Category: Nevin Manimala

Int J Equity Health. 2025 Apr 21;24(1):109. doi: 10.1186/s12939-025-02475-6.

ABSTRACT

BACKGROUND: Black individuals in the U.S. report experiencing the highest levels of racial discrimination in healthcare. Racial discrimination in healthcare contributes to mental health issues and has been shown to be associated with loneliness. Despite this, there is limited research on the role loneliness plays in the relationship between racial discrimination in healthcare settings and mental health outcomes. This study explored the relationship between racial discrimination in healthcare, loneliness, and mental health outcomes (depression and anxiety) among Black individuals.

METHODS: This study was part of the PhillyCEAL (Community Engagement Alliance) initiative. Between February 2024 and April 2024, 327 Black Philadelphia residents completed online surveys. Multiple linear regression analyses examined the associations between racial discrimination in healthcare, loneliness, depression, and anxiety. Covariates included Hispanic ethnicity, age, insurance, lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) status, sex assigned at birth, relationship status, employment, medical conditions, income, and education.

RESULTS: Racial discrimination in healthcare was positively associated with loneliness (b = 0.66, 95% CI: 0.29 to 1.04), depression (b = 0.52, 95% CI: 0.19 to 0.86), and anxiety (b = 0.85, 95% CI: 0.50 to 1.19). When controlling for loneliness, the association between racial discrimination in healthcare and depression became non-significant (b = 0.29, 95% CI: -0.03 to 0.61), while the association between racial discrimination in healthcare and anxiety remained significant (b = 0.62, 95% CI: 0.29 to 0.94).

CONCLUSION: Addressing racial discrimination within healthcare settings is crucial for improving mental health outcomes among Black populations. Given the significant role of loneliness in this relationship, interventions aimed at reducing loneliness may help mitigate the adverse mental health effects of racial discrimination in healthcare for Black populations.

PMID:40259356 | DOI:10.1186/s12939-025-02475-6

Eur J Med Res. 2025 Apr 21;30(1):312. doi: 10.1186/s40001-025-02527-1.

ABSTRACT

BACKGROUND: Lymphocyte-to-C-reactive protein ratio (LCR) has been linked to survival in malignancies. However, most studies are from Asia. The knowledge about the link between LCR levels and risks of all-cause mortality and cause-specific mortality among cancer participants in the US is lacking.

METHODS: Using multivariable Cox proportional hazards regression, we investigated the associations between LCR and mortalities in 1999 cancer participants from the National Health and Nutrition Examination Survey 1999-2008 with mortality follow-up through December 31, 2019.

RESULTS: The median follow-up time was 156 months. Cancer participants with low LCR levels were associated with increased risks for all-cause and cancer mortality. Based on the full adjustment model, compared to the lowest LCR tertile, the hazard ratios and 95% confidence interval (HR, 95% CI) of all-cause mortality were 0.75 (0.66-0.87) in the second tertile, 0.60 (0.49-0.72) in the top tertile. The HR of cancer mortality was 0.71 (0.52-0.99) in the second tertile and 0.53 (0.35-0.79) in the top tertile. The link between LCR level and all-cause and cancer mortality remained significant when individuals who died within 2 years of follow-up were excluded.

CONCLUSIONS: This prospective study provided evidence of inverse associations between LCR levels and all-cause and cause-specific mortalities based on representative noninstitutional US cancer survivors. Integrating LCR assessment in the clinical routine of US cancer patients may aid in identifying cancer individuals at high risk of mortalities.

PMID:40259355 | DOI:10.1186/s40001-025-02527-1

Health Qual Life Outcomes. 2025 Apr 21;23(1):42. doi: 10.1186/s12955-025-02366-y.

ABSTRACT

INTRODUCTION: Patients with multimorbidity who frequently require healthcare may experience a higher treatment burden. In this study, we investigated whether high perceived treatment burden and low perceived health-related quality of life (HRQoL) were associated with healthcare utilisation among patients who attended at least two medical outpatient hospital clinics.

METHODS: Patients who underwent medical treatment in two or more outpatient medical clinics at Silkeborg Regional Hospital in Denmark in August 2018 were included. The patients received a questionnaire containing the Multimorbidity Treatment Burden Questionnaire and the Short Form-12 questionnaire measuring HRQoL in terms of physical and mental health. Information on healthcare utilisation was collected from electronic registers one year prior to receiving the questionnaire. Logistic regression was applied to estimate the odds of ‘no/low’ and ‘high’ perceptions of treatment burden and ‘low’ self-rated HRQoL in relation to healthcare utilisation.

RESULTS: In total, 930 patients (59.8%) answered the questionnaire. The degree of patient-assessed treatment burden was not associated with the number of outpatient contacts, hospital admissions or admission days. A high perceived treatment burden was associated with a high number of general practice contacts, whereas a low treatment burden was associated with fewer contacts in general practice, indicating a dose‒response pattern. The same pattern of associations was observed for perceived physical and mental health.

