Nevin Manimala

JMIR Mhealth Uhealth. 2025 Jun 17;13:e58204. doi: 10.2196/58204.

ABSTRACT

Background: Perimenopausal and menopausal symptoms affect many women’s well-being and quality of life. Digital technologies, especially smartphones, allow self-management interventions for menopausal symptoms, but they are understudied., Objective: We evaluated whether a novel digital care app, Caria, effectively reduced vasomotor and behavioral health symptoms of menopause., Methods: We enrolled 149 women for a 6-week randomized controlled trial (app treatment: n=112; web-based educational control: n=37). Enrolled participants had problematic vasomotor symptoms and at least one elevated behavioral health symptom (depression, anxiety, or sleep issues). Web-based self-reported assessments (Hot Flush Rating Scale [HFRS], Patient Health Questionnaire Depression Scale-8 [PHQ-8], Generalized Anxiety Disorder-7, and Pittsburgh Sleep Quality Index [PSQI]) were conducted at baseline, 3 weeks, and 6 weeks., Results: For hot flash severity (HFRS; treatment baseline mean 16.4, SD 6.7 to 6-wk mean 13.6, SD 6.6; control: baseline mean 19.1, SD 7.3 to 6-wk mean 17.8, SD 7.2), a repeated-measures ANOVA revealed main effects for time (F2,262=9.82; P<.001) and treatment arm (F1,131=6.08; P=.01) and a significant time × treatment arm interaction (F2,262=3.23; P=.04); the treatment arm showed lower hot flash severity than the control arm (t147=2.72; P=.007). For depression scores (PHQ-8; treatment baseline mean 14.0, SD 3.8 to 6-wk mean 11.2, SD 5.3; control baseline mean 15.0, SD 3.7 to 6-wk mean 13.4, SD 4.1), a repeated-measures ANOVA showed a main effect of time in the treatment arm (F2,96=15.2; P<.001) but not the control arm (F2,40=2.0; P=.15). Follow-up 2-tailed paired t tests in the treatment arm showed depression decreased from baseline to week 3 (t49=3.3; P=.002) and from weeks 3 to 6 (t48=2.3; P=.02). For sleep quality scores (PSQI; treatment baseline mean 10.7, SD 3.1 to 6-wk mean 10.0, SD 3.5; control baseline mean 11.5, SD 3.7 to 6-wk mean 11.0, SD 3.7), the repeated-measures ANOVA showed a main effect of time in the treatment arm (F2,186=7.8; P=.001) but not the control arm (F2,62=1.3; P=.28). Follow-up 2-tailed paired t tests in the treatment arm showed a significant decrease in sleep issues from baseline to week 3 (t95=3.9; P<.001) but no change from weeks 3 to 6 (t93=0.2; P=.81). Participants with elevated anxiety symptoms showed decreased symptoms in both the treatment and control groups. App engagement was high (average logins over 6 weeks: 53.2)., Conclusions: The findings highlight the potential of digital interventions for mitigating menopausal vasomotor and behavioral health symptoms. Significant improvements in the intervention group underscore the app’s effectiveness in providing relief from some of the most challenging aspects of menopause. This study contributes to the evidence supporting digital health interventions in managing menopausal symptoms, presenting a promising avenue for accessible and scalable solutions for women in midlife.

PMID:40526898 | DOI:10.2196/58204

Rev Med Chil. 2025 May;153(5):362-372. doi: 10.4067/s0034-98872025000500362.

ABSTRACT

Suicidal behavior is a global public health issue, particularly among adolescents, where it stands as one of the leading causes of death in this age group. In Chile, adolescent suicide rates have alarmingly increased over recent decades, with psychological, clinical, and socio-familial factors emerging as key contributors. However, existing theoretical models face limitations when applied to specific sociocultural contexts.

AIM: To explain suicidal behavior in a clinical sample of Chilean adolescents, integrating psychological, clinical and socio-familial factors.

METHODS: A non-experimental cross-sectional study was carried out in 388 adolescents (59.3% female; mean age: 15.63 years) admitted to the healthcare system in the Maule Region. Validated instruments were applied, including the BIS-11, DASS-21, DERS, ISI, GHSQ-V, and C-SSRS, to assess impulsivity, emotional regulation, anxious-depressive symptoms, and suicide risk. Multiple logistic regression models were fitted to identify significant predictors of suicidal ideation and attempts. Model quality was assessed through ROC analysis.

