Nevin Manimala

JMIR Med Educ. 2025 Feb 19;11:e55861. doi: 10.2196/55861.

ABSTRACT

BACKGROUND: Student development is currently taking place in an environment governed by new technologies and social media. Some platforms, such as Instagram or X (previously known as “Twitter”), have been incorporated as additional tools for teaching and learning processes in higher education, especially in the framework of image-based applied disciplines, including radiology and pathology. Nevertheless, the role of social media in the teaching of core subjects such as histology has hardly been studied, and there are very few reports on this issue.

OBJECTIVE: The aim of this work was to investigate the impact of implementing social media on the ability to learn human histology. For this purpose, a set of voluntary e-learning activities was shared on Instagram as a complement to traditional face-to-face teaching.

METHODS: The proposal included questionnaires based on multiple-choice questions, descriptions of histological images, and schematic diagrams about the subject content. These activities were posted on an Instagram account only accessible by second-year medical students from the University of Malaga. In addition, students could share their own images taken during the laboratory practice and interact with their peers.

RESULTS: Of the students enrolled in Human Histology 2, 85.6% (143/167) agreed to participate in the platform. Most of the students valued the initiative positively and considered it an adequate instrument to improve their final marks. Specifically, 68.5% (98/143) of the student body regarded the multiple-choice questions and image-based questions as the most useful activities. Interestingly, there were statistically significant differences between the marks on the final exam (without considering other evaluation activities) for students who participated in the activity compared with those who did not or barely participated in the activity (P<.001). There were no significant differences by degree of participation between the more active groups.

CONCLUSIONS: These results provide evidence that incorporating social media may be considered a useful, easy, and accessible tool to improve the learning of human histology in the context of medical degrees.

PMID:39970433 | DOI:10.2196/55861

JMIR Form Res. 2025 Feb 19;9:e68840. doi: 10.2196/68840.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported.

OBJECTIVE: This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia.

METHODS: A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children’s Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models.

RESULTS: Among the students, 25.8% (32/124) were identified as having high anxiety levels, with 19.3% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26% (32/123) were classified as problem gamers, while 14% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference -4.11, 95% CI -6.98 to -1.24; P=.005) and video game addiction (mean difference -1.62, 95% CI -2.83 to -0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95% CI -0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention.

CONCLUSIONS: The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions.

PMID:39970430 | DOI:10.2196/68840

J Med Internet Res. 2025 Feb 19;27:e59338. doi: 10.2196/59338.

ABSTRACT

BACKGROUND: Adolescent substance use disorder is a pressing public health issue, with increasing prevalence as individuals age. Social media platforms like Reddit (Reddit Inc) serve as significant venues for teenagers to discuss and navigate substance use. Social media platforms, such as Reddit, serve as increasingly important spaces where teenagers discuss, share, and navigate their experiences with substance use, presenting unique opportunities and challenges for understanding and addressing this issue.

OBJECTIVE: This study aims to explore how teenagers frame substance-use discussions on the r/teenagers subreddit, focusing on their personal interpretations, causal attributions, and the social and psychological contexts that shape these online support groups. By identifying these interpretive frames, we aimed to better understand the complex drivers of adolescent substance use behavior and their potential interventions.

METHODS: Using natural language processing techniques, we analyzed 32,674 substance use-related posts from 2018 to 2022. A framing approach was used to identify and categorize prevalent themes, supplemented by emotional profiling using the EmoLLaMA-chat-13B model developed by Liu and colleagues.

RESULTS: In total, 7 primary frames emerged: normalization, risk awareness, social integration, autonomy and rebellion, coping mechanisms, media influence, and stigmatization. These frames varied in prevalence and were associated with distinct emotional profiles, highlighting the complex interplay between substance use and adolescent experiences. We observed that, for example, the normalization frame was often associated with a mix of sadness and anxiety, while the coping frame exhibited elevated levels of anger, sadness, and anxiety. These distinctive emotional landscapes associated with each frame reveal unique insights into the mental state of adolescents navigating substance use.

CONCLUSIONS: The findings underscore the multifaceted nature of adolescent substance-use discussions on social media. Interventions must address underlying emotional and social factors as well as identity to effectively mitigate substance use disorder among adolescents. By understanding the frames teenagers use to interpret substance use, we can pave the way for more effective and personalized public health campaigns, and support services designed to resonate with adolescents’ unique lived experiences.

PMID:39970428 | DOI:10.2196/59338

J Med Internet Res. 2025 Feb 19;27:e67567. doi: 10.2196/67567.

