Category: Nevin Manimala

Health Econ Rev. 2025 Nov 18;15(1):98. doi: 10.1186/s13561-025-00693-w.

ABSTRACT

BACKGROUND: While out-of-pocket health expenses continue to rise, households’ coping strategies remain largely unexplored. When individuals and families rely on unsustainable mechanisms such as borrowing, they may face heightened financial vulnerability, which can be particularly severe among certain socio-economic groups. This study examined the determinants of medical borrowing and the associated inequalities in Saudi Arabia.

METHODS: Nationally representative data from the 2021 World Bank Global Financial Inclusion (Global Findex) database were analysed. Descriptive statistics summarized respondents’ characteristics, and Chi-squared tests assessed bivariate associations between socio-economic factors and medical borrowing. Multivariate logistic regression models were then estimated to identify independent determinants of medical borrowing. Socioeconomic inequalities were further evaluated using concentration curves and concentration indices.

RESULTS: Approximately 16.3% of the 1019 respondents from the KSA reported borrowing money for medical purposes within the preceding 12 months. Medical borrowing was less common among higher-income and more educated individuals [Model 3 odds ratio = 0.561; 95% confidence interval: 0.391-0.807; p < 0.01). Borrowing incidence was slightly lower for males than for females. Across all models, government employees showed consistently higher odds of borrowing for medical expenses. Inequality analysis showed a negative education-based concentration index (-0.117, p ˂ 0.01), indicating that medical borrowing was disproportionately concentrated among individuals with lower educational attainment.

CONCLUSION: Socio-economic inequalities in borrowing for medical purposes exist in Saudi Arabia, highlighting the need to curb distress financing, particularly among lower-income groups, less-educated individuals, and public sector employees. These findings underscore the importance of expanding equitable insurance coverage and reducing reliance on out-of-pocket spending. Strengthening public healthcare quality and aligning reforms with Vision 2030 goals will be critical to curbing medical indebtedness and enhancing financial protection for all in Saudi Arabia.

PMID:41252078 | DOI:10.1186/s13561-025-00693-w

Eat Weight Disord. 2025 Nov 18;30(1):87. doi: 10.1007/s40519-025-01793-6.

ABSTRACT

PURPOSE: Carotid-femoral pulse wave velocity (cfPWV), an index of arterial stiffness, is one of the earliest indicators of cardiovascular risk. Studies of adolescents with anorexia nervosa have demonstrated increased arterial stiffness compared to healthy controls. Little information is available on the effect of weight restoration on arterial stiffness in adolescents with anorexia nervosa.

METHODS: This pilot longitudinal study examined changes in arterial stiffness during weight restoration in adolescent females admitted to an inpatient eating disorder unit. Female adolescents aged 15-19 years with a diagnosis of anorexia nervosa and a body mass index (BMI) < 85% of median BMI for age and sex, were recruited from consecutive eating disorder admissions at Westmead Hospital, Australia. Weekly measurements of cfPWV were performed for up to 4 consecutive weeks.

RESULTS: 12 participants were included, with an average follow-up of 3.2 ± 1.1 weeks. Using mixed-effects models, we observed a significant increase in BMI (95% CI 0.60, 0.80; p < 0.01) along with a modest but statistically significant decrease in cfPWV. The rate of change in cfPWV observed was – 0.2 m/s per week (95% CI – 0.37, – 0.03; p = 0.03). Mean arterial pressure (MAP) was significantly associated with cfPWV (p < 0.01). There was a borderline association between cfPWV and BMI (p = 0.05).

CONCLUSIONS: Our findings suggest a possible reduction in arterial stiffness with weight restoration, although results must be interpreted with caution due to the small sample. Nevertheless, serial measurements of cfPWV in this population are feasible, supporting the need for larger longitudinal studies in this population.

LEVEL OF EVIDENCE: Level III.

PMID:41252061 | DOI:10.1007/s40519-025-01793-6

J Gastrointest Cancer. 2025 Nov 18;56(1):224. doi: 10.1007/s12029-025-01350-5.

ABSTRACT

PURPOSE: Colorectal cancer remains a leading cause of cancer deaths, highlighting the need for early detection. Cologuard^®, a non-invasive stool DNA test, detects biomarkers for CRC and precancerous lesions but requires follow-up colonoscopy and has a high false-positive rate. This study evaluates colonoscopy follow-up rates and diagnostic outcomes after positive Cologuard^® results.

METHODS: We conducted a retrospective cohort study using the TriNetX database, a global federated real-world data platform, to analyze patients aged ≥ 18 years who tested positive on Cologuard. The primary outcome was whether patients underwent an endoscopic procedure (colonoscopy) within 12 months of a positive result. The secondary outcome was the diagnoses made during follow-up colonoscopy, including malignant neoplasms (colorectal cancer) and benign neoplasms (polyps).

RESULTS: A total of 3,916 patients underwent Cologuard^® testing, with 61.3% being female, 35% male, and 3.7% other genders. Of the 385 patients who tested positive for Cologuard^® (mean age 65 ± 8.75 years), 171 (44%) underwent follow-up colonoscopy within 12 months. Of these, 10 cases (5.8%) were diagnosed with malignant neoplasms, and 56 cases (32.7%) were diagnosed with benign neoplasms (polyps).

