Nevin Manimala

JMIR Form Res. 2025 Dec 9;9:e78489. doi: 10.2196/78489.

ABSTRACT

BACKGROUND: Research concerning the long-term health consequences of induced abortion is constrained by both the limitations in the availability of data necessary to construct complete reproductive histories, as well as the limitations in the analytical methods necessary to interpret them.

OBJECTIVE: This study aims to determine the association of induced abortion and the likelihood of a subsequent natural loss by applying the pregnancy outcome sequence (POS), a research construct that defines the number and order of all pregnancy outcomes (births, induced abortions, natural losses) in each woman’s reproductive history.

METHODS: Using the Medicaid Analytic eXtract files from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse, we identified a study population of 508 unique POSs, representing 5455 women, each of whom had 1 to 16 pregnancy outcomes, for a total of 14,198 pregnancies. We applied an exploratory iterative sequential analytical approach, which included aggregate POS correlation analysis, logistic multiple regression, and simultaneous CIs (Agresti and Tukey-Kramer methods). We also established counting methods to populate the data tables for each analytical phase.

RESULTS: Overall, we found evidence to conclude that both prior abortions and natural losses are significantly associated with the risk of subsequent natural losses. For abortion, there is evidence of a dose-response relationship from 0 to 3 abortions and the likelihood of subsequent natural loss. For natural loss, the risk of a subsequent natural loss is significant after 2 natural losses and between the first and second. There is no association of prior births, or any combination of birth/abortion or birth/natural loss, with the risk of subsequent natural loss. Limitations imposed by the skewed distribution of the number of total pregnancies per reproductive history, resulting in small cell sizes, and exclusion of important covariates, restrain assurance in the results.

CONCLUSIONS: The POS demonstrates that the order and combinations of pregnancy outcomes may result in varying conclusions that were previously undetectable. Therefore, further methodological development is indicated.

PMID:41364908 | DOI:10.2196/78489

Exp Physiol. 2025 Dec 9. doi: 10.1113/EP093300. Online ahead of print.

ABSTRACT

Aldehyde dehydrogenase 2 (ALDH2) is a mitochondrial enzyme that plays an important role in aldehyde detoxification. A large percentage (30-50%) of the East Asian population carry a single point mutation in the ALDH2 gene (ALDH2*2 variant) that causes a severe reduction or lack of ALDH2 enzyme activity, and leads to disrupted cellular homeostasis due to the accumulation of toxic reactive aldehydes. The ALDH2*2 variant has been associated with several degenerative diseases, with evidence suggesting a link to cardiovascular disease, potentially mediated by endothelial dysfunction. This, however, remains to be confirmed. We aimed to investigate whether the ALDH2*2 variant is associated with impaired endothelial function in young, healthy East Asians. Twenty-two participants were genotyped and divided into non-carriers (ALDH2*1/*1; n = 12; 7 females and 5 males; age = 23 ± 3 years; height = 167.4 ± 8.7 cm; body mass = 60.1 ± 9.0 kg) and carriers (ALDH2*1/*2 and ALDH2*2/*2; n = 10; 8 females and 2 males; age = 24 ± 5 years; height = 162.6 ± 10.1 cm; body mass = 62.1 ± 9.7 kg) of the ALDH2*2 allele. Endothelial function was assessed via flow-mediated dilation (FMD) following current guidelines. Carriers displayed lower FMD, either absolute or relative, which was not statistically significant but approached significance (unpaired t-test) (FMD%: non-carriers = 10.2 ± 1.9% vs. carriers = 8.1% ± 3.1%, P = 0.079, effect size: Cohen’s d = 0.82; FMD_abs: non-carriers = 0.32 ± 0.06 mm vs. carriers = 0.26 ± 0.09 mm, P = 0.082, effect size: Cohen’s d = 0.78). In conclusion, our data seem to suggest that the ALDH2*2 variant impairs endothelial function even in young and healthy individuals without the presence of other stressor agents. Future studies with larger sample size are necessary to confirm our findings.

PMID:41364906 | DOI:10.1113/EP093300

J Community Psychol. 2026 Jan;54(1):e70061. doi: 10.1002/jcop.70061.

