Nevin Manimala

Public Health Res (Southampt). 2025 Dec 3:1-17. doi: 10.3310/GJMW1501. Online ahead of print.

ABSTRACT

BACKGROUND: The United Kingdom Soft Drinks Industry Levy was introduced in April 2018, resulting both in changes in sugar levels in drinks and purchases of drinks. Both mechanisms could impact on the incidence and prevalence of raised body weight, diabetes and diet-related diseases, and therefore, have implications for economic costs to the health sector.

OBJECTIVES: To model future impacts of the Soft Drinks Industry Levy on population health and health sector costs and to estimate net monetary benefit to the health system.

DESIGN AND METHODS: Proportional multistate lifetable modelling study – open and closed cohort analyses.

SETTING AND POPULATION: All children and adults in the United Kingdom.

INTERVENTION: The Soft Drinks Industry Levy is a two-tier levy of £0.18/l on drinks with between 5 and 8 g of total sugars/100 ml and of £0.24/l on drinks with ≥ 8 g of total sugars/100 ml.

MAIN OUTCOME MEASURES: We evaluated impact of the sugar reduction on: (1) prevalence of overweight and obesity, obesity-related diseases and dental health out to 2050 and (2) lifetime population health (measured in quality-adjusted life-years), change in costs to the health sector and the resulting net monetary benefit.

DATA SOURCES: We estimated a per person reduction in sugar from a previously published interrupted time series analysis, which found an 8.0 g/household/week (95% confidence interval 2.4 to 13.6) reduction in sugar at 1 year after implementation. Our multistate lifetable model is parameterised using data from population health monitoring surveys, the Global Burden of Disease project, the Human Mortality Database and the Office for National Statistics. Health sector costs were obtained from Department of Health and Social Care budget allocations.

RESULTS: The model predicts that the Soft Drinks Industry Levy will reduce the prevalence of overweight and obesity in the United Kingdom by 0.18% points (95% uncertainty interval: 0.059 to 0.31) for males and by 0.20% points (0.064 to 0.34) for females. In the first 10 years of implementation, the reductions in sugar and overweight/obesity are predicted to prevent 270,000 (35,000-600,000) dental caries, 12,000 (3700-20,000) cases of type 2 diabetes, 3800 (1200-6700) cases of cardiovascular diseases and 350 (110-590) cases of obesity-related cancer. For the current United Kingdom population, it is estimated that the Soft Drinks Industry Levy will add 200,000 quality-adjusted life-years (63,500-342,000) over their lifetime and avert £174 million (£53.6-319) in their costs of health care (discounted at United Kingdom Treasury rates). At a United Kingdom Treasury value of £60,000 per quality-adjusted life-year, it is estimated that the Soft Drinks Industry Levy will produce a net monetary benefit of £12.2 billion (£3.88-20.8) for the health system.

LIMITATIONS: Modelled results assume that the effect of the Soft Drinks Industry Levy remains constant into the future. The longevity of the effect of the Soft Drinks Industry Levy has not been tested.

CONCLUSION: This study of the United Kingdom Soft Drinks Industry Levy tiered tax on sugar content provides further evidence that sugar-sweetened beverage taxes have the potential to achieve meaningful improvements in population health and reduce health sector spending.

FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 16/130/01.

PMID:41351382 | DOI:10.3310/GJMW1501

Cell Mol Biol (Noisy-le-grand). 2025 Dec 6;71(11):74-85. doi: 10.14715/cmb/2025.71.11.10.

