Nevin Manimala

Int J Occup Med Environ Health. 2025 Aug 29:208604. doi: 10.13075/ijomeh.1896.02626. Online ahead of print.

ABSTRACT

OBJECTIVES: Environmental intolerance (EI) can negatively impact well-being and daily life, and even lead to disability. Healthcare can detect EI early and conduct interventions. This study explored ways of identifying environmental exposure-related health worries and EI during occupational health (OH) check-ups, and their associations with unselected working-age employees’ perceived work ability, stress and overall health.

MATERIAL AND METHODS: A crosssectional survey was conducted among 355 employees attending OH check-ups at an occupational health services (OHS) unit in Southern Ostrobothnia, Finland. Health worries about environmental exposures were measured using 2 single-item questions, one on exposures in general, the other on indoor air. Cutoffs were set for excessive worries. Environmental intolerance was defined using the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Perceived stress, work ability and health were inquired. The analyses used descriptive statistics, Fisher’s exact test and linear regression.

RESULTS: Participants with EI (N = 25, 7%) reported significantly poorer work ability and health, and higher stress than those without EI. Environmental intolerance was also associated with comorbid diseases such as asthma, migraine, mental disorders and irritable bowel syndrome. Those with excessive health worries about environmental exposure (N = 73, 21%) and indoor air (N = 182, 51%) outnumbered and mostly included those with EI. All the participants’ (N = 355) increased health worry about environmental exposures was independently associated with poorer work ability and health, and higher perceived stress. The health worry questions for identifying EI were sensitively phrased, and the general question demonstrated good specificity.

CONCLUSIONS: The findings show that environmental exposure-related health worries can be detected by and EI identified by single questions. Their interrelation and association with poorer work ability and health suggest they are part of the same continuum of increasing environmental worries and exposure- related reactions. Identifying health worries enables early detection and interventions such as psychoeducation, to prevent any related disability and adverse health outcomes. Int J Occup Med Environ Health. 2025;38(4).

PMID:40891448 | DOI:10.13075/ijomeh.1896.02626

Magn Reson Med. 2025 Sep 2. doi: 10.1002/mrm.70054. Online ahead of print.

ABSTRACT

PURPOSE: χ $$ chi $$ -separation is an advanced quantitative susceptibility mapping (QSM) method that is designed to generate paramagnetic ( χ para $$ {chi}_{para} $$ ) and diamagnetic ( | χ dia | $$ mid {chi}_{dia}mid $$ ) susceptibility maps, reflecting the distribution of iron and myelin in the brain. However, vessels have shown artifacts, interfering with the accurate quantification of iron and myelin in applications. To address this challenge, a new vessel segmentation method for χ $$ chi $$ -separation is developed.

METHODS: The method comprises three steps: (1) seed generation from R 2 * $$ {R}_2^{ast } $$ and the product of χ para $$ {chi}_{para} $$ and | χ dia | $$ mid {chi}_{dia}mid $$ maps; (2) region growing, guided by vessel geometry, creating a vessel mask; (3) refinement of the vessel mask by excluding non-vessel structures. The performance of the method was compared to other vessel segmentation methods both qualitatively and quantitatively. To demonstrate the utility of the method, it was tested in two applications: quantitative evaluation of a neural network-based χ $$ chi $$ -separation reconstruction method ( χ $$ chi $$ -sepnet- R 2 * $$ {R}_2^{ast } $$ ) and population-averaged region of interest (ROI) analysis.

RESULTS: The proposed method demonstrates superior performance to other vessel segmentation methods, effectively excluding the non-vessel structures, achieving the highest Dice score coefficient against manually segmented vessel masks (3 T: 76.7% for χ para $$ {chi}_{para} $$ and 68.7% for | χ dia | $$ mid {chi}_{dia}mid $$ , 7 T: 76.9% for χ para $$ {chi}_{para} $$ and 72.6% for | χ dia | $$ mid {chi}_{dia}mid $$ ). For the applications, applying vessel masks report notable improvements for the quantitative evaluation of χ $$ chi $$ -sepnet- R 2 * $$ {R}_2^{ast } $$ and statistically significant differences in population-averaged ROI analysis. These applications suggest excluding vessels when analyzing the χ $$ chi $$ -separation maps provide more accurate evaluations.

CONCLUSION: The proposed method has the potential to facilitate various applications, offering reliable analysis through the generation of a high-quality vessel mask.

PMID:40891385 | DOI:10.1002/mrm.70054

Eur J Psychotraumatol. 2025 Dec;16(1):2543616. doi: 10.1080/20008066.2025.2543616. Epub 2025 Sep 2.