CONCLUSION: The study found poor follow-up adherence, with only 44% completing colonoscopy and a high false positive rate with just 38.5% of positive Cologuard^® results showing significant lesions. These findings emphasize the need for better patient education, streamlined care pathways, and improved communication to enhance follow-up compliance.

PMID:41252050 | DOI:10.1007/s12029-025-01350-5

Adv Exp Med Biol. 2026;1489:485-492. doi: 10.1007/978-3-032-03394-9_46.

ABSTRACT

This study aims to provide a brief review on the subject of aesthetic procedures. Worldwide information from 26 scientific articles and nineteen other sources was used. Definitions were sought, a historical review of cosmetic procedures was carried out, and the types of cosmetic procedures were separately analyzed; statistical data, the legal and ethical framework, and factors associated with cosmetic procedures were analyzed. Cosmetic procedures are at the individual’s choice and are aimed at improving a person’s appearance for cosmetic rather than medical reasons. Adolescents, on the other hand, experience changes that occur at a biological and psychosocial level; adolescents indulge in a multitude of cosmetic procedures worldwide despite legal and ethical restrictions due to psychological and social factors. Cosmetic procedures have multivalent physical, mental, and financial effects upon the well-being and life of adolescents. Therefore, concerns and questions arise.

PMID:41252033 | DOI:10.1007/978-3-032-03394-9_46

Adv Exp Med Biol. 2026;1489:375-384. doi: 10.1007/978-3-032-03394-9_36.

ABSTRACT

PURPOSE: To confirm the validity and reliability of the Greek version of the Clinical Cultural Competency Questionnaire (CCCQ) among mental healthcare professionals.

METHODOLOGY: A cross-sectional study was conducted with a convenience sample of 290 mental health professionals who worked in two psychiatric hospitals of Athens. Internal reliability, content validity, and construct validity were estimated. We conducted factor analysis in order to estimate the structure of the questionnaire.

RESULTS: Our six-factor model explained 67.0%of the variance and included the following factors: (a) knowledge, (b) skills, (c) encounter situation, (d) attitude, (e) awareness, and (f) education/training. All subscales resulting from the factor analysis had alphas that ranged from 0.72 to 0.93. Correlations among the scales were all statistically significant. Higher scores in all subscales were observed for mental health care professionals who had attended transcultural health care courses and had social interactions with people from different cultural backgrounds.

CONCLUSIONS: The Greek version of CCCQ was found to be a clear, valid, and reliable tool to assess the cultural competence of mental healthcare professionals.

PMID:41252023 | DOI:10.1007/978-3-032-03394-9_36

Adv Exp Med Biol. 2026;1489:347-356. doi: 10.1007/978-3-032-03394-9_34.

ABSTRACT

INTRODUCTION: Burns are injuries with local and systemic responses that cause severe complications to all systems in human body. Patients with moderate or severe burn injury are likely, over time, to develop metabolic, motor, psychiatric, and social disorders. The aim of this study was to explore the quality of life, post-traumatic stress disorder and insomnia in individuals with burn injuries.

MATERIAL AND METHODS: This cross-sectional study included adults with burn injuries in any area of the body. The research tools were BSHS-B, 5Q-5D-5L, ABSI, AIS, and IES-R which also included variables from medical or nursing documentation and records as well as reports from patients. Statistical significance was set at p < 0.05 and analyses were conducted using SPSS statistical software (version 26.0).

RESULTS: In the present study were enrolled 45 outpatients with burns. The findings revealed that insomnia was significantly associated with lower scores in Simple Abilities (p = 0.006), Treatment Regimen (p = 0.033), Heat Sensitivity (p = 0.005), Affect (p < 0.001), Sexuality (p = 0.023), Interpersonal Relationship (p = 0.046) domains of the BSHS-B index, as well as with the total BSHS-B score (p = 0.004). Greater Avoidance (p = 0.050) and Hyperarousal (p = 0.011) domains, as also the total IES-R scores (p = 0.018) of the IES-R scale were significantly associated with lower Simple abilities score of BSHS-B index.

CONCLUSION: There is a clear and urgent need for the continuation of this study with a larger sample, representative of the population, and over an extended period of time to produce more sufficient and significant statistical results.

PMID:41252021 | DOI:10.1007/978-3-032-03394-9_34

Adv Exp Med Biol. 2026;1489:335-345. doi: 10.1007/978-3-032-03394-9_33.

