Category: Nevin Manimala

Psychol Health Med. 2025 Sep 29:1-14. doi: 10.1080/13548506.2025.2565526. Online ahead of print.

ABSTRACT

This study aimed to explore the development of child anxiety and examine multiple mediating roles of child maltreatment and resilience in the association between caregiver anxiety and child anxiety. The longitudinal study included 1595 preschool children and their caregivers in Anhui Province, China. Paired t-tests were employed to compare differences in child anxiety between the baseline and follow-up. Linear regression analyses were performed to explore predictive effects of individual and family factors on child anxiety, while path analyses were applied to analyze mediating effects. The results indicated that child anxiety decreased during the one year follow-up. Child sex, resilience, mother’s education, caregiver anxiety and child maltreatment could longitudinally predict child anxiety. Child maltreatment and resilience not only independently mediated the association between caregiver anxiety and child anxiety but also played a chain-mediating effect. These results elucidated a complex mechanistic model involving both risk and protective factors, indicating that caregiver anxiety transmits its effects through increased maltreatment risk and diminished child resilience. Consequently, comprehensive intervention strategies should concurrently target the reduction of caregiver anxiety, prevention of maltreatment, and strengthen child resilience to effectively mitigate the development of anxiety in preschool children.

PMID:41021888 | DOI:10.1080/13548506.2025.2565526

Psychol Health Med. 2025 Sep 29:1-15. doi: 10.1080/13548506.2025.2565525. Online ahead of print.

ABSTRACT

This study investigates whether Tobacco smoke exposure (TSE) is associated with C-reactive protein (CRP) and depression and whether CRP plays a mediating role. The data set, including 8,917 adults aged more than 18 years old, was provided by US National Health and Nutrition Examination Survey during 2005-2010 and 2015-2018. A logistic-regression-based mediation analysis was applied to clarify the direct effect of serum cotinine on depression and the indirect effect mediated by CRP. The results indicated that serum cotinine was positively correlated with the risk of depression (Q4 vs. Q1, OR_{Model 1} = 2.72, 95% CI: 1.95-3.82; OR_{Model 2} = 1.62, 95% CI: 1.10, 2.37 OR_{Model 3} = 1.58, 95% CI: 1.07, 2.34). Active smoking was associated with the risk of depression (OR_{Model 2} = 1.69, 95% CI: 1.23, 2.31; OR_{Model 3} = 1.66, 95% CI: 1.21, 2.28), while passive smoking was not significantly associated with the risk of depression after adjusting for covariates (OR_{Model 2} = 1.02, 95% CI: 0.72, 1.44; OR_{Model 3} = 1.02, 95% CI: 0.72, 1.44). Increased serum cotinine level was associated with an increased risk of depression, and the effect (4.95%) can be explained by a significant indirect effect of CRP (OR = 3.80 × 10^-6, 95% CI: 2.81 × 10^-7, 8.52 × 10^-6). The findings suggest that anti-inflammation may be a potential goal for depression intervention among the tobacco-smoke-exposed population.

PMID:41021887 | DOI:10.1080/13548506.2025.2565525

Psychol Health Med. 2025 Sep 29:1-12. doi: 10.1080/13548506.2025.2565514. Online ahead of print.

ABSTRACT

This study aimed to investigate the effect of childbirth self-efficacy and fear of childbirth on prenatal attachment in patients with risky pregnancies. The study was designed as descriptive and cross-sectional research. Patients with risky pregnancies hospitalized in a perinatology clinic. A total of 210 pregnant women between 28 and 40 weeks of gestation were included in the study. Data were collected using the Personal Information Form, Childbirth Self-Efficacy Inventory Short Version 32 (CBSEI-32), Childbirth Attitudes Questionnaire, and Prenatal Attachment Inventory (PAI). The Statistical Package for the Social Sciences software version 23.0 was used to analyze study data. Pregnant women had moderate levels of childbirth self-efficacy, fear of childbirth, and prenatal attachment. A statistically significant weak positive correlation was observed between the total CBSEI-32 score, its subdimensions of outcome expectancy and efficacy expectancy, and PAI score (p = 0.000, p = 0.002, p = 0.000, respectively). The level of childbirth self-efficacy significantly and positively influenced prenatal attachment, with an explanatory power of 10.1% (F₍₁₎ = 23.254, p = 0.000). In pregnant women, as the childbirth self-efficacy level increased, their prenatal attachment level also increased. However, the level of fear of childbirth did not affect prenatal attachment. Based on these findings, healthcare professionals are recommended to provide specialized care, counseling, and support for patients with risky pregnancies to enhance the perceptions of self-efficacy, thereby improving prenatal attachment levels.

