Tag: nevin manimala

Eur J Surg Oncol. 2026 Jun 12;52(8):111946. doi: 10.1016/j.ejso.2026.111946. Online ahead of print.

ABSTRACT

OBJECTIVE AND BACKGROUND: The optimal surgical strategy for patients with hepatocellular carcinoma (HCC) and liver fibrosis/cirrhosis presenting with a future liver remnant to standard liver volume (FLR/SLV) ratio of 30%-40% remains a subject of clinical controversy. This study aimed to evaluate the safety and efficacy of one-stage hepatectomy (OSH) versus Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) and to validate the feasibility of OSH by benchmarking it against the standard safety criterion (FLR/SLV ≥40%).

METHODS: We conducted a retrospective analysis of 219 patients with HBV-related HCC and liver fibrosis/cirrhosis who underwent right hemihepatectomy. Patients were stratified into three groups: the OSH group (FLR/SLV 30%-40%, n = 62), the ALPPS group (FLR/SLV 30%-40%, n = 20), and the standard control group (FLR/SLV ≥40% undergoing OSH, n = 137). Perioperative outcomes, including post-hepatectomy liver failure (PHLF) and complications, as well as long-term overall survival (OS) and disease-free survival (DFS), were compared.

RESULTS: In the 30%-40% cohort, the incidence of severe PHLF (ISGLS Grade B or C) in the ALPPS group was comparable to that of the one-stage hepatectomy group (P = 0.128), and no 90-day mortality was observed in either group. However, in terms of severe postoperative complications (Clavien-Dindo grade ≥ IIIa), the ALPPS group demonstrated a higher incidence rate compared to the one-stage hepatectomy group, although the difference did not reach statistical significance (P = 0.082). Long-term oncological outcomes, including OS and DFS, were comparable between the OSH and ALPPS groups (p > 0.05). Furthermore, benchmarking analysis revealed preliminary observations that patients in the OSH group (30%-40%) achieved perioperative and long-term outcomes comparable to those in the standard control group (≥40%) (p > 0.05).

CONCLUSIONS: For selected HCC patients with liver fibrosis/cirrhosis and FLR/SLV ratio of 30%-40% undergoing standardized right hemihepatectomy, one-stage hepatectomy might serve as a safe and feasible alternative to ALPPS, though large-scale prospective validation is warranted.

PMID:42296572 | DOI:10.1016/j.ejso.2026.111946

JMIR Mhealth Uhealth. 2026 Jun 15;14:e83162. doi: 10.2196/83162.

ABSTRACT

BACKGROUND: The first 2000 days can profoundly influence long-term health. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is an SMS text messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care, which provides families with evidence-based, age- and stage-related preventive health information across the first 2000 days.

OBJECTIVE: This pilot study aimed to explore the feasibility, engagement, and acceptability of the HB4HNEKids program. It also aimed to explore the potential effectiveness of the program at 6 and/or 12 months post partum on outcomes including breastfeeding, child diet, child movement, and parental mental well-being.

METHODS: During the pilot phase (October 2021 to July 2024), project records were used to assess the number of families enrolled, number of SMS text messages sent (feasibility), and the number of opt outs (engagement). Repeat cross-sectional surveys were conducted at 5-7 months post partum and again at 12-14 months post partum using validated survey instruments. Using convenience sampling methods, survey participants consisted of birthing parents who had received HB4HNEKids and a concurrent nonrandomized comparison group that did not receive the program. Surveys assessed parental self-reported engagement with the messages, program acceptability, breastfeeding status, child diet, child movement, and parental mental well-being. Mixed linear regression analyses were conducted to calculate mean differences and odds ratios.

RESULTS: During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (99/383, 26% receiving HB4HNEKids), and 283 completed the survey at 12 months (104/283, 37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76% and 83% reported that they always or very often read the SMS text messages, spending on average 5-7 minutes engaged with the content. At both survey time points, more than 90% of participants receiving HB4HNEKids agreed that the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted mean difference 0.23, 95% CI 0.07-0.40; P=.006) than in the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental well-being scores (P=.005). While HB4HNEKids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12 months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors.

