Nevin Manimala

Rev Esc Enferm USP. 2025 Sep 8;59:e20250182. doi: 10.1590/1980-220X-REEUSP-2025-0182en. eCollection 2025.

ABSTRACT

OBJECTIVE: This study aimed to determine the factors relating to climate change anxiety in women at reproductive age.

METHOD: This study is descriptive and cross-sectional. This study included 351 women aged 18-45 years. Data were collected via face to face interviews using the ‘Women’s Descriptive Characteristics and Climate Change Perception Assessment Form’ and ‘Climate Change Anxiety Scale for Women’s Health’ between June and October 2024 at a family health center in Mersin province of Türkiye. Data analysis included descriptive statistical methods and chi-squared automatic ınteraction detector analysis.

RESULTS: The average age of the women was 27.91 ± 8.30 years (n = 351). The Climate Change Anxiety Scale for Women’s Health mean score was 52.46 ± 17.19. Women’s experience of anxiety regarding the negative consequences of climate change affected the scale and all sub-dimensions (physiological health, behavior, and gender) (p < 0.05).

CONCLUSION: Health professionals should provide information and assessments including the effects of climate change on health in care services. They should plan interventions to reduce women’s anxiety levels towards climate change.

PMID:40971202 | DOI:10.1590/1980-220X-REEUSP-2025-0182en

JMIR Hum Factors. 2025 Sep 19;12:e72749. doi: 10.2196/72749.

ABSTRACT

BACKGROUND: Smoking remains a leading cause of death worldwide, with young adults particularly at risk due to the lack of targeted cessation initiatives. While mobile apps show promise in supporting smoking cessation, they primarily target smokers already motivated enough to install them, highlighting the need for interventions that reach those who are not yet ready to take that step.

OBJECTIVE: This paper focuses on designing and evaluating Smokwit, a digital smoking cessation intervention aimed at young adults during the act of smoking. Smokwit seeks to investigate the early stages of smoking cessation (precontemplation and contemplation) that are important yet rarely investigated.

METHODS: The paper is based on the design science research methodology where a digital intervention-Smokwit-was designed and evaluated in the wild using a mixed method approach combining quantitative results of a quasi-experiment with qualitative insights from users and experts. More specifically, Smokwit is a novel gamified ambient intervention that integrates a connected ashtray with a mobile app. The ashtray aims to trigger processes of change, in particular consciousness raising and social liberation (as part of the transtheoretical model of change) by provoking curiosity, self-reflection, and ad-hoc peer discussions among smokers. The linked mobile app is designed to reinforce this goal by providing smoking cessation self-help material and coaching possibilities. We evaluated the effectiveness of this intervention through a 3-month field study designed as a quasi-experiment with a treatment and control group (n=46). A qualitative analysis with users (n=10) and smoking cessation experts (n=7) provides insights into the type of interactions that happened within and outside the system as well as practical implications for smoking cessation organizations.

RESULTS: The qualitative findings revealed that the intervention promoted smokers’ self-reflection, peer discussions, and mobile app interactions. Furthermore, the quantitative analysis uncovered a possible trend toward increased readiness to quit among smokers in the treatment group compared to the control group; however, this did not reach conventional levels of statistical significance (b=1.33; z=1.91; P=.06).

CONCLUSIONS: Smokwit provides encouraging insights into how to design a bottom-up digital intervention that targets young adults at an opportune moment to support them on their smoking cessation journey.

PMID:40971186 | DOI:10.2196/72749

Epilepsia. 2025 Sep 19. doi: 10.1111/epi.18633. Online ahead of print.