PMID:41021883 | DOI:10.1080/13548506.2025.2565514

JCO Glob Oncol. 2025 Sep;11:e2500304. doi: 10.1200/GO-25-00304. Epub 2025 Sep 29.

ABSTRACT

PURPOSE: This study aimed to assess cancer-related knowledge, attitudes, screening behaviors, and willingness to engage in community-based screening for cervical, breast, and oral cancers among women in rural Bangladesh, with the goal of informing the design of a scalable, national cancer screening strategy.

METHODS: A cross-sectional survey was conducted among 1,046 eligible women (age ≥ 30 years or married ≥ 10 years) in Nawly village, Jashore, Bangladesh. Trained interviewers administered a structured questionnaire assessing sociodemographics, cancer knowledge, attitudes, screening behaviors, and willingness to participate in organized screening. Descriptive statistics and multivariate logistic regression models identified predictors of knowledge, participation, and willingness.

RESULTS: Although 75.4% of women were aware of cervical cancer, only 28.3% correctly identified screening intervals. Awareness of breast and oral cancer screening was lower (11.5% and 6.2%, respectively). Participation in cervical cancer screening was 18.2%, and <1% for breast or oral cancer. However, willingness to participate in future community-based screening was high (>89% across all cancer types). Higher education and income were significantly associated with better knowledge and increased screening participation. Fear and misconceptions were the most common barriers among those unwilling to participate.

CONCLUSION: Despite limited screening uptake, there is strong community readiness for organized cancer screening. These findings underscore the need for tailored education campaigns and scalable, community-based programs to enhance early cancer detection in low-resource settings such as Bangladesh.

PMID:41021876 | DOI:10.1200/GO-25-00304

Neurology. 2025 Oct;105(8):e214150. doi: 10.1212/WNL.0000000000214150. Epub 2025 Sep 29.

ABSTRACT

BACKGROUND AND OBJECTIVES: Myasthenia gravis (MG) is a chronic antibody-mediated autoimmune neuromuscular disorder causing fluctuating muscle weakness due to autoantibodies that target the acetylcholine receptor (AChR) in the neuromuscular junction (NMJ). Despite extensive research, MG remains unpredictable and heterogeneous, underscoring the need for better insight into disease pathogenesis and clinical course. The objective of this study was to identify clinical and immunologic disease-related parameters that correlate with disease severity.

METHODS: This large-scale, multicenter, cross-sectional study included prospectively recruited patients with MG and MG serum samples procured from reputable biobanks. Inclusion criteria required an MG clinical presentation and a positive anti-AChR immunoglobulin G (IgG) titer (≥0.5 nM), confirmed by 2 independent tests. Enrolled patients underwent profiling of subunit-specific anti-AChR IgG titers. Disease severity patterns and their relation to age, sex, disease onset, thymic involvement, anti-AChR titer, and anti-AChR subunit immunodominance were investigated.