RESULTS: For the suicidal ideation model, significant predictors included maternal responsiveness, depressive symptoms, family history of mental illness, prior hospitalization due to suicide attempts, and victimization through bullying and sexual abuse. In the suicidal attempt model, relevant factors were the absence of siblings, unplanned impulsivity, emotional interference, previous hospitalizations for mental health, suicidal ideation, and serious intent to attempt suicide. The models demonstrated adequate predictive performance with areas under the curve (AUC) of 0.89 and 0.94, respectively.

CONCLUSIONS: The findings highlight the multidimensional nature of adolescent suicidal behavior, revealing the interplay between individual and contextual factors. These models contribute to understanding the phenomenon and could guide targeted preventive interventions and public policies aimed at this vulnerable group. Expanding the analysis to different regions and populations is suggested to validate and enrich the results.

PMID:40526864 | DOI:10.4067/s0034-98872025000500362

Fam Med. 2025 Jun 16. doi: 10.22454/FamMed.2025.362243. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Effective feedback is recognized as essential to clinical training. Hattie and Timperley conducted a comprehensive review of feedback to develop their Model of Feedback to Enhance Learning (MFEL). The MFEL proposes that effective feedback can focus on any of four levels: task, process, self-regulation, and self. While Hattie and Timperley are frequently cited for their review, few studies in medical education have used the MFEL to explore feedback. We used the MFEL to examine the content of documented workplace-based feedback to explore how this model applies in a family medicine residency program.

METHODS: We conducted this retrospective cross-sectional observational secondary data analysis (learning analytics) study in a Canadian university-based family medicine residency program. Our data source was de-identified field notes (a tool to document workplace-based feedback) for residents at two teaching sites. We coded the feedback using the levels from the MFEL. We used descriptive statistics to analyze the frequencies of each level and combinations of levels.

RESULTS: Of the 2,250 field notes examined, 422 (18%) were excluded because they contained no feedback. The majority (1,105; 60%) included a single feedback level, while 705 (38%) contained two levels, and 17 (1%) included three levels. No field notes included all four levels. Of the field notes containing one feedback level, the most common levels were task (835; 76%) and process (248; 22%). The most common combination of levels was process and task (649; 92.1%).

CONCLUSIONS: Hattie and Timperley’s MFEL offers a way to explore feedback documented in medical education programs and may help programs identify opportunities for faculty development to improve feedback effectiveness.

PMID:40526854 | DOI:10.22454/FamMed.2025.362243

JMIR Ment Health. 2025 Jun 17;12:e70253. doi: 10.2196/70253.

ABSTRACT

BACKGROUND: Suicide is a significant global public health concern. Individuals with suicidal behaviors often seek help in emergency departments (ED), making mental health providers critical to suicide prevention. Brief interventions such as safety planning are essential in these settings. However, there is a limited understanding of how mobile digital safety planning apps can aid in secondary suicide prevention.

OBJECTIVE: This study evaluated the effectiveness of a digital safety plan, delivered through the MeMind app, in reducing ED visits associated with suicidal behavior (ie, suicidal ideation or attempt).

METHODS: A one-year follow-up was conducted for individuals who presented to the ED for an index event of suicidal behavior (N=78). Participants were provided with a digital safety plan on their mobile devices and instructed to activate it during future suicidal crises.

RESULTS: At follow-up, participants who activated the digital safety plan showed a 50% lower likelihood of returning to the ED, when compared to those who did not activate it.

CONCLUSIONS: These findings suggest that digital safety planning may serve as a scalable and accessible intervention with the potential to significantly contribute to suicide prevention efforts.

PMID:40526825 | DOI:10.2196/70253

Nurs Open. 2025 Jun;12(6):e70245. doi: 10.1002/nop2.70245.

ABSTRACT

AIM: To examine the effect of implementing the patient complexity instrument (PCI) in addition to usual-care on complexity detection, clinical-care time allocation and referrals to supportive services compared to usual-assessment alone.

DESIGN: A parallel-group-blocked pragmatic randomised controlled trial.

METHODS: A mixed-method study conducted within a regional Australian community nursing service. Randomisation occurred at the initial client assessment following referral acceptance for community nursing support. Older people aged 65 years and over (client participants), referred to the service from 1st of July 2020 to 30th of September 2020, were eligible for Commonwealth Home Support Programme funding. A convenience sample of community nurses conducting client assessments was recruited. The intervention group included usual assessment plus the PCI, and the control group was usual assessment alone. Chi-square test independence compared complexity ratings (low, medium, high) between groups for the hypothesis that adding the PCI to usual assessment has no effect on nurses’ complexity detection compared to usual assessment alone.

