Nevin Manimala

Ann Intern Med. 2025 Oct 28. doi: 10.7326/ANNALS-25-01519. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with irritable bowel syndrome (IBS) frequently seek dietary advice, but few evidence-based options exist. Major societal guidelines recommend traditional dietary advice (TDA) as first-line therapy, with the cumbersome and resource-intensive low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet reserved as second-line therapy. Recent pilot data suggest that the Mediterranean diet (MD), renowned for its general health benefits, improves IBS symptoms, but whether it can be considered another first-line dietary option is unknown.

OBJECTIVE: To determine if the MD is noninferior to TDA in managing IBS symptoms.

DESIGN: Randomized noninferiority clinical trial. (ClinicalTrials.gov: NCT05985018).

SETTING: Online virtual platform.

PARTICIPANTS: 139 persons with IBS from across the United Kingdom.

INTERVENTION: 6 weeks of the MD (n = 68) or TDA (n = 71).

MEASUREMENTS: Primary end point was the proportion achieving clinical response, defined as 50-point or greater reduction in IBS Symptom Severity Scale (IBS-SSS). Secondary outcomes included changes in IBS-SSS scores, psychological health, somatic symptom reporting, quality of life, diet satisfaction, and Mediterranean Diet Adherence Screener (MEDAS).

RESULTS: Baseline characteristics (mean age, 40.4 years [range, 19 to 65 years]; 80% women) and IBS-SSS (mean, 309 [SD, 90]) were similar between groups. On modified intention-to-treat analysis, the primary end point was met by 62% (95% CI, 50% to 73%) following a MD versus 42% (CI, 31% to 55%) following TDA. The difference in clinical response favored the MD (difference, 20 percentage points [CI, 4 to 36 percentage points]; P = 0.017), demonstrating noninferiority and superiority. There was a greater reduction in the mean IBS-SSS after a MD than TDA (-101.2 vs. -64.5; Δ-36.7 [CI,-70.5 to -2.8]; P = 0.034). No statistically significant differences were seen between the groups with regard to changes in mood, somatic symptoms, quality of life, or diet satisfaction. The MEDAS significantly increased after a MD compared with TDA (P < 0.001).

LIMITATION: No long-term data.

CONCLUSION: The MD showed noninferiority and superiority to TDA in managing IBS symptoms. It represents a viable first-line dietary intervention for IBS.

PRIMARY FUNDING SOURCE: None.

PMID:41144975 | DOI:10.7326/ANNALS-25-01519

Issues Ment Health Nurs. 2025 Oct 27:1-13. doi: 10.1080/01612840.2025.2567886. Online ahead of print.

ABSTRACT

This study examined the effect of a self-compassion-oriented mindfulness-based psychoeducation program on internalized stigma in individuals diagnosed with schizophrenia. This single-blind, randomized controlled experimental study was conducted with individuals with schizophrenia who were receiving follow-up care at a Community Mental Health Center in a province in northern Türkiye between June and August 2024. Following the administration of pretest assessments, the sample was randomly allocated into an experimental group (n = 21) and a control group (n = 21) through simple randomization. The psychoeducation program, adapted to the specific needs of this population, was administered to the experimental group. Data were collected using the Internalized Stigma of Mental Illness (ISMI) scale and the Descriptive Characteristics Form. Posttest measurements revealed a statistically significant difference between the experimental and control groups in the total score and the subdimensions of Alienation, Stereotype Endorsement, Perceived Discrimination, and Social Withdrawal (p < 0.05). However, no significant difference was observed between the groups in the Stigma Resistance subdimension scores (p > 0.05). The psychoeducation program significantly reduced the total scores on the ISMI among individuals diagnosed with schizophrenia, demonstrating a large effect size of 17.3% (η2 = 0.173; p = 0.006). These findings suggest that a self-compassion-oriented mindfulness-based psychoeducation program, adapted specifically for individuals with schizophrenia, is an effective intervention for reducing internalized stigma in this population.