ABSTRACT

This study was undertaken to systematically evaluate the efficacy of cell therapy in reducing seizures in animal models of chronic epilepsy. Three databases, Ovid MEDLINE, Ovid Embase, and Web of Science, were searched using predetermined eligibility criteria. The relevant preclinical controlled studies were included for review and meta-analysis using a random-effects model to calculate summary estimates of the effect size (percentage reduction in seizures). The degree of heterogeneity among the included studies was assessed using the I² statistic. Subgroup meta-analysis and meta-regression were performed to further elucidate the sources of heterogeneity. Thirty published studies met the eligibility criteria, including a total of 1306 animals. The majority of studies used kainic acid and pilocarpine status epilepticus models of mesial temporal lobe epilepsy (MTLE). The random effects model revealed an overall reduction in seizure frequency of 54.8% (95% confidence interval = 48.0558-61.5455) compared to the control, and the heterogeneity was 87.1% among the included studies. The meta-regression revealed that seven study characteristics significantly accounted for the between-study heterogeneity. They can be grouped into three broad categories: epilepsy-specific, animal-specific, and cell transplantation-specific. The greatest seizure reduction was observed in the post-kainic acid status epilepticus model of chronic MTLE, when the cells were delivered intravenously and when the seizure reduction was measured as seizure frequency. Embryonic stem cell transplantation showed the greatest efficacy in reducing seizures. Cell transplantation shows favorable efficacy as a treatment that can reduce seizure recurrence in chronic animal models of epilepsy. High heterogeneity between studies reflects the diverse methodologies employed in preclinical research on cell therapy for epilepsy. Despite these encouraging findings, the high risk of publication bias and variability in study design emphasize the need for further robust preclinical studies to confirm these reported outcomes.

PMID:40971184 | DOI:10.1111/epi.18633

JAMA Health Forum. 2025 Sep 5;6(9):e253192. doi: 10.1001/jamahealthforum.2025.3192.

ABSTRACT

IMPORTANCE: Subspecialists-physicians with narrower clinical focus-play an increasing role in US health care, particularly in surgery, where most trainees now pursue fellowship training. Yet little is known about the degree of subspecialization among practicing surgeons and the evolving role of surgical generalists.

OBJECTIVE: To quantify trends in surgical subspecialization and examine the geographic distribution of subspecialists and the procedural scope of surgical generalists.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study using 100% Medicare Part B data from 2000, 2010, and 2021, including all fee-for-service beneficiaries treated by physicians in general surgery, neurosurgery, ophthalmology, orthopedic surgery, and otolaryngology was caried out. A novel classification method combining k-means clustering, large language models, and expert validation to distinguish subspecialists from surgical generalists based on procedural claims was used. The analysis was undertaken in 2023 and 2024.

MAIN OUTCOMES AND MEASURES: The number of distinct subspecialties, the share of subspecialists in each surgical specialty, their geographic distribution across hospital referral regions (HRRs), and the association between subspecialist supply and procedural diversity among generalists.

RESULTS: Overall, more than 70 000 surgeons were included. The share of subspecialists increased from 38% in 2000 to 58% in 2021, reflecting the growth of recognized subspecialties (from 24 to 33) and expansion of existing ones. Subspecialization rates varied by specialty, rising from 9% to 28% in otolaryngology and from 66% to 77% in neurosurgery. While subspecialist supply per 100 000 fee-for-service beneficiaries remained stable, the mean number of surgical generalists per 100 000 declined from 105 to 50. A 10% increase in subspecialist supply in an HRR was associated with a 0.94% decrease (95% CI, -0.15% to -0.41%) in the number of unique procedures performed by generalist surgeons.

CONCLUSIONS AND RELEVANCE: This cohort study found that subspecialization has considerably reshaped the surgical workforce, concentrating care among subspecialists while narrowing the procedural scope of generalist surgeons. These shifts raise concerns about access to generalist care, particularly in regions with declining generalist supply, and suggest the need for policies that consider both specialization and geographic equity in surgical workforce planning.

PMID:40971167 | DOI:10.1001/jamahealthforum.2025.3192

JAMA Health Forum. 2025 Sep 5;6(9):e253489. doi: 10.1001/jamahealthforum.2025.3489.

ABSTRACT

IMPORTANCE: Overdoses involving methamphetamines and cocaine have increased in recent years. Identification of individuals at highest risk could facilitate the implementation of evidence-based interventions to reduce overdose risk.

OBJECTIVE: To develop and internally validate a model that predicts hospitalization or emergency department (ED) treatment for stimulant-involved overdose among the Medicaid-insured population.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective case-cohort study using Medicaid claims data from 2016 to 2019 (development) and 2020 (validation) for all Medicaid enrollees age 15 years or older with a cocaine- or other stimulant-involved overdose. A subcohort was created using a simple random sample of the full cohort of all cases. Within the full cohort, cases were identified as those having any inpatient or ED encounter for stimulant-involved overdose during the following year. A case-cohort sample was obtained for each calendar year from 2016 to 2020, each with a subcohort size of 100 000. Each individual contributed only 1 case event (for an individual with multiple overdoses, only the first eligible was selected). For each of the 4 overdose outcomes, a predictive weighted Cox model was first developed among enrollees of sampling years 2016 to 2019 (development set), and its performance was evaluated in our test set of 2020. The prediction models were first developed in November 2023, and the model fairness assessment was performed in April to May 2025.

