Nevin Manimala

Int J Circumpolar Health. 2025 Dec 31;84(1):2580100. doi: 10.1080/22423982.2025.2580100. Epub 2025 Nov 16.

ABSTRACT

Northern regions of Canada have the highest reported incidence of childhood rickets in the country, yet this public health problem remains poorly described. The goal of this research was to explore the food and vitamin D supplementation experiences in pregnancy and infancy and examine associations with rickets diagnosis. Data were collected systematically through a retrospective chart review of Inuit children from 18 communities in Nunavut born from 2010-2013. Although most pregnant people reported consuming country food daily or weekly, one in three pregnant people reported being food insecure. Fewer than half of infants were reported to have received daily vitamin D supplement at two months of age, and frequency of supplement use declined with age. Rickets diagnosis was present in 1.63% of children (95% CI = 1.20%-2.20%). The odds of rickets diagnosis were higher for children whose mothers experienced food insecurity during pregnancy than for those whose mothers had never experienced food insecurity (OR = 5.279; 95% CI = 1.248-16.191). Enhanced support for food security, breastfeeding and vitamin D supplementation in early life is needed. In the context of social determinants of health, this study highlights the far-reaching and negative impacts of food insecurity on the health of Inuit children in Nunavut.

PMID:41243114 | DOI:10.1080/22423982.2025.2580100

Aust Health Rev. 2025 Dec 4;49(6):AH25105. doi: 10.1071/AH25105.

ABSTRACT

OBJECTIVE: The study analysed how the proportion of general practitioners (GPs) working in different practice sizes and how co-located health services changed over time in Australia, including the differences in these variables across different geographic and socioeconomic areas.

METHODS: A secondary analysis of University of Sydney’s Bettering the Evaluation and Care of Health dataset, a continuous cross-sectional study of GP activity in Australia, was performed. We analysed changes in practice size; changes in co-location of GP practices with other health services (e.g. physiotherapy, psychology, pathology, imaging); changes in practice nurses employed within GP practices; and changes in GP and practice characteristics (including GP sex, GP age, GP hours worked, and practice after-hours arrangements) from April 2000 to March 2016.

RESULTS: The average practice size increased from 4.6 (95% confidence interval (CI) 4.4-4.9) GPs in 2000-2001 to 7.5 (95% CI 7.2-7.8) GPs in 2015-2016. The proportion of GPs working at practices with co-located health services increased from 66.3% (95% CI 63.4-69.2) in 2008-2009 to 94.0% (95% CI 92.5-95.5) in 2015-2016. The proportion of GPs at practices with practice nurses significantly increased from 60.1% (95% CI 56.9-63.2) in 2004-2005 to 84.7% (95% CI 82.4-87.0) in 2015-2016. There were no significant differences across these variables in different geographic and socioeconomic areas, except for practice nurses.

CONCLUSION: This research confirms that GP practice size, co-location of health services, and the number of nurses employed within general practices have increased significantly from 2000 to 2016. We suggest that further data sources are required to explore the implications of these findings and to inform policy.

PMID:41243108 | DOI:10.1071/AH25105

BMC Oral Health. 2025 Nov 16;25(1):1787. doi: 10.1186/s12903-025-07165-x.

ABSTRACT

BACKGROUND: Primary teeth are necessary for mastication, speech, and guiding the eruption of permanent teeth. Dental caries often requires pulpectomy treatment to preserve these teeth. The success of pulpectomy depends on root canal obturation quality. This study aimed to compare the filling quality of zinc oxide-eugenol (ZOE) and Endoflas using lentulo and reverse rotary techniques, assessed by micro-computed tomography.

METHODS: An in vitro study was conducted on 32 extracted human primary mandibular second molars. Teeth were randomly divided into four groups (n = 8) based on obturation material (ZOE or Endoflas) and technique (lentulo spiral or reverse rotary file). After standard canal preparation, obturation was performed. Micro-computed tomography assessed the quality of obturation by measuring the percentage of void and filling volume. Statistical analysis was performed using analysis of variance (ANOVA) test (p < 0.05).

RESULTS: The lowest total void percentage was observed in the (ZOE + Lentulo) group (22.61 ± 9.00), and the highest in the (Endoflas|+Lentulo) group (35.97 ± 5.90). ZOE obturation resulted in lower voids (24.09 ± 8.50) compared to Endoflas (30.70 ± 8.50). The reverse rotary technique showed non significant lower voids (25.50 ± 7.60) than Lentulo (29.29 ± 10.10) (p = 0.181). A significant interaction effect was observed between material and technique in term of total voids (p = 0.021). (ZOE + Lentulo) group showed the highest filling volume (76.50 ± 9.10), while (Endoflas + Lentulo) had the lowest (64.02 ± 5.90). ZOE yielded higher filling volume (75.47 ± 8.50) compared to Endoflas (69.22 ± 8.50), with a significant material effect (p = 0.034), but no significant effect of technique (p = 0.138).

