi: 10.1177/08903344261470652. Online ahead of print.

ABSTRACT

BACKGROUND: Breastfeeding remains the recommended feeding method during public health emergencies; however, pandemic-related restrictions created new challenges for mothers and their healthcare teams, including lactation professionals (LPs). The COVID-19 pandemic may have heightened LPs’ occupational stress and limited their ability to provide lactation support.

RESEARCH AIMS: This study examined occupational stress among LPs, identified stressors and coping strategies, and explored how pandemic-related workplace policies influenced lactation services.

METHODS: A mixed-methods design was employed. A cross-sectional online survey assessed the experiences of hospital- and clinic-based LPs during the COVID-19 pandemic. Key informant interviews were conducted to identify stressors, coping strategies, and service delivery impacts. Descriptive and inferential statistics were conducted, and qualitative data were analyzed using reflexive thematic analysis.

RESULTS: The sample included 1,373 healthcare professionals. Most LPs (91.8%) reported moderate to high perceived stress consistent with other studies. Key stressor themes included new policy implementation, evolving personal protective equipment requirements, employment changes, the transition to telehealth, and fear of infection. Participants reported using problem management, emotional regulation, and meaning-based coping strategies. Themes describing impacts on lactation service provision included reduced or delayed support, protected breastfeeding practices, hindered interpersonal connectedness, and telehealth limitations. Clinical policy changes were perceived to both hinder and improve lactation services.

CONCLUSIONS: During public health emergencies, LPs-especially those with dual role responsibilities-require additional support. Interventions should build upon coping strategies identified in this study. Future research should examine how stressors influence service provision, the effectiveness of coping strategies, and the potential role of geographic context in policy implementation.

PMID:42590868 | DOI:10.1177/08903344261470652

J Hum Lact. 2026 Aug 12:8903344261470803. doi: 10.1177/08903344261470803. Online ahead of print.

ABSTRACT

BACKGROUND: Mothers of late preterm infants need support with breastfeeding.

AIM: The aim of this study was to examine the effect of Telephone Breastfeeding Support (delivered via telephone calls and WhatsApp messages) given to mothers of late preterm infants discharged from the neonatal intensive care unit (NICU) on breastfeeding outcomes.

METHODS: The study was a single-blind, pretest-posttest, randomized, parallel two-group, controlled experimental study. The study involved 62 mothers in a NICU from August 2021 to August 2022. After all late preterm infants participating in the study completed their routine discharge procedures, pre-intervention data were collected from their mothers, and a breastfeeding guide was sent to their phones. The intervention group (n = 31) received breastfeeding support through WhatsApp and phone calls for 16 weeks. Posttests were taken when the infant was 6 months old. Data were collected using the mother-infant information form, the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), the Iowa Infant Feeding Attitude Scale (IIFAS), and the breastfeeding duration assessment form.

RESULTS: When the infant reached 6 months, no statistically significant differences were found in inter- or intra-group BSES-SF scores, nor in inter-group IIFAS scores (p > 0.05). In the intragroup analysis, the intervention group showed a statistically significant improvement in pre- and post-intervention IIFAS scores (p < 0.05), while a significant difference was also observed between groups in breastfeeding cessation rates (p < 0.05).

CONCLUSION: Telephone breastfeeding support has been shown to improve infant feeding attitudes and increase breastfeeding maintenance. Telephone breastfeeding support can be safely implemented for mothers of late preterm infants.

PMID:42590865 | DOI:10.1177/08903344261470803

J Public Health Dent. 2026 Aug 12. doi: 10.1111/jphd.70074. Online ahead of print.

ABSTRACT

PURPOSE: The Canadian Dental Care Plan aims to reduce affordability barriers to oral health care for low- and middle-income families, including children. The selection of covered services is critical to ensure that both immediate needs and long-term oral health outcomes are adequately addressed. This study identified services considered essential for children by pediatric dentists and compared them with those included in the CDCP.

METHODS: A cross-sectional survey was electronically distributed by the Canadian Association of Pediatric Dentists/Académie Canadienne de Dentisterie Pédiatrique to certified and retired pediatric dentists in Canada (n = 297). The survey collected demographic, practice, and perspectives on essential services. Data were analyzed using descriptive statistics.

RESULTS: The response rate was 35% (n = 104; 78 complete). Most respondents were women, and aged 30-39 years (33%). Participants emphasized the equal importance of primary and permanent teeth and supported comprehensive care. While perspectives generally aligned with CDCP service grids, key gaps were identified in preventive services, including oral hygiene instruction, nutritional counseling, mouth guards, space maintainers, smoking cessation counseling, and primary tooth root canals.

