Category: Nevin Manimala

J Am Nutr Assoc. 2025 Mar 19:1-7. doi: 10.1080/27697061.2025.2475879. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the compatibility between the Mini Nutritional Assessment (MNA), a validated tool for screening for malnutrition among older adults, and the Healthy Diet Indicator-2015 (HDI-2015), a diet quality index, to investigate their relationship in assessing nutritional status.

METHOD: This cross-sectional study included 6094 community-dwelling older adults aged 65 and older. The MNA was administered to assess the nutritional status, and the adherence to the World Health Organization’s HDI-2015 was determined based on 24-hour dietary recalls.

RESULTS: According to the MNA, 70.4% of older adults had a normal nutritional status, 27.6% had a risk of malnutrition, and 2.0% were malnourished. Advanced age, female sex, poor appetite, difficulty chewing and swallowing, consistently skipping meals, and not exercising regularly were significantly associated with the rate of malnutrition in older adults (p < 0.001). Only 3.8% of older adults demonstrated high adherence to the HDI-2015, whereas 27.0% demonstrated moderate adherence and 69.2% demonstrated low adherence. The rate of malnutrition was higher in older adults who demonstrated low adherence to the HDI-2015 (p < 0.001). A weak positive correlation was found between the MNA and the HDI-2015 (r = 0.119; p < 0.01).

CONCLUSIONS: Even if older adults living in the community have a normal nutritional status according to the MNA, periodically obtaining dietary recalls to assess diet quality, such as using HDI-2015, is important for developing personalized nutrition plans.

PMID:40106508 | DOI:10.1080/27697061.2025.2475879

PLoS One. 2025 Mar 19;20(3):e0319396. doi: 10.1371/journal.pone.0319396. eCollection 2025.

ABSTRACT

INTRODUCTION: Autistic people experience higher risk of suicidal ideation (SI) and suicide attempts (SA) compared to non-autistic people, yet there is limited understanding of complex, multilevel factors that drive this disparity. Further, determinants of mental health service receipt among this population are unknown. This study will identify socioecological factors associated with increased risk of SI and SA for autistic people and evaluate determinants of mental health care receipt.

METHODS: This study will link information for individuals aged 12-64 years in healthcare claims data (IBM® MarketScan® Research Database and CMS Medicaid) to publicly available databases containing community and policy factors, thereby creating a unique, multilevel dataset that includes health, demographic, community, and policy information. Machine learning data reduction methods will be applied to reduce the dimensionality prior to nested, multilevel empirical estimation. These techniques will allow for robust identification of clusters of socioecological factors associated with 1) risk of SI and SA and 2) receipt of mental health services (type, dose, delivery modality). Throughout, the research team will partner with an established group of autistic partners to promote community relevance, as well as receive input and guidance from a council of policy and practice advisors.

DISCUSSION: We hypothesize that nested individual (co-occurring conditions, age, sex), community (healthcare availability, social vulnerabilities), and policy factors (state mental health legislation, state Medicaid expansion) will be associated with heightened risk of SI and SA, and that receipt, dose, and delivery of mental health services will be associated with interdependent factors at all three levels. The approach will lead to identification of multilevel clusters of risk and factors that facilitate or impede mental health service delivery. The study team will then engage the community partners, and policy and practice advisors to inform development of recommendations to reduce risk and improve mental health for the autistic population.

PMID:40106500 | DOI:10.1371/journal.pone.0319396

PLoS One. 2025 Mar 19;20(3):e0319972. doi: 10.1371/journal.pone.0319972. eCollection 2025.

ABSTRACT

BACKGROUND: Pelvic floor disorders (PFDs) are a group of conditions caused by injured or weakened pelvic muscles, ligaments, connective tissues, and nerves that support or hold pelvic organs in place so they can function correctly. Common PFDs are pelvic organ prolapse (POP), urinary incontinence (UI), and faecal incontinence (FI). A preliminary search on the subject within the last decade identified no review protocol or systematic review, despite a significant percentage of women in SSA suffering from it.

METHODS AND ANALYSIS: A comprehensive literature search will be gathered from electronic databases such as PubMed, Embase, Hinari, Cochrane Library, African Journals Online (AJOL), and Google Scholar. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocol (PRISMA-P) guideline. All studies conducted in sub-Saharan African countries will be included regardless of their study design as long as these studies report the magnitude of the problem under study. Joanna Briggs Institute’s (JBI) appraisal checklist will be used to assess the quality of individual studies. Heterogeneity will be checked using Cochrane Q test statistics and I2 test statistics, and a random-effects model will be employed to estimate the pooled prevalence of PFDs and its associated factors.