ABSTRACT

Background: Since 2020, modern youth in Ukraine have faced an exceptionally challenging period, first enduring the burdens of the COVID-19 pandemic and then being thrust into the full-scale war, characterized by persistent traumatic exposure. Given the profound and lasting psychological consequences of such crises, it is essential to monitor the long-term impact of war on youth mental health. However, despite the urgency of this issue, longitudinal studies with large, diverse samples remain scarce.Objective: This study aims to track changes in anxiety, depression, and stress and explore their associations with demographic and educational variables among university students in Ukraine, from the COVID-19 pandemic through two years of full-scale war.Method: Data were collected online at three time points over four years from independent samples of students from 27 higher education institutions across 12 Ukrainian cities. A total of 757 students participated in 2020, 2,592 in 2023, and 838 in 2024, all completing anonymous questionnaires. A one-way analysis of variance (ANOVA) and a General Linear Model were used to analyse the results.Results: The findings revealed a significant increase in anxiety, depression, and stress levels among university students during the transition from the pandemic to wartime conditions. Women reported higher levels of anxiety, depression, and stress, while students aged 15-25 exhibited poorer mental health than those aged 26-55. Although students across all fields of study experienced heightened distress in 2023, those in technical disciplines were the only group to show a decline in 2024.Conclusions: Ukrainian youth have been living under high levels of distress for more than four years, with little indication of improvement. The results highlight the urgent need for targeted strategies in prevention, intervention, and treatment of anxiety, depression, and stress among university students and other vulnerable young adults.

PMID:40891370 | DOI:10.1080/20008066.2025.2543616

Eur J Psychotraumatol. 2025 Dec;16(1):2543630. doi: 10.1080/20008066.2025.2543630. Epub 2025 Sep 2.

ABSTRACT

Background: Little is known regarding the association between adverse experiences and cognitive frailty, and the role of social support in this relationship.Objective: This study aimed to investigate the association between adverse experiences and cognitive frailty, as well as determine how social support affects this relationship among rural older adults in China.Methods: Data were obtained from two waves of follow-up surveys (2020 and 2022) conducted by the Shandong Rural Elderly Health Cohort (SREHC), including 2,572 participants aged 60 years or above. The primary outcome was cognitive frailty, defined as the co-existence of physical frailty (≥3 Fried criteria) and cognitive impairment (educationally adjusted Mini-Mental Status Examination). Self-reported adverse experiences were categorised as no adversity, only childhood adversity (≥1 of 12 events before age 17), only current adversity (≥1 of 7 events past year), and dual adversity (experiencing both childhood and current adversity). The Generalized Estimating Equation (GEE) analyses and the margins plot were performed to estimate our hypothetical models.Results: In fully adjusted models, older adults with dual adversity were significantly associated with a higher risk of cognitive frailty (OR = 1.64, 95% CI: 1.02-2.63), not significant in only childhood or only current adversity. Social support alleviated the risk of cognitive frailty among rural older adults with only childhood adversity (OR = 0.41, 95% CI: 0.21-0.79) or dual adversity (OR = 0.26, 95% CI: 0.09-0.72), but not among those with only current adversity.Conclusions: Our results underscore the relationship between dual adversity and cognitive frailty, not significant in only childhood or only current adversity, with social support serving as a pivotal moderating factor. Governmental authorities should elevate their awareness of adverse experiences, and enhancing social support is crucial to preventing cognitive frailty and promoting healthy aging.

PMID:40891356 | DOI:10.1080/20008066.2025.2543630

Clin Transplant. 2025 Sep;39(9):e70285. doi: 10.1111/ctr.70285.

ABSTRACT

BACKGROUND: Prior studies have demonstrated an association between donor/recipient sex mismatch and worse outcomes in donation after brain death (DBD) heart transplant. This study aims to determine the impact of donor/recipient sex mismatch on outcomes in donation after circulatory death (DCD) transplant.

METHODS: The study cohort consisted of 1260 patients from the United Network for Organ Sharing (UNOS) dataset who underwent DCD heart transplant between 12/2019 and 12/2023. Transplants were stratified into four groups: female donor/female recipient (FD/FR), female donor/male recipient (FD/MR), male donor/male recipient (MD/MR), and male donor/female recipient (MD/FR). The primary outcomes were acute rejection and post-operative complications, while the secondary outcome was mortality. Multivariable logistic regression was used to analyze factors associated with rejection, while Kaplan-Meier (KM) survival analyses were compared using the log-rank test with post-hoc binary comparisons.

RESULTS: Female recipients who received DCD transplant had higher rates of acute rejection compared to male recipients (FD/FR: 26 (20%), MD/FR: 28 (22.2%), MD/MR 110 (11.8%), FD/MR 6 (9%), p = 0.001) while rates of stroke, dialysis, and pacemaker implantation were similar. Among male recipients, weight, height, and left ventricular assist device (LVAD) were associated with acute rejection. However, neither weight nor height was associated with acute rejection in female recipients. The KM curve showed no difference in long-term mortality.

