Nevin Manimala

Age Ageing. 2025 May 6;54(5):afaf123. doi: 10.1093/ageing/afaf123.

ABSTRACT

BACKGROUND: Allied health professionals provide essential healthcare services to older adults with chronic health conditions. However, there are challenges to access and utilisation of these services for rural communities and limited scope of the existing literature.

OBJECTIVE: To conduct a scoping review of the literature related to access and utilisation of allied health services for older adults living in rural areas.

DESIGN: Scoping review.

METHODS: Four databases were searched. Articles were included based on pre-determined criteria and were limited to articles published between 2010 and 2023. Data were extracted with a focus on access and utilisation factors, enablers and barriers related to care recipients, care providers, other stakeholders and the healthcare system.

RESULTS: Thirty four studies met the inclusion criteria. The majority of studies focussed on accessibility from the perspective of the consumer (n = 31), whilst few studies focussed on the perspective of the care providers (n = 3). ‘Availability and accommodation’ was the most frequently explored dimension of accessibility in the included papers, from the consumers’ perspective (n = 18) and from the health system (n = 15).

CONCLUSION: This is the first scoping review to improve understanding of older adults’ access to and utilisation of allied health services in rural areas. Understanding the most impactful accessibility dimensions can enhance strategies for improving access and utilisation of allied health services, especially when tailored to the local context. More studies are needed to understand accessibility of allied health services in rural areas from the perspective of care providers.

PMID:40382790 | DOI:10.1093/ageing/afaf123

Dis Esophagus. 2025 May 3;38(3):doaf036. doi: 10.1093/dote/doaf036.

ABSTRACT

Paraesophageal hernia repair often includes both gastropexy and fundoplication. The fundoplication may cause persistent side effects, and the necessity of the procedure is uncertain. This study aimed to compare gastropexy with or without fundoplication. A retrospective multicenter study was conducted from three Scandinavian hospitals. Patients, with grade III-IV hiatal hernia, who had a laparoscopic repair with total hernia sack removal, closure of hiatus, gastropexy either with or without Nissen fundoplication were included. Outcomes were per- and postoperative complications, postoperative symptom control, and recurrence. A total of 320 patient cases were included in the study (72 patients with Nissen fundoplication and 248 patients without fundoplication). Baseline variables were comparable between the two groups. We found no difference in perioperative or postoperative events, reflux control or recurrence. Median operation time differed with 49 minutes (P < 0.001) in patients with fundoplication (Median: 108 minutes, interquartile range (IQR): 88-131 minutes) compared to patients without fundoplication (59 minutes, IQR = 46-78 minutes). We also found an increased risk for second repair in the fundoplication group (OR 4.3, 95% CI 1.4-13.3). This study shows no benefits of adding a Nissen fundoplication procedure to anterior gastropexy for paraesophageal hernia repair. It was not superior compared to gastropexy alone in terms of postoperative reflux control or preventing recurrence. In contrast, the fundoplication was associated with a four-fold increase of second repair, but the study design limits firm conclusions on this matter.

PMID:40382786 | DOI:10.1093/dote/doaf036

Drug Alcohol Rev. 2025 May 18. doi: 10.1111/dar.14052. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to provide a first-ever comprehensive epidemiology of vaping behaviours among Australian gender and sexuality diverse (LGBTQA+) youth.

METHODS: Using cross-sectional data from the Health4Life study, (N = 4,445 students, Mage = 15.7yrs), descriptive statistics and hierarchical mixed effects logistic regression models with nested random intercepts were used to calculate prevalence and differences in vaping behaviours by gender (trans [n = 142] vs. cisgender [n = 4,144]) and sexuality (gay or lesbian [n = 77], bisexual [n = 279], questioning [n = 167], queer [n = 90] vs. heterosexual [n = 3,638]), and associations of vaping with use of cigarettes and alcohol (including binge drinking), depression, and anxiety.

RESULTS: Over one-third of trans and bisexual adolescents had ever tried vaping. Trans adolescents were significantly more likely to report ever vaping, daily vaping, and intention to vape in the future, compared with their cisgender peers, irrespective of age, socio-economic status, and school. Relative to heterosexual peers, gay/lesbian adolescents were nearly three times as likely to report current regular use of vaping and bisexual adolescents were significantly more likely to report ever vaping and intentions to vape in the future. Among LGBTQA+ adolescents, ever using a vape was associated with increased odds of ever using cigarettes, ever binge drinking, ever drinking alcohol alone, probable depressive/anxiety disorders.

DISCUSSION: Vaping is significantly more common among LGBTQA+ adolescents, especially trans and bisexual adolescents, compared with their cisgender, heterosexual peers. Government health and education bodies should partner with LGBTQA+ community organisations to address the unique contexts of vaping among LGBTQA+ young people in an LGBTQA+ affirmative harm reduction manner.

