Category: Nevin Manimala

BMC Public Health. 2025 Feb 24;25(1):750. doi: 10.1186/s12889-025-21948-5.

ABSTRACT

BACKGROUND: Prolonged sitting time is associated with an increased risk of cardiovascular disease (CVD) in the general population. However, it is unclear how these risks differ across occupational groups. This study aimed to investigate the association between sitting time and CVD in manual and non-manual workers among Chinese adults.

METHODS: This population-based cohort study recruited 47,931 participants aged 35 to 70 years from 115 communities across 12 provinces in China between 2005 and 2009. Daily sitting time was measured using the International Physical Activity Questionnaire (IPAQ). The main outcome was a major CVD event (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Information on each participant’s occupation was collected using standardized questionnaires and categorized into manual and non-manual occupations according to the Italian National Institute of Statistics 2001 (ISTAT-2001) occupational classification standard. Cox frailty models were used to examine the associations.

RESULTS: Of 43,256 in the final sample (excluding those with CVD at baseline and missing data), 25,252 (58.4%) were women, and the mean (± SD, Standard Deviation) age was 50.6 ± 9.5 years. During a median follow-up of 11.9 (IQR, Interquartile Range: 9.5-12.6) years, 3,408 major CVD events (899 myocardial infarctions, 2,400 strokes, 240 incident heart failure, and 764 cardiovascular deaths) were documented. Compared with the reference group (< 4 h per day of sitting), the risk of major CVD events was positively associated with increasing sitting time among manual workers (HR, 1.20; 95% CI, 1.05-1.37 for 6-8 h per day; HR, 1.43; 95% CI, 1.12-1.82 for ≥ 8 h per day), while the risk among non-manual workers was greater for those reporting daily sitting times of more than 8 h (HR, 1.86; 95% CI, 1.18-2.95). Similar trends were observed when CVD mortality and incidence were analysed separately.

CONCLUSIONS: Longer daily sitting time was associated with an increased risk of major CVD in both manual and non-manual occupational groups, and the risk was especially high among non-manual workers. Our findings highlight the importance of including measures to reduce sedentary behaviour within a comprehensive strategy to reduce the burden of cardiovascular disease in China.

PMID:39994596 | DOI:10.1186/s12889-025-21948-5

BMC Pregnancy Childbirth. 2025 Feb 24;25(1):201. doi: 10.1186/s12884-025-07322-8.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) affects a significant proportion of pregnant women, impacting both physical and psychological well-being. This study aimed to investigate the factors influencing quality of life (QoL) in women with GDM.

METHODS: This systematic review followed PRISMA guidelines and was registered in PROSPERO (ID: CRD42024612587). A comprehensive search was conducted in PubMed, Scopus, ProQuest, Web of Science, and CINAHL, using MeSH terms related to gestational diabetes and quality of life. Eligible studies included adult women with gestational diabetes and assessed factors influencing their quality of life. The included studies were related to various stages including antenatal, during pregnancy or postpartum. Data extraction was performed independently by two authors, and study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Statistical analyses were conducted in STATA, including meta-analysis with a random-effects model.

FINDINGS: The findings reveal that women with GDM experience significantly lower QoL compared to healthy pregnant women, with sexual dysfunction being a notable contributor. Women with GDM reported lower sexual desire, satisfaction, and higher pain levels, which were significantly associated with poorer QoL, particularly in mental health and pain domains. Socio-demographic factors such as age, education, income, and marital status were significantly linked to QoL, with younger women and those with lower education or income reporting poorer outcomes. Psychological factors, including stress, depression, and anxiety, negatively impacted QoL, while social support, self-efficacy, and illness acceptance were positively correlated with better QoL outcomes. Additionally, stress was found to be the main predictor of QoL for women over 30, while social relationships were more important for younger women. Treatment with insulin or a combination of insulin and oral hypoglycemic agents was associated with lower QoL compared to dietary management alone.

CONCLUSION: This systematic review identified key psychosocial and medical factors influencing the quality of life in women with gestational diabetes. The findings emphasize the importance of addressing psychological well-being, social support, and treatment approaches to enhance QoL in these women. Further research is needed to explore interventions targeting mental health and stress management to improve outcomes for women with gestational diabetes.

PMID:39994595 | DOI:10.1186/s12884-025-07322-8

Spine (Phila Pa 1976). 2025 Mar 15;50(6):357-367. doi: 10.1097/BRS.0000000000005213. Epub 2024 Nov 13.

ABSTRACT

STUDY DESIGN: Retrospective cohort study of prospectively enrolled database.

OBJECTIVE: We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.

BACKGROUND: Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles.

