Nevin Manimala

Digit Health. 2025 Nov 3;11:20552076251393362. doi: 10.1177/20552076251393362. eCollection 2025 Jan-Dec.

ABSTRACT

BACKGROUND: Instagram is a key source of health information, particularly for promoting clear aligners therapy but raising concerns about misinformation. Despite over 400 million Arabic speakers across 22 countries, their representation in health information quality research is limited. Thus, this prospective cross-sectional study aimed to qualitatively and quantitatively analyses Arabic Instagram posts about clear aligner therapy.

METHODS: On 21 April 2025, Arabic posts were collected using 14 popular hashtags following a stratified random sampling approach, with the top 20 posts per hashtag included. Posts were classified by format, poster role, content type, thematic focus and type. Claim accuracy was assessed using established misinformation frameworks and orthodontic guidelines. Inter-rater reliability was ensured with a multi-coder protocol. Statistical analyses included Mann-Whitney U, Chi-square and Kruskal-Wallis tests with Bonferroni corrections (α = 0.05).

RESULTS: Of 1,058,700 initial posts, 264 were included. Most were promotional (63%), photo-based (75%) and originated from Saudi Arabia (56%). Video and sharing experience posts had higher likes and engagement than photo and marketing posts (p < 0.05). Clinical and educational posts contained more balanced facts (p < 0.001), while 36% of claims were non-factual, particularly in promotional, marketing and practice advertisement posts (p < 0.001, p < 0.05 and p = 0.011, respectively).

CONCLUSION: Arabic Instagram content on clear aligners is mainly promotional with substantial misinformation. Educational posts, though more accurate, are less common. Given Instagram’s impact on treatment decisions, improving the quality of Arabic orthodontic content is crucial for informed consent and public awareness.

PMID:41195371 | PMC:PMC12583866 | DOI:10.1177/20552076251393362

Breast J. 2025 Oct 28;2025:6615296. doi: 10.1155/tbj/6615296. eCollection 2025.

ABSTRACT

BACKGROUND: While the characteristics of pathologic nipple discharge (PND) are well documented in the literature, comparative clinical and risk factor analyses across different pathologic subtypes are lacking.

METHODS: Medical records of patients with nipple discharge were retrospectively retrieved from an electronic medical record database and analyzed. In this study, 375 patients with a postoperative pathologically confirmed diagnosis of PND were included.

RESULTS: Age serves as an important independent risk factor for precancerous lesions and breast cancer, with the median age increasing alongside the severity of the pathology. Individuals under 45 years of age predominantly exhibited non-neoplastic and benign neoplastic lesions, whereas those over 45 were more likely to have precancerous lesions or breast cancer, with statistical significance (p < 0.01). Discharge color was a significant factor in distinguishing between different pathological findings (p < 0.01). Discharge color serves as an important independent risk factor for breast cancer. Bloody discharge was associated with a significantly higher incidence of breast cancer and precancerous lesions compared to non-bloody discharges. Upon dividing bloody discharge into brown and bright red for in-depth analysis, no significant difference was observed among the different pathological types (p > 0.05). Ductoscopy has a higher diagnostic rate for breast cancer and precancerous lesions (p < 0.01).

CONCLUSION: These results suggest the clinical characteristics of PND patients across four pathological types: non-neoplastic lesions, benign neoplastic lesions, precancerous lesions, and breast cancer, at the same time emphasizing the importance of age and discharge color as independent risk factors in the prognosis and management of nipple discharge.

PMID:41195359 | PMC:PMC12585855 | DOI:10.1155/tbj/6615296

Front Psychiatry. 2025 Oct 21;16:1564915. doi: 10.3389/fpsyt.2025.1564915. eCollection 2025.

ABSTRACT

INTRODUCTION: Although the gender differences in suicide and smoking are well-known, studies exploring the impact of gender on the relationship between smoking and suicide are limited. This population-based nationwide cohort study examines the association between smoking and suicide risk among1.8 million depressed patients, analyzed separately by gender.

METHODS: This longitudinal cohort study included 1,827,249 adults diagnosed with depression between 2010 and 2015 from the Korean National Health Insurance Service database. Smoking status (never, former, current) was self-reported during health screenings, and suicides were identified via national mortality records. Cox proportional hazards models adjusted for demographic, clinical, and psychiatric covariates assessed hazard ratios (HRs) for suicide risk. Subgroup analyses explored effect modifications by covariates, including age, income, and alcohol use.

RESULTS: Over a median follow-up of 6.8 years, 6,318 individuals (0.35%) died by suicide. Smoking was associated with increased suicide risk in both men and women, with a stronger association in women. Current smoking showed a higher risk in women (HR = 2.646, 95% CI: 2.287-3.062) compared to men (HR = 1.376, 95% CI: 1.277-1.483). In men, factors such as younger age and alcohol consumption intensified this association, whereas in women, low income was a significant modifier; the highest suicide risk was observed in low-income former smokers.

