Nevin Manimala

Clin Psychol Psychother. 2025 Sep-Oct;32(5):e70167. doi: 10.1002/cpp.70167.

ABSTRACT

BACKGROUND: Bullying perpetration has been associated with depressive symptoms. Although the bullying literature is large, most studies are correlational and cannot address the question of causation directly. This study explored bidirectional causal relationships between bullying perpetration and depressive symptoms using data from the TwinLife study, a comprehensive longitudinal survey of German twins. We aimed to clarify whether bullying perpetration leads to depressive symptoms or vice versa, or if other underlying factors might explain their co-occurrence.

METHODS: The analysis included 1975 twin pairs from the TwinLife study, with data on depressive symptoms and bullying. The analysis used an extension to the Direction of Causation model, a bivariate causal inferential twin model that adjusts the effect of measurement error. A range of models was tested. Age, sex, inter-twin aggression and household income were included in all models as covariates.

RESULTS: After testing five models with and without causal paths, we found the model without causal paths but including common genetic and unique environmental liabilities best explained the data.

CONCLUSION: It was found that depressive symptoms and bullying perpetration share genetic influences.

PMID:41144883 | DOI:10.1002/cpp.70167

J Trauma Nurs. 2025 Oct 24. doi: 10.1097/JTN.0000000000000889. Online ahead of print.

ABSTRACT

BACKGROUND: Implicit biases and color blindness attitudes among health care providers negatively impact health outcomes and decision-making, particularly for marginalized trauma patients. While research highlights perspective-taking as a method to mitigate health care bias, effective educational strategies to reduce such biases among trauma care professionals remain understudied.

OBJECTIVE: To evaluate the effectiveness of “A Brain Game: Deconstructing Bias” as an intervention for levels of perspective-taking and color blindness attitudes among trauma care professionals.

METHODS: This is a single-center, prospective cohort survey study. Using a modified snowball sampling approach, participants were recruited and represented various trauma system roles, including clinicians, researchers, data analysts, social workers, and outpatient providers. Pre- and postintervention surveys assessed perspective-taking, color blindness attitudes, and willingness to consider bias.

RESULTS: A total of 132 participants initiated a presurvey with a total of 58 (44%) participants completing both pre- and postintervention surveys included in the analysis. Statistically significant changes observed with increases in perspective-taking scores (p < .001), understanding social constructs (p < .001), alongside decreases in color blindness (p = .049), and unawareness of institutional racism (p = .020). Additionally, 82.8% (n = 48) of participants expressed a willingness to consider their biases before patient interactions.

CONCLUSION: This pilot study found that the theatrical intervention, “A Brain Game: Deconstructing Bias,” improved trauma professionals’ understanding of social constructs, enhanced perspective-taking, reduced color blindness attitudes, and increased willingness to consider bias in patient care. Despite its feasibility, moderate completion rates and single-center design limit generalizability. Further research is warranted.

PMID:41144853 | DOI:10.1097/JTN.0000000000000889

J Pediatr Gastroenterol Nutr. 2025 Oct 27. doi: 10.1002/jpn3.70247. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate ultrasound parameters, particularly splenic stiffness, as predictors of pediatric esophageal varices.

METHODS: We included all children aged 0-19 years who underwent esophagogastroduodenoscopy, for variceal screening or surveillance, and abdominopelvic ultrasound with splenic elastography measurement. We also recorded biological parameters (platelets count, albumin) to determine a clinical prediction rule (CPR). Derivation and validation cohorts were defined according to measurement date. Receiver-operating characteristic (ROC) statistics and sensitivity, specificity, positive predictive value, and negative predictive value for the optimal threshold value were calculated, and used to assess the performance of each parameter.

RESULTS: Eighty derivation cohort children and 58 validation cohort children formed the study sample. Cohort characteristics did not differ for age, sex, distribution of varices but differ for some etiologies, abdominal surgery, spleen size, splenic stiffness measurement (SSM), ascites, and the presence of spontaneous portosystemic shunts. In the derivation cohort, splenic stiffness was the best independent predictor of esophageal varices, with an area under the ROC curve (AUC) of 0.83, a sensitivity of 0.90, and specificity of 0.73 at a threshold of 22 kPa. In the validation cohort, SSM was no longer significantly associated with esophageal varices at endoscopy, had a lower sensitivity of 0.26, and no other threshold could be found. Liver stiffness measurement (LSM) and CPR had a correct predictive value (AUC 0.70 for LSM; 0.78 for CPR in the derivation cohort and 0.64 for LSM; 0.71 for CPR in the validation cohort) for esophageal varices.