MATERIALS AND METHODS: Inclusion criteria were operative patients with ASD older than 18 years with complete baseline, 90 days perioperative, and 2Y postoperative data. We assessed differences in baseline demographics, surgical details, baseline health-related quality of life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, lumbar lordosis, T2 to T12 kyphosis, and maximum Cobb angle. In addition, HRQL measures included the physical component summary, Oswestry Disability Index, Neck Disability Index, EuroQol 5 dimensions, Scoliosis Research Society Questionnaire 22r total and domain scores, Numeric Pain Rating Scale-back, and Numeric Pain Rating Scale-leg. We used multivariable logistic regression and analysis of covariance to adjust for confounding.

RESULTS: A total of 471 patients with ASD met the inclusion criteria, with 59 designated ERAS+. Those individuals with ERAS+ were older (64.1 ± 13.0 vs. 58.0 ± 16.0; P = 0.005), had a higher Charlson Comorbidity Index, (2.4 ± 1.8 vs. 1.4 ± 1.6; P < 0.001), and exhibited a higher modified ASD frailty index (8.2 ± 5.4 vs. 6.3 ± 4.9; P = 0.019). The adjusted analysis demonstrated the ERAS+ cohort demonstrated a lower likelihood of overall reoperations (Odds ratio (OR): 0.3; 95% CI: 0.13-0.89), and a lower likelihood of overall adverse events (OR: 0.4; 95% CI: 0.19-0.93). ERAS+ was more likely to achieve the minimal clinically important difference in the Scoliosis Research Society Questionnaire 22r total scores at 6 months (6M; OR: 3.1; 95% CI: 1.2-8.4), self-image domain at 6M (OR: 9.0; 95% CI: 1.6-50.0), in the pain domain at 6M (OR: 3.5; 95% CI: 1.01-11.9) and 1 year postoperatively (OR: 2.6; 95% CI: 1.03-6.7), and in the SF-36’s physical component summary (PCS) scores at 1 year (OR: 2.1; 95% CI: 1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P > 0.05).

CONCLUSION: Our work is the first to evaluate HRQL metrics and complications over 2Y following ASD correction with ERAS. Despite presenting with more severe baseline frailty and higher comorbidity profiles, patients with ASD who underwent corrective surgery with an ERAS protocol experienced fewer short-term adverse events and improved HRQL. We believe ERAS following ASD surgery leads to faster functional recovery, reduced postoperative deconditioning, and improved quality of life.

PMID:39992724 | DOI:10.1097/BRS.0000000000005213

Paediatr Int Child Health. 2025 Feb 24:1-8. doi: 10.1080/20469047.2025.2459964. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital malaria, characterised by low parasitaemia in newborns’ peripheral blood, is difficult to diagnose by conventional techniques. Owing to its high sensitivity, polymerase chain reaction (PCR) allows for effective detection of low-density plasmodium infections. This study determined the prevalence of congenital malaria by PCR in newborns of mothers living in a malaria-endemic area of Kinshasa, Democratic Republic of Congo (DRC).

METHODS: A total of 576 mother-newborn pairs were enrolled in two clinical trials in Kinshasa. Maternal peripheral blood was collected at enrolment. At delivery, samples were taken from maternal and newborn peripheral blood, placental blood and placental imprints.

RESULTS: The prevalence of congenital malaria detected by PCR was 2.4% (14/576) compared with 0.9% (5/576) by microscopy. The prevalence of malaria at delivery was 8.9% (51/570), and placental malaria was 10.6% (59/556) by microscopy. At delivery, maternal malaria was significantly associated with congenital malaria [adjusted odds ratio (aOR) 16.06, 95% CI 2.6-98.5, p < 0.01). Placental malaria also increased the risk of congenital malaria (aOR 5.77, 95% CI 0.9-35.2, p = 0.05). Although 10 of 72 women (16.7%) with placental malaria gave birth to low-weight infants, the association was not statistically significant.

CONCLUSIONS: Although this first assessment of congenital malaria by PCR in DRC found a low prevalence, maternal and placental malaria at delivery were still associated with congenital malaria, highlighting the importance of maternal health in preventing neonatal infections.Abbreviations: Aor adjusted odds ratio; CI confidence interval; cOR crude odds ratio; DNA de-oxyribonucleic acid; GAPDH glyceraldehyde-3-posphate dehydrogenase; g/dL grams per decilitre; Hb haemoglobin; IQR interquartile range; IPTp-SP Intermittent Preventive Treatment in pregnancy with sulfadoxine-pyrimethamine; ITN insecticide-treated nets; PA pyronaridine-artesunate; PCR polymerase chain reaction; RDT rapid diagnostic tests; SD; standard deviation; uRDTs ultra-sensitive rapid diagnostic tests; WHO World Health Organization; µL microlitre.

