Nevin Manimala

BMC Pediatr. 2026 Jan 3;26(1):2. doi: 10.1186/s12887-025-06151-0.

ABSTRACT

BACKGROUND: Laughter yoga is a non-pharmacological and non-invasive therapeutic approach that integrates voluntary laughter with controlled breathing exercises. This systematic review aimed to evaluate research investigating the impact of laughter yoga on children’s health outcomes.

METHODS: This systematic review included studies with randomized controlled trial (RCT) and quasi-experimental designs, adhering to the PRISMA guidelines. This systematic review, conducted between December 18, 2023, and October 31, 2024, was guided by the PRISMA guidelines and a predefined protocol based on the PICOS-based protocol. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental designs. A comprehensive literature search was conducted in Google Scholar, Medline/PubMed, Cochrane Library, Science Direct, CINAHL Complete, and OVID databases. Study selection was based on the PICOS framework, and methodological quality was assessed using the Joanna Briggs Institute-Meta Analysis Statistical Assessment and Review Instrument (JBI-MAStARI). Based on the inclusion criteria, six studies were incorporated into the review.

RESULTS: The total sample across the included studies was 305 participants, with 66% of the studies involving at least 50 participants. Findings indicated that laughter yoga contributed to a reduction in anxiety and stress levels in children (p < 0.05), while no statistically significant effect was observed on depression scores (p > 0.05). Although no substantial improvement in self-esteem was reported, positive changes in self-concept were noted. Furthermore, laughter yoga was associated with an increase in salivary IgA levels (p < 0.01), whereas no significant influence on cortisol levels was found (p > 0.05). Additionally, the intervention was reported to alleviate pain, fatigue, and burnout while enhancing hope and overall happiness.

CONCLUSIONS: Study results showed that laughter yoga promoted the increase in happiness and self-concept in children and improved their ability to cope with stress. It also provided a physiological improvement by positively affecting pain and fatigue. In light of these results, it is recommended that laughter yoga be used more widely in children’s daily lives and clinical practices.

PMID:41485062 | DOI:10.1186/s12887-025-06151-0

J Exp Clin Cancer Res. 2026 Jan 2. doi: 10.1186/s13046-025-03619-w. Online ahead of print.

ABSTRACT

BACKGROUND: Metastatic colorectal cancer (CRC) harboring KRAS mutations presents a major therapeutic challenge due to its aggressive nature, poor prognosis, and resistance to EGFR-targeted therapies. This study aimed to identify novel drivers of metastasis specifically in KRAS-mutant CRC and to elucidate the underlying molecular mechanisms to undercover new therapeutic vulnerabilities.

METHODS: We integrated data from clinical databases (TCGA, CPTAC) with experimental validation using human CRC cell lines, a tissue microarray, and two distinct in vivo metastasis models (liver and lung colonization). ZBTB20 expression and function were analyzed by IHC, Western blotting, Transwell assays, and RNA-seq integrated with ChIP-seq data. The mechanism of ZBTB20 regulation was investigated via co-immunoprecipitation, mass spectrometry, truncation analysis, site-directed mutagenesis, and luciferase reporter assays. Statistical significance was determined using Student’s t-tests, ANOVA, and survival analysis.

RESULTS: ZBTB20 expression was significantly upregulated with metastatic progression specifically in KRAS-mutant CRC patients and correlated with reduced overall survival. Functionally, ZBTB20 promoted CRC cell migration, invasion, EMT in vitro, and drove metastatic colonization in vivo. Mechanistically, KRAS/ERK signaling directly phosphorylated ZBTB20 at Threonine 138, 142, and 232, a step essential for its nuclear localization and pro-metastatic activity. Integrating transcriptomic and cistromic data, we identified TGFBR2 as a direct transcriptional target of activated ZBTB20. Notably, pharmacological degradation of TGFBR2 with the inhibitor ITD-1 potently abrogated metastatic outgrowth in both liver and lung colonization models.

