Tag: nevin manimala

JAMA Netw Open. 2026 Jan 2;9(1):e2551878. doi: 10.1001/jamanetworkopen.2025.51878.

ABSTRACT

IMPORTANCE: Stress and its psychiatric consequences-including depression, anxiety, and posttraumatic stress disorder (PTSD)-are pertinent to women’s cardiovascular health, but research on intersections with relevant sex-specific factors (eg, hormonal contraceptives) is lacking.

OBJECTIVE: To examine whether stress-related psychiatric diagnoses moderate associations between hormonal contraceptive use and cardiovascular and thrombotic risk.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included electronic health record data collected from a US hospital-based biobank and analyzed from May 2, 2024, to November 3, 2025. Participants were women aged 18 to 55 years who consented into the biobank before or on September 12, 2020.

EXPOSURES: Lifetime history of stress-related psychiatric disorders, including depression (major depressive disorder), anxiety (generalized anxiety disorder, social anxiety disorder, or panic disorder), and PTSD, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes and analyzed as separate diagnoses, and lifetime history of combined hormonal contraceptive use, defined by RxNorm codes.

MAIN OUTCOMES AND MEASURES: The primary outcomes were major adverse cardiovascular events (MACE; defined as ICD-10 codes for infarction, unstable angina, heart failure, coronary revascularization, peripheral vascular disease, peripheral revascularization, stroke, and/or transient ischemic attack) and deep-vein thrombosis (DVT). Three 2-step hierarchical logistic regressions per outcome were conducted.

RESULTS: In this sample of 31 824 women (mean [SD] age, 38.5 [10.6] years), over one-third (11 950 women [37.6%]) had hormonal contraceptive use history, and stress-related disorders were common (depression, 9116 women [28.5%]; anxiety, 3533 women [11.1%]; PTSD, 1992 women [6.3%]). Associations were mixed across the stress-related disorders, in that depression and anxiety did not moderate associations between contraceptive use and MACE or DVT. In contrast, PTSD modified the association between contraceptive use and MACE but not that between contraceptive use and DVT. Analyses stratified by PTSD status found that only women without PTSD using contraceptives had lower odds for MACE (odds ratio, 0.69; 95% CI, 0.87-3.24). The odds ratio for MACE among women with PTSD was greater than 1, but the finding was not statistically significant (odds ratio, 1.68; 95% CI, 0.87-3.24).

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, combined hormonal contraceptive use was associated with lower cardiovascular risk in women regardless of depression or anxiety. These protective associations did not extend to women with PTSD, suggesting that there are unique cardiovascular processes in the context of this stress-related disorder and hormonal contraceptive use that warrant further research.

PMID:41481290 | DOI:10.1001/jamanetworkopen.2025.51878

Expert Rev Respir Med. 2026 Jan 2. doi: 10.1080/17476348.2026.2612785. Online ahead of print.

ABSTRACT

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) significantly increases lung cancer risk, with cumulative incidence exceeding 50% at 10 years. We evaluated whether antifibrotic therapies provide cancer-protective effects beyond their established antifibrotic actions.

METHODS: We conducted a systematic review searching MEDLINE, EMBASE, and Cochrane databases through July 2025 per PRISMA guidelines. Observational studies comparing lung cancer incidence in IPF patients receiving antifibrotics (pirfenidone or nintedanib) versus untreated controls were included. Random-effects meta-analysis with sequential sensitivity analyses was performed.

RESULTS: Four observational studies with 15,582 participants were included. Primary pooled risk ratio was 0.39 (95% CI: 0.13-1.14; I² = 98%). Sequential sensitivity analyses addressing confounding by indication and biological heterogeneity demonstrated statistically significant risk reductions: 73% (RR 0.27; 95% CI: 0.16-0.48; I² = 44%) and 76% (RR 0.24; 95% CI: 0.08-0.69; I² = 67%) in pirfenidone-specific analyses.

CONCLUSIONS: Pirfenidone specifically may reduce lung cancer risk in IPF patients by 73-76%, though evidence is limited by observational designs, geographic restriction to East Asian populations, and biological heterogeneity between mechanistically distinct antifibrotic agents. Insufficient data exist for nintedanib. Agent-specific prospective randomized controlled trials are warranted.Protocol registration: PROSPERO identifier CRD420251119104.

