Nevin Manimala

BMC Pregnancy Childbirth. 2025 Nov 22. doi: 10.1186/s12884-025-08523-x. Online ahead of print.

ABSTRACT

BACKGROUND: The postpartum period is a critical phase that can impact maternal mental health and functional adaptation. This study evaluated the effect of midwife-led psychosocial counseling with family support on postpartum depression and maternal functioning among primiparous women.

METHOD: This randomized controlled trial enrolled 56 primiparous women aged 15-45 years who were recruited from healthcare centers in Tehran, Iran. Participants were selected through convenience sampling and randomly assigned to intervention and control groups using a four- block randomization protocol. The intervention group received three individualized 120-minute sessions of midwife-led psychosocial counseling, with a family member support person present; these sessions were administered at 3-5, 15-30, and 42 days postpartum. The control group received routine postpartum care. The Edinburgh Postnatal Depression Scale and the Barkin Index of Maternal Functioning were administered before, immediately after, and one month post-intervention.

RESULTS: Repeated measures analysis revealed that depression scores declined over time in both groups; however, between-group differences were not statistically significant (P = 0.07, CI [-1.45-2.94]. Furthermore, repeated measures analysis indicated that maternal functioning improved significantly in the intervention group compared to the control group (p = 0.02, CI [0.58-7.03], η² = 0.075).

DISCUSSION: Midwife-led psychosocial counseling with family participation significantly enhances maternal functioning in the early postpartum period. However, no statistically significant between-group effect was observed for postpartum depression, indicating that improvements in depressive symptoms may require longer follow-up or more intensive approaches.

TRIAL REGISTRATION: The study was registered in the Iranian Clinical Trials Registry with NO (IRCT20231209060304N1) on 2024/2/20.

PMID:41275322 | DOI:10.1186/s12884-025-08523-x

BMC Oral Health. 2025 Nov 22. doi: 10.1186/s12903-025-07299-y. Online ahead of print.

ABSTRACT

BACKGROUND: Dental caries ranks among the most frequent childhood diseases worldwide, significantly impacting oral health and overall well-being. The objective of this systematic review and meta-analysis was to evaluate the efficacy of school-based supervised toothbrushing (STB) intervention in the prevention of dental caries by enhancing oral hygiene.

METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) sourced from PubMed, Scopus, Web of Science, and other databases up to February 2025. Eligible studies were those that contrasted school-based STB intervention with no-intervention controls, documenting results in DMFT/dmft or DMFS/dmfs indices. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Risk of Bias 2 (RoB2) tool. A random-effects model was used to pool the results, and standardized mean differences (SMDs) were calculated to account for differences in dentition types. Heterogeneity was assessed using the I² statistic and Cochran’s Q test.

RESULTS: Five of the eight RCTs that satisfied the inclusion requirements were included in the meta-analysis. A statistically significant reduction was shown in DMFS/dmfs that resulted from STB intervention (SMD = -0.22; 95% CI: -0.42 to -0.01; p = 0.037; I² = 64.6%), indicating a modest preventive effect with moderate heterogeneity. However, there was no significant effect on DMFT/dmft (SMD = 0.05; 95% CI: -0.27 to 0.37; p = 0.754; I² = 86.8%), reflecting high between-study variability.

CONCLUSION: School-based supervised toothbrushing intervention appear to effectively reduce dental caries at tooth surface level, as reflected in the significant reduction in DMFS/dmfs scores. However, their effect on whole-tooth caries, as measured by DMFT/dmft, remains less evident in the short term. These findings support using STB as a practical community-level intervention to promote oral health in children.

TRIAL REGISTRATION: We have registered the protocol on the Open Science Framework (OSF) (Registration DOI: https://doi.org/10.17605/OSF.IO/2JWR9).

