Nevin Manimala

Singapore Med J. 2025 Jun 6. doi: 10.4103/singaporemedj.SMJ-2024-076. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite the exponential increase in microbiome research, knowledge and beliefs about the gut microbiome and faecal microbiota transplantation (FMT) remain unclear. The aim of this study was to identify the extent of knowledge, awareness and perception among the general public regarding the gut microbiome and FMT.

METHODS: An online questionnaire on knowledge and beliefs about the gut microbiome and FMT was administered to 1831 participants. Data analysis software was used to generate descriptive statistics and explore associations between knowledge and sociodemographic variables.

RESULTS: Even though only 33% of participants had heard of the gut microbiome, more than 92% had consumed probiotic drinks or supplements. While 85% had not heard of the FMT procedure, 72% of respondents would consider having FMT to treat Clostridioides difficile infection (CDI). Willingness to receive FMT depended mainly on recommendation from healthcare providers (77%). Knowledge and awareness regarding the gut microbiome and FMT were relatively low, despite most participants having prior gut health-related behaviours.

CONCLUSION: This study identified the public’s perceptions of FMT and the potential barriers to its uptake. Insights from the study highlight the need for health education to enhance acceptance of FMT and the importance of using information supported by medical professionals to immunise the public against poorly validated science.

PMID:40472289 | DOI:10.4103/singaporemedj.SMJ-2024-076

Blood Adv. 2025 Jun 5:bloodadvances.2025016107. doi: 10.1182/bloodadvances.2025016107. Online ahead of print.

ABSTRACT

Venous thromboembolism is frequent in ovarian cancer especially after surgery. Elaboration of tissue factor bearing extracellular vesicles (TF+EV) has been linked to thrombosis in cancer and hypercoagulability of surgery. Rosuvastatin can reduce the generation of EV and decrease VTE risk in non-cancer populations. The use of rosuvastatin to mitigate post-surgical thrombosis by lowering TF+EV following ovarian cancer surgery has not been investigated. In a pilot phase 2 trial in women undergoing ovarian cancer, women were randomized to enoxaparin 40 mg daily for 30 days with or without rosuvastatin 40 mg daily (administered from days 15- 60). Women who elected to forgo randomization received enoxaparin 40 mg daily for 30 days per standard of care. Total EV and TF+EV were assessed at baseline, day 30, and day 60. Bilateral lower extremity ultrasound was performed on day 30 and 60. A total of 24 women enrolled in the trial, 15 underwent randomization and 7 women were randomized to enoxaparin with rosuvastatin (17 received enoxaparin alone). There were no statistical differences observed in circulating TF+EV with the addition of rosuvastatin to enoxaparin at day 30 or day 60. Similarly, there were no differences in C-reactive protein or D-dimer between groups. There were no lower extremity deep vein thrombosis identified on screening ultrasounds, although portal vein thrombosis was diagnosed in enoxaparin-only arm. No major hemorrhages were observed. The addition of rosuvastatin to enoxaparin following ovarian cancer surgery does not appear to impact number of circulating TF+EV nor alter markers of thromboinflammation.

PMID:40472284 | DOI:10.1182/bloodadvances.2025016107

Epidemiology. 2025 Jun 5. doi: 10.1097/EDE.0000000000001882. Online ahead of print.

ABSTRACT

BACKGROUND: For infectious diseases, characterizing symptom duration is of clinical and public health importance. Symptom duration may be assessed by surveying infected individuals and querying symptom status at the time of survey response. For example, in a severe acute respiratory syndrome coronavirus 2 testing program at the University of Washington, participants were surveyed at least 28 days after testing positive and asked to report current symptom status. This study design yielded current status data: outcome measurements for each respondent consisted only of the time of survey response and a binary indicator of whether symptoms had resolved by that time. Such study design benefits from limited risk of recall bias, but analyzing the resulting data necessitates tailored statistical tools.

METHODS: We review methods for current status data and describe a novel application of modern nonparametric techniques to this setting. The proposed approach is valid under weaker assumptions compared with existing methods, allows the use of flexible machine learning tools, and handles potential survey nonresponse. Our method relies on the assumption that the survey response time is conditionally independent of symptom resolution time within strata of measured covariates, and we propose an approach to assess the sensitivity of results to deviations from conditional independence.

RESULTS: From the university study, we estimate that 19% of participants experienced ongoing symptoms 30 days after testing positive, decreasing to 7% at 90 days. We found the estimates to be more sensitive to violations of the conditional independence assumption at 30 days compared with 90 days. Female sex, fatigue during acute infection, and higher viral load were associated with slower symptom resolution.

CONCLUSION: The proposed method and accompanying sensitivity analysis procedure provide tools for investigators faced with current status data.