PMID:41481252 | DOI:10.1080/17476348.2026.2612785

Int J Epidemiol. 2026 Jan 2;55(1):dyaf214. doi: 10.1093/ije/dyaf214.

ABSTRACT

INTRODUCTION: In air-pollution epidemiology, measured or modelled surrogate exposure estimates, prone to measurement error (ME), are used to investigate the health effects of exposure to pollution of outdoor origin, potentially leading to biased effect estimates. We predicted the annual personal exposure from outdoor sources by using personal measurements, compared it with concentrations from surrogate metrics, and quantified the ME magnitude, type, and determinants.

METHODS: We used measurements from four panel studies in London, UK, and predicted personal exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), and black carbon (BC). We compared those with surrogate exposures, including measurements from fixed-site monitors, modelled ambient concentrations, or hybrid methods accounting for people’s mobility. We estimated the exposure ME magnitude, correlations, and variance ratios between surrogate measures and personal exposure, and the percentages of classical/Berkson-type errors. Individual- and area-level characteristics, such as age, sex, socio-economic status, and time spent outdoors, were assessed as potential error determinants.

RESULTS: Predicted annual personal exposures to PM2.5, NO2, O3, and BC from outdoor sources were overestimated by surrogate metrics, with mean differences of up to 10.1, 40.0, 61.7, and 2.6 μg/m3, respectively. The variance ratios and Pearson correlation coefficients between surrogate and predicted personal exposures ranged from 0.03 to 165.02 and -0.24 to 0.25. Time-activity adjustment reduced errors substantially. Berkson-type errors dominated the ME for PM2.5 and BC (43%-81% and 26%-98%, respectively), whilst classical errors characterized gases (>94% for both NO2 and O3). Time spent outdoors, house type, and deprivation were associated with exposure error.

CONCLUSION: The use of surrogate exposures to investigate the health effects of long-term exposure to air pollution from outdoor sources may bias the epidemiological estimates due to ME. Information about the error structures and their determinants can be used for correction and the identification of the true exposure-response functions.

PMID:41481245 | DOI:10.1093/ije/dyaf214

Int J Epidemiol. 2026 Jan 2;55(1):dyaf208. doi: 10.1093/ije/dyaf208.

ABSTRACT

BACKGROUND: By mid-2024, >13 billion COVID-19 vaccine doses had been administered globally, with totals continuing to rise into 2025, yet persistent inequities remain in low- and middle-income countries (LMICs). We examined spatial determinants of COVID-19 vaccination uptake (proportion of eligible persons vaccinated) in Kenya by using the most recent nationally representative survey, the Kenya Demographic and Health Survey 2022. Our central contribution is the detection of seven spatially concentrated vulnerability clusters, complemented by using a Development Index (DI) and equity auditing to guide targeted action.

METHODS: We integrated socioeconomic, healthcare, environmental, and demographic measures at the Demographic and Health Survey cluster level; quantified spatial dependence (Moran’s I; spatial lag models); identified socio-geographic clusters (K-means); estimated variable importance (random forest); and synthesized a DI. Equity was assessed by using the Erreygers Concentration Index (ECI) along two axes: wealth-based (poorest→richest) and immunization-linked (lowest→highest routine child immunization coverage).

RESULTS: Our results reveal stark geographic disparities: vaccination rates range from 5.93% in Garissa to 46.02% in Nyeri, with urban clusters achieving significantly higher uptake. Key predictors include bank access (financial inclusion), household crowding, and environmental factors (nitrogen dioxide levels, precipitation). The DI correlated positively with uptake and the ECI indicated modest immunization-linked inequality and more pronounced wealth-related inequality.

CONCLUSION: This study underscores the need for targeted interventions, including mobile vaccination units, financial inclusion programs (e.g. M-Pesa subsidies), and the integration of COVID-19 vaccines into routine immunization programs. As Kenya and many LMICs integrate COVID-19 vaccination into routine immunization, our spatial approach, combining DI, cluster detection, and equity metrics, provides an operational toolkit to prioritize underserved areas, inform the placement of service points/mobile teams, and monitor equity as programs transition from campaigns to routine delivery.

