Nevin Manimala

J Autism Dev Disord. 2025 Nov 28. doi: 10.1007/s10803-025-07168-1. Online ahead of print.

ABSTRACT

PURPOSE: Family navigation (FN) is a promising intervention for reducing barriers and addressing inequities in healthcare, but engaging families in FN can be challenging. This study assessed FN engagement for historically underserved families of children newly diagnosed with autism. Objectives were to (1) describe FN engagement rates across four stages: recruitment, enrollment, retention, and involvement; (2) examine family characteristics influencing recruitment, enrollment, and retention; and (3) evaluate the receipt of autism-specific services based on family characteristics and number of interactions with navigators.

METHODS: This descriptive cohort study included families who were Medicaid recipients or self-identified as Hispanic/Latino or Black/African-American. Spanish-English bilingual, bicultural navigators provided FN through semi-structured sessions and brief contacts with participants. Descriptive statistics analyzed family demographics and engagement rates. Regression analyses examined family characteristics predictive of successful engagement and service receipt.

RESULTS: Of 292 eligible families, 210 (71.9%) were recruited, 155 of whom (73.8%) enrolled. Caregivers preferring a language besides English (85% of whom preferred Spanish) were five times more likely to enroll (OR = 5.15) and participated in significantly more interactions with navigators. Each additional FN session and contact increased the probability of obtaining autism-specific services by 61% and 17%, respectively.

CONCLUSION: About half of eligible families enrolled in this FN program. Families preferring a language besides English had higher engagement rates at multiple stages. Brief contacts complemented semi-structured sessions, each contributing to an increased likelihood of children receiving autism-specific services. Once families enroll, FN may increase service access for historically underserved families.

PMID:41313578 | DOI:10.1007/s10803-025-07168-1

Patient. 2025 Nov 28. doi: 10.1007/s40271-025-00793-z. Online ahead of print.

ABSTRACT

BACKGROUND: Early pregnancy loss (EPL) is associated with significant emotional burden. While multiple management options exist, psychological aspects are often underrepresented in decision-making support. The objective of this study is to identify criteria that are important to women when choosing between expectant, medical, and surgical management of EPL, with particular attention to psychological aspects.

METHODS: A mixed-methods study using the Analytic Hierarchy Process (AHP) was conducted. Criteria were identified via literature review and a focus group. Thirty-seven women with EPL history completed structured telephone interviews with pairwise comparisons. Quantitative data were analyzed to calculate criterion weights and assess consistency. Logistic regression explored factors associated with inconsistent responses.

RESULTS: Among 37 participants, ‘Minimizing psychological distress’ emerged as the most important criterion (local weight = 0.381), with sub-criteria such as ‘Experiencing miscarriage as a natural process’ (0.384; 0.252) and ‘Avoiding hospital treatment’ (0.355; 0.425) ranked most important for women preferring expectant and medical management, respectively. Women preferring surgical management prioritized ‘Short time to miscarriage completion’ (0.389). Sixty-five percent of participants demonstrated acceptable preference consistency (consistency ratio ≤ 0.2). Lower education showed the greatest and statistically significant negative influence on the consistency of the preferences in the regression models.

CONCLUSION: Preferences varied by treatment choice, indicating that psychological distress is defined differently across women. The AHP method enabled nuanced insights into individual decision-making. Emotional factors may influence preference patterns and should be considered in clinical counselling. These findings support the need for individualized counselling and shared decision-making. The results may inform the development of clinical tools and guidelines.

PMID:41313573 | DOI:10.1007/s40271-025-00793-z

Qual Life Res. 2025 Nov 28. doi: 10.1007/s11136-025-04088-6. Online ahead of print.

ABSTRACT

PURPOSE: To assess the possible effect of anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) on the health-related quality of life (HRQoL) in patients with ALK-positive non-small cell lung cancer (NSCLC).

METHODS: A systematic search was performed in PubMed, Web of Science, Embase, and ClinicalTrials.gov to identify literature published between January 2010 and January 2025. Publications reported quantitative assessments of HRQoL in ALK-positive NSCLC patients treated with ALK-TKIs were included. Meta-analyses were performed using random effect models.

RESULTS: A total of 805 records were identified, of which 21 were analyzed in the meta-analysis. Compared to crizotinib, next-generation ALK-TKIs showed statistically significant delayed time to deterioration (TTD) in global health status measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.67 to 0.96). Brigatinib and alectinib demonstrated superior TTD in fatigue symptom score of EORTC QLQ-C30 compared to crizotinib (HR: 0.71; 95% CI: 0.54 to 0.92). Regarding between-arm comparisons from baseline, brigatinib and lorlatinib outperformed crizotinib in global health status, physical and emotional functioning, and symptoms scores of nausea and vomiting, fatigue, constipation, and appetite loss using EORTC QLQ-C30.

