Nevin Manimala

Disaster Med Public Health Prep. 2025 Jun 13;19:e149. doi: 10.1017/dmp.2025.83.

ABSTRACT

OBJECTIVES: A train derailment in East Palestine, Ohio, near the Ohio-Pennsylvania border on February 3, 2023, resulted in the release of hazardous substances and chemical exposures among residents and Pennsylvania first responders. We aimed to analyze data collected from an Assessment of Chemical Exposure (ACE) survey to better understand unique exposures and health symptoms among Pennsylvania first responders and identify additional safety measures to protect responders in future hazardous materials spill events.

METHODS: Descriptive statistics for ACE survey results from 114 Pennsylvania first responders were produced and relationships between exposures, health symptoms, and occupation type were examined using logistical regression models.

RESULTS: First responder occupation title and job duties were determinants of chemical exposure types, and specific chemical exposure types were associated with unique health outcomes. Firefighters and those with a job duty to suppress the fire were more likely to report contact with vapor/gas compared to all other roles and those with a duty of environmental monitoring. Contact with vapor/gas was associated with increased likelihood of reporting 2 or more health symptoms.

CONCLUSIONS: This analysis highlights the necessity of tailoring emergency response action plans and personal protective equipment considering first responder occupation title and to the specific duties conducted within their role.

PMID:40511509 | DOI:10.1017/dmp.2025.83

J Glob Health. 2025 Jun 13;15:04155. doi: 10.7189/jogh.15.04155.

ABSTRACT

BACKGROUND: Some studies suggest a link between allergic rhinitis (AR) and irritable bowel syndrome (IBS), but evidence is insufficient. This meta-analysis aimed to explore the relationship between AR and IBS.

METHODS: We searched the relevant literature in six electronic databases. We included a total of nine articles, seven of which took AR as the research object, two of which took IBS as the research object. We performed a meta-analysis using random effects and estimated the resultant odds ratio (OR).

RESULTS: A total of 10 627 patients with AR were included in seven studies, including 956 patients diagnosed with AR in the IBS population and 9671 patients diagnosed with AR in the non-IBS population. By heterogeneity test, X² = 10.12, F-statistic (F) = 6, P = 0.12, I² = 41%, OR = 2.88, and Z-score (Z) = 21.97 (P < 0.00001), the results were statistically significant. Patients with AR have an increased risk of developing IBS compared to patients without AR. A total of 1099 patients with IBS were included in two studies, including 384 patients with IBS in AR patients and 715 patients with IBS in the healthy population. After the heterogeneity test, X² = 0.11, F = 1, P = 0.74, I² = 0%, OR = 2.15, and Z = 11.81 (P < 0.00001), the results were statistically significant. Patients with IBS have an increased risk of developing AR compared to patients without IBS.

CONCLUSIONS: The bidirectional association between AR and IBS provides a basis for exploring potential new mechanisms between the two.

REGISTRATION: No. INPLASY202440057.

PMID:40511506 | DOI:10.7189/jogh.15.04155

J Esthet Restor Dent. 2025 Jun 13. doi: 10.1111/jerd.13497. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to characterize the microstructural, mechanical, and surface properties of abutment screws with modified surface characteristics.

METHODS: Five anodized abutment screws of different coloration (green, purple, yellow, blue, brown), one Diamond-like carbon (DLC)-coated screw, one gold-alloy screw, one gold-coated screw, and one uncoated screw were used. Surface roughness parameters (S_a, S_q, S_sk, S_ku, S_pk, S_k, and S_vk) were assessed by an optical profiler. Microstructural observations and elemental analysis were conducted with a scanning electron microscope (SEM) equipped with energy dispersive X-ray detector (EDX). Martens Hardness (HM) and Indentation Elastic Modulus (E_IT) were evaluated using Ιnstrumented Ιndentation Testing (IIT) employing a nanoindentation testing device. One-way ANOVA and Tukey post hoc tests were performed for statistical analyses (a = 0.05).