PMID:41144956 | DOI:10.1080/01612840.2025.2567886

JMIR Mhealth Uhealth. 2025 Oct 27;13:e78036. doi: 10.2196/78036.

ABSTRACT

BACKGROUND: Chinese Americans with type 2 diabetes (T2D) face many linguistic, cultural, and social determinants of health-related barriers to accessing evidence-based diabetes interventions. Our team developed the culturally and linguistically tailored Chinese American Research and Education (CARE) program to provide evidence-based diabetes education and support to this group and demonstrated the feasibility, acceptability, and potential efficacy of the intervention on improving hemoglobin A_1c levels. However, it remains unclear whether the CARE program also improves diabetes self-efficacy and psychosocial outcomes in the same study sample.

OBJECTIVE: This is a secondary analysis to examine the potential efficacy of the CARE program on secondary outcomes, including diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress among Chinese Americans with T2D.

METHODS: A 2-arm, pilot randomized controlled trial was conducted to evaluate the CARE program between March 1, 2021, and April 21, 2023. The trial included 60 Chinese Americans aged 18 to 70 years who had a diagnosis of T2D and a baseline hemoglobin A_1c level of 7% or higher. Participants were recruited from various health care settings in New York City, including community health centers, private primary care providers, and NYU Langone Health and its affiliates, and were randomly assigned to either the CARE intervention group (n=30) or a waitlist control group (n=30). The intervention consisted of 2 culturally and linguistically tailored educational videos per week for 12 weeks, covering diabetes self-care topics such as healthy eating, physical activity, and medication adherence. These videos were delivered via the WeChat app. In addition, community health workers provided support calls to assist them in setting goals, problem-solving, and addressing social determinants of health barriers every 2 weeks. Secondary outcomes included patient self-reported diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress. Outcomes were assessed at baseline, 3 months, and 6 months.

RESULTS: Participants had a mean age of 54.3 (SD 11.5) years and 62% (37/60) were male, 78% (47/60) were married, 58% (35/60) were employed, 70% (42/60) had a high school education or lower, and 88% (53/60) reported limited English proficiency. Intervention participants demonstrated statistically significant improvements in self-efficacy at 3 months (estimated difference in change: 8.47; 95% CI 2.44-14.5; adjusted P=.02), diabetes distress at 6 months (estimated difference in change: -0.43; 95% CI -0.71 to -0.15; adjusted P=.009), and adherence to a healthy diet at both 3 months (estimated difference in change: 1.61; 95% CI 0.46-2.75; adjusted P=.02) and 6 months (estimated difference in change: 1.64; 95% CI 0.48-2.81; adjusted P=.02).

CONCLUSIONS: The culturally and linguistically tailored intervention showed promise in improving self-efficacy and diabetes self-care activities among Chinese Americans with T2D, warranting validation through a large-scale randomized controlled trial.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/study/NCT03557697.

PMID:41144955 | DOI:10.2196/78036

J Med Internet Res. 2025 Oct 27;27:e76947. doi: 10.2196/76947.

ABSTRACT

BACKGROUND: Large language models (LLMs) have the potential to revolutionize ophthalmic care, but their evaluation practice remains fragmented. A systematic assessment is crucial to identify gaps and guide future evaluation practices and clinical integration.

OBJECTIVE: This study aims to map the current landscape of LLM evaluations in ophthalmology and explore whether performance synthesis is feasible for a common task.

METHODS: A comprehensive search of PubMed, Web of Science, Embase, and IEEE Xplore was conducted up to November 17, 2024 (no language limits). Eligible publications quantitatively assessed an existing or modified LLM on ophthalmology-related tasks. Studies without full-text availability or those focusing solely on vision-only models were excluded. Two reviewers screened studies and extracted data across 6 dimensions (evaluated LLM, data modality, ophthalmic subspecialty, medical task, evaluation dimension, and clinical alignment), and disagreements were resolved by a third reviewer. Descriptive statistics were analyzed and visualized using Python (with NumPy, Pandas, SciPy, and Matplotlib libraries). The Fisher exact test compared open- versus closed-source models. An exploratory random-effects meta-analysis (logit transformation; DerSimonian-Laird τ²) was performed for the diagnosis-making task; heterogeneity was reported with I² and subgrouped by model, modality, and subspecialty.

