Nevin Manimala

BMC Oral Health. 2025 Feb 11;25(1):222. doi: 10.1186/s12903-025-05567-5.

ABSTRACT

BACKGROUND: The decisions individuals make regarding oral health reflect their values. Prioritizing oral and dental health is essential for public health. This study aimed to evaluate the validity and reliability of the Persian version of the Oral Health Values Questionnaire.

METHODS: A cross-sectional study was conducted involving 500 adults aged 18 years and older at health centers in Shiraz in 2023. The Original Oral Health Values Scale (OHVS) questionnaire was translated into Persian using a forward-backward translation. Participants completed the Persian version of the OHVS, which comprises a 12-item scale with a four-factor structure: professional dental care, appearance and health, flossing, and preservation of natural teeth. The Content Validity Index (CVI), Content Validity Ratio (CVR) and Scale-Level Content Validity Index (S-CVI/Ave) were assessed. Test-retest reliability and Cronbach’s alpha were used to evaluate the internal consistency of the questionnaire. To determine the adequacy of the sample size, the Kaiser-Meyer-Olkin (KMO) index, with a minimum value of 0.7, Bartlett’s test of sphericity, eigenvalues greater than 1, and the Varimax rotation method were utilized, using SPSS Version 24 statistical software.

RESULTS: All questions demonstrated satisfactory Content Validity Ratio (CVR) and Content Validity Index (CVI), scoring above the expected thresholds of 0.8 and 0.9, respectively. The test-retest correlation results confirmed the reliability of the questionnaire, with correlation coefficients exceeding 0.7 for all questions and their sub-areas. Internal consistency was also established usings domains. Factor analysis revealed four primary components with eigenvalues greater than 1, which collectively accounted for 58.963% of the total variance.

CONCLUSIONS: The Persian version of the OHVS demonstrated excellent validity and reliability. Consequently, it can be regarded as a reliable and valuable tool for epidemiological and behavioral dental studies.

PMID:39934814 | DOI:10.1186/s12903-025-05567-5

BMC Health Serv Res. 2025 Feb 11;25(1):233. doi: 10.1186/s12913-025-12368-7.

ABSTRACT

INTRODUCTION: In low-income countries such as the Democratic Republic of the Congo (DRC), the strategies implemented to combat tuberculosis (TB) are threatened by the emergence of non-communicable diseases (NCDs), such as diabetes mellitus (DM). Very little data on the implementation of services to manage TB-DM are generally available in these low-income countries. The aim of this study was therefore to assess the level of implementation of DM screening and treatment activities in TB unit clinics (TUCs) in Lubumbashi, DRC.

METHODS: A cross-sectional study was conducted using the Service Availability and Readiness Assessment (SARA) questionnaire from June to July 2023. Fourteen tracer items, divided into 4 domains-i) guidelines and staff, ii) basic equipment, iii) diagnostic capacity, and iv) drugs and products-were assessed. The readiness indices were compared according to the managerial instance and the activity package organized in each of the selected TUCs. A Chi² test with a significance level set at p = 0.05 was used for this comparison, and Cronbach’s α coefficient was calculated to estimate the reliability or consistency of the questionnaire.

RESULTS: Of the 35 TUCs visited, 19 (54.3%) were public health facilities, and 20 (57.1%) had a supplementary package of activities (SPA). The readiness of TUCs for providing DM diagnostic and treatment services was around 50%. A statistically significant difference was observed based on the managerial instance overseeing the TUC (p = 0.00) and the package of activities offered within these institutions (p = 0.00).

CONCLUSION: The current study has underscored the limited capability of TUCs in Lubumbashi to provide services for managing TB-DM comorbidity in DRC. It is imperative to implement strategies aimed at enhancing this capacity and taking into account the local context and influencing factors.

PMID:39934811 | DOI:10.1186/s12913-025-12368-7

BMC Musculoskelet Disord. 2025 Feb 11;26(1):136. doi: 10.1186/s12891-025-08330-7.

ABSTRACT

BACKGROUND: Thoracic hyperkyphosis (HK), common in older adults, has been linked to impairments in physical function, mobility, balance, gait, and falls. Our pilot study used a novel 4-week manual therapy and exercise intervention for HK and showed improved posture and function. This secondary analysis aims to explore 1) the changes in gait parameters after a novel intervention for HK, 2) the correlations between posture and gait variables at baseline, and 3) pre- to post intervention.

