Nevin Manimala

J Med Internet Res. 2025 Oct 15;27:e79161. doi: 10.2196/79161.

ABSTRACT

BACKGROUND: Breast cancer is the most common cancer diagnosis among women, with approximately 2.3 million new cases annually. When faced with a cancer diagnosis, individuals often turn to the internet for information or reassurance, despite the risk of encountering low-quality or incorrect information. While this observation is well documented in English, limited work has been done to understand the quality of breast cancer information in Spanish, the second most commonly spoken language in the United States.

OBJECTIVE: This study uses natural language processing methods and quantitative modeling to analyze English and Spanish breast cancer posts from Facebook, a vital source of health-related information for 40% of English-speaking and 60% of Spanish-speaking adults in the United States.

METHODS: Using the CrowdTangle application programming interface, we collected and processed 243,029 English-language and 96,334 Spanish-language Facebook posts. We applied BERTopic with the all-MiniLM-L6 model and k-means clustering to infer thematic structures and used coherence scores to determine the optimal number of topics for each language. Descriptive statistics compared metadata differences across languages. We calculated descriptive statistics and ran inferential tests for likes, comments, and shares. Finally, we examined the top 1% (n=2430 English and n=963 Spanish) of the most engaged content to analyze differences in poster characteristics across languages.

RESULTS: Coherence scores indicated an optimal topic solution of k=40 (coherence=0.58) for English and k=30 (coherence=0.52) for Spanish. Thematically, we observed similar content in both languages, with topics spanning mammography, breast cancer events, pink ribbon month, and personal narratives. However, Spanish posts included local and municipal breast cancer events not present in English. Additionally, Spanish posts were more likely to mention at-home breast exams, which are no longer recommended in the United States. Engagement behavior showed statistically significant differences by language across likes, comments, and shares. English posts exhibited more consistent liking and sharing behavior, while Spanish posts showed more consistency in commenting. The top 1% (n=2430) of engaged content in English came from leading breast cancer nonprofits, whereas in Spanish (n=963, 1%), it originated from local governments or food and beverage companies.

CONCLUSIONS: Facebook breast cancer content is generally consistent across languages. However, differences in engagement behavior suggest that English- and Spanish-speaking populations engage with content differently, highlighting cultural variability that warrants further exploration. Notably, leading cancer authorities may not have a strong presence in Spanish, indicating that the most accurate and up-to-date information may not be reaching a population particularly prone to worse breast cancer prognoses.

PMID:41091542 | DOI:10.2196/79161

Microb Genom. 2025 Sep;11(9). doi: 10.1099/mgen.0.001495.

ABSTRACT

Background. Shigella species are pathogenic bacteria that cause gastrointestinal symptoms ranging from mild watery diarrhoea to bacillary dysentery. Transmission is faecal-oral and historically associated with international travel. Recently, sexual transmission has been documented among gay, bisexual and other men who have sex with men (GBMSM). Through routine surveillance, we observed an increase in notifications of S. flexneri serotype 1b. We investigated the emergence of this serotype and examined possible drivers of transmission.Methods. We used historical data and whole-genome sequencing data from S. flexneri 1b isolates submitted to the United Kingdom Health Security Agency (UKHSA) to determine the relatedness of isolates and describe the population structure using phylogenetics. We tested for associations with possible epidemiological, biological and genetic drivers.Results. Between 1 January 2004 and 30 June 2024, 1,672 isolates of S. flexneri 1b were identified. Prior to 2019, there was a median of 12.5 [interquartile range (IQR) 10-17] notifications per quarter, rising to a median of 39.5 (IQR 23-58) notifications from 2019 to 2024. The rise was predominantly among adult males, consistent with patterns seen in prior sexually transmitted shigellosis epidemics among GBMSM. Unlike previous outbreaks of shigellosis among GBMSM, the emergence of S. flexneri 1b showed no evidence of an association with the acquisition of antimicrobial resistance determinants.Conclusions. Shigellosis can have severe clinical outcomes, and the repeated emergence of Shigella variants among GBMSM highlights the significance of the sexual transmission pathway. Continued surveillance of Shigella subtypes is necessary to inform public health interventions aimed at preventing sexual transmission of enteric pathogens in the GBMSM community.