RESULTS: The present study will estimate the pooled prevalence of pelvic floor disorders and their associated factors in sub-Saharan Africa countries.

SYSTEMATIC REVIEW REGISTRATION: This review was registered on PROSPERO with registration number CRD42024578550.

PMID:40106497 | DOI:10.1371/journal.pone.0319972

PLoS One. 2025 Mar 19;20(3):e0317521. doi: 10.1371/journal.pone.0317521. eCollection 2025.

ABSTRACT

The objective of this study was to determine the relationship between strict morphology as assessed on the initial semen analysis during fertility workup and pregnancy rates after intrauterine insemination. This is a retrospective study of couples undergoing intrauterine insemination from 2007 to 2012. Couple characteristics and semen analysis parameters were recorded and evaluated. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated, accounting for within-couple (cluster) correlation among repeated intrauterine insemination cycles. Four hundred thirty-five women (average ± standard deviation age 31.7 ± 4.8) undergoing 1,287 intrauterine insemination cycles were analyzed. Fecundability was not statistically different when low strict morphology (≤1% and 2-4%) was compared to the reference range of morphology > 14% [RR 0.99 (0.41-2.40) and 0.90 (0.48-1.70)]. Results were unchanged when adjusted for female characteristics, medication, and inseminating total motile sperm count [aRR 1.22 (0.51-2.93) and 1.00 (0.53-1.91)]. Evaluating combined effects of morphology with inseminating total motile sperm count, pregnancy rates among cycles with total motile count < 5 million and strict morphology ≤ 4% normal were reduced when compared to cycles with total motile count > 20 million and morphology > 4% normal (RR 0.37, 95% CI 0.17-0.82). These relationships remained when evaluating live birth/ongoing pregnancy per cycle. In intrauterine insemination cycles, initial strict morphology was associated with subsequent fecundability only when inseminating total motile count was below 5 million. For cycles with total motile count above this threshold, no impact of low morphology on success rates with intrauterine insemination was observed.

PMID:40106493 | DOI:10.1371/journal.pone.0317521

J Eval Clin Pract. 2025 Mar;31(2):e70052. doi: 10.1111/jep.70052.

ABSTRACT

OBJECTIVES: Fatigue is a common symptom in patients with the chronic obstructive pulmonary disease (COPD). The aim of this study was to assess patient-reported fatigue in the COPD and to investigate their attempts to cope with it.

METHODS: This cross-sectional study was conducted with 62 patients diagnosed with the COPD. Individual Introduction Form, Fatigue Intervention Form and Visual Analog Scale were used to collect research data. The data were presented in the form of numbers, percentages, means and standard deviations, while Chi-Square, Fisher Freeman Halton and Pearson Correlation analysis were applied in statistical analysis.

RESULTS: Patients have moderate fatigue, with a score of 6.91 ± 2.81 out of 10 and they experience fatigue for 4.95 ± 2.19 days in a week. Patients reported that the most common causes of fatigue were stress, illness and advanced age. They also mentioned feeling unhappy and angry due to fatigue, adopted a sedentary lifestyle, and being unable to do housework. The most common attempts made by patients to cope with fatigue are sleeping, taking a warm shower and using medication, while less frequently used methods include watching movies, praying, getting a massage and listening to music.

CONCLUSION: Patients diagnosed with the COPD frequently experience moderate fatigue, which can have harmful effects on their daily lives. In response, patients often implement strategies to conserve energy, with the aim of managing the fatigue symptoms. Nurses should routinely assess the fatigue status of the COPD patients and counsel them on coping with fatigue.

PMID:40105867 | DOI:10.1111/jep.70052

Clin Spine Surg. 2025 Mar 14. doi: 10.1097/BSD.0000000000001789. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study.

OBJECTIVE: To correlate the changes in the dural area on MRI and clinical outcome after unilateral biportal endoscopic (UBE) decompression.

SUMMARY OF BACKGROUND DATA: Clinical outcomes after UBE decompression have been published for up to 2 years for patients with isolated spinal stenosis at 1 level. Serial dural expansion after UBE decompression has not been published as well as correlation to clinical outcomes.

METHOD: We retrospectively reviewed the clinical and radiologic outcomes of 86 patients who underwent UBE decompression for spinal stenosis. Preoperative and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI) were analyzed, and MRI was used for radiologic evaluation before surgery, 3 days after surgery, and 2 years after surgery. The correlation of dural spinal area CSA (preoperative-final) and difference of clinical outcome (preoperative-final) were analyzed.

