Nevin Manimala

BMC Health Serv Res. 2025 Apr 26;25(1):609. doi: 10.1186/s12913-025-12806-6.

ABSTRACT

BACKGROUND: The COVID-19 pandemic presented unprecedented complexity for health care seeking globally. Little is known on how people living with HIV (PLHIV) and other co-morbidities including hypertension accessed healthcare services in resource limited settings like Uganda. Therefore, we explored qualitatively how the COVID-19 pandemic which was characterized by travel restrictions, social distancing requirements, and a heightened COVID-19 response impacted health care seeking for PLHIV and health care provision by providers in this context. We explored experiences of both PLHIV with hypertension who sought care and healthcare providers who offered HIV and hypertension services at two peri-urban HIV clinics; Kira Health center and Kisubi Hospital, in Uganda.

METHODS: We conducted 32 in-depth interviews at two peri-urban HIV clinics in Uganda with PLHIV and hypertension and their health care providers. We sought to understand PLHIV’s experiences seeking health care services and health care providers’ experiences delivering chronic care. We used an inductive thematic analysis drawing on the socio-ecological framework to explore this research question.

RESULTS: Our findings reveal that that the COVID-19 pandemic presented an extraordinary set of challenges for individuals with chronic conditions who required routine healthcare services. The Uganda government’s stringent public health measures apparently made it difficult for patients to access health care, impacted jobs, resulted in job losses, reduced income, and food scarcity. Additionally, healthcare providers prioritized COVID-19 related health services, diverting both material and human resources away from PLHIV with co-morbidities, which impacted continuity of care.

CONCLUSION: These findings highlight how the COVID-19 pandemic exacerbated PLHIV’s fragility suggesting that health systems may need support to cope with the demands of chronic care management especially during health emergencies such as pandemics. There is an urgent need to strengthen the health system in Uganda enabling resilience to deal with shocks resulting from major health outbreaks.

PMID:40287702 | DOI:10.1186/s12913-025-12806-6

J Ovarian Res. 2025 Apr 26;18(1):85. doi: 10.1186/s13048-025-01671-w.

ABSTRACT

BACKGROUND: Tri-ortho-cresyl phosphate (TOCP), a widely used plasticizer, has been shown to impair ovarian function. While tanshinone IIA exhibits ovarian protective effects in aging models, its potential to counteract TOCP-induced ovarian damage and associated signaling mechanisms remains unexplored. This study investigates the therapeutic effects of tanshinone IIA on TOCP-damaged ovaries in mice, with focus on Hippo, AKT, and MAPK pathways.

RESULTS: TOCP exposure (200 mg/kg/d for 28 days) significantly reduced ovarian follicle counts (primordial, preovulatory, and mature follicles) and disrupted hormone levels (elevated Estrogen(E2), decreased Follicle stimulating hormone(FSH)/ Anti-Mueller tube hormone(AMH)) in mice. Treatment with high-dose tanshinone IIA restored ovarian structure and function: growing follicle counts increased significantly (p < 0.001), FSH (p < 0.001) and AMH (p < 0.001) levels surged to marked degrees, while E2 (p < 0.001) levels decreased significantly. All changes were statistically significant. Immunohistochemistry and Western blot analysis revealed that tanshinone IIA restored ovarian AMH and Follicle-Stimulating Hormone Receptor (FSHR) protein expression, which were suppressed by TOCP. In vitro experiments further demonstrated that TOCP dose-dependently inhibited granulosa cell viability (p < 0.001) and proliferation (p < 0.001). Co-treatment with tanshinone IIA (0.01 mM) rescued cell viability (p < 0.01) and proliferation (p < 0.05). Mechanistically, tanshinone IIA suppressed ovarian apoptosis (p < 0.01) and modulated multiple signaling pathways: it attenuated Hippo signaling (p < 0.05) and reactivated PI3K/AKT (p < 0.05), p38 (p < 0.05), and ERK1/2 (p < 0.01) pathways.

