Nevin Manimala

Sex Health. 2025 Dec 23;22(6):SH25065. doi: 10.1071/SH25065.

ABSTRACT

BACKGROUND: Pre-exposure prophylaxis (PrEP) use could be accelerated by offering alternatives that overcome key barriers associated with oral PrEP. This study aimed to understand willingness and preferences for long-acting injectable cabotegravir (CAB-LA) among gay men and other men who have sex with men (MSM), and transgender women (TGW) in Asia.

METHODS: An online cross-sectional survey was conducted from May to November 2022 among HIV-negative or unknown status MSM and TGW aged ≥18 years across 15 and 11 Asian countries/territories, respectively. Survey items included awareness and use of PrEP and CAB-LA, willingness to use current and emerging PrEP options, and attitudes towards CAB-LA. Descriptive statistics and logistic regression were used to analyse associations with willingness to use CAB-LA.

RESULTS: Among 11,870 MSM and 980 TGW, 21.4% (n = 2448) and 32.5% (n = 295) were aware of CAB-LA, respectively, and 17.2% (n = 2036) and 16.8% (n = 165) were willing to use it. CAB-LA was the most preferred PrEP option for 3.6% (n = 400) of MSM and 6.5% (n = 61) of TGW. Awareness and willingness varied across countries/territories and populations. Key benefits of CAB-LA included HIV protection (57.8% MSM, 46.8% TGW), no need for daily pills (42.6% MSM, 31.1% TGW) and longer-term protection (38.0% MSM, 23.6% TGW). Main concerns included cost (39.6% MSM, 22.1% TGW), side-effects (37.5% MSM, 22.2% TGW), insufficient knowledge (33.3% MSM, 20.6% TGW) and pain (21.4% MSM, 24.9% TGW).

CONCLUSIONS: Successful introduction of CAB-LA, or other new long-acting injectable PrEP options, in Asia will require strategies to raise awareness and demand-generation that responds to the perceived benefits and concerns of communities.

PMID:41162336 | DOI:10.1071/SH25065

Acad Radiol. 2025 Oct 28:S1076-6332(25)00955-9. doi: 10.1016/j.acra.2025.09.049. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Spontaneous portosystemic shunt (SPSS) embolization represents a promising intervention for refractory hepatic encephalopathy (HE). This systematic review and meta-analysis evaluate the efficacy and safety of SPSS embolization in cirrhotic patients without transjugular intrahepatic portosystemic shunts (TIPS).

METHODS: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library through June 12, 2024 to identify studies investigating SPSS embolization for HE. Meta-analysis was performed using fixed-effect or random-effects models to calculate clinical success (defined as HE remission), procedural success rates, and complication frequencies.

RESULTS: Analysis of 10 retrospective studies encompassing 289 cirrhotic patients yielded the following pooled outcomes: hepatic encephalopathy remission rate of 83.1% (95% CI: 70.4%-93.1%), procedural success rate of 99.8% (95% CI: 98.3%-100%), and long-term adverse event rate of 42.9% (95% CI: 34.7%-51.4%). The predominant long-term complications included ascites (51.6% of complications), variceal progression (23.4%), and thrombosis (8.0%), while primary procedure-related adverse reactions were infection (37%) and fever (29%). Subgroup analyses demonstrated no statistically significant effect of etiology (p=0.788) or shunt type (p=0.271) on disease remission rates, but revealed significant differences between surgical approaches (p<0.001), with balloon-occluded retrograde transvenous obliteration (BRTO) showing the highest efficacy (97.4%-100%).

CONCLUSION: SPSS embolization demonstrates both high efficacy for refractory hepatic encephalopathy (83.1% remission rate) and exceptional procedural success (99.8%). Despite substantial long-term complications (42.9%, predominantly portal hypertension sequelae), current evidence from predominantly retrospective studies supports its consideration as a therapeutic option. Technique selection should be individualized pending further validation of BRTO’s superiority.

PMID:41162300 | DOI:10.1016/j.acra.2025.09.049

J Surg Educ. 2025 Oct 28:103755. doi: 10.1016/j.jsurg.2025.103755. Online ahead of print.

ABSTRACT

OBJECTIVE: Previously, we developed the Inpatient Leadership Assessment Device (I-LEAD), a multisource feedback (MSF) instrument assessing the essential leadership skills for surgical resident physicians leading inpatient teams. This pilot study sought to evaluate the feasibility of utilizing I-LEAD in real-world contexts and acquire psychometric evidence to support the validity and reliability of its leadership scores.