RESULT: None of the 86 patients had permanent neurological complications. Back VAS, leg VAS, and ODI showed improvement in symptoms postoperatively and 2 years postoperatively. The postoperative CSA of the dural sac on MRI was statistically significantly increased after surgery at all time points. VAS leg was moderately correlated with change in CSA, while ODI and VAS back were weakly correlated. Correlations were all statistically significant.

CONCLUSION: UBE decompression showed good clinical outcomes similar to previous studies, and the CSA of ​​the dural sac on MRI significantly increased in the late postoperative phase compared with the early postoperative phase. This technique is viable option to achieve radiographic dural expansion and improvement in clinical outcomes in degenerative lumbar spinal stenosis. However, there is at best only a moderate correlation with change in CSA and clinical outcomes.

PMID:40105859 | DOI:10.1097/BSD.0000000000001789

JAMA Psychiatry. 2025 Mar 19. doi: 10.1001/jamapsychiatry.2025.0091. Online ahead of print.

ABSTRACT

IMPORTANCE: Bariatric surgery, once the criterion standard in obesity treatment, has a small but concerning association with increased suicidality. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs), originally developed to treat diabetes, now provide substantial efficacy in the treatment of obesity. However, concerns of risk of suicidality with these medicines have been raised.

OBJECTIVE: To evaluate the risk of suicidality and self-harm in randomized, placebo-controlled trials of GLP-1 RAs in adults with diabetes or obesity.

DATA SOURCES: MEDLINE, Embase, ClinicalTrials.gov, and Cochrane databases were systematically searched from inception to August 29, 2023.

STUDY SELECTION: Reports of randomized clinical trials (RCTs) lasting 6 or more months comparing GLP-1 RAs with placebo for the treatment of diabetes or obesity published in peer-reviewed journals were identified. Two independent reviewers screened all search-identified studies for inclusion. Records of outcomes were queried from primary papers, ClinicalTrials.gov entries, and corresponding authors.

DATA EXTRACTION AND SYNTHESIS: Two independent researchers abstracted data and assessed data quality and validity using PRISMA guidelines. Data were pooled using random-effects models.

MAIN OUTCOMES AND MEASURES: Pooled incidence of completed or attempted suicide, occurrences of suicidal ideation, or self-harm.

RESULTS: A total of 27 of 144 RCTs meeting inclusion criteria systematically recorded suicide and/or self-harm-related events and included 32 357 individuals receiving GLP-1 RAs and 27 046 treated with placebo, over 74 740 and 68 095 person-years of follow-up, respectively. Event incidence was very low in the GLP-1 RA (0.044 per 100 person-years) and placebo (0.040 per 100 person-years) groups, with no statistically significant difference (rate ratio [RR], 0.76; 95% CI, 0.48-1.21; P = .24). Subgroup analyses did not suggest differences in outcomes based on diabetes status or GLP-1 RA used. Five studies were considered at risk of bias due to the loss of more than 5% of participants to follow-up. Otherwise, studies were not found to be heterogeneous nor at high risk of bias.

CONCLUSIONS AND RELEVANCE: There is unlikely to be an increase in the very low incidence of suicide-related adverse events among individuals receiving GLP-1 RAs within the context of RCTs. While these findings may further ease concerns about these adverse effects, continued monitoring is warranted to identify particular patients who may be at risk as extended use of GLP-1 RAs expands.

PMID:40105856 | DOI:10.1001/jamapsychiatry.2025.0091

JAMA Netw Open. 2025 Mar 3;8(3):e251092. doi: 10.1001/jamanetworkopen.2025.1092.

ABSTRACT

IMPORTANCE: Pediatric concussion affects millions and results in heterogeneous outcomes and recovery trajectories. Given favorable outcome for most children, it is useful to understand characteristics of positive outcome to promote full recovery in all children.

OBJECTIVE: To document the timeframe of recovery to optimal functioning, defined comprehensively across motor-physical, cognitive, socioemotional, and resilience-support domains, after concussion among children ages 8 to 16 years.

DESIGN, SETTING, AND PARTICIPANTS: For this prospective cohort study, children ages 8 to 16.99 years with a concussion or orthopedic injury (OI) were recruited between September 2016 and July 2019 from 5 Pediatric Emergency Research Canada emergency departments and assessed approximately 10 days, 3 months, and 6 months after their injury. Data were analyzed from January 29, 2024, to January 11, 2025.

