Nevin Manimala

Inquiry. 2025 Jan-Dec;62:469580251380412. doi: 10.1177/00469580251380412. Epub 2025 Oct 31.

ABSTRACT

Rural U.S. residents face higher mortality rates and reduced access to primary care physicians. Prior studies report mixed findings on physician supply and health outcomes, and few have examined whether increasing supply reduces rural-urban mortality disparities. The objective was to quantify the marginal benefits of additional primary care physician supply in rural and urban areas, independent of other healthcare and socioeconomic factors. We conducted a 23-year county-level longitudinal observational study of 2942 U.S. counties (1992-2014). Mortality rates were obtained from CDC WONDER, physician supply and socioeconomic characteristics from the Area Health Resource File, and rural-urban classification from the USDA’s 2013 Rural-Urban Continuum Codes. We estimated regressions of age-adjusted mortality rates as a function of physician supply, rurality, and county-level characteristics. Despite the higher per-capita supply of hospital beds and post-acute care services in rural areas, physician supply was lower and grow more slowly than in urban areas. County-level analysis showed a negative association between physician supply and mortality. In rural counties, greater physician supply was associated with lower mortality rate; an increase of 1 physician was associated with 1.4 (CI: -1.963 to -0.836) and 0.936 (CI: -1.411 to -0.462) fewer deaths per 100 k population of older adults in rural counties adjacent and non-adjacent respectively, compared to 0.038 fewer deaths per 100 k population of older adults in urban areas. The declining physicians supply in areas where the number of physicians is already low is an alarming problem for rural communities. Efforts by policymakers to broaden rural health networks and increase rural medical personnel may be needed to address disparities in access to care and associated mortality outcomes. Although the dataset covers 1992 to 2014, the findings remain highly relevant given the continued rural physician shortages and widening mortality disparities that persist across the United States.

PMID:41170580 | DOI:10.1177/00469580251380412

Biomol Biomed. 2025 Oct 29. doi: 10.17305/bb.2025.13309. Online ahead of print.

ABSTRACT

Bowel perforation represents a prevalent and life-threatening emergency within general surgical pathology. This study aims to evaluate clinical and biochemical parameters that predict mortality in cases of bowel perforation. A retrospective analysis was performed on 144 patients who underwent surgical intervention for bowel perforation between 2019 and 2024. Key variables assessed included the albumin/creatinine ratio, age, serum albumin levels, CRP, and history of COVID-19. Mortality-associated variables were analyzed using univariate and multivariate logistic regression, as well as receiver operating characteristic (ROC) analysis. The mean age of the patients was 60 years, with 84 patients (58.3%) being male. The overall mortality rate was 25%. Independent predictors of mortality identified in the study included an albumin/creatinine ratio <3.38 (odds ratio [OR]: 12.666, p<0.001), age >66 years (OR: 3.273, p=0.036), and serum albumin levels <3 g/dL (OR: 5.653, p=0.002). ROC analysis indicated that the area under the curve (AUC) for the albumin/creatinine ratio was 0.879, establishing it as the parameter with the highest predictive accuracy for mortality. Among patients with a history of COVID-19, ischemia was the predominant cause of perforation (87.5%), while malignancy was the leading cause (41.4%) in those without a COVID-19 history. This difference in etiology was statistically significant (p<0.001). In conclusion, the albumin/creatinine ratio, age, and serum albumin levels are robust parameters for predicting mortality in bowel perforation cases. Furthermore, a history of COVID-19 significantly increases the risk of bowel perforation due to ischemia.

PMID:41170570 | DOI:10.17305/bb.2025.13309

Circ Heart Fail. 2025 Oct 31:e013496. doi: 10.1161/CIRCHEARTFAILURE.125.013496. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with cardiovascular conditions like heart failure (HF) often exhibit significant heterogeneity of the risk of clinical events. In clinical trials, large risk heterogeneity can result in an underestimation of treatment effects derived from Cox proportional hazards models. This occurs due to selection bias when estimating the hazard ratio, stemming from a disproportionate reduction of event-free patients in the control group compared with an effective active group over time, ultimately reducing the statistical power. Therefore, it is important to explore alternative analysis methods for outcome trials that are robust with respect to risk heterogeneity.