ABSTRACT

This study aimed to evaluate the risk of hepatitis B virus reactivation (HBVr) in patients with HBV-related rheumatoid arthritis (RA) undergoing TNF inhibitor (TNFi) therapy. A systematic search of Embase, PubMed/MEDLINE, Scopus, Web of Science, ClinicalTrials.gov and the Cochrane Library was conducted, and pooled HBVr rates were calculated using random-effects models with subgroup analyses based on region, HBV serostatus, glucocorticoid use, antiviral prophylaxis, and TNFi type. Data from 15 studies, including 916 patients, were analyzed, revealing a pooled HBVr rate of 2% (95% CI: 0.01-0.03) with low heterogeneity (I² = 0.79%, p = 0.133). Regional variation was observed, with no HBVr cases in European studies (0.01; 95% CI: -0.01-0.03) and a 2% rate in Asian studies (95% CI: 0.01-0.04). HBsAg-positive patients demonstrated significantly higher HBVr rates (16%; 95% CI: 0.04-0.28) compared with HBsAg-negative patients (4%; 95% CI: -0.01-0.09), corresponding to an odds ratio (OR) of 12.60 (95% CI: 3.73-42.53). Patients receiving antiviral prophylaxis had a 6% HBVr rate compared to 3% in those without prophylaxis, though the difference was not statistically significant (OR: 1.30; p = 0.726). Similarly, glucocorticoid use did not significantly influence HBVr risk (6% vs. 5%; OR: 0.73; p = 0.563). HBVr rates also varied by TNFi type, with 4% for adalimumab, 3% for etanercept, and 2% for infliximab. Overall, TNFi therapy in HBV-related RA is associated with a low but clinically relevant risk of HBVr, with higher rates in HBsAg-positive patients and modest variation by region and drug type, while antiviral prophylaxis and glucocorticoid use appear to have no significant effect on risk.

PMID:41351367 | DOI:10.14715/cmb/2025.71.11.10

J Osteopath Med. 2025 Dec 8. doi: 10.1515/jom-2024-0133. Online ahead of print.

ABSTRACT

CONTEXT: The benefits of breastfeeding are well established, from reduced incidence of common childhood infections to decreased incidence of sudden infant death syndrome and infant mortality. Offering support to breastfeeding mothers should be a key aspect of care in the perinatal period.

OBJECTIVES: The purpose of this study was to evaluate whether utilization of a standardized osteopathic manipulative treatment (OMT) protocol as an adjunct to lactation support improves feeding dysfunction in breastfed newborns.

METHODS: This was a single-blinded, randomized, controlled, prospective pilot study of healthy, full-term neonates identified by an International Board Certified Lactation Consultant (IBCLC) as having feeding dysfunction. Neonates were subsequently randomized in an alternating fashion into an OMT protocol treatment vs. sham treatment. Infant LATCH (Latch, Audible swallowing, Type of nipple, Comfort of birth person, and Help birthing person needs holding infant to breast) scores were assessed by nurses and IBCLCs during hospitalization assessed with mean and median score improvement between groups.

RESULTS: Forty infants were included in the study, divided into a sham group (n=21) and OMT group (n=19). The groups had similar characteristics. The change between pre- and postintervention LATCH scores were calculated for each group, respectively. The mean LATCH score change in the OMT group was 2.0±1.8. The mean LATCH score change in the sham group was 0.9±1.2. The mean LATCH score change in the OMT group is statistically significantly greater than the mean LATCH score change in the sham group (p=0.030), indicating that the OMT group had greater improvement in their LATCH score compared to the sham group.

CONCLUSIONS: Healthy newborns with feeding dysfunction who were randomized to receive two OMT treatments during their hospitalization demonstrated a statistically significant moderate improvement in the changes in the median modified LATCH score compared with newborns randomized to the sham group. However, the effect size was moderate, at best. The LATCH score changes between groups cannot be highly attributed to the OMT interventions. However, there were no adverse effects of treatment. These findings suggest that OMT may be a safe adjunct to traditional lactation support in the care of healthy breastfed newborns with feeding dysfunction. Future studies could investigate other factors, such as the length of time that mothers breastfeed their infants after the two initial treatment sessions or potentially including a separate arm for neonates with ankyloglossia.

PMID:41351353 | DOI:10.1515/jom-2024-0133

Psychogeriatrics. 2026 Jan;26(1):e70121. doi: 10.1111/psyg.70121.

ABSTRACT

BACKGROUND: Previous research on caregiver depression has mainly focused on caregivers of late-onset dementia (LOD), whereas studies involving young-onset dementia (YOD) remain limited. This study aimed to examine the associations between psychosocial stressors and depression among YOD and LOD caregivers in Japan.

