Nevin Manimala

Health Promot Int. 2025 Oct 30;40(6):daaf217. doi: 10.1093/heapro/daaf217.

ABSTRACT

Despite their conceptual similarities and importance for effective health management, the relationship between health literacy and eHealth literacy remains poorly understood. This systematic review investigated the statistical association between health literacy and eHealth literacy in adults, along with study-level moderators and biopsychosocial correlates. CINAHL, Embase, Emcare, PubMed, ProQuest, PsycINFO, and Web of Science were searched until January 2025. Methodological reporting quality (QualSyst Checklist) was assessed and between-study heterogeneity explored using random and mixed-effects modeling. Twenty-three observational studies (N = 25 505 participants), all characterized by high methodological quality, were included. A weak positive relationship between overall health literacy and eHealth literacy was identified [r = 0.29, CI (0.21, 0.37)], with Category 2/comprehensive measures of health literacy correlating more strongly with eHealth literacy than Category 1/functional measures. Individual-level factors, including higher educational attainment, economic advantage, positive health behaviors, strong self-efficacy, and the ability to use digital resources were consistently linked to higher health literacy and eHealth literacy. The findings suggest that health literacy and eHealth literacy should continue to be researched in tandem to understand their impact on health outcomes in the digital age. Further research is also needed to understand how the surrounding environment, together with individual factors such as age and cultural background, influences the development of health literacy and eHealth literacy. Such studies are crucial for addressing disparities and enhancing access to health information and services.

PMID:41398315 | DOI:10.1093/heapro/daaf217

Glob Health Res Policy. 2025 Dec 15;10(1):66. doi: 10.1186/s41256-025-00454-6.

ABSTRACT

BACKGROUND: Malaria elimination in the Asia-Pacific region has stalled in recent years, partially due to disrupted access to antimalarial drugs during public health emergencies. This study aims to explore the access to antimalarial drugs and its contextual factors in health emergencies based on investigation into six Asia-Pacific countries during the COVID-19, including Bangladesh, India, Indonesia, Pakistan, Thailand and Viet Nam.

METHODS: We extracted the quarterly data for 37 antimalarial drugs using the IQVIA database from the first quarter in 2020 to the second quarter in 2022. We used standard units (SU) sold per 1000 incident cases and US dollars per 1000 incident cases to evaluate consumption (accessibility). Changes in consumption were estimated using compound annual growth rate (CAGR). Associations between consumption and country’s socioeconomic, health performance and product supplier indicators were measured using least squares (pooled) panel data regression model.

RESULTS: Available antimalarial drugs ranged from 31 in India, and 6 in Bangladesh and Viet Nam. The predominant medicine category in all six countries was quinine and other quinoline derivatives. The highest level of average consumption per 1000 incident cases was observed in Viet Nam (2004141.9 SU per 1000 incident cases). The country presenting the lowest level of accessibility was Indonesia (3668 SU per 1000 incident cases). Between 2020 and 2022, all countries except Viet Nam presented a decreased consumption per 1000 incident cases, with CAGRs being respectively – 15.11% in Bangladesh, – 3.66% in India, – 23.56% in Indonesia, – 13.28% in Pakistan and – 12.07% in Thailand. Increased Log consumption per 1000 incident cases was associated with higher proportion of health expenditure out of total government expenditure (coefficient 1.84, 95% confidence interval 0.47-3.21) and higher proportion of local supply (coefficient 0.43, 95% confidence interval 0.06-0.80).

CONCLUSIONS: There has been a disruption in the access to antimalarial drugs during the COVID-19 pandemic in the Asia-Pacific region, and the predominant available medicines were those with documented resistance. Greater priority should be given to drug innovation aimed at improving availability, along with strengthening health systems and local production to maintain accessibility to these drugs, especially during health emergencies.

PMID:41398305 | DOI:10.1186/s41256-025-00454-6

J Anesth Analg Crit Care. 2025 Dec 15. doi: 10.1186/s44158-025-00305-3. Online ahead of print.

ABSTRACT

BACKGROUND: To characterize current clinical practices and outcomes associated with the use of the extracorporeal blood purification (EBP) device Oxiris® in critically ill patients.

METHODS: This was a prospective clinical registry database that analyzed patients treated with Oxiris®. Three different clusters of critically ill patients were identified: Group A-patients with chronic kidney disease and systemic inflammation who required postoperative support of renal function; Group B-patients requiring immunomodulation without definitive indications for renal support; Group C-patients with abdominal septic shock necessitating both postoperative renal support and immunomodulation. The primary endpoint was the comparison between mortality rates predicted by the Simplified Acute Physiology Score II (SAPS II) and observed mortality rates 4 days after EBP initiation.