RESULTS: SEM-EDX analysis demonstrated differences in microstructure and elemental composition on the bulk and the surface of abutment screws tested. Statistically significant differences were found for all surface roughness parameters and mechanical properties tested. The green anodized screw demonstrated significantly higher S_a, S_q, S_pk, and S_{v k} values, while the gold-coated screw had significantly higher HM and E_IT.

CONCLUSIONS: The examined abutment screws displayed significant variations in the properties assessed, indicating that these differences may lead to variations in their clinical performance.

PMID:40511499 | DOI:10.1111/jerd.13497

JMIR Form Res. 2025 Jun 12;9:e60789. doi: 10.2196/60789.

ABSTRACT

BACKGROUND: Simulated electronic health records (EHRs) are used in structured teaching for health care students. This partly addresses inconsistent student exposure to EHRs while on clinical placements. However, simulated records are poor replacements for the complexity of data encountered in real EHRs. While routinely collected health care data are often used for research, secondary use does not include education. We are exploring the perceptions, governance, and ethics required to support the use of real patient records within teaching.

OBJECTIVE: The aim of the study is to explore the perspectives of health care professionals regarding the use of real patient records to deliver interprofessional EHR education to undergraduate health care students.

METHODS: We held 90-minute group discussions with 10 health care professionals from nursing, pharmacy, medicine, and allied health disciplines. We used the GRIPP2 (Guidance for Reporting Involvement of Patients and the Public 2) checklist for reporting Patient and Public Involvement and Engagement to present our reflections.

RESULTS: There was consensus on the need to upskill health care students in the use of EHRs. Participants emphasized teaching general EHR competencies and transferable skills to overcome the diversity in EHR systems. They highlighted limitations in current teaching due to accessibility issues, disparities within clinical teaching, and curricular gaps on important topics such as clinical documentation and coding. Highlighted benefits of using real EHRs in teaching included learning from the complexities and inaccuracies of real patient data, grasping real-world time frames, and better appreciation of multidisciplinary interactions. Concerns included exposing individual clinicians to unfounded scrutiny and the potential consequences of incidental findings within EHRs. The ethical implications of overlooking perceived errors within EHRs versus the impracticality of acting on them were discussed. To mitigate concerns, it was suggested that data donors would provide informed consent ensuring they understand that they will not be recontacted should any such errors be found.

CONCLUSIONS: Innovative solutions are needed to realign health care education with clinical practice in rapidly evolving digital environments. Real patient records are optimal for teaching students to handle complex and abundant real-world data. Data within EHRs represent a wealth of clinical knowledge encompassing professional and personal experiences spanning the lifetimes of patients and their caregivers. Drawing experiences and events from real EHRs will prepare health care students to anticipate, confront, and manage real patients in a variety of real-life scenarios. Our reflections highlight the processes and safeguards to consider when using real patient records to deliver EHR education to health care students. These detailed reflections from discussions with health care professionals provide the grounds for a robust framework, with appropriate governance and consent in place to use real health data in training to support preparation for clinical practice.

PMID:40511496 | DOI:10.2196/60789

BJOG. 2025 Jun 13. doi: 10.1111/1471-0528.18254. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the association between ethnicity and severe maternal morbidity (SMM) in England and the mediating effects of neighbourhood-level socio-economic deprivation across detailed ethnic groups.

DESIGN: Population-based nationwide cohort study using English Hospital Episode Statistics Admitted Patient Care (HES APC) data.

SETTING: All hospital births in NHS facilities in England between 1 January 2013 and 31 March 2023.

POPULATION: A cohort of 3 839 156 women aged 10- 55 years with births of ≥ 20 weeks’ gestation.

METHODS: Multivariable fixed and mixed-effects Poisson regression models were used to estimate adjusted risk ratios (RR) for SMM across 10 ethnic groups compared to White women and for each ethnic group in different deprivation quintiles compared to White women in the least deprived neighbourhoods, respectively. Causal mediation analysis was used to calculate the proportion of the association mediated by deprivation.

MAIN OUTCOME MEASURES: The modified English Maternal Morbidity Outcome Indicator (EMMOI), a composite outcome of SMM.