CONCLUSIONS: The HB4HNEKids SMS text messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedded into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental well-being. Further evaluation of this program using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.

PMID:42296558 | DOI:10.2196/83162

JMIR Mhealth Uhealth. 2026 Jun 15;14:e77736. doi: 10.2196/77736.

ABSTRACT

BACKGROUND: The benefits of multidisciplinary rehabilitation programs on pain and function in people with chronic low back pain (CLBP) are fairly well documented in the literature. However, these positive effects tend to fade over time due to low long-term patient adherence.

OBJECTIVE: The study aimed to evaluate the impact of a smartphone app on adherence to an exercise program for people with CLBP at 6 months. The secondary aims were to assess the effectiveness of the app on pain, disability, fears, and beliefs related to physical activity, physical capacity, and qualitative adherence (correctness of exercise execution) at 6 months.

METHODS: A total of 110 people with CLBP were included and randomized into 2 groups: 54 in the intervention group (IG) who received education on the use of the app in addition to usual care (a 3-week multidisciplinary rehabilitation program with self-management education) and 56 in the control group (CG) who received only usual care. Part B of the Exercise Adherence Rating Scale was used as the primary outcome to assess adherence to the 6-month exercise program. Secondary outcomes were pain (Numeric Rating Scale), disability (Oswestry Disability Index), barriers and facilitators to performing physical activity (Evaluation of Physical Activity Perception), physical capacity (battery of tests), and qualitative adherence (correctness of exercise execution). Statistical analyses were performed according to the intention-to-treat principle. A linear mixed model compared the primary end point between the groups at 6 months.

RESULTS: A total of 71 of 110 participants (n=35 in the CG vs n=36 in the IG) were evaluated at 6 months. We did not observe any significant difference in the Exercise Adherence Rating Scale score between the CG and the IG (group difference 0.01, 95% CI -2.4 to 2.4; P=.97). The same findings were found for pain, disability, and barriers and facilitators to physical activity, except for the motivation criterion. The 6-Minute Walk Test (group difference [log] 0.06, 95% CI 0.01-0.12; P=.06), cycle ergometer (group difference 9.30, 95% CI 0.48-18.13; P=.04), Ito (group difference [log] 0.31, 95% CI 0.01-0.62; P=.04), plank (group difference [log] 0.29, 95% CI 0.03-0.54; P=.03), and qualitative adherence (IG mean 12.6, SD 1.3 vs CG mean 11.4, SD 1.4; P=.02) differed between the groups in favor of the IG. All outcomes improved from baseline to 6 months in the IG but not in the CG.

CONCLUSIONS: The smartphone app did not impact adherence to an exercise program at 6 months in individuals with CLBP. Similar results were found for pain and function. Nevertheless, the app could be a useful self-management tool in view of the positive effects on physical capacity and qualitative adherence.

PMID:42296544 | DOI:10.2196/77736

JMIR Form Res. 2026 Jun 15;10:e91608. doi: 10.2196/91608.

ABSTRACT

BACKGROUND: The mortality rate from liver disease among people with type 2 diabetes mellitus (T2DM) increased by 20% between 2001 and 2018. There are marked racial and ethnic differences among people with T2DM at risk of metabolic dysfunction-associated steatotic liver disease (MASLD) and related complications.

OBJECTIVE: We aimed to investigate the distribution of individual-level social determinants of health (SDOH) in people living with both T2DM and MASLD.

METHODS: In this small cross-sectional study, patients (N=50) were recruited from a tertiary care general hepatology clinic to complete a survey that assessed potential determinants of health. We sought to oversample Black and Hispanic patients to better understand the prevalence of SDOH. Electronic health records were reviewed to determine stage of liver disease, and these data were linked to survey results to identify the distribution of individual-level determinants of health in patients with cirrhosis.

RESULTS: Black and Hispanic respondents were more likely to report more experiences of racial discrimination, worries about being discriminated against, and group-based medical mistrust, especially regarding unsupportive health care providers. Cirrhosis groups tended to have lower incomes and less coverage from private health insurance. However, no substantial trends were observed in the distribution of health literacy, discrimination, and diabetes stigma among patients with and without cirrhosis.

