Category: Nevin Manimala

BMJ Open. 2025 Nov 4;15(11):e101586. doi: 10.1136/bmjopen-2025-101586.

ABSTRACT

OBJECTIVES: To investigate patterns of sustainable working life, defined as a few or no interruptions from paid work due to sickness absence, unemployment or disability pension among Swedish twins with and without common mental disorders (CMDs). We also sought to examine the role of baseline sociodemographic factors for the identified patterns.

DESIGN: Prospective cohort study.

SETTING: Population-based sample of twins born in Sweden.

PARTICIPANTS: The sample of 5529 CMDs, discordant twin pairs between ages 18 and 59 years at baseline in 1998 (50% women) were followed annually for working life statuses using data obtained from national registers until 2020.

PRIMARY OUTCOME: Sustainable working life.

MEASURES: Group-based trajectory modelling was applied to identify distinct trajectory groups. Multinomial logistic regression models estimating ORs were performed.

RESULTS: For those with CMDs, a three-trajectory solution was the best-fitting model, while for those without CMDs, a two-trajectory solution had best fit; in both groups, sustainable working life constituted the largest trajectory group (71% and 83%, respectively). No sustainable working life yielded 14.5% and 17% in those with CMDs and those without CMDs, respectively, whereas, among those with CMDs, another 14.5% had a trajectory with decreasing sustainable working life. Higher education was associated with a lower likelihood (OR 0.12-0.47) and being single (with or without children, OR 2.23-2.51) with a higher likelihood of belonging to those trajectories characterised by no sustainable working life.

CONCLUSION: A small cluster among those with CMDs tended to follow a decreasing sustainable working life pattern, while a minority with or without CMDs had no sustainable working life. Although a sustainable working life seems common, those with CMDs should be identified early for preventive actions and support to remain in paid work.

PMID:41248389 | DOI:10.1136/bmjopen-2025-101586

BMJ Open. 2025 Nov 4;15(11):e099209. doi: 10.1136/bmjopen-2025-099209.

ABSTRACT

OBJECTIVES: To assess the relationship of infant growth, feeding practices and tummy time to their motor development at 12 months, with a special focus on how maternal physical activity during late pregnancy relates to infants’ motor skills.

DESIGN: Longitudinal study.

SETTING: Rural city in the Mid-Southern USA.

PARTICIPANTS: 16 singleton pregnant women in the third trimester and their term infants were recruited, excluding mother-infant pairs with health issues that impact infants’ motor development and restrict mothers’ physical activity.

PRIMARY AND SECONDARY OUTCOME MEASURES: Maternal physical activity and sedentary time during the third trimester were measured using Actigraph activity monitors. Labour nurses measured neonatal birth weight and length using standard procedures. Infants’ motor percentiles at 4 and 12 months were measured respectively using the Alberta Infant Motor Scale and Peabody Developmental Motor Scales II test by a licensed paediatric physical therapist. Feeding practices, infants’ time spent in different positions and family composition were evaluated separately at 4 and 12 months using a study-specific survey.

RESULTS: Infant motor percentiles at 4 months were positively associated with their 12-month motor percentiles (r=0.649, p=0.009). For each additional percentile at 4 months, the mean 12-month percentile increased by 0.4. Motor percentiles at 12 months were also positively associated with infants’ birth weight (r=0.553, p=0.026) and length (r=0.637, p=0.008), but not significantly associated with tummy time (r=-0.069, p=0.840). Infant motor percentiles at 12 months were not associated with time spent sedentary (r=-0.134, p=0.634), light activity (r=0.213, p=0.447) or moderate activity (r=-0.050, p=0.858) during the third trimester. At 12 months, breastfeeding status (p=0.576) and having siblings (p=0.230) were not related to motor scores.

CONCLUSIONS: Motor percentiles at 4 months, birth weight and length correlated with motor skills at 12 months, whereas tummy time, siblings, and breastfeeding were not significant predictors. Physical activity during pregnancy did not significantly correlate to motor skills at 12 months.

PMID:41248387 | DOI:10.1136/bmjopen-2025-099209

BMJ Open. 2025 Nov 13;15(11):e105613. doi: 10.1136/bmjopen-2025-105613.

