Nevin Manimala

BMC Public Health. 2025 Aug 21;25(1):2875. doi: 10.1186/s12889-025-24196-9.

ABSTRACT

BACKGROUND: Health literacy has recently been proposed as a resource to deal with health-related information during the COVID-19 pandemic. Especially the education sector was affected by the consequences of the pandemic, e.g. through school closures and reopenings by following strict hygiene regulations. During challenging times like these, school principals are the key actors in the school environment. They are not only responsible for school functioning, but school principals’ behavior and attitudes are also associated with health promoting school activities. The present study aimed to assess COVID-19 health literacy levels of German school principals, and to investigate the associations of COVID-19 health literacy with the implementation of health promotion in schools during the pandemic.

METHODS: As part of the joined studies coordinated by the COVID-HL Network, the COVID-19 Health Literacy School Principal Survey was conducted in Germany from March to April 2021. 2187 school principals and school management team members from four German federal states participated in the online survey. The HLS-COVID-Q22 was used to assess self-reported COVID-19 health literacy. The COVID-19 related HPS implementation scale was used to measure a holistic approach to school health promotion, consisting of 3 subscales: COVID-19 related support for students, staff and school. COVID-19 health literacy levels were computed using Rasch analysis. Multiple linear regression analysis was conducted to examine the association of school principals’ self-reported COVID-19 health literacy and the implementation of COVID-19 related health promotion in schools.

RESULTS: School principals showed good self-reported COVID-19 health literacy. Multiple linear regression analysis revealed that self-reported COVID-19 health literacy positively predicted the implementation of COVID-19 related health promotion in schools for all three subscales during the pandemic. In some regression models, the sociodemographic factors age, sex, and school type were also significant factors.

CONCLUSIONS: German school principals had high self-reported COVID-19 health literacy. School principals’ self-reported COVID-19 health literacy was a significant factor associated with the implementation of COVID-19 related health promotion in schools. The present findings underline the need to investigate the relationship of school principals’ health literacy and other potential influencing factors for the implementation of health promotion in schools.

PMID:40841892 | DOI:10.1186/s12889-025-24196-9

BMC Womens Health. 2025 Aug 21;25(1):403. doi: 10.1186/s12905-025-03947-1.

ABSTRACT

BACKGROUND: Women’s smoking is a serious and growing problem worldwide. Determining the variables related to smoking to stop this increase is important for the protection of women in special groups with psychological and social risks such as dependent relatives. It was aimed to determine the smoking use of women with dependent spouses and its relationship with marital adjustment and perception of social support.

METHODS: The research is a cross-sectional study. Population of the study consists of 1.500 women who are the spouses of men with the diagnosis of alcohol/substance use disorder and alcohol withdrawal syndrome. The population was calculated with a 20% prevalence 4% margin of error and a 95% confidence interval, and the sample size was 306. The research was carried out between November 2019 and July 2021. Statistical significance level was accepted as P < 0.05. Chi-square Test was used in the analysis of categorical data. Logistic Regression Analysis was used in multivariate analysis.

RESULTS: The spouses of 250 people experiencing alcohol or substance use disorder were included in the study. The coverage of the research is 81.7%. Smoking frequency of women is 65.2%. In bivariate analysis, women’s smoking was found to be statistically significant with the variables of spouse’s addiction type, age, longest place of residence, educational status, history of chronic disease, need for mental support, and presence of hobbies(p < 0.05). In multivariate analysis, it was observed that each unit increase in age, social support score and marital adjustment score was associated with 1.08 (95% CI: 1.01-1.15), 1.35 (95% CI: 1.18-1.55) and 1.12 (95% CI: 1.00-1.12) times increase in smoking risk, respectively.

CONCLUSIONS: In this study, two out of three women with spouses experiencing alcohol/substance use disorder were found to smoke. It has been determined that the risk of smoking is high in women whose spouses have substance use disorder, have a high education level, have a chronic illness, need mental support, do not have a hobby, have a low perception of social support, and have an incompatible marriage. High rate of smoking in this population indicates need for preventive studies with people experiencing alcohol/substance use disorder and their relatives. In addition, it would be beneficial to develop smoking cessation programs with cognitive-behavioral interventions and that strengthen psycho-social support systems in addition to pharmacological treatments.