METHODS: This secondary analysis uses data from a quasi-experimental, single group pilot study. Participants with HK underwent pre- and post intervention measurements in posture, function, and unique to this secondary analysis, gait parametrics of velocity (V), step length (SL), double limb support (DLS), and step width (SW) using the GAITRite® electronic walkway. Paired t-tests compared pre- and post intervention gait parameters. Pearson correlation coefficients were utilized to investigate correlations between all variables at baseline and in pre- and post intervention change values.

RESULTS: Fourteen women and 8 men (aged 65.9 years ±9.2; range 52 – 90) completed 12 treatments (3 times/week for 4-weeks). Statistically significant improvement (p≤.001) occurred pre- to post for postural measures: height (M=0.73cm ±0.54), Kyphotic index (-2.41 ±2.96), Block (-1.17cm ±1.22), Acromion to table (ATT) (-1.85cm ±1.42), and 3 gait measures: V (M=0.087m/s ±0.09), SL (2.34cm ±2.55), and DLS (- 0.031sec ±0.04). SW improvement was not statistically significant. Block and ATT measures were moderately correlated with V, SL, SW (Block only), and DLS (ATT only) at baseline. Strong correlations were found among V, SL, and DLS at baseline and in pre- to post change scores, but no correlation between change scores of posture and gait.

CONCLUSIONS: This study shows that a clinically practical 4-week PT intervention may benefit older adults with HK by demonstrating improved posture and gait parameters. Further research is warranted.

TRIAL REGISTRATION: This study was retrospectively registered on 16/09/2019 under ClinicalTrials.gov Identifier: NCT04114331.

PMID:39934800 | DOI:10.1186/s12891-025-08330-7

Malar J. 2025 Feb 12;24(1):40. doi: 10.1186/s12936-025-05278-w.

ABSTRACT

BACKGROUND: Rwanda has made significant strides in malaria control. This study reviews malaria epidemiology and control strategies in Rwanda from 2018 to 2023, documenting their impact, persistent gaps and emerging challenges.

METHODS: Data on Rwanda’s malaria context from 2018 to 2023 were obtained through a literature review of peer-reviewed articles and grey literature, including annual reports from the malaria programmes, partners, the African Union, and the World Health Organization (WHO). Specific keywords used for the search included “malaria”, “Rwanda”, “case management”, “control”, “treatment”, and “prevention”. Moreover, epidemiological data for this period was extracted from the Health Management Information System (HMIS). Data analysis was done using R & R-Studio, ANOVA to assess the statistical significance (P < 0.05) of observed trends and T-test to compare the focal and blanket IRS techniques.

RESULTS/DISCUSSION: Between 2018 and 2023, all malaria indicators showed improvement. Malaria incidence dropped from 345 to 40 cases per 1000 persons (P = 0.00292), the severe malaria rate decreased from 112 to 10/100,000 persons (P = 0.018), and the mortality rate fell from 2.72 to 0.258 deaths /100,000 persons (P = 0.00617). Among children under 5 years of age, incidence decreased significantly from 331 to 52/1,000 persons (P = 0.00123), the severe malaria rate dropped from 214 to 29/100,000 persons (P = 0.00399), and mortality declined from 5 to 0.453/100,000 persons (P = 0.00504). Over the same period, key malaria interventions expanded. The proportion of cases treated by CHWs increased significantly, improving access to early diagnosis and treatment (from 13 to 59%), and the new generations of ITNs (PBO and dual-active ingredient nets) were deployed in 9 districts. Since 2019, a blanket spraying technique has been adopted in 12 IRS districts replacing the focal spraying technique contributing to the significant decrease of malaria incidence from 2019 to 2023 (P = 0.0025). However, new challenges have emerged, including the rise of the K13 R561H mutation associated with artemisinin resistance, the spread of insecticide resistance, and limited intervention coverage due to resource constraints.

CONCLUSION: To sustain the progress achieved, it is essential to intensify malaria control efforts, foster compliance with intervention strategies, enhance surveillance systems for timely and effective responses, and secure long-term funding to sustain these measures.

PMID:39934796 | DOI:10.1186/s12936-025-05278-w

BMC Public Health. 2025 Feb 11;25(1):570. doi: 10.1186/s12889-025-21757-w.