PMID:41091541 | DOI:10.1099/mgen.0.001495

J Integr Complement Med. 2025 Oct 15. doi: 10.1177/27683605251387011. Online ahead of print.

ABSTRACT

Background: India bears a heavy burden of iron deficiency anemia (IDA), affecting nearly 50% of the population and contributing to adverse pregnancy outcomes, accounting for 20% of maternal deaths. While IDA continues to be a major health issue in India, there is a lack of comparative data on the efficacy of Ayurvedic treatments. This review aims to fill this evidence gap by systematically evaluating and ranking the efficacy of different Ayurvedic treatments for IDA using network meta-analysis (NMA). Methods: A systematic search was undertaken on May 1, 2024 using MEDLINE (via PubMed), Scopus, ScienceDirect, AYUSH Research Portal, and Google Scholar to locate randomized controlled trial (RCTs) evaluating interventions and their impact on hemoglobin (Hb) and serum ferritin. We conducted a random-effects NMA using a frequentist framework to estimate the mean difference (MD) and 95% confidence intervals (CIs) for the effects of interventions on outcomes, accounting for heterogeneity (I²). Results: Nineteen RCTs, comprising 2,121 individuals, assessed 26 different treatments for IDA and met the eligibility criteria. Results from the reference-based forest plots of the sensitivity analysis and corresponding P-scores revealed that both Sarva-Jvara-Hara-Lauha (SJHL) and Pippalyadi Yoga demonstrated statistically significant improvements in Hb levels, with MDs of 1.82 g/dL (95% CI: 0.66-2.98) and 1.45 g/dL (95% CI: 1.21-1.69), respectively. Among the interventions, Bibhitakadi Vatak demonstrated strong effectiveness in raising serum ferritin levels (MD: 3.87 ng/mL; 95% CI: -13.32-21.06). Conclusion: SJHL and Bibhitakadi Vatak were found to be the most effective strategies for treating IDA. Additional research is needed to substantiate these findings and assess their wider impact on public health. Trial Registration: PROSPERO registration number CRD42024541803.

PMID:41091535 | DOI:10.1177/27683605251387011

J Ethn Subst Abuse. 2025 Oct 15:1-21. doi: 10.1080/15332640.2025.2572334. Online ahead of print.

ABSTRACT

Substance misuse frequently serves as a primary coping mechanism in response to trauma. Because Black Adults disproportionately experience greater rates of trauma exposure than White adults, it is essential to determine buffers against racial trauma and subsequent substance use consequences. Previous literature has linked discrimination, a core contributing factor to racial trauma to substance misuse. The study aimed to determine the relationship between racial trauma and substance misuse among Black Americans and other potential moderating factors. Black Americans from across the U.S. (n = 327, M_age = 39.20, SD_age = 12.01) were recruited via Prolific to answer an online survey through Qualtrics. Linear regression analyses showed that racial trauma was positively associated with Alcohol Use Disorder. Denial coping was found to be a statistically significant moderator of this relationship. However, analyses did not find a significant relationship between racial trauma and drug use disorders. The absence of an association underscores the need for future research to examine factors that may reveal or clarify this potential relationship.

PMID:41091524 | DOI:10.1080/15332640.2025.2572334

JAMA Psychiatry. 2025 Oct 15. doi: 10.1001/jamapsychiatry.2025.2962. Online ahead of print.

ABSTRACT

IMPORTANCE: There have only been 3 efficacy trials reporting head-to-head comparisons of pharmacotherapy and trauma-focused psychotherapy for posttraumatic stress disorder (PTSD), and none were conducted in primary care. In addition, few trials have examined treatment sequences for patients not responding to an initial treatment.

OBJECTIVE: To test the hypothesis that (1) brief trauma-focused psychotherapy (written exposure therapy [WET]) is more effective than a choice of 3 selective serotonin reuptake inhibitors (SSRIs; ie, sertraline, fluoxetine, or paroxetine) and (2) WET augmentation is more effective than switching to the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine for those not responding to an SSRI.

