Nevin Manimala

JMIR Mhealth Uhealth. 2025 May 6;13:e70228. doi: 10.2196/70228.

ABSTRACT

BACKGROUND: Obesity represents a major public health crisis in the United States, imposing substantial health risks and economic costs. Medical nutrition therapy (MNT) is an evidence-based treatment where a registered dietitian provides personalized nutrition and lifestyle guidance to patients. MNT has been demonstrated to be effective for weight loss and managing chronic diseases in patients with obesity. With the rise of telehealth, MNT has gained popularity as an accessible alternative to traditional in-person care. While a nationwide program integrating MNT with a companion mobile app offers a comprehensive weight management solution, data supporting its clinical effectiveness is limited.

OBJECTIVE: This study aimed to evaluate the effectiveness of an MNT program with a companion mobile app on weight loss among adults with overweight and obesity.

METHODS: This retrospective cohort study included users of Nourish, an MNT program with a companion mobile app, who attended at least 1 appointment between August 2023 and October 2024 and had a baseline BMI≥30 kg/m² or a BMI between 27-30 kg/m² with diabetes or prediabetes. The primary outcome was the proportion of participants who achieved at least 5% weight loss; secondary outcomes included mean weight change, mean percent weight change, and the proportion of participants who achieved at least 3% weight loss. Statistical significance of weight change was determined using 2-tailed t tests. Subgroup analyses were performed by sex, BMI, follow-up time between weights, number of appointments completed, and levels of engagement according to appointment frequency and app usage.

RESULTS: In total, 3951 participants were included in the analysis. The mean age was 38 (SD 10) years, and 78% (3082/3951) of participants were female. Weight loss was reported as a program goal by 70% (2748/3951) of participants, while 31% (1204/3951) and 24% (939/3951) reported diabetes or prediabetes and a cardiovascular condition, respectively. Over a median follow-up of 2.2 months, 17% (689/3951) of participants achieved at least 5% weight loss. The mean weight change was -4.5 (SD 8.9) pounds, corresponding to a mean percent weight change of -2% (SD 3.9; P<.001). Males and participants aged 60 years or older were more likely to experience at least 5% weight loss. Longer follow-up time between weights and a higher number of completed appointments (≥5 appointments) were significantly associated with a significantly higher likelihood of achieving at least 5% weight loss (P<.001 for both). In addition, participants who were most engaged, based on appointment frequency and app usage, were more likely to achieve at least 5% weight loss compared with those who were less engaged (P<.001).

CONCLUSIONS: Engagement with an MNT program and companion mobile app is associated with significant weight loss for adults with overweight and obesity and may serve as an effective, scalable weight management solution.

PMID:40327381 | DOI:10.2196/70228

J Trauma Acute Care Surg. 2025 May 6. doi: 10.1097/TA.0000000000004635. Online ahead of print.

ABSTRACT

BACKGROUND: Leadership is a crucial component to successful team functioning in high-acuity scenarios. However, literature addressing the potential impact of leadership style on team members during trauma resuscitations is scarce. We aim to assess the link between leadership type and team resilience among trainees in the trauma bay through video review and hypothesize that transformational leadership would be predominant and positively linked with team member behaviors.

METHODS: We performed a single-center cross-sectional study of adult patients (14 years or older) presenting at our Level I trauma center. Trainee performance was evaluated with Behavior Anchored Rating Scales through post hoc audiovisual review of captured trauma resuscitations. Statistical analysis was performed to explore possible correlations between leadership style (transformational, transactional, and passive) and three team resilience behaviors (speaking up, knowledge sharing, and cooperation).