CONCLUSIONS: Tanshinone IIA alleviates TOCP-induced ovarian dysfunction primarily through coordinated modulation of Hippo signaling and AKT/MAPK pathway activities, offering a potential therapeutic strategy for chemical-induced ovarian injury.

PMID:40287698 | DOI:10.1186/s13048-025-01671-w

BMC Med Educ. 2025 Apr 26;25(1):615. doi: 10.1186/s12909-024-06435-6.

ABSTRACT

INTRODUCTION: Surgical trainees spend key years of their reproductive potential in training. However, their family planning needs are seldom addressed and remain poorly understood. This study was designed to understand the current landscape of family planning among General Surgery (GS) trainees and to identify the career-specific barriers they face.

METHODS: We created a 26-question survey to assess GS trainee experiences surrounding family planning. The survey was distributed to residency and fellowship program directors nationwide. Outcome measures were evaluated using Pearson’s Chi-Square test and Fisher’s exact test.

RESULTS: Two hundred thirty-four US GS surgical trainees completed the survey (male = 32.1%, female 66.2%, unreported = 1.7%). Work hours (p = 0.007) and female gender (p = 0.002) were associated with delayed childbirth. Time (93.2%), career/education goals (63%), and cost (59.5%) were most reported to prohibit childbearing. Females were significantly more impacted by time (p = 0.021) and career/education goals (p = 0.001) and more frequently considered fertility preservation (p < 0.001).

CONCLUSION: Time constraints and career goals are disproportionally more prohibitive to female surgeons when considering childbearing. Institutional resources should be tailored to gender-specific needs and address barriers to family planning.

PMID:40287697 | DOI:10.1186/s12909-024-06435-6

J Health Popul Nutr. 2025 Apr 26;44(1):138. doi: 10.1186/s41043-025-00856-9.

ABSTRACT

BACKGROUND: The increasing prevalence of adolescent overweight and obesity poses significant public health challenges, particularly in China. With the rapid adoption of the Internet, adolescents’ lifestyles, including dietary habits and physical activity levels, have undergone substantial changes. However, the causal relationship between Internet use and adolescent nutritional outcomes, especially in transitional economies, remains underexplored.

METHODS: This study employs longitudinal data from the China Health and Nutrition Survey (CHNS) and China Family Panel Studies (CFPS) to investigate the impact of Internet use on adolescents’ BMI-for-age z-scores and overweight status. An endogenous switching regression (ESR) model addresses potential self-selection bias. Heterogeneity analyses examine urban-rural and gender differences, while mechanism analyses identify dietary pathways influencing outcomes.

RESULTS: Internet use increases BMI-for-age z-scores and the likelihood of being overweight among adolescents, with more intensive Internet use further amplifying these effects. These effects hold across urban and rural areas as well as for both boys and girls, though the magnitude may vary. Mechanism analyses suggest that Internet use enhances protein intake while also leading to higher consumption of fast food and soft drinks.

CONCLUSION: Internet use increases BMI-for-age z-scores and overweight risks among adolescents, reinforcing the need for targeted interventions to mitigate its negative health impacts. Policies promoting healthier online behaviors and better access to nutritional education are essential to ensuring that adolescents develop healthy lifestyle habits in the digital age. Addressing these challenges can help policymakers develop equitable health strategies for adolescents in transitional economies.

PMID:40287688 | DOI:10.1186/s41043-025-00856-9

Cardiovasc Diabetol. 2025 Apr 26;24(1):183. doi: 10.1186/s12933-025-02742-4.

ABSTRACT

BACKGROUND: Cardiovascular-Kidney-Metabolic (CKM) syndrome, as a new clinical concept, emphasizes the multifaceted interaction between metabolic disorders, chronic kidney disease (CKD), and cardiovascular disease (CVD). Some evidence suggests atherogenic index of plasma (AIP) is strongly linked to cardiovascular mortality. However, data on its association with mortality across CKM syndrome remain scarce. Our study aimed to investigate the association between AIP and all-cause and cardiovascular mortality among individuals with CKM syndrome.