PMID:40472281 | DOI:10.1097/EDE.0000000000001882

Int J Adolesc Med Health. 2025 Jun 6. doi: 10.1515/ijamh-2025-0012. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate adolescents’ knowledge, attitude, and risk perceptions regarding e-cigarette usage and examine the associations and differences across various socio-demographic characteristics.

METHODS: A cross-sectional study was conducted in two government secondary schools in Johor. A total of 391 respondents were enrolled conveniently using a pre-validated questionnaire. The data were analysed using SPSS descriptive and inferential statistics.

RESULTS: Most participants demonstrated a moderate level of knowledge regarding e-cigarettes (77.5 %), achieving an average score of 3.82 (±0.89). A significant portion of the respondents were female (56.3 %) and Chinese (57.5 %), predominantly aged between 16 and 17 years (53.7 %). Presently, 11.5 % of the participants reported using e-cigarettes, while 6.6 % reported using traditional tobacco cigarettes. Notably, 12.3 % of adolescents correctly identified nicotine as a common component in e-cigarettes, highlighting its addictive nature. Furthermore, significant association and differences were observed between e-cigarette usage and a positive attitude towards them (86.7 %, p<0.001), as well as the perception of reduced health risks associated with e-cigarette consumption (9.11 ± 2.68, p<0.001). Adolescents who were susceptible to e-cigarette use were more inclined to support their usage (63.1 %, p<0.001) and perceived fewer health consequences (6.91 + 3.12, p=0.019) in comparison to those who were not susceptible.

CONCLUSIONS: E-cigarette users exhibited a moderate level of understanding along with a positive stance towards e-cigarettes, viewing them as less risky compared to non-e-cigarette users. As a result, collaborative endeavours are essential to enhance adolescent knowledge about e-cigarettes via community outreach initiatives. Consequently, all governing bodies must explore effective strategies to tackle this issue by implementing strict legislation.

PMID:40472268 | DOI:10.1515/ijamh-2025-0012

J Particip Med. 2025 Jun 5;17:e69253. doi: 10.2196/69253.

ABSTRACT

BACKGROUND: Patient portals demonstrate significant potential for improving health care engagement but face critical adoption challenges. Disparities persist across different demographic groups, creating a digital divide in health care access. Targeted training strategies, particularly personalized and one-on-one approaches, show promise in increasing portal utilization. Innovative solutions, like community health workers specializing in digital navigation, offer a potential pathway to reduce enrollment barriers. The key challenge remains developing a scalable, cost-effective training model.

OBJECTIVE: Our quality improvement (QI) project aimed to assess the feasibility and effectiveness of a collaborative effort between a free community-based digital navigation program and an urgent care clinic in facilitating patient access to their portal.

METHODS: We created the Digital Health Equity Navigation Training (DHENT) program to improve patient portal access and usage. The program used a train-the-trainer model to scale up patient portal training across the community. DHENT trainers partnered with urgent care physicians to enroll patients in the portal. Physicians briefly explained portal benefits and referred interested patients for DHENT assistance. Trainers then contacted patients by phone to help with enrollment and navigation. We employed 3 Plan-Do-Study-Act cycles to understand the feasibility of the collaboration. We used descriptive statistics to describe participant characteristics and referral processes.

RESULTS: The collaboration was marginally successful, exceeding referral targets by 27.7% (115/90). Most patients were under 60 years old (94/115, 81.7%) and White (78/115, 67.8%). There was a significant delay in contact, averaging 37 days. While 4.8% (5/104) of patients accessed the portal with DHENT trainer assistance, 9.6% (10/104) had already signed up independently after their urgent care visit.

CONCLUSIONS: Overall, we found our partnership had a moderate impact, and only a low dose of intervention and resources were needed.

PMID:40472267 | DOI:10.2196/69253

JMIR Aging. 2025 Jun 5;8:e64974. doi: 10.2196/64974.

ABSTRACT

BACKGROUND: With an aging population driven by advances in medical technology, digital literacy has become essential for improving the quality of life of older adults, enhancing access to health information, and promoting healthy lifestyles. Furthermore, the COVID-19 pandemic may have influenced the subjective health perceptions and healthy lifestyle behaviors of older adults. However, there is limited research exploring the relationship between digital literacy, subjective health perceptions, and healthy lifestyle behaviors in Korea.

OBJECTIVE: This study aimed to investigate digital literacy’s impact on Korean older adults’ subjective health status and healthy lifestyle behaviors.

METHODS: Data of 8664 respondents (aged 65 years and older) from the 2020 National Survey of the Older Koreans were analyzed. Digital literacy was measured based on the use of IT devices (ITDs), difficulty using online information, and inconvenience of ITDs. Statistical analyses, such as the Rao-Scott chi-square test, Wilcoxon rank sum test, and multiple regression analysis, were conducted.