DESIGN, SETTING, AND PARTICIPANTS: This was a pragmatic comparative effectiveness trial conducted from April 2021 to June 2024 that randomized primary care patients to 1 of 3 treatment sequences: (1) SSRI followed by WET augmentation, (2) SSRI followed by switch to SNRI, or (3) WET followed by SSRI. Effectiveness in this pragmatic trial depends on treatment engagement and treatment fidelity. The study included patients meeting clinical criteria for PTSD from primary care clinics of 7 federally qualified health centers and 8 Department of Veterans Affairs medical centers.

INTERVENTIONS: SSRI followed by WET augmentation, SSRI followed by switch to SNRI, or WET followed by SSRI.

MAIN OUTCOMES AND MEASURES: PTSD symptom severity, as measured by the DSM-5 PTSD Checklist (PCL-5).

RESULTS: A total of 700 patients (mean [SD] age, 45.1 [15.4] years; 368 men [62.1%]). The mean (SD) baseline PCL-5 score was 52.8 (11.1), indicating considerable symptom severity. At 4 months, 144 of 278 patients (51.8%) randomized to an SSRI were adherent and reported a 14.0-point PCL-5 decrease, whereas 11 of 352 patients (31.5%) randomized to WET completed all sessions and reported a 12.1-point decrease. There was no significant between-group difference (adjusted mean difference [MD], 1.79; 95% CI, -0.76 to 4.34; P = .17). For the 122 of 295 patients (41.4%) randomized to an SSRI who did not respond to treatment, those randomized to switch to the SNRI reported a 9.2-point PCL-5 decrease compared with a 2.3-point decrease for those randomized to WET augmentation, which was a statistically significant between-group difference (adjusted MD, 10.19; 95% CI, 4.97-15.41; P < .001).

CONCLUSIONS AND RELEVANCE: Study results showed that treatment of PTSD in primary care with either SSRIs or WET was feasible and effective. For patients not responding to an SSRI, switching to an SNRI may be more effective than WET augmentation.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04597190.

PMID:41091477 | DOI:10.1001/jamapsychiatry.2025.2962

JAMA Netw Open. 2025 Oct 1;8(10):e2537655. doi: 10.1001/jamanetworkopen.2025.37655.

ABSTRACT

IMPORTANCE: Patient uptake of updated COVID-19 vaccines is crucial for reducing severe outcomes, yet national uptake remains low.

OBJECTIVE: To determine if tailored messaging or simple inquiry about vaccine acceptance increases 30-day uptake of updated COVID-19 vaccines among emergency department (ED) patients.

DESIGN, SETTING, AND PARTICIPANTS: This 3-arm, cluster randomized clinical trial conducted from January 29 to June 18, 2024, enrolled adult ED patients who had not received a COVID-19 vaccine in the prior 6 months across 6 EDs in San Francisco, California; Philadelphia, Pennsylvania; Houston, Texas; and Durham, North Carolina.

INTERVENTIONS: Intervention M involved tailored messaging about updated COVID-19 vaccines and inquiry about vaccine acceptance. Intervention Q involved only inquiry about vaccine acceptance. Usual care (no messaging or vaccine acceptance questions) served as the control.

MAIN OUTCOMES AND MEASURES: The primary outcome was updated COVID-19 vaccine receipt within 30 days of the ED visit, assessed via electronic health record review and follow-up telephone calls. Secondary outcomes included vaccine acceptance and vaccination during the ED visit. Outcomes were also compared between study sites that had the updated COVID-19 vaccine available and those that did not.

RESULTS: Of 852 participants (median age, 47 years [IQR, 33-63 years]; 464 [54.5%] women), 247 (29.0%) were in the intervention M group, 273 (32.0%) in the intervention Q group, and 332 (39.0%) in the control group. Vaccine uptake at 30 days was not significantly higher in either the intervention M group compared with control (14 participants [5.7%] vs 10 [3.0%]; absolute difference, 2.7 percentage points [pp] [95% CI, -0.8 to 6.3 pp]) or the intervention Q group compared with control (11 [4.0%] vs 10 [3.0%]; absolute difference, 1.0 pp [95% CI, -2.0 to 4.2 pp]). However, at sites where vaccines were available, the intervention M group had higher uptake compared with control (13 of 132 [9.8%] vs 5 of 150 [3.3%]; absolute difference, 6.5 pp [95% CI, 0.5-12.5 pp]).