DESIGN: At the end of a clinical rotation, surgical attendings, advanced practice providers (APPs), interns, and senior residents were invited to complete the I-LEAD instrument, which is structured as a 27-item online survey. Ratings were summarized with descriptive statistics, and psychometric properties were characterized with a many-facet Rasch model (MFRM) encompassing measures of resident leadership ability, item difficulty, and rater role severity.

SETTING: An academic general surgery residency program at a tertiary hospital in the Northeast United States over 9 months during the 2024 to 2025 academic year. It encompassed 6 inpatient general surgery services.

PARTICIPANTS: Twenty senior residents were evaluated by 8 attendings, 7 APPs, and 19 interns.

RESULTS: Residents had a mean of 3.1 evaluations. Overall, 65.5% of all item ratings were “Excellent,” 24.0% “Good,” 2.5% “Marginal,” 0.3% “Poor,” and 7.6% “Unable to assess,” resulting in a mean of 3.71 of 4. All 27 items demonstrated good fit with the MFRM. There was also good fit among rater roles with statistically significant differences in scores across groups (p < 0.001): attendings and interns assigned higher scores than APPs and senior residents. The model demonstrated strong reliability.

CONCLUSIONS: It is feasible to solicit structured MSF from surgical inpatient team members regarding senior resident leadership behaviors via the I-LEAD instrument. Differences in scores across rater roles emphasizes the value of soliciting input from team members with varying perspectives. Next steps are to create and assess the effectiveness of educational interventions to enhance specific resident leadership behaviors.

PMID:41162292 | DOI:10.1016/j.jsurg.2025.103755

J Surg Educ. 2025 Oct 28:103731. doi: 10.1016/j.jsurg.2025.103731. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore program-level variations in ACGME Milestone 2.0 ratings for Interpersonal & Communication Skills (ICS) and Professionalism (PROF) in general surgery residency programs.

DESIGN: Descriptive analysis of milestone 2.0 ratings using intraclass correlation coefficients (ICCs) to assess program-level variation at each PGY level across ICS and PROF sub-competencies. Wilcoxon Rank Sum tests were conducted to compare program sizes between uniform and nonuniform rating programs.

SETTING: General surgery residency programs across the United States during the 2020 to 2021 academic year.

PARTICIPANTS: About 7,581 residents in PGY1 through PGY5 from 328 general surgery residency programs.

RESULTS: Analysis of descriptive statistics highlighted considerable variation across programs. Analysis of ICC revealed that program-level differences contributed to 0.298 to 0.713 of the total variance in milestone ratings. ICCs were highest in PGY1 and PGY5 residents, suggesting stronger program influence at the start and end of residency. Uniform rating-where all residents at a given PGY level received the same rating-was common, particularly in PGY1 and PGY5, occurring in up to 41.2% of programs. Programs with uniform patterns tended to be smaller in size.

CONCLUSIONS: This study highlights substantial program-level variation in milestone ratings for ICS and PROF across all PGY levels in general surgery residency. High ICCs and uniform rating patterns suggest that milestone ratings may reflect institutional norms rather than resident performance. Future research should explore contributing factors and develop strategies to enhance fairness and quality in resident assessment.

PMID:41162291 | DOI:10.1016/j.jsurg.2025.103731

Curr Probl Diagn Radiol. 2025 Oct 24:S0363-0188(25)00193-8. doi: 10.1067/j.cpradiol.2025.10.015. Online ahead of print.

ABSTRACT

Program directors (PDs) oversee training and generously provide their time to mentorship. Cultural competency and diverse mentorship may better prepare doctors while increasing student interest. This study examines PD demographic data in IR, noting changes from 2020 to 2023. A list of IR PDs for IR programs was obtained from the ACGME. Duplicates were removed. Public websites were searched to collect age, sex, ethnicity, training, and research metrics (RM). Descriptive statistics were made for demographic data and analyzed. There were 114 unique IR PDs. By sex, 18.4 % were female. Mean age was 42.7. Of the 114, 79 had ethnic data, the most common being non-Hispanic white (54.5 %) and the least common were Hispanic (2.5 %) and Black (3.5 %). Only 2.6 % held DO degrees. In 2020, 12 % of PDs were female. In 2019, 17.8 % of trainees were female and 11.3 % were ethnicities under-represented in medicine (3.1 % Black, 8.2 % Hispanic). From 2020 to 2023, the proportion of women PDs increased by 6.4 % surpassing 2019’s 17.8 % of female trainees. Strictly comparing URM, the 7.7 % PDs has not yet met 2019’s 11.3 % of URM IR trainees. However, diversity has increased as Asian and Middle Eastern PDs account for 37.2 %, a greater than 10 % increase from 2019’s trainees. PD diversity may reflect trends in overall IR diversity. The increase in diverse PDs thus far is promising. Increased PD diversity may garner diverse student interest and provide better trained physicians.