RESULTS: Compared to usual-assessment alone, adding the PCI did not change nurses’ level detected complexity rating. However, for older people initially assessed with low levels of complexity, the PCI indicated a need for additional clinical-care-time. The nurses’ contribution to process evaluation showed that the PCI was useful in providing prompts for aspects to consider during their assessment.

CONCLUSION: The addition of PCI to nurses’ usual assessment did not improve levels of complexity ratings. However, the PCI enhanced complexity detection by pinpointing areas of care requiring referrals for additional care and extra time required. The ImPaCt trial demonstrated the PCI as a useful tool for enhancing care for older people receiving nursing support in the community. The PCI is a beneficial guidance resource for those new to the Community Nursing role caring for older people.

REPORTING METHOD: The study adhered to the updated guidelines for reporting parallel group randomised trials. Reporting was conducted according to the CONSORT checklist.

PATIENT OR PUBLIC CONTRIBUTION: This study was focused on the nurses’ perspective of client complexity and how this complexity is detected. During the protocol development phase, a presentation about the study was made to a consumer group (older people) from the lead researcher’s workplace. This presentation was well received, with five consumers in attendance. The protocol was also presented to the Board of the lead researcher’s workplace, which was a large regional public health service. Four board members were in attendance and showed positive interest.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This study underscores the merit of incorporating a care complexity assessment tool into community nursing care for older people, amplifying decision-making regarding patient complexity. Future studies should explore clients’ perspectives, the PCI’s effect on and implications for hospital (re)admissions and longevity at home.

TRIAL REGISTRATION: The trial was registered with the Australian and New Zealand Clinical Trials Registry (blinded for review).

PMID:40526821 | DOI:10.1002/nop2.70245

J Ethn Subst Abuse. 2025 Jun 17:1-18. doi: 10.1080/15332640.2025.2517776. Online ahead of print.

ABSTRACT

College students indicate high use of alcohol and marijuana; cultural influences may affect substance use. This study assessed the associations between alcohol and marijuana past 30-day use, and microaggressions, acculturation, and familism among Latinx college students. Participants (n = 484) completed measures, and structural equation modeling was used to yield results. Findings suggested that microaggressions were a risk factor for alcohol use, (B = -1.29, p = .007) while acculturation was a risk factor for marijuana use (B = 1.06, p = .011). No other statistically significant associations with alcohol or marijuana past 30-day use were observed. Culturally based prevention and intervention efforts appear warranted.

PMID:40526820 | DOI:10.1080/15332640.2025.2517776

Nurs Open. 2025 Jun;12(6):e70243. doi: 10.1002/nop2.70243.

ABSTRACT

Universal accessibility is one of the most active lines of action among the steps to mitigate and compensate the restriction in participation and the limitation of activity in people with disabilities. Occupational therapists often work in a person’s natural environment to assess and intervene in occupational performance. In addition to being a tool for evaluating the accessibility of individuals who visit community health professionals, especially nursing staff, this resource can significantly improve patient care and outreach efforts.

OBJECTIVE: The main aim of this study was to create and validate an instrument to measure the limitations in the activity of each person related to the vertical accessibility of their home.

DESIGN: The methodology of this work is a psychometric design. This is a process of construct validation of a vertical accessibility scale through confirmatory factor analysis.

METHODS: The scale construction is carried out following a content validation process, involving the participation of five expert occupational therapists, and the analysis of their contributions using the Attribute Agreement Analysis. In this process, Fleiss Kappa statistical analysis is used, and Kendal’s W is included due to the utilisation of ordinal variables. For the construct validation of the tool, the most suitable process is followed, an Exploratory Factor Analysis, and subsequent Confirmatory Factor Analysis using Global Absolute Adjustment indices for all the subscales of the test. The analysis of the indicators was performed using the weighted least squares (DWLS) estimation method. An initial test of 63 items distributed into four subscales was configured based on the different determined accessibility spaces: (a) exterior areas and access to the building/living space; (b) horizontal mobility inside the building and common areas; (c) vertical mobility of the building/living spaces and (d) access to and the entrance door as well as the interior of the living spaces.

RESULTS: Once the analysis has been carried out with the absolute fit indices obtaining excellent values, the validation process is concluded and the final scale with 48 items is finalised. This validation process allows us to affirm that it is a useful and viable tool to evaluate accessibility. No public or patient contribution.

PMID:40526819 | DOI:10.1002/nop2.70243

Br J Surg. 2025 May 31;112(6):znaf075. doi: 10.1093/bjs/znaf075.