CONCLUSIONS: These findings will inform a future study aimed at assessing and developing interventions to address the combined impact of individual- and neighborhood-level SDOH on health-related outcomes in patients with T2DM and MASLD.

PMID:42296541 | DOI:10.2196/91608

J Med Internet Res. 2026 Jun 15;28:e95562. doi: 10.2196/95562.

ABSTRACT

BACKGROUND: Refugees frequently face language and access barriers to preventive oral health information. Brief multilingual digital interventions may help reduce such barriers in shelter settings.

OBJECTIVE: This randomized controlled trial evaluated whether a multilingual digital microlearning video improved plaque control and selected self-reported oral health-related behaviors among adults living in refugee shelters.

METHODS: A 2-arm, parallel-group randomized controlled trial was conducted among 86 adults living in 2 municipal refugee shelters in Germany. Participants were randomized (1:1) to receive either a multilingual 4-minute oral hygiene microlearning video or delayed access (control group). Plaque index and gingival index were assessed clinically at baseline and at 2-month follow-up. Secondary outcomes included questionnaire-based measures of oral health literacy-related cognitions and self-reported oral health behaviors. Between-group differences in change scores were analyzed using 2-sided tests; exploratory multivariable regression analyses were conducted to assess potential effect modifiers.

RESULTS: Follow-up was completed by 83 (97%) of 86 participants. Plaque index decreased more in the intervention group than in the control group (mean change -0.21, SD 0.27 vs mean change -0.04, SD 0.17; P=.002). Gingival index decreased in both groups, but the between-group difference was not significant. Among questionnaire-based outcomes, toothbrushing frequency increased substantially, whereas the remaining oral health literacy-related items showed small numerical changes that did not reach statistical significance or remained stable. Approximately three-quarters of participants in the intervention group (32/42, 76%) reported reviewing the video at least once.

CONCLUSIONS: Brief multilingual digital microlearning improved plaque control and self-reported toothbrushing frequency in refugee shelters. Effects on broader oral health literacy-related outcomes were limited and should be interpreted cautiously. Larger, prospectively powered trials with longer follow-up periods and blinded outcome assessment are warranted.

PMID:42296536 | DOI:10.2196/95562

JMIR Res Protoc. 2026 Jun 15;15:e88001. doi: 10.2196/88001.

ABSTRACT

BACKGROUND: As the first peoples of Australia, Aboriginal and Torres Strait Islander peoples have continuing cultures that are essential to wellbeing. Complex sociocultural, health, and wellbeing inequities stemming from colonization, settler-colonialism, and mental health system challenges have led to high rates of negative mental health and wellbeing for Aboriginal and Torres Strait Islander peoples. Improving Aboriginal and Torres Strait Islander mental health and wellbeing outcomes is a national public health priority. Social and emotional wellbeing (SEWB) and the cultural determinants of health (CDH) provide evidence-based approaches for providing culturally centered wellbeing support. There is a need to increase the availability, accessibility, and effectiveness of culturally relevant, holistic, and strengths-based wellbeing supports. It is essential that Aboriginal communities have self-determined opportunities to develop and implement culturally centered wellbeing supports informed by SEWB and the CDH. Aboriginal digital health and wellbeing support research is an emerging field offering potential to help improve wellbeing outcomes. This study aims to explore how virtual reality (VR) could be used to provide SEWB and CDH support for Aboriginal and Torres Strait Islander peoples.

OBJECTIVE: This study protocol outlines a 3-phase mixed-methods approach that will inform the co-design and codevelopment of a VR application that aims to provide SEWB and CDH support. In partnership with Tribal Warrior, an Aboriginal Community Controlled Organization, Studio Gilay, an Aboriginal-led animation and storytelling studio, and Phoria, an Australian immersive storytelling technology company, this study will assess cultural relevance, acceptability, and feasibility of the VR application.

METHODS: Using Indigenist and Participatory Action Research methodologies, purposive sampling will be used to recruit 35 Tribal Warrior staff and Aboriginal community members to participate in each phase of research. Qualitative data collection will occur in each phase through yarning circles. Reflexive thematic analysis will guide qualitative analysis. Phase 3 will involve a quantitative survey, generating cultural relevance, acceptability, and feasibility evidence. Descriptive statistics analysis will be used to report results.