METHODS: A total of 1798 questionnaires were distributed to family caregivers affiliated with 214 organisations, including dementia family associations and care facilities. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and their associations with psychosocial stressors was analysed through multiple regression analysis both in the dementia onset group and in the total sample.

RESULTS: Of the 380 respondents, 194 were YOD caregivers and 186 were LOD caregivers. The prevalence of elevated depression scores (CES-D ≥ 16) was significantly higher in the YOD group than in the LOD group. Among YOD caregivers, financial difficulties were the strongest psychosocial stressor associated with CES-D scores, followed by caregiving-related lifestyle restrictions and social isolation. In contrast, among LOD caregivers, caregiving-related lifestyle restrictions were most strongly correlated with increased CES-D scores, with social isolation also being significant. Male sex was additionally associated with lower CES-D scores. A comprehensive hierarchical regression, including interaction terms, confirmed that the association between financial difficulties and depression was stronger among YOD caregivers, whereas the impact of caregiving-related lifestyle restrictions was weaker than among LOD caregivers.

CONCLUSIONS: The findings indicate differences between YOD and LOD caregivers in psychosocial stressors linked to depression. These findings underscore the necessity of multifaceted and adaptable support strategies tailored to the distinct characteristics of each group. Furthermore, over half of both caregiver groups exhibited depressive symptoms, with YOD caregivers demonstrating a particularly higher propensity for depression. These findings provide foundational evidence for developing effective support and interventions tailored to the specific stressors experienced by YOD and LOD caregivers to alleviate their depressive symptoms.

PMID:41351314 | DOI:10.1111/psyg.70121

Br J Clin Pharmacol. 2025 Dec 5. doi: 10.1002/bcp.70389. Online ahead of print.

ABSTRACT

AIMS: Post-mortem detection of a medicine following suicide can be due to two main reasons: the decedent was taking that medicine therapeutically before death, and/or the medicine was involved in the suicidal act (poisoning-related suicide). We aimed to investigate how antidepressant concentrations differed between poisoning and non-poisoning suicides. We hypothesized that the predictive value of these concentrations and the separation between poisoning and non-poisoning concentrations would improve by adjusting for dose dispensed to the decedent.

METHODS: We analysed post-mortem toxicology results from suicides in Australia, July 2013 to October 2019, linked to the individual’s dispensing history. Suicides were classified as poisoning- or non-poisoning-related by coroners. We analysed the distribution of concentrations through descriptive statistics, precision-recall curves and quantile regression to compare poisoning and non-poisoning concentrations. We adjusted concentrations by estimated daily dose and total drug quantity dispensed in 90 days and re-assessed model performance.

RESULTS: We had sufficient sample size to analyse nine antidepressants: amitriptyline (n = 149), mirtazapine (n = 399), citalopram (n = 116), escitalopram (n = 297), fluoxetine (n = 183), sertraline (n = 253), duloxetine (n = 122), venlafaxine (n = 261), desvenlafaxine (n = 194). Selective Serotonin Reuptake Inhibitor non-poisoning and poisoning concentrations were similar, with no high certainty threshold for poisoning for citalopram and sertraline. Amitriptyline had the best separation between poisoning and non-poisoning concentrations. Adjustment by estimated daily dose improved the separation of lower quantiles through quantile regression but did not help identify thresholds that separated poisonings and non-poisonings.

CONCLUSIONS: Dose adjustment generally did not improve the separation of poisoning vs non-poisoning suicides, indicating that post-mortem concentrations may not have clear dose-concentration relationships.

PMID:41351311 | DOI:10.1002/bcp.70389

J Agromedicine. 2025 Dec 5:1-7. doi: 10.1080/1059924X.2025.2591051. Online ahead of print.

ABSTRACT

OBJECTIVES: The primary objective of this study was to determine if workers occupationally exposed (WOE) to sheep, specifically shepherds and cheesemakers in central Portugal, are more likely to be seropositive for anti-Toxoplasma gondii IgG compared to the general population. Additionally, the study aimed to explore potential differences in seropositivity between shepherds and cheesemakers, while evaluating age, gender, and activity as possible risk factors for T. gondii infection.