RESULTS: The study included 513 patients with MG (50.5% female) with a median age of 64 years (range 14-98.5). Extended clinical data were available for 232 patients. Anti-AChR titers increased monotonically with disease severity (ρ = 0.31, 95% CI 0.17-0.44, p < 0.0001) and were higher in female patients (median 14.6 nM vs 7.7 nM, 95% CI for Δ 2.1-7.3 nM, p < 0.0001) in whom higher antibody titers decreased monotonically with age. Male patients’ titers were predominantly alpha-immunodominant (male 23.2% vs female 16.6%, 95% CI for Δ 0%-7.6%, p = 0.031), while female patients’ titers were gamma-immunodominant (female 30% vs male 24.5%, 95% CI for Δ 2%-11%, p = 0.0027). Gamma immunodominance correlated with higher anti-AChR titer (ρ = 0.25, 95% CI 0.16-0.33, p < 0.0001) and severe (Myasthenia Gravis Foundation of America IV-V) disease (44% vs 27%, 95% CI for Δ 4%-34%, p = 0.0141). Unsupervised principal component analysis disclosed 2 distinct disease endotypes: female patients with moderate to severe early-onset MG, gamma subunit immunodominance, high anti-AChR titers, and frequent thymic hyperplasia (endotype A) and the remaining patients, mostly patients with late-onset MG, alpha subunit immunodominance, and low anti-AChR titers (endotype B).

DISCUSSION: Two distinct MG endotypes emerge based on sex, age, thymic involvement, autoantibody titer, and immunoglobulin AChR subunit immunodominance-suggesting different underlying etiologies with potential implications for sex-dependent precision medicine, women’s health, and the development of new therapeutic modalities for MG.

PMID:41021867 | DOI:10.1212/WNL.0000000000214150

Rev Med Chil. 2025 Oct;153(10):708-719. doi: 10.4067/s0034-98872025001000708.

ABSTRACT

The perception of academic mistreatment among medical students is associated with burnout, emotional disorders, and poorer professional performance. Conversely, a positive environment that promotes respectful teaching can enhance empathy, reduce burnout, and increase student satisfaction. This study examines perceptions of respectful teaching and its associations with demographic and academic characteristics among medical students in Chile.

AIM: To evaluate perceptions of respectful teaching among medical students in Chile and their relationship with sociodemographic, academic, and personal satisfaction factors.

METHODS: A cross-sectional study was conducted across six Chilean universities, involving 443 medical students. We used the Good Teaching Practices Questionnaire (40 items in 9 dimensions) and tools for sociodemographic characterization and academic satisfaction. Data were analyzed using descriptive statistics, reliability coefficients, Spearman correlations, and ANOVA, with significance set at p<0.05.

RESULTS: Younger students, those in earlier years, or those recently admitted reported better perceptions of respectful teaching (p<0.05). Men perceived greater support in flexible planning, feedback, and concern for students (p<0.01). Theoretical and synchronous courses were associated with better perceptions of class agility and teaching passion (p<0.001). The highest-rated dimension was subject mastery (Md= 4.00), while concern for students received the lowest score (Md= 3.00).

CONCLUSION: Higher life satisfaction and work-life balance levels are related to respectful teaching. Differences between universities and demographic groups highlight the need for inclusive institutional policies and faculty training to foster equitable and empathetic environments in medical education.

PMID:41021858 | DOI:10.4067/s0034-98872025001000708

Rev Med Chil. 2025 Oct;153(10):674-685. doi: 10.4067/s0034-98872025001000674.

ABSTRACT

AIM: This study evaluates regional disparities in access to treatment and preventive screenings for high-mortality non-communicable diseases (NCDs) -specifically cancer and diabetes- in Chile, using data from the 2022-2023 National Health, Sexuality, and Gender Survey (ENSSEX).

METHODS: Four key indicators were analyzed: mammography (MAM), Pap smear (PAP), prostate-specific antigen test (PSA), and diabetes treatment (DIA). Disparities were assessed using both general and relative disparity indices (ID) to quantify regional inequalities.

RESULTS: The general disparity index (IDg) revealed substantial differences in access to preventive screenings, with regional gaps reaching up to 20% for PSA tests, mammograms, and Pap smears. In contrast, disparities in diabetes treatment access were notably smaller (<5%). Better performance was observed in the northern and southern macrozones, while regions such as Tarapacá, Maule, and Metropolitana showed significant lags.

CONCLUSIONS: The findings underscore persistent regional disparities in preventive healthcare services in Chile. Targeted decentralization policies and subnational prioritization are crucial to reducing these gaps. Addressing these disparities is essential for achieving Sustainable Development Goal 3.4 and lowering premature mortality from NCDs.