RESULTS: Respondents with above-average ITD use (adjusted odds ratio [aOR] 1.73, 95% CI 1.50-1.99) and less difficulty using online information (aOR 1.41, 95% CI 1.24-1.61) had higher odds of perceiving themselves as healthy. Conversely, high difficulty using ITDs was associated with lower odds of respondents perceiving themselves as healthy (aOR 0.84, 95% CI 0.82-0.87). Furthermore, high ITD use predicted engagement in healthy lifestyle behaviors (aOR 1.51, 95% CI 1.33-1.72), whereas high difficulty using ITDs predicted lower odds of engagement (aOR 0.94, 95% CI 0.92-0.97). In contrast, there was no difference in the odds of engaging in healthy lifestyle behaviors regardless of difficulty using online information (aOR 1.03, 95% CI 0.92-1.15).

CONCLUSIONS: This study underscores the significant association between digital literacy and improved health outcomes among older adults. Promotion of digital literacy and relevant policies is essential to help older adults effectively obtain health information online, thereby improving their quality of life and overall health.

PMID:40472263 | DOI:10.2196/64974

JMIR Form Res. 2025 Jun 5;9:e67906. doi: 10.2196/67906.

ABSTRACT

BACKGROUND: While mobile health (mHealth) apps have been made for various diseases, including sickle cell disease (SCD), most focus on a single purpose. SCD is a chronic disease that requires knowledge of the disease, self-management, and adherence to treatment plans. While mHealth apps have been made with single features for SCD, there is limited understanding of using an mHealth app with a more comprehensive set of features that could engage adults with SCD, depending on what features they prefer and need to engage and empower them in living with their disease.

OBJECTIVE: We evaluated the usage of an mHealth app with various features, including pain tracking, quizzes for patient-facing guidelines, pain and asthma action plans, and goal setting.

METHODS: Adults with SCD were enrolled at 2 sickle cell centers between 2018 and 2022 as part of a 6-month feasibility randomized controlled trial with participants completing surveys at baseline and 6 months. Participants were randomized into receiving either an mHealth app and booklet with patient-facing guidelines or a booklet with the guidelines alone. The mHealth app comprised web pages with patient-facing guideline material and a Research Electronic Data Capture (REDCap) project. The REDCap project included a personal profile, a pain tracker, goal setting, quizzes about the guidelines, and pain or asthma action plans. The REDCap project also included the ability to send daily text messages at a time they chose, which contained a message they could create and a link to their profile. Outcomes included SCD-specific knowledge and acute health care utilization (emergency room visits and hospitalizations). We evaluated the usage of these different features and relationships with baseline variables, each other, and study outcomes.

RESULTS: Approximately 75% (50/67) of the enrolled and randomized participants completed all the study components, and 100% (26/26) of the participants who were randomized to the mHealth app arm and completed the study used the mHealth app. Further, 15/30 (50%) participants used multiple features. Baseline sickle cell knowledge and female gender were associated with more usage of pain diary (P=.04) and mission (P=.046) features, respectively. While not significant, mission completion was associated with lower hospitalizations (P=.06).

CONCLUSIONS: Adults with SCD engaged differently with an mHealth app with multiple features. As this study was not focused on one part of our app, engagement with features in this app was entirely patient-driven, which may demonstrate the expected real-world use of an mHealth app in this population. A multipurpose app can help engage participants in self-management strategies through different features and potentially improve outcomes.

PMID:40472251 | DOI:10.2196/67906

Pediatr Infect Dis J. 2025 Jun 3. doi: 10.1097/INF.0000000000004860. Online ahead of print.

ABSTRACT

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant public health threat, causing skin and soft tissue infections (SSTIs) and severe complications in children. Virulence factors such as Panton-Valentine leucocidin (PVL) enhance its pathogenicity. This study investigates the epidemiology, antibiotic resistance and PVL production of community-acquired MRSA (CA-MRSA) infections among children.

METHODS: A nationwide multicenter retrospective study was conducted on children under 18 years diagnosed with CA-MRSA infections in Spain between 2018 and 2020. Positive MRSA cultures were obtained from biological samples within the first 48 hours of hospital or primary care contact and analyzed for antibiotic susceptibility and PVL production. Epidemiological, clinical and microbiological data were described and compared with previous colonization data. Statistical analyses, including multivariate logistic regression, were performed to identify factors associated with infection.