CONCLUSIONS: SSM cannot be used as a single parameter to predict esophageal varices. LSM and CPR despite their lower AUC appear to much more robust measures with consistent results across cohorts.

PMID:41144851 | DOI:10.1002/jpn3.70247

Acta Obstet Gynecol Scand. 2025 Oct 27. doi: 10.1111/aogs.70071. Online ahead of print.

ABSTRACT

INTRODUCTION: Fertility after cancer represents a growing clinical concern. This study assessed childbearing outcomes among women diagnosed with cancer during reproductive age between 2012 and 2017 in Lombardy, the largest region in Italy.

MATERIAL AND METHODS: Women aged 15-45 years with a primary diagnosis of cancer recorded in hospital discharge records from regional healthcare databases were selected. Each woman diagnosed with cancer was matched with up to five cancer-free women of the same age at diagnosis. The cumulative probability of childbirth up to December 31, 2022 was estimated using the Kalbfleisch-Prentice cumulative incidence function estimator. Cox regression models were used to estimate the cause-specific hazard ratios (HRs) and the 95% confidence intervals (CIs) of childbirth according to the cancer diagnosis. Furthermore, in the group of cancer survivors, exposure to antineoplastic treatment was considered and included in the model as a time-dependent covariate. Finally, a log-binomial regression model was used to assess the association between antineoplastic therapy and medically assisted reproduction.

RESULTS: A total of 13,877 women were diagnosed with cancer at reproductive age during the study period (1.16 per 1000 person-years). The cumulative probability of childbirth was lower among women diagnosed with cancer compared to cancer-free women across all age groups: 31.4% vs 32.2% (p = 0.02) among those diagnosed under 30, 13.3% vs 22.7% (p < 0.01) among those aged 30-39, and 0.8% vs 1.6% (p < 0.01) among those aged 40 and over. The corresponding HRs were 0.93 (95% CI: 0.83-1.05), 0.58 (95% CI: 0.53-0.64), and 0.52 (95% CI: 0.40-0.68). When analyses were stratified by time since diagnosis, the reduced probability among cancer survivors was confirmed to be significant only within the first 5 years after diagnosis, also for younger individuals. Antineoplastic treatment was associated with a reduced probability of subsequent birth (HR = 0.46, 95% CI: 0.39-0.52). Moreover, the therapy was positively associated with medically assisted reproduction (RR = 1.71, 95% CI: 1.14-2.56).

CONCLUSIONS: The probability of childbearing was reduced within the first 5 years of diagnosis, regardless of the patient’s age. A more pronounced reduction was observed in women diagnosed after the age of 30. Age and antineoplastic therapy were key factors in determining childbearing in women diagnosed with cancer.

PMID:41144834 | DOI:10.1111/aogs.70071

Adv Sci (Weinh). 2025 Oct 27:e13878. doi: 10.1002/advs.202513878. Online ahead of print.

ABSTRACT

Oxidizing transition metal surfaces are generally characterized by an increasing heterogeneity at simultaneous lowering of crystalline order. This complexity eludes present-day first-principles descriptions, with predictive-quality surface phase diagrams commonly derived from comparing the stability of a small number of ordered surface structural models that are motivated by partial experimental characterization or chemical intuition. Here the computational acceleration brought by machine-learned interatomic potentials is leveraged for a systematic sampling of the configurational phase space through replica exchange molecular dynamics. Thermodynamic averaging subsequently yields grand-canonical expectation values for observables like O coverage that account for the disorder and diversity of the sampled structures. Application to the initial oxidation of the Cu(111) surface reveals the (purely entropic) stabilization of sparse O adsorbates at the onset, a plethora of energetically essentially degenerate polymeric -O-Cu-O- ring and chain networks at higher O loading, as well as the presence of experimentally discussed minority species. The in silico surface phase diagram correspondingly shows marked differences to one based merely on established ordered surface reconstructions.

PMID:41144830 | DOI:10.1002/advs.202513878

Laryngoscope. 2025 Oct 27. doi: 10.1002/lary.70222. Online ahead of print.

ABSTRACT

OBJECTIVES: Medialization thyroplasty (MT) is a procedure used to treat glottal insufficiency. It is conducted with the patient under procedural sedation for vocal feedback. The objective of this study is to evaluate the patient’s perception of pain after MT surgery.