RESULTS: Minoritised ethnic groups experienced higher SMM risks than White women, with the highest risk for Black African women (RR 1.96, 95% CI: 1.82-2.02) and Bangladeshi women (RR 1.97, 95% CI: 1.88-2.07) compared to White women. The strength of the association varied across ethnic subgroups. Most of the effect of ethnicity on SMM was not mediated by deprivation (11%-29%).

CONCLUSIONS: Deprivation plays a minor role in ethnic disparities in SMM. Policies must address the unique challenges faced by minoritised ethnic women.

PMID:40511482 | DOI:10.1111/1471-0528.18254

Zhonghua Yi Xue Za Zhi. 2025 Jun 13;105:1-8. doi: 10.3760/cma.j.cn112137-20250415-00936. Online ahead of print.

ABSTRACT

Objective: To investigate the relationship between preoperative ultrasound-guided intra-articular local anesthetics injection at different time points and postoperative infection risk and inflammatory response after hip arthroscopy in femoroacetabular impingement(FAI). Method: This retrospective observational study enrolled FAI patients who underwent hip arthroscopy surgery at the General Hospital of the People’s Liberation Army from May 2017 to October 2023. According to the time interval between intra-articular injection and the surgery, the patients were divided into four groups: injection time≤30 days prior to surgery, injection time between 30-90 days prior to surgery, injection time>90 days prior to surgery, and non-injection group. The temperature and peripheral blood inflammation indicators of patients within one week before surgery and during hospitalization after surgery were collected. The international hip joint score (IHOT-12), visual analogue scale (VAS) of pain and the modified Harris Hip Score (mHHS) before and within 12 months after surgery were collected. The postoperative infection rates, clinical scores, temperature and inflammatory markers between groups were compared. Results: A total of 425 patients were included, with 264 males and 161 females, aged (37.2±12.9) years. There were 152 cases in the≤30 d group, aged (36.9±12.5) years; 58 cases in the 30-90 d group, aged (41.4±13.2) years; 28 cases in the>90 d group, aged (37.3±12.0) years; and 187 cases in the non-injection group, aged (36.2±13.0) years. No acute and chronic infections were found in the enrolled patients, and 8 cases of suspected acute infections were found: 5 cases (2.7%) in the non-injection group, 2 cases (3.5%) in the 30-90 d group, 1 case (3.6%) in the>90 d group, and 0 case in the≤30 d group, and the difference in the proportion of patients with suspected acute infections among the various groups was not statistically significant (P=0.061). There were 17 patients with maximum body temperature≥38.0 ℃ on postoperative day 1, 9 (4.8%) in the non-injection group, 2 (7.1%) in the>90 d group, 1 (1.7%) in the 30-90 d group, and 5 (3.3%) in the≤30 d group. There were 143 patients with mildly elevated body temperature (37.1-37.9 ℃), 74 (39.6%) in the non-injection group, 10 (35.7%) in the>90 d group, 17 (29.3%) in the 30-90 d group, and 42 (27.6%) in the≤30 d group, and the difference in the proportion of the number of people with different degrees of fever among the groups was not statistically significant (P=0.180). The peripheral blood leukocyte level was 10.6 (8.5, 12.2) x10⁹/L in the≤30 d group, 9.7 (7.8, 10.5) x10⁹/L in the 30-90 d group, 8.9 (8.0, 10.7) x10⁹/L in the>90 d group, 10.0 (7.9, 11.3) x10⁹/L in the non-injection group, and peripheral blood leukocytes in the≤30 d group were significantly higher than those in the other three groups (all P<0.05). The differences in neutrophil ratio, neutrophil-to-lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate were not statistically significant among the groups after the surgery (all P>0.05). The IHOT-12, VAS of pain and mHHS scores of patients in all groups improved at 12 months after surgery when compared with the values before the operation (all P<0.001). Conclusion: Preoperative ultrasound-guided intra-articular hip anesthetic injection performed with standardized sterile technique does not increase postoperative infection risk or inflammatory response in FAI patients.

PMID:40511480 | DOI:10.3760/cma.j.cn112137-20250415-00936

Zhonghua Yi Xue Za Zhi. 2025 Jun 13;105:1-6. doi: 10.3760/cma.j.cn112137-20250209-00290. Online ahead of print.