CONCLUSION: Patients with high perceived treatment burden and low HRQoL seemed to consult their general practitioner primarily despite hospital involvement. These patients may require frequent primary care attention due to other factors than those being treated at the hospital. However, further research is warranted to explore the mechanisms underlying these associations and strategies for reducing treatment burden and enhancing HRQoL in patients with multiple medical conditions.

PMID:40259350 | DOI:10.1186/s12955-025-02366-y

Nutr J. 2025 Apr 21;24(1):63. doi: 10.1186/s12937-025-01106-8.

ABSTRACT

BACKGROUND: Animal proteins (APs) and plant proteins (PPs) seem to exhibit different thermic and metabolic effects, which may be attributed to differences in amino acid profiles, bioavailability, and digestibility.

OBJECTIVES: In this study, we aimed to investigate and compare the postprandial effects of AP and PP meals on energy metabolism parameters, including resting energy expenditure (REE) and substrate oxidation (SO), in overweight and obese men.

METHODS: This acute randomized crossover clinical trial involved forty-eight overweight and obese men, with a mean age of 33.48 ± 8.35 years and an average BMI of 29.15 ± 2.33 kg/m². Participants consumed two high-protein test meals with different protein sources (AP and PP) on separate days, with a washout period of 7 to 10 days between them. On each test day, energy metabolism parameters were measured in both the fasting state and postprandial phase using indirect calorimetry. Statistical analysis was conducted using SPSS version 25 and R programs, evaluating the effects of carry-over, treatment, time, and treatment × time interaction through generalized estimating equations (GEE) analysis.

RESULTS: After controlling for baseline values, there was a significant effect of time (P < 0.05), protein source (P < 0.05), and protein source × time (P < 0.05) on REE, TEF, and carbohydrate oxidation. REE showed an increase following the consumption of both meals; however, the rise observed after AP (14.2%) was greater than that of PP (9.55%). The trends in TEF changes were similar to those of REE. The mean carbohydrate oxidation after consuming PP remained relatively stable throughout the test, whereas the AP meal gradually increased, reaching its peak at the 180th minute. The decline in carbohydrate oxidation was more pronounced following the AP meal than the PP meal by the end of the test.

CONCLUSION: This clinical trial demonstrates that animal-based protein results in higher energy expenditure and carbohydrate oxidation than plant-based protein.

PMID:40259349 | DOI:10.1186/s12937-025-01106-8

BMC Rheumatol. 2025 Apr 21;9(1):45. doi: 10.1186/s41927-025-00487-x.

ABSTRACT

BACKGROUND: Early initiation of effective treatment is associated with positive long-term prognosis for patients with rheumatoid arthritis (RA). Currently, there are no biomarkers in clinical use to predict treatment response. A predictor of treatment response may be the B-cell compartment, as this is altered in RA patients, making it a potential candidate for predicting treatment response. In this study, we sought to identify B-cell subset(s) at diagnosis that might be associated with Clinical Disease Activity Index (CDAI) remission at 24-week follow-up.

METHODS: Seventy early RA patients from the NORD-STAR trial, recruited from two Swedish sites, and 28 matched healthy controls, were included in this spin-off study. In NORD-STAR, all patients were randomized to methotrexate (MTX) combined with 1) prednisolone, 2) anti-TNF (certolizumab-pegol), 3) CTLA4-Ig (abatacept), or 4) anti-IL-6R (tocilizumab). Circulating B-cell subsets at diagnosis were assessed by flow cytometry. The primary outcome measure was remission according to CDAI ≤ 2.8. A multivariate two-part discriminant analysis was performed to assess whether B-cell subpopulations at diagnosis could predict remission at 24 weeks. Subsequent univariable statistical analyses were performed using t-tests, Mann-Whitney U, or Kruskal-Wallis tests, as appropriate. Correlations were analyzed using Spearman or Pearson tests, depending on data type. The impact of specific B-cell populations on remission at week 24 was assessed using logistic regression models. The logistic regression model was also used to simultaneously visualize the sensitivity and specificity of the model for all possible values of the exposure (B-cell subpopulations) in predicting the outcome.

RESULTS: Patients who achieved CDAI remission at 24 weeks had higher proportions of transitional (p < 0.01) and CD21^– PD-1⁺ (p < 0.01) B cells at diagnosis compared to those who did not. When the two B-cell populations were combined, the sensitivity and specificity for remission, including all treatment arms, were 59% and 86%, respectively. Stratification of the patients by treatment arm revealed a significant negative correlation between the proportion of transitional B cells at baseline and disease activity after 24 weeks of treatment with either MTX and prednisolone or anti-IL-6R.