METHODS: A total of 96 WOE, including 21 shepherds and 75 cheesemakers, were tested for anti-T. gondii IgG using a commercial enzyme-linked immunosorbent assay (ELISA). The control group consisted of 192 sera samples from blood donors matched by age, gender, and residence. Chi-square tests with Yates correction were used to compare seroprevalence between WOE and the general population, and between shepherds and cheesemakers. Univariate and multivariable logistic regression analyses were performed to evaluate potential associations between T. gondii seropositivity and factors such as activity, gender, and age.

RESULTS: The overall seroprevalence was 63.5% in the WOE and 52.6% in the general population, with no statistically significant difference (p = .101). Among WOE, 52.4% of shepherds and 66.7% of cheesemakers were seropositive, with no significant difference between the two groups (p = .344). Univariate and multivariable analyses indicated neither activity, age, nor gender were significant risk factors for seropositivity in the case population.

CONCLUSION: The study did not find a significant increased risk of T. gondii seropositivity among shepherds and cheesemakers compared to the general population. While high seroprevalence was observed in both groups, other factors unrelated to occupational exposure may be influencing the risk of T. gondii infection. More research is needed, particularly focusing on cheesemakers, to further explore potential occupational health risks related to T. gondii.

PMID:41351305 | DOI:10.1080/1059924X.2025.2591051

Eur J Public Health. 2025 Nov 29:ckaf217. doi: 10.1093/eurpub/ckaf217. Online ahead of print.

ABSTRACT

There is a need to efficiently identify groups at risk of unmet health service needs. In response, we developed and evaluated the performance of a regression model to assess unmet health service needs in the Finnish population. The study population consisted of population-based Healthy Finland 2022-cohort participants (N = 18 442), aged 20-104. The primary outcome was self-reported unmet need for physician’s or nurse’s services. A total of 38 potential risk factors were evaluated. Statistical models were developed using bootstrap-enhanced LASSO regression (bolasso). Of the participants, 5875 (32%) were classified as experiencing unmet health care need. The C-index from the final model including 15 predictors from the best bolasso models varied between 0.73 and 0.76 and pooled C-index over the imputed data sets was 0.75 (95% CI 0.70-0.79). Fifteen factors-including health-related, socioeconomic variables, heavy alcohol use, experiences with health services, caregiving for others, and language group-were found to be strongly associated with an increased risk of unmet health care needs and may be a useful targets for preventing unmet health care need.

PMID:41351301 | DOI:10.1093/eurpub/ckaf217

J Clin Lab Anal. 2025 Dec 5:e70136. doi: 10.1002/jcla.70136. Online ahead of print.

ABSTRACT

BACKGROUND: This study investigates the potential interplay between gut microbiota and circulating cytokines in Sjögren’s syndrome (SS) through a bidirectional and mediation Mendelian randomization (MR) approach.

METHODS: Summary-level statistics of 473 gut microbiota (n = 5959), 41 circulating cytokines (n = 8293), and SS (ncase = 2735, ncontrol = 399,355) were obtained from genome-wide association studies (GWAS) in European populations. A two-sample MR analysis was employed to investigate the bidirectional causal effects of gut microbiota and circulating cytokines on SS, and mediation analyses were applied to discover potential mediating gut microbiota and circulating cytokines. A series of sensitivity analyses were conducted to address heterogeneity and pleiotropy concerns.

RESULTS: Fifteen taxa were found to be causally associated with SS, and SS had a causal effect on 26 taxa. A bidirectional causal relationship was identified between CAG-269 sp001916065 and SS, and between UBA7703 and SS. Genetically predicted levels of five circulating cytokines-MIG, IL-5, IL-1RA, IL-2RA, and SCGF-β-were found to potentially affect SS, and genetically predicted SS was associated with increased levels of two circulating cytokines, IL-1β and IL-5. A bidirectional causal relationship was identified between circulating IL-5 and SS. Mediation analyses further revealed that circulating cytokines do not mediate the gut microbiome’s influence on SS, and conversely, the gut microbiome does not influence circulating cytokines to affect SS.