EXPOSURE: Concussion.

MAIN OUTCOMES AND MEASURES: Participants completed self-report and direct assessment measures of postconcussive symptoms, physical activity and function, balance, cognitive function, quality of life, resilience, and social support. The main outcome was optimal functioning, which was derived from 11 variables and criteria indicative of absence of impairment and average or above functioning in each domain (overall score, 0-11; higher score indicates better function). A longitudinal, multivariable, cumulative probability ordinal regression model was fitted to examine factors associated with optimal functioning.

RESULTS: A total of 967 children (median [IQR] age, 12.3 [10.5-14.3] years; 562 [58.1%] male) were enrolled, including 633 children with a concussion and 334 children with an OI. The median (IQR) optimal functioning scores for the OI group were 6.0 (4.0-8.0) at 10 days, 7.0 (5.0-9.0) at 3 months, and 7 (5.0-9.0) at 6 months, compared with 4.0 (2.0-6.0) at 10 days, 6.0 (4.0-9.0) at 3 months, and 7.0 (4.0-9.0) at 6 months in the concussion group. The 3 main variables (time, sex, and group) were significantly associated with optimal functioning, as were all 2-way interactions. Time was the strongest factor associated with optimal functioning (Wald χ258 = 485.11; P < .001), followed by group (Wald χ26 = 95.10; P < .001), and sex (Wald χ26 = 23.19; P < .001). At the 10-day follow-up, concussion was associated with lower optimal functioning than OI among females (odds ratio [OR], 0.24 [95% CI, 0.16-0.36]) and males (OR, 0.37 [95% CI, 0.26-0.53]). This difference persisted for females at 3 months (OR, 0.57 [95% CI, 0.35-0.93]) but not for males. Optimal functioning was comparable at 6 months.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of children with concussion, achieving optimal functioning levels across physical, cognitive, socioemotional, and resilience domains took 3 months or more, especially for girls with concussion. Multiple domains of outcome need to be taken into account when considering full recovery and optimal function after pediatric concussion.

PMID:40105842 | DOI:10.1001/jamanetworkopen.2025.1092

JAMA Netw Open. 2025 Mar 3;8(3):e251100. doi: 10.1001/jamanetworkopen.2025.1100.

ABSTRACT

IMPORTANCE: The Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1) is supported by observational studies that report SEP-1 compliance is associated with lower mortality. Most studies, however, adjusted for limited confounders and provided little insight into why bundle-compliant care was not provided.

OBJECTIVES: To identify the clinical factors that complicate the diagnosis and management of sepsis and assess their association with SEP-1 compliance and mortality.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted among 590 adults with sepsis in the emergency department of 4 academic hospitals from January 1, 2019, to December 31, 2022. Patients’ medical records were reviewed between September 2022 and December 2023.

MAIN OUTCOMES AND MEASURES: Study outcomes were (1) characteristics of patients who received SEP-1-compliant care vs characteristics of patients who received noncompliant care and (2) association between SEP-1 compliance and hospital mortality using multivariable models to adjust for successively more potential confounders (first demographics and comorbidities, then infection source, then severity of illness, and then clinical markers of complexity).

RESULTS: Of 590 patients with sepsis (median age, 65 years [IQR, 53-77 years]; 329 men [55.8%]), 335 (56.8%) received SEP-1-compliant care, and 225 (43.2%) received noncompliant care. Compared with patients in the compliant group, patients in the noncompliant group were more likely to be 65 years or older (142 [55.7%] vs 158 [47.2%]; odds ratio [OR], 1.41 [95% CI, 1.01-1.95]), to have multiple comorbidities (Elixhauser score >20: 99 [38.8%] vs 99 [29.6%]; OR, 1.51 [95% CI, 1.07-2.13]), and to have a higher incidence of septic shock (107 [42.0%] vs 107 [31.9%]; OR, 1.54 [95% CI, 1.10-2.16]), kidney dysfunction (87 [34.1%] vs 80 [23.9%]; OR, 1.65 [95% CI, 1.15-2.37]), and thrombocytopenia (43 [16.9%] vs 37 [11.0%]; OR, 1.16 [95% CI, 1.02-2.62]) on presentation. Compared with patients in the compliant group, those in the noncompliant group also had more nonfebrile presentations (136 [53.3%] vs 121 [36.1%]; OR, 2.02 [95% CI, 1.45-2.82]), impaired mental status (92 [36.1%] vs 94 [28.1%]; OR, 1.45 [95% CI, 1.02-2.05]), need for bedside procedures (57 [22.4%] vs 41 [12.2%]; OR, 2.06 [95% CI, 1.33-3.21]), acute concurrent noninfectious illnesses (140 [54.9%] vs 151 [45.1%]; OR, 1.48 [95% CI, 1.07-2.06]), and noninfectious illness as the primary factor associated with their presentation (84 [32.9%] vs 71 [21.2%]; OR, 1.82 [95% CI, 1.08-3.08]). SEP-1 compliance was associated with lower crude mortality rates compared with noncompliance (40 [11.9%] vs 41 [16.1%]; unadjusted OR, 0.60 [95% CI, 0.37-0.98]), but there was no statistically significant difference between groups after successively adjusting for demographics and comorbidities (adjusted OR [AOR], 0.71 [95% CI, 0.42-1.18]), infection source (AOR, 0.71 [95% CI, 0.43-1.20]), severity of illness (AOR, 0.86 [95% CI, 0.50-1.49]), and clinical markers of complexity (AOR, 1.08 [95% CI, 0.61-1.91]).