CONCLUSIONS AND RELEVANCE: In this cluster randomized clinical trial of adult ED patients, tailored messaging and simple inquiry alone did not significantly increase 30-day updated COVID-19 vaccine uptake among patients. The slight increase in uptake among participants in the EDs that had access to the updated COVID-19 vaccines suggested that vaccine availability was an effect modifier, underscoring the importance of opportunity and convenience in vaccine delivery.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06156215.

PMID:41091465 | DOI:10.1001/jamanetworkopen.2025.37655

Clin Transl Oncol. 2025 Oct 15. doi: 10.1007/s12094-025-04077-8. Online ahead of print.

ABSTRACT

PURPOSE: Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is a validated endpoint for long-term survival in HER2-positive breast cancer. Identifying clinical and biomarker-based predictors of pCR is essential for optimizing treatment strategies. This study investigated the predictive role of nutrition- and inflammation-based indices (HALP, CALLY, PNI, SII, PIV, SIRI, NLR) in determining pCR.

METHODS: A total of 169 HER2-positive patients who underwent NACT followed by surgery at Ankara Etlik City Hospital between January 2023 and December 2024 were retrospectively analyzed. Indices were calculated from baseline laboratory values. Receiver operating characteristic (ROC) analysis was used to evaluate discriminatory ability and determine cut-off values for significant variables. Univariate logistic regression was performed initially; variables significant at the univariate level were included in the multivariate model.

RESULTS: The overall pCR rate was 56.8%. ROC analysis identified the CALLY index (AUC = 0.681; p < 0.001) and Ki-67 (AUC = 0.603; p = 0.022) as significant predictors, while HALP, PNI, NLR, PIV, SII, and SIRI lacked predictive value. In univariate analysis, high CALLY (p < 0.001), high Ki-67 (p = 0.012), and pertuzumab-containing regimens [AC + taxane + trastuzumab + pertuzumab (p = 0.003) and docetaxel + trastuzumab + carboplatin + pertuzumab (THCP) (p = 0.004)] were associated with higher pCR, whereas ER positivity was associated with a reduced likelihood of pCR (OR = 0.41; p = 0.011). In multivariate analysis, CALLY (OR = 4.03; p < 0.001), Ki-67 (OR = 2.21; p = 0.038), and pertuzumab-containing regimens remained independent predictors: AC + taxane + trastuzumab + pertuzumab (OR = 3.24; p = 0.020) and THCP (OR = 3.86; p = 0.037). Although ER positivity was significant in univariate analysis, it lost statistical significance in the multivariate model (OR = 0.49; p = 0.072).

CONCLUSIONS: High CALLY index and high Ki-67 were found to be statistically significant in predicting pCR, and pertuzumab-containing regimens were shown to increase pCR rates. In contrast, classical histopathological parameters and other immunonutritional scores demonstrated limited predictive value. These findings require validation through prospective, multicenter studies. The limited number of studies investigating the association between pCR and CALLY highlights the originality of our work.

PMID:41091451 | DOI:10.1007/s12094-025-04077-8

Drugs Aging. 2025 Oct 15. doi: 10.1007/s40266-025-01258-6. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies have suggested potential benefits of antihypertensive medication (AHM) in preventing atrial fibrillation. It remains uncertain whether these benefits are uniform across different AHM classes. This study aims to compare the risk of AF across AHM classes in older adults.

METHODS: This study included 8942 individuals from a randomized trial of aspirin, who were aged ≥ 65 years, free of cardiovascular disease (CVD) and AF, treated with any AHM at baseline. Exposures of interest included four first-line AHM medications: angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics. Participants were assigned a diagnosis of probable, possible or no AF via a clinical algorithm. Possible AF cases were excluded. Cox proportional-hazards model was used to compare risk of probable AF among baseline users of different AHM classes, adjusting for potential confounders and blood pressure.