CONCLUSION: Smoking is associated with increased suicide risk among individuals with depression, with notable gender differences in risk magnitude and modifying factors. These findings highlight the need for gender-specific suicide prevention strategies. Limitations include reliance on self-reported smoking data and lack of time-varying measures of exposure.

PMID:41195353 | PMC:PMC12583080 | DOI:10.3389/fpsyt.2025.1564915

Front Psychiatry. 2025 Oct 21;16:1621768. doi: 10.3389/fpsyt.2025.1621768. eCollection 2025.

ABSTRACT

BACKGROUND: Mental health disorders among college students have surged in recent years, exacerbated by barriers such as stigma, cost associated with treatment, and limited access to mental health providers. Artificial intelligence (AI)-driven chatbots have emerged as scalable, stigma-free tools to deliver evidence-based mental health support, yet their efficacy specifically for college populations remains underexplored.

OBJECTIVE: This systematic rapid review evaluates the effectiveness of chatbots in improving mental health outcomes (e.g., anxiety, depression) and well-being among college students while identifying key design features and implementation barriers.

METHODS: Four databases (PubMed, PsycInfo, Applied Science & Technology Source, ACM Digital Library) were searched for studies published between 2014 and 2024. Two reviewers independently screened articles using predefined PICO criteria, extracted data and assessed quality via the PEDro scale. Included studies focused on chatbot interventions targeting DSM-5-defined mental health conditions or well-being in college students.

RESULTS: Nine studies (n=1,082 participants) were included, with eight reported statistically significant improvements in anxiety (e.g., GAD-7 reductions), depression (e.g., PHQ-9 scores), or well-being. Effective chatbots frequently incorporated cognitive-behavioral therapy (CBT), daily interactions, and cultural personalization (e.g., 22% depression reduction with Woebot; p<0.05). However, heterogeneity in study quality (PEDro scores: 1-7), high attrition rates (up to 61%), and reliance on self-reported outcomes limited generalizability.

CONCLUSIONS: Though the use of chatbots for the improvement of mental health and well-being is promising based on the review’s results, future research should prioritize rigorous RCTs, standardized outcome measures (e.g., PHQ-9, GAD-7), and strategies to improve attrition.

PMID:41195352 | PMC:PMC12582922 | DOI:10.3389/fpsyt.2025.1621768

Front Psychiatry. 2025 Oct 21;16:1652020. doi: 10.3389/fpsyt.2025.1652020. eCollection 2025.

ABSTRACT

AIM: To compare the incidence of AUD and correlation between metabolic changes and addictive behaviors in patients who underwent SG.

METHODS: A retrospective study was conducted on 160 obese patients who underwent SG treatment at our hospital between February 2023 and April 2024 (SG group), and another 160 non-surgical obese patients admitted during the same period were selected as the control group. The Alcohol Use Disorders Identification Test (AUDIT)was used to assess the risk of AUD in both groups (AUDIT≥eight points defined as high risk) and to compare the differences in high-risk rates between the groups. Differences in impulsivity scores (Barratt Impulsivity Scale [BIS]-11), addictive behavior scores(Visual Analog Scale for Addictive Behaviors[VAS]),and glucose-fat metabolism indexes between the high-and low-risk AUD subgroups within the SG group were analyzed using Pearson correlation and multiple regression analyses to explore associations between metabolic indicators and addictive behavior scores.

RESULTS: The SG group had a higher rate of alcohol use disorder (AUDIT ≥ 8 points) after surgery than the control group (26.88% vs. 8.125%) (χ² = 19.32, P < 0.001).The impulsivity score[BIS-11:(68.43 ± 9.35)points vs.(61.22 ± 8.71)points] and addictive behavior score[VAS:(6.42 ± 1.14)points vs.(3.88 ± 1.06)points]were significantly higher in the high-risk group than in the low-risk group(P<0.001).Fasting plasma glucose, glycated hemoglobin, and homeostasis model assessment of insulin resistance levels were significantly higher in the AUDIT high-risk group than in the low-risk group(P<0.001).lipoprotein cholesterol (TC, TG, LDL-C, HDL-C) did not differ significantly between high- and low-risk groups (P > 0.05).Glucose metabolism indices(fasting plasma glucose, glycated hemoglobin, and homeostasis model assessment of insulin resistance)were strongly and positively correlated with AUDIT and VAS scores(r=0.682-0.716,P<0.05).However, multivariate linear regression analysis indicated that impulsivity, addictive behavior propensity, and glucose metabolism abnormalities were not independently associated with statistical significance(P>0.05).The propensity for addictive behavior and abnormal glucose metabolism remained independent risk factors for AUD after SG(P<0.05),and the risk was significantly higher in men than in women. This age group had significantly higher AUDIT high-risk rates, BIS-11 impulsivity, and VAS addiction behavior scores vs. the >25 group (P<0.05).