PMID:40382785 | DOI:10.1111/dar.14052

J Burn Care Res. 2025 May 18:iraf089. doi: 10.1093/jbcr/iraf089. Online ahead of print.

ABSTRACT

The U.S. faces a surgeon shortage, threatening a decline in burn care specialists as surgeons shift to other fields. With only 0.3% of the workforce in burn surgery, attrition could severely impact burn care availability. Addressing recruitment and retention challenges requires identifying stressors and workload factors contributing to the strain of operative burn care. In May 2024, a de-identified survey was conducted with Institutional Review Board approval to assess burn surgeons’ self-reported well-being. A diverse surgeon panel reviewed the survey, and the American Burn Association distributed it via email and Survey Monkey™. Statistical analysis included Chi-square and t-tests. Seventy-seven burn surgeons (62% male) participated, representing a 20% response rate. Most took burn call (95%) and worked in an academic setting (80%). While 73% were satisfied with their careers and 91% valued the complexities of burn care, 54% lacked time for personal activities, and 62% felt maternity/paternity leave was insufficient. Forty percent experienced burnout, and 26% considered leaving the field. Over half (54%) felt they lacked time to recover after demanding cases, and 65% believed burn surgery negatively impacted their health. Using a Likert scale (10 = high performance), they rated their ability to meet job demands at 7 (±1), with a projected decline to 4.2 (±0.5) in two years. Despite overall career satisfaction, burn surgeons face challenges that threaten their health and the quality and sustainability of burn care. Our findings highlight the need for interventions to mitigate burnout and enhance well-being, ensuring the long-term viability of burn surgery and patient care.

PMID:40382783 | DOI:10.1093/jbcr/iraf089

J Frailty Aging. 2025 May 16;14(3):100052. doi: 10.1016/j.tjfa.2025.100052. Online ahead of print.

ABSTRACT

OBJECTIVES: Examine the effect of frailty on physical function recovery in people admitted to hospital who received a physiotherapy Early Rehabilitation program.

METHODS: Observational cohort (1 January 2021 to 31 December 2021). Patients admitted to the acute site at Austin Health, Australia who received an Early Rehabilitation program (targeted physical rehabilitation to address goals aligned to physiotherapy intervention in parallel with acute medical treatment) were eligible. Frailty was measured with the Clinical Frailty Scale (CFS). The primary outcome was, across the CFS, magnitude of change from admission to discharge in physical function assessed with the modified Iowa Level of Assistance Scale (mILOA). Secondary outcomes were length of stay and discharge destination. Generalised additive models were used.

RESULTS: There were 674 patients included in the study. Irrespective of frailty status, mean improvement in physical function from admission to discharge exceeded the minimal datable change of 5.8 points for the mILOA. Larger average improvements in mILOA were observed in patients with lower degrees of frailty (p < 0.001 overall effect), where a portion of patients with severe frailty did not make clinically meaningful gains in physical function following Early Rehabilitation. Mean improvement in physical function and predicted probabilities for discharge home were similar; where greater frailty severity was associated with a lesser chance of going home at acute hospital discharge (p = 0.002 overall effect).

CONCLUSIONS: Validating the link between predictions for change in physical function and discharge home in people receiving early rehabilitation during acute hospitalisation would be of great clinical utility.

PMID:40382776 | DOI:10.1016/j.tjfa.2025.100052

Eur J Orthop Surg Traumatol. 2025 May 18;35(1):201. doi: 10.1007/s00590-025-04324-2.

ABSTRACT

PURPOSE: The aim of this study was to determine if a delay to surgery of more than 48 h was associated with poorer functional outcomes and increased 1-year mortality rates for elderly hip fractures.

METHODS: A retrospective review of surgically treated elderly (≥ 60 years old) hip fracture patients in a single institution was conducted. Patients were divided into 2 groups depending on hours from admission to surgery: Group 1 ( ≤ 48 h) and Group 2 (> 48 h); these groups were 1:1 matched for the initial Modified Barthel’s Index (MBI) and Charlson Comorbidity Index (CCI).

RESULTS: 2562 patients were eligible for the study. The cut-point value in a receiver operating curve analysis for 12-month MBI against time to surgery was not robust enough to determine an optimal time for surgery. Group 1 (n = 888) had significantly better MBI scores at 6-months [mean 78.7 (± 19.9) vs. mean 75.5 (± 20.6)] and 1-year [mean 80.4 (± 20.1) vs. mean 76.9 (± 22.3)] (p < 0.001). This difference in MBI scores between the groups did not meet the minimal clinically important difference of 10 points. There was no significant difference in 1-year mortality (3.7% vs. 4.4%) (p = 0.427). Delayed surgery past 48 h significantly increased the risk of post-operative complications. (Urinary tract infection, acute retention of urine and pneumonia) (p < 0.001).