PMID:41162207 | DOI:10.1067/j.cpradiol.2025.10.015

Travel Med Infect Dis. 2025 Sep-Oct;67S:102826. doi: 10.1016/j.tmaid.2025.102826. Epub 2025 Oct 27.

ABSTRACT

BACKGROUND: Malaria remains a significant public health threat, particularly in vulnerable populations. Insecticide-treated mosquito nets (ITNs) have been a cornerstone of malaria prevention efforts for decades. ITNs have demonstrably reduced malaria morbidity and mortality. However, their widespread use has raised concerns about a potential unintended consequence: environmental pollution.

METHODS: To assess the potential environmental impact of ITNs in a real-world setting, a Knowledge, Attitudes and Practices (KAP) survey was conducted in Djougou, a high malaria burden in Northen Benin. The survey employed a two-stage stratified random sampling approach.

RESULTS: There is an average of 2.4 people per ITN. Half of the ITNs are less than 2 months old, indicating a recent distribution campaign. The reported ITNs used the night before the survey was 73 %. Over half of the households (52 %) reported losing at least one ITN in the past year, with an average of 2.53 nets lost per household. The most common ITN brand contains alpha-cypermethrin and chlorfenapyr insecticides. We can estimate that Djougou releases approximately 133 kg of insecticides and 57.6 tons of plastic waste annually from discarded ITNs. Extrapolations to Benin and to Sub-Saharan Africa suggest a large potential environmental impacts.

CONCLUSION: The study highlights a potential environmental challenge associated with large-scale ITN use – plastic and insecticide waste from discarded nets. Further research is needed to quantify the environmental impact of abandoned nets. ITNs distribution programs should be complemented by collection and potential recycling initiatives. A circular economy approach could transform waste into a resource for fuel generation.

PMID:41162134 | DOI:10.1016/j.tmaid.2025.102826

Travel Med Infect Dis. 2025 Sep-Oct;67S:102817. doi: 10.1016/j.tmaid.2025.102817.

ABSTRACT

BACKGROUND: Malaria elimination efforts are expensive and often challenging because they are usually located in the hard-to-reach areas. Malaria elimination efforts can be greatly enhanced through the involvement of village health workers (VHWs). This systematic review aimed to study the role of VHWs in malaria elimination programs in hard-to-reach areas.

METHODS: A systematic review was conducted in five life sciences databases including PubMed, Web of Sciences, Scopus, ProQuest, and Medline, and Google. They were searched from their inception to October 2024 for studies reporting the roles of VHW in malaria elimination activities.

RESULTS: Of 14,884 articles screened, 44 articles met the inclusion criteria. Nearly 65.9 % (29) of the studies were from Africa and the rest were from Asia. Thirty-seven studies were from the hard-to-reach areas. The hard-to-reach areas included villages (18/44), hard-to-reach villages (2/44), rural areas (7/44), one study each on border areas, border forested areas, and refugee and conflict areas. VHWs were mostly involved in diagnosis and treatment of malaria (21/44), three studies on behaviour change communication and reactive case detection, four on prevention using long-lasting insecticidal nets and intermittent preventive treatment of children, two studies each on seasonal malaria chemoprevention, health education, and intermittent preventive treatment in children.

CONCLUSION: VHWs engaged in a number of malaria control activities in a hard-to-reach areas. They were primarily involved in routine control of malaria and were not regularly engaged in malaria elimination activities. As more countries are pursuing the national goal of malaria elimination, VHWs should be integrated into the elimination program.

PMID:41162133 | DOI:10.1016/j.tmaid.2025.102817

Lancet Public Health. 2025 Nov;10(11):e988-e1000. doi: 10.1016/S2468-2667(25)00222-1.