METHODS: This study included 15,703 participants with CKM syndrome from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. The AIP index is calculated as log10(triglycerides/high-density lipoprotein cholesterol [TG/HDL-C]). Mortality outcomes were determined by linking NHANES participants with the National Death Index (NDI), with follow-up data available through December 31, 2019. Kaplan-Meier (K-M) survival curves, Cox regression analysis, restricted cubic spline (RCS) and subgroups analysis were used to explore the relationship between AIP levels and mortality in individuals with CKM syndrome.

RESULTS: Over a median follow-up of 7.67 years, a total of 1570 deaths were documented, including 344 cardiovascular deaths. Kaplan-Meier survival analysis demonstrated that the lowest all-cause and CVD mortality rates were observed in the lowest AIP tertile. Compared with individuals in the lowest AIP tertile, Cox analysis indicated that those in highest tertile were associated with a higher risk of all-cause and CVD mortality (HR = 1.19, 95% CI 1.08-1.31, P < 0.001; HR = 1.38, 95% CI 1.22-1.57, P < 0.001) after adjusting for covariates, respectively. As a continuous variable, AIP levels had an approximate positive linear dose-response relationship with all-cause and CVD mortality. Subgroup analysis revealed no significant interactions with the examined variables, except for gender.

CONCLUSIONS: This study demonstrated that elevated AIP levels in individuals with CKM syndrome are strongly linked to higher mortality risks, notably all-cause mortality in advanced stages and CVD mortality across both non-advanced and advanced stages. These findings further highlight the importance of AIP as a valuable risk biomarker, providing a simple and effective tool for identifying mortality risk in individuals with CKM syndrome.

PMID:40287685 | DOI:10.1186/s12933-025-02742-4

BMC Health Serv Res. 2025 Apr 26;25(1):608. doi: 10.1186/s12913-025-12746-1.

ABSTRACT

BACKGROUND: Given the home health care industry’s growth, increasing demand for workers, and complex patient care needs, investigating initiatives to maintain home health care workers’ health and ability to work is crucial. This study aims to assess the feasibility of an organizational intervention for equal distribution of physical and psychosocial work demands among home health care aides.

METHOD: We conducted a 7-week quasi-experimental feasibility study at a Danish home health care institution with 27 home health care aides. The 6SQuID framework was used to develop, test and evaluate the feasibility of the organizational intervention, inspired by the ‘Goldilocks Work Principle’. The intervention consisted of three activities: (1) classification workshop, (2) individual dialogue with a schedule coordinator, and (3) reorganizing work schedules. Feasibility was assessed through: (1) acceptability evaluated by interview and questionnaire post-intervention, (2) fidelity assessed by documentation during intervention, and (3) potential effects on selected psychosocial factors and physical work demands evaluated pre-post intervention with technical measurements and questionnaire.

RESULTS: Nineteen home health care aides participated in the evaluation of the intervention. Most of the home health care aides (73.33%) reported to like or really like the intervention. The interviewees expressed general acceptance of both the intervention activities and the overall aim of the intervention. Most home health care aides (77.8%) participated in the Classification workshop and 124 citizens were classified. All home health care aides participated in the Individual dialogue. No significant changes were seen in the Reorganized work schedules (p > 0.05). Physical and emotional fatigue and physical exertion showed statistically significant change (p < 0.05), with a mean difference of 17 and 11 (100 point scale), and 1.7 (10 point scale) points respectively.

CONCLUSION: This study found components of the intervention to be feasible, but concludes that adaptions to enhance implementation addressing barriers related to time pressure, improving fidelity to the intervention, and ensuring practical applicability within the home health care context are critical for future success.

TRIAL REGISTRATION: The study was registered in the ISRCTN registry under registration number ISRCTN15131198 on August 8, 2023.

