Nevin Manimala

J Steroid Biochem Mol Biol. 2025 Mar 8:106720. doi: 10.1016/j.jsbmb.2025.106720. Online ahead of print.

ABSTRACT

Vitamin D deficiency (VDD) is prevalent globally and in pediatric intensive care units, where it represents a modifiable risk factor that may impact patient recovery during hospitalization. Herein, we performed a retrospective analysis of serum samples from a phase-II randomized placebo-controlled trial involving a single large bolus of 10,000 IU/kg vitamin D3 ingested by critically ill children with VDD (25-OH-D < 50 nmol/L). Targeted and untargeted methods were used to comprehensively measure 6 vitamin D metabolites, 239 lipids, 68 polar metabolites, and 4 electrolytes using a multi-step data workflow for compound authentication. Complementary statistical methods classified circulating metabolites/lipids associated with vitamin D repletion following high-dose vitamin D3 intake (n=20) versus placebo (n=11) comprising a standard of care maintenance dose (< 1000 IU/day). There was a striking increase in median serum concentrations of 25-OH-D3 (4.7-fold), 3-epi-25-OH-D3 (24-fold) and their C3-epimer ratio (6.7-fold) in treated patients on day 3, whereas serum vitamin D3 peaked on day 1 (128-fold) unlike placebo. Treatment response differences were attributed to D3 bioavailability and C3-epimerase activity without evidence of hypercalcemia. For the first time, we report the detection of circulating 3-epi-D3 that was strongly correlated with vitamin D3 uptake (r = 0.898). Metabolomic studies revealed that vitamin D sufficiency (serum 25-OH-D >75 nmol/L) coincided with lower circulating levels of 3-methylhistidine, cystine, S-methylcysteine, uric acid, and two lysophosphatidylcholines 7 days after treatment. Rapid correction of VDD was associated with indicators of lower oxidative stress, inflammation, and muscle protein turn-over that may contribute clinical benefits in high-risk critically ill children.

PMID:40064426 | DOI:10.1016/j.jsbmb.2025.106720

J Nutr. 2025 Mar 8:S0022-3166(25)00154-3. doi: 10.1016/j.tjnut.2025.03.004. Online ahead of print.

ABSTRACT

INTRODUCTION: In Canada, those who are or who could become pregnant are recommended to consume a daily multivitamin containing 400 μg of folic acid to help prevent neural tube defects.

OBJECTIVES: To report the prevalence and determinants of folic acid-containing supplement use among females of childbearing age in Canada.

METHODS: Data were combined from cycles 2015/16 and 2017/18 of the maternal experiences module of the cross-sectional Canadian Community Health Survey, which was completed by females aged 15-55 years. Representative weighted estimates (means/percentages, 95% CI) were generated for folic acid-containing supplement use among all pregnant, non-pregnant, and lactating respondents. For those who had given birth in the preceding 5 years, estimates were also generated for supplement use in the 3 months before and first 3 months of their most recent pregnancy, and pre-pregnancy awareness of the link between folic acid and some birth defects. We examined associations with sociodemographic factors using multivariable logistic regression.

RESULTS: Overall, 16.5% (15.9-17.0%) of non-pregnant, 80.3% (77.1-83.5%) of pregnant, and 58.4% (54.8-61.9%) of lactating females aged 15-55 reported using a folic acid-containing supplement. Among those who had given birth in the preceding 5 years, 63.7% (62.2-65.1%) consumed a folic acid-containing supplement in the 3 months prior to pregnancy, while 89.9% (88.8-90.9%) did so during the first trimester. Lower prevalence of supplement use before or during pregnancy was reported among the 23.7% (22.4-25.1%) of respondents unaware of the relationship between folic acid and birth defects. Younger age, single marital status, lower educational attainment, income below the median, and smoking were associated with lower odds of awareness or supplement use.

CONCLUSION: While most females living in Canada reported using folic acid-containing supplements prior to and during pregnancy, use of these supplements among non-pregnant females of childbearing age is low, and sociodemographic inequalities exist.

CLINICAL TRIAL REGISTRY NUMBER: not applicable REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OF META-ANALYSIS: not applicable.

