Category: Nevin Manimala

Hum Vaccin Immunother. 2025 Dec;21(1):2592425. doi: 10.1080/21645515.2025.2592425. Epub 2025 Dec 3.

ABSTRACT

Co-administration of multiple vaccines during a single clinical visit is common in pediatric immunization programs, but administering three or more injections simultaneously has raised safety concerns. This systematic review, conducted in 2023, assessed the safety of administering three or more vaccines at the same time compared with giving fewer or the same vaccines across separate sessions. Data from 26 studies were analyzed using random-effects meta-analyses. The risk of any adverse event (AE) was modestly increased (OR ≈ 1.54), mainly due to expected and transient reactions such as fever, irritability and injection-site pain. Importantly, there was no significant increase in serious adverse events (SAEs) (OR 1.07, 95% CI 0.92-1.25). Differences in systemic (OR 1.19, 95% CI 0.95-1.50) or local AEs (OR 1.37, 95% CI 0.85-2.22) were not statistically significant. These findings support the continued co-administration of multiple vaccines in pediatric programs, providing a nuanced safety profile for policymakers and clinicians.

PMID:41335471 | DOI:10.1080/21645515.2025.2592425

Eur J Public Health. 2025 Dec 3:ckaf232. doi: 10.1093/eurpub/ckaf232. Online ahead of print.

ABSTRACT

BACKGROUND: Nurse retention is a critical challenge across Europe, directly affecting workforce sustainability, quality of care, and health systems resilience. Despite persistent shortages and increasing emigration, evidence on nurse retention determinants within the Portuguese National Health Service (NHS) remains limited. This study aims to identify factors influencing nurses’ intention to stay in the NHS, contributing to national and European debates on sustainable workforce strategies.

METHODS: A quantitative, observational, cross-sectional survey was conducted among a representative sample of 1 494 nurses working in NHS. A validated questionnaire was developed using a Nominal Group Technique and Delphi Panel with stakeholders, to measure job satisfaction with Likert scales. Inferential statistical analyses, including t-tests and multiple linear regression, examined associations between intention to stay and factors such as job satisfaction, work-life balance, career development opportunities, remuneration, and sociodemographic characteristics.

RESULTS: Fixed work schedules, overall job satisfaction, age, satisfaction with work-life balance, and career development emerged as significant predictors of intention to stay. Satisfaction with salary and financial incentives, while low, was not statistically significant. Findings highlight the importance of integrated workforce retention strategies combining organisational improvements, career progression pathways, and work-life balance policies. These findings differ from those observed among physicians in parallel research, confirming the need for profession-specific retention approaches.

CONCLUSION: This study provides new evidence on nurse retention in Portugal, reinforcing the need for human resources policies aligned with European Union priorities on workforce sustainability. Cross-country policy learning and evidence-informed, context-sensitive strategies are crucial for supporting nurse retention and health system resilience.

PMID:41335460 | DOI:10.1093/eurpub/ckaf232

JAMA Surg. 2025 Dec 3. doi: 10.1001/jamasurg.2025.5282. Online ahead of print.

ABSTRACT

IMPORTANCE: Unhoused individuals face significant structural barriers to postacute recovery following traumatic injury. However, national estimates of trauma readmission risk in this population remain limited. This study aimed to evaluate the association between unhoused status and 30-day hospital readmission after trauma.

OBJECTIVE: To assess if unhoused status is linked to higher 30-day readmission rates after traumatic injury.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the 2017 through 2019 National Readmission Database. These data included a national, population-based sample of hospitalizations in the US. Participants included adults aged 18 years or older who were admitted for traumatic injury, identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Elective admissions, in-hospital deaths, and discharges in December were excluded, given the 30-day outcome. Unhoused status was defined using ICD-10-CM code Z59.0. A total of 2 663 876 trauma admissions were included, of whom 46 381 were unhoused (1.7%). Patients were stratified by housing status based on the ICD-10 code for homelessness. The primary outcome was 30-day all-cause readmission. Multivariable logistic regression and marginal effects models estimated adjusted odds ratios (aOR) and predicted probabilities, controlling for demographic and clinical factors.

RESULTS: Unhoused patients were substantially younger (65 years, 10.4% vs 59.4%), predominantly male (77.8% vs 48.2% female), and had much higher rates of substance use disorders (alcohol, 41.3% vs 9.9%; drug, 38.4% vs 5.1%) compared with housed patients; all comparisons were statistically significant (P < .001). The 30-day readmission rate was significantly higher among unhoused patients (19.3% vs 12.2%; P < .001), with increased adjusted odds of readmission on multivariable analysis (aOR, 1.63; 95% CI, 1.58-1.67). Against medical advice discharge carried the highest readmission risk among unhoused patients (predicted probability, 30.3%; aOR, 1.81; 95% CI, 1.67-1.96). Unhoused patients were more likely to be readmitted for new traumatic injuries (aOR, 1.48; 95% CI, 1.41-1.56), sequelae of prior trauma (aOR, 1.19; 95% CI, 1.02-1.39), and postprocedural complications (aOR, 1.26; 95% CI, 1.12-1.42).