CONCLUSION: Delayed surgery for elderly hip fractures after 48 h increases the risk of acute post-operative complications. There is no increase in 1-year mortality and no clinically important deterioration of MBI if operated on after 48 h.

LEVEL OF EVIDENCE: III.

PMID:40382761 | DOI:10.1007/s00590-025-04324-2

Discov Oncol. 2025 May 18;16(1):801. doi: 10.1007/s12672-025-02654-5.

ABSTRACT

BACKGROUND: Previous studies have investigated the potential role of immune factors in chondrosarcoma (CHS). However, the causal relationship is unknown.

METHODS: A two-sample Mendelian randomization (MR) was used to explore potential correlations between 731 immunocyte phenotypes, 91 inflammatory proteins, and CHS. The data were derived from published summary statistics of genome-wide association studies. Inverse-variance weighted was employed as the primary method. Furthermore, a range of analytical methods, including MR-Egger, weighted mode, and weighted median was used to enhance the robustness of the results. A two-step MR was used to assess the mediating effects of inflammatory proteins. Subsequently, sensitivity and MR Steiger directionality tests were performed.

RESULTS: MR analyses showed that 12 immunocyte phenotypes were positively correlated with CHS (P < 0.05, OR > 1), and 11 immunocyte phenotypes were negatively correlated with CHS (P < 0.05, OR < 1). Five inflammatory proteins were positively associated with CHS (P < 0.05, OR > 1). No heterogeneous or horizontal pleiotropy was found. The MR Steiger analysis found no statistically significant evidence of reverse causation. Mediation analysis did not identify any potential mediating effects.

CONCLUSION: Our study underscores the pivotal role of immune factors in CHS and offers insights that can inform future research.

PMID:40382743 | DOI:10.1007/s12672-025-02654-5

Pediatr Surg Int. 2025 May 18;41(1):138. doi: 10.1007/s00383-025-06042-6.

ABSTRACT

BACKGROUND: A well accepted approach to the management of gastroschisis is gradual reduction of the herniated viscera using preformed silos followed by surgical closure of the abdominal wall defect. However, if the abdominal wall closure is delayed for a longer duration than necessary, it may increase morbidities. We sought to compare the outcomes of infants undergoing silo reduction whose abdominal wall defect was closed ≤ 5 days versus > 5 days after birth.

METHODS: Retrospective cohort study (January-2010 to December-2020).

RESULTS: One-hundred-and-nine infants who were managed using primary silo with staged reduction were included. Median gestation was 36.2 (interquartile range, IQR: 35.2, 37) weeks. Ten infants had complex gastroschisis. Thirty-four infants underwent early-closure of abdominal wall defect and 75 had delayed closure. Mortality rate was 2.7% (3/109; one in early and two in delayed closure). The median age at full feeds was 24.5 days (IQR 17.5, 30) in the delayed-closure group vs 15 (12.5, 22.5) in the early-closure group. The median hospital stay was 32 days (IQR 23, 43) vs 19 (15, 30) days. On multivariable analysis, delayed closure (Exponentiated regression coefficient ERC 1.40, 95% confidence interval CI: 1.05, 1.86, P = 0.020) and complex gastroschisis (ERC 2.03; 95% CI: 1.11, 3.72, P = 0.021) were associated with longer time to reach full feeds. Same factors were associated with longer duration of hospital stay.

CONCLUSIONS: Gradual reduction using silos achieved excellent outcomes in neonates with gastroschisis. Completing the silo reduction and closing the abdominal wall within five days could further improve their outcomes.

PMID:40382741 | DOI:10.1007/s00383-025-06042-6

CNS Drugs. 2025 May 18. doi: 10.1007/s40263-025-01190-8. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Chronic sleeplessness is a primary clinical symptom of vascular depression (VaDep). We investigated the efficacy and safety of escitalopram plus tandospirone citrate for patients with VaDep and chronic insomnia and the potential correlation of insomnia severity with neurotransmitter indexes, including serotonin (5-HT), serotonin 2C receptor (5-HT_2CR), serotonin 7 receptor (5-HT₇R) in platelets, and plasma 5-HT.

METHODS: This double-blind, randomized controlled study randomized patients with VaDep and chronic insomnia [Hamilton depression rating scale (HAMD) > 17 points] into a monotherapy group [escitalopram (10 mg once daily) plus placebo] or combined group [escitalopram (10 mg once daily) plus tandospirone citrate (10 mg three times daily)] by using a 1:1 assignment algorithm generated by SPSS 25.0 software. The primary endpoint was the change in sleep quality from baseline to week 12, evaluated by the Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG), Epworth Sleepiness Scale, and Asen Self-Rating Insomnia Scale (AIS). Secondary outcomes were the changes in depression and anxiety assessment and the levels of peripheral blood neurotransmitters from baseline to week 12, including HAMD, the Hamilton anxiety scale (HAMA), 5-HT, 5-HT_2CR, 5-HT₇R in platelets, and plasma 5-HT. The levels of 5-HT, 5-HT_2CR, and 5-HT₇R were detected with the enzyme-linked immunosorbent assay kits. The safety assessment included the Treatment-Emergent Symptom Scale and clinical and laboratory variables. The therapeutic improvement was analyzed by a generalized estimation equation.