RESULTS: A total of 118 Level I and II trauma activations were analyzed. The average age was 34 [26-47] years, with 23% (n = 27) penetrating injuries, and an average Injury Severity Score of 12.5 [5-23.5]. Trauma leads scored highest on passive leadership (M = 2.96, SD = 1.16), followed by transactional (M = 2.67, SD = 1.29) and transformational (M = 2.33, SD = 1.19). Team members scored highest on knowledge sharing (M = 3.67, SD = 0.78) but lower on cooperation (M = 3.10, SD = 0.70) and speaking up (M = 3.10, SD = 1.17). Transformational and transactional leaderships were both positively correlated to the capacity in which team members cooperate (r = 0.53, p < 0.001 and r = 0.53, p < 0.001, respectively), share knowledge (r = 0.47, p < 0.001 and r = 0.47, p < 0.001, respectively), and speak up (r = 0.52, p < 0.001 and r = 0.49, p < 0.001, respectively). Passive leadership was negatively correlated with all three trauma team behaviors (p < 0.001).

CONCLUSION: Both transactional and transformational leaderships were positively associated with team resilience behaviors during trauma resuscitations. Opportunities for improvement among trainees suggest adopting an active rather than passive leadership style to promote team performance.

LEVEL OF EVIDENCE: Single-Center Prospective Observational Study; Level IV.

PMID:40327368 | DOI:10.1097/TA.0000000000004635

JMIR Mhealth Uhealth. 2025 May 6;13:e70473. doi: 10.2196/70473.

ABSTRACT

BACKGROUND: Encouraging physical activity improves mental health and is recommended in workplace mental health guidelines. Although mobile health (mHealth) interventions are promising for physical activity promotion, their impact on mental health outcomes is inconsistent. Furthermore, poor user retention rates of mHealth apps pose a major challenge.

OBJECTIVE: This study aimed to examine the effectiveness and implementation outcomes of the smartphone app ASHARE in Japanese workplace settings, leveraging a deep learning model to monitor depression and anxiety through physical activity.

METHODS: This hybrid effectiveness-implementation trial was a 3-month nonrandomized controlled trial conducted from October 2023 to September 2024. Work units and employees were recruited and allocated to the intervention or active control group based on preference. The intervention group installed the ASHARE app, whereas the control group participated in an existing multicomponent workplace program promoting physical activity. Changes in physical activity and psychological distress levels were compared between the groups. User retention rates, participation rates, acceptability, appropriateness, feasibility, satisfaction, and potential harm were also assessed.

RESULTS: A total of 84 employees from 7 work units participated (67 from 5 units in the intervention group and 17 from 2 units in the control group). In total, 78 employees completed the 3-month follow-up survey (follow-up rate: 93%). Both groups showed increased physical activity, and the intervention group showed reduced psychological distress; however, the differences between groups were not statistically significant (P=.20; P=.36). In a sensitivity analysis of protocol-compliant employees (n=21), psychological distress levels were significantly reduced in the intervention group compared with the control group (coefficient=-3.68, SE 1.65; P=.03). The app’s 3-month user retention rate was 20% (12/61), which was lower than the participation rate in each component of the control programs. Implementation outcomes evaluated by employees were less favorable in the intervention group than in the control group, whereas health promotion managers found them to be similar.

CONCLUSIONS: The ASHARE app did not show superior effectiveness compared with an existing multicomponent workplace program for promoting physical activity. An implementation gap may exist between health promotion managers and employees, possibly contributing to the app’s low user retention rate. Future research should focus on examining the effectiveness of strategies to get engagement from managers and from segments of employees with favorable responses in the workplace at an early stage.

PMID:40327360 | DOI:10.2196/70473

JAMA Netw Open. 2025 May 1;8(5):e258479. doi: 10.1001/jamanetworkopen.2025.8479.

ABSTRACT

IMPORTANCE: Displaced pediatric medial humeral epicondyle fractures are traditionally treated nonoperatively with casting. However, the use of surgical treatment has increased despite limited high-level evidence supporting its benefits.

OBJECTIVE: To determine whether open surgical reduction and internal fixation improve functional outcomes compared with long arm casting in children with displaced medial humeral epicondyle fractures at 12 months post injury.

