Nevin Manimala

Disaster Med Public Health Prep. 2025 Jun 19;19:e152. doi: 10.1017/dmp.2025.10080.

ABSTRACT

OBJECTIVES: Breastfeeding assumes critical importance in the aftermath of disasters such as earthquakes, as it provides all the essential nutrients required by infants, enhances their immune systems, and mitigates the risks associated with using contaminated water for formula preparation. This study investigates the experiences of breastfeeding mothers living in temporary shelters within the earthquake-affected region.

METHODS: A qualitative approach was employed to identify the challenges faced by breastfeeding mothers. The study’s sample included 14 mothers who met the inclusion criteria. Data were collected through a semi-structured interview form and analyzed using MAXQDA qualitative data analysis software, following Colaizzi’s 7-step method.

RESULTS: The mothers in the study ranged in age from 31-37 years, with their infants ranging from 10 days-6 months old. Based on the data gathered from the interviews, 4 main themes were identified: basic life needs (with sub-themes of housing, warmth, nutrition, hygiene/sanitation, sleep, and clothing), emotional difficulties (with sub-themes of shock, fear, crying, and stress), care difficulties (with sub-themes of challenges in accessing medication, constipation, diarrhea, reduced comfort, and decreased urine output), and breastfeeding difficulties (with sub-themes of breast rejection, breast engorgement, baby feeding issues, reduced milk production or interruption, and privacy concerns).

CONCLUSIONS: From the onset of the earthquake, mothers encountered significant challenges in breastfeeding their infants. In emergency and disaster situations, it is imperative that experienced health care personnel offer essential information and support to assist these mothers in navigating the difficulties they face.

PMID:40536007 | DOI:10.1017/dmp.2025.10080

Cogn Sci. 2025 Jun;49(6):e70078. doi: 10.1111/cogs.70078.

ABSTRACT

According to the cross-situational learning account, infants aggregate statistical information from multiple parent naming events to resolve ambiguous word-referent mappings within individual naming events. While previous experimental studies have shown that infant and adult learners can build correct mappings based on statistical regularities encoded in multiple learning situations in an experiment, other studies that use more naturalistic stimuli (e.g., real-world video) reveal poor performance in adults’ ability to infer the correct referent. Based on those results derived from more naturalistic stimuli, the cross-situational learning solution cannot be useful to solve the mapping problem in the real world because cross-situational statistics from the real world are much more ambiguous than those created in experimental studies. To examine the feasibility of cross-situational learning in everyday contexts, the present study aims to quantify visual-audio statistics from one of everyday activities-parent-child toy play. We analyze parent naming events in a video corpus of infant-perspective scenes during parent-child toy play in a naturalistic lab setting, where we found three distinct properties that characterize statistical regularities perceived by young learners: (1) there are a limited number of visual scene compositions perceived by young learners at the moments when they hear object names; (2) the frequencies of parent naming events are distributed in a skewed, Zipfian fashion; and (3) cross-situational statistics in naturalistic toy play are comparable to those used in laboratory experiments. Our results underscore the importance of quantifying the statistical regularities in the input from the learner’s perspective in order to shed light on the mechanisms supporting early word learning.

PMID:40535997 | DOI:10.1111/cogs.70078

Fam Pract. 2025 Jun 4;42(4):cmaf048. doi: 10.1093/fampra/cmaf048.

ABSTRACT

BACKGROUND: Sex workers face significant barriers to accessing health services, including stigma, economic constraints, and safety concerns. In Turkey, this group is often subjected to discrimination and prejudiced approaches when accessing sexual health services, which reduces the uptake of health services. This study aims to analyze the health care experiences of sex workers in depth.

METHODS: The study conducted semi-structured in-depth interviews with 16 women working as sex workers in Adana brothel in July-October 2024, and the data were analyzed through thematic analysis. Participants were selected through purposive sampling to ensure socio-demographic diversity.

RESULTS: Four main themes were identified through the analysis: Barriers to Access and Use of Health Services, Health Service Experiences and Satisfaction, Information and Awareness, and Emotional Situations. Participants indicated that they often preferred private health facilities due to difficulties in accessing public health services and long waiting times, but that these preferences were limited by cost.

CONCLUSIONS: Improving the quality of public health services and reducing costs may improve public health by encouraging this group to use health services.