ABSTRACT

Neighborhood environments may significantly impact psychological well-being, particularly in Black American communities where historical inequities and resilience factors intersect. This mixed-methods study investigates retrospective perceptions of childhood and current neighborhood social environments and their associations with loneliness and psychological distress in adulthood. Data were drawn from the Think PHRESH study, an ancillary project to the Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH). A mixed-methods design integrated survey data from 739 participants (77.5% female; mean age = 63.37) and qualitative interviews with 56 residents (60.7% female; mean age = 65.95). Measures assessed childhood and adulthood neighborhood social cohesion, collective child-rearing, current neighborhood safety, satisfaction, loneliness, and distress. A mixed-methods expansion approach was used, where qualitative themes informed quantitative model development. Thematic analysis was applied to qualitative data, and regression analyses examined associations between neighborhood factors and mental health. Participants reported significantly higher childhood social cohesion (M = 4.47, SD = 0.70) than adulthood (M = 3.22, SD = 0.69). Qualitative findings highlighted declines in community engagement and safety. Regression analyses showed greater current social cohesion (b = -0.61, SE = 0.25, p = 0.02), neighborhood safety (b = -0.48, SE = 0.21, p = 0.02), and satisfaction (b = -0.55, SE = 0.18, p = 0.002) were associated with lower distress, while higher satisfaction was linked to lower loneliness (b = -0.08, SE = 0.03, p = 0.002). Findings highlight the importance of policies that enhance neighborhood social environments, particularly in predominantly Black urban communities affected by structural inequities.

PMID:41364904 | DOI:10.1002/jcop.70061

JCO Oncol Pract. 2025 Dec 9:OP2500651. doi: 10.1200/OP-25-00651. Online ahead of print.

ABSTRACT

PURPOSE: Over 10 million jail admissions occur each year in the United States. Whether county-level incarceration shapes population-level cancer mortality remains unclear. We assessed county jail incarceration rates in relation to lung, liver, and colorectal cancer deaths.

METHODS: This ecological study linked county incarceration rates (1995-2018, Vera Institute) with age-adjusted cancer mortality from the National Vital Statistics System (2000-2019). Incarceration was grouped into lagged quartiles (Q1 lowest; Q4 highest). Pooled Poisson regression with county-clustered robust errors estimated adjusted incidence rate ratios (aIRRs) while controlling for sociodemographic, behavioral, health care, and structural factors. Sex- and race-stratified analyses and longer exposure lags tested robustness.

RESULTS: Relative to Q1, Q4 counties had higher mortality from lung (aIRR, 1.08 [95% CI, 1.04 to 1.12]), liver (aIRR, 1.10 [95% CI, 1.00 to 1.22]), and colorectal (aIRR, 1.09 [95% CI, 1.04 to 1.15]) cancers. Among men, liver cancer deaths rose 13% in Q4 (aIRR, 1.13 [95% CI, 1.03 to 1.24]). Black residents experienced elevated lung and colorectal mortality across all incarceration quartiles and a 29% increase in liver cancer deaths in Q4 (aIRR, 1.29 [95% CI, 1.04 to 1.61]); excess mortality among White residents emerged only in Q4 counties (all P < .05). Findings persisted in sensitivity analyses.

CONCLUSION: Counties with the highest jail incarceration rates had 7%-10% more lung, liver, and colorectal cancer deaths with disproportionate impacts on men and Black residents. Incarceration operates as a structural driver of cancer disparities; targeted prevention, screening, and treatment efforts are urgently needed in high-incarceration communities.

PMID:41364883 | DOI:10.1200/OP-25-00651

Diving Hyperb Med. 2025 Dec 20;55(4):391-397. doi: 10.28920/dhm55.4.391-397.

ABSTRACT

INTRODUCTION: Diving induced immersion diuresis predisposes divers to dehydration. Dehydration is considered a risk factor for decompression sickness (DCS) but there is very little evidence to prove it. Dehydration also potentially modifies venous gas emboli (VGE) formation and impairs endothelial function. The purpose of this study was to report the effects of fluid loss during a dive on the diver’s physiology.

METHODS: Nine divers performed a 45 metre fresh water (mfw) and a 100 mfw dive with predetermined dive profiles. Body weight was measured before and after the dive. Post-dive detection of VGE was performed according to the extended Eftedal-Brubakk scale. We also measured haematocrit and flow mediated dilation before and after the 100 mfw dives.

