Category: Nevin Manimala

BMC Health Serv Res. 2025 Dec 10;25(1):1591. doi: 10.1186/s12913-025-13649-x.

ABSTRACT

BACKGROUND: Patient satisfaction is a key indicator of healthcare system performance and legitimacy. Understanding its determinants provides valuable insights for policy design. To identify healthcare-related and socioeconomic determinants at both the individual and contextual levels (including regional indicators such as healthcare expenditure, physician density, life expectancy, and poverty rate) associated with satisfaction with the Spanish public healthcare system, and to assess changes in satisfaction levels before and after the COVID-19 pandemic.

METHODS: We conducted a cross-sectional analysis using nationally representative data from the Spanish Healthcare Barometer for the years 2018, 2019, 2022, and 2023. Individual-level data were linked with regional-level indicators, aggregated at the level of Spain’s autonomous communities, including public healthcare expenditure, physician density, life expectancy, and poverty rate. Descriptive statistics were used to examine temporal trends. For descriptive purposes, overall satisfaction was analyzed using the original 1-10 scale. For multivariate analysis, satisfaction was operationalized as a three-category ordinal outcome (low, moderate, and high satisfaction). Additional models included interaction terms with the pandemic period, defined as surveys conducted from March 2020 onwards, to assess changes in determinants over time.

RESULTS: The final sample included 29,146 adult respondents. Based on the original 1-10 scale, overall satisfaction declined significantly following the pandemic (from 6.66 to 6.26; p < 0.001), indicating a negative shift in public perception after COVID-19. Higher satisfaction was associated with better self-rated health, lower frequency of healthcare visits, and recent utilization of public healthcare services, including hospital, specialist, and emergency care. Sociodemographic factors such as being female, younger, and born outside of Spain were also positively associated with satisfaction. Lower satisfaction was observed among individuals with chronic conditions, lower socioeconomic status, or limited educational attainment. Contextual variables showed weaker associations, with only life expectancy exhibiting a significant positive relationship.

CONCLUSIONS: Satisfaction with the Spanish healthcare system is primarily shaped by individual characteristics and experiences, with only limited evidence of associations with broader contextual indicators. The post-pandemic decline in satisfaction highlights the need for targeted policies that improve responsiveness, equity, and user confidence in public healthcare services.

PMID:41372909 | DOI:10.1186/s12913-025-13649-x

Reprod Health. 2025 Dec 10. doi: 10.1186/s12978-025-02236-2. Online ahead of print.

ABSTRACT

BACKGROUND: Antenatal care (ANC) is essential for improving maternal and child health outcomes, as it helps prevent pregnancy complications and reduces maternal and child mortality. Ensuring that all pregnant women receive comprehensive, high-quality ANC is critical for a positive pregnancy experience. This study aimed to identify the determinants of quality ANC visits among pregnant adolescent girls and women in Sierra Leone.

METHODS: We analyzed data from the 2019 Sierra Leone Demographic and Health Survey, including 7,276 adolescent girls and women who had a live birth or stillbirth in the two years preceding the survey. Quality antenatal care was defined as receipt of all essential ANC components: at least four ANC visits, receipt of tetanus toxoid injection, blood pressure measurement, urine and blood sample collection, and counseling on pregnancy complications. Binary logistic regression was used to identify factors associated with quality ANC, adjusting for demographic and socioeconomic variables. Survey weights were applied to account for the sampling design.

RESULTS: Overall, 79.7% of adolescent girls and women received quality antenatal care services. In the fully adjusted mixed effects model, attending four or more ANC visits (aOR: 1.92; 95% CI: 1.42-2.59) and receiving care from a skilled provider (aOR: 1.80; 95% CI: 1.40-2.31) were both strongly associated with increased odds of receiving quality ANC. Conversely, initiating ANC in the second trimester was linked to lower odds of receiving quality care (aOR: 0.61; 95% CI: 0.51-0.74) compared to those who began care in the first trimester. Socioeconomic factors also played an important role: adolescent girls and women in the richest wealth quintile (aOR: 1.89; 95% CI: 1.12-3.19) and those residing in the Western region (aOR: 3.78; 95% CI: 2.26-6.31) were significantly more likely to receive quality ANC visits. Furthermore, urban residence was associated with lower odds of receiving quality ANC visits (aOR: 0.68; 95% CI: 0.47-0.97) compared to rural areas. While higher education level, being married, and having media access were positively associated with quality ANC visits, these relationships did not reach statistical significance.