RESULTS: Of the 817 identified records, 187 studies met the inclusion criteria. Closed-source LLMs dominated: 170 for ChatGPT, 58 for Gemini, and 32 for Copilot. Open-source LLMs appeared in only 25 (13.4%) of studies overall, but they appeared in 17 (77.3%) of evaluation-after-development studies, versus 8 (4.8%) pure-evaluation studies (P<1×10^-5). Evaluations were chiefly text-only (n=168); image-text tasks, despite the centrality of imaging, were used in 19 studies. Subspecialty coverage was skewed toward comprehensive ophthalmology (n=72), retina and vitreous (n=32), and glaucoma (n=20). Refractive surgery, ocular pathology and oncology, and ophthalmic pharmacology each appeared in 3 or fewer studies. Medical query (n=86), standardized examination (n=41), and diagnosis making (n=29) emerged as the 3 predominant tasks, while research assistance (n=5), patient triaging (n=3), and disease prediction (n=3) received less attention. Accuracy was reported in most studies (n=176), whereas calibration and uncertainty were almost absent (n=5). Real-world patient data (n=45), human performance comparison (n=63), non‑English testing (n=24), and real-world deployment (n=4) were relatively absent. Exploratory meta-analysis pooled 28 diagnostic evaluations from 17 studies: overall accuracy was 0.594 (95% CI 0.488-0.692) with extreme heterogeneity (I²=94.5%). Subgroups remained heterogeneous (I²>80%), and findings were inconsistent (eg, pooled GPT-3.5>GPT-4).

CONCLUSIONS: Evidence on LLM evaluations in ophthalmology is extensive but heterogeneous. Most studies have tested a few closed-source LLMs on text-based questions, leaving open-source systems, multimodal tasks, non-English contexts, and real-world deployment underexamined. High methodological variability precludes meaningful performance aggregation, as illustrated by the heterogeneous meta-analysis. Standardized, multimodal benchmarks and phased clinical validation pipelines are urgently needed before LLMs can be safely integrated into eye care workflows.

PMID:41144954 | DOI:10.2196/76947

J Clin Lab Anal. 2025 Oct 27:e70126. doi: 10.1002/jcla.70126. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhagic fever with renal syndrome (HFRS) is an endemic disease occurring in various parts of the world. Prompt access to care with proper treatment is essential for preventing patients from developing renal failure and unfavorite outcomes. This study aimed to elucidate laboratory parameters associated with HFRS severity and prognosis to predict disease course and initiate prompt clinical management.

METHODS: Retrospective analysis of laboratory data was performed on HFRS patients from December 2016 to January 2022 in Baoji City of Shaanxi Province in China using different statistical methods.

RESULTS: The WBC and neutrophils in peripheral blood, RBC in urine sediments, blood, protein, and glucose in urine, PT/INR, aPTT, TT, AST, ALT, AST/ALT, MAO, AD, urea, creatinine, cystatin C, CK-MB, LDH, α-HBDH, mAST, triglycerides, glucose, amylase, ferritin, and PCT in serum increased in HFRS patients along with disease severity, while the lymphocytes, monocytes, platelets, plateletcrit, fibrinogen, serum total protein, albumin, HDL-c, magnesium, complement C3 and C4, IgG, triiodothyronine, thyroxine, and free triiodothyronine were reduced. Results also indicated that in uncured HFRS patients, the NEUT%, CRP, cast, PT/INR, aPTT, D-dimer, AST/ALT, CK-MB, LDH, α-HBDH, m-AST, ferritin, and PCT were significantly higher than in cured patients, while platelets, C3, and C4 in uncured patients were significantly lower than in cured patients. The NEUT%, CRP, AST/ALT, and LDH were associated with patients’ prognosis.