RESULTS: After a 68-minute dive to 45 mfw, median weight loss was -1.1 kg, (IQR -1.2, -1.0; range -2.0, -0.6), P = 0.009 and VGE were detected in all divers. After a 170-minute dive to 100 mfw, median weight loss was -1.5 kg (IQR -1.8, -1.1; range -2.2, -0.8), P = 0.009 and VGE were detected in seven divers. Weight loss after the dive was statistically significant and there was a negative correlation between weight loss and bubbling after the 45 mfw dives. None of the divers suffered any symptoms of DCS.

CONCLUSIONS: We found significant weight loss after both decompression dives but there were no clinical DCS symptoms in any of the divers. This study does not offer new evidence supporting the notion that dehydration increases decompression stress in divers.

PMID:41364863 | DOI:10.28920/dhm55.4.391-397

Diving Hyperb Med. 2025 Dec 20;55(4):384-390. doi: 10.28920/dhm55.4.384-390.

ABSTRACT

INTRODUCTION: Breath-hold divers can surface with neurological symptoms consistent with nitrogen buildup in tissues or gas entry into the arterial circulation, collectively termed decompression illness (DCI). While DCI has historically been attributed to diving with compressed air, breath-hold divers have reported similar syndromes. The causes, diagnosis, and management of DCI in breath-hold divers is poorly understood.

METHODS: We developed an online survey that queried breath-hold divers on the symptoms they experienced during decompression illness events and the medical management of each event.

RESULTS: A total of 36 (31 M, 5 F) breath-hold divers filled out the survey. A majority identified as recreational freedivers, competitive freedivers, and/or spearfishers with an average age of 45 years and 18 years of breath-hold diving experience. Of those surveyed, 33 (92%) held a certification from an accredited training agency. A total of 18 (50%) reported experiencing DCI, with 21 DCI incidents reported by 13 individuals from 1999-2024. Sixteen (76%) of DCI incidents occurred during training, with an average depth of 83.4 m and average speed of 1.0 m∙s-1. Thirteen (62%) percent of DCI incidents occurred while diving to depths shallower than a previous personal best. The most common symptoms were weakness, numbness, slurred speech, and fatigue. The most common treatment modalities were surface oxygen, in-water recompression, and hyperbaric oxygen therapy. Sixteen divers (76%) had partial or complete resolution of their symptoms. The top cited contributors to the DCI incidents were depth, short surface interval between dives, and pulmonary barotrauma.

CONCLUSIONS: Breath-hold divers can experience DCI even when diving within their limits. The most cited contributors to DCI were depth, short surface interval between dives, and pulmonary barotrauma. Most divers’ symptoms resolved after treatment with surface oxygen, in-water recompression, and/or hyperbaric oxygen therapy.

PMID:41364862 | DOI:10.28920/dhm55.4.384-390

Diving Hyperb Med. 2025 Dec 20;55(4):369-375. doi: 10.28920/dhm55.4.369-375.

ABSTRACT

INTRODUCTION: Rebreather diving carries a high fatality rate (estimated 1.8-3.8 deaths per 100,000 dives), yet its popularity is growing. Among 54 French military divers who lost consciousness underwater, none died when using a mouthpiece retaining strap (MRS) in a team diving setup. Despite this, MRS use remains limited among recreational divers for whom drowning is a major cause of death. This study assessed knowledge, perceptions, and training regarding MRS use within the rebreather diving community.

METHODS: An international online survey targeting certified rebreather divers was disseminated via social media. The survey gathered demographic information, diving experience, MRS usage, and details on related training.

RESULTS: A total of 563 responses were collected. Of these, 133 (23.6%) were instructors, and 210 (37.3%) had received MRS training. On a 0 to 100 scale, divers trained on MRS use rated MRS importance higher (median score: 74 [IQR 33-90]) than divers with no MRS training (median: 49 [IQR 16-67]). Barriers to MRS adoption included negative past experiences, poor training, misuse, and concerns about complications during bailout procedures.

CONCLUSIONS: While not widely adopted among recreational divers, the MRS is supported by strong safety data. Formal training significantly improves its perceived value and acceptance. Greater involvement from manufacturers, training agencies, and instructors is essential to promote education and encourage MRS adoption as a key safety measure in rebreather diving.

PMID:41364860 | DOI:10.28920/dhm55.4.369-375

Diving Hyperb Med. 2025 Dec 20;55(4):352-368. doi: 10.28920/dhm55.4.352-368.