PMID:39992706 | DOI:10.1080/20469047.2025.2459964

Cancer Cytopathol. 2025 Mar;133(3):e70003. doi: 10.1002/cncy.70003.

ABSTRACT

INTRODUCTION: The aim of this project is to assess interobserver agreement for programmed death-ligand 1 (PD-L1) scoring on of non-small cell lung cancer (NSCLC) on cytological specimens in a large-scale multicenter study, by exploiting the cell block-derived tissue microarray (cbTMA) approach.

METHODS: A total of 65 cell blocks (CB) diagnosed as NSCLC were retrospectively collected and selected for TMA preparation. Hematoxylin-eosin and PD-L1 stained slides were digitized and uploaded on a free web sharing platform. Participants were asked to provide PD-L1 assessment by using the clinically relevant cutoff of tumor proportion score (TPS) (<1%; 1%-49%; >50%). Interobserver agreement was calculated using Fleiss’s κ.

RESULTS: Of 65 CBs, 11 were deemed not suitable; therefore, an overall number of 54 cores were used for the preparation of four TMAs. A total of 1674 evaluations were provided by 31 cytopathologists from 21 different institutions in nine countries. The statistical analysis showed a moderate overall agreement (κ = 0.49). The highest agreement was achieved in the TPS >50% category (κ = 0.57); moderate agreement was observed in TPS <1% category (κ = 0.51) and the lowest κ value was obtained for TPS 1%-49% category (k = 0.32).

CONCLUSIONS: The overall moderate agreement observed showed that there is still room for improvement in inter-pathologist agreement for PD-L1 evaluation on cytological samples, highlighting the need for standardization in sample preparation, focused training in PD-L1 evaluation on cytological material, and the integration of machine learning tools to improve interobserver consistency.

PMID:39992702 | DOI:10.1002/cncy.70003

Pediatrics. 2025 Mar 1;155(3):e2024067831. doi: 10.1542/peds.2024-067831.

ABSTRACT

BACKGROUND AND OBJECTIVES: Neonatal intensive care unit (NICU) aggregate service and outcome descriptions focus on high-illness-acuity neonates. We sought to describe the high-level landscape of lower-acuity inborn NICU admissions (LAINAs).

METHODS: This cross-sectional study of a nearly three-quarters population sample from 2022 describes 120 California hospitals with inborn NICU admissions. Binary illness acuity stratification was based on high-acuity criteria-admission within 28 days of birth and either birthweight of 1500 g or less, gestation of 31 weeks 6 days or less, or more than 1500 g with at least 1 of the following: death, assisted ventilation for 4 hours or more whether intubated or not, early bacterial sepsis, major surgery requiring anesthesia, acute transport in or out, suspected encephalopathy/perinatal asphyxia, active therapeutic hypothermia, or seizures. Exposure: inborn NICU admission; main outcomes: LAINA categorization, diagnostic categories, patient-days, length of stay.

RESULTS: Of 44 330 total NICU admissions, 26 257 (59.2%) were LAINAs and accounted for 31.2% of all NICU patient-days. Mean length of stay for all NICU admissions was 12.9 days, compared with 8.0 days for LAINAs. The most common LAINA diagnostic categories included respiratory distress (43.0%), suspected infection (39.6%), admission policy based only on birthweight/gestational age (30.7%), hyperbilirubinemia (28.9%), and feeding difficulty (25.6%). NICUs varied widely in the diagnostic categories represented.

CONCLUSIONS: LAINAs outnumbered high-illness-acuity admissions in most NICUs, accounting for almost a third of NICU patient-days. These findings merit reflection and research on data elements needed to describe service provision and clinical outcome and on preferable hospital settings for clinical management.

PMID:39992693 | DOI:10.1542/peds.2024-067831

J AOAC Int. 2025 Feb 24:qsaf012. doi: 10.1093/jaoacint/qsaf012. Online ahead of print.

ABSTRACT

BACKGROUND: Emerging organic contaminants are increasingly present in the environment, with several pollution sources. Soil and household dust are critical pathways for human exposure, posing significant health risks, especially for vulnerable children.

OBJECTIVE: The objective of this study was to identify and characterize the presence of emerging contaminants in soil and house dust samples in Miami-Dade and Broward counties, Florida, evaluating how seasonal, socioeconomic, and geographic factors influence the distribution of these pollutants.

METHODS: Soil and house dust samples were collected from 49 families twice a year between May 2022 and February 2024. Samples were processed by accelerated solvent extraction (ASE) and analyzed by liquid chromatography-high-resolution mass spectrometry (LC-HRMS). Chemical identification was performed using Compound Discoverer software.