CONCLUSION: ZOE + Lentulo technique provided the most root canal obturation quality, while Endoflas + Lentulo showed the least quality. The root canal filling quality was more influenced by the obturation material than the technique used.

PMID:41243100 | DOI:10.1186/s12903-025-07165-x

Pharmacoepidemiol Drug Saf. 2025 Nov;34(11):e70269. doi: 10.1002/pds.70269.

ABSTRACT

PURPOSE: Self-medication carries the potential for significant adverse events when practiced irresponsibly. The indiscriminate use of medicines notably intensified during the COVID-19 pandemic. This study aimed to investigate the epidemiological profile of exogenous intoxications due to self-medication among Brazilians from 2014 to 2023.

METHODS: This was a cross-sectional, descriptive, and exploratory study utilizing secondary data from the Brazilian Ministry of Health’s Notifiable Diseases Information System. Confirmed cases of self-medication intoxication reported between 2014 and 2023 were included. Descriptive analysis, incidence and lethality rate calculations, chi-squared tests (p ≤ 0.05), and Multiple Correspondence Analysis (MCA) were performed to explore potential associations between sociodemographic and clinical variables.

RESULTS: A total of 23 859 cases were analyzed. The study observed a predominance of adults (20-59 years), women (70.8%), and individuals self-identifying as White or Brown (mixed-race). Most cases resulted from an acute-single exposure to the medication and resolved with complete recovery without sequelae. There was a national increase in incidence, particularly in 2022 and 2023, and significant variations among Brazilian Federative Units. The MCA identified associations between advanced age and the type of exposure (repeated or chronic) and the severity of outcomes. It also revealed changes in the sociodemographic profile of self-medication intoxications during the COVID-19 pandemic.

CONCLUSIONS: These findings underscore the pandemic’s impact on self-medication patterns and intoxication notifications. The study highlights the need for public policies focused on health education, appropriate medicine use, and strengthening the culture of reporting in Brazil.

PMID:41243099 | DOI:10.1002/pds.70269

Sex Health. 2025 Dec 23;22(6):SH24236. doi: 10.1071/SH24236.

ABSTRACT

BACKGROUND: Congenital syphilis is a preventable disease and a direct reflection of rates of syphilis in the population. Between 2013 and 2022, Australia’s infectious syphilis notification rate increased six-fold in women. Between 2013 and 2022, 54% (n = 45) of congenital syphilis cases were reported in Aboriginal infants, and 61% (n = 11) of congenital syphilis-associated deaths between 2016 and 2022 occurred in Aboriginal infants. In 2018, Communicable Diseases Network Australia National Guidelines were updated, recommending syphilis serology testing five times for women during the perinatal period in outbreak areas. The aim of the study was to gain an understanding of the rates of perinatal syphilis serology testing, and to formulate recommendations on how syphilis serology testing can be improved for pregnant Aboriginal women in the Northern Territory.

METHODS: A retrospective audit of antenatal and postpartum episodes of care and syphilis serology testing of Aboriginal women who birthed a live born or stillborn baby was undertaken at four sites including three Northern Territory Health remote clinics and one Aboriginal Community Controlled Health Service. This was an audit of electronic medical records, between 1 May 2019 and 31 March 2021.

RESULTS: The study found that 94% (n = 358) and 93% (n = 357) of Aboriginal women had a first antenatal episode of care and first antenatal syphilis test, respectively. The proportion receiving syphilis serology decreased to a greater extent than the number of women attending antenatal episodes of care with increase in gestational age. Postpartum episodes of care were attended by 27% (n = 103) of Aboriginal women, with 29% (n = 112) having a postpartum syphilis test.

CONCLUSION: Pregnant Aboriginal women are attending for antenatal care; however, the majority are not having syphilis tests as per current guidelines. It is recommended that the primary healthcare sector implement a prompt system for syphilis serology testing, provide more opportunistic syphilis serology testing and monitor adherence to syphilis serology testing guidelines in pregnancy.

PMID:41243092 | DOI:10.1071/SH24236

Res Integr Peer Rev. 2025 Nov 17;10(1):24. doi: 10.1186/s41073-025-00183-x.

