Category: Nevin Manimala

Lipids Health Dis. 2025 Jul 3;24(1):230. doi: 10.1186/s12944-025-02648-w.

ABSTRACT

BACKGROUND: This study employed representative data from the U.S. and China to delve into the correlation among migraine prevalence, the triglyceride‒glucose index, a marker of insulin resistance, and the composite indicator of obesity.

METHODS: Cross-sectional data were acquired from the National Health and Nutrition Examination Survey conducted between 1999 and 2004, as well as from the China Longitudinal Study of Health and Retirement (CHARLS) performed from 2011 to 2012. Weighted logistic regression analysis, subgroup analysis, smooth curve fitting and threshold effect analysis were used to ascertain the intricate relationships among triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist height ratio (TyG-WHtR) and migraine. Boruta’s algorithm and nine machine learning models were applied. SHapley Additive Explanations (SHAP) values were used to analyze leading models, highlighting influential features.

RESULTS: The analysis included 6,204 U.S. participants and 9,401 Chinese participants. TyG-BMI as well as TyG-WHtR were shown to be strongly correlated with the incidence of migraine among U.S. adults (TyG-BMI: OR = 1.28, 95% CI 1.14-1.44, P < 0.001; TyG-WHtR: OR = 1.17, 95% CI 1.09-1.26, P < 0.001). However, this correlation was not detected in Chinese adults. TyG-BMI indicated a strong positive association beyond the threshold of 206, while TyG-WHtR demonstrated a significant positive link below the cutoff of 7.4. In addition, age was an important interaction factor between TyG-BMI and TyG-WHtR and migraine. The XGBoost model showed excellent performance, with higher AUC values for TyG-BMI than for TyG-WHtR (0.929/0.926).

CONCLUSIONS: The TyG-BMI, relative to the TyG-WHtR, may provide clinicians with information about patients’ insulin sensitivity, thus helping to develop individualized treatment strategies. These findings contribute to population-level health interventions aimed at mitigating metabolic and neurological disease burdens, ensuring healthy lives and promoting well-being.

PMID:40611268 | DOI:10.1186/s12944-025-02648-w

Crit Care. 2025 Jul 3;29(1):269. doi: 10.1186/s13054-025-05429-0.

ABSTRACT

BACKGROUND: Despite advances in noninvasive neuromodulation for disorders of consciousness (DoC), the available evidence is inconclusive. We sought to elucidate the efficacy and safety of these interventions for DoC.

METHODS: We systematically searched Embase, EBSCO, CINAHL, Medline, PsycINFO, the Cochrane Library, and Web of Science from inception until 15 Mar, 2025, supplemented by manual searches from other sources. Randomised controlled trials (RCTs) comparing any noninvasive neuromodulation (e.g., transcranial direct current stimulation [tDCS], repetitive transcranial magnetic stimulation [rTMS], median nerve stimulation [MNS], trigeminal nerve stimulation [TNS], or transauricular vagus nerve stimulation [tVNS]) with sham control for DoC were selected. Relevant data were extracted. Primary efficacy outcome (change in levels of consciousness post intervention) and safety outcome (adverse events and dropout) were assessed. Effect sizes were pooled for standard pairwise meta-analyses using random-effects model and reported as Hedges’ g or risk ratio (RR) with 95% confidence interval (CI). Studies with less than five stimulation sessions were excluded. Methodological quality was assessed by the PEDro scale, risk of bias was evaluated using the RoB 2 tool. Heterogeneity was measured using τ² and I² statistic. The quality of evidence was performed using the Grade approach.

RESULTS: We included 24 studies and six studies (147 participants) provided data for meta-analysis. The methodological quality was good for all trials according to the PEDro scale, while most studies (18 out of 24 studies, 75%) were rated high risk of bias by the RoB 2 tool. For efficacy, the effect of rTMS (g = 0.49, 95% CI = 0.01, 0.98) and TNS (g = 0.59, 95% CI = 0.08, 1.10) for DoC compared with sham stimulation was medium, while tDCS was not more effective than sham control. No difference was found for dropout in TNS or rTMS compared with sham control.

CONCLUSIONS: Our findings provide evidence that rTMS and TNS showed more positive effects for DoC, while tDCS was no better than sham stimulation. While, due to the small number of patients in the different studies, the small number of studies and potential risk of bias in the meta-analysis, robust evidence of noninvasive neuromodulation for patients with DoC is lacking. These findings highlight the importance of precision in targeting noninvasive neuromodulation for patients with DoC, RCTs with high-quality methodological design, conduct and reporting. Trial registration PROSPERO Identifier: CRD42024499177. Registered 20 January 2024.

