Nevin Manimala

BMC Health Serv Res. 2025 Apr 12;25(1):537. doi: 10.1186/s12913-025-12710-z.

ABSTRACT

BACKGROUND: Smart healthcare systems are expected to have a positive impact on addressing challenges in healthcare. However, the real-world adoption and widespread integration of Smart healthcare systems still face many barriers, and their clinical utility lacks empirical research with large sample sizes, particularly in rural areas. The aim of this study is to evaluate the impact of a new smart healthcare system, the Health All-in-One Machines (HAMs), on improving the health services in rural areas of China.

METHODS: The data included health services information from 1,866 village clinics in Hainan, China, covering the period November 30, 2020, to April 30, 2023. The impact of Health All-in-One Machines on access to healthcare was measured using four outcome indicators: the number of patient visits, medical revenue, pharmaceutical revenue, and medical expense per patient. We conducted a three-phase interrupted time series study to explore the effects of the Health All-in-One Machines intervention on these indicators across two distinct periods: the second phase (26 weeks, adaptation period) and the third phase (74 weeks, full-scale implementation period).

RESULTS: The interrupted time-series analysis revealed that the Health All-in-One Machines intervention had no significant impact on outcome indicators comparing the pre-intervention period to the adaptation period. However, from the adaptation period to full implementation, significant impacts were observed. Specifically, notable level changes were observed: the number of patient visits increased by 37.85% (p < 0.01), medical revenue increased by 54.03% (p < 0.001), pharmaceutical revenue increased by 32.84% (p < 0.05), and medical expense per patient increased by 2.368 CNY (p < 0.001). Additionally, a significant trend change was observed in medical expense per patient, with a decrease of 0.15 CNY per week (p < 0.05).

CONCLUSIONS: This study provides empirical evidence of some positive changes in the Health All-in-One Machines intervention on the outcome indicators regarding the access to healthcare. Moreover, our analysis indicates that the Health All-in-One Machines intervention would at least take longer to take effect when implemented in large-scale rural healthcare institutions. The findings from this study provide insights for future delivery and policy making of Smart healthcare systems in rural areas.

PMID:40221780 | DOI:10.1186/s12913-025-12710-z

Harm Reduct J. 2025 Apr 12;22(1):52. doi: 10.1186/s12954-025-01207-x.

ABSTRACT

BACKGROUND: In 2017, Clark County, NV, implemented Public Health Vending Machines (PHVMs), an innovative approach to the dispensation of harm reduction supplies to persons who inject drugs (PWID), including sterile equipment and naloxone. Administrative data associated with PHVM operations can be valuable for understanding drug use behaviors among PWID. The current study examines the demographics and drug use profiles of PHVM registrants who completed the harm reduction survey between January 2021 to June 2023 with comparison to nation-wide trends.

METHODS: All registration forms for PHVM services in Clark County, NV, between 1/1/2021-6/30/2022 with a completed harm reduction survey were included for analysis. Descriptive statistics were used to characterize differences in applicant demographics as well as self-reported injection and non-injection drug use, risk behaviors, and interest in harm reduction services. Logistic regression models tested the association between types of injection drug use and overdose and risk behaviors.

RESULTS: A total of 637 PHVM applications with completed survey data were included for analysis. Respondents were an average of 36.1 ± 10.2 years old, 56.3% male sex, and 63.6% non-Hispanic White with 85.1% reporting injection drug use (IDU). Notably, greater proportions of respondents with histories of IDU also indicated non-injection drug administration, such as smoking and snorting. In the 3 months prior to registration, the majority of IDU respondents reported high risk drug use behaviors, including daily use, multiple injections per day, and opioid and stimulant co-use. Fentanyl was suspected in 62.1% of overdoses in the last 3 months. Compared to PWID using stimulants only, respondents with opioid and stimulant co-use had a higher likelihood of overdose (aOR 4.51; 95% CI 2.05, 11.1; p < 0.001) and re-using injection supplies (aOR 2.14; 95% CI 1.33, 3.48; p = 0.002). More opioid and stimulant co-use respondents were interested in treatment/detox and obtaining naloxone than those without co-use.