CONCLUSIONS AND RELEVANCE: In this observational study, unhoused status was independently associated with significantly higher odds of 30-day readmission following trauma, often for new injury or poor healing. Improved discharge planning, continuity of care, and access to housing and postacute services are needed.

PMID:41335455 | DOI:10.1001/jamasurg.2025.5282

J Crohns Colitis. 2025 Dec 3:jjaf209. doi: 10.1093/ecco-jcc/jjaf209. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: This study aims to evaluate the diagnostic accuracy of tools commonly employed in clinical practice for the assessment of malnutrition in patients with inflammatory bowel disease (IBD), including Global Leadership Initiative on Malnutrition (GLIM) criteria, Subjective Global Assessment (SGA), European Society of Parenteral and Enteral Nutrition (ESPEN) criteria, and World Health Organization (WHO) related-Body Mass Index (BMI).

METHODS: Eligible observational studies and randomized controlled trials (RCTs) were identified through searches of databases, including PubMed, Scopus, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and Epistemonikos until August 2024. Clinical trial registries, grey literature, and reference lists of included studies were also screened. Study selection, data extraction, and quality assessment were conducted independently by two reviewers. A bivariate mixed-effects model was utilized to evaluate the diagnostic test accuracy, producing pooled estimates for sensitivity and specificity with the corresponding confidence intervals (CI), using SGA as reference method for malnutrition diagnosis.

RESULTS: Nine primary studies (1420 participants) and data from one unpublished work were included in the present review. Based on data deprived from three studies, GLIM criteria demonstrated high sensitivity (0.80, 95% CI: 0.68-0.88) and moderate specificity (0.71, 95% CI: 0.53-0.84) using the SGA as reference standard. The certainty of the evidence supporting these findings was rated as very low.

CONCLUSIONS: The GLIM criteria demonstrate potential as an effective tool for diagnosing malnutrition in patients with IBD. However, further validation is necessary, requiring additional diagnostic accuracy studies to enhance their reliability and establish their clinical applicability.

PMID:41335454 | DOI:10.1093/ecco-jcc/jjaf209

JAMA Psychiatry. 2025 Dec 3. doi: 10.1001/jamapsychiatry.2025.3652. Online ahead of print.

ABSTRACT

IMPORTANCE: As mental health challenges continue to increase globally, using rigorous surveillance frameworks is essential for delivering nuanced population-level insights and informing evidence-based policy decisions.

OBJECTIVE: To develop a standard for using nonprobability and probability-based online panel surveys in psychiatric epidemiological research.

EVIDENCE REVIEW: The traditional use of high-quality probability samples to carry out psychiatric epidemiological surveys of the household population is facing increasing financial and operational challenges. Surveys from nonprobability and probability-based online panels have emerged as cost-effective alternatives with the additional advantage of rapid turnaround time, albeit with biases that can in some cases be substantial.

FINDINGS: We recommend a middle ground of integrating surveys from online panels with small parallel high-quality probability samples to enhance the practicality of carrying out large-scale epidemiological studies while maintaining validity. The key features of such “hybrid designs” are as follows: use of a high-quality probability sample as a population surrogate to provide information about the distributions of otherwise unavailable variables that differentiate participants in online panels from the larger household population, inclusion in both surveys of measures that are both strongly associated with the outcomes of interest and strongly predictive of membership in the online panel, and use of best-practice statistical methods that blend results across the 2 samples. Such a hybrid design should be the minimally acceptable design for psychiatric epidemiological surveys of the household population given the biases known to exist in online panels. However, we also comment on several other designs that might be used for more rapid and less expensive exploratory analyses.

CONCLUSIONS AND RELEVANCE: Hybrid designs address both the biases of surveys from online panels and the operational problems of surveys from high-quality probability samples. They should be the minimally acceptable design for psychiatric epidemiological surveys of the household population.

PMID:41335451 | DOI:10.1001/jamapsychiatry.2025.3652

J Crohns Colitis. 2025 Dec 3:jjaf207. doi: 10.1093/ecco-jcc/jjaf207. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Chronic background mucosal inflammation contributes to colorectal cancer (CRC) development in ulcerative colitis (UC), but its prognostic impact is unclear. We evaluated whether background mucosal inflammation documented at cancer diagnosis is associated with oncologic outcomes.