CONCLUSIONS: Our findings delineate a novel KRAS-ERK-ZBTB20-TGFBR2 signaling axis that is a critical driver of metastasis colonization in KRAS-mutant CRC. The robust efficacy of a TGFBR2 degrader in multiple in vivo models validates this axis as a viable therapeutic target, offering a promising strategy to inhibit metastatic progression in patients with this aggressive disease.

PMID:41485060 | DOI:10.1186/s13046-025-03619-w

BMC Med Educ. 2026 Jan 3. doi: 10.1186/s12909-025-08514-8. Online ahead of print.

NO ABSTRACT

PMID:41485041 | DOI:10.1186/s12909-025-08514-8

BMC Womens Health. 2026 Jan 3. doi: 10.1186/s12905-025-04203-2. Online ahead of print.

ABSTRACT

BACKGROUND: Women’s ability to refuse unwanted sex is a fundamental dimension of gender equality and a key determinant of overall well-being. Despite its importance, there is limited evidence on the prevalence and factors influencing this ability in Tanzania. This study therefore aimed to investigate the prevalence and determinants of women’s ability to refuse sex among reproductive-age women in the country.

METHOD: This study analyzed secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS), using a weighted sample of 9,090 women aged 15-49. Descriptive statistics summarized socio-demographic characteristics, while binary logistic regression identified factors associated with women’s ability to refuse sex. Both unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals were reported, with statistical significance set at p < 0.05.

RESULTS: The study found that 69.6% of Tanzanian women of reproductive age had the ability to refuse sex (95% CI: 68.5%-70.4%). After adjusting for confounders, women’s ability to refuse sex was associated with their education, primary (aOR = 1.354, p < 0.001), secondary (aOR = 1.74, p < 0.001), higher (aOR = 2.253, p = 0.024), and their partners’ education, secondary (aOR = 1.269, p = 0.015), higher (aOR = 1.756, p = 0.009). Wealth (aOR = 1.241, p = 0.017), awareness of sexually transmitted infections (aOR = 1.368, p < 0.001), prior HIV testing (aOR = 1.714, p < 0.001), media access, low (aOR = 1.273, p < 0.001), medium (aOR = 1.612, p < 0.001), high (aOR = 1.954, p < 0.001), and contraceptive use, calendar-based (aOR = 1.311, p < 0.001) or other methods (aOR = 1.525, p < 0.001), were also positively associated. Women from Unguja (aOR = 0.425, p < 0.001) and Pemba (aOR = 0.376, p = 0.004) were less likely to refuse sex.

CONCLUSION: The study found that a majority of Tanzanian women have the ability to refuse sex and that the ability to refuse sex is significantly linked to education, economic status, partner’s education, access to media, STI awareness, HIV testing, and contraceptive use. However, women in Unguja and Pemba had lower ability to refuse sex compared to those in mainland urban areas. The findings highlight the need for targeted interventions to address regional disparities and promote equitable access to resources that support women’s ability to refuse sex.

PMID:41485040 | DOI:10.1186/s12905-025-04203-2

BMC Public Health. 2026 Jan 3. doi: 10.1186/s12889-025-25928-7. Online ahead of print.

ABSTRACT

BACKGROUND: Child undernutrition remains a major public health concern in Ethiopia, influenced by multiple and interacting household and community factors. Despite large-scale initiatives such as the Productive Safety Net Program, Emergency Aid Program, and Health Extension Program, evidence is still needed on how these interventions affect the determinants of child nutritional status over time.

METHODS: We applied a Dynamic Copula Bayesian Network (DCBN) to model time-varying associations between program participation and key determinants of child undernutrition: food security (FS), household wealth (WQ), and mother subjective well-being (MSW). Data were drawn from the Young Lives-Ethiopia surveys (waves 2009, 2013, 2016) with baseline information from 2002 and 2006. The DCBN framework incorporated 26 copula families, Kendall’s τ for dependence measures, and Markov Chain Monte Carlo (MCMC) for parameter estimation. Model performance was evaluated using root mean square error (RMSE) and Nash-Sutcliffe efficiency (NSE). We further accounted for program spillovers through a community program intensity proxy and assessed robustness with baseline conditioning and inverse probability weighting (IPW).