METHODS: We used clinical data from 2 dapagliflozin HF trials-DAPA-HF (Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction) and DELIVER (Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction) to characterize the extent of risk heterogeneity and nonproportionality of hazards in HF. We then evaluated a candidate method for estimating treatment effects in HF outcome trials, namely the survival proportional odds model, and compared this to traditional Cox regression in a simulation study.

RESULTS: In the dapagliflozin trials, nonproportional hazards were a larger issue in the HFpEF population of the DELIVER trial compared with the more homogeneous heart failure with reduced ejection fraction population of the DAPA-HF trial. In simulations of populations with varying degrees of heterogeneity, the survival proportional odds model was more robust to heterogeneity and demonstrated higher power compared with traditional Cox regression in high heterogeneity populations, while performing similarly or slightly worse in more or less heterogeneous populations. Reanalyses of the dapagliflozin trials confirmed these findings, with the survival proportional odds model providing consistently higher power in the DELIVER trial and similar power in the DAPA-HF trial.

CONCLUSIONS: In HF trials, the survival proportional odds model is a viable and more robust alternative for analyzing time to event outcomes, also providing an intuitive interpretation of the treatment effect directly linked to survival probability: improved odds of being event-free in the active group compared with the control group.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03036124 and NCT03619213.

PMID:41170566 | DOI:10.1161/CIRCHEARTFAILURE.125.013496

Glob Health Action. 2025 Dec;18(1):2576369. doi: 10.1080/16549716.2025.2576369. Epub 2025 Oct 31.

ABSTRACT

BACKGROUND: Reliable measurement of occupational stress is essential for designing effective interventions for healthcare workers; however, Vietnam currently lacks culturally validated assessment tools.

OBJECTIVES: To develop and validate the Healthcare Worker Stress Scale – Vietnam (HWSS-V), a profession-inclusive, culturally grounded instrument that extends the Health Professions Stress Inventory (HPSI) and the Nursing Stress Scale (NSS) by adding Vietnam-salient domains and crisis-monitoring utility.

METHODS: We conducted a cross-sectional survey of 520 physicians, nurses, and medical technicians at two university hospitals (June-December 2021). Fifty items adapted from HPSI/NSS underwent forward – backward translation and expert review. Psychometric evaluation included item-level content validity index (I-CVI), scale-level content validity index (S-CVI), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing (Cronbach’s alpha).

RESULTS: All fifty items showed strong content validity (I-CVI ≥0.80; κ 0.67-0.97; S-CVI = 0.90). EFA supported a five-factor structure. After removing six low-loading items, forty-four items explained 87.1% of variance with excellent reliability (overall Cronbach’s alpha = 0.96; subscales 0.85-0.95). CFA indicated acceptable fit (Root Mean Square Error of Approximation = 0.077; Standardized Root Mean Squared Residual = 0.060; Tucker – Lewis Index = 0.827; Comparative Fit Index = 0.816).

CONCLUSIONS: HWSS-V enables practical hospital-level stress surveillance and quality improvement. Hospitals can: (i) embed HWSS-V into biannual staff health checks to benchmark units and triage high-risk groups; (ii) integrate scores into dashboards to trigger tailored responses; and (iii) deploy rapid assessments during crises (e.g. outbreaks, patient surges) to guide resource allocation. By addressing culturally specific stressors across major clinical professions, HWSS-V provides actionable capabilities beyond HPSI/NSS for Vietnam’s hospitals.

PMID:41170556 | DOI:10.1080/16549716.2025.2576369

Exp Biol Med (Maywood). 2025 Oct 15;250:10610. doi: 10.3389/ebm.2025.10610. eCollection 2025.