PMID:40611258 | DOI:10.1186/s13054-025-05429-0

BMC Nurs. 2025 Jul 3;24(1):836. doi: 10.1186/s12912-025-03465-3.

ABSTRACT

BACKGROUND: Critical care nurses’ boundaries between personal and professional life are sometimes blurred by the high demands placed on nurses. The rise in workaholism in this high-stress setting puts nurses’ health at serious risk and can intensify work-family conflict, endangering both personal health and well-being and professional output.

AIM: This study examined the relationship between workaholism and work-family conflict among critical care nurses.

DESIGN: A descriptive cross-sectional design that adheres to STROBE criteria.

METHODS AND TOOLS: The study participants consisted of 360 nurses from the critical care units at Alexandria University Hospital. This hospital is the highest-capacitated hospital in Alexandria governorate in terms of bed capacity (6760), number of nurses, and the diversity of services rendered in different qualifications. It provides therapeutic and educational services. Nurses completed two tools, the Dutch Work Addiction Scale (DUWAS) and the Work-Family Conflict Multidimensional Scale (WFC). Statistical tests comprised the Pearson coefficient, the Student t-test, and a one-way ANOVA. The 5% level was used to assess the results’ significance.

RESULTS: Overall workaholism (DUWAS) is positively and significantly correlated with WFC (r = 0.415, p = < 0.001).

CONCLUSION: The results of this cross-sectional study show that among critical care nurses, workaholism is a major factor in work-family conflict. The necessity of focused organizational initiatives in healthcare settings is highlighted by these findings. To lessen excessive job participation, hospital administrators should specifically develop structured work-life balance initiatives, such as flexible scheduling, workload management guidelines, and access to mental health services. Recognizing workaholism symptoms and promoting helpful supervisory techniques should also be emphasized in leadership training.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40611251 | DOI:10.1186/s12912-025-03465-3

Cir Cir. 2025;93(3):292-301. doi: 10.24875/CIRU.23000411.

ABSTRACT

OBJECTIVE: COVID-19 pandemic produced a deficit situation of intensive care units (ICU) beds. To optimize resources, the post-anesthetic resuscitation units and operating rooms were initially used in order to care for these patients, due to their equipment and personnel. This meant a significant surgical suspension. To avoid this, during the second wave, our hospital transformed the major ambulatory surgery unit into a critical care unit. The main objective is to develop the processes carried out in our hospital for this adaptation.

METHOD: Cross-sectional study developed according to STROBE that exposes the processes carried out for this transformation. We include logistical adaptations, number of patients attended/stays won and the staff with which the unit was equipped. The information was provided by management and the admission and clinical documentation service. Improvement surveys are included.

RESULTS: A total of 44 patients undergoing mechanical ventilation without cessation of surgical activity were achieved at the time of maximum occupancy. The total number of stays won from 01/03/2020 to 31/12/2020 was 755.

CONCLUSIONS: The transformation of the major ambulatory surgery unit into an ICU quickly increased the capacity of critical care beds without relenting surgical activity. This transformation process is completely reversible.

PMID:40609111 | DOI:10.24875/CIRU.23000411

Cir Cir. 2025;93(3):267-272. doi: 10.24875/CIRU.24000076.

ABSTRACT

OBJECTIVE: Survival in lung transplantation (LT) may be influenced by recipient-related variables, donor factors, donor-recipient interaction, surgical approach, and medical center expertise. The objective of this study was to describe the sociodemographic, clinical characteristics, and survival of patients who have undergone LT.

METHOD: We conducted an observational analysis between 2014 and 2022. Survival was calculated using the Kaplan-Meier method at the 1^st, 3^rd, and 5^th years of follow-up post-transplantation.

RESULTS: We analyzed data from 50 subjects, of whom 56% (28/50) were men, with a median age of 54 years (interquartile range: 39-59). The unadjusted survival rates post lung transplantation were 81.4% at 12-months, 65.8% at 3-years, and 53.6% at 5-years. Excluding mortality attributed to COVID-19, survival rates were 78.2% at 12-months, 68.8% at 3-years, and 63.5% at 5-years. The survival of pulmonary fibrosis with a non-usual interstitial pneumonia (N-UIP) pattern was 85% at 1 year and 54% at 5 years, while pulmonary fibrosis with a usual interstitial pneumonia (UIP) pattern demonstrated a solid survival rate of 80% at 1 year and 60% at 5 years.