CONCLUSIONS AND RELEVANCE: In this cohort study of adults with sepsis, complex clinical presentations were more common among patients whose treatment was noncompliant with SEP-1. These nuances are poorly captured in most observational studies but confound the association between SEP-1 compliance and mortality.

PMID:40105841 | DOI:10.1001/jamanetworkopen.2025.1100

JAMA Netw Open. 2025 Mar 3;8(3):e251122. doi: 10.1001/jamanetworkopen.2025.1122.

ABSTRACT

IMPORTANCE: Children with growth faltering are more susceptible to infections and may experience cognitive, physical, and metabolic developmental impairments.

OBJECTIVE: To assess whether prenatal and preconception meteorological and environmental factors are associated with village-level rates of childhood growth outcomes in Uganda.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data collected between June 20, 2015, and December 16, 2016, from the 2016 Ugandan Demographic and Health Survey for individuals aged 0 to 59 months with available anthropometric measures (weight and length or height). Data analysis was conducted from October 2020 to April 2024.

EXPOSURES: Factors assessed included meteorological information, such as drought index (Standardized Precipitation-Evapotranspiration Index [SPEI]), Aridity Index, rainfall, temperature, and vegetation indices; demographic and economic development factors (nighttime light emissions, driving time to the nearest city); and land topography (slope angle, elevation above sea level).

MAIN OUTCOMES AND MEASURES: The main outcomes were height-for-age z score (HAZ), weight-for-age z score (WAZ), and weight-for-height z score (WHZ). Spatial resolution estimates, at 1 km × 1 km of childhood growth faltering indicators, were created.

RESULTS: Of the 5219 individuals aged 0 to 59 months included in the analysis, 2633 (50%) were female; mean (SD) age was 29 (17) months. Of these individuals, 30.22% (95% CI, 29.36%-30.98%) had stunting, 12.23% (95% CI, 11.55%-12.91%) had underweight, and 3.63% (95% CI, 3.46%-3.80%) had wasting. Large disparities in the burden of childhood growth faltering existed within Uganda at smaller and larger spatial scales; villages in the northeastern and southwestern areas of the country had the highest prevalence of all forms of growth faltering (stunting, >40%; underweight, >16%; and wasting, >6%). Higher SPEI at 3 months before birth was positively associated with all childhood growth outcomes: HAZ (β, 0.06; 95% CI, 0.02-0.10), WAZ (β, 0.04; 95% CI, 0.01-0.07), and WHZ (β, 0.03; 95% CI, 0.001-0.06). Higher location mean rainfall 11 months before birth was also positively associated with HAZ (β, 0.06; 95% CI, 0.01-0.10). Aridity Index associations with WAZ (β, 0.09; 95% CI, 0.04-0.13) and WHZ (β, 0.09; 95% CI, 0.02-0.16) were consistent with findings for SPEI.

CONCLUSIONS AND RELEVANCE: In this study of 5219 individuals 0 to 59 months of age in Uganda, rainfall and long-term availability of water at preconception and during gestation were positively associated with nutritional child growth outcomes. Understanding the relative contributions of meteorological environment factors on the spatial distribution of undernutrition at various spatial scales within Uganda (from the village to the district level) may help in the design of more cost-effective delivery of precision public health programs.

PMID:40105840 | DOI:10.1001/jamanetworkopen.2025.1122