ABSTRACT

Many studies reported that glaucoma is associated with cardiovascular disease (CVD). This study aims to investigate the potential causal relationship between glaucoma and CVD using a bidirectional two-sample Mendelian randomization (MR) analysis. The genome-wide association studies (GWAS) of glaucoma and CVD were downloaded from the IEU OpenGWAS project. The CVD included unstable angina pectoris (UAP), coronary artery disease (CAD), high blood pressure (HBP), myocardial infarct (MI), heart failure (HF), ischemic stroke (IS), atrial fibrillation (AF), and pulmonary embolism (PE). The inverse variance weighting (IVW) analysis was the primary method in MR analysis. Meanwhile, sensitivity analysis and statistical power tests were performed. The random effects IVW method showed a causal relationship between glaucoma and a decreased risk of MI (Odds ratio (OR): 0.94, 95% confidence interval (CI): 0.89-0.99; P = 0.012). In the reverse MR analysis, genetic susceptibility of UAP (OR: 1.12, 95% CI: 1.02-1.23; P = 0.022), CAD (OR: 1.1, 95% CI: 1-1.21; P = 0.041), and HBP (OR: 1.83, 95% CI: 1.25-2.67; P = 0.002) was significantly linked to an increased risk of glaucoma. MR-Egger (P = 0.005) and IVW (P = 0.005) methods found that HBP presented different degrees of heterogeneity. The random effects IVW method also demonstrated that HBP is the risk factor for glaucoma (P = 0.0017). Although reverse MR initially suggested a potential association between CAD and glaucoma, MVMR showed no causal relationship after adjusting for obesity and BMI. The MR analysis found that glaucoma serves as a protective factor for MI, while UAP and HBP were risk factors for glaucoma in the European population, which may contribute to preventing and managing glaucoma and CVD.

PMID:41170525 | PMC:PMC12568447 | DOI:10.3389/ebm.2025.10610

Chem Sci. 2025 Oct 29. doi: 10.1039/d5sc05991g. Online ahead of print.

ABSTRACT

Exotic cycloaddition entrance channels were discovered for the bimolecular gas-phase reactions of the phenylethynyl radical (C₆H₅CC, X²A₁) with ethylene-d₄ (C₂D₄) and propylene (C₃H₆) as explored under single-collision conditions utilizing the crossed molecular beams technique combined with electronic structure and statistical calculations. Connecting the concepts of barrierless entrance channels, excited states, and facile non-photochemically activated cycloadditions, the reaction pathway features an unconventional thermal [2 + 2] cycloaddition forming a four-membered ring collision complex followed by multiple isomerizations prior to unimolecular decomposition via atomic hydrogen loss to (un)substituted naphthalenes-naphthalene-d₄ (C₁₀H₄D₄) and 1-/2-methylnaphthalene (C₁₁H₁₀). The small energy gap between the singly-occupied a₁ highest occupied molecular orbital (HOMO) with a σ-character and the underlying doubly-occupied b₁ molecular orbital with a π-character allows a facile promotion of an electron. This in turn enables a versatile low-temperature reactivity of phenylethynyl, where the end-on and side-on barrierless approaches of ethylene are due to its interaction with the σ and π orbitals, respectively, thus suggesting this mechanism as a possible method for tuning substituents in polycyclic aromatic hydrocarbon (PAH) formation and highlighting its versatility as a probe of fundamental carbon chemistry via counterintuitive cycloaddition reactions under single-collision conditions.

PMID:41170523 | PMC:PMC12569633 | DOI:10.1039/d5sc05991g

Biomed Res Int. 2025 Oct 29;2025:4866275. doi: 10.1155/bmri/4866275. eCollection 2025.

ABSTRACT

BACKGROUND AND OBJECTIVE: Cameroon, located in Central Africa, is characterized by a high endemicity of hepatitis B. National studies estimate the prevalence of HBs antigen carriage to range between 8% and 15% in the general population. Identified high-risk groups include adolescents and young adults, among whom university students represent a vulnerable population. The objective of this study was to assess the seroprevalence of hepatitis B viral biomarkers among students at the University of Yaoundé II in Cameroon.