CONCLUSIONS: Patients with pulmonary fibrosis with a N-UIP pattern demonstrated superior survival after 1 year of follow-up, while those with pulmonary fibrosis with a UIP pattern described the highest survival at the 5^th year. COVID-19 decreased long-term survival in transplant patients.

PMID:40609107 | DOI:10.24875/CIRU.24000076

Obstet Gynecol. 2025 Jul 3. doi: 10.1097/AOG.0000000000005992. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the risks of neonatal and maternal adverse outcomes in individuals with low-risk, singleton, term breech presentation associated with vaginal compared with cesarean delivery in a contemporary cohort in the United States.

METHODS: We conducted a propensity score analysis to evaluate adverse neonatal and maternal outcomes associated with mode of delivery among individuals with breech presentation at term. We used U.S. vital statistics data, which included information on all live births from 2015 to 2020. The eligible cohort was restricted to individuals who delivered a liveborn singleton, nonanomalous neonate at term. The treatment was vaginal or cesarean delivery. Composite neonatal and maternal outcomes were examined using a propensity score analysis to create groups based on mode of delivery with a 5-to-1 match of cesarean to vaginal deliveries. The composite neonatal outcome included neonatal mortality, 5-minute Apgar score less than 4, seizures or serious neurologic dysfunction, neonatal intensive care unit admission, or assisted ventilation 6 hours or longer. The composite maternal outcome included uterine rupture, maternal transfusion, intensive care unit admission, unplanned hysterectomy, or perineal lacerations.

RESULTS: Of 23,118,953 singleton births, 375,500 term, nonanomalous, breech live births were identified. Of these, 5.1% (95% CI, 5.0-5.2; n=19,256) were vaginal deliveries. After propensity score matching, the final cohort comprised 96,095 patients, including 17,558 vaginal deliveries and 78,537 cesarean deliveries. The risks of the composite adverse neonatal outcome were 7.2% in the vaginal delivery group, compared with 6.3% in the cesarean delivery group (risk difference [RD] 1.0; 95% CI, 0.9-1.2; doubly robust odds ratio 1.14; 95% CI, 1.06-1.22). The primary contributor to neonatal morbidity within the vaginal breech cohort was 5-minute Apgar score less than 4 (RD 1.6; 95% CI, 1.4-1.9). Other neonatal outcomes were not different. Neonatal mortality rates were 0.4% (n=67) for vaginal births and 0.1% (n=102) for cesarean births (RD 0.3; 95% CI, 0.2-0.4). The risk of the composite adverse maternal outcome (excluding perineal lacerations) was 0.3% for vaginal births and 0.5% for cesarean breech births (RD -0.4, 95% CI, -0.5 to -0.3).

CONCLUSION: Although term vaginal breech delivery was associated with slightly higher odds of the composite adverse neonatal outcome compared with cesarean delivery, the absolute risk remains low. Short-term maternal outcomes were better for individuals who underwent vaginal delivery compared with cesarean delivery, after exclusion of perineal lacerations.

PMID:40609093 | DOI:10.1097/AOG.0000000000005992

JMIR Res Protoc. 2025 Jul 3;14:e71927. doi: 10.2196/71927.

ABSTRACT

BACKGROUND: Adolescent tobacco and nicotine use is a major public health concern, with lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents showing disproportionately high use compared to their heterosexual and cisgender peers. Research suggests factors such as socialization, stress, mood, and craving exacerbate tobacco and nicotine use. However, there is a dearth of knowledge of how these factors influence tobacco, nicotine, and cannabis use among LGBTQ+ adolescents in general and particularly on a momentary basis.

OBJECTIVE: This study aims to use ecological momentary assessment (EMA) to assess real-time predictors of tobacco, nicotine, and cannabis product use among LGBTQ+ adolescents.

METHODS: The Puff Break protocol was adapted from existing EMA protocols, key informant recommendations, LGBTQ+ adolescent perspectives, and insights from community members. Recruitment occurred through multiple channels, with high recruitment results via social media. Eligible participants were aged 14 to 19 years; self-identified as LGBTQ+; and used tobacco, nicotine, or cannabis products at least once in the past 30 days. The EMA pilot began with a 1.5-hour in-person or remote meeting where participants completed a timeline follow-back assessment for tobacco and nicotine use, salivary cotinine assessment, baseline survey, and EMA protocol training. Then, participants completed a 2-week EMA trial during which they received 1- to 2-minute surveys 5 times a day. Within a week of completing the EMA trial, participants concluded with an exit survey and exit interview.