CONCLUSIONS: Although the CDCP aligns with many professional priorities, omissions in preventive services limit its comprehensiveness. An upstream approach could support more sustainable oral health care for children and reduce long-term burdens.

PMID:42586950 | DOI:10.1111/jphd.70074

BMJ Paediatr Open. 2026 Aug 12;10(1):e005044. doi: 10.1136/bmjpo-2026-005044.

ABSTRACT

BACKGROUND: Early-onset sepsis (EOS) is a leading cause of neonatal morbidity and mortality and contributes substantially to empirical antibiotic use in neonatal intensive care units (NICUs). In low-resource settings, limited diagnostic capacity often results in overtreatment, increasing unnecessary antibiotic exposure and its associated risks. Evidence on context-adapted EOS risk assessment pathways in sub-Saharan Africa remains scarce.

OBJECTIVE: To evaluate the impact of implementing an adapted EOS risk assessment pathway on antibiotic use and clinical outcomes among neonates admitted to NICUs in Northwest Ethiopia.

METHOD: A prospective multicentre quasi experimental pre-post-implementation study was conducted in three tertiary NICUs in Northwest Ethiopia from January to April 2026. A total of 412 neonates aged ≤72 hours and born at ≥34 weeks’ gestation with suspected EOS were included (pre-implementation, n=208; post-implementation, n=204). An adapted EOS risk assessment and antimicrobial stewardship pathway was implemented during the post-implementation phase. Differences between groups were assessed using χ², Fisher’s exact, independent t or Mann-Whitney U tests, as appropriate. Logistic regression and Cox regression were used to evaluate empirical antibiotic use and 28-day mortality, respectively. Statistical significance was declared at p<0.05.

RESULTS: Maternal and neonatal characteristics were similar between study phases. Empirical antibiotics intuition decreased from 80.8% to 55.4% (risk ratio (RR)=0.69, 95% CI 0.60 to 0.80; p<0001), prolonged antibiotics treatment (>5 days) decreased from 40.8% to 18.1% (RR=0.44, 95% CI 0.31 to 0.62; p=0.004), antibiotic discontinuation within 48 hours increased from 8.2% to 15.7% (RR=1.90, 95% CI 1.1=3.34; p=0.02). Complete blood count, C-reactive protein and blood culture testing also decreased (all p<0.001), and mean NICU safety was shorter after implementation (8.9±2.9 vs 8.1±2.5 days; p=0.002). In multivariable analysis, implementation of the EOS pathway was associated with lower odds of empirical antibiotic use (adjusted OR 0.29, 95% CI 0.19 to 0.46). No significant adverse clinical outcomes difference between study phases. 28-day mortality did not differ between groups (15.9% vs. 17.2%; p=0.7).

CONCLUSIONS: Implementation of an adapted EOS risk assessments and stewardship pathway significantly reduced unnecessary antibiotic exposure and laboratory testing without observed increase in adverse clinical outcomes. These findings support the use of structured EOS risk assessment to improve antibiotic stewardship in NICU in resource-limiting settings.

PMID:42586946 | DOI:10.1136/bmjpo-2026-005044

Mol Biol Evol. 2026 Aug 13:msag195. doi: 10.1093/molbev/msag195. Online ahead of print.

ABSTRACT

We investigate the predictability of evolution in terms of the phylogenetic placement of new lineages. This leads us to develop a class of coalescent models that relax neutrality by allowing the rate of coalescence to vary as a continuous heritable trait. In this setting, each lineage has a relative propensity to coalesce, with coalescent odds ratios defined from the product of pairwise propensities. Estimated coalescent odds provide a statistic that captures variation in lineage growth and are informative about the strength of natural selection acting on individual lineages. A number of practical statistical methods are then developed: techniques to adjust for biased and non-uniform sampling; procedures to automatically calibrate hyperparameters governing the evolution of coalescent propensity; and, methods for clustering phylogenies into sets that delineate clades according to coalescent propensity. Simulations show sensitivity of these methods to detecting small selective effects acting on rare variants, and strong robustness to imbalanced sampling. We demonstrate these methods using two datasets reflecting microbial populations evolving under strong selection. First, we examine a large set of Neisseria gonorrhoeae genomes, and show that lineages with high coalescent odds feature a unique antibiotic resistance pattern which presaged its subsequent expansion. We then re-analyse SARS-CoV-2 data in combination with independent estimates of reproduction numbers corresponding to major variants of concern 2020-2023. This indicates that coalescent odds can function as an excellent tree-based proxy for relative fitness of major SARS-CoV-2 lineages.

PMID:42586937 | DOI:10.1093/molbev/msag195