PMID:40064422 | DOI:10.1016/j.tjnut.2025.03.004

Pediatr Infect Dis J. 2025 Apr 1;44(4):333-341. doi: 10.1097/INF.0000000000004623. Epub 2024 Nov 8.

ABSTRACT

BACKGROUND: Knowledge regarding the impact of respiratory pathogen co-infection in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children seeking emergency department care is limited, specifically as it relates to the association between SARS-CoV-2 viral co-infection and disease severity and factors associated with co-infection.

METHODS: This secondary analysis included data from 2 prospective cohort studies conducted between March 2020 and February 2022 that included children <18 years of age tested for SARS-CoV-2 infection along with additional respiratory viruses in a participating emergency department. Outcomes included the detection rate of other respiratory viruses and the occurrence of severe outcomes (ie, intensive interventions, severe organ impairment and death).

RESULTS: We included 2520 participants, of whom 388 (15.4%) were SARS-CoV-2-positive. Detection of additional respiratory viruses occurred in 18.3% (71/388) of SARS-CoV-2-positive children, with rhinovirus/enterovirus being most frequently detected (42/388; 10.8%). In multivariable analyses (adjusted odds ratio and 95% confidence interval), among SARS-CoV-2-positive children, detection of another respiratory virus was not associated with severe outcomes [1.74 (0.80-3.79)], but detection of rhinovirus/enterovirus [vs. isolated SARS-CoV-2 detection 3.56 (1.49-8.51)] and having any preexisting chronic medical condition [2.15 (1.06-4.36)] were associated with severe outcomes. Among SARS-CoV-2-positive children, characteristics independently associated with an increased odds of any other viral co-infection included: age and delta variant infection.

CONCLUSIONS: Approximately 1 in 5 children infected with SARS-CoV-2 had co-infection with another respiratory virus, and co-infection with rhinovirus/enterovirus was associated with severe outcomes. When public health restrictions were relaxed, co-infections increased.

PMID:40063967 | DOI:10.1097/INF.0000000000004623

J Spec Oper Med. 2025 Mar 10:FEE1-GMH5. doi: 10.55460/FEE1-GMH5. Online ahead of print.

ABSTRACT

PURPOSE: This study evaluated the feasibility of performing a surgical cricothyrotomy (CTT) in lieu of a tube tracheostomy (TT) as the first-line emergent surgical airway access technique in military working dogs (MWDs).

METHODS: In a crossover, randomized trial, five emergency medicine physician residents (MD group), trained in performing CTT in people but not canines, and five early career veterinarians (DVM group), trained in performing TT in canines but not trained in performing CTT in canines, performed a CTT and TT on 10 canine cadavers.

RESULTS: The time to complete CTT within the MD group was statistically shorter than the time to complete TT (P<.05). In the DVM group, the time to complete TT was shorter than that of CTT, but the time difference was not statistically significant (CTT: 239.6 [SD 251.7] s vs. TT: 133.4 [SD 88.0] s). In the MD group, the TT damage score was statistically higher than the CTT damage score (CTT: 0 vs. TT: 1.6 [SD 0.9], P<.01). There was no statistically significant difference between the damage scores of CTT and TT in the DVM group (CTT: 1.4 [SD 1.1] vs. TT: 1.6 [SD 0.9]). Overall, the participants reported a positive response with CTT compared to TT.

CONCLUSION: CTT is a viable first-line emergent surgical airway access technique when used by veterinarians and human healthcare clinicians with limited surgical experience or no proficiency in performing TT.

PMID:40063951 | DOI:10.55460/FEE1-GMH5

JMIR Form Res. 2025 Mar 10;9:e64239. doi: 10.2196/64239.

ABSTRACT

BACKGROUND: Many couples undergoing fertility treatment face multiple lifestyle risk factors that lower their chances of achieving pregnancy. The MyFertiCoach (MFC) app was designed as an integrated lifestyle program featuring modules on healthy weight management, nutrition, exercise, quitting smoking, reducing alcohol and drug use, and managing stress. We hypothesized that supplementing standard care with the MFC app would improve lifestyle outcomes.