PMID:41021855 | DOI:10.4067/s0034-98872025001000674

JMIR Med Inform. 2025 Sep 29;13:e74116. doi: 10.2196/74116.

ABSTRACT

BACKGROUND: Data scarcity and dispersion pose significant obstacles in biomedical research, particularly when addressing rare diseases. In such scenarios, synthetic data generation (SDG) has emerged as a promising path to mitigate the first issue. Concurrently, federated learning is a machine learning paradigm where multiple nodes collaborate to create a centralized model with knowledge that is distilled from the data in different nodes, but without the need for sharing it. This research explores the combination of SDG and federated learning technologies in the context of acute myeloid leukemia, a rare hematological disorder, evaluating their combined impact and the quality of the generated artificial datasets.

OBJECTIVE: This study aims to evaluate the privacy- and fidelity-related impact of horizontally federating SDG models in different data distribution scenarios and with different numbers of nodes, comparing them with centralized baseline SDG models.

METHODS: Two state-of-the-art generative models, conditional tabular generative adversarial network and FedTabDiff, were trained considering four different scenarios: (1) a nonfederated baseline with all the data available, (2) a federated scenario where the data were evenly distributed among different nodes, (3) a federated scenario where the data were unevenly and randomly distributed (imbalanced data), and (4) a federated scenario with nonindependent and identically distributed data distributions. For each of the federated scenarios, a fixed set of node quantities (3, 5, 7, 10) was considered to assess its impact, and the generated data were evaluated, attending to a fidelity-privacy trade-off.

RESULTS: The computed fidelity metrics exhibited statistically significant deteriorations (P<.001) up to 21% in the conditional tabular generative adversarial network and up to 62% in the FedTabDiff model due to the federation process. When comparing federated experiments trained with diverse numbers of nodes, no strong tendencies were observed, even if specific comparisons resulted in significative differences. Privacy metrics were mainly maintained while obtaining maximum improvements of 55% and maximum deteriorations of 26% between both models, although they were not statistically significant.

CONCLUSIONS: Within the scope of the use case scenario in this paper, the act of horizontally federating SDG algorithms results in a loss of data fidelity compared to the nonfederated baseline while maintaining privacy levels. However, this deterioration does not significantly increase as the number of nodes used to train the models grows, even though significative differences were found in specific comparisons. The different data partition distribution configurations had no significant effect on the metrics, as similar tendencies were found for all scenarios.

PMID:41021276 | DOI:10.2196/74116

JAMA Netw Open. 2025 Sep 2;8(9):e2530132. doi: 10.1001/jamanetworkopen.2025.30132.

ABSTRACT

IMPORTANCE: The tobacco industry spends more than $8 billion annually in the US on marketing at the point of sale. Exposure to tobacco retail has been associated with smoking outcomes, but substantially less is known about how objectively logged everyday tobacco retail exposure is associated with smoking outcomes.

OBJECTIVE: To assess preregistered hypotheses that individuals would report (1) greater craving and (2) more cigarettes smoked on days when their exposure to tobacco retail is higher than usual.

DESIGN, SETTING, AND PARTICIPANTS: This multimodal, within-person cohort study combined objectively logged geolocation tracking, public tobacco retail location records, and ecological momentary assessment data. Eligible participants recruited from the GeoSmoking Study were aged 21 to 65 years, smoked at least 5 cigarettes per day over the previous 6 months, owned a smartphone, and were a resident of Pennsylvania, New Jersey, or Delaware. Data were collected from May 25, 2022, to June 10, 2024.

EXPOSURE: Exposure to tobacco retail stores was assessed using mobility data matched with locations of tobacco retailers across Pennsylvania, New Jersey, and Delaware.

MAIN OUTCOMES AND MEASURES: Daily mean craving and daily number of cigarettes smoked were computed using ecological momentary assessment.

RESULTS: A total of 273 participants were included in the final analyses (mean [SD] age, 42.5 [10.7] years; 151 women [55.3%]). Multilevel models revealed support for both preregistered hypotheses. On days when individuals had more tobacco retail exposure than their own average, they reported significantly higher levels of craving (b = 0.04; 95% CI, 0.01-0.07; t3457 = 2.72; P = .01) and smoking significantly more cigarettes (b = 0.01; 95% CI, 0.0002-0.01; t3469 = 2.05; P = .04).