ABSTRACT

Objective: To evaluate the clinical efficacy of the combined internal-external approach in establishing surgical portals for hip arthroscopy. Methods: A prospective analysis was conducted on patients who underwent hip arthroscopy at the General Hospital of the People’s Liberation Army from March 2021 to May 2023. The patients were divided into a trial group (using the combined internal-external approach) and a control group (using the traditional puncture method) based on their voluntary choices of surgical plans. All patients underwent imaging examinations before surgery. During the operation, the time taken to establish the anterolateral approach (AL approach), the time taken to establish the mid-anterior auxiliary approach (MA approach), and the total surgical time were recorded. After surgery, a 1-year follow-up was carried out. Indicators such as the visual analog scale (VAS) of pain, the modified Harris Hip Score (mHHS), the International Hip Outcome Tool-12 (iHOT-12) score, the Hip Outcome Score-Activities of Daily Living Subscale (HOS-ADL), and the Hip Outcome Score-Sports Subscale (HOS-SSS) were recorded and compared for the two groups. Results: A total of 77 patients were enrolled with a mean age of (37.9±12.6) years(48 males and 29 females). There were 37 cases in the trial group[ with a mean age of (38.0±11.8) years, 24 males and 13 females] and 40 patients in the control group[ with a mean age of (37.8±13.4) years, 24 males and 16 females]. All indicators in both groups demonstrated significant improvement postoperatively compared with the preoperative values (all P<0.001). No significant intergroup differences existed in the indicators preoperatively (all P>0.05). Postoperatively, there was no significant defferences in VAS of pain [(2.3±2.1) vs (2.4±1.9) points], mHHS [(83.3±7.4) vs (80.2±9.2) points], iHOT-12 [(72.8±15.5) vs (71.1±17.4) points], HOS-ADL [(81.4±16.9) vs (84.0±15.0) points] and HOS-SSS [(55.7±23.4) vs (56.1±19.1) points] or AL approach time [(5.3±0.5) vs (5.4±0.4) minutes] between the trial group and the control group(all P>0.05); however, the MA approach time [(9.0±0.6) vs (14.8±1.3) minutes] and total operative time [(105.2±8.8) vs (119.4±4.7) minutes] in the trial group were both shorter than those in the control group (both P<0.001). The trial group had a lower postoperative complication rate than the control group, but the difference was not statistically significant [5.4% (2/37) vs 15.0% (6/40), P=0.263]. Conclusion: Portal establishment using the combined internal-external approach significantly reduces operative time and postoperative complication rate when compared to the traditional puncture technique, representing a safer and more efficient method for hip arthroscopy.

PMID:40511479 | DOI:10.3760/cma.j.cn112137-20250209-00290

Zhonghua Yi Xue Za Zhi. 2025 Jun 13;105:1-4. doi: 10.3760/cma.j.cn112137-20250101-00006. Online ahead of print.

ABSTRACT

This study intends to compare the differences in psychological status of patients with chronic pain in different lower extremity joints. A retrospective cross-sectional study was used to assess patients with chronic hip, knee, and ankle pain hospitalized from June 2024 to December 2024 in the Sports Medicine Ward of the Department of Orthopaedic Medicine, General Hospital of the People’s Liberation Army. A total of 75 patients with chronic pain in the joints, 36 males and 39 females, aged (31.6±9.5) years, were included. General information such as age, gender, and body mass index (BMI) were recorded, and the pain status of patients with chronic pain in each joint was assessed and compared by visual analog scores (VAS) and pain sensitivity scale (PSQ), and the psychological status of patients was assessed by the Zong-type Anxiety Scale (SAS) and Beck Depression Inventory (BDI). A total of 25 patients each with chronic hip, knee, and ankle pain were included, and the differences in baseline data among the three groups were not statistically significant and were comparable. The results showed that the SAS scores in the hip group were higher than those in the ankle group (mean difference=0.101, 95%CI: 0.029-0.174) and the knee group (mean difference=0.164, 95%CI: 0.094-0.235); the BDI scores in the hip group were higher than those in the ankle group (mean difference=2.081, 95%CI: 0.848-3.314) and knee group (mean difference=2.044, 95%CI: 0.866-3.222). This study suggests that psychological disorders in patients with chronic hip pain are more significant compared to other lower extremity arthralgia patients, and psychological intervention support should be strengthened in this group of patients.