CONCLUSIONS: Laboratory data are helpful in predicting HFRS patients’ progress, severity, and prognosis, thus, these parameters are useful in guiding prompt clinical management of patients.

PMID:41144944 | DOI:10.1002/jcla.70126

Psychol Health Med. 2025 Oct 27:1-20. doi: 10.1080/13548506.2025.2575410. Online ahead of print.

ABSTRACT

Breast cancer is the most common cancer type among women, and it is a life-threatening disease. Although women with breast cancer may experience psychological distress, they may also experience posttraumatic growth (PTG). Therefore, this pilot study aimed to develop and test the effectiveness of an online group intervention focused on posttraumatic growth (PTGG) in women diagnosed with breast cancer. The sample of the randomized controlled trial consisted of 49 women with a mean age of 45.94 (7.57) years, ranging from 28 to 64 years, who were randomly assigned to eight weekly group sessions of PTGG, support groups (SG), and waitlist control groups (WLG). PTG, depression, anxiety, and stress scores were assessed at the pretest, posttest, and one-month follow-up. ANCOVA results indicated that PTGG was effective in promoting PTG on both the total and subscales and in reducing depression, compared with the other groups. These improvements were maintained at follow-up in favor of PTGG. However, no statistically significant differences were found between PTGG, SG, and WLG for anxiety and stress, indicating that no advantages were found in favor of either PTGG or SG. It was observed that the intervention effect was significant in analyses that included only clinically distressed individuals. Clinically depressed and anxious individuals in the PTGG reported greater improvements than those in the control group. Concerning these findings, our results also suggest that PTGG could be considered an effective online group intervention for distressed individuals with scores above the threshold, particularly for depression and anxiety. In conclusion, online PTGG can be used as an effective approach to enhance PTG and reduce psychological distress in women with breast cancer.

PMID:41144939 | DOI:10.1080/13548506.2025.2575410

Suicide Life Threat Behav. 2025 Oct;55(5):e70060. doi: 10.1111/sltb.70060.

ABSTRACT

INTRODUCTION: We investigated predictors of suicide among Add Health longitudinal survey participants with over 20,000 high school students using National Death Index (NDI) mortality records, exploring behavioral, attitudinal, and demographic correlates of suicide risk.

METHOD: We investigated early correlating suicide risk factors when students were in high school and whether they died by suicide during the next 28 years. We used multiple linear regression to distill the most essential correlates of suicide risk for male (n = 58) and female (n = 14) suicide decedents.

RESULTS: Findings indicated suicide rates four times higher for males than for females, with males dying at younger ages on average than females. Many risk factors established from previous research were found to be associated with suicide risk. Regression analysis showed only two factors associated with a male’s suicide risk: experiencing a friend’s death by suicide and running away from home. For females, being expelled from school and having a conflicted relationship with one’s father were the most significant correlates.

CONCLUSION: This follow-up provides insights into how risk factors evolve over time, highlighting the importance of early-life psychosocial challenges and gender-specific dynamics in creating suicide risks. Findings underscore the need for differentially targeted interventions to mitigate suicide risk across the lifespan.

PMID:41144913 | DOI:10.1111/sltb.70060

Vet Clin Pathol. 2025 Oct 27. doi: 10.1111/vcp.70066. Online ahead of print.

ABSTRACT

BACKGROUND: The number of backyard chicken (Gallus gallus domesticus) flocks in the US in urban and suburban areas has continued to increase over the past three decades. These flocks are often raised as both production animals and as pets. Electrophoretic evaluation of plasma proteins has been held as the reference standard for protein evaluation. Reference intervals (RIs) for plasma protein electrophoresis (PPE) in chickens in northern Colorado are not readily available but could aid diagnostic evaluations.

OBJECTIVES: We aimed to generate RIs for PPE in adult non-molting backyard chicken flocks in northern Colorado.

METHODS: Plasma from 120 healthy adult chickens in 7 flocks located in northern Colorado was used. Electrophoretic evaluation was completed using a biuret total protein assay and agarose gel electrophoresis, with proteins fractionated into 6 parts. RIs for PPE fractions were generated, and partitioning by sex was performed according to ASVCP guidelines.