RESULTS: Observed 4-day mortality rates were markedly lower than SAPS II-predicted rates: 16.7% vs. 41% in Group A, 30.8% vs. 77% in Group B, and 21.3% vs. 83% [66;89] in Group C. Early mortality was significantly associated with baseline hemodynamic instability (vasopressor requirement, OR = 3.62 [1.59-9.80], p = 0.005) and a lower PaO₂/FiO₂ ratio (OR = 0.99 [0.98-0.99], p = 0.001).

CONCLUSIONS: The removal of inflammatory mediators and microbial components is an emerging therapeutic target for Oxiris® use. Oxiris® may offer therapeutic benefit through the removal of inflammatory mediators in critically ill patients with severe systemic inflammation and renal failure. Although observed mortality was lower than historical estimates, these findings must be interpreted cautiously given the lack of a control group and the limitations of SAPS II. Controlled trials are needed to confirm its clinical impact.

TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (Identifier: NCT03807414; Registration Date: June 28, 2019).

PMID:41398301 | DOI:10.1186/s44158-025-00305-3

Nutr J. 2025 Dec 15;24(1):183. doi: 10.1186/s12937-025-01254-x.

ABSTRACT

BACKGROUND: Low muscle mass exhibits a high prevalence in population, with its incidence increasing with age. Body mass index (BMI) has been identified as an independent predictor of poor muscle quality, and people with higher BMI have higher risk of low muscle mass. Nutrition interventions have been demonstrated efficacy in mitigating its effects. The Healthy Eating Index-2020 (HEI-2020) assesses overall diet quality but lacks studies on its association with low muscle mass. This study aims to investigate the association between the HEI-2020 and low muscle mass and to explore the mediating role of BMI among middle-aged individuals.

METHODS: Participants aged 40-59 were recruited from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Muscle mass was quantified using the ratio of appendicular lean mass (ALM) to BMI, with low muscle mass criteria defined at 0.789 kg/kg/m² for men and 0.512 kg/kg/m² for women. The HEI-2020 score was constructed based on two days of 24-hour dietary recalls and consists of 13 components. Logistic regression models analyzed the associations between HEI-2020, its components, and low muscle mass. Mediation analysis assessed the role of BMI in the association between HEI-2020 and low muscle mass.

RESULTS: The sample comprised 4,355 individuals with a median age of 50 (45, 55) years, of whom 9.7% had low muscle mass. The HEI-2020 scores ranged from 22.85 to 91.33, with an average score of 52.10 ± 11.78. Participants in the highest HEI-2020 score quartile had a 65% lower risk of low muscle mass compared to those in the lowest quartile. Adequate intake of vegetables, fruits, beans, proteins and fatty acids, along with restricted intake of added sugars, was associated with lower risk of low muscle mass. BMI was identified as a mediator, accounting for 33.1% of the association between HEI-2020 and low muscle mass.

CONCLUSIONS: HEI-2020 was inversely associated with low muscle mass among middle-aged individuals. The impact of a healthy diet on muscle mass is partially mediated by BMI. Adhering to the healthy eating patterns and keeping a healthy weight is conducive to the maintenance of muscle mass and the prevention of low muscle mass.

PMID:41398280 | DOI:10.1186/s12937-025-01254-x

BMC Nurs. 2025 Dec 15;24(1):1481. doi: 10.1186/s12912-025-04118-1.

ABSTRACT

BACKGROUND: A substantial body of research has been accumulated regarding the transition shock of newly graduated registered nurses (NGRNs). However, studies on person-organization fit remain insufficient. Improving person-organization fit among NGRNs can positively enhance job satisfaction, reduce turnover rates, and improve the quality of care. As a psychological resource, resilience can mitigate the negative impacts of job demands such as transition shock. However, the associative mechanisms among transition shock, person-organization fit, and resilience in NGRNs remain unclear.

METHODS: A cross-sectional survey was administered to 429 NGRNs recruited from three tertiary hospitals in Sichuan Province, China, between December 2024 and February 2025. Data were collected via an online platform using three validated self-report instruments: the Nurse Person-Organization Fit Assessment Scale, the Chinese version of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and the Transition Shock of Newly Graduated Nurses scale. Statistical analyses were performed using IBM SPSS 24.0 for descriptive and correlational analyses. Structural equation modeling (SEM) was employed to test the hypothesized mediation model linking transition shock, resilience, and person-organization fit, with AMOS 24.0 used to estimate path coefficients and assess model fit.