CONCLUSION: Compared to nonsurgical patients with obesity, patients with obesity who underwent SG exhibited a significantly high incidence of AUD. Patients in the high-risk subgroup for AUD also showed high impulsivity scores, greater addictive behavior scores, and notable abnormalities in glucose metabolism indices.

PMID:41195349 | PMC:PMC12582919 | DOI:10.3389/fpsyt.2025.1652020

Parkinsons Dis. 2025 Oct 28;2025:9860808. doi: 10.1155/padi/9860808. eCollection 2025.

ABSTRACT

BACKGROUND: Parkinson’s disease (PD) is the second most common neurodegenerative disorder with significant social costs, mainly owing to hospitalization, which is frequently associated with high levodopa equivalent daily dose (LEDD) and polypharmacy rather than neurological symptoms alone. Integrative treatment combining Western and Korean medicine may help control these factors and reduce the need for hospitalization. We investigated the potential impact of integrative treatment on LEDD and polypharmacy in patients with PD > 5 years postdiagnosis.

METHODS: Fifteen patients with PD (KCD code G20), diagnosed > 5 years earlier, who received integrative treatment at Gwangju Korean Medicine Hospital, Wonkwang University, from April 1, 2022, to July 30, 2024, were enrolled. A retrospective chart review was conducted to collect demographic and clinical data, including LEDD, medication count, and treatment details. Summary statistics were presented as median (IQR) and mean ± SD.

RESULTS: In the integrative treatment cohort, the prevalence of both LEDD and polypharmacy was lower than that in studies involving conventional treatment alone. The mean LEDD was 321.71 (median, 200.0) mg, while only two patients exceeded the LEDD threshold of 300 mg, which was associated with motor complications. Polypharmacy was observed in 13.3% of patients and hyperpolypharmacy in 6.7%, representing lower proportions compared with previous reports on conventional treatments. Representative cases highlighted symptom improvement and a reduced need for medication with integrative approaches, particularly acupuncture and herbal medicine.

CONCLUSION: These findings suggest that integrative treatment may contribute to lowering LEDD and medication counts in patients with PD, which could potentially reduce hospitalization rates and the associated social costs. Further prospective studies comparing the integrative and nonintegrative treatment groups are needed to clarify these findings and evaluate the role of integrative treatment in the long-term management of PD.

PMID:41195340 | PMC:PMC12585846 | DOI:10.1155/padi/9860808

Pediatr Int. 2025 Jan-Dec;67(1):e70248. doi: 10.1111/ped.70248.

ABSTRACT

AIM: Runaway behavior, defined as leaving home without parental permission and not returning, is associated with adverse educational, physical, and mental health outcomes. In Japan, since around 2018, a group of runaway adolescents known as “Toyoko Kids” has emerged in Tokyo’s Kabukicho area, reportedly engaging in substance use, violence, and prostitution. This study aimed to examine the psychosocial characteristics of Toyoko Kids who were transported to emergency care due to impaired consciousness from drug overdose or alcohol intoxication.

METHODS: We conducted a retrospective chart review of eight female adolescents under 18 years old, transported from Kabukicho to Keio University Hospital between June 2022 and August 2023. Inclusion criteria included having run away for at least two nights (or one night for those under 15) and being transported by a third party. A multidisciplinary team assessed psychosocial risks using a Bio-Psycho-Social model. Data on consciousness level, pregnancy, substance use, self-harm, psychiatric history, family structure, school attendance, abuse, and child welfare involvement were analyzed and compared with national statistics.

RESULTS: All subjects were female, aged 12-16. The most common reason for transport was impaired consciousness due to overdose, primarily involving over-the-counter medications. Self-harm was confirmed in 86% and abuse in 67% of cases. Although several had prior psychiatric or welfare intervention, support was often temporary and insufficient. Most came from single-parent households, and over half had a history of school absenteeism.

CONCLUSIONS: This study identified severe psychosocial vulnerabilities among Toyoko Kids. Findings highlight gaps in mental health and child protection systems.

PMID:41194319 | DOI:10.1111/ped.70248

Health Econ. 2025 Nov 5. doi: 10.1002/hec.70051. Online ahead of print.

