Nevin Manimala

BMC Public Health. 2025 May 7;25(1):1692. doi: 10.1186/s12889-025-22803-3.

ABSTRACT

BACKGROUND: The European Code Against Cancer (ECAC) aims to increase the awareness of modifiable cancer risk factors among the general public. A goal set by the European Commission was that 80% of European citizens should be aware of this code by 2025. This study aims to examine the awareness and attitudes towards the ECAC among the general public in Sweden.

METHODS: A randomly selected sample of 1520 Swedes (18-84 years old) were recruited from a survey panel and invited to respond to an online study-specific questionnaire. The questionnaire included general questions regarding cancer prevention, as well as awareness and attitudes specific to the ECAC. Data were analysed univariately and with adjusted logistic regression, using post-stratification weights based on gender, age, education, and expressed political party orientation.

RESULTS: In total, 3.7% of the respondents had heard about the ECAC before taking this survey. Respondents with a college/university education were more likely to have heard about the ECAC (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.23-4.06). Males (OR 0.56; 95% CI 0.32-0.99), and those living alone (OR 0.47; 95% CI 0.23-0.95) were less likely to have heard about the ECAC. In total, 60.6% of the respondents agreed with the ECAC recommendations, while 27.4% reported that their motivation to improve their lifestyle increased after reading the ECAC.

CONCLUSIONS: Awareness of the ECAC among the general public in Sweden is very low. Still, a majority seem to agree with its recommendations. The results also indicate that the ECAC motivates some, but far from all, to improve their lifestyle habits to reduce their cancer risk. Consequently, further research is warranted on how the ECAC best could and should be used in order to improve cancer prevention awareness and motivation.

PMID:40336012 | DOI:10.1186/s12889-025-22803-3

BMC Med Educ. 2025 May 7;25(1):666. doi: 10.1186/s12909-025-07250-3.

ABSTRACT

BACKGROUND: Large language models (LLMs) like GPT-4o have shown promise in advancing medical decision-making and education. However, their performance in Spanish-language medical contexts remains underexplored. This study evaluates the effectiveness of single-agent and multi-agent strategies in answering questions from the EUNACOM, a standardized medical licensure exam in Chile, across 21 medical specialties.

METHODS: GPT-4o was tested on 1,062 multiple-choice questions from publicly available EUNACOM preparation materials. Single-agent strategies included Zero-Shot, Few-Shot, Chain-of-Thought (CoT), Self-Reflection, and MED-PROMPT, while multi-agent strategies involved Voting, Weighted Voting, Borda Count, MEDAGENTS, and MDAGENTS. Each strategy was tested under three temperature settings (0.3, 0.6, 1.2). Performance was assessed by accuracy, and statistical analyses, including Kruskal-Wallis and Mann-Whitney U tests, were performed. Computational resource utilization, such as API calls and execution time, was also analyzed.

RESULTS: MDAGENTS achieved the highest accuracy with a mean score of 89.97% (SD = 0.56%), outperforming all other strategies (p < 0.001). MEDAGENTS followed with a mean score of 87.99% (SD = 0.49%), and the CoT with Few-Shot strategy scored 87.67% (SD = 0.12%). Temperature settings did not significantly affect performance (F2,54 = 1.45, p = 0.24). Specialty-level analysis showed the highest accuracies in Psychiatry (95.51%), Neurology (95.49%), and Surgery (95.38%), while lower accuracies were observed in Neonatology (77.54%), Otolaryngology (76.64%), and Urology/Nephrology (76.59%). Notably, several exam questions were correctly answered using simpler single-agent strategies without employing complex reasoning or collaboration frameworks.

CONCLUSIONS AND RELEVANCE: Multi-agent strategies, particularly MDAGENTS, significantly enhance GPT-4o’s performance on Spanish-language medical exams, leveraging collaboration to improve diagnostic accuracy. However, simpler single-agent strategies are sufficient to address many questions, high-lighting that only a fraction of standardized medical exams require sophisticated reasoning or multi-agent interaction. These findings suggest potential for LLMs as efficient and scalable tools in Spanish-speaking healthcare, though computational optimization remains a key area for future research.

PMID:40336004 | DOI:10.1186/s12909-025-07250-3

BMC Oral Health. 2025 May 7;25(1):689. doi: 10.1186/s12903-025-06069-0.