DESIGN, SETTING, AND PARTICIPANTS: This noninferiority randomized clinical trial was conducted in 4 university hospitals in Finland between August 30, 2019, and August 22, 2023, with a 12-month follow-up completed August 20, 2024. Participants included children (aged 7-16 years) with nonincarcerated medial humeral epicondyle fractures and more than 2 mm of displacement. Data analysis was based on intention to treat.

INTERVENTIONS: Open reduction and fixation, followed by a long arm cast for 4 weeks, or long arm cast without reduction for 4 weeks.

MAIN OUTCOME AND MEASURE: The primary outcome was the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 12 months (range, 0-100 points, with 0 denoting no disability and 100 extreme disability; prespecified noninferiority margin was 6.8 points).

RESULTS: Seventy-two patients were randomized (43 [59.7%] female; mean [SD] age, 12.1 [2.1] years; range, 7.9-15.9 years), with 37 (19 [51.4%] female) to the surgery group (mean [SD] age, 12.2 [2.3] years; range, 7.9-15.9 years) and 35 (24 [68.6%] female) to the cast group (mean [SD] age, 11.9 [2.0] years; range 7.9-15.9 years). At 12 months, the mean QDASH score was 1.73 (95% CI, 0.65-2.81) in the surgery group and 2.71 (95% CI, 0.52-4.90) in the cast group, showing noninferiority (mean difference, -0.98 [95% CI, -2.95 to 0.98] points). The cosmetic visual analog scale favored the cast group, with a statistically significant between-group difference of -8.9 points (95% CI, -16.6 to -1.2 points; P < .001). Nonunion occurred in 1 of 37 surgically treated patients (2.7%) and 24 of 35 cast-treated patients (68.6%). No crossovers from casting to surgery occurred.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of displaced medial epicondyle fractures, treatment with casting alone was noninferior at 12 months to surgical reduction and internal fixation followed by casting. Findings support nonoperative care as effective at 1 year; longer-term outcomes remain to be studied.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04531085.

PMID:40327343 | DOI:10.1001/jamanetworkopen.2025.8479

Am J Physiol Renal Physiol. 2025 May 6. doi: 10.1152/ajprenal.00259.2024. Online ahead of print.

ABSTRACT

Chronic kidney disease (CKD) is a progressive disorder marked by a decline in kidney function. Obesity and sedentary behavior contribute to the development of CKD, though mechanisms by which this occurs are poorly understood. This knowledge gap is worsened by the lack of a reliable murine CKD model that does not rely on injury, toxin, or gene deletion to induce a reduction in kidney function. High-fat diet (HFD) feeding alone is insufficient to cause reduced kidney function until later in life. Here, we employed a small mouse cage (SMC), a recently developed mouse model of sedentariness, to study its effect on kidney function. Wildtype C57BL/6J male mice were housed in sham or SMC housing for six months with HFD in room (22°C) or thermoneutral (30°C) conditions. Despite hyperinsulinemia induced by the SMC+HFD intervention, kidneys from these mice displayed normal glomerular filtration rate (GFR). However, the kidneys showed early signs of kidney injury, including increases in Col1a1 and NGAL transcripts, as well as fibrosis by histology, primarily in the inner medullary/papilla region. High-resolution respirometry and fluorometry experiments showed no statistically significant changes in the capacities for respiration, ATP synthesis, or electron leak. These data confirm the technical challenge in modeling human CKD. They further support the notion that obesity and a sedentary lifestyle make the kidneys more vulnerable, but additional insults are likely required for the pathogenesis of CKD.

PMID:40327334 | DOI:10.1152/ajprenal.00259.2024

J Racial Ethn Health Disparities. 2025 May 6. doi: 10.1007/s40615-025-02461-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Pregnancy and childbirth traditionally bring worry or a sense of anxiety and distress, particularly among Black women that face historical and contemporary anti-Black racism. We employed two frameworks to assess manifestations of anti-Black racism, structural racism and obstetric racism, as predictors of worry about pregnancy and birth within the Black reproducing community.