INTERVENTIONS OR EXPOSURES: Individual-level candidate predictors were demographic characteristics, enrollment, health care utilization, and other clinical variables. Area-level variables included social, economic, housing, and demographic characteristics data from the American Community Survey, rural-urban classification, Social Deprivation Index, retail opioid dispensing rates, and health resources.

MAIN OUTCOMES AND MEASURES: Four types of stimulant-involved overdose associated with hospitalization or ED treatment: cocaine-involved overdose, (1) involving an opioid or (2) not involving an opioid; or methamphetamine-, ecstasy-, or other psychostimulant-involved overdose (hereafter, other stimulant), (3) involving an opioid or (4) not involving an opioid.

RESULTS: The analysis included 78 795 enrollees with cocaine- and other stimulant-involved overdose (mean [SD] age, 42.2 [13.7] years; 33 304 [42%] female and 45 491 [58%] male individuals). Weighted Cox regression prediction models showed good calibration and high discriminatory performance (Harrell C statistic): cocaine-involved overdose, with (0.923) or without (0.902) an opioid; other stimulant-involved overdose, with (0.909) or without (0.868) an opioid. For cocaine-involved overdose with opioids, previous individual opioid use disorder diagnosis or cocaine use disorder diagnosis played the largest role in overdose risk prediction. For cocaine-involved overdose without opioids, previous cocaine use disorder diagnosis and area-level income inequality and housing variables contributed most to prediction. For other stimulant-involved overdose with opioids, previous opioid use disorder diagnosis and area-level percentage of those living with a disability contributed most to prediction. For other stimulant-involved overdoses without opioids, previous stimulant-related disorder and area-level proportion of individuals receiving Supplemental Nutrition Assistance Program contributed most to prediction.

CONCLUSIONS AND RELEVANCE: This case-cohort study found that readily available data can be used to identify those at high risk of hospitalization or ED visit for cocaine- or stimulant-involved overdose. These individuals would likely benefit most from evidence-based interventions and awareness of risk factors for overdose.

PMID:40971166 | DOI:10.1001/jamahealthforum.2025.3489

JAMA Netw Open. 2025 Sep 2;8(9):e2532741. doi: 10.1001/jamanetworkopen.2025.32741.

ABSTRACT

IMPORTANCE: Poverty and social disadvantage are associated with increased risks of pregnancy complications. It is not known whether poverty and social disadvantage are associated with subfertility and miscarriage risks.

OBJECTIVE: To assess whether poverty and markers of social disadvantage, including low educational level and household income among both women and men, are associated with subfertility and miscarriage risks.

DESIGN, SETTING, AND PARTICIPANTS: This population-based prospective cohort study, which was conducted in an urban setting in Rotterdam, the Netherlands, between August 9, 2017, and July 1, 2021, included women and their partners from the preconception period onward with follow-up until birth. The date of analysis was July 8, 2025.

EXPOSURES: Poverty, defined as a household income of less than €3000 per month and experiencing financial difficulties; educational level; and household income.

MAIN OUTCOMES AND MEASURES: The main outcomes were fecundability, defined as the per-month probability of conceiving; subfertility, defined as a time to pregnancy or the duration of actively pursuing pregnancy of more than 12 months or use of assisted reproductive technology; and miscarriage, defined as pregnancy loss before 22 weeks’ gestation. Data were analyzed using Cox proportional hazards regression and modified Poisson regression models.