CONCLUSIONS: This study is by far the most comprehensive systematic review and meta-analysis on HRQoL among ALK-positive NSCLC patients treated with ALK-TKIs. These findings extended prior literature by conducting a granular comparison of all available ALK-TKIs across multiple endpoints and highlighted the improved performance of next-generation ALK-TKIs in enhancing HRQoL for ALK-positive NSCLC patients.

PMID:41313568 | DOI:10.1007/s11136-025-04088-6

Breast Cancer. 2025 Nov 28. doi: 10.1007/s12282-025-01806-3. Online ahead of print.

ABSTRACT

BACKGROUND: The safety of postmastectomy radiation therapy (PMRT) after autologous breast reconstruction remains unclear. Therefore, we conducted a systematic review and meta-analysis to investigate the effects of PMRT on patients with breast cancer who underwent autologous breast reconstruction.

METHODS: A comprehensive literature search of English and Japanese articles until March 2021 was performed using PubMed/MEDLINE, the Cochrane Library, and Ichushi-Web. We included studies that compared the outcomes of patients with breast cancer who underwent immediate autologous breast reconstruction with and without PMRT. Outcomes including major complications, fat necrosis, and cosmetic results were assessed. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model.

RESULTS: Ten studies (two retrospective case-controlled and eight retrospective cohort studies) comprising 3,123 cases were included. The rate of major complications was slightly higher in the PMRT group compared to the no PMRT group, but the difference was not statistically significant (13.2% vs. 12.2%, OR 1.58, 95% CI 0.93-2.68, P = 0.09). In contrast, the rate of fat necrosis was significantly increased in the PMRT group (17.2% vs. 8.1%, OR 2.71, 95% CI 1.58-4.65, P = 0.0003). Data on cosmetic outcomes were limited and not pooled for the meta-analysis.

CONCLUSIONS: PMRT following autologous breast reconstruction was associated with a higher risk of fat necrosis, but not with a significantly increased rate of major complications. With careful patient selection and monitoring, PMRT after autologous breast reconstruction can be considered a safe and acceptable treatment option.

PMID:41313567 | DOI:10.1007/s12282-025-01806-3

Sports Med. 2025 Nov 28. doi: 10.1007/s40279-025-02367-3. Online ahead of print.

ABSTRACT

BACKGROUND: Pacing strategy is a key determinant of endurance performance, enabling athletes to regulate effort to optimise outcomes. While various pacing profiles (e.g. self-selected, fast-start, even, or slow) have been proposed, their comparative effects on performance remain unclear because of conflicting findings and methodological variability across studies.

OBJECTIVE: We aimed to conduct a systematic review and network meta-analysis to compare the effects of different pacing strategies on endurance time-trial performance in healthy athletes.

METHODS: We included peer-reviewed experimental studies comparing at least one imposed pacing strategy (fast-start, even, slow) against a self-selected or alternative strategy, with performance assessed via time-trial tests based on distance. Studies involved endurance sports (e.g. cycling, running, swimming) encompassing middle- and long-duration events. Data from 24 studies (n = 302 participants; 765 observations) were analysed using a frequentist network meta-analytic framework under a random-effects model.

RESULTS: There were no differences in performance between self-selected and imposed pacing strategies across the network (standardised mean differences < 0.20, all p > 0.05). However, subgroup and meta-regression analyses revealed that the performance impact of slow-start strategies was modulated by factors such as duration of the initial start. Notably, prolonged slow starts were associated with impaired performance. No significant differences were observed in secondary outcomes (peak oxygen uptake, mean oxygen uptake, end-test lactate) across pacing strategies.

CONCLUSIONS: This review found no consistent performance advantage of any imposed pacing strategy over self-selected pacing. While average effects were comparable across strategies, the efficacy of slow-start pacing was particularly sensitive to contextual factors such as the length of the initial slow start. These findings underscore the value of self-pacing as a flexible and context-adaptive strategy, and highlight that pacing interventions must be aligned with individual, environmental, and task-specific demands to optimise endurance performance.

CLINICAL TRIAL REGISTRATION: Registered in PROSPERO with ID CRD420251011233.