METHODS: In a secondary cross-sectional analysis, we analyzed data from Black women in the Giving Voice to Mothers study who completed all relevant items (n = 260). We conducted descriptive analyses and logistic regression models to explore how worry about pregnancy and birth for the Black reproducing community varies with experiences of obstetric racism and different manifestations of structural racism.

RESULTS: Approximately 71% of the sample worried about pregnancy and birth for themselves and their community. Black women who experienced obstetric racism were statistically significantly more likely to be worried about pregnancy and birth experiences compared to Black women who did not. Furthermore, when structural racism was manifested and measured as hidden resources, among Black women reporting fewer pregnancy and birthing care options for women of color, those who experienced obstetric racism during care were 15.6 times more likely to worry about pregnancy and birthing experiences than those who did not (OR 15.667; 95% CI 1.348-182.058).

CONCLUSION: The findings demonstrate the complexity of racialized harm enacted against Black women during the perinatal period and underscore the ways in which obstetric racism and contexts of structural racism powerfully shape the meaning and subsequent emotional impact of pregnancy and birthing while Black.

PMID:40327291 | DOI:10.1007/s40615-025-02461-2

Adv Ther. 2025 May 6. doi: 10.1007/s12325-025-03183-x. Online ahead of print.

ABSTRACT

INTRODUCTION: This study used network meta-analysis (NMA) to evaluate the comparative efficacy of available advanced therapies for moderately to severely active Crohn’s disease (CD) versus the IL-23 inhibitor guselkumab.

METHODS: A systematic literature review was conducted to identify randomized controlled trials (RCTs) of advanced therapies in moderately to severely active CD. Bayesian NMAs were conducted for outcomes of clinical response, clinical remission, endoscopic response, and a combined outcome of clinical remission with endoscopic response, at the end of the maintenance phase (up to 1 year). Primary analyses included patients with varied prior inadequate treatment responses, with additional analyses conducted for specific subgroups. Re-randomized trials were normalized in several cases to mimic a standard treat-through design, incorporating data from additional sources, when necessary, for patients who had an inadequate response or experienced a delayed response following induction.

RESULTS: Of the 58 RCTs identified, 13 with maintenance endpoint data were ultimately included in the NMAs. Guselkumab 100 mg and 200 mg were more likely to be effective versus several comparators. Guselkumab 200 mg demonstrated significantly greater efficacy versus infliximab 10 mg/kg every 8 weeks and upadacitinib 30 mg daily for clinical response and clinical remission. For endoscopic response, guselkumab 200 mg showed significantly greater efficacy than ustekinumab, adalimumab, and upadacitinib. Significance was also noted versus ustekinumab on the combined outcome of clinical remission with endoscopic response. Similarly, guselkumab 100 mg demonstrated efficacy versus comparators across analyses. Guselkumab achieved higher rankings based on surface under the cumulative ranking curve. Findings of primary analyses within mixed populations were generally corroborated by subpopulation analyses.

CONCLUSION: Results of this NMA in moderately to severely active CD indicate a higher likelihood of guselkumab achieving each clinical and endoscopic endpoint analyzed at the end of the maintenance phase versus other advanced therapies assessed.

PMID:40327280 | DOI:10.1007/s12325-025-03183-x

AIDS Behav. 2025 May 6. doi: 10.1007/s10461-025-04741-8. Online ahead of print.

ABSTRACT

Accurate adherence measures to HIV pre-exposure prophylaxis (PrEP) are essential for identifying individuals with low adherence and providing tailored support. This systematic review summarizes evidence on the performance of PrEP indirect adherence measures and explores their potential use in clinical practice. Following a registered protocol (PROSPERO: CRD42020144733) we searched PubMed, Embase, LILACS and Web of Science until December 2024. We included studies that assessed PrEP adherence among individuals using daily oral PrEP with tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC). The reference standard involved quantifying PrEP in dried blood spots or plasma, and index tests included self-reported adherence, pill counts, pharmacy records, electronic monitoring, or composite measures. We used QUADAS-2 to assess the risk of bias and applicability concerns. Twenty-three studies, which included 6649 individuals, fulfilled the inclusion criteria. Most were observational studies (n = 17, 73.9%), and the most common measure was self-report (n = 18, 78.3%). The performance of indirect measures was reported through accuracy statistics in 12 studies (52.2%), concordance in two (8.7%), correlation in eight (34.8%), and proportions in one (4.3%). The risk of bias and applicability concerns were generally low or unclear due to unclear reporting. This review underscores the wide heterogeneity of indirect measures used to assess PrEP adherence, with self-reports being the most frequently utilized. Despite some correlation with direct measures, these methods showed mixed evidence of accuracy, with studies reporting moderate discriminatory capacity for identifying high protective levels of TFV-DP. This finding limits the broader applicability of the measures and underscores the need for further research.