PMID:40511478 | DOI:10.3760/cma.j.cn112137-20250101-00006

Euro Surveill. 2025 Jun;30(23). doi: 10.2807/1560-7917.ES.2025.30.23.2500011.

ABSTRACT

IntroductionInfluenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses circulated in Europe in 2023/24, with A(H1N1)pdm09 dominance. First influenza infections in childhood may lead to different vaccine effectiveness (VE) in subsequent years.AimThe VEBIS primary care network estimated influenza VE in Europe using a multicentre test-negative study.MethodsPrimary care practitioners collected information and specimens from patients consulting with acute respiratory infection. We estimated VE against influenza (sub)type and clade, by age group and by year of age for A(H1N1)pdm09, using logistic regression.ResultsWe included 29,958 patients, with 3,054, 1,053 and 311 influenza A(H1N1)pdm09, A(H3N2) and B cases, respectively. All-age VE against influenza A(H1N1)pdm09 was 52% (95% CI: 44-59). By year of age, VE was 27% (95% CI: -2 to 47) at 44 years with peaks at 72% (95% CI: 52-84) and 54% (95% CI: 41-64) among children and those 65 years and older, respectively. All-age A(H1N1)pdm09 VE against clade 5a.2a was 41% (95% CI: 24-54) and -11% (95% CI: -69 to 26) against clade 5a.2a.1. The A(H3N2) VE was 35% (95% CI: 20-48) among all ages and ranged between 34% and 40% by age group. All-age VE against clade 2a.3a.1 was 38% (95% CI: 1-62). All-age VE against B/Victoria was 83% (95% CI: 65-94), ranging between 70 and 92% by age group.DiscussionThe 2023/24 VEBIS primary care VE against medically attended symptomatic influenza infection was high against influenza B/Victoria, but lower against influenza A(H1N1)pdm09 and A(H3N2). Clade- and age-specific effects may have played a role in the lower A(H1N1)pdm09 VE.

PMID:40511473 | DOI:10.2807/1560-7917.ES.2025.30.23.2500011

Euro Surveill. 2025 Jun;30(23). doi: 10.2807/1560-7917.ES.2025.30.23.2400682.

ABSTRACT

BackgroundDuring the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) such as social distancing, lockdowns and enhanced hygiene led to a decrease in respiratory pathogens. However, as NPIs were relaxed, a resurgence in several respiratory pathogens was observed including one local Chlamydia pneumoniae outbreak in Switzerland, prompting the need for a better understanding of C. pneumoniae epidemiology.AimTo assess temporal and geographical variations in C. pneumoniae detection before, during and after the COVID-19 pandemic.MethodsData on C. pneumoniae PCR detection ratios (number of positive tests/ total number of tests) across pre-pandemic (2018-2019), pandemic (2020-2022) and post-pandemic (2023) periods were collected via a global survey disseminated through various professional networks.ResultsC. pneumoniae detection ratios were analysed across 28 sites (27 in Europe, one in Taiwan) in 2023 (Dataset A, n = 172,223 tests) and 20 sites from 2018 to 2023 (Dataset B, n = 693,106 tests). Twenty-seven sites were laboratories (hospital or clinical) and one a surveillance system (Denmark). A significant decrease in detection ratios was observed during the pandemic period (from 1.05% to 0.23%, p < 0.001). In 2023, detection ratios increased to 0.28% (p < 0.002). Notable regional variations were found, with statistically significant increases in detection ratios at six sites located in Switzerland and Slovenia, where ratios ranged from 0.52% to 3.25%.DiscussionThe study highlights how NPIs influenced C. pneumoniae epidemiology, with reduced detection during the pandemic and partial resurgence afterwards. Regional variations suggest differing NPI impacts and underscore the need for continued surveillance.

PMID:40511472 | DOI:10.2807/1560-7917.ES.2025.30.23.2400682