ABSTRACT

OBJECTIVE: Studying issues related to stroke medication non-adherence is essential for secondary prevention of stroke. This study aimed to identify the prevalence of medication non-adherence and risk factors among stroke survivors. The reasons behind this are that some patients may not follow stroke medication plans, and potential ways to help patients adhere better to medication plans.

DESIGN: This study employed a cross-sectional patient survey.

SETTING: The study was conducted in 20 public and private healthcare facilities in a resource-constrained setting, in Punjab, the largest province of Pakistan.

PARTICIPANTS: We included 6538 stroke survivors aged 21-75 years with at least a 6 month history of stroke who were prescribed one or more anti-stroke medications and met the inclusion criteria.

PRIMARY OUTCOME MEASURES: The main outcome was medication non-adherence, measured by the Self-Efficacy for Appropriate Medication Scale (SEAMS) and self-reported pill count. Descriptive statistics were used to summarise study variables. chi-square (χ²)/Fisher’s exact test and independent t-test/ANOVA were employed. A generalised linear model (logit model using multivariable logistic regression shows that several factors are associated with medication non-adherence and adherence. Odds ratio (OR) plots were generated using Seaborn and Matplotlib.

RESULTS: Non-adherence based on pill counts was 49.7%, while the mean SEAMS score (31.3±7.7) showed moderate self-reported adherence. After adjusting for age, gender, marital status, education, income, health insurance, smoking status, comorbidities, stroke type, disease duration, blood pressure control, number of medications, dosing frequency, physiotherapy continuation, perceived side effects and doctor-patient satisfaction, we found that female gender (vs male: AOR 0.31, 95% CI 0.27 to 0.35), lower income (10k-25k PKR vs >100k PKR: AOR 0.31, 95% CI 0.23 to 0.41; 26k-50k PKR vs >100k PKR: AOR 0.57, 95% CI 0.47 to 0.68), primary/secondary education (vs postgraduate: AOR 0.74, 95% CI 0.64 to 0.87), controlled BP (vs uncontrolled: AOR 0.66, 95% CI 0.59 to 0.73), longer disease duration (≥5 years vs <5 years: AOR 0.43, 95% CI 0.37 to 0.49), one time per day dosing (vs three times per day: AOR 0.25, 95% CI 0.21 to 0.29) and fewer medications (<5 vs 10+: AOR 0.50, 95% CI 0.43 to 0.58; 5-9 vs 10+: AOR 0.71, 95% CI 0.61 to 0.83) significantly reduced non-adherence odds (all p<0.001). Married status (vs other: AOR 1.22, 95% CI 1.02 to 1.45, p=0.028) and diabetes (vs obesity: AOR 1.29, 95% CI 1.09 to 1.53, p=0.003) increased non-adherence risk.

CONCLUSION: This study addresses the significant issue of medication non-adherence in stroke patients in Pakistan, reflecting global patterns yet remaining under-explored locally. It emphasises the critical role of adherence in managing chronic conditions such as stroke, where consistent use of preventive therapies is vital for reducing recurrence and improving outcomes. While the non-adherence rates are consistent with global trends, there is a notable lack of observational studies and epidemiological data in the Pakistani context. Our findings support a comprehensive approach to enhance medication adherence, taking into account the complex connections among social, behavioural and clinical factors. It also highlights the importance of maintaining detailed records to monitor adherence trends, identify high-risk groups and inform targeted public health interventions.

PMID:41248386 | DOI:10.1136/bmjopen-2025-105613

Anatol J Cardiol. 2025 Nov 17. doi: 10.14744/AnatolJCardiol.2025.5649. Online ahead of print.

ABSTRACT

BACKGROUND: Calcific aortic valve stenosis (CAVS), the predominant valvular heart disease in developed countries, arises primarily from metabolic and inflammatory dysregulation. The triglyceride-glucose (TyG) index, a composite biomarker of insulin resistance and systemic inflammation, has been associated with cardiovascular diseases. However, its causal association with CAVS remains unclear. This study employs bidirectional Mendelian randomization (MR) to elucidate the potential causal relationship between the TyG index and CAVS.