PMID:40841890 | DOI:10.1186/s12905-025-03947-1

Sci Rep. 2025 Aug 22;15(1):30831. doi: 10.1038/s41598-025-99971-0.

ABSTRACT

Advancing the mechanical properties of naturally weak clayey soils is crucial in geotechnical engineering and is often achieved through targeted stabilization techniques. This research focuses on reinforcing clayey soil by integrating inert material, specifically aeolian sand collected from roadside deposits, in varying proportions from 2.5 to 30%. An experimental approach is adopted to analyze the improvement in geotechnical properties resulting from the addition of aeolian sand to clay through a series of geotechnical tests. These tests include the methylene blue test (MBV), the determination of Atterberg limits (LL, PL, PI), compaction characteristics (MDD and OMC), direct shear testing (C and ϕ), and oedometer tests (Cc and Cs). Furthermore, an optimization approach based on response surface methodology (RSM) and a central composite design (CCD) is implemented to determine the optimal mixture composition and accurately predict the evolution of the geotechnical properties of the soil. The experimental findings demonstrate significant improvements in the mechanical characteristics of the soil following the incorporation of aeolian sand, with the best performance achieved at a 30% sand content. The MBV decreased by 34.98%, the LL decreased by 39.62%, the PL decreased by 37.50%, and the PI decreased by 45.45%. In contrast, the MDD increased by 12.25%, enhancing the compaction and load-bearing capacity of the soil. A reduction of approximately 7.59% in the OMC was observed, lowering the water demand. The internal friction angle (ϕ) increased significantly by up to 233.33%, improving the shear strength, whereas the cohesion decreased by 49.78%. Additionally, the Cc and Cs decreased by 16.15 and 54.45%, respectively, which reduced the sensitivity of the soil to volume changes. Mathematical models are developed and statistically validated using the clay and aeolian sand contents as predictive variables, while key parameters such as the maximum dry density (MDD), cohesion (C), internal friction angle (ϕ), compressibility coefficient (Cc), and swelling coefficient (Cs) serve as response metrics. By applying analysis of variance (ANOVA) and refining the quadratic model via RSM, the study demonstrated significant results, with a coefficient of determination (R²) exceeding 0.97 for all the responses. The alignment between R² and adjusted R², along with the observed P values for critical parameters, highlights the robustness of the model. These findings pave the way for practical applications in foundation and road infrastructure projects, particularly in arid regions where water management and soil stability are critical concerns. The integration of 30% sand proves to be an effective and sustainable solution for enhancing the strength and stability of clayey soils in moisture-sensitive environments.

PMID:40841757 | DOI:10.1038/s41598-025-99971-0

Sci Rep. 2025 Aug 21;15(1):30728. doi: 10.1038/s41598-025-16160-9.

ABSTRACT

Prostate cancer (PC) is a significant global health concern, particularly among older men (OM), and smoking is a well-established modifiable risk factor contributing to its incidence and mortality. However, a comprehensive assessment of the global burden of PC attributable to smoking among OM, with specific analyses by age and Socio-demographic Index (SDI) regions, is still lacking. This study utilized data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to systematically analyze the global burden of PC attributable to smoking among OM (aged 55 years and older) from 1990 to 2021. The analysis included trends in deaths and Disability-Adjusted Life Years (DALYs) across different age groups and SDI regions. The estimated annual percentage change (EAPC) and Joinpoint regression analysis were employed to assess temporal trends. From 1990 to 2021, the global burden of PC attributable to smoking among OM exhibited a significant decline, with the age-standardized death rate decreasing from 3.08 per 100,000 in 1990 to 1.80 per 100,000 in 2021 (EAPC: -2.02, 95% CI: -2.14 to -1.90). Similarly, the age-standardized DALY rate decreased from 65.28 per 100,000 in 1990 to 37.75 per 100,000 in 2021 (EAPC: -2.05, 95% CI: -2.16 to -1.94). However, disparities across SDI regions were evident. The high SDI region experienced the most substantial decline in burden. In contrast, the low-middle SDI region showed an increasing trend, highlighting enduring socioeconomic disparities. Notably, Despite the overall reduction in the global burden, the burden among the older age group, specifically 90-95 years old, remained the most severe in 2021. This study reveals a complex landscape of the global burden of PC attributable to smoking among OM, with an overall decline masking enduring socioeconomic disparities and a severe burden among the older age group. These findings underscore the need for targeted interventions and public health strategies to address these disparities. Future efforts should focus on implementing smoking cessation programs and improving healthcare access in vulnerable populations.