RESULTS: Among 3604 women (median age, 31.2 [IQR, 28.5-34.3] years) and 2557 male partners (median age, 33.2 [IQR, 30.0-36.6] years), the time-to-pregnancy study population consisted of 2851 episodes among women (median age, 31.5 [IQR, 29.1-34.4] years) and 2830 episodes among men (median age, 33.3 [IQR, 30.4-36.7] years). The miscarriage study population consisted of 2515 episodes among women (median age, 31.3 [IQR, 28.8-34.1] years) and 2498 episodes among men (median age, 33.3 [IQR, 30.1-36.5] years). Among women, the median time to pregnancy was 3.5 months (95% range [2.5%-97.5%], 0-67.8 months); in total, 974 episodes (34.6%) were subfertile, and 297 pregnancy episodes (11.8%) led to a miscarriage. Subanalyses were based on 2103 to 2805 episodes among women. Poverty was associated with lower fecundability (confounder model fecundability ratio [FR], 0.61 [95% CI, 0.51-0.72]). Also, as compared with high educational level, low educational level among women (FR, 0.61 [95% CI, 0.50-0.74]) and men (FR, 0.72 [95% CI, 0.62-0.85]) was associated with lower fecundability. As compared with a household income of €6000 or more per month, a household income of less than €3000 per month was associated with lower fecundability (FR, 0.59 [95% CI, 0.51-0.68]). The effect estimates of subfertility were in line with those for fecundability; for example, poverty was associated with increased subfertility risk (32.5% vs 50.3%; relative risk, 1.37 [95% CI, 1.16-1.62]). These associations were only partly explained by demographic and lifestyle factors. Poverty and markers of social disadvantage were not associated with miscarriage risk.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that poverty and social disadvantage, characterized by low educational level and household income among both women and men, were associated with lower fecundability and increased risks of subfertility but not with miscarriage risk. Further studies are needed to identify the underlying and explanatory mechanisms associated with fertility outcomes and the potential for novel public health strategies for couples desiring pregnancy.

PMID:40971155 | DOI:10.1001/jamanetworkopen.2025.32741

Clin Transplant. 2025 Sep;39(9):e70325. doi: 10.1111/ctr.70325.

ABSTRACT

BACKGROUND: Transplant is the optimal treatment for kidney failure; however, disparities in access persist. We developed and validated risk indices to predict early dropout at key stages of the transplant-seeking process not captured in national registries.

METHODS: We included patients referred for kidney transplant at Houston Methodist Hospital between June 2016, and November 2023. We collected demographic, clinical, patient- and contextual-level socioeconomic variables from electronic health records and publicly available census data. We used machine learning (ML) models to predict the characteristics of patients at higher risk of dropping out: (1) at referral (before starting evaluation), (2) in the process of evaluation (before waitlisting), and (3) during waitlisting (before receiving a transplant). Model performance was evaluated using AUROC.

RESULTS: Of 4133 referred patients, 46% did not attend their first transplant evaluation visit. Of 2414 patients who were medically eligible for transplant and started evaluation, 54% did not become waitlisted. Of 2457 waitlisted patients, 31% became inactive on the waitlist. Higher risk patients were consistently older, obese, and socioeconomically disadvantaged, with stage-specific differences: social factors-such as being single, unemployed, less educated, and living in high-deprivation areas-and African American race dominated at referral (AUROC 0.79); clinical comorbidities and both African American and Hispanic ethnicity were prominent at evaluation (AUROC 0.71); and Hispanic ethnicity, smoking, and digital exclusion were key drivers at waitlisting (AUROC 0.76).

CONCLUSION: ML models effectively identified dropout risk at referral, evaluation, and waitlisting, enabling early identification of at-risk patients. Targeted interventions could reduce disparities, improve evaluation completion, and increase transplant access.

PMID:40971151 | DOI:10.1111/ctr.70325

Am J Clin Dermatol. 2025 Sep 19. doi: 10.1007/s40257-025-00962-8. Online ahead of print.

ABSTRACT

BACKGROUND: Atopic dermatitis (AD), a chronic systemic disease, can cause intense skin itching and negatively impact sleep, mood, and quality of life (QoL) for patients and families.

METHODS: PEDISTAD is an ongoing, 10-year, observational registry describing disease characteristics, atopic comorbidities, and treatment patterns in pediatric patients (aged <12 years at enrollment) with moderate-to-severe AD. This 3-year interim analysis evaluates clinician-reported and caregiver-reported/patient-reported outcomes (Eczema Area and Severity Index [EASI], percent body surface area affected, worst itching/scratching, Children’s Dermatology Life Quality Index, and Dermatitis Family Impact) in children treated with dupilumab, methotrexate, and/or cyclosporine. Outcomes were assessed as change from therapy start to last observation (either data cutoff date or treatment discontinuation).