OBJECTIVE: This study aims to assess the impact of the MFC app on changing multiple lifestyle habits in women seeking fertility treatment. The primary outcome is the change in the total risk score (TRS) at 3- and six-month follow-ups. The TRS is calculated for each individual as the sum of all risk scores per behavior (eg, vegetable/fruit/folic acid intake, smoking, and alcohol use) at 3 and 6 months. A higher TRS indicates unhealthier nutrition and lifestyle habits and a lower likelihood of achieving pregnancy. The secondary endpoints include changes in BMI, activity score, preconception dietary risk score, distress score (eg, perceived burden), smoking habits, alcohol intake, and program adherence.

METHODS: This retrospective, observational, single-center evaluation included patients between January 1, 2022, and December 31, 2023. Subfertile female patients aged 18-43 years and their partners, who were referred to a gynecologist, were invited to participate in online lifestyle coaching via the MFC app. The gynecologist selected relevant lifestyle modules based on the results of integrated screening questionnaires. We used (hierarchical) linear mixed models (LMMs) to estimate changes in outcomes. For missing data patterns deemed missing not at random, joint modeling was applied. Statistical significance was set at P≤.05, with methods in place to maintain the same false-positive rate.

RESULTS: A total of 1805 patients were invited to participate in the evaluation, with an average of 737 (40.83%) completing the screening questionnaire at baseline. For the TRS, 798 (44.21%) patients were included at baseline, of whom 517 (64.8%) involved their partner. On average, 282 of 744 (37.9%) patients submitted at least one follow-up questionnaire. Patients rated the app above average (n=137, median score of 7 on a 1-10 scale) on days 7 and 14. The TRS decreased by an average of 1.5 points (P<.001) at T3 and T6 compared with baseline, a clinically meaningful improvement. All secondary outcomes showed statistically significant positive changes for patients who used a relevant lifestyle module (P<.001). Most improvements were achieved by 3 months and remained significant at 6 months (P<.001), except for alcohol intake (P<.53). These findings were consistent across both LMMs and joint models.

CONCLUSIONS: Our evaluation of a mobile health app integrated into standard care demonstrates immediate and clinically meaningful improvements in key lifestyle parameters among women seeking to become pregnant. Additional scientific research is needed to identify the causal pathways leading to sustained effectiveness. To maintain and enhance these outcomes, further tailoring of patient-specific programs is essential.

PMID:40063944 | DOI:10.2196/64239

J Med Internet Res. 2025 Mar 10;27:e55844. doi: 10.2196/55844.

ABSTRACT

BACKGROUND: The key to gestational weight management intervention involves health-related behaviors, including dietary and exercise management. Behavioral theory-based interventions are effective in improving health-related behaviors. However, evidence for mobile health interventions based on specific behavioral theories is insufficient and their effects have not been fully elucidated.

OBJECTIVE: This study aimed to examine the effects of a gestational mobile health intervention on psychological cognition and behavior for gestational weight management, using an integrated behavioral model as the theoretical framework.

METHODS: This study was conducted in a tertiary maternity hospital and conducted as a single-blind randomized controlled trial (RCT) in Changzhou, Jiangsu Province, China. Using the behavioral model, integrated with the protection motivation theory and information-motivation-behavioral skills model (PMT-IMB model), the intervention group received a mobile health intervention using a self-developed app from 14 to 37 gestational weeks, whereas the control group received routine guidance through the application. Psychological cognition and behaviors related to weight management during pregnancy were the main outcomes, which were measured at baseline, and at the second and third trimesters of pregnancy using a self-designed questionnaire. Generalized estimation and regression equations were used to compare the outcome differences between the intervention and control groups.