PMID:40841756 | DOI:10.1038/s41598-025-16160-9

Sci Rep. 2025 Aug 21;15(1):30745. doi: 10.1038/s41598-025-15935-4.

ABSTRACT

During the design of hypothesis-driven, comparative laboratory animal experiments, investigators must control for cage effects, ensure full blinding and full randomization while adhering to established experimental designs, notably variations of the Completely Randomized Design and the Randomized Block Designs. Failure to meet these criteria introduces partial or complete confounding by multiple known and unknown variables, resulting in biased outcome measures and rendering valid statistical analysis impossible. Our analysis of a stratified, random sample of comparative laboratory animal experiments conducted in North America and Europe and published in 2022, shows that as few as 0-2.5% utilized valid, unbiased experimental designs. The failure of investigators to adopt valid, unbiased study designs undermines scientific rigour, squanders resources and animal lives, and impedes the reliable translation of preclinical research findings to human and veterinary medicine. We propose practical, achievable solutions focused on enhancing the rigour and validity of study designs. This includes developing a specialized group of scientists with expertise in the design of laboratory animal experiments and data analysis, to ensure future studies are conducted with the highest scientific standards.

PMID:40841741 | DOI:10.1038/s41598-025-15935-4

Sci Rep. 2025 Aug 21;15(1):30741. doi: 10.1038/s41598-025-13294-8.

ABSTRACT

Effective flossing is essential for preventing periodontal disease. However, in a rural Appalachian community, adherence to flossing routines remains low, contributing to significant oral health disparities. The purpose of this study was to conceptualize intention of initiation and sustenance of flossing behaviors using the multi-theory model (MTM) of health behavior change. A cross-sectional survey was administered to individuals recruited from a shopping mall in rural Appalachia. The MTM constructs were measured and data were analyzed using multiple linear regression models. Of the 228 participants, 55% did not floss daily. Behavioral confidence (β = 0.571, p < 0.001) was a significant predictor for the intention of initiation of flossing among non-daily flossers, while emotional transformation (β = 0.377, p = 0.836) significantly explained sustenance among non-daily flossers. For daily flossers, changes in the physical environment (β = 0.432, p = 0.003) significantly predicted the intention of initiation of flossing, whereas emotional transformation (β = 0.344, p = 0.008) and practice for change (β = 0.594, p < 0.001) significantly predicted sustenance of flossing behavior. The MTM appears to be a robust framework for understanding and predicting flossing behaviors in rural Appalachian populations. Interventions designed to enhance behavioral confidence, physical environment changes, emotional transformation, and practice for change could improve flossing adherence. Further research should explore these constructs to develop targeted public health strategies.

PMID:40841729 | DOI:10.1038/s41598-025-13294-8

Sci Rep. 2025 Aug 21;15(1):30782. doi: 10.1038/s41598-025-16307-8.