PMID:40287681 | DOI:10.1186/s12913-025-12746-1

BMC Public Health. 2025 Apr 26;25(1):1565. doi: 10.1186/s12889-025-22394-z.

ABSTRACT

BACKGROUND: Recent Western studies link long-term particulate matter (PM) exposure to type 2 diabetes mellitus (T2DM) progression, but little is known for low- and middle-income countries. This study aimed to estimate the relationship between PM exposure and T2DM progression in China, and also assess urban-rural disparities.

METHODS: Using 7-year cohort data of 1.3 million Chinese over 40, a multistate model estimated the associations of PM exposure with T2DM progression. Covariates included demographics, socioeconomic status, health behaviors, medication, and meteorological factors. Sub-sample analyses were done for rural and urban areas.

RESULTS: For participants exposed to high levels of ${\text{PM}}_{2.5}$ , the 5-year absolute risks of developing T2DM and its complications were 4.31% (95% CI: 4.22-4.40) and 31.04% (95% CI: 29.97-32.08), respectively. In the low- ${\text{PM}}_{2.5}$ -exposure group, these risks were 3.82% (95% CI: 3.74-3.91) and 30.55% (95% CI: 29.43-31.65). For each 10 µg/m³ increase in ${\text{PM}}_{2.5}$ exposure, the HRs (95% CI) for the progression from no T2DM diagnosis to a T2DM diagnosis were 1.13 (1.13-1.14), and for the progression from T2DM to the development of T2DM complications were 1.04 (1.03-1.06). Moreover, the HRs (95% CI) for mortality risk were 1.09 (1.08-1.09) for participants without T2DM, 1.06 (1.00-1.14) for those with T2DM, and 1.10 (1.05-1.16) for those with T2DM complications. Similar associations were observed for other PM-related metrics. In rural areas, PM exposure was more strongly associated with the progression from T2DM and its complications to death. Conversely, in urban areas, PM exposure had a stronger association with the progression from a non-T2DM state to a formal T2DM diagnosis. Urban residents are exposed to higher levels of toxic components like heavy metals, potentially increasing T2DM risk, yet urban healthcare infrastructure offers protection against T2DM-related mortality.

CONCLUSIONS: PM exposure is significantly associated with T2DM progression. Urban areas should focus on primary prevention, while rural areas need to improve secondary and tertiary prevention like healthcare services.

PMID:40287677 | DOI:10.1186/s12889-025-22394-z

BMC Med Educ. 2025 Apr 26;25(1):618. doi: 10.1186/s12909-025-07023-y.

ABSTRACT

BACKGROUND: This study aimed to assess the effectiveness of an integrated Team-Based Learning (TBL) and Peer Teaching (PT) model in enhancing theoretical knowledge, clinical competencies, and engagement among dental residents, offering insights for improving stomatology education.

METHODS: This study was conducted at the affiliated stomatology hospital of Guangzhou medical university between 2021 and 2023. The 2021-22 cohort (n = 39) students received a traditional teacher-centered approach, whereas the 2022-23 cohort (n = 43) underwent a combined TBL and PT approach. Following a three-month training period, theoretical exams and OSCE were administered. Student engagement was evaluated using the SCEQ, and satisfaction was assessed through SSS. Data were analyzed using independent t-tests, Mann-Whitney U tests, and χ² tests, with statistical significance set at p < 0.05.

RESULTS: No significant baseline differences were observed in demographics. TBL + PT cohort demonstrated significantly higher theoretical test scores and OSCE performance in most assessed skills, including pulpotomy, tooth preparation, incision and suturing, and patient intake. Engagement scores were also significantly higher in the domains of emotional engagement and participation/interaction, and overall student satisfaction improved, particularly regarding teaching quality and student-centric learning methods. Word cloud analyses of student feedback revealed a stronger emphasis on collaboration, participation, and innovation in the TBL + PT cohort compared to the traditional group.