RESULTS: The predominant compounds in soil were personal care products (PCP)/surfactants, industrial products, and pesticides in the dry season, while pharmaceuticals were found in higher abundance in the rainy season. The most abundant compounds in household dust were pharmaceuticals, industrial products and PCP/surfactants in the dry season, while pesticides stood out in the rainy season. Geographically, the central Miami region presented a wider diversity of contaminants in dust and more PCP/surfactants in soil, while the northern region presented greater contamination by pharmaceuticals and industrial products in soil and more surfactants in dust. Overall, lower-income regions showed greater diversity and abundance of pollutants in dust and soil.

CONCLUSION: These results suggest that the distribution of organic pollutants in soil and house dust is influenced by seasonal, socioeconomic, and geographic factors. These differences highlight the need for adaptive environmental policies and integrated strategies to mitigate the risks associated with exposure to these pollutants in urban environments, protecting public health.

HIGHLIGHTS: Seasonal variations significantly influence the distribution of emerging contaminants in soil and household dust. Socioeconomic and geographic factors contribute to distinct contamination patterns across Miami-Dade and Broward.

PMID:39992692 | DOI:10.1093/jaoacint/qsaf012

Physiother Theory Pract. 2025 Mar;41(3):664-681. doi: 10.1080/09593985.2024.2346729. Epub 2024 Apr 26.

ABSTRACT

BACKGROUND: Primary motor cortex (M1) organization and quadriceps femoris excitability may change after anterior cruciate ligament injury (ACLi) and anterior cruciate ligament reconstruction (ACLr), as demonstrated by transcranial magnetic stimulation (TMS) studies.

OBJECTIVE: To systematically review studies evaluating changes in quadriceps femoris corticospinal and intracortical excitability in subjects with ACLi and ACLr.

METHODS: Database searches were conducted in PubMed, Embase, Scopus, and ScienceDirect, with the last search performed on November 23, 2023. Newcastle-Ottawa Scale and a specific checklist for evaluating descriptions in studies using TMS assessment were used. Continuous variables were expressed as mean and standard deviation and represented by the estimated difference from the mean and 95% confidence interval (CI). Heterogeneity was assessed by Chi² and I² and the level of statistical significance was 5%.

RESULTS: Fourteen studies, comprising 381 individuals, using TMS were identified. Meta-analysis results showed significantly higher motor threshold (MT) in ACLi/ACLr individuals compared to healthy controls (p < .01, mean difference 6.72). Additionally, MTs were significantly higher on the uninjured side compared to healthy controls (p < .0001, mean difference 3.82). Motor-evoked potentials (MEP) amplitude was significantly higher on the uninjured side compared to the injured side (p < .00001, mean difference 0.01). Short-interval intracortical inhibition (SICI) amplitude was significantly lesser on the injured limb compared to the uninjured side (p < .00001, mean difference 0.50).

CONCLUSION: Quadriceps MT and SICI are altered in ACLi and ACLr populations, and minor alterations were identified in MEP, demonstrating brain changes related to anterior cruciate ligament injury and/or reconstruction.

PMID:39992686 | DOI:10.1080/09593985.2024.2346729

JAMA Intern Med. 2025 Feb 24. doi: 10.1001/jamainternmed.2024.8354. Online ahead of print.

ABSTRACT

IMPORTANCE: Low-value care is a persistent problem with direct and cascading harms. Telemedicine is now commonly used and may reduce low-value testing by introducing barriers to completing tests at a given visit or expand opportunities for low-value testing by contributing to higher visit volumes.

OBJECTIVE: To quantify the association between telemedicine adoption and low-value testing among fee-for-service Medicare beneficiaries.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study using 100% fee-for-service Medicare claims data, US health systems were divided into quartiles based on 2020 telemedicine adoption. Beneficiary-level linear regression in difference-in-differences (DiD) analyses was used to compare beneficiaries who were continuously enrolled from 2019 through 2022 and were attributed before telemedicine adoption (2019) to high telemedicine-adopting (top quartile) vs low telemedicine-adopting (bottom quartile) health systems on low-value test and visit outcomes in 2022 vs 2019. Data were analyzed from October 2023 to December 2024.

EXPOSURE: Health system telemedicine adoption.

MAIN OUTCOMES AND MEASURES: Receipt of, and spending on, 20 low-value screening, preoperative, chronic condition management, and acute diagnostic tests, as well as total visits (in person and virtual).