CONCLUSIONS: Female recipients who receive DCD hearts from male and female donors have an increased risk of acute rejection compared to their male counterparts. Height and weight are associated with acute rejection in male patients. Male and female recipients have similar long-term mortality.

PMID:40891331 | DOI:10.1111/ctr.70285

Stroke. 2025 Sep 2. doi: 10.1161/STROKEAHA.125.051312. Online ahead of print.

ABSTRACT

BACKGROUND: The introduction of novel therapeutics into clinical practice could impact equity in health outcomes.

METHODS: This was a retrospective, observational cohort study based on the Get With The Guidelines-Stroke program of the American Heart Association. Two epochs were considered: January 2010 to December 2014 and January 2016 to December 2019. The primary exposure was the availability of endovascular thrombectomy (EVT) at the hospital level defined by the degree of implementation of EVT (>10% change from pre-2015 to post-2015) after balancing key patient and hospital characteristics with overlap weighting. The coprimary end points were (1) the difference in in-hospital mortality for patients from counties with median income >$60 000 versus <$60 000 and (2) the difference in in-hospital mortality between Black and White patients. Secondary end points were differences in in-hospital mortality by sex, insurance status, county-level poverty, and county-level educational attainment. Exploratory end points were differences in ambulatory status at hospital discharge and a composite of in-hospital mortality/discharge to hospice across the above categories.

RESULTS: Of 173 049 patients (median age, 75 years; 53.9% female) potentially eligible for EVT, 39 196 (22.7%) received EVT (7572 [10.0% of potentially eligible patients] between 2010 and 2014 and 31 624 [32.6% of potentially eligible patients] between 2016 and 2019). From 2010 to 2014, 1565 (20.7%) of patients and from 2016 to 2019, 5158 (16.3%) who received EVT died in hospital. Implementation of EVT was associated with decreased disparities in mortality rates for patients from counties with median inflation-adjusted income >$60 000 versus <$60 000 (absolute risk difference, 3.9% [95% CI, 0.53%-7.3%]). Implementation of EVT was not associated with changes in differences in in-hospital mortality by race, sex, county poverty rates, county educational attainment, or insurance status.

CONCLUSIONS: Among patients with acute ischemic stroke who were potentially eligible for EVT, the implementation of EVT on a hospital level did not worsen health equity in any dimension (race/ethnicity, sex, or insurance status) and was associated with improvements in socioeconomic equity in acute ischemic stroke mortality.

PMID:40891327 | DOI:10.1161/STROKEAHA.125.051312

Clin Transplant. 2025 Sep;39(9):e70300. doi: 10.1111/ctr.70300.

ABSTRACT

BACKGROUND: Heart transplantation (HT) following donation after circulatory death (DCD) has grown substantially in recent years. However, the effects of functional ischemic injury during procurement on exercise capacity remain unknown. We compared exercise performance parameters between DCD and donation after brain death (DBD) recipients.

METHODS: We conducted a single-center, retrospective, case-control study of adults with isolated HT between January 2022 and April 2024 and completed a treadmill cardiopulmonary exercise test (CPET) post-transplant. DCD-HT recipients (cases) were matched to DBD-HT recipients (controls) based on major demographics and CPET timing. The primary outcome was peak oxygen consumption (pVO₂). Secondary outcomes included additional exercise capacity parameters and echocardiographic indices at peak exercise.

RESULTS: Cases (DCD-HT: n = 10, 20% female) and controls (DBD-HT: n = 10, 20% female) had similar baseline characteristics. Total ischemic time was longer in the DCD group (6.9 [interquartile range (IQR): 6.4-7.1] vs. 4.6 [IQR: 3.94.8] h; p = 0.002). Time from HT to CPET did not differ. DCD and DBD-HT recipients had similar pVO₂ (17.1 [IQR: 15.2-19.7] vs. 19.7 [IQR: 13.3-21.2] mL/kg/min; p = 0.545). Respiratory exchange ratio (RER) was slightly lower in the DCD group (1.1 [IQR: 1.0-1.2] vs. 1.2 [IQR: 1.21.3]; p = 0.031). Ventilatory efficiency (VE/VCO₂) at anaerobic threshold, left ventricular ejection fraction, and E/e’ at peak exercise were comparable between groups.

CONCLUSION: DCD and DBD heart transplant recipients demonstrate similar exercise performance. Overall, exercise capacity remains limited after HT, highlighting the need for further studies to identify underlying mechanisms and potential therapeutic interventions.

PMID:40891317 | DOI:10.1111/ctr.70300

Anxiety Stress Coping. 2025 Sep;38(5):599-606. doi: 10.1080/10615806.2025.2475292. Epub 2025 Mar 6.