PMID:41313565 | DOI:10.1007/s40279-025-02367-3

Discov Oncol. 2025 Nov 28. doi: 10.1007/s12672-025-04172-w. Online ahead of print.

ABSTRACT

BACKGROUND: The current understanding of the relationship between circulating metabolites and neuroblastoma (NB) risk is insufficient. Herein, bidirectional Mendelian randomization (MR) studies were utilized to examine the potential causal associations of metabolites and the risk of NB.

METHODS: Significant single-nucleotide polymorphisms (SNPs) associated with circulating metabolites were obtained from the genome-wide association study (GWAS) in the European population (N = 7824). Summary statistics for NB were aggregated from prior GWAS studies encompassing 1,627 patients and 3,254 cancer-free children. The causality was assessed primarily by inverse-variance weighted (IVW), along with MR-Egger regression, weighted median estimator, and weighted mode method.

RESULTS: Among the 486 metabolites analyzed, a genetically determined elevation in blood butyrylcarnitine concentration (log₁₀) was significantly correlated with a 51.5% decrease in NB risk [IVW odds ratio (OR) = 0.485, 95% confidence interval (CI): 0.285-0.826, P = 0.008]. In the reverse MR analyses, an increase in log odds of NB risk demonstrated a significant correlation with a decrease in guanosine [IVW Beta ± SE: -0.042 ± 0.015 log₁₀ change, P = 0.004] and an elevation in 3-methyl-2-oxobutyrate [IVW Beta ± SE: 0.010 ± 0.004 log₁₀ change, P = 0.011] levels. Besides, no significant causal effect of NB on butyrylcarnitine was observed.

CONCLUSIONS: This research identifies bidirectional causal relationships between circulating metabolites and NB. Increased levels of blood butyrylcarnitine are associated with a reduced risk of NB, whereas lower levels of guanosine and higher levels of 3-methyl-2-oxobutyrate are indicative of NB patients. Further investigation is required for the mechanisms.

PMID:41313542 | DOI:10.1007/s12672-025-04172-w

J Endocrinol Invest. 2025 Nov 28. doi: 10.1007/s40618-025-02770-7. Online ahead of print.

ABSTRACT

BACKGROUND: Endothelial dysfunction may contribute to the increased cardiovascular risk associated with thyroid diseases. This systematic review and meta-analysis aimed to assess endothelial function, evaluated by flow-mediated dilation (FMD), in both hypo and hyperthyroidism, and its response to treatment.

METHODS: We searched Embase and PubMed (until April 2025) for studies on FMD in hypo- and hyperthyroidism (PROSPERO registration number: CRD42024629806). Risk of bias was assessed using Cochrane criteria. Mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Statistical heterogeneity was assessed with I² statistics. Analyses were conducted using Review Manager 5.4.1.

RESULTS: Forty-two studies (1,663 subjects with hypothyroidism, 247 with thyrotoxicosis/endogenous hyperthyroidism, and 1520 euthyroid controls) were included. FMD was significantly reduced in subjects with untreated hypothyroidism compared to euthyroid controls (MD -2.99, 95% CI, -3.83, -2.14; I² = 99%), improved with levothyroxine treatment (MD 3.06, 95% CI: 1.94, 4.19; I² = 91%) and reached values similar to controls upon restoration of euthyroidism (MD 0.22, 95% CI: -0.75, 1.18; I² = 75%). A non-statistically significant difference emerged comparing untreated hyperthyroid subjects with controls (MD – 2.55; 95% CI: -5.38, 0.28; I² = 98%), and low risk of bias studies showed reduced FMD in this subset (MD – 6.57; 95% CI: -7.53, – 5.60; I² = 45%). Subclinical hyperthyroidism was associated with FMD impairment (MD – 4.21; 95% CI: -7.07, – 1.35; I² = 97%).

CONCLUSION: Hypothyroidism is associated with endothelial impairment, reversible after restoration of euthyroidism, highlighting the importance of appropriate management. Hyperthyroidism, especially subclinical, seems associated with FMD reduction, but larger, well-designed studies are needed.

PMID:41313532 | DOI:10.1007/s40618-025-02770-7

Environ Sci Pollut Res Int. 2025 Nov 28. doi: 10.1007/s11356-025-37176-8. Online ahead of print.