METHODS: Prospective observational study. Patients undergoing MT completed the validated short-form McGill Pain Questionnaire (SF-MPQ) before surgery and post-operative days (PODs) 1 and 7, and Voice Handicap Index-10 questionnaire (VHI-10) before surgery and POD7. Demographic and clinical data were collected. Nonparametric tests were conducted for statistical analysis.

RESULTS: Fifty-three patients (47% male), with a median age of 67 years (IQR 15) were recruited between March 2023 and February 2025. On POD1, 74% required analgesia and 52% required opioids. Pre-operative SF-MPQ was median 0 (IQR 0), which increased significantly on POD1 to 3.0 (IQR 7.5) (p < 0.0001) and decreased significantly on POD7 to median 1.0 (IQR 3.0) (p < 0.0001). Voices significantly improved, from pre-operative VHI-10 score of 26 (IQR 14) to POD7 score of 12 (IQR 13) (p < 0.0001). None of the following factors were associated with increased pain: age, sex, BMI, anxiety diagnosis, per-operative, regular intake of pain medication, surgical time or pre-operative VHI score.

CONCLUSIONS: Although MT was completed under procedural sedation, pain was well tolerated after surgery. Half of the patients used opioids for post-operative pain, and the levels of pain were mild. There are opportunities for improved opioid stewardship in the pain management of this surgery. This study is one of the few prospective studies evaluating pain with MT.

PMID:41144815 | DOI:10.1002/lary.70222

Acta Anaesthesiol Scand. 2026 Jan;70(1):e70140. doi: 10.1111/aas.70140.

ABSTRACT

BACKGROUND: Continuous regional anesthesia (CRA) techniques are used for analgesia in patients with acute rib fractures. However, there is a paucity of evidence supporting the initiation of CRA in patients receiving mechanical ventilation (MV). We therefore performed this retrospective study to assess changes in opioid consumption and the rate of liberation from MV in patients with traumatic rib fractures.

METHODS: Patients referred to the Acute Pain Service (January 2022-July 2023) who were mechanically ventilated with acute rib fractures were included in this study. Patients received consultation either with or without CRA. Demographic and severity of injury data were collected. Mechanical ventilator requirements, pain scores, sedation use, opioids, adjunct analgesics, neurological status, and sedation status were collected for the 24 h prior to APS consultation/CRA intervention and for 48 h afterward.

RESULTS: Forty patients were included in the study, with 18 in the non-CRA group and 22 in the CRA group. There was a statistically significant decrease in overall opioid consumption (oral morphine equivalents) for the CRA group compared to the non-CRA group 0-48 h postintervention (0-24 h post-CRA [median 135 mg { 33.1-296.6}]) versus non-CRA 368.3 (121.5-727.9) (p = 0.018), 24-48 h post-CRA (31.5 mg [11.5-131.6] vs. non-CRA 342.8 [99.3-645.8]) (p = 0.001). There was no significant difference in rates of liberation from MV between groups.

CONCLUSIONS: CRA use was associated with a decrease in opioid consumption 24-48 h after CRA intervention compared to baseline. CRA did not facilitate early liberation from MV.

EDITORIAL COMMENT: This retrospective study provides evidence that CRA may reduce opioid requirements in mechanically ventilated patients with rib fractures. Although CRA did not facilitate earlier liberation from ventilation, the opioid-sparing effect is clinically relevant in this population. Larger prospective studies are warranted to define optimal timing, patient selection, and integration of CRA into critical care pathways.

PMID:41144812 | DOI:10.1111/aas.70140

J Appl Clin Med Phys. 2025 Nov;26(11):e70305. doi: 10.1002/acm2.70305.

ABSTRACT

BACKGROUND: Radiation oncology residents report a lack of understanding and confidence in assessing radiotherapy plan quality. A contributing factor is the environment in which plan review is taught during residency, that is, routine clinical practice, which does not provide ample time for self-guided practice in a low-stakes setting. Expertise in plan review requires diverse case presentation and many examples, which are often not achievable in smaller programs and for less common cancer types. As plan quality affects patient outcomes, it is important to address these pitfalls in the education of residents on plan review.

PURPOSE: To address the identified pitfalls of clinic-based training, we have developed techniques to create realistic dose distributions that appear suboptimal in a controllable way. These plans can provide many more case examples in the training curriculum and present a low-stakes technique for safe and effective education of radiation oncology residents.

METHODS: High-quality dose distributions were first generated with a pre-trained deep learning model (trained using only high-quality plans). The dose distributions were then altered directly to create three classes of suboptimal dose distributions: (1) decreased organ-at-risk sparing, (2) decreased target conformality, and (3) hotspots in the target. Experienced clinicians then reviewed a subset of these suboptimal dose distributions to assess realism.