RESULTS: RIs were generated for all birds and after partitioning by sex. For all birds, agarose gel electrophoretic RIs were: A:G 0.24-1.20, albumin 1.33-2.91 g/dL, alpha-1 globulin 0.13-0.47 g/dL, alpha-2 globulin 0.33-0.91 g/dL, beta-1 globulin 0.24-1.50 g/dL, beta-2 globulin 0.33-1.79 g/dL, and gamma globulin 0.26-0.82 g/dL. A statistical difference, p < 0.05, was noted between hens and roosters for all electrophoretic fractions except total alpha globulin, beta-2 globulin, and A:G, and partitioning was warranted based on the method recommended by Lahti; the data were partitioned by sex, and RIs were generated.

CONCLUSIONS: RIs are available for PPE in backyard chickens in northern Colorado.

PMID:41144912 | DOI:10.1111/vcp.70066

J Air Waste Manag Assoc. 2025 Oct 27. doi: 10.1080/10962247.2025.2572810. Online ahead of print.

ABSTRACT

The Midwestern city of Kansas City, Missouri, has a long history of redlining practices that have deeply segregated the city. This segregation persists to the present, making Kansas City an important place to study pollution disparities. However, the monitoring landscape in Kansas City is sparse, leading to unique challenges in identifying pollution disparities. Here, we examine disparities in fine particulate matter (PM_2.5) in the Kansas City Metropolitan Area (KCMA) across demographics and present methodology that can be applied to other cities with sparse monitoring infrastructure. We examine quantitative decadal trends in disparities from 2010 to 2019 using Census tract demographic information and PM_2.5 modeled at the intra-urban scale. We find statistically significant (p < 0.05) differences in PM_2.5 distributions between predominantly white communities and communities of color that persist throughout the past decade in all seasons. On an annual basis, majority Black and African-American (BAA) Census tracts have experienced on average 2.7% (0.2 µg m^-3) higher PM_2.5 burden than majority White American (WA) Census tracts. Higher disparities occur between the most and least WA Census tracts (3.4%; 0.3 µg m^-3). The largest disparities in PM_2.5 occur during winter (6.8%; 0.7 µg m^-3). Despite large overall decreases in PM_2.5 mass concentrations of 27%, the disparity between communities remains remarkably persistent over time, indicating that the pollution gap between communities has not been narrowed by emissions regulations. Source attribution simulations performed via the Intervention Model for Air Pollution (InMAP) suggest that non-point sources such as residential heating contribute primarily to observed PM_2.5 disparities. This suggests that the air pollution disparity in Kansas City can be at least partially addressed through mitigation efforts targeting non-point sources of pollution.

PMID:41144901 | DOI:10.1080/10962247.2025.2572810

Anim Sci J. 2025 Jan-Dec;96(1):e70127. doi: 10.1111/asj.70127.

ABSTRACT

The technical efficiencies of transhumance goat farms were evaluated using a non-parametric data envelopment analysis (DEA) model under constant returns to scale (CRS) and variable returns to scale (VRS) assumptions. Data were collected from 37 transhumance goat farms in Mersin province, Turkey. The analysis revealed mean efficiency scores of 0.64 under CRS and 0.82 under VRS, indicating suboptimal input utilization across the majority of farms. Specifically, the findings suggest that input usage could be reduced by 36% under CRS and 18% under VRS without compromising output levels. The use of both models enabled the separation of scale-related inefficiencies from pure technical inefficiency, providing a more nuanced view of farm performance. Given the structural heterogeneity and scale constraints of transhumant systems, the VRS model is more reflective of real-world conditions. These findings underscore the need for targeted policy interventions-such as farmer education programs, grazing optimization, and infrastructure support-to enhance technical efficiency and farm viability. The study contributes valuable insights for policy development aimed at improving productivity and sustainability in traditional livestock systems.

PMID:41144890 | DOI:10.1111/asj.70127