ABSTRACT

Anaerobic digestion is an effective technology for converting organic waste into biogas while reducing environmental pollution. This study investigates the impact of co-digesting waste-activated sludge (WAS) with wheat straw, rice straw, and bokashi on biogas production. Nine anaerobic batch reactors were operated under mesophilic conditions (35 °C), incorporating different proportions of bokashi (1% and 2%) along with rice and wheat straw (4%). The results revealed that reactors supplemented with wheat and rice straw exhibited higher biogas production than the control reactor (sludge only). Wheat straw outperformed rice straw in improving biogas yield, total solids (TS) reduction, total volatile solids (TVS) degradation, and chemical oxygen demand (COD) removal. The addition of bokashi enhanced biogas production, confirming its role in accelerating organic matter breakdown. The maximum biogas yield was observed in the reactor containing sludge co-digested with wheat straw and 2% bokashi, which generated three times more biogas than the control. This reactor also exhibited the highest degradation rates of TS (57.83%), TVS (66.37%), and COD (71.53%). Furthermore, pH remained stable within the optimal range across all reactors, ensuring a balanced digestion process. Statistical analysis revealed significant correlations between organic matter degradation (COD, TS, TVS reduction) and biogas production, demonstrating that effective substrate decomposition improves biogas yield. The recurrent neural network (RNN) model was applied to experimental data to predict biogas production. With an exceptionally low root mean square error (RMSE) of 0.0041, R² close to 1, and MAE 0.0117, the model exhibited excellent accuracy and reliability in generating precise predictions.

PMID:41313517 | DOI:10.1007/s11356-025-37176-8

Dan Med J. 2025 Nov 12;72(12):A04250344. doi: 10.61409/A04250344.

ABSTRACT

INTRODUCTION: Since 2022, Denmark has received approx. 50,000 Ukrainian refugees. We examined the sociodemographic characteristics, disease patterns and associated risk factors of Ukrainian refugees receiving a general health assessment (GHA) at the Migrant Health Outpatient Clinic, Hvidovre Hospital.

METHODS: This cross-sectional study based on a prospective inclusion of patients, included all Ukrainian adults assessed between April 2022 and December 2024. The GHAs included blood samples (biochemistry and screening for infectious diseases), a questionnaire, a medical interview and a physical examination. Data were analysed using descriptive and inferential statistics.

RESULTS: A total of 101 participants were included. Common findings were poor oral health (44%) and PTSD symptoms (22%). Screening for infectious diseases revealed previous hepatitis B infection (15%), tuberculosis infection (12%) and HIV infection (4%). COVID-19 vaccine adherence was low (50%). We also found that exposure to war trauma was associated with PTSD symptoms.

CONCLUSIONS: The study population had a significant burden of mental and physical health problems and indications of low vaccine coverage, highlighting the need for increased awareness of the health needs of Ukrainian refugees in Denmark and the importance of providing GHAs to at-risk individuals.

FUNDING: None.

TRIAL REGISTRATION: Ethical approval was granted by the Team for Medical Records Data, Capital Region of Denmark.

PMID:41312704 | DOI:10.61409/A04250344

Int J Technol Assess Health Care. 2025 Nov 28;41(1):e81. doi: 10.1017/S026646232510322X.

ABSTRACT

INTRODUCTION: The simultaneous existence of low-value health care and underutilization of high-value care are global problems. Health technology reassessment (HTR) aims to optimize the value for money of technologies already in use within health care. Identifying candidate interventions for HTR remains challenging. Therefore, we tested a novel method to identify candidate outpatient prescription drugs for HTR through practice variation.

METHODS: We used administrative data for all publicly funded outpatient prescriptions dispensed to persons aged 65 or older in Alberta in 2023. Through quantitative comparison of funnel plots for Anatomic Therapeutic Chemical (ATC) classes at the fourth level stratified by prescriber specialty, variation in prescription dispensation rates between prescribers was used to estimate three outcomes: the number of prescribers affected, the number of patients affected, and the potential budgetary impact. We ranked combinations of ATC class and prescriber specialty in descending order for each outcome, with use above and below the mean considered separately.

RESULTS: We analyzed data on 17.5 million dispensations, encompassing more than 8,000 prescribers and approximately 600,000 patients. The top ATC class-prescriber specialty combinations for each outcome showed high similarity above and below control limits while exhibiting minimal overlap between outcomes.

CONCLUSIONS: Our method successfully identified ATC class-prescriber specialty combinations with marked variation in use, for potential advancement through the HTR process. Depending on the perspective of those undertaking HTR of prescription drugs, different outcomes may be useful in technology prioritization. To make the ATC class-prescriber specialty combinations actionable, future efforts should focus on exploring the patients affected.

PMID:41312685 | DOI:10.1017/S026646232510322X