CONCLUSIONS: Incorporating Team-Based Learning and Peer Teaching into standardized dental residency training markedly enhanced theoretical knowledge, clinical proficiencies, and learner engagement. This instructional strategy improved residents’ technical competencies and cultivated stronger team collaboration, communication, and higher satisfaction levels, offering a promising alternative to traditional teaching for residency training in oral medicine.

PMID:40287670 | DOI:10.1186/s12909-025-07023-y

BMC Vet Res. 2025 Apr 26;21(1):290. doi: 10.1186/s12917-025-04533-1.

ABSTRACT

BACKGROUND: Periodontal disease is common in dogs and is initiated by the build-up of plaque on the tooth surface. There is evidence that the feeding of dry diets may help prevent the build-up of plaque and calculus compared to softer wet diets. The primary objective of this study was to determine whether diet format influences the microbial composition of dental plaque.

RESULTS: Subgingival (SG) and gingival margin (GM) plaque samples were collected from 28 Yorkshire terriers, housed within a research facility, between 37 and 53 weeks of age. Dogs were fed either wet commercial diets, dry commercial diets, or a simultaneous offering of the two. Illumina sequencing of the 16 S rRNA gene (variable regions 3 and 4) of 43 SG and 43 GM plaque samples resulted in the generation of 6,725,682 paired end reads. Exploratory factor analysis, a statistical method for dimensionality reduction of multivariate data, was used to identify groups of covarying bacterial species. Subsequent mixed effects modelling revealed significant differences in the scores of two of these groupings indicating systematic differences in prevalences of their component taxa. One grouping revealed that for GM plaque samples, the profile of bacterial species most descriptive of the wet diet was biased towards those associated with periodontal disease whereas for the dry diet it was biased towards those associated with healthy gingiva. The dogs fed a mixture of wet and dry diets had bacterial profiles in between the wet and dry diets, i.e. a mix of both health and disease associated taxa. The other bacterial grouping indicated that, in dogs fed a wet diet only, GM plaque was significantly associated with bacteria that preferred aerobic conditions whereas SG plaque was associated with taxa that favoured anaerobic conditions.

CONCLUSIONS: Although dry diets shifted the bacterial community towards a healthier profile compared to wet diets there was no evidence of improved periodontal health. Additional methods to maintain dental hygiene should therefore be promoted to ensure effective management of periodontal disease in dogs.

PMID:40287669 | DOI:10.1186/s12917-025-04533-1

Molecules. 2025 Apr 3;30(7):1609. doi: 10.3390/molecules30071609.

ABSTRACT

Sample pretreatment is one of the most important steps in guaranteeing the success of a chromatographic analysis. The selected methodology must ensure simultaneously that a sample is “clean” enough for analysis and that the target analytes are not removed in the process. This can be especially difficult when working with complex matrices such as natural waters and wastewater. For pharmaceutical active compounds (PhACs) analysis by solid-phase extraction (SPE) followed by ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS), and due to the high level of organic matter in wastewater, the water samples are filtered consecutively through three filters, a paper filter, a glass microfiber filter of 1 µm, and a Nylon filter of 0.45 µm. This filtration allows the sample’s passage through the SPE cartridge to be faster, and there is no cartridge clogging, allowing for greater efficiency in the adsorption process. The big question is whether the PhACs are eliminated during filtration, since they may be adsorbed to organic matter. This work aimed to determine if the best approach for quantifying PhACs in wastewater and surface waters would be to filter them prior or to perform SPE directly. Both approaches analyzed a total of 26 PhACs. Turbidity (TUR) and permanganate index (PI) were determined, and their values were high for samples with a high organic matter content. A statistical analysis was performed to determine the best approach to treat these water samples and whether any correlation existed between PhAC concentrations, PI, and TUR. The PhAC quantification shows a positive correlation with TUR and a negative correlation with PI for most of the target PhACs. However, there are not significantly different results for filtered and not-filtered wastewater samples.

PMID:40286260 | DOI:10.3390/molecules30071609