ABSTRACT

BACKGROUND: Effective patient education is critical in enhancing treatment outcomes and reducing anxiety in dental procedures. This study compares the effectiveness of AI-generated educational materials with traditional methods in improving patient comprehension and reducing anxiety during endodontic and restorative dental treatments.

METHODS: A cross-sectional, comparative study was conducted with 100 participants undergoing restorative or endodontic procedures. Patients were randomized into two groups: those receiving AI-generated instructional materials (via ChatGPT) and those receiving traditional education (verbal explanations and pamphlets). Baseline knowledge and post-intervention knowledge retention were assessed using structured tests. Patient perceptions of clarity, usefulness, comprehensiveness, trust, and anxiety were measured using Likert-scale surveys. Three dental experts evaluated the educational content for accuracy and suitability. Statistical analysis included t-tests and Cohen’s kappa to measure inter-rater reliability.

RESULTS: AI-generated materials significantly outperformed traditional methods in all measured dimensions, including clarity (4.42 vs. 3.25), usefulness (4.63 vs. 3.50), comprehensiveness (4.50 vs. 3.29), trust (4.00 vs. 2.96), and anxiety reduction (mean anxiety score: 2.63 vs. 3.38, p < 0.001). Pre- and post-intervention knowledge assessments revealed substantial knowledge improvement in the AI group. Expert evaluations confirmed the accuracy and suitability of AI-generated materials, with high inter-rater reliability (κ = 0.75, p < 0.001).

CONCLUSIONS: AI-generated educational materials demonstrate superior effectiveness in improving patient comprehension and reducing anxiety compared to traditional methods. Their integration into dental practice could enhance patient satisfaction and streamline the educational process, particularly for complex or anxiety-inducing procedures. Future research should explore their application in diverse dental specialties and assess long-term impacts on patient behavior and clinical outcomes.

PMID:40335999 | DOI:10.1186/s12903-025-06069-0

J Pediatr Nurs. 2025 May 6;83:154-159. doi: 10.1016/j.pedn.2025.04.033. Online ahead of print.

ABSTRACT

BACKGROUND & OBJECTIVE: Identifying the care needs of parents of children with epilepsy using a reliable tool can help improve the quality of life for both parents and children, enhance care provision, and facilitate disease management. This study aimed to design and psychometrically evaluate the Needs of Parents Caring for Children with Epilepsy Questionnaire (NPCEQ).

METHODS: This study employed a two-stage exploratory sequential mixed-methods design. In the first stage, 13 semi-structured interviews were conducted to clarify the concept of “parental care needs for children with epilepsy.” A conventional content analysis of the interview transcripts was performed to identify subscales and items for inclusion in the instrument. In the second stage, the psychometric properties of the questionnaire were evaluated. The NPCEQ utilizes a 5-point Likert scale. Face validity was assessed by 20 parents, and content validity was evaluated by 35 faculty members. Reliability was tested in a random sample of 331 caregivers.

RESULTS: The final NPCEQ consists of five dimensions with 31 items, accounting for 59.07 % of the total variance. The overall CVR was 0.853, and CVI was 0.877, both indicating very good levels. Internal consistency was assessed using Cronbach’s alpha (0.761). Internal stability was evaluated using the intraclass correlation coefficient (ICC), which was found to be adequate (ICC = 0.62-0.86). The NPCEQ demonstrated evidence of content validity, construct validity, internal consistency, and stability.

CONCLUSION: The NPCEQ demonstrated evidence of content validity, construct validity, internal consistency, and stability. The statistical analysis of the NPCEQ provided an objective tool for assessing the care needs of parents of children with epilepsy in clinical and domestic contexts.

PMID:40334568 | DOI:10.1016/j.pedn.2025.04.033

J Pediatr Nurs. 2025 May 6;83:146-153. doi: 10.1016/j.pedn.2025.04.034. Online ahead of print.

ABSTRACT

AIMS: To examine the relationship between caregiving burden and parenting stress in caregivers of children with esophageal atresia and to identify factors associated with caregiving burden. Additionally, it explores whether self-efficacy mediates this correlation.

DESIGN: An analytical cross-sectional study.

METHODS: Data were collected from 139 caregivers using the Zarit Caregiving Burden Scale (ZCB), Coping Self-Efficacy Scale (CSE), and Parental Stress Scale (PS) between June and October 2023. Statistical analyses included structural equation modeling and logistic regression using IBM SPSS 28.0, SPSS Amos, and Jamovi software.