RESULTS: Program participation was positively associated with household food security and wealth. Both FS → CUS and WQ → CUS edges showed negative and strengthening dependencies across waves, indicating that improvements in food security and wealth are associated with reductions in child undernutrition. These associations were robust to baseline conditioning, spillover adjustments, IPW weighting, and estimation method (MCMC vs. local optimization).

CONCLUSIONS: The study demonstrates the utility of DCBNs for mapping dynamic, nonlinear associations between social protection and health programs and child undernutrition determinants. The results highlight that strengthening household food security and wealth plays a central role in reducing child undernutrition. Although findings are associational, the transferable dependence map can be re-estimated with contemporary data to guide program targeting, monitoring, and policy decisions in Ethiopia.

PMID:41485035 | DOI:10.1186/s12889-025-25928-7

BMC Gastroenterol. 2026 Jan 2. doi: 10.1186/s12876-025-04570-y. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the care practices of adult patients with percutaneous endoscopic gastrostomy and the care burden of individuals who provide care for these patients in this regard.

METHODS: The study was carried out in a descriptive and cross-sectional research design. The sample of the study consisted of 139 patients with percutaneous endoscopic gastrostomy and 139 primary caregivers. The research data were collected through face-to-face interviews with the patients and their caregivers using patient and caregiver information forms, a percutaneous endoscopic gastrostomy care questionnaire, and the Zarit care burden scale. The data obtained in the study were analyzed using the SPSS 23.0 program. Independent samples t-test, one-way analysis of variance, Mann-Whitney U test and Kruskal-Wallis test were used in data analyzing. Statistical significance was assumed at p < 0.05.

RESULTS: It was determined that 59.7% of patients were female and 60.4% were aged 65 and over. 59.7% of carers were male and 50.4% were aged between 45 and 64. The mean score on the Zarit care burden scale of the caregivers was 34.21 ± 21.37. The average care burden score for caregivers of patients aged 65 and over was 38.45 ± 22.73, which was statistically significantly higher than that of caregivers of patients under the age of 65 (p = 0.004). Other factors that affecting caregivers’ burden of care include percutaneous endoscopic gastrostomy control status, the duration of care, maintenance of percutaneous endoscopic gastrostomy care, the status of closing the percutaneous endoscopic gastrostomy area, the type of feeding, the type of equipment used in feeding, the patient’s education for percutaneous endoscopic gastrostomy care, and the amount of daily food given (p < 0.05).

CONCLUSIONS: This study showed that the caregivers of patients with percutaneous endoscopic gastrostomy had a moderate care burden. In addition, this study showed that caregivers who had training on percutaneous endoscopic gastrostomy care had a higher care burden.

PMID:41485022 | DOI:10.1186/s12876-025-04570-y

BMC Geriatr. 2026 Jan 3. doi: 10.1186/s12877-025-06938-x. Online ahead of print.

ABSTRACT

BACKGROUND: Sarcopenia, defined as progressive loss of skeletal muscle mass and function, is a major health issue with economic consequences in aging societies. Physical activity is recognized as preventive, but its long-term impact across different life stages is not well established. This study examined the association between lifetime physical activity and sarcopenia prevalence using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS: Data from the 2014 CHARLS Life History Survey were matched with 2015 cross-sectional health assessments. After excluding participants younger than 60 years or with missing data, a final sample of 6,696 individuals was analyzed. Physical activity at different life stages was assessed using a self-reported questionnaire in the 2014 Life History Survey. Sarcopenia was classified according to the AWGS 2019 criteria. Multivariate logistic regression was conducted to evaluate the association between physical activity at different life stages and sarcopenia prevalence. A significance level of 0.05 was adopted for hypothesis testing.