PMID:40535989 | DOI:10.1093/fampra/cmaf048

Hong Kong Physiother J. 2025 Jun;45(1):23-33. doi: 10.1142/S1013702525500027. Epub 2024 Apr 27.

ABSTRACT

BACKGROUND: Stress and sedentary lifestyles negatively impact the physical fitness of overweight and obese female university students. Physical activity has been shown to promote psychological as well as physical wellness. However, the effects of Surya Namaskar (SN) yoga on stress and physical fitness remain unclear.

OBJECTIVE: This study aimed to compare the physical fitness, anthropometric measures, and perceived stress between the SN yoga training program group and the control group.

METHODS: In a randomized controlled study, 44 overweight and obese female university students participated. For 8 weeks, the exercise group received training in SN yoga, whereas the control group was not permitted to participate in any form of exercise. At baseline and after 8 weeks of training, all participants completed the Thai Perceived Stress Scale-10 (T-PSS-10), and assessed the body mass index (BMI), waist-hip ratio, body fat percentage, maximum oxygen consumption (VO₂max), and muscle strength and flexibility. We used the dependent t-test or Wilcoxon sign rank test to examine the differences between the T-PSS-10 and physical fitness within each group. The statistical differences of all parameters between the two groups were compared using an independent t-test or a Mann-Whitney U test. A p– $\text{value}<0.05$ was considered statistically significant.

RESULTS: Compared to the baseline, the SN yoga group’s post-training period had a significant increase ( $p<0.05$ ) in forward back flexibility, hand grip strength, leg strength, and VO₂max, while a significant decrease ( $p<0.05$ ) in T-PSS-10 scores and BMI. In addition, we found a significant difference between the both groups in forward back flexibility and T-PSS-10 scores in the post-training period ( $p=0.015$ and $p=0.009$ , respectively).

CONCLUSION: This study’s findings demonstrated that SN yoga is a useful exercise for enhancing overweight and obese female university students’ perceived stress scales and physical fitness.

PMID:40535981 | PMC:PMC12171770 | DOI:10.1142/S1013702525500027

Hong Kong Physiother J. 2025 Jun;45(1):11-22. doi: 10.1142/S1013702525500015. Epub 2024 Mar 21.

ABSTRACT

BACKGROUND: Correct goal setting for patients is one of the most important aspects of physical therapy.

OBJECTIVE: The purpose of this study was to investigate the effect of physical therapy using goal attainment scaling (GAS) scores to assess the gait function in patients with subacute stroke and related factors.

METHODS: This retrospective cohort study was conducted using the medical records of 129 patients with subacute stroke who had been treated with intensive rehabilitation intervention. This study was approved by the Institutional Review Board of Bundang Cha Hospital (2021-06-008). The functional ambulation category (FAC) was used to set goals with the involvement of patients and their caregivers after the initial assessment, and raw GAS scores were calculated according to whether the goals were achieved through assessment one month later based on the FAC score. The groups were then divided according to the raw GAS scores (-1, 0, 1, or 2), and the general characteristics and clinical assessment scores were statistically analysed.

RESULTS: From our results, there were differences in clinical assessment scores based on raw scores on the GAS ( $p<0.05$ ) and correlation between raw scores on the GAS and improvement scores on the clinical assessment items ( $p<0.05$ ). Moreover, when the gait function measured by FAC was used as a GAS in subacute stroke patients, the better the function of Rivermead mobility index ( $\beta =0.613$ , $p<0.05$ ) and Korean-mini-mental state examination ( $\beta =0.217$ , $p<0.05$ ) than the other clinical factors, the higher the goal attainment raw score.

CONCLUSION: Functions, including cognitive function, should be included when setting goals to improve the gait function and should be considered when developing the neurological physiotherapy programmes. This study helps physicians and physical therapists who first apply functional gait assessment as a GAS to set the initial goals and improves patient and caregiver motivations by applying GAS to patients with lower initial cognitive levels.

PMID:40535979 | PMC:PMC12171774 | DOI:10.1142/S1013702525500015

J Health Monit. 2025 Jun 11;10(2):e13178. doi: 10.25646/13178. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Coronary heart disease (CHD) is the leading cause of death in Germany. Comprehensive analyses of long-term trends in CHD mortality that also distinguish between acute myocardial infarction (AMI) and non-AMI-related chronic CHD are currently lacking.