RESULTS: Among the participants, 68.3 % experienced a moderate-to-high caregiving burden. A statistically significant negative correlation was found between ZCB and CSE scores, while a moderate positive correlation was observed between ZCB and PS scores. Parenting stress was associated with caregiving burden; however, self-efficacy did not mediate this relationship.

CONCLUSION: Caregivers, particularly mothers with high parental stress, a history of miscarriage, and a gestational age above 30 weeks, should be prioritized for interventions addressing caregiving burden.

IMPLICATIONS FOR THE PROFESSION: Assessing caregiving burden and stress in outpatient clinics is critical for effective home care management. Standardized discharge education and psychosocial support should be provided to caregivers to alleviate their burden.

IMPACT: This study fills a research gap regarding caregivers of children with esophageal atresia and provides guidance for healthcare professionals, hospital administrators, and policymakers. Promoting community-based and personal care support services is essential for reducing caregiving burden and parental stress.

REPORTING METHOD: This study adhered to the STARD guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

PMID:40334567 | DOI:10.1016/j.pedn.2025.04.034

J Clin Anesth. 2025 May 6;104:111861. doi: 10.1016/j.jclinane.2025.111861. Online ahead of print.

ABSTRACT

CONTEXT AND OBJECTIVES: The efficacy of erector spinae plane block (ESPB) analgesia among children undergoing surgery remains unsettled. We aimed to perform an updated systematic review, meta-analysis, and trial sequential analysis to determine whether ESPB is effective for pediatric patients undergoing major surgeries.

METHODS: PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing systemic analgesia with vs. without ESPB in pediatric patients undergoing surgery. We computed mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95 % confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R Software, version 4.2.3.

RESULTS: We included 10 RCTs, comprising 570 participants, of whom 287 (50,4 %) underwent ESPB. Compared with systemic analgesia alone, ESPB was associated with a lower intraoperative (MD -1.03 μg/kg; 95 % CI -1.73 to -0.33; p < 0.01) and postoperative (MD -0.08 mg/kg; 95 % CI -0.12 to -0.03; p < 0.01) opioid consumption; a longer time to first analgesic requirement (MD 138.76 min; 95 % CI 84.20 to 193.32; p < 0.01); and lower incidence of postoperative nausea and vomiting (PONV) (RR 0.42; 95 % CI 0.23 to 0.77; p < 0.01). There were no differences between groups for postoperative pain at 6 h (SMD -0.61; 95 % CI -1.16 to -0.07; p = 0.03), and 12 h (SMD -0.13; 95 % CI -0.36 to 0.11; p = 0.28); however, postoperative pain at 24 h was lower with ESPB (SMD -0.59; 95 % CI -0.97 to -0.21; p < 0.01).

CONCLUSIONS: In children undergoing surgery, ESPB was associated with lower intra and postoperative opioid consumption, higher time to first analgesic requirement, and lower PONV, but these differences may be of modest clinical significance.

PMID:40334564 | DOI:10.1016/j.jclinane.2025.111861

Mar Pollut Bull. 2025 May 6;217:118065. doi: 10.1016/j.marpolbul.2025.118065. Online ahead of print.

ABSTRACT

Himalayan rivers were observed to be more vulnerable having irregular water flows, flooding, and contamination due to various stresses, including climate change, urbanization, and industrial development. This study investigated the occurrence, sources, ecological, and health-based ramifications for heavy metal(loid)s (HM), i.e., As, Cu, Zn, Co, Pb, Sb, Cr, Cd, Mn, and Ni in the Astore river basin (ARB), Himalayas, Pakistan. Results of HM contamination index (HCI) estimations suggested that 2.43 %, 12.2 %, and 24.4 % of water samples from the Astore and Rupal valleys may pose strong, moderate, and low toxicity risks, respectively. Pb, Cu, and Cd contribute more to the aquatic toxicity than any other HM included in the ecological risk index (ERI) estimations. Children are the most vulnerable age group to health ailments caused by HM. Statistical analyses revealed that geogenic sources mainly contribute to HM, except for Ni and Cr, which are mainly derived from anthropic sources in ARB.

PMID:40334560 | DOI:10.1016/j.marpolbul.2025.118065

J Environ Radioact. 2025 May 6;287:107704. doi: 10.1016/j.jenvrad.2025.107704. Online ahead of print.