RESULTS: Among the study participants, 51.7% were without sarcopenia, 36.0% had possible sarcopenia, and 12.3% had sarcopenia. Across all life stages, individuals with sarcopenia were less likely to have engaged in regular physical activity. After adjusting for all covariates, engaging in physical activity for at least one year at any life stage was associated with a 47% lower odds of sarcopenia (OR = 0.53, 95% CI: 0.40-0.69). The strongest protective effect was observed for physical activity during middle adulthood (41-65 years) (OR = 0.36, 95% CI: 0.19-0.69), whereas physical activity in young adulthood (≤ 40 years) and older adulthood (> 65 years) showed no significant associations.

CONCLUSION: Our findings highlight that maintaining physical activity, particularly during middle adulthood, is associated with reduced risk of sarcopenia. Because physical activity was self-reported, future research should employ objective measures and longitudinal designs to confirm these associations.

PMID:41485020 | DOI:10.1186/s12877-025-06938-x

Genet Sel Evol. 2026 Jan 3. doi: 10.1186/s12711-025-01026-5. Online ahead of print.

ABSTRACT

BACKGROUND: Early sexual maturation is a challenging obstacle to overcome in Atlantic salmon farming. This trait primarily affects males and occurs in both freshwater fish farms and sea culture cages during the fattening phase. Current strategies for preventing early maturation include a combination of genetic selection and management practices. However, the genetic architecture of early maturation appears to vary across populations, strains and environments. Our study aimed to elucidate the genetic architecture of early maturation in the Lochy strain of Atlantic salmon using genome-wide SNP panels. This European-origin strain grows rapidly but is prone to high rates of precocious male maturation if not properly managed.

RESULTS: We report two genome-wide association (GWAS) results focusing on males of the Lochy strain of Atlantic salmon. The first included seawater-cultured fish (Group-SA: 714 males, 80 precocious and 634 immature) with an artificial continuous light photoperiod, while the second included freshwater-cultured fish (Group-FN: 707 males, 333 precocious and 374 immature) with a natural photoperiod. Group-SA was genotyped using a custom 46,115-SNP Illumina microarray, whereas Group-FN employed a custom 62,044-SNP Thermo microarray. Genomic heritability of early maturation in males was consistently high across models-ranging from 0.62-0.79 in seawater and from 0.54-0.62 in freshwater. In Group-SA, one significant SNP associated with early sexual maturation were identified on chromosome Ssa25. In Group-FN, sixty significant SNPs associated with early sexual maturation were identified on chromosomes Ssa5, Ssa7, and Ssa25. The genetic variance explained by these SNPs ranged from 16.1-53.7%, while the proportion of phenotypic variance explained varied from 8.7% to 29.1%. The identified candidate genes included chmp2b and vgll3, both previously reported in other domesticated European-origin populations, suggesting some degree of convergence.

CONCLUSIONS: The SNPs associated with early maturation are promising candidates for application in breeding programs in the Lochy strain aimed at implementing improved control strategies against early maturation in both freshwater and sea environments.

PMID:41485019 | DOI:10.1186/s12711-025-01026-5

Int J Behav Nutr Phys Act. 2026 Jan 3. doi: 10.1186/s12966-025-01869-7. Online ahead of print.

ABSTRACT

BACKGROUND: Mobile Health (mHealth) interventions are promising for addressing the growing burden of noncommunicable diseases and common mental disorders but often focus on single domains and lack adaptability. LvL UP (“Level Up”) is a holistic mHealth lifestyle coaching intervention that integrates physical activity, diet, and emotional regulation. It provides blended coaching support through an app-based conversational agent with adaptive human support. This pilot trial assessed the feasibility of delivering the LvL UP intervention and implementing its adaptive procedures using a sequential multiple assignment randomised trial (SMART) design.