METHOD: Age-specific and age-standardised CHD mortality rates for the period 1998 – 2023 were calculated based on data from the cause-of-death statistics of the Federal Statistical Office of Germany. Annual percentage changes (APC) and average annual percentage changes (AAPC) were estimated using joinpoint regression analysis.

RESULTS: Between 1998 and 2023, the average annual change in age-standardised CHD mortality rates for women was -3.9 % ((-4.1) – (-3.7)) per year, compared with -3.2 % ((-3.3) – (-3.0)) for men. However, since the 2010s, the downward trend in CHD mortality has flattened, particularly among those aged 60 to 74 years. In the analysis by ICD subgroups, mortality rates for chronic CHD declined less sharply than for AMI over the entire period 1998 – 2023, especially among men.

CONCLUSIONS: The flattening of the CHD mortality trend, particularly among middle-aged adults over the last decade, and the smaller decline in chronic CHD mortality, especially among men, require further exploration in order to identify unmet needs at various levels of prevention for specific life stages. In addition, the influence of the COVID-19 pandemic on CHD mortality trends should be further investigated.

PMID:40535977 | PMC:PMC12175194 | DOI:10.25646/13178

Clin Epidemiol. 2025 Jun 14;17:551-565. doi: 10.2147/CLEP.S520168. eCollection 2025.

ABSTRACT

PURPOSE: Multi-database studies may provide heterogeneous results despite using common protocols, leading to challenges in interpretation, but also providing an opportunity to gain insights on populations or healthcare systems. The objectives of these analyses were to develop a framework for exploring sources of statistical heterogeneity and apply it to the multi-database EXACOS-CV (EXAcerbations of COPD and their OutcomeS on CardioVascular diseases) program.

METHODS: A conceptual framework to systematically assess sources of statistical heterogeneity in multi-database studies was developed. This framework distinguishes between methodological diversity and true clinical variation. Methodological diversity includes differences in study design and database selection, while true variation considers population and healthcare differences. Possible sources of methodological diversity were identified via a novel checklist and explored. In turn, hypotheses were generated about true variation. The framework and checklist were applied to EXACOS-CV cohort studies in Germany, Canada, the Netherlands, and Spain which deviated least from the common protocol and so were included. Focus was on adjusted hazard ratios (aHR) for post-exacerbation associations with decompensated heart failure (HF) and all-cause death, for which results were most and least heterogeneous, respectively.

RESULTS: Across EXACOS-CV studies, the adjusted hazard ratios (aHR) for HF in the first 1-7 days post-exacerbation, compared to non-exacerbation periods, ranged from 2.6 (95% CI, 2.3, 2.9) in Germany to 72.3 (64.4, 81.2) in Canada, and the association with death, relative to non-exacerbation periods, ranged from 3.5 (2.4, 5.3) in the Netherlands to 22.1 (19.9, 24.4) in Spain. Completed methodological diversity checklists linked differences in aHRs to possible variation in ability to capture pre-existing cardiovascular comorbidities across studies, as well as differences in confounder measurement. Standardizing adjusted models across studies did not fully explain heterogeneity, suggesting other contributing factors. Heterogeneity may result from genuine variation in prevalence of CV disease. It was hypothesized that patients with pre-existing CV disease have more accurate diagnoses and management of post-exacerbation CV events, possibly leading to lower risks of such events.

CONCLUSION: Multi-database studies can provide directional insights on the study research question while considering healthcare system and population differences. The developed framework aids assessment of heterogeneity sources.

PMID:40535967 | PMC:PMC12176119 | DOI:10.2147/CLEP.S520168

J Mens Health. 2025 Jan;21(1):39-50. Epub 2025 Jan 30.

ABSTRACT

BACKGROUND: African American men (AAM) have persistently had the highest incidence and mortality rates for prostate cancer (PrCa) in the United States. Considering that current guidelines recommend the practice of shared decision-making to determine whether or not to undergo a Prostate-Specific Antigen (PSA) test for the early detection of PrCa, this study focuses on the identification of key factors influencing AAM decisions regarding having or not having PSA screenings.

METHODS: Cross-sectional study of 152 AAM who completed study surveys. Statistical analysis included frequencies, means, and distributions and methods to test for differences in knowledge confidence, satisfaction and, self-efficacy when making decisions.