METHODS: We conducted a cross-sectional analytical study from February 20 to June 20, 2024. Samples were collected at the Soa campus of the University of Yaoundé II. Initial testing was performed using rapid diagnostic tests at the university, followed by ELISA (Fortress Diagnostics) at the blood bank of the Central Hospital of Yaoundé. The detection of anti-HBs, HBe antigen (HBeAg), anti-HBe, and anti-HBc was carried out using the Hightop HBV 5-in-1 rapid test. Data were processed and analyzed using Microsoft Excel 2019 and SPSS Version 25. The chi-square test, Fisher’s exact test, and odds ratio calculations for comparing proportions and logistic regression were used to search for risk factors. The result was significant with a p value less than 5%.

RESULTS: A total of 250 students were tested. HBs antigen was positive in eight students (3.2%). Among these, anti-HBs and HBeAg were absent, while anti-HBe was positive in six out of eight (75.0%) and anti-HBc was positive in all eight cases (100%). Only two students (0.8%) had been vaccinated against hepatitis B.

CONCLUSION: All eight HBsAg-positive students were in the chronic phase of hepatitis B infection. A history of blood transfusion and unprotected sexual intercourse was strongly associated with HBV infection. Vaccination coverage was extremely low, highlighting the need for targeted immunization programs in this population. Educational and awareness efforts regarding transmission routes and preventive measures must be strengthened.

PMID:41170507 | PMC:PMC12571039 | DOI:10.1155/bmri/4866275

Biomed Res Int. 2025 Oct 29;2025:4302237. doi: 10.1155/bmri/4302237. eCollection 2025.

ABSTRACT

Pediatric drug prescriptions raise significant safety concerns, particularly when potentially inappropriate medications are involved. This study is aimed at identifying and evaluating the frequency of antimicrobial and psychotropic medications considered potentially inappropriate when prescribed by dentists to children and adolescents in Brazil. A cross-sectional study was conducted using secondary data from the National System for Controlled Products Management (SNGPC) between December 2020 and November 2021. To assess the frequency of adverse drug reactions (ADRs), medications were classified according to the Key Potentially Inappropriate Drugs in Pediatrics (KIDs’ List). Data were organized in Excel and analyzed descriptively. Negative binomial regression models were used to estimate prevalence ratios (PRs) with 95% CI, adjusted for age and gender. Analyses were performed in SPSS Version 29.0. A total of 204,026 dental prescriptions for individuals under 18 years of age were recorded over the 12 months. The overall prescription rate of risky medication was 2.2 per 10,000 pediatric patients. Among the risky prescriptions, antibiotics were the most frequently dispensed, accounting for 41.2%, with azithromycin being the most commonly prescribed (68.5%). The Southeast region showed the highest frequency of both total and risky prescriptions. Males and neonates/infants received a higher number of risky prescriptions. These findings underscore the urgent need for personalized clinical guidelines for pediatric dental prescribing in Brazil. Promoting the rational use of medications in this population is essential to minimizing ADRs and improving patient safety.

PMID:41170506 | PMC:PMC12570961 | DOI:10.1155/bmri/4302237

Front Public Health. 2025 Oct 15;13:1676418. doi: 10.3389/fpubh.2025.1676418. eCollection 2025.

ABSTRACT

BACKGROUND: Social determinants of health (SDoH) are regarded as the fundamental causes of health and disease. Nevertheless, the relationship between SDoH and mortality risk in osteoarthritis (OA) patients remains poorly understood. This study aims to examine the associations between SDoH and all-cause or cardiovascular mortality risks among OA patients.

METHODS: Analysis of data from ten National Health and Nutrition Examination Survey (NHANES) cycles (1999-2018) encompassing 4,681 OA participants was conducted. Multivariable Cox proportional hazards models and Kaplan-Meier survival analyses were employed to assess the associations between SDoH and mortality outcomes, encompassing all-cause mortality and cardiovascular mortality. Restricted cubic spline (RCS) modeling was employed to assess potential non-linear associations. Subgroup analyses and interaction evaluations were subsequently performed to investigate the consistency of the observed associations across predefined demographic and clinical subgroups.