CONCLUSIONS: The demographics and drug use behaviors of the PHVM PWID are consistent with contemporaneous county and nation-wide. As the overdose crisis evolves, PHVM could be pivotal tools in the early detection of new risks to facilitate timely adaptation of harm reduction strategies to improve morbidity and mortality.

PMID:40221778 | DOI:10.1186/s12954-025-01207-x

Antimicrob Resist Infect Control. 2025 Apr 12;14(1):29. doi: 10.1186/s13756-025-01530-9.

ABSTRACT

BACKGROUND: Good quality data is essential in optimising containment strategies for antimicrobial resistance, a global public health threat estimated to cause around 10 million deaths yearly and up-to 5% loss in GDP by 2050 if left unaddressed. The laboratory system plays an important role in the collection of high-quality data as well as ensuring validity, reliability and timeliness of data. However, in many low-medium income countries including Nigeria, the technical capacity of the laboratory for fulfilling these responsibilities is unknown. This paucity of information limits piloting of strategies to complement existing surveillance and planning improvement of subsequent laboratory iterations into the surveillance system. The focus of this study was to assess the gaps, vulnerabilities and enablers of laboratory strengthening processes in the scope of technical capacity for clinical and public health functions and to provide a roadmap for improved surveillance of antimicrobial resistance in Nigeria.

METHODS: A cross-sectional study design utilising structured questionnaire administered online via Qualtrics and reported in accordance with strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data analysis involved descriptive and inferential statistics as well as bivariate and multivariate logistics to test predictive analysis of relationship between variables.

RESULTS: A total of 302 laboratories completed the questionnaire, 107 (53.4%) government laboratories and 195 (64.6%) private sector laboratories. 18.2% reported excellent knowledge, 25.5% has excellent capacity, 7.3% are fully ready for surveillance, 12.3% are participating in some surveillance, and 1.0% record important microbiological data that correlates with epidemiological information.

CONCLUSION: Tertiary laboratories reported highest performance across all surveillance quality indicators (SQIs). AMR surveillance is skewed toward government and tertiary laboratories, leaving lower-level and rural facilities underutilized despite their potential. This results in missing community-level data and undermines the representativeness of surveillance. The study identifies gaps in recruitment, assessment, and oversight but also offers strategies to address these issues.

PMID:40221775 | DOI:10.1186/s13756-025-01530-9

Ital J Pediatr. 2025 Apr 12;51(1):114. doi: 10.1186/s13052-025-01954-4.

ABSTRACT

BACKGROUND: There is currently no established optimal anticoagulation protocol for plasma exchange (PE) in pediatric patients at a high risk of bleeding. Therefore, we aimed to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) and nafamostat mesylate (NM) for PE anticoagulation in this patient group.

METHODS: This retrospective study analyzed data from 66 children with high bleeding risk who underwent PE in the Pediatric Intensive Care Unit of Hunan Children’s Hospital between June 2018 and January 2023. Patients were divided into two groups: RCA-PE (n = 45) and NM-PE (n = 21), and filter performance and adverse reaction rates were compared. Statistical analysis utilized SPSS 25.0, comprising two-sample t-tests, chi-square or Fisher’s exact tests, and Mann-Whitney U tests, as appropriate. Data visualization was performed using ggplot2 in R-studio. P < 0.05 was considered statistically significant.

RESULTS: No statistically significant differences were found between the two groups in initial transmembrane pressure (TMP) [17.0 (14.0, 21.5) mmHg vs. 16.0 (14.0, 19.5) mmHg, P = 0.614], maximum TMP [46.0 (42.0, 49.5) mmHg vs. 43.0 (41.5, 49.5) mmHg, P = 0.689], and final TMP [40.0 (35.5, 45.0) mmHg vs. 38.0 (35.0, 42.0) mmHg, P = 0.298]. Filter grade distribution and bleeding events also showed no statistically significant difference between the groups. However, the NM-PE group had significantly lower overall adverse reaction and metabolic alkalosis rates (both P < 0.05) compared to the RCA-PE group.

CONCLUSIONS: NM demonstrates similar efficacy but superior safety compared with RCA, making it a more suitable anticoagulation strategy for children with high bleeding risk. Study limitations include single-center design, selection bias, and uncertain NM dosage.