CONCLUSION: While most adolescent girls and women in Sierra Leone received quality antenatal care, significant disparities persist based on demographic, socioeconomic, and healthcare-related factors. These findings underscore the urgent need for targeted interventions by the national directorate of reproductive and child health, reproductive health and family planning, and school and adolescent health programmes. Strategies should prioritize improving early ANC initiation, expanding access to skilled providers, and addressing barriers faced by the poorest and urban populations. Tailored community outreach, education campaigns are essential to reduce inequities and ensure that all pregnant adolescent girls and women receive comprehensive, high-quality ANC services.

PMID:41372898 | DOI:10.1186/s12978-025-02236-2

BMC Oral Health. 2025 Dec 10;25(1):1893. doi: 10.1186/s12903-025-06951-x.

ABSTRACT

BACKGROUND: This study aimed to investigate the relationship between posterior mandibular ridge morphology, cortical bone characteristics, and the Mandibular Cortical Index (MCI), and to assess their potential impact on the complexity of dental implant placement. Understanding these parameters is essential to optimize implant planning, minimize surgical complications, and improve clinical outcomes, particularly in regions where anatomical variations pose increased risks.

METHODS: In this retrospective observational study, 100 cone-beam computed tomography (CBCT) scans of edentulous mandibles were analyzed in Turkish population. Each mandible was evaluated through 10 sagittal cross-Sect. (5 from each side), resulting in 1000 sections. The sample consisted of equal numbers of male and female patients aged between 32 and 79 years. Morphological parameters, including lingual concavity and convexity, bucco-lingual width, cortical bone thickness (buccal and lingual), alveolar crest height, and ridge morphology types, were evaluated in sagittal sections. Ridge shapes were categorized as saddle, kidney, pen shape, toucan beak, straight, hourglass, or basal. The MCI was classified as C1 (normal cortex), C2 (moderate erosion), or C3 (severe erosion) based on cortical integrity. Statistical analyses were conducted to determine the relationships between MCI, ridge morphology, and bone parameters.

RESULTS: A statistically significant relationship was observed between MCI groups and ridge morphology types (p < 0.001). The C3 group exhibited significantly thinner lingual cortical bone (0.81 ± 0.22 mm), lower alveolar crest heights, and increased bucco-lingual width compared to the C1 group (1.29 ± 0.26 mm, p < 0.001), along with lower alveolar crest heights and increased bucco-lingual width (p < 0.05). Basal-shaped ridges showed the widest bucco-lingual dimensions but the lowest alveolar crest heights, suggesting advanced vertical bone loss. Conversely, straight and pen-shaped ridges demonstrated greater lingual cortical thickness. Lingual concavity was more pronounced in cases with lower MCI.

CONCLUSION: CBCT-based evaluation of mandibular ridge morphology and cortical bone integrity, supported by appropriate statistical analyses (ANOVA, Chi-square, Kruskal-Wallis), offers clinically valuable insights for implant planning. Incorporating these assessments helps identify patients at greater risk for complications, guides the need for augmentation procedures, and supports safer and more predictable implant placement. These findings underscore the clinical relevance of ridge morphology and MCI in preoperative risk assessment, helping clinicians tailor implant planning strategies to anatomical variations and minimize complications.

PMID:41372870 | DOI:10.1186/s12903-025-06951-x

BMC Pediatr. 2025 Dec 10. doi: 10.1186/s12887-025-06391-0. Online ahead of print.

ABSTRACT

BACKGROUND: Late preterm infants (33-36 weeks gestation) are at increased risk for neurodevelopmental delays, but early signs often go unrecognized due to subtle presentations and inconsistent follow-up. While screening tools are available, few studies have examined how well parents identify developmental concerns compared to trained professionals.

AIM: To evaluate neurodevelopmental outcomes in late preterm infants at 3 and 6 months of corrected age by comparing parental and therapist-reported developmental scores, and to identify predictors influencing developmental scores.

METHODS: Sixty late preterm infants were screened using the Trivandrum Developmental Screening Tool (TDST) at discharge and followed up at 3 and 6 months of corrected age. Both therapists and parents completed the TDST independently during follow-up. Developmental scores were compared using Wilcoxon signed-rank tests. Regression analyses were conducted to identify predictors that influence parent and therapist scoring. A p-value of < 0.05 was considered statistically significant.