RESULTS: Funded in July 2022, the Puff Break study conducted EMA data collection between August 2023 and November 2024, recruiting a sample of 50 participants. Analyses evaluating the feasibility and acceptability of the Puff Break EMA protocol will be completed by July 2025. Multilevel modeling techniques to estimate both contemporaneous and lagged associations among stress, socialization, and craving (exposures) and smoking (outcomes-combustible cigarette, smokeless product, e-cigarette, and cannabis use) are expected to be completed by November 2025. Finally, qualitative thematic analyses to identify robust tailoring variables, intervention options, and decision rules to support future just-in-time-adaptive intervention development are expected to be completed by May 2026.

CONCLUSIONS: Puff Break is an innovative EMA protocol developed to capture factors influencing tobacco, nicotine, and cannabis use among LGBTQ+ youth. Despite some inherent limitations to the EMA design, the Puff Break protocol has the potential to inform the development of a just-in-time-adaptive intervention to reduce tobacco, nicotine, and cannabis use among LGBTQ+ adolescents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/71927.

PMID:40609086 | DOI:10.2196/71927

JMIR Public Health Surveill. 2025 Jul 3;11:e69768. doi: 10.2196/69768.

ABSTRACT

BACKGROUND: Avoidable hospitalizations (AHs) have been widely used in high-income countries as a proxy indicator for the quality of primary care. However, it is rarely evaluated in low- and middle-income countries such as China. Studies examining changes in AHs before and during the COVID-19 pandemic are also limited. The appropriateness of AHs as an indicator measuring primary care quality under pandemic conditions has not been well discussed.

OBJECTIVE: This study aims to describe trends in AHs in Beijing, China, during both the prepandemic (2016-2019) and pandemic (2020-2021) periods and examine factors associated with AH rates.

METHODS: We used hospital discharge data of Beijing residents between January 1, 2016, and December 31, 2021. We identified AH cases from all discharge cases and calculated AH rates each year, adjusting for population structure changes. We performed regression analyses to explore factors associated with AH rates, where the COVID-19 outbreak, health care resources, and socioeconomic characteristics were used as the main explanatory variables.

RESULTS: Before the COVID-19 pandemic, the total number of hospital discharges in Beijing increased steadily from 2016 to 2019 but decreased sharply in 2020 and partially rebounded in 2021. The sex- and age-standardized AH rate per 100,000 population rose from 514.7 (95% CI 511.4-517.9) in 2016 to 552.8 (95% CI 549.4-556.1) in 2019. Then it declined to 331.2 (95% CI 328.6-333.8) in 2020 and rebounded to 465.1 (95% CI 462.1-468.1) in 2021, which was still below the prepandemic level. Regression analyses show that the presence of newly confirmed COVID-19 cases was significantly associated with a lower AH rate. As for other factors, higher densities of primary physicians were linked to lower AH rates. Moreover, AH rates were also associated with population structure, the level of economic development, and demographic variables.

CONCLUSIONS: The AH rate in Beijing exhibited a consistent upward trend before the pandemic and remained higher than in many high-income countries. These characteristics suggest a potential overuse of tertiary care and highlight the necessity for health care system reforms in Beijing, particularly a transition from the hospital-centered model to a primary care-focused delivery system. In addition, the observed associations between AH rates and factors, such as pandemic shock and socioeconomic variables, indicate that AH should be interpreted with appropriate controls when it is used as an indicator of primary care performance.

PMID:40609083 | DOI:10.2196/69768

JMIR Cancer. 2025 Jul 3;11:e71062. doi: 10.2196/71062.

ABSTRACT

BACKGROUND: Breast cancer survivors have increased cardiovascular risk compared to those without cancer history. Cardiovascular disease is the most common cause of death in breast cancer survivors. Cardiovascular risk in breast cancer survivors is impacted by both cancer treatment-associated effects and in risk factors for breast cancer and cardiovascular disease overlap. Strategies to improve screening for and management of cardiovascular disease in breast cancer survivors are needed to improve the delivery of survivorship care.

OBJECTIVE: This study aims to assess current cardiovascular risk counseling practices and perceived cardiovascular risk in breast cancer survivors.