PMID:41275321 | DOI:10.1186/s12903-025-07299-y

BMC Nurs. 2025 Nov 22. doi: 10.1186/s12912-025-04090-w. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer and its treatments accelerate frailty in older adults with cancer (OACA). Exercise is safe and beneficial during and after treatment, yet many, including older adults, do not meet current exercise guidelines. The primary objective of this study was to understand oncology clinic nurses’ knowledge and current practices regarding exercise discussion and promotion in patients with cancer, including in older patients. The secondary objectives were to: (1) explore barriers to initiating exercise discussion and promotion; and (2) explore the relationship between oncology nurses’ exercise behavior, and their knowledge about existing guidelines and exercise promotion practices.

METHODS: A cross-sectional online survey was conducted via REDCap between February and May 2023 involving nurses who practice in outpatient oncology clinics. The survey was developed based on the expert consensus of the study team and was distributed through professional networks. Descriptive statistics and chi-square were used to analyze the collected data.

RESULTS: Ninety-seven nurses participated. The majority were aged 41-50 years (38.1%) and 31-40 years (27.8%). Mean years of practice was 13.5 (0.5-45). Many nurses lacked formal training on exercise discussion with patients (57.8%), yet expressed interest in learning (91%). Most nurses (90%) agreed exercise benefits patients during treatment. The majority (75%) reported discussing or recommending exercise to patients with cancer, especially advising patients to stay active during and after treatment. Barriers to promoting exercise included limited clinic time (77.7%) and concerns about safety especially for OACA (72.2%). 37.6% of nurses reported engaging in moderate-intensity aerobic activity. 26.6% endorsed both being quite/very knowledgeable in discussing exercise guidelines with patients with cancer in general and 74.7% reported typically discussing exercise with patients with cancer in general. A statistically significant association was found between nurses’ exercise promotion behaviour and perceived knowledge about exercise promotion (p = .01).

CONCLUSION: Many nurses agree that exercise promotion is important and consider it part of their scope of practice to discuss exercise with patients with cancer. Although perceived knowledge regarding specific recommendations is generally low, nurses express interest in enhancing their knowledge and participating in diverse educational opportunities. Institutions should prioritize nurse education to support efforts in exercise promotion.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41275319 | DOI:10.1186/s12912-025-04090-w

Antimicrob Resist Infect Control. 2025 Nov 22. doi: 10.1186/s13756-025-01653-z. Online ahead of print.

ABSTRACT

BACKGROUND: The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.

METHODS: A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.

RESULTS: During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58-79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.

CONCLUSIONS: In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.

PMID:41275300 | DOI:10.1186/s13756-025-01653-z

BMC Sports Sci Med Rehabil. 2025 Nov 22. doi: 10.1186/s13102-025-01418-6. Online ahead of print.

ABSTRACT

Despite significant debate over UEFA’s decision to abolish the away goals rule in 2021 and introduce the use of Video Assistant Refereeing (VAR), little research has considered its potential effects on team performance. Hence, this study investigates how the change in the goals rule and use of (VAR) during the knock phase of UEFA Women’s Champions League affected selected game-related statistics. Data were sourced via the Wyscout platform. The sample consists of 78 UEFA Women’s Champions League knockout round matches; 30 of the matches took place in seasons with the away goals rule (AGR) and no VAR (2016 to 2019) and 48 in seasons without AGR and VAR included (2021 to 2025). Data analysis was performed using a combination of T-Tests; Mann-Whitney-U Tests and Generalised Linear Models. The findings demonstrate that the change in rules resulted in a reductions in the numbers of balls lost (p < 0.01), ball recoveries (p < 0.01), long passes (p < 0.01), forward passes (p < 0.05), passes to the final third (p < 0.01), fouls (p < 0.05), aerial duels (p < 0.01), aerial duels won (p < 0.01), and free kicks (p < 0.01). In contrast, elimination of the away goals rule and inclusion of VAR led to a significant increase in the number of goals (p < 0.05), percentage of accurate passes and counter attacks with shots (p < 0.05). Football governing bodies could consider these findings when deciding whether the rule changes has impacted on the women’s game as expected.

PMID:41275298 | DOI:10.1186/s13102-025-01418-6

Int J Health Geogr. 2025 Nov 22;24(1):35. doi: 10.1186/s12942-025-00423-9.