METHODS: This retrospective study analyzed 1,189 UC patients diagnosed with CRC using a nationwide, multicenter database in Japan. Patients were classified as CRC within the UC-involved area (within-area) or outside the UC-involved area (outside-area), based on tumor location relative to the UC disease extent documented endoscopically at cancer diagnosis. The primary endpoint was 5-year recurrence-free survival (RFS), and the secondary endpoint was 5-year cancer-specific survival (CSS). In within-area cases, inflammation severity was assessed using the Mayo Endoscopic Score (MES), stratified as Inactive, Mild-Moderate, and Severe.

RESULTS: Of 723 eligible patients, 683 had within-area and 40 outside-area CRC. Five-year RFS was significantly lower in within-area than outside-area CRCs (75.1% vs 87.6%, P = 0.022). Multivariable Cox regression analysis of RFS revealed this classification as an independent prognostic factor (HR = 2.99, 95% CI: 1.09-8.18, P = 0.030). A significant difference was also observed in 5-year CSS (P = 0.038). Among within-area cases, higher MES was associated with stepwise declines in RFS (P = 0.150), and a similar, statistically significant gradient in CSS (P = 0.048).

CONCLUSIONS: Background mucosal inflammation at cancer diagnosis is associated with significantly worse prognosis of CRC in UC patients. Systematic endoscopic assessment at cancer diagnosis may aid prognostic stratification and inform management.

PMID:41335449 | DOI:10.1093/ecco-jcc/jjaf207

JAMA. 2025 Dec 3. doi: 10.1001/jama.2025.19808. Online ahead of print.

ABSTRACT

IMPORTANCE: The efficacy and safety of guideline-recommended treatments for heart failure (HF) are uncertain in patients with Chagas disease.

OBJECTIVE: To evaluate the efficacy and safety of the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan in patients with HF with reduced ejection fraction due to Chagas disease.

DESIGN, SETTING, AND PARTICIPANTS: From December 10, 2019, through September 13, 2023, patients with HF, confirmed diagnosis of Chagas disease, left ventricular ejection fraction of 40% or less, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) of 600 pg/mL or greater (or B-type natriuretic peptide [BNP] ≥150 pg/mL) or 400 pg/mL or greater (or BNP ≥100 pg/mL) if hospitalized for HF within the previous 12 months were screened at 83 sites in Argentina, Brazil, Colombia, and Mexico. Statistical analysis was conducted between May and July 2025.

INTERVENTIONS: Patients were randomized to receive sacubitril/valsartan (target dose, 200 mg twice daily) or enalapril (target dose, 10 mg twice daily), in addition to standard therapy.

MAIN OUTCOMES AND MEASURES: The primary end point was a hierarchical composite outcome tested, in order, of death from cardiovascular causes, hospitalization for HF, or relative change in NT-proBNP from baseline to 12 weeks. The primary analysis was done using a win ratio approach.

RESULTS: Overall, 462 participants were randomized to receive sacubitril/valsartan and 460 to receive enalapril (mean [SD] age, 64.2 [10.8] years; 387 [42.0%] were female). Over a median (IQR) follow-up of 25.2 (18.4-33.2) months, cardiovascular death occurred in 110 patients (23.8% [18.3% wins in the hierarchical comparison]) in the sacubitril/valsartan group and 117 patients (25.4% [17.5% wins]) in the enalapril group. A total of 102 patients (22.1% [7.7% wins]) in the sacubitril/valsartan group and 111 (24.1% [6.9% wins]) in the enalapril group experienced a first hospitalization for HF. Patients in the sacubitril/valsartan group had a median (IQR) decrease in NT-proBNP of 30.6% (-54.3% to -0.9%) at 12 weeks, leading to 22.5% wins, while those in the enalapril group had a 5.5% (-31.9% to 37.5%) decrease (7.2% wins). The resulting stratified win ratio was 1.52 (95% CI, 1.28-1.82; P < .001) for sacubitril/valsartan compared with enalapril.

CONCLUSIONS AND RELEVANCE: In patients with HF with reduced ejection fraction due to Chagas disease, there was no significant difference in clinical outcomes between sacubitril/valsartan and enalapril, but there was a greater reduction in NT-proBNP at 12 weeks in patients in the sacubitril/valsartan group.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04023227.

PMID:41335448 | DOI:10.1001/jama.2025.19808

CA Cancer J Clin. 2026 Jan-Feb;76(1). doi: 10.3322/caac.70048.