ABSTRACT

BACKGROUND: The ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) (NHHR) served as a novel comprehensive lipid indicator. This study aimed to explore the association between NHHR and the incidence of cardiometabolic multimorbidity (CMM).

METHODS: This study included 8191 individuals from the China Health and Retirement Longitudinal Study (CHARLS) database. We used multivariable cox proportional hazards regression, logistic regression, and restricted cubic splines (RCS) analysis to evaluate the association between NHHR and CMM. Subgroup analyses and interaction tests were also performed.

RESULTS: The incidences of CMM among participants in quartiles (Q) 1-4 of NHHR were 7.03%, 8.3%, 10.06%, and 16.55%, respectively. The NHHR was significantly higher in individuals with CMM compared to those without CMM (P < 0.001). When assessed as a continuous variable, NHHR was independently associated with the risk of CMM, as demonstrated by both multivariable cox proportional hazards regression analysis (HR = 1.05, 95% CI = 1.02-1.07, P < 0.001) and logistic regression analysis (OR = 1.09, 95% CI = 1.04-1.15, P < 0.001). Compared to individuals in the lowest quartiles of the NHHR (Q1), the risk of CMM in the highest quartiles (Q4) was increased by 1.25-fold according to multivariable cox proportional hazards regression analysis (HR = 2.25, 95% CI = 1.73-2.93, P < 0.001) and by 1.48-fold according to logistic regression analysis (OR = 2.48, 95% CI = 1.86-3.31, P < 0.001). This association was consistent across nearly all subgroups. RCS analysis revealed a significant nonlinear association between NHHR and CMM. Additionally, the predictive ability of NHHR for CMM was 0.613, which was superior to that of both HDL-C and non-HDL-C (P < 0.05). Furthermore, the composite variable comprising NHHR and other traditional risk factors exhibited the highest predictive value (C statistic = 0.679).

CONCLUSION: A higher NHHR was closely associated with an increased risk of CMM. Further studies on NHHR could be beneficial for preventing and treating CMM.

PMID:39934789 | DOI:10.1186/s12889-025-21757-w

Semin Arthritis Rheum. 2025 Feb 1;71:152649. doi: 10.1016/j.semarthrit.2025.152649. Online ahead of print.

ABSTRACT

OBJECTIVES: Assess reliability and validity of Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric self-report and parent-proxy report fixed short forms in juvenile myositis (JM).

METHODS: Children with JM (8-17yo) and parents of 5-17 yo JM patients completed PROMIS measures (Physical Function, Pain Interference, Fatigue, Emotional Distress), PedsQL Generic Core scales and Rheumatology Module (PedsQL-GC/-RM). Internal consistency reliability was assessed via Cronbach’s alpha. Patient-parent agreement was assessed via intraclass correlations (ICC). Concurrent and construct validity were assessed via Spearman’s correlations between PROMIS versus PedsQL-GC/-RM and clinical/lab data respectively. Known-groups validity was assessed by comparing PROMIS T-scores between clinically distinct JM patients.

RESULTS: We enrolled 75 JM participants, with 57 administered self-report and all 75 administered parent-proxy report measures per participant age. PROMIS measures were feasible (>96% completion), with high internal consistency reliability (Cronbach’s alpha >0.8). Patient-parent assessments demonstrated moderate agreement (ICC >0.5) for Mobility, Upper Extremity, and Fatigue domains, and smaller correlations (ICC 0.41-0.47) as expected for Pain Interference, Depressive Symptoms, and Anxiety. Concurrent validity was demonstrated by moderate correlation (Spearman’s rho >0.5) for all but 1 hypothesized relationships of PROMIS and PedsQL-GC/-RM domains. Although low disease activity and small sample size limited statistical power, construct validity and known-groups validity were demonstrable for multiple PROMIS pediatric self-report and parent-proxy report measures.

CONCLUSION: PROMIS measures show evidence of reliability and validity in JM. Child and parent reports differ sufficiently to suggest both should be collected. PROMIS measures can be considered for clinical and research use in JM.

PMID:39933204 | DOI:10.1016/j.semarthrit.2025.152649

Am J Trop Med Hyg. 2025 Feb 11:tpmd240653. doi: 10.4269/ajtmh.24-0653. Online ahead of print.