ABSTRACT

BACKGROUND: Mental-health geomatics require reliable ways to convert high-frequency GPS trajectories into meaningful place types that support indicators such as homestay, location entropy, and spatial extent of daily activities. Raw coordinates are typically noisy and carry little semantic information. We introduce H3-MOSAIC(H3-based Multimodal OSM-and-Satellite AI for Classification), a multimodal generative framework that fuses OpenStreetMap (OSM) building text and satellite imagery on H3 grids to infer place semantics from high-frequency GPS.

METHODS: Raw GPS was smoothed by minute-level speed filtering, then assigned to Level 10 H3 hexagons. Cells were retained if the mean speed was ≤ 1.2 m/s and the cumulative duration was ≥ 15 min, contiguous cells were merged, and home was defined as the cell with the longest dwell from 23:45 to 06:00. We compared text-only OSM classification with image-based and fused approaches across open-source models (DeepSeek, CLIP, LLaVA, Qwen-VL) and proprietary models (GPT-4o-mini, Gemini-2.5-flash-lite). Performance was assessed by accuracy, Cohen’s kappa, precision, recall, F-measure, and confusion matrices. Day level associations between H3 semantic exposures and stress were examined by a random forest model and explainable methods.

RESULTS: Multimodal methods outperformed single-modality baselines. In the 11-class task, accuracies were: CLIP 0.179, LLaVA 0.269, Qwen-VL 0.565, GPT-4o-mini 0.779, and Gemini-2.5-flash-lite 0.790. In the 5-class consolidation, accuracies rose to 0.702 (Qwen-VL), 0.849 (GPT-4o-mini), and 0.858 (Gemini-2.5-flash-lite). Text-only OSM baselines were lower (≈ 0.60-0.68). Across 3,845 hexagons with OSM text, closed-source models agreed on 79% of labels; disagreements concentrated in mixed-use, office, and green classes. Error modes reflected area-dominant versus keyword-triggered reasoning, hybrid-parcel ambiguity, tag sparsity, and symbolic artifacts. Stabilized semantics support more robust computation of homestay, entropy, and activity space and are suitable for privacy-aware, cross-city reuse. In a day-level case study, minutes at Home related to lower stress; Green showed a U-shaped pattern.

CONCLUSIONS: H3-MOSAIC provides a scalable, auditable pipeline for semantic place detection from high-frequency GPS. Multimodal fusion markedly improves accuracy and consistency. Proprietary models are most robust on hard classes and open-source models are practical for coarse taxonomies. H3 day level exposures show stress patterns consistent with established mental health pathways, supporting face validity. The framework enables downstream exposure analyses with reduced misclassification and improved interpretability.

PMID:41275284 | DOI:10.1186/s12942-025-00423-9

Lipids Health Dis. 2025 Nov 22. doi: 10.1186/s12944-025-02782-5. Online ahead of print.

ABSTRACT

BACKGROUND: Lipid metabolism may be linked to chronic gastritis, but its causal role remains unclear. While current research emphasizes inflammation, mucosal changes, immune regulation, genetics, and the gut microbiota, the contribution of lipid metabolism is understudied. This study aims to evaluate the impact of serum lipids and the mechanistic roles of lipid-lowering drug targets in chronic gastritis.

METHODS: We conducted a cross-sectional study using data from real world. Multivariable logistic regression was performed to assess the association between serum lipid profiles and gastritis. Mendelian randomization (MR) analyses based on genome-wide association study (GWAS) datasets were performed to detect the causal relationship of serum lipids, plasma lipid species, and lipid-lowering drug targets. Experimental validation was conducted using high-fat diet (HFD)-fed mice and chemically induced CAG rat models.