METHODS: Genome-wide association study) summary statistics of TyG index and CAVS were obtained from UK-biobank cohort (n = 273 368) and FinnGen database (cases = 12 418 and controls = 487 930). Two-sample MR and multiple MR analyses were conducted to evaluate the association of TyG index with CAVS. The primary method was inverse variance weighted (IVW), complemented by MR-Egger, weighted median, and sensitivity analyses to ensure robustness.

RESULTS: The MR analysis demonstrated a significant causal effect of the higher TyG index (per 1-unit increment of TyG index) on CAVS risk (odds ratio [OR] = 1.50, P = .007, 95% CI: 1.12-2.02). Similar causal relationships were observed for triglyceride and glucose levels with CAVS. Sensitivity analyses confirmed robustness with no evidence of horizontal pleiotropy (P > .05). This association remained statistically significant in multiple MR analyses after adjusting for potential confounders (OR = 1.64, P = .003, 95% CI: 1.18-2.28). No reverse causality from CAVS to the TyG index was detected.

CONCLUSION: This MR study provides evidence supporting the causal effect of higher TyG index on CAVS.

PMID:41243889 | DOI:10.14744/AnatolJCardiol.2025.5649

Nurs Crit Care. 2025 Nov;30(6):e70241. doi: 10.1111/nicc.70241.

ABSTRACT

BACKGROUND: Delirium is a common neuropsychiatric complication in the intensive care unit (ICU), the occurrence of which is closely associated with patient prognoses.

AIM: To examine the associations between sleep quality and circadian rhythm stability measured by actigraphy and changes in delirium state in intensive care unit (ICU) patients, as well as their predictive power for mortality risk.

STUDY DESIGN: ICUs of a medical centre in Taiwan, from September 1, 2024, to January 31, 2025. A prospective observational study was conducted in adult ICU patients. Wrist-worn actigraphy was used to monitor total sleep time (TST, h), wake after sleep onset (WASO, h), and circadian rhythm stability (24-h autocorrelation coefficient, r24) for 72 consecutive hours. Delirium was assessed twice daily for three days using the Confusion Assessment Method for the ICU (CAM-ICU) and categorized as no delirium, prolonged delirium (lasting ≥ 3 days), or new-onset delirium (developed after enrollment).

RESULTS: A total of 74 ICU patients were included. Among them, 30 had no delirium, 20 had prolonged delirium, and 24 developed new-onset delirium. Mortality rates in both the prolonged delirium and new-onset delirium groups were 45%, significantly higher than in the no-delirium group (13.3%, p = 0.015). The prolonged delirium group had higher Sequential Organ Failure Assessment (SOFA) scores, longer WASO and lower r24 than the no-delirium group, with r24 significantly associated with prolonged delirium (OR = 0.001, p = 0.012). The new-onset delirium group showed higher WASO, which was significantly associated with delirium (OR = 1.04, p = 0.046). Multivariate Cox analysis identified prolonged delirium (HR = 3.92, p = 0.049) and SOFA score (HR = 1.32, p = 0.027) as independent predictors of mortality.

CONCLUSIONS: WASO and r24 were closely linked to delirium state changes. Lower r24 was strongly associated with prolonged delirium and higher mortality, while higher WASO was related to new-onset delirium.

RELEVANCE TO CLINICAL PRACTICE: Continuous monitoring of sleep continuity and circadian rhythms in ICU patients is recommended. Incorporating WASO into early delirium risk assessments may facilitate timely interventions, reduce delirium incidence and mortality and improve critical care quality.

PMID:41243871 | DOI:10.1111/nicc.70241

Clin Transplant. 2025 Nov;39(11):e70382. doi: 10.1111/ctr.70382.

ABSTRACT

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially life-saving intervention in refractory out-of-hospital cardiac arrest (OHCA). ECPR enables, in most of the treated cases, ICU admission to patients who otherwise would have died at the emergency department (ED). Still, many of them die, frequently after withdrawal of life-sustaining therapies due to irreversible critical conditions and related complications. The additional time provided by ECPR, however, might allow for the assessment of organ donor suitability. The aim of this study was to evaluate the impact of ECPR on the number of potential organ donors after refractory OHCA.