ABSTRACT

There is uncertainty regarding the usefulness of predictive models for dengue prognosis. We performed a systematic review to identify and evaluate prognostic models in patients with dengue. We conducted a literature search in PubMed, Embase, and Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) up to May 24, 2023. We included case-control and cohort studies that developed or validated multivariable prognostic models related to severity, hospitalization, intensive care unit (ICU) admission, or mortality in patients of any age with a laboratory-based diagnosis of dengue. A narrative synthesis of the performance measures of the prognostic models evaluated in each study was performed. Of the 4,211 articles, a total of 35 studies reporting information on 43 prognostic models were included. Among these, 35 were developmental and 8 were for external validation. Most models were designed to predict severity (n = 30), followed by mortality (n = 10), hospitalization (n = 2), and ICU admission (n = 1). The reported C-statistic in the models ranged from 0.70 to 0.95 for severity, 0.83 to 0.99 for mortality, 0.87 for hospitalization, and 0.92 for ICU admission. Calibration measures were poorly reported in the vast majority of models. According to the Prediction Study Risk of Bias Assessment Tool, the risk of bias was considered high for all included models, and applicability was of low concern for most models. Our study identified multiple prognostic models, particularly for predicting severity and mortality in patients with dengue. Although most models demonstrated acceptable discriminative ability, calibration measures were poorly reported, and the overall methodological design was poor.

PMID:39933179 | DOI:10.4269/ajtmh.24-0653

JMIR Serious Games. 2025 Feb 11;13:e56269. doi: 10.2196/56269.

ABSTRACT

BACKGROUND: During keyhole surgery, the surgeon is required to perform highly demanding tasks while only being able to see part of the patient’s anatomy. This limited field of view is widely cited as a key limitation of the procedure, and many computational methods have been proposed to overcome it. However, the precise effects of a limited field of view on task performance remain unknown due to the lack of tools to study these effects effectively.

OBJECTIVE: This paper describes our work on developing a serious game with 2 objectives: (1) to create an engaging game that communicates some of the challenges of keyhole surgery, and (2) to test the effect of a limited field of view on task performance. The development of a serious game that can be played by a wide range of participants will enable us to gather quantitative data on the effects of the reduced field of view on task performance. These data can inform the future development of technologies to help surgeons reduce the impact of a limited field of view on clinical outcomes for patients. The game is open source and may be adapted and used by other researchers to study related problems.

METHODS: We implemented an open-source serious game in JavaScript, inspired by the surgical task of selectively cauterizing blood vessels during twin-to-twin transfusion surgery. During the game, the player is required to identify and cut the correct blood vessel under different fields of view and varying levels of vascular complexity. We conducted a quantitative analysis of task performance time under different conditions and a formative analysis of the game using participant questionnaires.

RESULTS: We recruited 25 players to test the game and recorded their task performance time, accuracy, and qualitative metrics. Reducing the field of view resulted in participants taking significantly longer (P<.001) to perform otherwise identical tasks (mean 6.4 seconds, 95% CI 5.0-7.8 seconds vs mean 13.6 seconds, 95% CI 10.3-16.9 seconds). Participants found the game engaging and agreed that it enhanced their understanding of the limited field of view during keyhole surgery.

CONCLUSIONS: We recruited 25 players to test the game and recorded their task performance time, accuracy, and qualitative metrics. Reducing the field of view resulted in participants taking statistically significantly longer (16.4 vs 9.8 seconds; P=.05) to perform otherwise identical tasks. Participants found the game engaging and agreed that it enhanced their understanding of the limited field of view during keyhole surgery.

PMID:39933172 | DOI:10.2196/56269

JMIR Med Educ. 2025 Feb 11;11:e64780. doi: 10.2196/64780.

ABSTRACT

BACKGROUND: Virtual reality simulation (VRS) teaching offers nursing students a safe, immersive learning environment with immediate feedback, enhancing learning outcomes. Before the COVID-19 pandemic, nursing students had limited training and opportunities to care for patients in isolation units with infectious diseases. However, the pandemic highlighted the ongoing global priority of providing care for patients with infectious diseases.

OBJECTIVE: This study aims to (1) examine the effectiveness of VRS in preparing nursing students to care for patients with infectious diseases by assessing its impact on their theoretical knowledge, learning motivation, and attitudes; and (2) evaluate their experiences with VRS.