PMID:40221768 | DOI:10.1186/s13052-025-01954-4

Harm Reduct J. 2025 Apr 12;22(1):51. doi: 10.1186/s12954-025-01201-3.

ABSTRACT

BACKGROUND: Over a million people have died from overdose since 1999, over 600,000. of which involved opioids. Treatment options that focus on overdose prevention are desperately needed and buprenorphine treatment is a form of opioid prevention if provided in a harm reduction setting. Co-morbid opioid and stimulant use disorders have increased at a higher rate than other co-morbid combinations between 2011 and 2019. The objective of this study was to identify the effects of psychostimulant use on buprenorphine treatment retention.

METHODS: We conducted an analysis of a cohort of 143 individuals with opioid use disorder that initiated treatment in a low-threshold, urban office based opioid treatment (OBOT) clinic located in Nashville Tennessee between 2018 and 2020. Retention was measured at 1, 3, and 6-months. Logistic regression was used to identify differences between people who tested positive for stimulants and people who did not.

RESULTS: The majority of the patients were white (83%), male (64%), unhoused (59%) and uninsured (70%). There was moderate psychostimulant use in the sample with 19% testing positive for cocaine and 13% testing positive for methamphetamine at baseline. Patients testing positive for cocaine prior to their six month retention point had 0.279 lower odds of being retained in treatment. Further, testing positive for either cocaine or methamphetamine resulted in 0.284 and 0.258 odds of retention at 3 and 6-months respectively.

CONCLUSION: This study examined the impact of stimulant use on retention in buprenorphine treatment within a low-threshold OBOT clinic. Our findings differ from previous research that reported significant decreases in retention among methamphetamine users. Instead, results suggest that patients using psychostimulants can be effectively retained in care within a low-resource, low-threshold setting, though increased clinical engagement may be beneficial for those testing positive for cocaine or methamphetamine. Given the limited access to buprenorphine treatment, these findings underscore the urgent need for expanded, accessible treatment models that can effectively serve individuals with co-occurring stimulant use.

PMID:40221764 | DOI:10.1186/s12954-025-01201-3

BMC Public Health. 2025 Apr 12;25(1):1376. doi: 10.1186/s12889-025-22648-w.

ABSTRACT

BACKGROUND: E-health literacy is closely linked to a wide range of health outcomes, encompassing the control of diseases, self-efficacy, and the quality of life concerning health, as well as the attitudes and behaviors exhibited by patients. Therefore, we conducted this study to investigate e-health literacy and examine the relationship between e-health literacy and self-care behaviors in Iranian middle-aged type 2 diabetes.

METHODS: This cross-sectional study was conducted among 313 middle-aged (30-60 years) type 2 diabetics covered by the health care centers of Neyshabur City, Iran, in 2023. They were selected through a stratified random sampling method. Data was gathered using a demographic characteristics questionnaire, a Summary of Diabetes Self-care Activities, and an Electronic Health Literacy scale. Collected data were analyzed using multiple linear regression, t-test, one-way analysis of variance, and chi-square tests by SPSS software version 22, and the significance level was considered 0.05.

RESULTS: The mean age of the respondents was 48.41 ± 7.1 years. The mean (± SD) of the diabetes Self-care activities was 49.28 (14.9), and the mean (± SD) of e-health literacy was 20.6 (7.78). Most diabetics had low e-health Literacy 192(61.5%). After adjusting for the variables of type of treatment, measuring blood sugar at home, marital status, occupation and economic status, e-health literacy (B = , 0.277, T = 4.5, P < .05) was the statistically significant independent factor associated with diabetes self-care activities.

CONCLUSION: Executing educational programs focusing on promoting e-health literacy can increase diabetes self-care activities, increasing overall diabetes’s quality of life.

PMID:40221762 | DOI:10.1186/s12889-025-22648-w

BMC Public Health. 2025 Apr 12;25(1):1383. doi: 10.1186/s12889-025-22607-5.