RESULTS: In total, 302 (302/360, 83.9%) participants underwent all measurements at 3 time points (intervention group: n=150; control group: n=152). Compared with the control group, the intervention group had significantly higher scores for information, perceived vulnerability, response cost, and exercise management in the second trimester, while their scores for perceived vulnerability, response cost, and diet management were significantly higher in the third trimester. The results of repeated measures analysis revealed that, in psychological cognition, the information dimension exhibited both the time effects (T3 β=3.235, 95% CI 2.859-3.611; P<.001) and the group effects (β=0.597, 95% CI 0.035-1.158; P=.04). Similarly, response costs demonstrated both the time effects (T3 β=0.745, 95% CI 0.199-1.291; P=.008) and the group effects (β=1.034, 95% CI 0.367-1.700; P=.002). In contrast, perceived vulnerability solely exhibited the group effects (β=0.669, 95% CI 0.050-1.288; P=.03). Regarding weight management behaviors, both time (T3 β=6, 95% CI 4.527-7.473; P<.001) and group (β=2.685, 95% CI 0.323-5.047; P=.03) had statistically significant impacts on the total points. Furthermore, the exercise management dimension also demonstrated both the time effects (T3 β=3.791, 95% CI 2.999-4.584; P<.001) and the group effects (β=1.501, 95% CI 0.232-2.771; P=.02).

CONCLUSIONS: The intervention program was effective in increasing psychological cognitions in terms of information, perceived vulnerability, and response costs, as well as promoting healthy behaviors among Chinese pregnant women. This study provides new evidence supporting the effectiveness of mobile intervention based on behavioral science theory in gestational weight management.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100043231; https://www.chictr.org.cn/showproj.html?proj=121736.

PMID:40063942 | DOI:10.2196/55844

J Med Internet Res. 2025 Mar 10;27:e66321. doi: 10.2196/66321.

ABSTRACT

BACKGROUND: Young people are disproportionately impacted by self-harm and suicide, and concerns exist regarding the role of social media and exposure to unsafe content. Governments and social media companies have taken various approaches to address online safety for young people when it comes to self-harm and suicide; however, little is known about whether key stakeholders believe current approaches are fit-for-purpose.

OBJECTIVE: From the perspective of young people, policy makers and professionals who work within the social media industry, this study aimed to explore (1) the perceived challenges and views regarding young people communicating on social media about self-harm and suicide, and (2) what more social media companies and governments could be doing to address these issues and keep young people safe online.

METHODS: This qualitative study involved 6 focus groups with Australian young people aged 12-25 years (n=7), Australian policy makers (n=14), and professionals from the global social media industry (n=7). Framework analysis was used to summarize and chart the data for each stakeholder group.

RESULTS: In total, 3 primary themes and six subthemes are presented: (1) challenges and concerns, including the reasons for, and challenges related to, online communication about self-harm and suicide as well as reasoning with a deterministic narrative of harm; (2) roles and responsibilities regarding online safety and suicide prevention, including who is responsible and where responsibility starts and stops, as well as the need for better collaborations; and (3) future approaches and potential solutions, acknowledging the limitations of current safety tools and policies, and calling for innovation and new ideas.

CONCLUSIONS: Our findings highlight tensions surrounding roles and responsibilities in ensuring youth online safety and offer perspectives on how social media companies can support young people discussing self-harm and suicide online. They also support the importance of cross-industry collaborations and consideration of social media in future suicide prevention solutions intended to support young people.

PMID:40063940 | DOI:10.2196/66321

J Med Internet Res. 2025 Mar 10;27:e50313. doi: 10.2196/50313.

ABSTRACT

BACKGROUND: eHealth literacy has increasingly emerged as a critical determinant of health, highlighting the importance of identifying its influencing factors; however, these factors remain unclear. Numerous studies have explored this concept across various populations, presenting an opportunity for a systematic review and synthesis of the existing evidence to better understand eHealth literacy and its key determinants.

OBJECTIVE: This study aimed to provide a systematic review of factors influencing eHealth literacy and to examine their impact across different populations.

METHODS: We conducted a comprehensive search of papers from PubMed, CNKI, Embase, Web of Science, Cochrane Library, CINAHL, and MEDLINE databases from inception to April 11, 2023. We included all those studies that reported the eHealth literacy status measured with the eHealth Literacy Scale (eHEALS). Methodological validity was assessed with the standardized Joanna Briggs Institute (JBI) critical appraisal tool prepared for cross-sectional studies. Meta-analytic techniques were used to calculate the pooled standardized β coefficient with 95% CIs, while heterogeneity was assessed using I2, the Q test, and τ2. Meta-regressions were used to explore the effect of potential moderators, including participants’ characteristics, internet use measured by time or frequency, and country development status. Predictors of eHealth literacy were integrated according to the Literacy and Health Conceptual Framework and the Technology Acceptance Model (TAM).