RESULTS: Four thousand sixty one person, including 1,023 patients with chronic atrophic gastritis (CAG), 1,742 with non-atrophic gastritis (NAG), and 1,296 as healthy population were included in the analysis. Through covariates adjustment, TC, ApoA1, and HDL-C showed to be associated with an increased risk of chronic gastritis, whereas TG exhibited a protective effect. MR analysis confirmed a significant inverse causal relationship between TG and gastritis (OR = 0.889, 95% CI: 0.825-0.958). Ten plasma lipid species and lipid-lowering gene targets, including LPL and APOC3, were identified as causally associated with disease risk. Mediation analysis revealed six plasma lipid species as potential intermediaries linking genetic variation to gastritis. In vivo experiments demonstrated progressive hepatic steatosis and mild gastric mucosal changes in HFD-fed mice. Immunohistochemical analysis further revealed a significant reduction in LPL and APOC3 expression in gastric tissue (P < 0.05). In the CAG rat model, histological analysis revealed hepatocyte disarray, edema, and gastric mucosal atrophy. Elevated levels of TNF-α, IL-6, IL-1β and decreased levels of GAS-17 and PG I/II were also observed (P < 0.05). Western blot analyses further confirmed the downregulation of LPL and APOC3 expression in gastric tissue (P < 0.05).

CONCLUSIONS: This study provides genetic and experimental evidence, supporting a causal role of lipid metabolism in chronic gastritis. LPL and APOC3 are implicated in its pathogenesis, highlighting potential lipid-targeted strategies for prevention and treatment.

PMID:41275282 | DOI:10.1186/s12944-025-02782-5

BMC Oral Health. 2025 Nov 22. doi: 10.1186/s12903-025-07362-8. Online ahead of print.

ABSTRACT

BACKGROUNDS: The aim of this study was to compare the gloss values obtained from two different 3D-printed resins and one composite resin following the application of various polishing techniques, and to evaluate their gloss retention after exposure to different aging protocols.

METHODS: Two 3D-printed resins, Varseo Smile Crown (BEGO, Germany) and Saremco Print Crowntec (Saremco Dental, Switzerland) and one composite resin (G-aenial Universal Posterior, A2, GC, Japan) were tested. A total of 280 specimens were fabricated and subjected to four different polishing protocols (Enhance + Twist Dia, Enhance + Polishing paste, Enhance + Twist Dia + Polishing paste, and glazing). An additional group received no polishing and served as the control. Gloss values were measured using a glossmeter (NovoGloss; Rhopoint Instrument, UK) at three time points: after fabrication (T0), after polishing (T1), and after 1- hour aging (T2). After the first measurement, the specimens were subjected to three aging procedures: toothbrushing simulation, exposure to acidic fluoride gel (Elmex Gelée, GABA, Switzerland), and immersion in alcohol (75% ethanol). Distilled water served as the control group. Data were statistically analyzed using paired t-tests, one-way ANOVA, and Tamhane’s T2 post hoc tests, with significance set at p < 0.05.

RESULTS: Initial gloss values of both 3D-printed resins were comparable, with glazing achieving the highest gloss. Regardless of the polishing technique, the composite resin exhibited the highest gloss values, with the Enhance + Polishing paste method yielding the best results. Among all aging procedures, toothbrushing mechanical aging resulted in the most significant gloss reduction for all three materials.

CONCLUSION: For the composite resin, the Enhance + Polishing paste technique provided the highest gloss. For the 3D-printed resins, glazing was the most effective method in achieving higher gloss. Mechanical aging had the greatest detrimental effect on gloss for all tested materials.

PMID:41275278 | DOI:10.1186/s12903-025-07362-8

Cancer Imaging. 2025 Nov 22. doi: 10.1186/s40644-025-00957-y. Online ahead of print.

ABSTRACT

BACKGROUND: New factors predicting response in patients with a PD-L1 tumor proportion score (TPS) ≥ 50% for locally advanced or metastatic non-small cell lung cancer (NSCLC) are needed to better select first-line therapy. Based on the literature, we previously developed a radiomic model predicting the KEAP1/NFE2L2 mutational status.