RESULTS: 94% of participants would get a PSA test if offered, only 57% knew that the PSA test is a blood test. Participants who reported having had a PSA test before the baseline had significantly higher mean scores than their counterparts in the knowledge about the definition of the PSA and biopsy exams (p = 0.04), and in the confidence (p = 0.005) and efficacy (p = 0.002) scales when making PSA screening decisions. Older participants were more likely to have had a PSA test (p < 0.0001) and to intend to screen (p = 0.0441).

CONCLUSIONS: Significant differences in the satisfaction scale by clinical site (p < 0.001) may underscore the influence of clinicians’ practices in participants’ satisfaction with their decisions. Results suggest that patients’ experience of care has the potential to positively influence PSA screening. It is our call that type of health insurance, knowledge about PrCa and PSA, and having had a PSA test in the past, as well as the patient’s characteristics (age, race and family history of PrCa) be considered when discussing with patients the harms/benefits of PSA screening and their preferences to have or not have the PSA test.

PMID:40535958 | PMC:PMC12176403

Cureus. 2025 Jun 16;17(6):e86127. doi: 10.7759/cureus.86127. eCollection 2025 Jun.

ABSTRACT

Background There is a growing interest in the use of biomaterials to treat chondral and osteochondral knee lesions, given their ability to replicate the biological and functional properties needed for simultaneous cartilage and bone regeneration. A novel aragonite-based, cell-free biomimetic scaffold (CARTIHEAL AGILI-C^TM, Smith + Nephew, UK) was developed for treating chondral and osteochondral defects in traumatic and osteoarthritic joints. A short-term follow-up study was designed to assess the safety and feasibility of this scaffold. Materials and methods This retrospective review included data from nine centers in the United States (US) between August 22, 2023 and December 30, 2024. Adult patients (≥18 years of age) who received the aragonite-based scaffold as standard of care for the treatment of knee chondral/osteochondral lesions in accordance with the manufacturer’s instructions for use were eligible. There were no prespecified exclusion criteria. All patients underwent magnetic resonance imaging (MRI) for radiologic assessment of knee cartilage lesions, which informed the development of presurgical plans. A diagnostic arthroscopy was performed before arthrotomy to confirm the radiographic findings obtained for preoperative planning. The primary endpoint was the incidence of early clinical and radiographic complications occurring within at least 30 days after the operation. Secondary endpoints included an assessment of the accuracy of presurgical planning relative to intraoperative findings, proportion of implants determined to be improperly implanted based on the first postoperative X-rays, change in the numeric pain rating score from baseline, and the proportion of patients cleared for various postoperative activities. Results A total of 33 patients (34 knees; mean age, 47.2 years; 18 (52.9%) male) were included. After a mean postoperative follow-up of 45.7 days (standard deviation, 14.4), one patient (2.9%) experienced a postoperative complication (pain, with no associated infection). Success rate was 96.97% (95% CI, 84.24-99.92). In 27 (79.4%) cases, the presurgical plan based on MRI was modified following arthroscopic visualization of the knee joint surface. Postoperative radiography revealed no complications for the 28 patients with data. Mean postoperative numeric pain rating significantly improved from 6.6 at baseline to 3.9 at follow-up (p<0.05). The majority of patients (n=24; 70.6%) were cleared for partial or full weightbearing by the 30-day postoperative follow-up visit. Conclusions This case series across multiple centers in the US demonstrates the clinical safety and feasibility of aragonite scaffold implantation. The flexibility of the scaffold in accommodating intraoperative findings and the low rate of early complications are encouraging.

PMID:40535950 | PMC:PMC12174689 | DOI:10.7759/cureus.86127

R Soc Open Sci. 2025 Jun 18;12(6):241934. doi: 10.1098/rsos.241934. eCollection 2025 Jun.

ABSTRACT

We construct a multiscale model of dispersion of mountain pine beetles in western North American forests. Dispersion is modelled at a macroscale (regional scale) by a novel nonlinear stochastic process for population density. This is coupled to a microscale (tree scale) model of population dynamics using a sequential approach, which assumes that dispersion occurs on a slower time scale than local dynamics. We conduct a numerical investigation of the multiscale model properties. While the model depends on a relatively small number of parameters, it can produce a wide range of behaviours, including dispersion patterns qualitatively similar to those of mountain pine beetle infestations. We also conduct a Bayesian calibration for key parameters in the model using synthetic and real data.

PMID:40535940 | PMC:PMC12174937 | DOI:10.1098/rsos.241934