METHODS: This 2-phased mixed methods study recruited third-year undergraduate nursing students enrolled in the Integrated Emergency and Critical Care course at a university in Taiwan. Phase 1 used a quasi-experimental design to address objective 1 by comparing the learning outcomes of students in the VRS teaching program (experimental group) with those in the traditional teaching program (control group). Tools included an infection control written test, the Instructional Materials Motivation Survey, and a learning attitude questionnaire. The experimental group participated in a VRS lesson titled “Caring for a Patient with COVID-19 in the Negative Pressure Unit” as part of the infection control unit. In phase 2, semistructured interviews were conducted to address objective 2, exploring students’ learning experiences.

RESULTS: A total of 107 students participated in phase 1, and 18 students participated in phase 2. Both the VRS and control groups showed significant improvements in theoretical knowledge scores (for the VRS group t₄₆=-7.47; P<.001, for the control group t₅₉=-4.04; P<.001). However, compared with the control group, the VRS group achieved significantly higher theoretical knowledge scores (t_98.13=2.70; P=.008) and greater learning attention (t₁₀₅=2.30; P=.02) at T1. Additionally, the VRS group demonstrated a statistically significant higher regression coefficient for learning confidence compared with the control group (β=.29; P=.03). The students’ learning experiences in the VRS group were categorized into 4 themes: Applying Professional Knowledge to Patient Care, Enhancing Infection Control Skills, Demonstrating Patient Care Confidence, and Engaging in Real Clinical Cases. The core theme identified was Strengthening Clinical Patient Care Competencies.

CONCLUSIONS: The findings suggest that VRS teaching significantly enhanced undergraduate nursing students’ infection control knowledge, learning attention, and confidence. Qualitative insights reinforced the quantitative results, highlighting the holistic benefits of VRS teaching in nursing education, including improved learning outcomes. The positive impact on student motivation and attitudes indicates a potentially transformative approach to nursing education, particularly in the post-COVID-19 era, where digital and remote learning tools play an increasingly vital role.

PMID:39933166 | DOI:10.2196/64780

JMIR Mhealth Uhealth. 2025 Feb 11;13:e52887. doi: 10.2196/52887.

ABSTRACT

BACKGROUND: Adolescence through emerging adulthood represents a critical period associated with changes in lifestyle behaviors. Understanding the dynamic relationships between cognitive, social, and environmental contexts is informative for the development of interventions aiming to help youth sustain physical activity and limit sedentary time during this life stage. Ecological momentary assessment (EMA) is an innovative method involving real-time assessment of individuals’ experiences and behaviors in their naturalistic or everyday environments; however, EMA compliance can be problematic due to high participant burdens.

OBJECTIVE: This systematic review synthesized existing evidence pertaining to compliance in EMA studies that investigated wake-time movement behaviors among adolescent and emerging adult populations. Differences in EMA delivery scheme or protocol, EMA platforms, prompting schedules, and compensation methods-all of which can affect participant compliance and overall study quality-were examined.

METHODS: An electronic literature search was conducted in PubMed, PsycINFO, and Web of Science databases to select relevant papers that assessed movement behaviors among the population using EMA and reported compliance information for inclusion (n=52) in October 2022. Study quality was assessed using a modified version of the Checklist for Reporting of EMA Studies (CREMAS).

RESULTS: Synthesizing the existing evidence revealed several factors that influence compliance. The platform used for EMA studies could affect compliance and data quality in that studies using smartphones or apps might lessen additional burdens associated with delivering EMAs, yet most studies used web-based formats (n=18, 35%). Study length was not found to affect EMA compliance rates, but the timing and frequency of prompts may be critical factors associated with missingness. For example, studies that only prompted participants once per day had higher compliance (91% vs 77%), but more frequent prompts provided more comprehensive data for researchers at the expense of increased participant burden. Similarly, studies with frequent prompting within the day may provide more representative data but may also be perceived as more burdensome and result in lower compliance. Compensation type did not significantly affect compliance, but additional motivational strategies could be applied to encourage participant response.

CONCLUSIONS: Ultimately, researchers should consider the best strategies to limit burdens, balanced against requirements to answer the research question or phenomena being studied. Findings also highlight the need for greater consistency in reporting and more specificity when explaining procedures to understand how EMA compliance could be optimized in studies examining physical activity and sedentary time among youth.

TRIAL REGISTRATION: PROSPERO CRD42021282093; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282093.

PMID:39933165 | DOI:10.2196/52887