RESULTS: The sample included 1 382 033 beneficiaries who were attributed to high-telemedicine systems (mean [SD] age, 71.6 [10.5] years; 58.8% female) and 999 051 beneficiaries who were attributed to low-telemedicine systems (mean [SD] age, 71.8 [10.0] years; 57.0% female). From 2019 to 2022, those in high-telemedicine systems had a small differential rise in visits (DiD visits per beneficiary, 0.12; 95% CI, 0.03 to 0.21) and differential decreases in use of 7 of 20 low-value tests: cervical cancer screening (DiD, -0.45 percentage points [pp]; 95% CI, -0.72 to -0.17 pp), screening electrocardiograms (DiD, -1.30 pp; 95% CI, -1.96 to -0.65 pp), screening metabolic panels (DiD, -1.84 pp; 95% CI, -2.87 to -0.80 pp), preoperative complete blood cell counts (DiD, -0.64 pp; 95% CI, -1.06 to -0.22 pp), preoperative metabolic panels (DiD, -1.35 pp; -1.91 to -0.80 pp), total or free T3 (triiodothyronine) level testing for hypothyroidism (DiD, -0.90 pp; 95% CI, -1.38 to -0.41 pp), and imaging for uncomplicated low back pain (DiD, -1.66 pp; 95% CI, -2.35 to -0.98 pp). There were no statistically significant differences in other tests. Those in high-telemedicine systems saw statistically significant differential decreases in spending on visits per beneficiary (-$47.87; 95% CI, -$86.85 to -$8.88) and on 2 of 20 low-value tests, but no differences in low-value spending overall.

CONCLUSIONS AND RELEVANCE: In this cohort study, telemedicine adoption was associated with modestly lower use of 7 of 20 examined low-value tests (most point-of-care) and no changes in use of other low-value tests, despite a small rise in total visits that might offer more testing opportunities. Results suggest possible benefits of telemedicine and mitigate concerns about telemedicine contributing to increased spending.

PMID:39992684 | DOI:10.1001/jamainternmed.2024.8354

JAMA Pediatr. 2025 Feb 24. doi: 10.1001/jamapediatrics.2024.6613. Online ahead of print.

ABSTRACT

IMPORTANCE: Hypothermia begun less than 6 hours after birth reduces death or disability in infants with encephalopathy due to hypoxia-ischemia at 36 or more weeks’ gestation. Trials of hypothermia for infants younger than 36 weeks’ gestation are lacking.

OBJECTIVE: To assess the probability that hypothermia at less than 6 hours after birth decreases death or disability in infants 33 to 35 weeks’ gestation with moderate or severe hypoxic-ischemic encephalopathy.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted between July 2015 and December 2022 for infants 33 to 35 weeks’ gestation with moderate or severe hypoxic-ischemic encephalopathy at less than 6 hours after birth. Bayesian and intention-to-treat analyses were prespecified. The setting included 19 US Neonatal Research Network centers. Data were analyzed from March 2023 to November 2024.

INTERVENTIONS: Infants received unblinded targeted esophageal temperature management. Infants with hypothermia were maintained at 33.5 °C (acceptable 33-34 °C) for 72 hours and then rewarmed. Infants with normothermia were to be maintained at 37 °C (acceptable 36.5-37.3 °C).

MAIN OUTCOMES AND MEASURES: Composite of death or disability (moderate or severe) at 18 to 22 months’ corrected age adjusted for level of encephalopathy and center.

RESULTS: A total of 168 infants with hypothermia and normothermia were preterm (mean [SD] age, 34.0 [0.8] weeks’ gestation and 34.1 [0.8] weeks’ gestation, respectively), while 46 of 88 (52%) and 45 of 80 (56%) were male, respectively. Randomization occurred at mean (SD) 4.5 (1.2) hours and 4.5 (1.3) hours for the groups with hypothermia and normothermia, respectively. The primary outcome occurred in 29 of 83 infants (35%) with hypothermia and 20 of 69 infants (29%) with normothermia (adjusted relative risk [hypothermic/normothermic], 1.11; 95% credibility interval, 0.74-2.00), and death occurred in 18 of 88 infants (20%) with hypothermia and 9 of 78 infants (12%) with normothermia (adjusted relative risk, 1.38; 95% credibility interval, 0.79-2.85). Bayesian analysis with neutral prior indicated 74% probability of increased death or disability and 87% probability of increased death with hypothermia.

CONCLUSIONS AND RELEVANCE: Among infants 33 to 35 weeks’ gestation with hypoxic-ischemic encephalopathy, hypothermia at less than 6 hours’ age did not reduce death or disability at 18 to 22 months’ corrected age.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01793129.

PMID:39992674 | DOI:10.1001/jamapediatrics.2024.6613