METHODS: We performed a post-hoc analysis of the multicenter INCEPTION trial, which randomized 134 OHCA patients between conventional CPR (CCPR) and ECPR. Detailed patient reports were presented to transplant physicians to determine the acceptability of the liver and kidneys for organ donation. In addition to the intention to treat analysis, we performed an “as-treated” analysis, limited to patients arriving without return of spontaneous circulation (ROSC) at the ED.

RESULTS: Out of 70 patients randomized to ECPR and 64 to CCPR, potential organ donors were identified in 14 (20%) and 4 (6%) patients, respectively (χ² test, p = 0.038). In the as-treated analysis, 15 out of 55 (27%) treated with ECPR were potential donors, compared to 0 out of 59 treated with CCPR (p < 0.001). This included five (9%) potential kidney donors and 15 (27%) potential liver donors.

CONCLUSION: Although ECPR is currently used with life-saving intentions, it may simultaneously increase the number of potential organ donors following cardiac arrest in selected patients.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03101787.

PMID:41243868 | DOI:10.1111/ctr.70382

J Pediatr Orthop. 2025 Nov 17. doi: 10.1097/BPO.0000000000003162. Online ahead of print.

ABSTRACT

BACKGROUND: Although periacetabular osteotomy (PAO) provides excellent clinical outcomes for patients with hip dysplasia, it still remains uncertain how it affects coronal and sagittal spinopelvic alignment. Therefore, this study aims to evaluate changes of coronal and sagittal spinopelvic parameters on standing AP and Lateral entire spine EOS radiographs following unilateral and bilateral PAO surgery.

METHODS: Skeletally mature patients who underwent unilateral and bilateral PAO surgery for symptomatic hip dysplasia were included in this study. Standing anteroposterior (AP) and lateral EOS spine radiographs (EOS Imaging, Paris, France) obtained preoperatively and at the last follow-up were analyzed to assess changes in coronal and sagittal plane measurements. Preoperative and postoperative radiographic outcomes were assessed using the Paired Sample t test for normally distributed variables and the Wilcoxon Signed-Rank test for non-normally distributed variables.

RESULTS: A total of 31 patients with 44 hips were included in this study following our exclusion criteria. Of those, 18 patients (58%) underwent unilateral PAO (Unilateral group) and 13 patients (42%) underwent bilateral staged PAOs (Bilateral group). The mean age of patients at first surgery was 16±3 years in the Unilateral group and 19±5 years in the Bilateral group (P>0.05). The mean preoperative Lateral Central Edge Angle (LCEA) was 13 degrees in the Unilateral group, which improved to 28 degrees at final follow-up (P<0.001). In the Bilateral group, the mean LCEA was 16 degrees preoperatively, which improved to 32 degrees at last follow-up (P<0.001). While the mean Acetabular Index (AI; Tönnis Angle) improved from 17 to 5 degrees at last follow-up in the Unilateral group (P<0.001), it improved from 9 to -1 degrees at last follow-up in the Bilateral group (P<0.001). There were no statistically significant preoperative and postoperative Pelvic Tilt, Sacral Slope, Pelvic Incidence, Lumbar Lordosis changes in the Unilateral and Bilateral groups.

CONCLUSIONS: Spinopelvic alignment did not significantly change following either unilateral or bilateral PAOs, as assessed on standing spine radiographs. Taken together with findings from previous research, our results suggest that pelvic tilt in skeletally mature patients with acetabular dysplasia is likely a fixed morphologic characteristic rather than a compensatory or reversible mechanism.

LEVEL OF EVIDENCE: Level III.

PMID:41243865 | DOI:10.1097/BPO.0000000000003162

Int J Gynaecol Obstet. 2025 Nov 17. doi: 10.1002/ijgo.70671. Online ahead of print.

ABSTRACT

OBJECTIVE: Fetal size and gestational age are essential factors to consider when determining the timing of delivery between mothers and obstetricians in term pregnancies. Previous studies have shown that both fetal size and gestational age have associations with cognitive or academic outcomes. This study aimed to determine whether the association between gestational age (37-41 weeks) and child intelligence is moderated by fetal size in term-born children.