RESULTS: As of April 2026, data collection and analysis for phases 1 and 2 are complete. This study will culminate in the development and assessment of a co-designed and codeveloped VR application that aims to provide SEWB and CDH support for Aboriginal peoples. Findings from each phase will be published in academic papers and nonacademic outputs. The VR application will be implemented by Tribal Warrior into existing community programs and supports.

CONCLUSIONS: Findings from this study have potential implications for improving availability and accessibility to culturally centered wellbeing supports for Aboriginal and Torres Strait Islander peoples. Assessing the cultural relevance, acceptability, and feasibility of using VR technology to provide culturally centered wellbeing support will contribute novel evidence to the fields of public health, digital health, and design-based research.

PMID:42296535 | DOI:10.2196/88001

JMIR Med Inform. 2026 Jun 15;14:e85255. doi: 10.2196/85255.

ABSTRACT

BACKGROUND: Laboratory testing is a cornerstone of diagnostic decision-making in emergency departments (EDs), yet its overuse contributes substantially to unnecessary health care costs and inefficiencies. Predictive approaches that leverage electronic health record data may help optimize and guide more appropriate test use.

OBJECTIVE: This study aims to develop and evaluate machine learning models that predict laboratory test use during ED visits by integrating structured clinical data and unstructured text from electronic health records.

METHODS: We analyzed 13,115 adult ED visits from the 2021 National Hospital Ambulatory Medical Care Survey-Emergency Department dataset. Structured predictors included demographics, vital signs, insurance status, and medical history, while unstructured data from chief complaints and injury descriptions were encoded using Bidirectional Encoder Representations from Transformers-based embeddings. Four model configurations were developed: structured-only, unstructured-only, combined structured and unstructured data, and an ensemble (mean probability) approach. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS: The combined model achieved the highest predictive performance (AUC=0.83), outperforming both the structured-only model (AUC=0.78) and the unstructured-only model (AUC=0.74). The ensemble model also performed well but did not exceed the combined model. Key predictors of laboratory testing included older age, ambulance arrival, abnormal vital signs, and chronic comorbidities, whereas injury-related visits were associated with a lower likelihood of testing.

CONCLUSIONS: Integrating structured and unstructured electronic health record data improves the prediction of laboratory test use in ED settings. These findings support the development of data-driven clinical decision support tools aimed at enhancing diagnostic efficiency and reducing unnecessary testing.

PMID:42296534 | DOI:10.2196/85255

J Med Internet Res. 2026 Jun 15;28:e82996. doi: 10.2196/82996.

ABSTRACT

BACKGROUND: Online health communities (OHCs) have emerged as critical platforms for patients with type 1 diabetes (T1D) to exchange informational and emotional support. However, how stakeholder roles and disease duration jointly shape support dynamics and influence formation remains underexplored.

OBJECTIVE: This study aimed to examine network-based social support mechanisms in a large T1D OHC, focusing on how stakeholder diversity and disease duration are associated with social support behaviors, subnetwork structures, and user influence.

METHODS: This retrospective observational study analyzed digital trace data from China’s largest T1D online community (January 1-May 20, 2024), comprising 43,788 posts and 145,423 comments contributed by 1393 users. We manually annotated 2000 randomly sampled posts and fine-tuned a GPT-4o-mini (OpenAI) to classify support type (informational or emotional, and seeking or providing), yielding 20,384 support-related posts and 56,953 comments from 1224 users. We constructed weighted directed informational and emotional interaction networks and modeled predictors of a composite influence metric (Relative Centrality) using a gamma log-link generalized linear model (including demographics, identity, sentiment, disease duration, posting orientation, and cyclical activity time). Analyses were conducted in Python (version 3.11; Python Software Foundation). Statistical significance was set at P<.05.