RESULTS: Mean (±SE) EASI scores at the time of the last 3-year interim observation were consistent with mild disease in the dupilumab cohort and moderate disease in the methotrexate and cyclosporine cohorts. Improvements in pruritus were numerically greater in the dupilumab cohort relative to the methotrexate and cyclosporine cohorts, while improvements in QoL were similar in the dupilumab and methotrexate cohorts, with no significant change in the cyclosporine cohort. Rates of AD exacerbation were numerically lower with dupilumab treatment relative to methotrexate treatment which were numerically lower than cyclosporine treatment. Dupilumab discontinuation rates were numerically lower relative to methotrexate which were numerically lower than cyclosporine.

CONCLUSIONS: This PEDISTAD 3-year interim analysis of dupilumab, methotrexate, and cyclosporine treatment in children with AD demonstrates numerically greater improvements in AD signs, symptoms and QoL with dupilumab treatment relative to methotrexate and cyclosporine [Video abstract and graphical abstract available].

CLINICAL TRIAL REGISTRATION: NCT03687359. Supplementary file1 (MP4 58163 KB).

PMID:40971133 | DOI:10.1007/s40257-025-00962-8

Ir J Med Sci. 2025 Sep 19. doi: 10.1007/s11845-025-04080-6. Online ahead of print.

ABSTRACT

OBJECTIVES: The main goal of this study was to determine the frequency of cape use among superheroes and predictors of superhero status.

DESIGN: Observational case-control study where superheroes were considered cases and villains/neutral characters controls.

SETTING: Top 25 highest grossing superhero movies.

PARTICIPANTS: Main characters in superhero movies classified as superheroes and villains through a multi-tier systems including videographic review and information collected in a superhero community database.

MAIN OUTCOME MEASURES: Frequency of different attributes between superheroes/villains (e.g., cape wearing), correlation of attributes and univariate and multivariable adjusted models of attributes associated with a superhero status.

RESULTS: There were 97 observations of 68 characters over 25 movies from three studios. There were 61 observations of superheroes and 36 villains and neutrals. Just 16% of superheroes wore capes, while 11% of non-superheroes did so. The majority (67%) of superheroes were humans, while among non-superheroes were 56%. Almost all superheroes had an altruistic mission (98%), while this attribute was present in just 19% of non-superheroes.

CONCLUSIONS: In a sample of characters from the highest grossing superhero movies, most superheroes did not wear a cape. The strongest predictor for a superhero status was having an altruistic mission.

PMID:40971124 | DOI:10.1007/s11845-025-04080-6

Ir J Med Sci. 2025 Sep 19. doi: 10.1007/s11845-025-04088-y. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative pain remains a significant concern in pediatric patients undergoing laparoscopic appendectomy. The transversalis fascia plane block (TFPB) is a recently described regional technique. In this study, we aimed to adapt this block into a laparoscopy-assisted approach and compare its analgesic efficacy with conventional wound infiltration in pediatric appendectomy.

METHODS: In this prospective, randomized controlled trial, 60 pediatric patients undergoing laparoscopic appendectomy were allocated to receive either laparoscopy-assisted TFPB (n = 30) or standard wound infiltration (WI; n = 30) with 0.25% bupivacaine (0.5 mL/kg). The primary outcome was postoperative pain evaluated via the FLACC (Face, Legs, Activity, Cry, Consolability) scale at seven time points within 24 h. Secondary outcomes included paracetamol consumption and parental satisfaction.

RESULTS: Demographic and perioperative variables were comparable between groups (p > 0.05). Paracetamol was required in significantly fewer patients in the TFPB group (36.7% vs 66.7%, p = 0.038), with fewer requiring repeated doses (13.3% vs 46.7%, p = 0.041). Although FLACC pain scores were statistically comparable between groups (p > 0.05), the TFPB group consistently showed lower median values from the fourth postoperative hour onward. Likewise, parental satisfaction was consistently high in both cohorts, with no significant variation between the analgesic techniques (p = 0.788). No adverse effects or block-related complications were reported.

CONCLUSION: Laparoscopy-assisted TFPB significantly reduced postoperative analgesic requirements compared to wound infiltration. Given its feasibility, efficacy, and safety, laparoscopy-assisted TFPB technique should be considered an alternative component of multimodal analgesia in pediatric laparoscopic abdominal surgery.

PMID:40971123 | DOI:10.1007/s11845-025-04088-y