RESULTS: In total, 17 studies met the inclusion criteria for the meta-analysis. Key factors influencing higher eHealth literacy were identified and classified into 3 themes: (1) actions (internet usage: β=0.14, 95% CI 0.102-0.182, I2=80.4%), (2) determinants (age: β=-0.042, 95% CI -0.071 to -0.020, I2=80.3%; ethnicity: β=-2.613, 95% CI -4.114 to -1.112, I2=80.2%; income: β=0.206, 95% CI 0.059-0.354, I2=64.6%; employment status: β=-1.629, 95% CI -2.323 to -0.953, I2=99.7%; education: β=0.154, 95% CI 0.101-0.208, I2=58.2%; perceived usefulness: β=0.832, 95% CI 0.131-1.522, I2=68.3%; and self-efficacy: β=0.239, 95% CI 0.129-0.349, I2=0.0%), and (3) health status factor (disease: β=-0.177, 95% CI -0.298 to -0.055, I2=26.9%).

CONCLUSIONS: This systematic review, guided by the Literacy and Health Conceptual Framework model, identified key factors influencing eHealth literacy across 3 dimensions: actions (internet usage), determinants (age, ethnicity, income, employment status, education, perceived usefulness, and self-efficacy), and health status (disease). These findings provide valuable guidance for designing interventions to enhance eHealth literacy.

TRIAL REGISTRATION: PROSPERO CRD42022383384; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022383384.

PMID:40063939 | DOI:10.2196/50313

J Med Internet Res. 2025 Mar 10;27:e67188. doi: 10.2196/67188.

ABSTRACT

BACKGROUND: The pursuit of sleep quality has become an important aspect of people’s global quest for overall health. However, the objective neurobiological features corresponding to subjective perceptions of sleep quality remain poorly understood. Although previous studies have investigated the relationship between electroencephalogram (EEG) and sleep, the lack of longitudinal follow-up studies raises doubts about the reproducibility of their findings.

OBJECTIVE: Currently, there is a gap in research regarding the stable associations between EEG data and sleep quality assessed through multiple data collection sessions, which could help identify potential neurobiological targets related to sleep quality.

METHODS: In this study, we used a portable EEG device to collect resting-state prefrontal cortex EEG data over a 3-month follow-up period from 42 participants (27 in the first month, 25 in the second month, and 40 in the third month). Each month, participants’ sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) to estimate their recent sleep quality.

RESULTS: We found that there is a significant and consistent positive correlation between low α band activity in the prefrontal cortex and PSQI scores (r=0.45, P<.001). More importantly, this correlation remained consistent across all 3-month follow-up recordings (P<.05), regardless of whether we considered the same cohort or expanded the sample size. Furthermore, we discovered that the periodic component of the low α band primarily contributed to this significant association with PSQI.

CONCLUSIONS: These findings represent the first identification of a stable and reliable neurobiological target related to sleep quality through multiple follow-up sessions. Our results provide a solid foundation for future applications of portable EEG devices in monitoring sleep quality and screening for sleep disorders in a broad population.

PMID:40063935 | DOI:10.2196/67188

J Med Internet Res. 2025 Mar 10;27:e64307. doi: 10.2196/64307.

ABSTRACT

BACKGROUND: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them.

OBJECTIVE: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals’ intentions to adopt these behaviors in the United States.

METHODS: This study uses data from 3 selected top national newspapers in the United States, Twitter discussions, and a US nationwide longitudinal panel survey from February 2020 to April 2021. We used the Intermedia Agenda-Setting Theory and the Protective Action Decision Model to develop the theoretical framework.

RESULTS: We found a 2-way agenda flow between selected national newspapers and the social media platform Twitter, particularly in controversial topics like vaccination (F_1,426=16.39; P<.001 for newspapers; F_1,426=44.46; P<.001 for Twitter). Exposure to media coverage increased individuals’ perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals’ media exposure increased perceived benefits of mask-wearing (β=.057; P<.001 for household benefits; β=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks (β=-.026; P=.04).

CONCLUSIONS: This study integrates media flow across platforms with US national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align.

PMID:40063934 | DOI:10.2196/64307