RESULTS: Over 4.5 years, 535 (6.0%) participants developed probable AF. CCB-based therapy, alone or in combination, showed the lowest AF risk among all classes (HR [95% CI] for CCB-based therapy versus ARB-, ACEI-, and diuretic-based therapy, alone or in combination: 0.74 [0.57-0.98], 0.85 [0.64-1.13], and 0.81 [0.62-1.06], respectively). A lower AF risk was also observed with CCB monotherapy (HR from 0.58-0.71 compared with monotherapy of other classes).

CONCLUSIONS: CCB-based AHM therapy was linked to a lower risk of probable AF events compared with non-CCB regimens in older adults who were initially free of CVD and AF and treated with any AHM. Additional studies are warranted to clarify the mechanisms underlying this association.

PMID:41091441 | DOI:10.1007/s40266-025-01258-6

J Immigr Minor Health. 2025 Oct 15. doi: 10.1007/s10903-025-01788-6. Online ahead of print.

ABSTRACT

This study compared the state of suicide deaths among foreign nationals across government ordinance-designated cities in Japan between 2013 and 2022 using vital statistics data containing information on all suicide deaths. We analyzed data on suicide deaths, defined as deaths due to “intentional self-harm” (codes X60-X84) in accordance with the International Statistical Classification of Diseases and Related Health Problems 10th Revision, among foreign nationals and Japanese citizens aged ≥ 10 years who lived in a designated city between 2013 and 2022. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated for each city, with the total population of Japanese citizens as the standard population. Suicide mortality differed across designated cities. The number of deaths and mortality rate from suicide were particularly high among Korean residents, especially those living in Osaka where the presence of a significant Korean population is largely rooted in historical circumstances. Osaka also had a significantly higher relative suicide mortality for female foreign nationals compared with other designated cities (SMR 1.6, 95% CI 1.4-2.0). To achieve an inclusive society that guarantees well-being for all of its population, area-specific trends in suicide deaths among foreign nationals living in Japan, especially Korean and elderly residents in a specific urban area, should be recognized and considered in developing suicide prevention policies and measures for foreign nationals.

PMID:41091429 | DOI:10.1007/s10903-025-01788-6

Saudi Dent J. 2025 Oct 15;37(7-9):63. doi: 10.1007/s44445-025-00071-6.

ABSTRACT

The colour stability of occlusal devices is a critical factor in their long-term aesthetic performance. This in vitro study aimed to evaluate and compare the colour stability of 3D-printed, thermoplastic, and conventional resin materials used in occlusal devices under extrinsic and intrinsic factors. In vitro – comparative study. Sixty rectangular specimens (15 × 15 × 2 mm) of Dentaclear (CAD/CAM 3D-printed), IMPAK (CAD/CAM milled thermoplastic), and ProBase Hot (heat-polymerised) resins were fabricated. Each material group consisted of 20 specimens, with 10 assigned to a control group (immersed in artificial saliva(serving both as the control group and as the intrinsic factor) and 10 to a test group (subjected to 5000 thermocycles in coffee). Baseline colour measurements (L*, a*, b*) were obtained using a spectrophotometer with D65 standard illumination. Colour changes (ΔE00) were calculated using the CIEDE2000 formula, and statistical analysis was performed using 2-way ANOVA (α = 0.05). 2-way ANOVA (α = 0.05). Significant colour changes (ΔE00) were observed in all materials following coffee thermocycling (P < .001). ProBase Hot exhibited the lowest ΔE00 values, indicating the highest colour stability, while IMPAK and Dentaclear showed higher ΔE00 values, with no significant difference between them (P = .287). The control group showed minimal colour change, indicating the negligible effect of intrinsic factors like saliva. Coffee thermocycling significantly impacted colour stability, with ProBase Hot demonstrating superior colour stability compared to IMPAK and Dentaclear. Intrinsic factors like Saliva had minimal influence on colour stability when compared to extrinsic factors like coffee.

PMID:41091420 | DOI:10.1007/s44445-025-00071-6