ABSTRACT

BACKGROUND: Research methodology education aims to equip students with the foundational knowledge of robust scientific practices, emphasizing deep understanding of scientific inquiry, integrity, and critical thinking in research practice. A literature review reveals that the observed diversity in research methods course design and instruction stems from a lack of consensus about the essential foundations required to critically engage with, design, and execute research in education. This is further compounded by a limited pedagogical innovation. However, no study has yet investigated how research methodology is taught and perceived across European universities. The objective of this study is to examine practices and attitudes regarding teaching research methodology in different European countries, across different disciplines and different training stages to identify commonalities and discrepancies.

METHODS: A cross-sectional survey was designed based on the Structure of Observed Learning Outcome (SOLO) taxonomy and further developed in several rounds of expert input and feedback, ensuring comprehensive inclusion of diverse teaching formats and assessment types. The survey was distributed to research methodology and non-research methodology higher education teachers across Europe through stratified and snowball sampling methods.

RESULTS: The survey was completed by 559 respondents across 24 countries and seven disciplinary categories. The findings identified a predominant reliance on traditional passive teaching formats, such as face-to-face or online lectures. Active methods such as flipped classroom (8.4% Bachelor, 4.8% Master, 2.3% PhD) and protocol writing (8.2% Bachelor, 6.6% Master, 3.9% PhD) were less frequently used. Written exams dominated assessment strategies at all levels. Across our stratification levels, all topics were rated very important, with hypothesis formulation, research integrity, and study design as the most necessary topics, while pre-registration, peer review, and data management plan were prioritized slightly less.

CONCLUSIONS: These findings reveal relative homogeneity in research methodology teaching across academic levels and disciplines in Europe. The persistence of passive teaching formats and the limited adoption of active methodologies reflects an untapped opportunity to improve the effectiveness of research methodology education in fostering critical thinking and ethical practices. Higher education institutions need to reevaluate research methodology curricula to better align with contemporary research demands.

PMID:41243091 | DOI:10.1186/s41073-025-00183-x

J Robot Surg. 2025 Nov 17;20(1):18. doi: 10.1007/s11701-025-02987-x.

ABSTRACT

BACKGROUND: Robotic surgery has revolutionized minimally invasive procedures by integrating advanced technology and improving outcomes. While adoption is increasing in East Asia, nationwide analyses across surgical specialties are limited. This study presents a 14-year analysis (2011-2024) of robotic surgery in Taiwan to elucidate trends on a national level and to provide insights to guide future surgical development and innovation.

MATERIALS AND METHODS: Data were collected from the Taiwan National Health Insurance Research Database from January 2011 to December 2024. Key metrics included the number and growth of certified robotic surgeons and the distribution of robotic surgical cases by specialty. Statistics with a focus on trend analysis were examined using Microsoft Excel^® (Microsoft 365).

RESULTS: Between 2011 and 2024, Taiwan saw a 13-fold increase (from 6 to 78) in da Vinci system installations and a rise in certified robotic surgeons from 38 to 697. Robotic case volume increased 23-fold (from 732 to 16,770). Urology remained dominant (43.1%), followed by gynecology (22.3%), general surgery (10.3%) and colorectal surgery (8.7%). Emerging adoption in otorhinolaryngology (8.0%), thoracic surgery (5.1%), and cardiovascular surgery (2.5%) reflect growing confidence in robotics for complex, high-risk procedures. These trends underscore Taiwan’s expanding multidisciplinary integration of robotic surgery.

CONCLUSIONS: This analysis highlights the evolution of robotic surgery in Taiwan, exemplifying broader innovation within East Asia. Robotic surgery remains promising across specialties, and ongoing technological integration and structured training are needed to sustain and expand its clinical impact.

PMID:41243064 | DOI:10.1007/s11701-025-02987-x

Ann Biomed Eng. 2025 Nov 16. doi: 10.1007/s10439-025-03898-6. Online ahead of print.

ABSTRACT

PURPOSE: This paper investigates the well-known Empirical Wavelet Transform (EWT) and the recently introduced Empirical Fourier Decomposition (EFD) for the early diagnosis of Alzheimer’s disease (AD). Both synthetic signals and real EEG data are decomposed and reconstructed, particularly under noisy conditions.

METHODS: EWT and EFD were applied to decompose non-stationary EEG signals into five sub-bands (Delta, Theta, Alpha, Beta, and Gamma). From each sub-band, eight features were extracted and used to classify subjects into AD and Mild Cognitive Impairment (MCI) groups. Among the five classifiers tested, Random Forest (RF) yielded the best performance for both EWT and EFD. In addition to conventional evaluation metrics, Dynamic Time Warping (DTW) and the Kolmogorov-Smirnov (KS) statistic were used for algorithm assessment.