METHODS: Data were harmonized for four national cohorts in the USA, UK, Ireland, and Australia. Predictors included fetal size and gestational age. Fetal size was calculated using Fenton’s chart and grouped into three categories: Large for gestational age (LGA) (>90th percentile), appropriate for gestational age (AGA) (10th to 90th percentile), and small for gestational age (SGA) (<10th percentile). The outcome was intelligence quotient (IQ) scores at age 5 years. Linear models, contrast analyses, and point plots were employed.

RESULTS: In total, 30 035 term-born participants were included in the analysis. Overall, being born before 41 weeks and being born with SGA (but not LGA) were both negatively associated with IQ. No statistically significant interactions between fetal size category and gestational age at term were found. At each gestation from 37 to 41 weeks, being born SGA (but not LGA) was associated with lower IQ when compared to AGA. A small but clinically significant reduction in IQ (i.e., 0.23 IQ Z-score, equivalent to a 3.45 IQ difference) was found in SGA-born children who were born at 37 weeks compared to 41 weeks.

CONCLUSION: The association between gestation and child IQ at age 5 was not moderated by fetal size in term-born children. Regardless of gestational age at term, SGA (but not LGA) is consistently and unfavorably associated with poorer cognitive outcomes. The IQ at age 5 was only clinically meaningfully decreased in SGA children born at 37 weeks.

PMID:41243845 | DOI:10.1002/ijgo.70671

Int J Gynaecol Obstet. 2025 Nov 17. doi: 10.1002/ijgo.70654. Online ahead of print.

ABSTRACT

OBJECTIVE: To measure the woman-centeredness of family planning (FP) care and determine its correlates in West Cameroon.

METHODS: We conducted a cross-sectional analytical study from August to November 2024 in the Mifi Health District (MHD). We included women receiving FP care in all the public health facilities. We collected data were using the person-centered FP care scale (PCFPS). Descriptive and inferential statistics were computed with R software. Respondents’ characteristics were summarized, and woman-centeredness scores computed using the PCFPS guide. We used the cutoff threshold technique to distinguish high and low scores. Bivariate and multivariate linear regressions were conducted to determine the correlates of woman-centeredness of FP care. Regression coefficients with their 95% confidence intervals (CIs) were computed with a significance threshold of 5%.

RESULTS: The median (range) woman-centeredness score for the 179 respondents was 73.33% (12.22-88.88). Specifically, the median (range) score (76.38% [8.33-91.66]) for woman’s respect and autonomy was higher than that (61.11% [5.55-100]) for health facility environment. The FP care woman-centeredness score at the district hospital was seven-point higher than in first-level primary healthcare facilities (a.Coefficient: 7.33; 95% CI: 1.11-13.56; P = 0.02). Likewise the woman-centeredness score of FP care for women with a monthly income ≤100 USD was significantly lower than for women earning >300 USD monthly (a.Coefficient: -6.98; 95% CI: -12.96 to -1.01; P = 0.02).

CONCLUSION: FP care in the MHD was highly women centered. However, FP care was less likely to be woman-centered for low-income women and for those attending first-level primary health care facilities.

PMID:41243834 | DOI:10.1002/ijgo.70654

Pharmacol Res Perspect. 2025 Dec;13(6):e70194. doi: 10.1002/prp2.70194.

ABSTRACT

Avacopan, an oral C5a receptor antagonist approved for treating anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis, has established efficacy and short-term safety from clinical trials, but its post-marketing adverse events (AEs) in real-world settings require further characterization. We conducted a retrospective analysis of the U.S. FDA Adverse Event Reporting System (FAERS) database from Q1 2022 to Q1 2025. After data cleaning, Avacopan-related AEs were extracted, coded using MedDRA terminology, and analyzed via four signal detection methods; subgroup analyses by age, sex, and reporter type were performed. Among 3529 reports, significant disproportionality signals emerged for known AEs (e.g., hepatobiliary disorders, serious infections) and unexpected signals including venous thromboembolism, cholestatic jaundice, and alopecia. Most AEs occurred within the first 30 days of treatment, with variations observed by age and sex. This study provides the first FAERS-based pharmacovigilance assessment of Avacopan, confirming known risks and identifying novel post-approval safety signals, underscoring the need for close early-treatment monitoring and personalized strategies. Further research is warranted to confirm emerging signals and explore their mechanisms.

PMID:41243819 | DOI:10.1002/prp2.70194