CONCLUSIONS AND RELEVANCE: In this cohort study of individuals who smoke cigarettes daily, exposure to tobacco retail in their everyday lives was associated with increases in craving and smoking. These findings highlight the importance of retail exposure and smoking outcomes, information that is critical for developing effective tobacco control interventions and lays the foundation for broader health research on environmental factors that shape health behaviors.

PMID:41021230 | DOI:10.1001/jamanetworkopen.2025.30132

JAMA Netw Open. 2025 Sep 2;8(9):e2533912. doi: 10.1001/jamanetworkopen.2025.33912.

ABSTRACT

IMPORTANCE: Suboptimal child passenger safety behaviors are common despite the availability of effective child restraint systems (CRS), with national guidelines promoting-and state laws requiring-their use.

OBJECTIVE: To compare 6-month guideline adherence following the Tiny Cargo, Big Deal, Abróchame Bien, Cuídame Bien (TCBD/ABCB) intervention vs enhanced usual care (EUC); assess 12-month maintenance effect; and evaluate sequential, multiple-assignment, randomized trial (SMART) phase 2 outcomes by intervention intensity.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial using a SMART study design was conducted at 1 pediatric emergency department (ED), 1 community ED, and 2 urgent care centers in metropolitan Chicago, Illinois, from February 2020 to August 2022. Eligible caregivers spoke English or Spanish, lived in Illinois, owned a smartphone, traveled weekly with their child (aged 6 months to younger than 11 years), and reported suboptimal child passenger safety behaviors. Of 5416 caregivers who were screened, 1517 were potentially eligible. Data analysis occurred from October 2024 to March 2025.

INTERVENTIONS: Phase 1 included basic TCBD/ABCB (remote motivational interviewing [MI] plus tailored mobile health [mHealth]) vs EUC (text message photograph requests, follow-up activity reminders, and corrective feedback only for predefined critical errors). In phase 2, participants exposed to TCBD/ABCB but who were nonadherent at 6 months received high-intensity (second remote MI session plus extra text messages) or low-intensity (mHealth alone) interventions.

MAIN OUTCOME AND MEASURES: The primary outcome was guideline adherence, a dichotomous measure of all 3 criteria: (1) appropriate CRS, (2) back seat location, and (3) never unrestrained. Outcomes were assessed at 6 and 12 months using logistic regression with prevalence differences, adjusted for randomization strata, caregiver gender, race, and ethnicity.

RESULTS: In phase 1, there were 474 participants (mean [SD] caregiver age, 36.1 [6.2] years; 443 mothers [93.5%]; 52 [11.0%] preferred Spanish]) of whom 342 were randomized to basic TCBD/ABCB and 132 to EUC. Among participants with 6-month follow-up data, 131 of 278 caregivers receiving TCBD/ABCB (47.1%; 95% CI, 41.3% to 53.0%) vs 38 of 118 receiving EUC (32.2%; 95% CI, 23.8% to 40.6%) were guideline adherent (absolute change in treatment response, 13.1%; 95% CI, 3.6% to 22.6%; P = .007) with 12-month maintenance effects (adjusted prevalence difference, 39.2%; 95% CI, 26.5% to 51.9%; P < .001). In phase 2, 185 participants who received TCBD/ABCB and were not guideline adherent were rerandomized to high-intensity (87 participants) or low-intensity (84 participants) intervention. High-intensity TCBD/ABCB had no effect compared with low-intensity TCBD/ABCB (adjusted prevalence difference, -3.9%; 95% CI -17.9% to 10.1%; P = .59).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of caregivers, TCBD/ABCB was associated with improved adherence to child passenger safety guidelines with lasting effects among those caregivers who were adherent at 6 months. These findings suggest that this remote precision prevention intervention against a leading cause of death may be adaptable to other settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04238247.

PMID:41021229 | DOI:10.1001/jamanetworkopen.2025.33912