METHOD: This was a retrospective monocenter study including 94 consecutive patients with advanced or metastatic PD-L1 ≥ 50% NSCLC, treated with pembrolizumab, who underwent a pre-therapeutic FDG-PET/CT and were followed up for 1 year. Seventy-seven patients who did not progress within the first 60 days of treatment were analyzed. Each primary lesion was segmented by 2 physicians on PET and CT scans. Radiomic features were calculated using MIM software on both PET and CT imaging. A previously developed KEAP1/NFE2L2 radiomic prediction model (called MUT_PET) was applied to this cohort using the initial FDG-PET/CT. The primary endpoint was the validation of the MUT_PET model as a predictive factor of PFS via the non-invasive prediction of KEAP1/NEF2L2 mutation.

RESULTS: The main characteristics of this cohort were: median age of 67.0 years [range, 48.0-84.0], sex ratio M/F = 60/17, 74.0% of patients with a histopathology of adenocarcinoma and 85.0% with a stage IV disease. The median follow-up was 20.0 months [range, 15.3-23.9]. Fifty-six (72.2%) patients experienced a disease progression with a median PFS of 11.8 months (CI95% 8.6-15.8) among which 51 (66.2%) died. In univariable analysis, MUT_PET model was statistically significant as a predictive factor of improved PFS (HR = 0.51, CI95% 0.30-0.91, p = 0.02) whereas it was not statistically significant regarding OS (HR = 0.61, CI95% 0.34-1.11, p = 0.10). In multivariable analysis, the MUT_PET model was associated with a HR of 0.6 (CI95% 0.34-1.06, p = 0.08). Combining the MUT_PET prediction, the histology subtype and the existence of liver metastases, a multimodal nomogram was able to predict PFS (chi-test of 39.43, p < 0.0001).

CONCLUSION: In PD-L1 TPS ≥ 50% NSCLC patients treated with pembrolizumab, our results suggest an improved PFS in patients predicted to be KEAP1/NFE2L2 mutated.

PMID:41275271 | DOI:10.1186/s40644-025-00957-y

BMC Health Serv Res. 2025 Nov 22. doi: 10.1186/s12913-025-13694-6. Online ahead of print.

ABSTRACT

BACKGROUND: Chinese government has been adjusting its strategies in response to rapid domestic and international changes to devise effective health policies and enhance public health. However, with the rapid socio-economic development and the COVID-19 outbreak, many researchers have identified issues of inefficiency and uneven distribution in health resource allocation within China. Therefore, how to scientifically allocate and efficiently use Chinese health resources has become an urgent issue.

METHODS: The super-efficiency SBM model and global Malmquist model were used to measure and dynamically monitor the health resource allocation efficiency of 31 provinces in China from 2008 to 2020. Moran’s I was applied to test the spatial autocorrelation of the efficiency, and the spatial Dubin model was constructed to analyze influencing factors. All data were collected from the China Health Statistical Yearbook and China Statistical Yearbook from 2008 to 2020.

RESULTS: The super-efficiency SBM model revealed an average health resource allocation efficiency score of 0.632. The average Malmquist productivity index for the same period was 1.090, indicating a generally positive growth. Moran’s I test showed a notable spatial autocorrelation in efficiency distribution. And the regression results of the spatial Dubin model showed that the efficiency was affected by the dependency ratio, illiteracy rate, per capita disposable income, per capita public health budget expenditure, number of medical insurance participants, and the balance of medical insurance fund revenue and expenditure.

DISCUSSIONS: The results revealed that China’s health resource allocation exhibited low efficiency and regional disparities, primarily driven by uneven regional development. From 2008 to 2020, overall productivity increased by 9%, which were predominantly attributable to technological advancements. Under conditions of strong spatial autocorrelation, the efficiency of health resource allocation was shaped by multiple factors operating through distinct spatial channels.

CONCLUSION: Given the challenges of health resource allocation efficiency in China, it is vital to implement targeted strategies. These include strengthening policy support for inefficiency regions, relying on technological progress and scientific management, fostering cross-regional collaboration to leverage spatial effects, and considering multiple factors for rational health resource allocation to ensure the sustainability of the health services.

PMID:41275267 | DOI:10.1186/s12913-025-13694-6