RESULTS: Over a median follow-up of 84 months, 1,300 participants died, including 447 cardiovascular deaths. In the fully adjusted multivariable model, Cox proportional hazards models showed that each 1-point increase in the cumulative SDoH score are associated with a 15% increased risk of all-cause mortality (HR = 1.15, 95% CI: 1.11-1.19) and a 13% elevated risk of cardiovascular mortality (HR = 1.13, 95% CI: 1.06-1.21). Most notably, Individuals with ≥5 adverse SDoH factors had a 119% higher risk of all-cause mortality (HR = 2.19, 95% CI: 1.72-2.79) and a 109% greater risk of cardiovascular mortality (HR = 2.09, 95% CI: 1.30-3.37) compared to those without any adverse factors. Kaplan-Meier survival curves further indicated significantly worse cumulative survival in high SDoH burden groups (Log-rank p < 0.001). Moreover, RCS analyses confirmed a linear dose-response gradient for SDoH levels and mortality risk (Non-linearity p > 0.05). Subgroup analyses identified stronger SDoH to all-cause mortality associations in low-BMI participants than high-BMI counterparts (Interaction p = 0.034).

CONCLUSION: Among US adults with OA, adverse SDoH are associated with increased risks of all-cause mortality and cardiovascular mortality. Developing and implementing innovative public health approaches aimed at SDoH is crucial for mitigating premature mortality and addressing health inequities in this population. Integrating SDoH assessment into OA clinical management pathways and public health programs may improve prognostic outcomes; however, future research should validate these findings through large-scale prospective cohort studies and intervention trials.

PMID:41170494 | PMC:PMC12568563 | DOI:10.3389/fpubh.2025.1676418

Front Public Health. 2025 Oct 15;13:1676425. doi: 10.3389/fpubh.2025.1676425. eCollection 2025.

ABSTRACT

OBJECTIVE: The perceived burdensomeness is a negative emotion and cognition that arises from an individual’s belief that they place an excessive burden on others. For older adult hemodialysis patients who migrated with their families, they not only endure the pain of their illness but also face the challenges of living in a different place. They worry that their illness will burden their families, and perceived burdensomeness may be even more pronounced. This study aimed to explore the trend of perceived burdensomeness over time and its influencing factors in older adult migrant hemodialysis patients in China.

METHODS: A longitudinal study was conducted on 120 older adult hemodialysis patients who migrated with their families in Qilu Hospital of Shandong University from June 2022 to October 2023. The patients were surveyed using the perceived burdensomeness subscale, general information questionnaire, and family support scale at T1 (first admission for hemodialysis), T2 (6 months after hemodialysis), and T3 (12 months after hemodialysis). Changes in perceived burdensomeness and family support were analyzed. Generalized estimating equations were used to analyze factors influencing perceived burdensomeness among older adult migrant hemodialysis patients.

RESULTS: This study initially included 120 older adult hemodialysis patients who migrated with their families as research subjects, and no patient dropped out during the study. Among them, 61 were male, with an average age of (71.9 ± 7.5) years. 86 were married, and 34 were divorced or widowed. 68 were able to take care of themselves, and 52 were unable to. 74 had one adult child, 36 had two adult children, and 10 had three or more adult children. The perceived burdensomeness scores of patients showed a gradually increasing trend across the three time points (T1: 23.29 ± 3.82, T2: 23.98 ± 3.84, and T3: 24.58 ± 3.84), remaining consistently at a high level. The family support scores showed a gradually decreasing trend (T1: 10.25 ± 1.91, T2: 9.70 ± 1.84, and T3: 9.13 ± 1.88). The differences in both perceived burden and family support scores across the three time points were statistically significant (F = 3.337, 10.702, all p < 0.05). Generalized estimating equation analysis revealed that marital status, household registration, family income per capita, number of adult children, self-care ability, comorbidities, dialysis frequency, and family support significantly influenced the changes of perceived burdensomeness among older adult migrant hemodialysis patients (P<0.05).

CONCLUSION: The perceived burdensomeness of older adult migrant hemodialysis patients shows a trend of gradual increase over time and is at a relatively high level. Targeted intervention measures should be formulated according to the patients’ marital status, household registration, family income per capita, number of adult children, self-care ability, comorbidities, dialysis frequency and family support to improve the patients’ perceived burdensomeness, mental health level and quality of life.

PMID:41170492 | PMC:PMC12568331 | DOI:10.3389/fpubh.2025.1676425