RESULTS: At 3 months there is no significant difference between the parent and therapist TDST overall scores, while at 6 months, therapist and parent TDST overall scores showed significant difference (p < 0.001). Regression analysis identified rolling and object transfer as strong predictors of overall scores for both parent and therapist scores at 6 months.

CONCLUSIONS: Despite similar overall scores at 3 months, significant discrepancies between parent and therapist scoring emerged by 6 months. These findings emphasise the importance of caregiver education in early neurodevelopmental surveillance.

PMID:41372868 | DOI:10.1186/s12887-025-06391-0

JACC Adv. 2025 Dec 8;5(1):102460. doi: 10.1016/j.jacadv.2025.102460. Online ahead of print.

NO ABSTRACT

PMID:41370863 | DOI:10.1016/j.jacadv.2025.102460

Curr Opin Neurobiol. 2025 Dec 9;96:103144. doi: 10.1016/j.conb.2025.103144. Online ahead of print.

ABSTRACT

Predictive processing frameworks have emphasized the role of forward prediction as a critical ingredient for learning and perceptual inference. We anticipate sensory events that are likely in the future on the basis of past and current sensory events. By comparing these forward predictions against incoming input, we can obtain an accurate estimate of the environment (i.e. perceive) and improve the predictions themselves (i.e. learn). Interestingly however, research in the field of statistical learning has taught us that backward predictive relationships – reflecting the probability of past events given present events – are learnt equally well. This questions the privileged status of forward-looking mechanisms. Here we discuss commonalities and differences between implications for learning and perception. We conclude that while forward and backward predictive relationships both shape learning, we retrieve future, but not past, predicted states during perception.

PMID:41370861 | DOI:10.1016/j.conb.2025.103144

Cancer Discov. 2025 Dec 11. doi: 10.1158/2159-8290.CD-25-1493. Online ahead of print.

ABSTRACT

We estimated trends in age-standardized childhood and adolescent cancer rates between 2001-2022 using national data from the United States Cancer Statistics database. The incidence of cancer in 0-19-year-olds was 18.2 per 100,000 with rates increasing 0.94%/year between 2001-2016 and then decreasing 0.96%/year during 2016-2022. Lymphoma rates increased 0.49%/year during 2001-2022, while trajectories of other cancers varied over time. Leukemia rates increased by 1.03%/year during 2001-2010 and then plateaued. Rates of central nervous system tumors increased by 0.81%/year during 2001-2014 and then declined 2.10%/year during 2014-2022. Rates of other epithelial neoplasms were stable from 2001-2013, increased in 2013-2016, and were stable during 2016-2022. There were an estimated 1,040 additional childhood cancer diagnoses in 2022 compared with what would have been expected based on 2001 rates. Modifications in cancer classifications, screening practices, and diagnostic technology likely contributed to the observed changes, in addition to the potential contributions of putative risk factors.

PMID:41370847 | DOI:10.1158/2159-8290.CD-25-1493

JMIR Mhealth Uhealth. 2025 Dec 10;13:e79347. doi: 10.2196/79347.

ABSTRACT

Regular physical activity offers extensive health benefits, yet current consumer wearables struggle to accurately quantify these effects at an individualized level. Sensor performance often falls short due to susceptibility to interferences, nonstandardized validation, and reliance on indirect estimations. Further, sensors often cannot capture or account for disparities in measurement types, populations, and physiological or anatomical characteristics, nor can they account for how different exercise modalities affect results on a personalized scale. There is a drive for developers to refine the impact of how we measure the benefits of exercise, improving the usefulness of data through advanced optical modeling and spectroscopic applications. This review critically examines the shortcomings of prevailing noninvasive measurements and techniques used in common, commercially available fitness trackers and describes why it is difficult to quantify the effects of exercise as an individualized, quality-based metric. Next, we discuss newer sensing applications that attempt to curtail known limitations, some of which may unveil novel biometric insights through differentiated approaches, bridging gaps not only in technological advancement but also in physiological metrology. In conclusion, we believe that new sensing techniques should explore solutions beyond population-based statistics and aim to provide an individualized understanding of a person’s response to exercise, while also reducing disparities in personalized health monitoring. The results could lead to a more effective understanding of exercise efficacy and its impact on performance management and clinical outcomes.

PMID:41370827 | DOI:10.2196/79347

J Med Internet Res. 2025 Dec 10;27:e76999. doi: 10.2196/76999.