PMID:41481244 | DOI:10.1093/ije/dyaf208

Int J Epidemiol. 2026 Jan 2;55(1):dyaf215. doi: 10.1093/ije/dyaf215.

NO ABSTRACT

PMID:41481241 | DOI:10.1093/ije/dyaf215

Int J Epidemiol. 2026 Jan 2;55(1):dyaf213. doi: 10.1093/ije/dyaf213.

ABSTRACT

BACKGROUND: Epidemiological studies evaluating the potential association between oral contraceptive (OC) use and melanoma risk have reported conflicting results. We assessed the association of OC use with melanoma risk in a large prospective cohort.

METHODS: The Nightingale Study comprises 59 944 Dutch female nurses at ages 19-65 years (mean, 46.9 years; SD, 11.0) who completed a baseline questionnaire in 2011, including information on lifetime OC use. Melanoma incidence was retrieved through linkage with the Netherlands Cancer Registry. Associations between lifetime OC use and risk of melanoma were assessed by using Cox proportional hazard models. Women who used OCs at baseline were considered current users and women who had used OCs but stopped before baseline were considered former users. Never OC users were defined as the reference.

RESULTS: During 10 years of follow-up, 447 women were diagnosed with melanoma. Melanoma risk was not increased among women who used OCs for a duration of <9, 10-15, or ≥16 years compared with never CO users. Melanoma risk was increased for current OC users [hazard ratio (HR), 1.53; 95% confidence interval (CI), 1.03-2.29], without a trend with duration of use (P-trend = .42) and age at cohort entry (P-trend = .05). Melanoma risk was not increased among former OC users (HR, 0.99; 95% CI, 0.72-1.38) nor when they had last used OC <2 years before baseline (HR, 0.69; 95% CI, 0.36-1.32).

CONCLUSION: Current OC use was associated with increased melanoma risk, irrespective of the duration or recency of use.

PMID:41481240 | DOI:10.1093/ije/dyaf213

Int J Epidemiol. 2026 Jan 2;55(1):dyaf212. doi: 10.1093/ije/dyaf212.

ABSTRACT

BACKGROUND: The association between wildfire smoke (WFS) exposure and pregnancy loss has been understudied. Here, we examined the association between prenatal wildfire-specific particulate matter ≤2.5 µm (PM2.5) exposure and pregnancy loss in Colorado, USA.

METHODS: We retrieved all birth records from the 17 ‘Front Range’ counties (just east of the Rocky Mountains) of Colorado from 2007 to 2018 (n = 614 321). We considered two PM2.5 exposures-wildfire-specific PM2.5 from a novel machine learning model and non-wildfire PM2.5 constructed using the Community Multiscale Air Quality model. We fitted quasi-Poisson distributed lag models to estimate the associations between the two weekly-resolved PM2.5 exposures during pregnancy and live birth-identified conceptions (LBICs) in each county. That is, we used the predicted change in the LBICs to directly infer the change in the number of pregnancy losses due to the exposure.

RESULTS: Average weekly non-wildfire PM2.5 was 6.2 µg/m3 (SD 2.3). In weeks with non-zero WFS (27% of all county-weeks), the average wildfire-specific PM2.5 was 0.92 µg/m3 (SD: 1.55). Wildfire-specific PM2.5 appeared important in gestational weeks 6-13-a 1-µg/m3 higher exposure sustained in these gestational weeks was associated with 20 [95% confidence interval (CI): 4-34] losses/year. In contrast, the cumulative association with non-wildfire PM2.5 was stronger-a 1-µg/m3 higher exposure sustained in every week of pregnancy was associated with 84 (95% CI: 46-129) losses/year.

CONCLUSION: Our findings suggest that both wildfire-specific and non-wildfire PM2.5 exposures were associated with more pregnancy loss and add to the growing literature on the harmful effects of wildfires and, more broadly, air pollution.

PMID:41481237 | DOI:10.1093/ije/dyaf212

J Environ Sci Health B. 2026 Jan 2:1-11. doi: 10.1080/03601234.2025.2608417. Online ahead of print.