ABSTRACT

This paper examines the effects of increased trade between Japan and the U.S. on mortality rates in the U.S. using a shift-share instrumental variables approach. Overall, we find that an increase in Japanese imports is associated with higher rates of cardiovascular disease (CVD) mortality and lower rates of mortality from accidents. Effects of Japanese imports on deaths of despair are inconsistent, but there is a positive association between imports and drug-related deaths. These effects exhibit significant racial disparities. Specifically, a $1000 increase in import competition is associated with a 3.0% increase in CVD deaths per 100,000 Black individuals aged 20-64 years old, while there is no statistically significant effect among whites. Additionally, a $1000 increase in import competition is associated with a 13.5% increase in drug-related deaths per 100,000 Black individuals aged 20-64 years old compared to a 7.8% increase among white individuals. Effects on mortality rates from accidents are driven by deaths among whites. Our findings also indicate that the rise in CVD and drug-related mortality is concentrated among males and in regions with relatively high shares of employment in the automobile or computer industries.

PMID:41194310 | DOI:10.1002/hec.70051

Breast Cancer Res. 2025 Nov 5;27(1):199. doi: 10.1186/s13058-025-02145-z.

ABSTRACT

OBJECTIVES: To validate cone-beam breast computed tomography (CBBCT) for evaluating NAT response using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and to explore correlations between multidimensional CBBCT features and pathological complete response (pCR).

METHODS: We prospectively analyzed 73 patients who underwent pre- and post-NAT CBBCT, of whom 41 also received paired magnetic resonance imaging (MRI). Inter-modality and imaging-pathology concordance were assessed using Cohen’s κ statistics. Determinants of CBBCT accuracy were identified through univariate and logistic regression analyses. Receiver operating characteristic (ROC) analysis with DeLong’s test was used to determine the optimal quantitative parameter for discriminating pCR from non-pCR. Associations between pCR and changes in calcification, vascularity, and background parenchymal enhancement (BPE) were evaluated using Pearson’s χ² and Fisher’s exact tests.

RESULTS: CBBCT showed excellent agreement with MRI (κ = 0.809) and good pathological concordance (κ = 0.618; MRI κ = 0.700). The area under the curve (AUC) for distinguishing responders from non-responders was 0.950 for CBBCT and 0.905 for MRI. For pCR assessment, the AUC values were 0.643 and 0.786, respectively. Targeted therapy (odds ratio [OR] = 0.059, p = 0.013) and linear/segmental calcifications (OR = 0.127, p = 0.042) were independent factors affecting CBBCT accuracy. The enhanced degree change (ΔE) on CBBCT demonstrated strong predictive performance for pCR (AUC = 0.941) with high computational efficiency. Significant associations with pCR were observed for reductions in calcification extent (p = 0.021), adjacent vascular sign (AVS) grade (p = 0.004), and BPE levels (p = 0.001).

CONCLUSION: CBBCT demonstrates high accuracy in assessing NAT response, with excellent agreement to MRI. ΔE is recommended as an optimal quantitative parameter for predicting pCR, supported by dynamic changes in calcification extent, AVS, and BPE grade as valuable markers, positioning CBBCT as a comprehensive tool for breast cancer management.

CLINICAL RELEVANCE STATEMENT: CBBCT enables a comprehensive and efficient tool for monitoring NAT response, showing excellent concordance with MRI, and its multidimensional features are also valuable for predicting pCR.

PMID:41194290 | DOI:10.1186/s13058-025-02145-z

Diabetol Metab Syndr. 2025 Nov 5;17(1):415. doi: 10.1186/s13098-025-01936-w.

ABSTRACT

BACKGROUND: This study aimed to investigate whether recent physical activity (PA), assessed in a real-world outpatient setting, is associated with a lower prevalence of cardiovascular autonomic neuropathy (CAN) in individuals with type 1 diabetes.

METHODS: Sixty-six patients with type 1 diabetes were tested for CAN using cardiovascular reflex tests. PA level was assessed using the International Physical Activity Questionnaire (IPAQ) and patients were classified into low, moderate, or high PA groups.

RESULTS: PA was low in 13 (19.7%), moderate in 19 (28.8%) and high in 34 (51.5%) patients. Fisher’s exact test conducted to examine the relationship between PA groups and diabetic CAN categories revealed a statistically significant difference (p < 0.001) being absent in 67.7% and early in 29.4% of the patients belonging to the high PA group. In addition, engagement in at least 600 MET minutes per week was independently associated with a lower probability of having CAN (OR = 0.131, 95% CI: 0.017-0.986, p = 0.048).

CONCLUSIONS: Higher levels of self-reported physical activity are associated with a reduced likelihood of CAN in patients with type 1 diabetes. These findings support the importance of promoting regular PA as part of routine diabetes care.

PMID:41194278 | DOI:10.1186/s13098-025-01936-w