ABSTRACT

BACKGROUND: Health care providers must carefully monitor patients receiving long-term opioid therapy (LTOT) to minimize risks and maximize benefits. Yet, algorithms to support intervention during patient encounters are lacking, with accurate LTOT identification in routine care being the essential first step.

OBJECTIVE: This study aims to develop and validate an LTOT identification algorithm using electronic health record (EHR) data.

METHODS: In this cross-sectional study, we used 2016-2021 OneFlorida+ EHR data linked with Florida Medicaid claims to identify patients aged ≥18 years who received opioid prescriptions. The main outcome was the first LTOT episode in the algorithm development (2016-2018) and validation (2019-2021) periods. A Medicaid claims-based LTOT algorithm served as the reference standard, defined as ≥90 days of continuous opioid use with ≤15-day gaps. Given strong correlations among covariates, an elastic net regression model was applied to identify LTOT episodes in EHR data using patient characteristics, clinically relevant features, and medication use, and to evaluate the model’s classification performance. We randomly split the 2016-2018 cohort into development and internal validation datasets (2:1 ratio), stratified by LTOT incidence. External validation was performed using 2019-2021 data.

RESULTS: Among 64,206 eligible patients identified in 2016-2018 (mean age 35.7, SD 12.3 years; 51,421/64,206, 80.1% female), a total of 8899 (13.9%) had LTOT. Among 50,009 eligible patients identified in 2019-2021 (mean age 37.3, SD 12.5 years; 39,866/50,009, 79.7% female), a total of 6000 (12%) had LTOT. The model selected 29 out of 131 candidate features. Among 2967 individuals with LTOT in the 2016-2018 OneFlorida+ internal validation dataset, a total of 2176 (73.3%) individuals were identified in the top 3 deciles of risk scores. The model achieved a C-statistic of 0.83 (95% CI 0.82-0.84), with 73.4% (95% CI 71.8%-75%) sensitivity, 76.8% (95% CI 76.2%-77.4%) specificity, 33.8% (95% CI 33.1%-34.6%) precision, 76.3% (95% CI 75.8%-76.9%) accuracy, and an F₁-score of 0.46. In the 2019-2021 OneFlorida+ external validation dataset, a total of 75.5% (4527/6000) individuals were correctly captured in the top 3 risk subgroups. The model achieved a C-statistic of 0.83 (95% CI 0.83-0.84), with 78.8% (95% CI 77.8%-79.9%) sensitivity, 73.3% (95% CI 72.9%-73.7%) specificity, 28.7% (95% CI 28.3%-29.1%) precision, 73.9% (73.6%-74.3%) accuracy, and an F₁-score of 0.42.

CONCLUSIONS: The EHR-based LTOT algorithm showed comparable accuracy to the claims-based reference and may support risk stratification and inform decision-making during clinical encounters.

PMID:41370825 | DOI:10.2196/76999

JMIR Res Protoc. 2025 Dec 10;14:e83983. doi: 10.2196/83983.

ABSTRACT

BACKGROUND: Regular participation in some type of physical activity brings improvements in health indicators such as cardiorespiratory fitness, muscle strength, and body composition. However, despite evidence indicating health benefits, 1 in 4 adults is physically inactive, a situation that also occurs in the university population. Walking is a physical activity modality that can be easily incorporated into daily activities; therefore, using a walking-based physical activity intervention could improve some health indicators.

OBJECTIVE: This protocol aims to analyze the impact of a walking-based physical activity intervention on health indicators in university students.

METHODS: An intervention group (n=99) and a control group (n=99) will be randomly selected. All participants will be assessed at the beginning and end of the intervention for indicators of health, cardiorespiratory fitness, muscle strength, and body composition. The intervention group will participate in a 14-week walking program with individualized daily goals, self-monitoring, personalized feedback, and weekly educational material, while the control group will only record their steps without receiving personalized goals or feedback.

RESULTS: The recruitment process will begin in March 2026. Initial assessments are scheduled to take place from March 2, 2026, to March 13, 2026. The intervention will be performed from March 16, 2026, to June 19, 2026 (14 weeks). From June 22, 2026, to July 6, 2026, the final evaluations will be performed. The final results of this study are expected to be published by October 2026.

CONCLUSIONS: This protocol proposes a novel and feasible approach to overcome common barriers to physical activity in university students, with the potential for large-scale application in similar contexts.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06580769; https://clinicaltrials.gov/study/NCT06580769.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/83983.

PMID:41370823 | DOI:10.2196/83983