ABSTRACT

BACKGROUND: Unguided internet-based cognitive behavioral therapy (ICBT) has been proven effective for major depressive disorder (MDD). However, few studies have examined its cost-effectiveness in low-resource countries and under nonspecialist routine care.

OBJECTIVE: This study aimed to evaluate the short- and long-term cost utility of unguided ICBT compared to a waitlist control for persons with MDD from the perspectives of society and the health care system.

METHODS: This analysis was implemented alongside an 8-week 2-arm randomized controlled trial with a 12-month follow-up period conducted in Shenzhen, China. Outcomes including cost and health utility were collected at the pretreatment and posttreatment time points and 3, 6, and 12 months after the intervention. Direct medical costs and indirect costs were prospectively collected using the hospital information system and the Sheehan Disability Scale. Health outcomes were measured using the Chinese version of the Short-Form Six-Dimension health index. The primary outcome was incremental cost utility ratio (ICUR) expressed as the difference in costs between 2 therapies by the difference in quality-adjusted life years (QALYs). The seemingly unrelated regression model and the bootstrap method were performed to estimate adjusted ICURs. Cost-effectiveness planes and cost-effectiveness acceptability curves were used to demonstrate uncertainty. A series of scenario analyses were conducted to verify the robustness of base-case results.

RESULTS: In total, 244 participants with MDD were randomly allocated to the ICBT (n=122, 50%) or waitlist control (n=122, 50%) groups. At the pretreatment time point, no statistically significant difference was observed in direct medical cost (P=.41), indirect cost (P=.10), or health utility (P=.11) between the 2 groups. In the base-case analysis, the ICBT group reported higher direct medical costs and better quality of life but lower total costs at the posttreatment time point. The adjusted ICURs at the posttreatment time point were CN ¥-194,720.38 (US $-26,551.50; 95% CI CN ¥-198,766.78 to CN ¥-190,673.98 [US $-27,103.20 to US $-25,999.70]) and CN ¥49,700.33 (US $6776.99; 95% CI CN ¥46,626.34-CN ¥52,774.31 [US $6357.83-$7196.15]) per QALY from the societal and health care system perspectives, respectively, with a probability of unguided ICBT being cost-effective of 75.93% and 54.4%, respectively, if the willingness to pay was set at 1 time the per-capita gross domestic product. In the scenario analyses, the probabilities increased to 76.85% and 77.61%, respectively, indicating the potential of ICBT to be cost-effective over the long term.

CONCLUSIONS: Unguided ICBT is a cost-effective treatment for MDD. This intervention not only helps patients with MDD improve clinically but also generates societal savings. These findings provide health economic evidence for a potential scalable MDD treatment method in low- and middle-income countries.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2100046425; https://tinyurl.com/bdcrj4zv.

PMID:39970426 | DOI:10.2196/67567

Int J Lang Commun Disord. 2025 Mar-Apr;60(2):e70002. doi: 10.1111/1460-6984.70002.

ABSTRACT

PURPOSES: Investigating the contribution of each component of the Western Aphasia Battery (WAB) to the aphasia quotient (AQ) helps better understand the mechanisms of change in the AQ. Previous studies on patients with English-speaking aphasia have shown that spontaneous speech contributes the most to the AQ. However, the same conclusion may not be applicable to Chinese-speaking patients with aphasia because of the differences between Chinese and English languages. The primary objective of this study was to investigate differences between Chinese and English people with aphasia in the contribution of WAB components to the AQ. The second objective was to explore the effect of aphasia severity to the AQ.

METHODS: A total of 94 patients with Mandarin aphasia participated in this study. The Lmg and Pmvd algorithms based on relative weight analysis were conducted to calculate the contributions of the four main components and 10 subtests of the WAB to the AQ. Lmg measures the relative importance of each variable by allocating the explanatory power of the model, while Pmvd analyses through a decomposition method based on statistical explanatory quantities. In addition, the same method was applied to the severe, moderate and mild aphasia groups.

RESULTS: Of the four main components, naming contributed the most to the AQ, followed by spontaneous speech, listening comprehension and repetition. Object naming contributed the most among the 10 subtests. Among the different severity groups, naming contributed the most to the severe and moderate groups, while spontaneous speech contributed the most to the mild group.

CONCLUSIONS: There were significant differences between Chinese and English patients with aphasia in terms of the contribution of each component of the WAB to the AQ. In Chinese, the largest contributor is naming, as opposed to spontaneous speech in English. Therefore, in a cross-linguistic context, it is important to carefully consider the impact of language differences, as this may help explain and understand the severity of Chinese aphasia.