RESULTS: A total of 252 children with CA-MRSA infections were included, with a median age of 5.5 years (interquartile ranges: 2-10). SSTIs accounted for 89.3% of cases, and 23.6% required hospitalization. Migrant status (52.5%) and prior SSTIs (39.1%) were significantly associated with MRSA infection (P < 0.05). MRSA strains causing infection exhibited high resistance to ciprofloxacin (32.2%) and clindamycin (18.3%). No differences in antibiotic susceptibility were observed between strains causing infection and colonization. Reinfection occurred in 21% of cases, despite 45.3% undergoing decolonization. PVL genes were detected in 76.9% of MRSA strains, and were significantly more frequent in infection compared to colonization (P < 0.001).

CONCLUSIONS: Migrant status and PVL toxin production are significant risk factors for MRSA infections. The high prevalence of antibiotic resistance highlights the importance of tailoring empirical treatment strategies based on local resistance patterns.

PMID:40472240 | DOI:10.1097/INF.0000000000004860

JMIR Rehabil Assist Technol. 2025 Jun 5;12:e70063. doi: 10.2196/70063.

ABSTRACT

BACKGROUND: With the rapid advancement of technology, using wearable devices and mobile health (mHealth) apps to monitor and promote physical activity (PA) has become increasingly popular among individuals with various chronic conditions. However, such work remains limited among individuals with spinal cord injury (SCI), especially those who use a manual wheelchair for mobility.

OBJECTIVES: The study aims to describe the development of the WheelFit mHealth app for monitoring and promoting PA in manual wheelchair users (MWUs) with SCI and evaluate its feasibility and usability in free-living conditions.

METHODS: The WheelFit app, based on the Fogg Behavioral Model with inputs from stakeholders, including MWUs, physical therapists, and personal trainers, was developed to promote PA in MWUs. It works with two commercial wearable devices, that is, an Android smartwatch and a wheel sensor, which stream users’ upper extremity and wheelchair movement to the app to calculate PA variables using custom algorithms. Users can set personal goals, review daily progress and PA history, and access an adaptive workout library within the app. A 4-week single-group pre-post study, consisting of a 1-week baseline and 3-week intervention phase, was conducted to evaluate WheelFit’s feasibility and usability. Feasibility was evaluated using the session attendance rate, device and app usage, and implementation of action plans. Usability was assessed using the system usability scale. The preliminary effectiveness was assessed by comparing preintervention and postintervention PA variables and scores from the SCI exercise self-efficacy scale.

RESULTS: A total of 16 participants completed the study protocol with 100% session attendance and maintained 14.2 hours of daily device and app connection. Participants demonstrated varying levels of adherence to their action plans. The excellent usability of WheelFit was indicated by an average system usability scale score of 81.8 (SD 19.2) points. Statistically significant increases between pre-post daily exercise times (preintervention: mean 26.4, SD 16.9 minutes; postintervention: mean 33.3, SD 24.9 minutes; P=.049) and exercise self-efficacy scale scores (preintervention: mean 33.9, SD 4.5 points; postintervention: mean 35.9, SD 3.2 points; P=.043) were observed.

CONCLUSIONS: The WheelFit app demonstrated promising feasibility, usability, and a positive impact on promoting PA in MWUs with SCI. Future investigation exploring the potential integration of the WheelFit app into clinical practice is warranted.

PMID:40472238 | DOI:10.2196/70063

Ocul Immunol Inflamm. 2025 Jun 5:1-8. doi: 10.1080/09273948.2025.2507709. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the risk of osteonecrosis (ON) among patients with Vogt-Koyanagi-Harada (VKH) receiving varying cumulative corticosteroid dosages and to evaluate changes in risk over time.

METHODS: We retrospectively analyzed data from 1,512 patients with VKH in Taiwan’s National Health Insurance Research Database from 2000 to 2019. Patients were categorized based on cumulative prednisone-equivalent dosages in the first 3 months of treatment as follows: low dose (n = 544; 0 < dose ≤ 2 g), medium dose (n = 369; 2 < dose ≤ 4 g), high dose (n = 332; > 4 g), and non-users (n = 267; 0 g).

RESULTS: Among VKH patients, combined immunotherapy (IMT) was used in 13.1% within 3 months. After adjustments for age, sex, Charlson Comorbidity Index score, disease stage and the IMT use within the first 3 months, the cumulative risk of ON became significant in the fourth and fifth years for both the low-dose group (HR = 4.59, p = 0.047) and the high-dose group (HR = 5.02, p = 0.043).

CONCLUSIONS: In this study, only 13.1% of VKH patients received combined IMT within the first 3 months, indicating substantial room to increase early IMT utilization. Early use of combination therapy may potentially reduce corticosteroid exposure, lower the risk of ON, and improve visual outcomes. Patients should be informed of the prolonged risk of corticosteroid-induced ON, which can persist for up to four years, to ensure appropriate monitoring and prevention.

PMID:40472209 | DOI:10.1080/09273948.2025.2507709