RESULTS: We successfully decreased the quality of radiotherapy dose distributions. The decreased organ-at-risk sparing, decreased target conformality, and increased target hotspots were statistically significant (p < 0.05) when assessed by dose-volume histogram metrics for all parameters evaluated, and the magnitude of dose change was controllable. The resulting dose distributions were overall scored by experienced clinicians as realistic.

CONCLUSION: In this study, we developed techniques to generate realistic but suboptimal dose distributions. The techniques operate directly on existing dose distributions without the need for a treatment planning system and produce dose distributions that appear realistic to experienced clinicians.

PMID:41144809 | DOI:10.1002/acm2.70305

Phys Occup Ther Pediatr. 2025 Oct 27:1-15. doi: 10.1080/01942638.2025.2576746. Online ahead of print.

ABSTRACT

AIMS: To assess test-retest reliability and concurrent validity of the 1-min sit-to-stand test (1-minSTST) in children and adolescents who are overweight or obese.

METHODS: Thirty-nine overweight and obese children and adolescents were included. The 1-minSTST was administered twice with a one-hour break. Concurrent validity was evaluated by assessing correlations between 1-minSTST repetitions and six-minute walk test (6MWT) distances. The cardiorespiratory measures (blood pressure, heart rate, oxygen saturation, respiratory rate, dyspnea, and perceived fatigue) were recorded before and after each test.

RESULTS: Test-retest reliability was excellent (ICC: 0.90, 95% confidence interval 0.90-0.97). There was no relationship between scores on the 1-minSTST and 6MWT (r = -0.06, p = 0.71). No statistically significant correlation was found between scores on each test and change in cardiorespiratory responses, except for respiratory rate (r = 0.43, p = 0.006). Change in cardiorespiratory responses was similar when performing each test (p > 0.05).

CONCLUSION: While the 1-minSTST seems promising, it is not significantly related to the 6MWT, indicating they may assess different dimensions of fitness in this population. Further investigations are needed to determine the clinical implications of 1-minSTST outcomes in pediatric population.

PMID:41143870 | DOI:10.1080/01942638.2025.2576746

JMIR Res Protoc. 2025 Oct 27;14:e73366. doi: 10.2196/73366.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and imposes a significant public health burden. In 2019, HPV was responsible for approximately 620,000 cancer cases in women, 70,000 in men, and more than 300,000 deaths globally. Despite the proven efficacy of the vaccine, vaccination rates remain alarmingly low in certain regions of France. In Réunion Island, only 16% of girls and 9% of boys under 16 years old were fully vaccinated in 2024. This underscores the need for increased awareness, education, and outreach programs. Peer learning is well-established in health education, whereas serious game-style card games are newer and require further research. Both methods have been shown to improve knowledge on specific topics.

OBJECTIVE: The main objective of this study is to assess the impact of 2 awareness-raising strategies on increasing HPV vaccination rates among middle school students by actively involving them in the process.

METHODS: This protocol describes the design of a randomized, open-label, controlled trial aimed at evaluating the effectiveness of 2 awareness-raising interventions-peer learning and a card-based serious game-in improving HPV vaccination rates among middle school students in Réunion Island. The study will span an entire school year, beginning in August. Approximately 3600 students from 24 middle schools in Réunion Island will be included, with schools randomized into 3 groups of 8 each: (1) a control group receiving the existing national vaccination campaign initiated by the French public health institute; (2) ambassador classes, whose students will receive education about the HPV vaccine and later educate other students in the same school; and (3) serious game card group, where students can play and learn about HPV during a science class. The primary outcome will be the proportion of teenagers who initiate the vaccination process, compared across the 3 groups using appropriate statistical methods. Anonymized data will be collected at the end of the school year using social security records. Teenagers’ knowledge of HPV will be assessed both before and 3 months after each intervention, and satisfaction will also be evaluated after the intervention in each group.

RESULTS: As of May 2025, a preliminary result enrolling 124 students showed an increase in vaccination coverage after students played a serious game. We expect higher vaccination rates in the intervention groups compared with the control group, although it is difficult to predict which strategy will be more effective. The estimated target vaccination coverage for groups b and c is 45%.

CONCLUSIONS: This study aims to improve HPV vaccination rates among teenagers in Réunion Island by evaluating the impact of 2 awareness-raising strategies using innovative and engaging tools. If successful, this approach could be adapted and implemented in other regions of France or internationally.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/73366.

PMID:41143859 | DOI:10.2196/73366