ABSTRACT

The purpose of this study is to investigate the relationship between physical activity and exercise self-efficacy among college students and to examine the mediating effects of loneliness and body image. Through an analysis of parallel mediating effects, the intrinsic mechanisms underlying these variables are revealed and provide theoretical support for promoting healthy behaviours among college students. The study, conducted in April 2025, employed a cross-sectional design to survey college students across northeast, North, central, East, and South China. A total of 1102 valid questionnaires were collected. The level of physical activity was assessed using the Physical Activity Rating Scale (PARS-3). Exercise self-efficacy was measured using the Exercise Self-Efficacy Scale. Body image was assessed using the Physical Self-Esteem Scale (PSPP), and loneliness was calculated using the UCLA Loneliness Inventory (3rd edition). The data were analysed using SPSS 27 software for descriptive statistics, correlation analyses, and mediation effect analyses. A significant direct positive correlation was found between physical activity and exercise self-efficacy (β = 0.2313, p < 0.001). Furthermore, loneliness and body image played important mediating roles in the relationship between physical activity and exercise self-efficacy. Specifically, physical activity indirectly improved exercise self-efficacy by reducing loneliness (β=-0.124, p < 0.001) and enhancing body image (β = 0.383, p < 0.001). The mediating effect accounted for 32.1% of the total impact, and the mediating effect of body image (28.5%) was significantly more potent than that of loneliness (3.5%). This study reveals the mechanism by which physical activity indirectly increases college students’ sense of exercise self-efficacy by reducing loneliness and improving body image. This finding shows the importance of focusing on individual psychological states when promoting physical activity. Interventions should promote both positive body image and a favourable social environment to improve college students’ exercise self-efficacy and overall psychological well-being.

PMID:40841721 | DOI:10.1038/s41598-025-16307-8

J Patient Rep Outcomes. 2025 Aug 21;9(1):107. doi: 10.1186/s41687-025-00938-6.

ABSTRACT

BACKGROUND: Cervical cancer remains a significant public health issue in underdeveloped regions like Xinjiang, Western China, where health literacy is low and economic disparities are prominent. While previous studies have focused on preventive measures, there is limited research on the willingness to pay (WTP) for cervical cancer treatments. This study aimed to assess patient preferences and WTP from patient perspective for quality of life improvement, unadjusted life-year extension, and targeted and immunotherapy drugs among cervical cancer patients in Xinjiang.

METHODS: A face-to-face survey was conducted using the Contingent Valuation Method (CVM) and Discrete Choice Experiment (DCE) to evaluate WTP for cervical cancer treatments. The CVM assessed patients’ WTP for two scenarios: living in perfect health for 5 or 10 years versus unadjusted life-year extension for the same durations. Health related quality of life (HRQoL) was measured using both the EQ-5D-5 L and EQ-VAS instruments. The DCE evaluated patients’ preferences and WTP for targeted therapy and immunotherapy drugs.

RESULTS: This study included 106 valid questionnaires (response rate 96.4%), primarily comprising stage III cervical cancer patients (EQ-5D-5 L 0.89, EQ-VAS 0.80) with characteristics of low income and educational attainment. Key findings revealed: (1) Patients prioritized quality of life improvement over lifespan extension, with WTP/QALY in the 10-year perfect health scenario exceeding Xinjiang’s 2024 per capita disposable income threshold while other scenarios remained below this value, and WTP/QALY being significantly higher in the 10-year scenario compared to the 5-year scenario; (2) Medication preference analysis demonstrated that quality of life improvement, cost, and incidence of adverse reactions were key decision-making factors, whereas survival extension held relatively lower importance. WTP valuations exhibited significant attribute-specific variations, with the highest WTP corresponding to quality of life improvement attributes and the lowest to survival extension attributes.

CONCLUSIONS: Cervical cancer patients in Xinjiang prioritize quality of life improvement over lifespan extension, with their preferences and WTP being influenced by treatment-related factors, disease characteristics, and socioeconomic background. Therefore, when formulating reimbursement policies and resource allocation strategies, priority should be given to interventions that can significantly improve quality of life, while implementing differentiated support policies for patient populations with varying socioeconomic statuses.

PMID:40841713 | DOI:10.1186/s41687-025-00938-6

Acta Pharmacol Sin. 2025 Aug 21. doi: 10.1038/s41401-025-01636-1. Online ahead of print.