WHAT THIS PAPER ADDS: What is already known on the subject Among native English-speaking patients with mild aphasia, Spontaneous Speech test contributed most to the aphasia quotient of the Western Aphasia Battery. However, it is not known whether this finding applies to Chinese-speaking patients with aphasia as well as those with moderate-to-severe aphasia. What this study adds to the existing knowledge The subjects of our study were native speakers of Chinese with aphasia, and the results showed that the scores of the Naming test contributed the most to the total score. Further studies found that when grouped by severity, the Spontaneous Speech test contributed the most to the total score in the mild group, and the Naming test contributed the most to the total score in the moderate and severe groups. What are the clinical implications of this work? Patients with Chinese aphasia of different severity effectively improve their aphasia quotient in different ways. Mild patients correspond to spontaneous speech while moderate to severe patients correspond to naming. This may provide suggestions for the rehabilitation of patients.

PMID:39970393 | DOI:10.1111/1460-6984.70002

Integr Environ Assess Manag. 2025 Mar 1;21(2):326-334. doi: 10.1093/inteam/vjae010.

ABSTRACT

The water system in the Gaza Strip is deteriorating as the agricultural sector consumes more than 50% of the available water. There is an urgent need for effective tools that rationalize agricultural water consumption. The concept of the blue and green water footprint (WF) was applied to determine the actual water consumption of all crops in the Gaza Strip and evaluate the sustainability of the agricultural water footprint. The CROPWAT 8.0 model was used to calculate the crop water requirements (CWR) and estimate evapotranspiration (ET) according to the Hoekstra manual. The results show that the blue water footprint of crops was 82.15 mm3 distributed among 59.4 mm3 of horticulture trees, 3.65 mm3 of field crops, and 19.2 mm3 of vegetables whereas the green water footprint was 33.82 mm3. The main insight is that the water footprint’s sustainability reflects a serious indicator of the depletion of blue water in the Gaza Strip and if WF is applied, 40 mm3 of water can be saved annually, which constitutes 33% less than the current usage. It is promising to use the water footprint concept as a distinct tool in supporting the decision-maker to reduce water consumption and enhance water resource sustainability.

PMID:39970381 | DOI:10.1093/inteam/vjae010

Integr Environ Assess Manag. 2025 Mar 1;21(2):442-454. doi: 10.1093/inteam/vjae033.

ABSTRACT

Elevated blood lead levels (BLLs) in children still represent a major public health problem worldwide. In China, children’s lead (Pb) exposure assessment constitutes a priority issue for research, also due to the scarce availability of human biomonitoring data and limited detailed exposure assessments outside urban areas. This work aims to analyze children’s health impact by exploiting exposure modeling approaches to identify the most relevant Pb sources and exposure routes for 0-7-year-old children in a historical Pb-Zn smelter site in Yunnan province (southwestern China), characterized by heavy environmental pollution conditions. For this purpose, two exposure modeling tools, the Integrated Exposure Uptake Bio-Kinetic and MERLIN-Expo, were applied, using measured Pb concentrations in environmental media and food items from a local field campaign as input data. Simulated BLLs, including probabilistic estimates, were obtained and verified against real biomonitoring data from the literature. Model results for the simulated exposure scenario indicate significantly high children’s BLLs (>10 µg/dl), which reflect the elevated Pb concentrations measured in environmental matrices and are mostly in agreement with previous biomonitoring data from the region. Moreover, soil and dust ingestion resulted to be the dominant exposure pathway, contributing more than 70% to the overall Pb exposure in children in all investigated scenarios. This work showed how tools for internal exposure modeling can contribute to Pb exposure assessment as complementary tools to demanding and invasive biomonitoring studies and can help identify priority exposure routes for improving risk management.

PMID:39970377 | DOI:10.1093/inteam/vjae033

JMIR Ment Health. 2025 Feb 19;12:e64716. doi: 10.2196/64716.

ABSTRACT

BACKGROUND: The early detection of mild cognitive impairment is crucial for providing treatment before further decline. Cognitive challenge tests such as the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) can identify individuals at highest risk for cognitive deterioration. Performance on elements of the LASSI-L, particularly proactive interference, correlate with the presence of critical Alzheimer disease biomarkers. However, in-person paper tests require skilled testers and are not practical in many community settings or for large-scale screening in prevention.

OBJECTIVE: This study reports on the development and initial validation of a self-administered computerized version of the Loewenstein-Acevedo Scales for Semantic Interference (LASSI), the digital LASSI (LASSI-D). A self-administered digital version, with an artificial intelligence-generated avatar assistant, was the migrated assessment.