ABSTRACT

Abdominal aortic aneurysm (AAA) is one of the leading causes of death worldwide. Considering that most AAAs remain asymptomatic until they are close to rupture, an efficient workflow for the accurate detection and delineation is crucial for the clinical outcome. In this study, we conduct a comparative analysis of two different AAA segmentation algorithms using X-ray Computed Tomography (CT) images from 18 patients diagnosed with AAA, which have not been used in similar studies before. The methodologies employed include an in-house segmentation algorithm based on conventional image analysis techniques, and a deep learning approach based on the nnU-Net -framework called TotalSegmentor. The CT dataset, which contained baseline studies, was processed, and the manual annotations by clinicians were used as ground truth. Results demonstrated a high degree of accuracy and robustness, with TotalSegmentor achieving an average Sorensen-Dice coefficient of 0.89 and Jaccard index of 0.81 across the dataset, compared to the proposed unsupervised method’s scores of 0.85 and 0.77, respectively. These findings highlight the potential of deep learning-based models to enhance clinical workflows, ultimately improving early detection and monitoring of AAA.

PMID:41252020 | DOI:10.1007/978-3-032-03394-9_33

Adv Exp Med Biol. 2026;1489:297-304. doi: 10.1007/978-3-032-03394-9_30.

ABSTRACT

The preference for the gender of physicians has been the subject of numerous studies, primarily conducted abroad. Several of these studies reveal that a considerable number of female patients prefer to consult with a female doctor, especially for issues related to gynecological care. This study aimed to: (a) investigate patient preferences regarding the gender of physicians in pulmonology, (b) explore factors related to these preferences, and (c) examine the relationship between gender preferences and health locus control among the treated individuals.

METHODS: A cross-sectional study design was applied in this study. Data were collected using a self-administered questionnaire. The questionnaire consists of three parts: The first part includes questions related to the demographic characteristics of the sample (age, profession, education, etc.). The second part of the questionnaire consists of a specially designed section that examines (a) gender preferences for the pulmonologist, (b) age preferences of the physician, and (c) reasons for choosing a specific gender, such as knowledge and skills, communication, etc. Finally, the third part of the questionnaire includes the Health Locus of Control scale. The statistical software package for social sciences (SPSS), version 25.0, was utilized for data analysis. The level of statistical significance will be set at 0.05.

RESULTS: According to the results, the majority of the participants didn’t have a specific preference, but if they did, they favored female pulmonologists over men. Moreover, only monthly income emerged as a significant associated factor for pulmonologist gender preference.

CONCLUSION: The majority exhibited no specific preference, but among those who did, a preference for female pulmonologists over males was observed. Monthly income emerged as a significant factor associated with pulmonologist gender preference.

PMID:41252017 | DOI:10.1007/978-3-032-03394-9_30

Adv Exp Med Biol. 2026;1489:69-76. doi: 10.1007/978-3-032-03394-9_7.

ABSTRACT

This research aims to analyze discrimination experienced by individuals with di verse gender identities and sexual orientations in their daily lives when seeking medical assistance, and its impact on their quality of life. Conducted as a cross-sectional study, it utilized a questionnaire developed based on the 2019 Southern LGBTQ Health Survey. Linear regression analysis identified factors influencing difficulties accessing health and public services, and Quality of Life SF-12 scores. The sample comprised 152 individuals, predominantly aged 18-30, female, and identifying as bisexual. Most resided in urban areas and were educated, yet a significant part of them were unemployed. While many preferred private clinics for medical care, few delayed seeking care due to LGBTQ+ identity. Participants reported workplace difficulties and experienced violence, correlating with poorer physical and mental health. Positive opinions about healthcare services corresponded to better mental health. Educational level and employment status influenced mental well-being. Exclusion from healthcare and public services detrimentally affected LGBTQ+ individuals’ mental health, emphasizing the need for inclusive policies, education for healthcare professionals, and specialized services. Efforts to promote inclusion across social groups are imperative for enhancing overall well-being and ensuring equitable access to healthcare.

PMID:41251994 | DOI:10.1007/978-3-032-03394-9_7

Adv Exp Med Biol. 2026;1489:37-45. doi: 10.1007/978-3-032-03394-9_4.

ABSTRACT

BACKGROUND: Covid-19 vaccinations of the general population and special groups such as football players are expected to reduce the transmission of disease and achieve herd immunity.

METHODS: We conducted a cross-sectional study among professional football players in Greece via an online survey prepared using Google Forms. The study was conducted during the period April-June 2022. In this study, we aimed to assess the knowledge and attitude of professional football players inthe second division of Greece’s football league, together with their vaccination coverage against Covid-19.

RESULTS: We found that the majority of participants were fully vaccinated against Covid-19 (72% vaccination coverage). Since the start of the pandemic, 70.4% of the football players had been diagnosed with Covid-19. A significant difference in Covid-19 vaccination was reported, with players who believed that vaccines are important for public health in comparison to counterparts that were opposed to that (p-value = 0.000005, CI = 1.422-18.34). Players with trust of health professionals also showed higher Covid-19 vaccination rates relative to players who did not against Covid-19 (p-value <0.0000001; CI = 2.906-41.64). A small proportion of medical staff of football teams recommended vaccination against the Covid-19 pandemic to football players.

CONCLUSIONS: Targeting the holistic approach of knowledge of football players’ vaccination, it may have an impact to next generation’s vaccination’s behavior and knowledge, that will eventually lead to the existence of future influencers for vaccination campaigns.

PMID:41251991 | DOI:10.1007/978-3-032-03394-9_4