PMID:40327271 | DOI:10.1007/s10461-025-04741-8

J Cancer Educ. 2025 May 6. doi: 10.1007/s13187-025-02638-7. Online ahead of print.

ABSTRACT

In 2021, the US Preventive Services Task Force (USPSTF) issued a final recommendation to lower the initial age for colorectal cancer (CRC) screening to 45¹. At many institutions, trainees play a critical role in the implementation of CRC screening guidelines. The aim of the current study is to assess trainee awareness of recent changes to CRC screening guidelines. Trainees in surgical and non-surgical residency and fellowship programs at a single academic medical center were surveyed, in February of 2023, regarding awareness of recent changes to CRC screening guidelines. Additional information regarding trainee recommendations for various types of screening modalities and their perceptions of patient awareness was obtained. A total of 116 trainees responded to the survey, reflecting a 39% response rate. Of trainees recommending CRC screening, 75% recommended screening to be initiated at age 45, 13% at age 50, 6% at age 40, and 2% at age greater than 50. Trainee knowledge of screening guidelines came from medical school learning (70.7%) and USPSTF guidelines (82%). The most recommended screening modalities were colonoscopy (87%), fecal immunochemical testing (FIT) (31%), and fecal occult blood testing (FOBT) (15%). In comparing trainees who perform colonoscopies versus trainees from primary care specialties, there was no statistical difference between groups regarding knowledge on current screening guideline recommendations. Most trainees recommended CRC screening during their training. Unfortunately, many trainees were unaware of recent changes to CRC screening guidelines. These results revealed an important knowledge gap to be addressed among surgical and non-surgical trainees.

PMID:40327250 | DOI:10.1007/s13187-025-02638-7

J Assist Reprod Genet. 2025 May 6. doi: 10.1007/s10815-025-03496-4. Online ahead of print.

ABSTRACT

PURPOSE: The impact of oral GnRH antagonists on IVF treatment outcomes remains unclear. The aim of the study is to investigate the impact of GnRH antagonist over the outcomes of IVF.

METHODS: We performed an electronic search using MEDLINE® with the OvidSP interface PUBMED, Embase, Web of Science, and Cochrane Library up to December 16, 2024. We included experimental and non-experimental studies, assessing the role of oral GnRH during controlled ovarian stimulation protocols. Our main outcomes were cycle cancelation rate and mean number of mature oocytes retrieved at oocyte pickup (OPU) day.

RESULTS: We included four studies comprising 813 patients, of whom 452 women received oral GnRH antagonists and 294 received injectable subcutaneous GnRH antagonists. No statistical differences were noted in the meta-analysis between each outcome measured (cycle cancelation, mean overall and mature oocytes, fertilization rate, and blastulation rate). Using the GRADE criteria, the overall quality of the existing evidence was determined as moderate.

CONCLUSIONS: This is the first systemic review and meta-analysis to examine the usage of oral GnRH antagonists for ovulation suppression during IVF treatments. Our findings suggest the use of oral GnRH antagonists may be beneficial in infertility treatments; however, caution should be taken, as robust establishment of their effectivity and safety in clinical practice is still pending.

TRIAL REGISTRATION: Registration Number: PROSPERO study ID: CRD42024599730.

PMID:40327246 | DOI:10.1007/s10815-025-03496-4