ABSTRACT

Agriculture represents a cornerstone of the Algerian economy. To sustain agricultural production, fungicides, including the Bordeaux mixture, a copper (Cu)-based fungicide, are used extensively. The amounts applied, along with the frequency of their use in the absence of adequate regulatory oversight, raise significant concerns. Bou-Ismaïl Bay receives this compound through runoff and urban discharge. Cu is essential at low doses; however, at higher levels, it can cause serious toxicity. Here, 120 sardines were sampled from Bou-Ismaïl Bay in February and May 2023. Cu concentrations in the tissues were measured using atomic absorption spectrophotometry. Statistical analyses were conducted using R version 4.3.2. The results revealed a significant difference between the tissues. Concentrations ranged from 0.581 to 9.032 µg/g in the gills and from 0.378 to 1.543 µg/g in the muscle. The maximum Cu concentrations in the gills in February and May indicate chronic contamination of the marine environment. The Cu content in sardines was closely linked to the extent of agricultural land using the Bordeaux mixture. The absence of international maximum permissible levels of Cu specifically for sardines increases the potential risk of consumer overexposure. This regulatory gap, combined with the limited research on Cu’s effects in coastal populations, represents a significant concern.

PMID:41481209 | DOI:10.1080/03601234.2025.2608417

Glob Health Action. 2026 Dec;19(1):2598132. doi: 10.1080/16549716.2025.2598132. Epub 2026 Jan 2.

ABSTRACT

Heritable human genome editing (HHGE) presents new possibilities for the prevention of genetic diseases but also raises ethical and societal questions. While international surveys have explored public attitudes, particularly in high-income countries, there is a lack of large-scale empirical data from the Global South. In South Africa, previous work used deliberative public engagement to examine public perspectives. The present study aims to complement this by capturing public opinion through a cross-sectional survey, enabling direct comparison with deliberative findings. This study will recruit 400 adult participants residing in South Africa using targeted Facebook advertisements. A two-phase sampling process will be employed: initial screening for demographic information, followed by stratified sampling to ensure a representative South African population. The opinion survey consists of 19 HHGE scenarios, each explored through private and public moral lenses. Additionally, participants will indicate their interpretation of ‘safe and effective’ genome editing. Quantitative data will be analysed using descriptive statistics, chi-square tests, and logistic regression. Qualitative responses will undergo thematic analysis using both manual coding and generative AI tools under human oversight. The study includes two stages of informed consent and ensures data confidentiality through strict data handling protocols. Results will be disseminated in peer-reviewed journals and policy forums. The study will also generate a secondary dataset for evaluating AI-assisted qualitative analysis, to be conducted under separate ethical clearance.

PMID:41481170 | DOI:10.1080/16549716.2025.2598132

Psychol Health. 2026 Jan 2:1-39. doi: 10.1080/08870446.2025.2610270. Online ahead of print.

ABSTRACT

OBJECTIVE: Physical activity (PA) may offer health benefits for individuals undergoing substance use disorder (SUD) treatment, yet relapse, comorbidities, and motivational challenges often hinder PA maintenance. This study assessed the impact of a motivational intervention aimed at increasing PA motivation and maintenance in a residential SUD treatment setting.

METHODS AND MEASURES: This non-concurrent multiple-baseline N-of-1 study consisted of a six-week baseline and a ten-week intervention period. The study was conducted with 17 participants from a male-only residential SUD treatment facility in Perth, Australia. Seven participants provided sufficient data for statistical analysis. Participants received ten weekly sessions of a motivational face-to-face intervention. Daily data on PA motivation, substance use cravings, and affect were collected through ecological momentary assessments. Non-overlap methods and randomisation tests, and piecewise regression analyses were employed to assess changes in all variables between study phases.

RESULTS: No changes in PA were observed across study phases. However, measures of affect improved, and self-reported craving decreased over time. Notably, the intervention enhanced autonomous motivation in some participants, although its effects on controlled motivation were mixed.

CONCLUSION: These findings suggest that the motivational intervention may enhance autonomous motivation. Future studies should involve larger samples and diverse SUD treatment settings.

PMID:41481160 | DOI:10.1080/08870446.2025.2610270