ABSTRACT

Mitochondrial DNA (mtDNA) damage and accumulation activate the cGAS-STING DNA-sensing pathway, which promotes immune clearance of tumor cells. Maintenance of the cytosolic level of mtDNA is key to sustain immune activation. T cell malignancies (T-CMs) are a general name of diseases with abnormal clonal proliferation of T lymphocytes at various stages. Immunotherapy of T-CMs is challenged by the lack of specific antigens to discriminate T-CMs from normal T cells. As intrinsic STING activation can promote the clearance of T-CMs by immune cells, we herein explored whether isoliensinine (IsoL), a natural compound from Nelumbinis Plumula could enhance NK clearance by mtDNA-mediated immune responses in tumor cells. To investigate whether IsoL modulated immune recognition and clearance of T-CMs, we pre-treated three T-CM cell lines (Jurkat, Molt4 and Hut102) with IsoL then co-cultured with NK-92MI cells. We showed that IsoL pre-treatment promoted cytosolic mtDNA accumulation by inducing ROS-dependent mitochondrial damage and inhibiting mitophagy via peroxiredoxin 1 (PRDX1), an antioxidant enzyme. Loss of PRDX1 in T-CMs also induced ROS-dependent mitochondrial DNA damage, and blocked mitophagy by preventing accumulation of mature PINK1, which was required to initiate mitophagy via recruiting Parkin to the damaged mitochondria. Remarkably, IsoL could induce expression of activating ligands in vitro, enhance NK cell infiltrations, and increase apoptosis of T-CMs. Moreover, we demonstrated that IsoL could sensitize T-CMs for NK clearance in vitro and in vivo. These results suggest that IsoL could be a potential therapeutic agent to enhance immune therapy of T-CMs.

PMID:40841706 | DOI:10.1038/s41401-025-01636-1

Infect Dis Poverty. 2025 Aug 21;14(1):88. doi: 10.1186/s40249-025-01356-y.

ABSTRACT

BACKGROUND: Loiasis affects millions in Central Africa and, though historically considered benign, emerging data suggest possible renal involvement. This study investigated the association between Loa microfilaremia and renal function.

METHODS: We conducted a cross-sectional study in the Republic of Congo in May-June 2022. Renal function was assessed via estimated glomerular filtration rate (eGFR) using Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) equations, and proteinuria and/or haematuria (renal abnormalities, RAb). Multinomial logistic regression assessed associations between microfilarial density (MFD) and chronic kidney disease (CKD), using EKFC with Dubois correction. Population attributable fractions were estimated from a logistic model including Loa microfilaremia as a binary variable (present versus absent).

RESULTS: Among 986 participants, CKD prevalence ranged from 13.4% [95% confidence interval (CI) 11.4-15.7%, CKD-EPI] to 17.6% (95% CI 15.3-20.1%, EKFC) for KDIGO stages 1-5, and from 3.0% (95% CI 2.1-4.3%, CKD-EPI) to 7.6% (95% CI 6.1-9.4%, EKFC) for stages 3-5. Loa MFD was associated with higher odds of CKD, particularly in individuals with RAb. Compared to amicrofilaremic participants, those with Loa MFD ≥ 20 000 mf/ml had significantly increased risk: adjusted relative risk ratio (aRRR) for CKD severity categories (≤ 2nd, 2nd-10th, 10th-50th, > 50th eGFR percentile) with RAb were 8.67 (95% CI 2.62-28.64, P = 0.021), 14.26 (95% CI 3.41-59.68, P < 0.001), 5.50 (95% CI 0.55-61.78, P = 0.145), and 26.21 (95% CI 1.64-417.84, P = 0.021). Population attributable fractions of CKD stages 1-5 to Loa microfilaremia was 14.7% (95% CI 4.3-24.0) and 30.1% (95% CI 16.2-42.8) for CKD stages 1-5 with RAb.

CONCLUSIONS: This study provides the first epidemiological evidence linking loiasis to renal impairment, likely via glomerular damage. Given loiasis high endemicity in Central Africa, it may contribute to the burden of unexplained nephropathies. Longitudinal studies and renal biopsies are warranted to clarify underlying mechanisms.

PMID:40841693 | DOI:10.1186/s40249-025-01356-y