ABSTRACT

Life expectancy in the USA is considerably lower than in most high-income countries, with many deaths considered preventable. The extent by which poor performance on prevention measures and public health policies in the USA could be contributing to this issue is not well understood. To address this issue, we compared publicly available population-based indicators of health care across different levels of prevention in the USA and six high-income countries (ie, Australia, Canada, Germany, France, Sweden, and the UK) and Organisation for Economic Co-operation and Development countries between 2010 and 2023. Relative to comparator countries, the USA had a younger population and lower smoking rates, but it had higher obesity prevalence, calorie intake, illicit drug use, and gun and vehicle ownership. Regarding public health policies that lie largely outside the health-care system, the USA compared unfavourably to comparator countries. For measures dependent on the health-care system, the USA performed well across several measures of clinical prevention, including screening rates and diagnosis and control of chronic conditions. However, the USA was worse on measures of access to health care and coverage. While the USA performs well in prevention efforts within the health-care system compared with other countries for people with access to the system, it faces greater risk from external factors, generally worse dietary intake, and implements weaker public health prevention and regulation against harmful products that might exacerbate these issues. To improve population health, policy makers should prioritise multi-sectoral investments in prevention policies and improve access to health care.

PMID:41162132 | DOI:10.1016/S2468-2667(25)00222-1

Lancet Public Health. 2025 Nov;10(11):e979-e987. doi: 10.1016/S2468-2667(25)00226-9.

ABSTRACT

BACKGROUND: Premature mortality rates are higher in the USA than other peer nations. Few studies have assessed the association between cumulative unsecured debt and subsequent premature mortality. The aim of this study was to investigate the association between cumulatively accrued unsecured debt over 20 years of early adulthood and subsequent premature mortality in midlife (age 41-62 years).

METHODS: For this longitudinal analysis, we used data from 6954 participants included in the US National Longitudinal Survey of Youth 1979. Participants were followed up from 1985 to 2004 to assess debt trajectory, and from 2004 to 2018 to assess premature mortality. A group-based trajectory model was used to classify four groups of unsecured debt trajectories: no debt, constant low debt, constant medium debt, and increasing debt. Multivariable adjusted Cox proportional hazards models were used to assess associations between debt trajectory and mortality.

FINDINGS: Of the 6954 participants included in our analysis, 5670 (81·5%) individuals had constant low debt, 712 (10·2 %) had constant medium debt, 148 (2·1%) had increasing debt, and 424 (6·1%) had no debt. In adjusted models, the risk of mortality was 89% higher in the increasing debt group than the constant low debt group (hazard ratio 1·89 [95% CI 1·14-3·12]). In unadjusted models, individuals with no debt had a numerically higher risk of premature mortality compared with those with constant low debt; however, this difference was not statistically significant.

INTERPRETATION: Cumulative increasing unsecured debt in early adulthood was associated with increased risk of premature mortality in midlife. Interventions and policies targeting unsecured debt might reduce premature mortality.

FUNDING: National Institute of Health National Institute on Aging.

PMID:41162131 | DOI:10.1016/S2468-2667(25)00226-9

Lancet Public Health. 2025 Nov;10(11):e971-e978. doi: 10.1016/S2468-2667(25)00227-0.

ABSTRACT

BACKGROUND: Living in poverty increases the risk for mortality. Existing research that examines life course poverty typically relies on measures separated by decades of time. Here, we aimed to estimate the association of 20-year cumulative poverty exposure from emerging adulthood through to established adulthood with premature mortality assessed over the following 15 years.

METHODS: We included National Longitudinal Survey of Youth 1979 study participants with three or more family income measures between 1985 and 2004. Participants were, on average, aged 23 years at the start and aged 42 years at the end of this period. Follow-up for premature mortality began in 2004 and ended in 2019, at which time participants were aged 53-62 years. We defined cumulative poverty by the proportion of family size-adjusted income measures less than 200% of the Federal Poverty Level: never in poverty, sometimes in poverty (>0 and less than a third of measures), often in poverty (a third or more but not all measures), and always in poverty. Primary analyses used confounder-adjusted Cox proportional hazards regression models. Our outcome was mortality between 2004 and 2019.

FINDINGS: Our sample included 5653 participants, with 1484 (26·2%) never in poverty, 1867 (33·0%) sometimes in poverty, 1852 (32·8%) often in poverty, and 450 (8·0%) always in poverty. 363 (6·4%) participants were reported deceased over follow-up. Compared with participants never in poverty, those sometimes, often, and always in poverty had 1·10 (95% CI 0·79-1·53), 1·53 (1·09-2·14), and 2·53 (1·61-3·96) times higher rates of premature mortality, respectively.

INTERPRETATION: Greater cumulative exposure to poverty across emerging and established adulthood is associated with a greater risk for premature mortality. To inform public health action and policy, future research should evaluate the effects of providing support to individuals who are experiencing financial hardships during these important life stages on health and longevity.

FUNDING: National Institute of Health’s National Institute on Aging.

PMID:41162130 | DOI:10.1016/S2468-2667(25)00227-0