CONCLUSION: This study provides compelling evidence for causal effects of gut microbiome composition and circulating cytokines on SS risk. Further mediation analysis suggests that these biological factors may operate independently to influence SS development.

PMID:41351294 | DOI:10.1002/jcla.70136

Transl Behav Med. 2025 Jan 16;15(1):ibaf081. doi: 10.1093/tbm/ibaf081.

ABSTRACT

BACKGROUND: Rising use of electronic nicotine delivery systems (ENDS) and tobacco products among rural youth challenges tobacco control efforts, with higher use rates compared to urban youth. Exposure to tobacco retail outlets (TROs) and marketing influences tobacco use, but the longitudinal pathways of these factors in rural youth are underexplored.

PURPOSE: This study examines the feasibility of app-based ecological momentary assessment (EMA) in capturing real-time exposure to TROs and tobacco marketing and its link to tobacco use and susceptibility among rural youth.

METHODS: Participants (n = 25) residing in Southwest Virginia were recruited for a 14-day EMA sub-study via the Effortless Assessment Research System (EARS) app. We assessed exposure to TROs and tobacco marketing as predictors and tobacco use susceptibility and past 24-hour tobacco use as outcomes. GPS data identified exposure to TROs within 100 m, and associations with tobacco outcomes were examined using generalized linear mixed-effect regression models.

RESULTS: Most participants were 9th graders (36%; range 9th grade-12th grade) and white (56%), with slightly more female (56%) than male (44%). One-third were tobacco-susceptible, and 13% had used tobacco. TRO exposure was higher in activity space outside of the home and school (M = 7.2 exposures) than near home (4.1) or school (2.1). Over 14 days, 328 EMA responses were collected from 25 participants (72.9% response rate), demonstrating EMA’s feasibility. TRO exposure was positively associated with recent tobacco use (P = .04) and negatively associated with recalling combustible tobacco ads (P = .03).

CONCLUSIONS: This study examined the feasibility of app-based EMAs to track rural youth’s exposure to TROs, tobacco marketing, and tobacco outcomes. Findings demonstrate the feasibility of EMA for capturing tobacco-related exposures among adolescents.

PMID:41351280 | DOI:10.1093/tbm/ibaf081

Equine Vet J. 2025 Dec 5. doi: 10.1111/evj.70126. Online ahead of print.

ABSTRACT

BACKGROUND: The widespread assumption that there is minimal potential for pathogen transmission between British racehorse and sport horse populations remains unverified by empirical evidence.

OBJECTIVES: To characterise spatiotemporal patterns of horse attendance at racing and other sport events in Great Britain in 2018.

STUDY DESIGN: Spatiotemporal analysis.

METHODS: Publicly available data from British Horseracing Authority, British Dressage, British Eventing, Endurance GB, and British Showjumping events in Great Britain during 2018 were analysed. Horse attendance was summarised by discipline, month, and season. Venue density was mapped with kernel density estimation. Sport venues within 5 km of racecourses with horse attendance within 24 h of racing were identified and Kulldorff’s spatial scan statistic was used to detect significant time-space clustering of venue use.

RESULTS: Excluding showjumpers, 49,012 horses competed in 8314 events across 598 venues during 2018, generating over 400,000 horse-venue attendances. Most horses (97.2%; n = 47,635/49,012) competed in a single discipline. Venue attendances peaked in summer and were concentrated in southeast England. There were five significant space-time clusters of venue-events within 5 km and 24 h of each other involving 5 racecourses and 8 sport venues. The most likely cluster was in the southeast of England, between January and July, with a relative risk of 62.54.

MAIN LIMITATIONS: Inconsistent horse identification precluded horse-level analysis of showjumping data.

CONCLUSIONS: Racehorse and sport horse populations competing in Great Britain are largely separate, but limited opportunities for local or indirect pathogen spread do exist during peak seasons in areas with high venue density.

PMID:41351275 | DOI:10.1111/evj.70126