RESULTS: A total of 123 subjects (30.89% male) were included, with a mean age of 70.56 ± 6.37 (mean ± standard deviation, SD) years. In the monotherapy group, the baseline HAMD and PSQI scores (n = 61 for both) were 28.84 ± 2.49 and 14.16 ± 1.86, respectively. In the combined group, the baseline HAMD and PSQI scores (n = 62 for both) were 28.81 ± 2.51 and 14.21 ± 1.87, respectively. The HAMA and HAMD scores in both groups were significantly lower at weeks 4, 8, and 12 after treatment than before treatment (P < 0.001). Compared with the monotherapy counterpart, the combined group displayed significantly lower PSQI and AIS scores at weeks 4, 8, and 12 and improved PSG sleep macrostructure at week 12, including total sleep time (TST), sleep latency, sleep efficiency, sleep maintenance rate (SMT), wake time after sleep onset, and percentage of sleep in each phase. Platelet 5-HT, plasma 5-HT, and platelet 5-HT₇R decreased in both groups at the end of weeks 4, 8, and 12 of treatment. Platelet 5-HT₇R was moderately negatively correlated with the percentage of nonrapid eye movement 3 sleep time (N3). Plasma 5-HT was moderately positively correlated with PSQI and AIS and negatively with TST, SMT, nonrapid eye movement 2 sleep time (N2), and percentage of N2 sleep time. No statistical difference in the total incidence of adverse events was found between the two groups (P = 0.842).

CONCLUSIONS: The statistically significant changes in PSG, PSQI, and AIS may indicate that the combination of escitalopram and tandospirone may improve, with a reasonable safety profile, the sleep quality of patients with VaDe. The clinical results observed were associated with changes in measures of plasma 5-HT and platelet 5HT₇R; these findings suggest that a possible role of central serotonergic function in the mechanism of action of the drug combination in this trial could be a relevant subject of future studies.

CLINICAL TRIAL REGISTRY NUMBER: ChiCTR2300075407.

PMID:40382735 | DOI:10.1007/s40263-025-01190-8

Eur Radiol. 2025 May 18. doi: 10.1007/s00330-025-11684-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to develop and validate a predictive model for preoperative extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) using MRI features.

METHODS: We retrospectively analyzed 140 confirmed PTC cases, divided into training (n = 84) and validation (n = 56) groups. MRI features such as T2-weighted imaging, multiphase contrast-enhanced MRI, and diffusion-weighted imaging were evaluated along with clinical data. Univariate and multivariate logistic regression identified independent predictors of ETE and developed a predictive nomogram. We evaluated the nomogram’s discrimination, calibration, and clinical utility, and performed subgroup analyses to explore the relationships between risk factors and baseline data. Predictive performance was assessed using ROC curves and DeLong tests.

RESULTS: Age, protrusion value, and apparent diffusion coefficient_Brightest_rate (ADC_Best_rate) were independent predictors of ETE. The nomogram effectively differentiated ETE from no-ETE, showing strong discrimination, clinical utility, and calibration in both the training (AUC = 0.826, Hosmer-Lemeshow p = 0.882) and validation cohorts (AUC = 0.805, Hosmer-Lemeshow p = 0.585). The model performed consistently across different MRI systems (1.5 T and 3.0 T) and gender subgroups. Notably, ADC_Best_rate (AUC = 0.742) outperformed ADC_mean_rate and ADC_minimum_rate. A significant interaction between ADC_Best_rate and gender (p = 0.02) showed that ADC_Best_rate predicted ETE in PTC more accurately in males (AUC = 0.897) compared to females (AUC = 0.644).

CONCLUSION: Our nomogram model, incorporating age, protrusion value, and ADC_Best_rate, effectively predicted preoperative ETE in PTC patients, aiding surgeons in optimizing therapeutic decision-making. ADC_Best_rate may be a promising potential indicator in MRI functional imaging.

KEY POINTS: Question This study addresses the challenge of accurately predicting extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) to improve surgical decision-making. Findings A predictive nomogram incorporating age, protrusion value, and ADC_Best_rate effectively differentiates ETE from no-ETE, showing strong performance in both training and validation cohorts. Clinical relevance This nomogram aids surgeons in identifying patients at risk for ETE, enhancing therapeutic decision-making and potentially improving patient outcomes in PTC management.

PMID:40382730 | DOI:10.1007/s00330-025-11684-0