METHODS: Semistructured interviews were conducted from May to December 2021 with breast cancer survivors identified as having a primary care clinician within an academic family medicine center in Charleston, South Carolina. The interview guide and content were developed using the Health Belief Model with a focus on cardiovascular risk behaviors, risk perception, and barriers to risk reduction. Analysis of categorical data was conducted by frequency and quantitative variables by mean and SD. Template analysis was performed for qualitative analysis. Outcome measures included self-reported history of cardiovascular disease, risk perception, and risk behaviors.

RESULTS: The average age of participants (n=19) was 54 (SD 7) years; 68% (13/19) were White and 32% (6/19) were Black or African American. Of the interviewed women, 90% (17/19) reported a personal history and 90% (17/19) reported a family history of cardiovascular disease. Only 53% (10/19) had previously reported receipt of cardiovascular counseling. Primary care most commonly provided counseling, followed by oncology. Among breast cancer survivors, 32% (6/19) reported being at increased cardiovascular risk, and 47% (9/19) were unsure of their relative cardiovascular risk. Factors affecting perceived cardiovascular risk included family history, cancer treatments, cardiovascular diagnoses, and lifestyle factors. Video (15/19, 79%) and SMS text messaging (13/19, 68%) were the most highly reported mechanisms through which breast cancer survivors requested to receive additional information and counseling on cardiovascular risk and risk reduction. Commonly reported barriers to risk reduction such as physical activity included time for meal planning and exercise, resources to support dietary and exercise changes, physical limitations, and competing responsibilities. Barriers specific to survivorship status included concerns for immune status during the COVID-19 pandemic, physical limitations associated with cancer treatment, and psychosocial aspects of cancer survivorship.

CONCLUSIONS: Breast cancer survivors identified that factors associated with their cancer diagnosis and treatment both impacted their cardiovascular risk and introduced additional barriers to risk reduction. Potential strategies to improve counseling and awareness around cardiovascular risk include video and messaging platforms. Further risk reduction strategies should consider the unique challenges of cancer survivorship in delivery and implementation.

PMID:40609074 | DOI:10.2196/71062

Neurology. 2025 Aug 12;105(3):e213717. doi: 10.1212/WNL.0000000000213717. Epub 2025 Jul 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Alzheimer disease and other dementias are accompanied by depression and agitation and other behavioral and neuropsychiatric symptoms. In 2023, brexpiprazole became the first antipsychotic approved by the US Food and Drug Administration to treat agitation in persons with Alzheimer disease, but, like all atypical antipsychotics, it includes a black box warning of an increased risk of mortality among persons with dementia. This study provides real-world evidence of mortality in a heterogeneous sample of brexpiprazole users to understand effects in the population.

METHODS: We used a 100% sample of Medicare claims data Parts A, B, and D from 2014 to 2023. Our sample was limited to beneficiaries with diagnosed dementia, who were continuously enrolled for at least 2 years and were new users of the atypical antipsychotics brexpiprazole or aripiprazole in a given year. We used matching and logistic regression to estimate the relationship between incident use of brexpiprazole, compared with aripiprazole, and mortality, emergency department (ED) visits, and hospitalization within 6 months.

RESULTS: Among the 41,871 beneficiaries with dementia, 71.7% of brexpiprazole and 69.7% of aripiprazole users were women with a mean age of 75.7 and 78.0 years, respectively. Among persons living with dementia (PLWD), 6-month mortality was statistically lower among new users of brexpiprazole based on estimates from logistic regression and a matched sample of new users of brexpiprazole or aripiprazole (OR 0.49, [95% CI 0.37-0.65]).There was no statistical difference between the incident use of brexpiprazole and aripiprazole use for ED visits or hospitalization within 6 months of use initiation. Adjustment for potential unobserved confounding used two-stage least squares estimation and found no statistically significant differences in six-month mortality, ED visits, or hospitalizations between the 2 groups.

DISCUSSION: Brexpiprazole use is not associated with differential mortality risk compared with aripiprazole use among PLWD. Brexpiprazole offers a treatment option which is important given the heterogeneity of effects of antipsychotics on persons. A two-stage least squares method is used to eliminate bias on estimates because of observed and unobserved differences between the 2 groups, but the small sample size is a limitation.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that brexpiprazole does not increase the risk of mortality at 6 months compared with aripiprazole in PLWD.

PMID:40609065 | DOI:10.1212/WNL.0000000000213717