ABSTRACT

BACKGROUND AND OBJECTIVES: This study investigated the impact of war stress on birth outcomes, specifically birth mode and the subjective childbirth experience (“flow”). We hypothesized that war stress would adversely affect birth mode and the reported “flow.”

DESIGN AND METHODS: A comparative study was conducted utilizing birth data from two online surveys of 411 Israeli women who gave birth before (82%) and during (17.8%) the Israel – Hamas war. Data collected included demographics, birth mode, and self-reported childbirth experience.

RESULTS: Contrary to our initial hypothesis, no significant differences between the two groups regarding birth mode or reported flow during childbirth were found.

CONCLUSIONS: These findings suggest women possess an innate ability to immerse themselves in the birthing process, disconnecting from external stressors, particularly within a safe and supportive birthing environment. We explain our findings from evolutionary, psychological, and biochemical perspectives. Humans have likely evolved to focus on childbirth and shut out external threats. A safe birthing space allows women to enter a focused state for successful birth. Moreover, women tend toward “tend-and-befriend” behavior under stress, seeking safety and social support. The study highlights the importance of the immediate birthing environment for successful childbirth outcomes, even during times of significant external stress.

PMID:40891311 | DOI:10.1080/10615806.2025.2475292

Eur J Psychotraumatol. 2025 Dec;16(1):2542045. doi: 10.1080/20008066.2025.2542045. Epub 2025 Sep 2.

ABSTRACT

Background: Non-suicidal self-injury (NSSI) is a significant public health concern among adolescents, particularly in psychiatric settings, where prevalence rates exceed those observed in the general community. Childhood maltreatment (CM) is a known risk factor for NSSI; however, the mechanisms linking CM to NSSI are not fully understood.Objective: This study explored the mediating roles of stressful life events (SLEs) and negative affect (depression and anxiety) in the relationship between CM and NSSI, grounded in the cumulative adversity theory.Methods: In this cross-sectional survey, 226 Chinese adolescents (Mage = 14.76, SD = 1.70) admitted to a psychiatric unit participated. Measures included the Childhood Trauma Questionnaire (CTQ-SF), the Adolescent Self-Rating Life Events Checklist (ASLEC), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC). Structural equation modelling (SEM) was used to analyze mediation pathways.Results: Stressful life events and negative affect fully mediated the relationship between childhood maltreatment and NSSI. Specifically, CM indirectly influenced NSSI severity through increased negative affect (β = 0.088, 95% CI: 0.014-0.186, p = .039) and through a sequential pathway involving both SLEs and negative affect (β = 0.137, 95% CI: 0.072-0.251, p = .002). However, the pathway from CM to NSSI via SLEs alone was not significant (β = -0.053, 95% CI: -0.267 to 0.093, p = .565).Conclusion: The findings align with cumulative adversity theory, suggesting that childhood maltreatment elevates NSSI risk by increasing emotional distress in response to subsequent stressful life events. Targeted interventions should focus on helping at-risk adolescents manage stress and strengthen emotional resilience.

PMID:40891308 | DOI:10.1080/20008066.2025.2542045

J Liver Cancer. 2025 Sep 2. doi: 10.17998/jlc.2025.08.26. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying metabolic biomarkers can enhance early detection and risk stratification of hepatocellular carcinoma (HCC). We conducted a two-sample Mendelian randomization (MR) study to assess the potential causal effects of metabolites on HCC risk.

METHODS: We performed meta-analyses to pool the effects of genetic instruments from 64 previously published genome-wide association studies. Summary statistics for HCC were obtained from a meta-analysis of the UK BioBank and FinnGen cohorts. MR analyses for the association between 3,275 metabolites and HCC risk were performed using inverse variance weighted, weighted median, MR-Egger, and MR-PRESSO methods to estimate the association. Enrichment analyses were performed on the significant metabolites to identify biological pathways associated with macronutrient intake.

RESULTS: We identified 99 metabolites that were positively and 36 metabolites that were negatively associated with HCC risk. Methyl glucopyranoside and phosphatidylcholine C38:3 were positively associated with HCC risk, whereas while 3-dehydrocarnitine and 10-undecenoate were inversely associated, with no evidence of heterogeneity, pleiotropy, or outlier effects for any of these associations. Pathway enrichment analysis showed that metabolites associated with increased HCC risk were primarily related to amino acid transport and solute carrier transporter disorders, whereas those linked to reduced risk were mainly involved in inositol and phosphatidylinositol metabolism, glycerophospholipid catabolism, and MeCP2-related regulatory processes.

CONCLUSION: This comprehensive MR study identified several metabolites with potential causal roles in HCC development. Our findings highlight nutrient transport, lipid metabolism, and related regulatory mechanisms as key components of HCC pathogenesis, offering new avenues for biomarker discovery and therapeutic intervention.

PMID:40891298 | DOI:10.17998/jlc.2025.08.26