METHODS: Cloud-based software was developed, using voice recognition technology, for English and Spanish versions of the LASSI-D. Participants were assessed with either the LASSI-L or LASSI-D first, in a sequential assessment study. Participants with amnestic mild cognitive impairment (aMCI; n=54) or normal cognition (NC; n=58) were also tested with traditional measures such as the Alzheimer Disease Assessment Scale-Cognition. We examined group differences in performance across the legacy and digital versions of the LASSI, as well as correlations between LASSI performance and other measures across the versions.

RESULTS: Differences on recall and intrusion variables between aMCI and NC samples on both versions were all statistically significant (all P<.001), with at least medium effect sizes (d>0.68). There were no statistically significant performance differences in these variables between legacy and digital administration in either sample (all P<.13). There were no language differences in any variables (P>.10), and correlations between LASSI variables and other cognitive variables were statistically significant (all P<.01). The most predictive legacy variables, proactive interference and failure to recover from proactive interference, were identical across legacy and migrated versions within groups and were identical to results of previous studies with the legacy LASSI-L. Classification accuracy was 88% for NC and 78% for aMCI participants.

CONCLUSIONS: The results for the digital migration of the LASSI-D were highly convergent with the legacy LASSI-L. Across all indices of similarity, including sensitivity, criterion validity, classification accuracy, and performance, the versions converged across languages. Future studies will present additional validation data, including correlations with blood-based Alzheimer disease biomarkers and alternative forms. The current data provide convincing evidence of the use of a fully self-administered digitally migrated cognitive challenge test.

PMID:39970376 | DOI:10.2196/64716

Folia Med Cracov. 2024 Dec 26;64(3):155-163. doi: 10.24425/fmc.2024.152176.

ABSTRACT

OBJECTIVE: Our study aimed to evaluate the association between single nucleotide polymorphism of IL-6-174G/C and the disease course in patients with ulcerative colitis (UC) and Crohn’s disease (CD).

METHODS: 105 patients (aged 18-75 years) with diagnosed inflammatory bowel disease (IBD), 50 with CD, and 55 with UC, were involved in the study. The controls consisted of 124 healthy individuals. In all patients, the following parameters were evaluated: disease duration, location, presence of complications, and past surgical procedures. Morphology, biochemical parameters, fibrinogen, interleukin 6 (IL-6) level, and IL-6 single nucleotide (174 G/C) polymorphism were assessed in all subjects. Associations of those markers with disease activity, location, complications, and inflammatory markers were evaluated.

RESULTS: No statistically significant differences in IL-6 single nucleotide (174 G/C) polymorphism were observed between patients with UC, CD, and controls. In IBD patients with the GG genotype, a higher mean IL-6 level was noticed than in patients with other genotypes (4.685 ± 5.9 vs. 2.715 ± 5.1 in GC and 3.186 ± 3.6 in CC). A positive correlation was found between IL-6 and fibrinogen levels and CRP in UC and CD patients with GG and GC genotypes. In IBD patients with CC genotype, no correlation between IL-6 and fibrinogen was found (p = 0.48).

CONCLUSIONS: The risk of developing IBD appears not connected with IL-6 polymorphism. However, IL-6 variation might influence the course of the disease in UC patients.

PMID:39970364 | DOI:10.24425/fmc.2024.152176

Folia Med Cracov. 2024 Dec 26;64(3):119-127. doi: 10.24425/fmc.2024.152172.

ABSTRACT

Complex regional pain syndrome (CRPS) is a descriptive term for a complex of symptoms and signs, including pain, swelling and vasomotor disturbances. The disease causes also functional impairment of the affected extremity and limitation in daily activities. Even after effective treatment, the condition frequently leaves residual symptoms and impairment of the limb. The objective of this study was assessment of the level of functional impairment in patients who got over CRPS. Materials and Methods: Fifty-two patients, 45 women (86%) and 7 men (14%) in a mean age of 57 years who were got over CRPS were asked to fill 2 questionnaires for assessment of function of their upper limbs in daily living. The questionnaires included the Raadboud Skills Questionnaire (the RASQ) and the Disability of Arm, Shoulder and Hand (the DASH). Results of this study show statistically significant differences in functional impairment of the limbs between the groups with different recovery status and duration of CRPS: the patients with longer lasting disease and those, who did not feel recovered showed greater functional impairment of their limbs than remaining patients. Conclusion: These results suggest that, in spite of a satisfactory outcome of treatment, significant long- term sequelae of the disease impair function of the affected limbs and reduce quality of life in a proportion of patients.

PMID:39970360 | DOI:10.24425/fmc.2024.152172