RESULTS: The results show that EFD outperforms EWT and achieves competitive performance compared to state-of-the-art approaches.

CONCLUSION: EFD is a novel decomposition method that demonstrates robust performance on both synthetic and real EEG signals, supporting its potential use in the early diagnosis of Alzheimer’s disease.

PMID:41243056 | DOI:10.1007/s10439-025-03898-6

J Robot Surg. 2025 Nov 17;20(1):20. doi: 10.1007/s11701-025-02974-2.

ABSTRACT

Open retroperitoneal lymph node dissection (O-RPLND) has historically been the established standard surgical procedure for managing retroperitoneal lymph node disease in testicular cancer. In recent years, however, the adoption of robotic surgical systems has led to a gradual shift in urological practice, with numerous procedures traditionally performed via open surgery being increasingly accomplished using robotic techniques. This study aims to systematically compare the perioperative safety and clinical efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus O-RPLND in the treatment of testicular cancer. Following the AMSTAR quality rating criteria and PRISMA principles, a thorough literature search was carried out. With no start date restrictions, databases such as Web of Science, Embase, PubMed, and the Cochrane Library were searched for pertinent papers until September 2025. The study was prospectively registered in PROSPERO with the registration number CRD420251147469. Statistical analyses were carried out with Review Manager version 5.4. WMD and OR were used as effect measures for continuous and dichotomous variables, respectively, with 95% CIs. This meta-analysis incorporated 10 comparative studies comprising 6,802 patients, including 587 who underwent RA-RPLND and 6,215 treated with O-RPLND. The analysis revealed that RA-RPLND was associated with significantly prolonged operative duration (WMD = 47.71 min; 95% CI: -0.62 to 96.04; P = 0.05), yet demonstrated advantages in reduced hospitalization period (WMD = -3.89 days; 95% CI: -4.89 to -2.88; P < 0.00001). The robotic approach also showed superior outcomes in terms of diminished intraoperative blood loss (WMD = -135.11 ml; 95% CI: -162.50 to -107.71; P < 0.00001) and lower transfusion requirements (OR = 0.11; 95% CI: 0.06 to 0.21; P < 0.00001). No statistically significant differences were observed between the surgical approaches regarding overall complications, major complications (Clavien-Dindo grade ≥ III), lymph node yield, nodal positivity rates, recurrence during surveillance, or postoperative ejaculatory function. ​​Conclusion:​​ Both RA-RPLND and O-RPLND demonstrate acceptable safety and efficacy profiles for patients with testicular cancer. While the robotic technique needs longer operational durations, it has some advantages, including less blood loss, fewer transfusions, shorter hospital stays, and faster recovery. RA-RPLND therefore offers a feasible alternative to traditional open surgery. However, more studies with longer follow-up periods are needed to establish its long-term oncological results and safety profile.

PMID:41243044 | DOI:10.1007/s11701-025-02974-2

J Robot Surg. 2025 Nov 17;20(1):21. doi: 10.1007/s11701-025-02964-4.

ABSTRACT

Robotic surgical platforms facilitate accurate dissection with the help of high-definition 3D camera and greater freedom of manoeuvrability of robotic instruments. Aim was to evaluate short-term results (mucosal integrity and hospital stay) and long-term outcomes [symptom improvement and Quality of life (QoL)] of patients undergoing Robotic Heller’s Cardiomyotomy (RHC). A retrospective analysis of data collected prospectively of achalasia patients undergoing primary RHC between July 2009 and June 2025 was performed. Information collected were demography, Eckardt symptom score (ESS), QoL scores with SF-36, type and stage of achalasia, peri and post-operative data. Sixty-eight patients underwent RHC (33-males). Median age was 46 years (18-82). Median length of myotomy was 8 cm (7-11). Median length of hospital stay was 2 days (1-28). One patient had aspiration pneumonia and DVT, and another had a postoperative leak needing emergency surgery. There was no mortality. Median follow-up was 102 months (3- 192). Twenty-one (31%) needed further intervention during follow-up. There was a significant improvement in ESS and in all components of QoL (p < 0.05). RHC can be performed accurately with a very low leak rate. RHC improves symptoms and quality of life and is an alternative to Laparoscopic Heller’s Cardiomyotomy or per-oral endoscopic myotomy (POEM) in the Modern Era.

PMID:41243042 | DOI:10.1007/s11701-025-02964-4