RESULTS: Support predominantly flowed from longer-duration members (≥ y) to those at earlier stages (≤5 y). Both subnetworks exhibited multicentered, star-like structures; the informational subnetwork had broader participation (density 0.031, diameter 7), while the emotional network was denser (density 0.039, diameter 6). In the influence model, peer supporters had substantially higher influence than patients (exp(β)=34.79, 95% CI 18.94-64.08; P<.001), professionals lower (exp(β)=0.41, 95% CI 0.17-0.99; P=.055), and women higher than men (exp(β)=1.65, 95% CI 1.23-2.23; P=.001). Positive sentiment was associated with higher influence (exp(β)=1.91, 95% CI 1.22-2.97; P=.005), and negative lower (exp(β)=0.54, 95% CI 0.37-0.79; P=.001). Influence followed an inverted U-shaped trajectory over disease duration, peaking at approximately the 116th month (95% CI 43.25-188.91).

CONCLUSIONS: This study suggests that social support patterns and user influence in a T1D OHC vary by stakeholder role and disease duration. Users with shorter disease duration more often sought support, whereas longer-duration users more often provided support, and informational and emotional exchanges formed distinct interaction subnetworks. Peer supporters were the most influential users; influence was also associated with gender, sentiment, activity timing, and a nonlinear (inverted U-shaped) relationship with disease duration. These findings may inform peer-facilitated, stage-tailored community strategies, with professionals engaged in targeted, complementary roles. A patient-centered collaborative care approach integrating peer experience with multidisciplinary clinical input could be explored in future work.

PMID:42296532 | DOI:10.2196/82996

J Aging Health. 2026 Jun 15:8982643261446020. doi: 10.1177/08982643261446020. Online ahead of print.

ABSTRACT

ObjectivesThis study examined the influence of hearing status and loneliness on verbal fluency trajectories in adults aged 60 years and older, assessing their contributions to baseline performance and longitudinal change over time.MethodsData were drawn from 4,929 participants in the Health and Retirement Study (HRS) with objective hearing assessment in 2018 and three waves of semantic verbal fluency and loneliness measured in 2018, 2020, and 2022. Latent growth curve models were estimated to examine longitudinal change.ResultsVerbal fluency showed a small but statistically significant increase over time, whereas loneliness showed a slight decrease over time. Worse hearing status predicted lower baseline verbal fluency and higher baseline loneliness. The association between hearing status and longitudinal change in verbal fluency was observed in partially adjusted models but was attenuated and did not reach statistical significance after full covariate adjustment.DiscussionThese findings support an association between hearing status and baseline levels of verbal fluency and loneliness, while evidence for longitudinal change in verbal fluency was limited to partially adjusted models.

PMID:42296508 | DOI:10.1177/08982643261446020

Am J Phys Med Rehabil. 2026 Jun 11. doi: 10.1097/PHM.0000000000003064. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of an individualized multidisciplinary rehabilitation program for treating individuals with persistent post-concussive symptoms (PPCS), and identify initial symptoms which predict overall symptom burden after rehabilitation.

DESIGN: This retrospective cohort study employed routine assessment data from the Epworth HealthCare Rehabilitation Concussion Clinic. Patients with PPCS (n=528) participated in an individualized outpatient rehabilitation program, and self-reported symptoms and activity levels (using the Oregon Post-Concussion Symptom Checklist) on clinic admission and discharge. Summed checklist scores produced four subscale scores (physical, thinking, emotional and sleep) and a total score.

RESULTS: On Clinic admission, patients self-reported a mean of 10.9 symptoms (SD: 6.0). Fatigue, cognitive impairments and headache were common. There was a statistically significant mean decrease in checklist scores (symptom burden) after rehabilitation (P=<0.001). Patients’ mean daily activity levels also significantly increased between clinic admission (43.1%) and discharge (73.9%) (mean difference: 30.8%, 95% CI: 28.2-33.5, P=<.001). A subset of somatic and vestibular-ocular symptoms cumulatively predicted 31.1% of the total variance in symptom burden on clinic discharge.

CONCLUSION: This study suggested that a multidisciplinary rehabilitation model was effective for treating PPCS. A focus should be on early, tailored intervention to moderate the initial symptom burden and improve patient prognosis.

PMID:42296468 | DOI:10.1097/PHM.0000000000003064