ABSTRACT

INTRODUCTION: Research in hyperbaric oxygen (HBO) medicine is growing, but the quality of HBO studies is variable. Low study quality may compromise evidence-based decision-making and clinical translation.

METHODS: This cross-sectional study examined the adherence of 50 randomly selected HBO clinical trials (25 randomised controlled trials [RCTs] and 25 observational studies) to relevant core reporting guidelines: consolidated standards of reporting trials (CONSORT), non-pharmacologic treatments (NPT), and strengthening the reporting of observational studies in epidemiology (STROBE). Studies published in peer-reviewed journals between January 2018 and May 2023 and indexed on PubMed were analysed. Reporting quality was classified as ‘excellent’ (> 85% of guideline items adequately reported), ‘good’ (50-85%), or ‘poor’ (< 50%).

RESULTS: The sample represented 29% of RCTs and 16% of observational studies for the timeframe assessed. No study was rated as ‘excellent’ for completeness, 28 (56%) were rated as ‘good’, and 22 (44%) as ‘poor’. In RCTs, only one study (4%) adequately reported protocol adherence and eight studies (32%) reported blinding procedures. The NPT checklist showed that key items, including care provider adherence (0 studies) and participant adherence (one study; 4%), were frequently not reported. For observational studies, basic design elements were adequately reported, but with significant gaps in bias management (nine studies; 36%) and missing data handling (13 studies; 52%). Only six studies (12%) mentioned the use of reporting guidelines.

CONCLUSIONS: Our results showed that quality of reporting of HBO studies is suboptimal. These findings highlight the need for increased awareness and implementation of reporting guidelines, as well as the potential development of HBO-specific guidelines.

PMID:41364859 | DOI:10.28920/dhm55.4.352-368

Diving Hyperb Med. 2025 Dec 20;55(4):338-342. doi: 10.28920/dhm55.4.338-342.

ABSTRACT

INTRODUCTION: Cardiac arrest (CA) during hyperbaric oxygen treatment (HBOT) is exceedingly rare with only a few cases reported. It is unknown if in-chamber defibrillation of a patient has been performed in Australasia. In-chamber defibrillation is potentially dangerous with the risk of fire in an oxygen-rich environment. Australasian Standards prohibit the use of currently available defibrillators licensed for in-chamber use, as they contain lithium batteries. This study aimed to investigate how CA is managed in Australasian hyperbaric medicine units (HMUs) and to establish if there is a need to develop standardised protocols.

METHODS: A 10-part SurveyMonkey® questionnaire sent to all 15 Australasian HMUs. Questions aimed to ascertain if there were cases where defibrillation during HBOT was indicated and if it was performed. We asked about emergency treatment protocols, defibrillation capabilities and if regular training drills were conducted. We asked if colleagues felt the need to have a uniform treatment protocol across Australasia and invited them to share their emergency protocols.

RESULTS: Fourteen responses (93.3%) were received. No clinical cases of in-chamber CA or defibrillation were reported. Examples of emergency treatment protocols were provided by two respondents. Six respondents (43%) stated that regular emergency training drills for CA are performed in their HMU. Eleven respondents (79%) favoured standardised treatment protocols; however, comments suggested that this might be unachievable.

CONCLUSIONS: CA requiring defibrillation in the hyperbaric medicine context is rare and has not been performed in Australasia. Most HMUs have protocols in place, but they are not universally practiced regularly.

PMID:41364857 | DOI:10.28920/dhm55.4.338-342

AACN Adv Crit Care. 2025 Dec 15;36(4):317-324. doi: 10.4037/aacnacc2025924.

ABSTRACT

In-hospital strokes carry high long-term morbidity and mortality rates, but treatment pathways for inpatient strokes are not as well studied as those for community-onset strokes. This single-center, retrospective study of in-hospital Code Strokes extracted data from a database maintained by stroke nurse coordinators at an urban academic institution (January 2017 to March 2023). The objective was to explore the benefits of a rapid response team-driven Code Stroke model. Of 900 Code Stroke activations, 836 were driven by the rapid response team and 64 were not driven by the rapid response team. Patients with codes activated by the rapid response team received imaging faster than did those with codes not activated by the rapid response team (mean [SD] time, 15.7 [13.7] minutes vs 23.2 [23.1] minutes; P = .03). More Code Strokes were activated in the intensive care units and cardiovascular units than in other areas.

PMID:41364849 | DOI:10.4037/aacnacc2025924