ABSTRACT

BACKGROUND: Studies focusing on the return for young employees are scarce. The aim of this study was to investigate the return to work process after a period of sick leave due to common mental disorders among young male and female employees, with a specific focus on promoting and hindering factors. A gender perspective was applied to examine potential patterns of similarities and differences in the study participants’ experiences.

METHODS: A qualitative approach with an applied gender perspective was used to capture both young employees’ and managers’ experiences of the return to work process. The data consisted of interviews with 12 young male and 13 young female employees (aged 20-29) and 23 interviews with managers with experience of supervising at least one young employee during return to work. An inductive, conventional content analysis was conducted.

RESULTS: The analysis resulted in three main categories and five subcategories describing hindering and promoting factors in young employees’ return to work processes. The main and subcategories were (1) “Coordinating, planning, and timing the return to work process” (with subcategories “Lack of coordination and support from key stakeholders”, “The importance of a return to work plan and follow-up”, and “The timing of the return to work”); (2) “Gaining sufficient support and having personal resources” (with subcategories: “Level and quality of support in the work environment”, and “Resources and obstacles on a personal level”); and (3) “Poor match between the young employees’ capabilities and the work demands or working conditions”.

CONCLUSION: The study participants identified similar factors that promoted and hindered the return to work process. Young employees need more support from employers and various welfare agencies. Managers need to know more about the return to work process and the responsibility of involved stakeholders. No expressed gender differences were identified.

PMID:40221752 | DOI:10.1186/s12889-025-22607-5

J Orthop Surg Res. 2025 Apr 12;20(1):371. doi: 10.1186/s13018-025-05774-4.

ABSTRACT

The aim of this study is to evaluate the effects of midshaft femoral derotation surgery on the alignment of the lower limbs in the coronal and sagittal planes, as well as its impact on pelvic parameters in patients with significant femoral anteversion or retroversion.A retrospective review was conducted on patients who underwent femoral derotation procedures using a minimally invasive patient-specific external guide system from January 2014 to January 2022 at Macquarie University Hospital. The surgery was done using preoperative 3D modeling and patient-specific external guides. Inclusion criteria comprised patients presenting with hip, knee, or patellofemoral symptoms due to high femoral anteversion who had complete EOS scans performed preoperatively and postoperatively. The EOS imaging system was utilized for accurate assessment and comparative analysis of alignment changes following the femoral derotation.There were 22 limbs from 15 patients with an average age at operation of 30.41 ± 10.14 years (range 16.77-47.50). The average preoperative 3D EOS measurement of the femoral version in anteversion and retroversion groups were 32.84 ± 7.53° and – 22.67 ± 13.32°, respectively. The postoperative femoral version in anteversion and retroversion groups were 13.39 ± 12.90° and 3.67 ± 9.29° having p < 0.001 and p < 0.014, respectively. Paired t-test was employed to calculate statistical values. Other parameters, including Hip-knee-shaft (HKS) angle, knee angle, pelvic tilt, pelvic incidence, mechanical lateral distal femoral angle (mLDFA), and coronal plane alignment of the knee, were not statistically significant differences.This study provides evidence that femoral midshaft derotation surgery using patient-specific instrumentation (PSI) guides is an effective approach for correcting femoral anteversion and retroversion with no significant impact on coronal and sagittal lower limb alignment except femoral neck offset.

PMID:40221750 | DOI:10.1186/s13018-025-05774-4

J Neuroeng Rehabil. 2025 Apr 12;22(1):82. doi: 10.1186/s12984-025-01621-z.

ABSTRACT

BACKGROUND: Stroke often results in gait dysfunction, impairing daily activities and quality of life. Overground robotic exoskeletons hold promise for post-stroke rehabilitation. This study primarily aimed to assess the safety of hands-free Atalante exoskeleton training in post-stroke subjects, with a secondary aim to assess gait and balance.