ABSTRACT

A harmonized, publicly accessible database of worldwide observations and experiments on radiocaesium transfer from soil to plants is lacking. Such a database is needed for evaluating and establishing transfer models, especially for regions with limited research but operational or planned nuclear reactors. Therefore, we systematically screened the literature for radiocaesium soil-to-plant transfer factors (CR, i.e., concentration ratios), extracted data that met the criteria for experimental soundness, relevance, and traceability, and compiled a harmonized database. The database included 7,182 CR data points and associated variables from 139 source documents. The CRs ranged from 0.000028 to 380 kg kg^-1, with the highest CR observed with soils from tropical climates and the lowest with soils from temperate climates. However, data from tropical (N = 411) and arid climates (N = 335) remained limited. Univariate and multivariate analyses revealed that CRs were most influenced by the specific study (methods and designs) in which the data were obtained, followed by soil properties and plant species-based categories. On a subset (N = 199) that contained all variables required for semi-mechanistic models, it was found that these models fitted the CR data rather well (R² = 0.42-0.50). Slightly better predictions with the same data were found with a random forest model (R² = 0.51) or a statistical mixed-effects model (R² = 0.58). More adequate machine learning models could not yet be created due to insufficient reliable data. The harmonized database in this study can be further completed and analyzed to support machine learning applications and improve impact assessments of food chain contamination following accidental radiocaesium deposition on agricultural land.

PMID:40334553 | DOI:10.1016/j.jenvrad.2025.107704

Nurse Educ Pract. 2025 May 5;85:104389. doi: 10.1016/j.nepr.2025.104389. Online ahead of print.

ABSTRACT

AIM: The aim of the study was to explore midwifery students’ experiences with simulation as pedagogic method when learning management of postpartum haemorrhage patients.

BACKGROUND: Malawi is just starting to implement simulation-based education, even though it is recommended in midwifery education to enhance patient safety. Therefore, to ensure successful incorporation of simulation-based education into midwifery training programs, it is crucial to understand students’ experiences with the pedagogic method.

DESIGN: The study applied a descriptive-mixed-convergent design.

METHOD: One-hundred and seven midwifery students participated in the study. Data were collected through questionnaires and three focus group discussions. Quantitative and qualitative data were analysed using descriptive statistics and content analysis respectively.

RESULTS: Quantitatively, students graded all the questions related to the simulation design elements, educational practices and students’ satisfaction and self-confidence in learning with mean scores above four on a 5-point Likert Scale. One theme and two sub-themes emerged from qualitative data analysis. Main theme: simulation mirrors demanded competence for professional practice; sub-themes: (1) a realistic and active learning method; and (2) a conducive environment for students’ learning.

CONCLUSION: Midwifery students experienced simulation as a valued pedagogical approach to teaching and learning that mirrored postpartum management clinical skills necessary for them to practice as professionals in the resource-limited setting. More research is necessary to explore feasibility for simulation-based education in Malawi and whether students can apply the knowledge and skills acquired during simulation into clinical practice particularly within constrained environment.

PMID:40334551 | DOI:10.1016/j.nepr.2025.104389

Theriogenology. 2025 May 3;243:117417. doi: 10.1016/j.theriogenology.2025.117417. Online ahead of print.

ABSTRACT

Oxidative stress during oocyte in vitro maturation (IVM) is still concerned. Lipoamide (LAM) has been widely studied as an agent for alleviating various diseases associated with oxidative disruption. This work aimed to evaluate the potential effects of LAM on bovine oocyte IVM and its mechanisms. Different concentrations of LAM (0, 10, 50, 100, and 200 μmol/L) were supplemented to bovine oocyte IVM medium. The IVF derived zygote cleavage and blastocyst formation rate in the 100 μmol/L LAM treatment group was increased compared with the control group (P < 0.05).There was no statistical difference in PBI between 100 μmol/L LAM treatment and the control group, although the treatment tended to increase it (P = 0.059). Further revealed that LAM increased the expression of PI3K and phosphorylated-AKT1 (pAKT1), improved mitochondrial profile, and reduced apoptosis in bovine oocytes. Meanwhile, the reactive oxygen species (ROS) as well as the 8-Hydroxydeoxyguanosine (8-OHdG, DNA damage-specific marker) displayed lower levels accumulation in LAM-exposed oocytes. Taken together, the results show that administration of LAM (100 μmol/L) during IVM can ameliorate the developmental competence of bovine oocyte through the potential regulation of oxidative stress, apoptosis, DNA damage, and PI3K/AKT signaling.

PMID:40334541 | DOI:10.1016/j.theriogenology.2025.117417