ABSTRACT

BACKGROUND: Removal of Kirschner wires (K-wires) after fracture treatment in the upper limb is unpleasant for children. The aim of this study was to evaluate whether virtual reality (VR) distraction could improve pain and the overall experience for children.

METHODS: An RCT was performed in a single outpatient fracture clinic, where children (aged 6-15 years) were randomized 1 : 1, in three age strata, to additional VR or standard of care. Pain perception was assessed using the Wong-Baker Faces Pain Rating Scale by neutral observers and later by the patients and their guardians. Further measures included the Face/Legs/Activity/Cry/Consolability (FLACC) Pain Scale, the modified Yale Pain Anxiety Scale (mYPAS), and questionnaires, as well as objective data, such as heart rate variability and blood pressure.

RESULTS: A total of 146 patients were recruited into the trial. The VR group showed significantly less pain on the Wong-Baker Faces Pain Rating Scale (OR 0.23 (95% c.i. 0.12 to 0.43)) compared with the control group. Observers rated the pain >2 for 43% of patients in the VR group and 74% of patients in the control group. Observer scales (the FLACC Pain Scale and the mYPAS) during K-wire removal also indicated less pain (OR 0.36 (95% c.i. 0.19 to 0.24) and 0.29 (95% c.i. 0.16 to 0.52) respectively). The difference in pain rated >2 between the VR and control group was smaller directly after (59% versus 69% respectively) and 2 weeks after (58% versus 70% respectively) K-wire removal. Children in the VR group were less aware of the painful stimulus directly after and 2 weeks after wire extraction.

CONCLUSION: VR distraction effectively reduces pain during K-wire removal in children. VR positively impacts the procedural memory of children.

REGISTRATION NUMBER: DRKS00020229 (Deutsches Register Klinischer Studien (DRKS; that is the German Clinical Trials Register); date of registration 10 December 2019).

PMID:40526816 | DOI:10.1093/bjs/znaf075

Sex Health. 2025 Jun;22:SH24230. doi: 10.1071/SH24230.

ABSTRACT

Background Despite partner notification (PN) being an essential component of sexually transmitted infection (STI) control programs, little is known about how contacts of STIs are notified, and the time taken to present for testing. We aimed to evaluate both aspects in people presenting to Sydney Sexual Health Centre who reported being a sexual contact of someone diagnosed with an STI. Methods We conducted a retrospective observational study of data collected between 1 April 2020 and 31 March 2021 at Sydney Sexual Health Centre. A pop-up field in the electronic medical record collected data about people’s experience of being notified of their sexual contact with an STI. We ran univariable and multivariable analysis of time to presentation and PN method against clinical and demographic information. Results There were 2182 presentations because of STI contact notification. Median time to presentation was 3days (IQR 1-7days), which did not differ by spoken or electronic PN. In the multivariable model, people who received spoken PN were less likely to present in P =0.007). This indicates electronic PN may prompt faster testing for STIs. Higher partner number was associated with receiving electronic PN. Conclusions Our study suggests that electronic PN may prompt faster testing for STIs. It provides valuable insights into the characteristics of STI contacts, who are rarely the focus of PN research. Understanding what motivates notified contacts to seek care is integral in modernising PN practices, as rates of STIs climb.

PMID:40526810 | DOI:10.1071/SH24230

PLoS One. 2025 Jun 17;20(6):e0321204. doi: 10.1371/journal.pone.0321204. eCollection 2025.

ABSTRACT

Many investors and financial managers view portfolio optimisation as a critical step in the management and selection processes. This is due to the fact that a portfolio fundamentally comprises a collection of uncertain securities, such as equities. For this reason, having a solid understanding of the elements responsible for these uncertainties is absolutely necessary. Investors will always look for a portfolio that can handle the required amount of risk while still producing the desired level of expected returns. This article uses feature-based models to investigate the primary elements that contribute to the optimal composition of a specific portfolio. These models make use of physical analyses, such as the Fourier transform, wavelet transforms and the Fourier-Mellin transform. Motivated by their use in medical analysis and detection, the purpose of this research was to analyse the efficacy of these methods in establishing the primary factors that go into optimising a particular portfolio. These geometric features are input into artificial neural networks, including convolutional and recurrent networks. These are then compared with other algorithms, such as vector autoregression, in portfolio optimisation tests. By testing these models on real-world data obtained from the US stock market, we were able to obtain preliminary findings on their utility.

PMID:40526747 | DOI:10.1371/journal.pone.0321204