METHODS: Forty subjects (10.2 ± 12.1 months post-stroke) with gait dysfunction (Functional Ambulation Category [FAC] score ≤ 3) underwent five training sessions over three weeks with a hands-free exoskeleton (Atalante, Wandercraft, France). Safety, the primary outcome, was evaluated by the number and severity of adverse events (AEs), judged by an independent clinical evaluation committee (CEC). A usability test was performed during the fifth training session followed by the exoskeleton use questionnaire. Gait and balance were assessed pre/post-training via walking capacity score (FAC), gait speed by 10-meter walk test (10MWT), walked distance by 6-minute walk test (6MWT), and balance by Berg Balance Scale (BBS). Spasticity was assessed with the Modified Ashworth scale. Anxiety and depression were quantified using the Hospital Anxiety and Depression Scale. Safety outcomes were analyzed using the Wilson, Lee and Dubin methods for proportions, and occurrence rates were computed. Within-group differences were compared using Wilcoxon, McNemar, and Friedman tests, with significance set at P < 0.05.

RESULTS: Thirty-one subjects completed the training sessions, while nine discontinued. The study reported two serious adverse events (SAE) (vertigo, dysarthria) and six AEs, with the CEC concluding that no SAE was linked to the device/study procedure. The average AE rate per session was 2.5 ± 1.4%, including four events possibly linked to the device/study procedure (knee pain [n = 1], skin lacerations [n = 3]), classified as negligible or minor by the CEC. A high proportion (82.6%) successfully completed the usability test and reported satisfaction (90%) on the exoskeleton use questionnaire. For gait and balance, favorable changes were observed in FAC, 10MWT, 6MWT, and BBS scores Post-training (p < 0.05, respectively). Spasticity, anxiety, and depression remained unchanged.

CONCLUSIONS: This study indicates that the hands-free Atalante exoskeleton is safe, feasible, and well-tolerated for gait and balance rehabilitation in post-stroke subjects, warranting larger randomized controlled trials to assess its efficacy.

TRIAL REGISTRATION: Evaluation of the Use of the Atalante Exoskeleton in Patients Presenting an Hemiplegia Due to Cerebrovascular Accident (INSPIRE) trial was registered at ClinicalTrials.gov (NCT04694001, registered on 20201231).

PMID:40221748 | DOI:10.1186/s12984-025-01621-z

World J Surg Oncol. 2025 Apr 12;23(1):143. doi: 10.1186/s12957-025-03767-5.

ABSTRACT

BACKGROUND: In recent years, triple therapy (molecular targeted agent + PD-1 inhibitor + transarterial therapy) has emerged as a promising strategy for unresectable hepatocellular carcinoma (uHCC). However, the optimal molecular targeted agent choice within triple therapy remains unclear. Donafenib is currently the only targeted drug with superior survival benefits compared with sorafenib monotherapy. This study aimed to compare donafenib-based versus sorafenib-based triple therapy in patients with uHCC, providing preliminary evidence to guide molecular targeted agent selection in this emerging treatment paradigm.

METHODS: This retrospective study enrolled 106 patients with initially uHCC who received triple therapy combining either donafenib or sorafenib with PD-1 inhibitors and transarterial therapies. A 1:2 nearest neighbour propensity score matching was used to minimize selection bias. The primary endpoints were overall survival (OS) and progression-free survival (PFS) based on Kaplan-Meier analysis. The secondary endpoints included objective response rate (ORR), surgical conversion rate and adverse events (AEs). Statistical comparisons used Cox regression for survival data and chi-squared/ t-tests for other metrics, with p < 0.05 indicating significance.

RESULTS: After matching, 30 patients received sorafenib-based triple therapy (Sor-P-T/H group) and 50 patients received donafenib-based triple therapy (Don-P-T/H group). Although the median OS was not attained, the Don-P-T/H regimen demonstrated a statistically significant survival advantage (HR = 0.317, P = 0.004). Moreover, the Don-P-T/H group demonstrated significantly higher median PFS (9.00 vs. 4.62 months, P = 0.005), ORR (64% vs. 40%, P = 0.037) and surgical conversion rate (26.0% vs. 3.3%, P = 0.01) compared to the Sor-P-T/H group. The two groups showed no notable difference in the overall severity of adverse events but the Don-P-T/H group demonstrated less liver impairment.

CONCLUSION: Donafenib may be more advantageous than sorafenib in triple therapy for patients with uHCC.

PMID:40221746 | DOI:10.1186/s12957-025-03767-5