METHODS: This eight-week pilot trial was conducted from 29 March to 1 August 2024. We recruited adults in Singapore aged 21-59 at risk of chronic conditions. Participants were randomised 2:1 to the intervention (LvL UP app with a peer supporter-LvL UP Buddy) or comparison (control app with educational resources). After four weeks, non-responders (defined as completing < 6 digital coaching sessions or rated session usefulness < 4/5) were re-randomised 1:1 to continue or receive three additional motivational interviewing (MI)-informed sessions with a human coach; responders remained on their original allocation. Primary outcomes included feasibility indicators: recruitment, LvL UP Buddy enrolment, non-responder rate, trial retention, data completion rate, and intervention engagement. Secondary outcomes measured changes from baseline to eight weeks in mental well-being, psychological distress, physical activity, sleep duration, and fruit and vegetable intake. Six progression criteria were prespecified to guide advancement to a definitive trial.

RESULTS: Of the 458 individuals screened, 394 were eligible, and 123 were enrolled (82 interventions; 41 controls). Most intervention participants (95.1%) were paired with a LvL UP Buddy. Thirty-eight participants (46.3%) were non-responders; of those assigned to MI-informed sessions, 52.6% (10/19) completed all three. Eight-week retention was high (91.5% intervention; 92.7% control), with 12.2% missing data. Positive trends were observed in mental well-being (2.12, 95% CI [-0.58, 4.82]), psychological distress (-0.94 [-2.08, 0.20]), and sleep duration (0.49 h/week [0.17, 0.82]). The study met five of six prespecified progression criteria: recruiting ≥ 60 participants within six weeks, achieving ≥ 75% retention, maintaining ≤ 20% missing data, obtaining a 40-60% non-responder rate, and showing a positive change in ≥ 1 health-related outcome. The digital coaching session adherence fell below the target (39.5% vs. 70%).

CONCLUSIONS: LvL UP was feasible to deliver and evaluate using a SMART design. The results provide strong operational guidance and a solid foundation for the refinement and implementation of a fully powered trial.

TRIAL REGISTRATION: ClinicalTrials.gov, TRN: NCT06360029, Registration date: 7 April 2024.

PMID:41485014 | DOI:10.1186/s12966-025-01869-7

Int J Health Geogr. 2026 Jan 3. doi: 10.1186/s12942-025-00449-z. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) had become one of the increasingly serious public health problems in the world. This study aimed to explore the temporal-spatial distribution characteristics and associated socioeconomic factors of medical expenditures for rural patients with CKD in Fujian province from 2007 to 2016.

METHODS: The medical expenditures information of patients with CKD was abstracted from the database of New Rural Cooperative Medical Scheme. Geographically and temporally weighted regression model was used to analyze the associations between per capita annual medical expenditures and six socioeconomic factors at the county level.

RESULTS: The number of rural patients with CKD who visited in medical institutions increased from 3,099 in 2007 to 19,803 in 2016. The total and per capita medical expenditures of rural patients with CKD increased to 545.4 million yuan and 27,539.7 yuan in 2016, respectively. The ratio of per capita out-of-pocket expenses to per capita disposable income decreased from 108.5% in 2007 to 63.2% in 2016. The top 10% of patients with the highest total medical expenditures account for 31.2% ~ 52.5% of total medical expenditures from 2007 to 2016. The counties with high per capita annual medical expenditures mainly concentrated in the southern region and Longyan city. In which, the per capita annual medical expenditures were negatively associated with the percentage of female patients and number of health technicians per 10,000 persons, and positively associated with the percentage of patients who aged ≥ 60 years, percentage of patients whose length of stay > 10 days, per capita annual disposable income and number of beds per 10,000 persons.

CONCLUSIONS: The out-of-pocket ratio of rural patients with CKD decreased, but suffering from CKD was still catastrophic. The distribution of medical expenditures in rural residents was uneven and there was temporal-spatial heterogeneity in the associations between per capita annual medical expenditures and socioeconomic factors. It is necessary to improve the awareness and health literacy of residents, systematically carry out CKD screening program in high-risk populations, incorporate CKD into the National Basic Public Health Service Program and increase the number of health technicians which could effectively delay the disease progression and reduce medical expenses.

PMID:41485013 | DOI:10.1186/s12942-025-00449-z