CONCLUSIONS: Our results indicate that transitional and CD21^– PD-1⁺ B cells are associated with remission in early RA.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40259340 | DOI:10.1186/s41927-025-00487-x

BMC Health Serv Res. 2025 Apr 21;25(1):571. doi: 10.1186/s12913-025-12753-2.

ABSTRACT

BACKGROUND: Sickle cell disease (SCD) is a chronic hematologic disease associated with increased morbidity and mortality. The study aims to investigate the suggested socio-economic and clinical factors and their contribution to the frequency of pain episodes among sickle cell patients in Uganda.

METHOD: We used pre-existing secondary data from sickle cell clinic records at Mulago referral hospital collected in 2019, with a sample of 2532 sickle cell patients. In support of the outcome being count data, the Negative Binomial Regression model was utilized to estimate how the independent factors affected the frequency of pain episodes among the patients.

RESULTS: The frequency of pain episodes was different among age groups as age group (16/24) experienced the highest number of pain episodes on average (Incidence Rate Ratio = 1.39; 95% CI = 1.277-1.522; p = 0.000) compared to young children because as individuals age, pain management declines, and repeated episodes can lead to increased sensitivity, making them more prone to pain. While increased temperature (°C) (fever) increased the frequency of pain episodes by 24% (Incidence Rate Ratio = 1.243; 95% CI = 1.147-1.348; p = 0.000), infection by 27% (Incidence Rate Ratio = 1.27; 95% CI = 1.191-1.354; p < 0.000), other chronic diseases by 11% (Incidence Rate Ratio = 1.11; 95% CI = 1.038-1.188; p < 0.002), malaria by 38% (Incidence Rate Ratio = 1.38; 95% CI = 1.036-1.836; p < 0.027). The rate of hydroxyurea usage was very high at 90%. The intake of the drug reduced the frequency of pain episodes by 34% (Incidence Rate Ratio = 0.662; 95% CI = 0.584-0.750; p < 0.000). According to the observations, there is a high chance that hydroxyurea also had a strong protective against malaria in SCD patients. Nevertheless, there was no evidence that being a male or female would influence the frequency of pain episodes among sickle cell patients.

CONCLUSIONS: These findings are expected to add to the body of knowledge in the health sector, assist in advocacy programs, inform policy, and aid in tailored interventions.

PMID:40259337 | DOI:10.1186/s12913-025-12753-2

Eur J Public Health. 2025 Apr 21:ckaf043. doi: 10.1093/eurpub/ckaf043. Online ahead of print.

ABSTRACT

Improving the quality of the most basic health behavior among youth may contribute to short-term body composition management with long-term implications for noncommunicable disease regression. This investigation aimed to assess the impact of primary school physical activity (PA), dietary, or dual approach interventions on pupils’ body weight (BW) and body mass index (BMI). A systematic review and meta-analysis was completed following a study protocol and a trial registration (PROSPERO: CRD4202347770) with the PRISMA approach. Publications in English or German were included with school-based randomized controlled trials on diet and/or PA. Pupils of primary schools (aged 5-10) with no major nutritional deficiency or unstable health condition were included. The Boolean search strategy revealed a total of 9479 articles, qualifying 39 studies with 20 462 pupils (including 10 211 girls and 10 251 boys) for quantitative synthesis. The interventions were mostly PA (n = 31), several were dietary (n = 6), and some were dual approach (n = 5). Random effects meta-analyses revealed PA intervention (n = 20) to have an effect size of +0.07 kg (95% CI: -0.01 to 0.15) and -0.12 kg/m2 (95% CI: -0.23 to -0.01). Low statistical heterogeneity was found for BW (I2 = 0%; P = 1.000) and BMI (I2 = 0%; P = .9688), respectively. The findings indicate a scarcity of top-quality scientific research performed on healthy diet for body weight management in primary schools. PA intervention for elementary school pupils provides support for a healthier body composition profile amidst the current world health crisis.

PMID:40258297 | DOI:10.1093/eurpub/ckaf043

Retina. 2025 Apr 16. doi: 10.1097/IAE.0000000000004488. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy of autologous retinal graft (ARG) surgery using a novel technique of Viscoat as a graft adherent and stabilizer for large, refractory macular holes (MHs) without postoperative face-down positioning.

METHODS: This retrospective interventional case series included 13 patients with refractory MHs who underwent ARG surgery. The surgical technique involved retinal graft placement stabilized with Viscoat, without postoperative positioning. Preoperative, 6 months and 12 months postoperative outcomes, including MH closure rates and visual acuity (VA) were analyzed.

RESULTS: Pre-op mean MH size was 821.69 ± 180.65 µm (range: 563-1200 µm). Anatomical closure was achieved in 76.9% (10/13) of cases. Median VA improved from 1.7 logMAR (20/1000) preoperatively to 1.3 logMAR (20/400) at 6 months and at 12 months postoperatively, although this change was not statistically significant (p = 0.106 and p = 0.311 respectively). No major complications were reported. Larger MH size and chronicity might limit functional improvement despite successful closure.