ABSTRACT

Cancers of the lip, oral cavity, and pharynx (LOCP) represent a substantial public health challenge worldwide. Using GLOBOCAN national estimates of incidence, detailed cancer registry data from Cancer Incidence in Five Continents, and population statistics from the United Nations, the authors report the distribution of new cases of LOCP cancers in 185 countries by sex in 2022. Age-standardized incidence rates were calculated. For countries lacking registry data, regional averages from high-quality registries were used to impute subsite-specific estimates. Worldwide, 758,000 people were diagnosed with LOCP cancers in 2022, with oral cavity cancer accounting for approximately 42% of cases, followed by oropharynx (19.3%), nasopharynx (15.9%), hypopharynx (11.4%), salivary gland (7.3%), and lip (4.2%) cancers. Oral cavity cancer was the most frequent LOCP subsite among women in 141 countries and among men in 93 countries, and incidence rates were highest in countries in South-Central Asia. Oropharyngeal cancer was the most frequent LOCP subsite among men in 44 countries and among women in five countries across Europe, Northern America, South America, Australia, and New Zealand. Nasopharyngeal cancer was the most common subsite among men in 39 countries and women in 23 countries, mainly in Northern Africa, Middle Africa, and Eastern and South-Eastern Asia. Rates of hypopharyngeal and salivary gland cancers were low globally, although the incidence burden was greater than that of lip cancer. The authors discuss incidence patterns in relation to disease etiology and the prospects of delivering effective cancer control measures, spanning primary prevention, early detection, cancer treatment, and survivorship.

PMID:41335400 | DOI:10.3322/caac.70048

Eur J Epidemiol. 2025 Dec 3. doi: 10.1007/s10654-025-01301-1. Online ahead of print.

ABSTRACT

Screening colonoscopy has been shown to reduce colorectal cancer incidence. However, the magnitude of this effect is debated. There is concern that some trial participants already had colorectal cancer at baseline. The screening procedure could not prevent disease occurrence in these participants, leading to “prevalence bias”. Some authors have argued that the effect of interest is confined to participants without disease at baseline, and failing to exclude prevalent cases supposedly leads to effect underestimation. Yet, the issue is debated, with other authors arguing that conventional randomized trials provide the effects that are most relevant to public health. Here we present new, formal arguments that clarify misconceptions in this debate. We show that, under mild assumptions, the so-called “prevalence bias” is not a concern when researchers are interested in estimating risk differences, rather than risk ratios. This is because of a statistical property of the causal risk difference when outcomes are rare, called “doomed-selection stability”.

PMID:41335397 | DOI:10.1007/s10654-025-01301-1

Eur Radiol. 2025 Dec 3. doi: 10.1007/s00330-025-12160-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Arterial transit artefacts (ATAs) on pseudo-continuous arterial spin labelling (pCASL) MRI represent visual markers of delayed arterial transit. This study aimed to investigate their prevalence and distribution and to evaluate the effects of sex, ethnicity, intracranial arterial anatomy, and cardiovascular parameters in a subgroup of the UK tri-ethnic population-based Southall and Brent REvisited (SABRE) study.

MATERIALS AND METHODS: We analysed 360 participants-120 each of White European, South Asian, and African Caribbean origin-from the prospective SABRE cohort who underwent 3.0-T brain MRI and clinical assessment between 2014 and 2018. ATAs were visually rated across 40 predefined brain regions on pCASL perfusion images and summarised as percentage ATA scores. Intracranial arterial anatomy was classified on time-of-flight MR angiography, and cardiovascular parameters were obtained from clinical assessment. ATAs were compared by sex and ethnicity, and associations with demographic, anatomical, and cardiovascular factors were analysed using multivariable regression.

RESULTS: Of 360 participants, 284 (78.89%; mean age 70.12 ± 6.58 years; range 49-89; 139 women) had usable pCASL data. ATA prevalence varied across vascular territories and between women and men. African Caribbean participants showed a higher frequency of ATAs in the posterior circulation, whereas in most anterior territories they had fewer ATAs than White Europeans or South Asians.

CONCLUSION: Visual rating of ATAs revealed sex- and ethnicity-specific differences in ATA distribution, reflecting variations in arterial transit time influenced by intracranial vascular anatomy and cardiovascular parameters. These findings highlight the potential of ATAs as imaging markers for personalised cerebrovascular assessment and risk stratification.

KEY POINTS: Question Prevalence and distribution of arterial transit artefacts (ATAs) on arterial spin labelling MRI, and their relationship to sex, ethnicity, vascular anatomy, and cardiovascular parameters, have not been systematically investigated. Findings ATAs were most prevalent in African Caribbeans, particularly in MCA-PCA borderzones and PCA territories; no significant differences were found between White Europeans and South Asians. Clinical relevance Visual rating revealed substantial differences in the ATA distribution among ethnic populations, as well as between women and men. Recognising these specific patterns can help distinguish physiological from pathological perfusion, thereby enhancing diagnostic accuracy and treatment planning.

PMID:41335377 | DOI:10.1007/s00330-025-12160-5