CONCLUSION: This is the first study to demonstrate that ARG surgery with Viscoat can achieve high closure rates without postoperative head positioning. The technique offers a patient-friendly alternative for refractory MH management, reducing postoperative burden while maintaining promising anatomical outcomes. Further studies with larger cohorts are warranted to validate these findings.

PMID:40258292 | DOI:10.1097/IAE.0000000000004488

Retin Cases Brief Rep. 2025 Apr 16. doi: 10.1097/ICB.0000000000001765. Online ahead of print.

ABSTRACT

PURPOSE: Evaluate the safety and efficacy of membrane rich in growth factors (mPRGF) and its effects on retinal vasculature and anatomy in refractory and poor-prognosis macular holes.

METHODS: Retrospective, interventional, longitudinal, case series and single-center study conducted at Dr. Elías Santana Hospital, Dominican Republic. Patients with macular hole larger than 400 microns, refractory or with poor prognosis were treated with posterior pars plana vitrectomy (PPV) plus adjuvant therapy mPRGF. A total of seven eyes were included: refractory MH (n=6) and traumatic MH (n=1). The anatomical closure was evaluated by optical coherence tomography (OCT) and foveal avascular zone (FAZ), and foveal density (FD) was measured with optical coherence tomography angiography (OCT-A) pre- and post-surgery. Also, the corrected visual acuity (CVA) was compared pre- and post-intervention.

RESULTS: A total of seven eyes were intervened with a surgical-anatomic closure rate was 85.7%. The average CVA resulted in an improvement of over six lines in Snellen notation which was statistically significant (p=0.036). FAZ and FD showed a decrease (p=0.002) and increase (p=0.043), respectively after surgery.

CONCLUSIONS: In conclusion, this clinical research provides compelling evidence supporting the efficacy and safety of mPRGF in achieving the anatomical closure of refractory or traumatic macular holes larger than 400 microns. Notably, mPRGF treatment demonstrated significant improvements in patients’ visual acuity and contributed to the restoration of normal retinal vasculature. These exciting results pave the way for the potential utilization of mPRGF as a reproducible and cost-effective adjuvant therapy in the surgical management of macular holes.

PMID:40258274 | DOI:10.1097/ICB.0000000000001765

J Med Internet Res. 2025 Apr 21;27:e60681. doi: 10.2196/60681.

ABSTRACT

BACKGROUND: Identifying patients with inherited colorectal cancer (CRC) syndromes offers many potential benefits. However, individuals often experience decisional conflict regarding genetic testing for CRC, and the uptake rate remains low. Given the growing popularity of genetic testing and the increasing demands on genetic service providers, strategies are needed to promote informed decision-making, increase genetic testing uptake among at-risk individuals, and ensure the rational use of genetic service resources.

OBJECTIVE: This study aims to determine whether a decision aid (DA) tool could promote informed decision-making among family members regarding the genetic testing of a patient with CRC.

METHODS: A single-center, parallel-group, randomized controlled trial was conducted. We randomized 82 family members of patients with CRC, who were involved in major medical decision-making for the patient, to either a DA intervention or usual care. The primary outcome was informed decision-making, assessed through measures of knowledge, decisional conflict, decision self-efficacy, and preparation for decision-making. Secondary outcomes included patients’ uptake of genetic counseling and testing, participants’ CRC screening behavior, healthy lifestyle scores, anxiety and depression levels, quality of life, and satisfaction with the intervention. Data were collected at baseline (T0), after the intervention (T1), and 3 months after the baseline survey (T2). The DA intervention and outcome assessments at T1 and T2 were delivered via WeChat. The effects of the intervention were analyzed using generalized estimating equation models.

RESULTS: Statistically significant improvements were observed in knowledge (T1: β=2.049, P<.001; T2: β=3.317, P<.001), decisional conflict (T1: β=-11.660, P<.001; T2: β=-17.587, P<.001), and decision self-efficacy (T1: β=15.353, P<.001; T2: β=22.337, P<.001) in the DA group compared with the usual care group at both T1 and T2. Additionally, the DA group showed significantly greater improvement in processed and red meat intake (β=-1.494, P<.001) at T1 and in healthy lifestyle scores (β=1.073, P=.03) at T2. No differences were found between the groups for other outcomes.

CONCLUSIONS: A DA tool may be a safe, effective, and resource-efficient approach to facilitate informed decision-making about genetic testing. However, the current DA tool requires optimization and further evaluation-for example, by leveraging more advanced technology than WeChat to develop a simpler and more intelligent DA system.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100048051; https://www.chictr.org.cn/showproj.html?proj=129054.

PMID:40258273 | DOI:10.2196/60681