RESULTS: The person-organization fit, transition shock, and resilience of NGRNs were at a moderate level or above. Person-organization fit was negatively correlated with transition shock (r = -0.417, p < 0.001), and positively correlated with resilience (r = 0.440, p < 0.001). Resilience was negatively correlated with transition shock (r = -0.332, p < 0.001). Psychometric testing confirmed excellent reliability and validity for most scales, while transition shock showed moderate indices, attributed to its complex multidimensional nature. The structural equation modeling (SEM) showed a satisfactory model fit: χ2/df = 3.004, comparative fit index (CFI) = 0.970, Tucker-Lewis index (TLI) = 0.953, root mean square error of approximation (RMSEA) = 0.068, standardized root mean square residual (SRMR) = 0.050. The mediating effect value of resilience is -0.127, which accounts for 24.5% of the total effect value of -0.518. Resilience partially mediates the relationship between NGRNs’ transition shock and person-organization fit.

CONCLUSION: Transition shock directly and indirectly (via resilience) negatively impacts NGRNs’ person-organization fit, supporting the JD-R model in nursing transitions. Nursing managers should pay attention to the resilience level of NGRNs, implement dynamic assessments and time-sensitive intervention strategies to mitigate the multifaceted impacts of transition shock, foster enhancement of person-organization congruence, and consequently elevate job satisfaction, improve care quality, and reduce turnover rates.

PMID:41398274 | DOI:10.1186/s12912-025-04118-1

Sci Rep. 2025 Dec 15. doi: 10.1038/s41598-025-31876-4. Online ahead of print.

ABSTRACT

Betalains are natural pigments with diverse biological properties found in Celosia argentea var. plumosa, a member of the Amaranthaceae family. This study established an optimized cell suspension culture system for enhanced betalain production from C. argentea var. plumosa through combined elicitor treatment. Three elicitors were evaluated: 6-benzylaminopurine (BAP), methyl jasmonate (MeJA), and copper sulfate (CuSO₄), using response surface methodology (RSM) based on central composite design (CCD). Under standard conditions, maximum total betalain content (TBC) and dry weight reached 35.61 mg/L (1.95 mg/g DW) and 19.90 g/L, respectively, on day 15. The optimal formulation consisted of 2.28 µM BAP, 49.97 µM MeJA, and 6.71 µM CuSO₄, applied during the exponential growth phase on day 9. These optimized conditions achieved a 3.9-fold increase in betalain production on day 15, reaching a maximum TBC of 139.99 mg/L (7.54 mg/g DW) with biomass of 16.90 g/L. Additionally, betalain extracts from cells cultured under optimal conditions demonstrated higher antioxidant capacity than unoptimized culture extracts. These findings suggest that using statistical experimental design with combined elicitors provides an optimized platform for scalable betalain production with enhanced bioactive properties. This information will be valuable for food, pharmaceutical, and cosmetic industries requiring natural colorants with functional benefits.

PMID:41398259 | DOI:10.1038/s41598-025-31876-4

BMC Med Inform Decis Mak. 2025 Dec 15;25(1):442. doi: 10.1186/s12911-025-03274-3.

ABSTRACT

BACKGROUND: Early identification of septic patients who will require vasopressor support could provide a critical window for hemodynamic optimisation, yet current bedside cues often appear only when shock is imminent.

OBJECTIVE: We aimed to develop and validate an interpretable electronic health record (EHR)-based machine-learning model that predicts vasopressor initiation several hours before therapy in intensive care unit (ICU) patients with sepsis.

METHODS: We conducted a retrospective study using the MIMIC-IV v2.2 database (2008-2019). We screened adult Sepsis-3 ICU stays and labeled the patients who commenced continuous vasopressor infusions 6 to 48 hours after admission as cases; we defined controls as sepsis patients with ICU stays ≥48 hours and no vasopressor exposure. We performed one to one nearest neighbour matching on age, sex, Charlson index, SOFA score with the cardiovascular component removed, weight, and early lactate/hematocrit availability to minimise confounding. We engineered demographic, physiological, and laboratory features measured from -6 to -2 hours relative to vasopressor initiation (or a matched time point) under multiple parameter combinations. We trained seven algorithms with Monte Carlo cross validation and evaluated performance on an independent validation set. We assessed model interpretability with Shapley values.

RESULTS: We analyzed 1,539 cases and 1,431 controls; the independent validation set comprised 751 stays (~25%). A Random Forest classifier achieved an area under the receiver operating characteristic (AUROC) of 0.75 (95% CI, 0.72-0.79), a sensitivity of 0.74 (95% CI, 0.69-0.78), a specificity of 0.65 (95% CI, 0.60-0.70), a precision of 0.70 (95% CI, 0.66-0.74) and a F1 score of 0.72 (95% CI, 0.68-0.75) at the Youden’s index threshold. The model outperformed simple surrogates-mean blood pressure (AUROC, 0.68; 95% CI, 0.64-0.72) and modified shock index (AUROC, 0.65; 95% CI, 0.62-0.69)-and a reproduced bidirectional LSTM (AUROC, 0.73; 95% CI, 0.70-0.77). Key predictors included declining mean blood pressure at – 2 to -4 hours, elevated lactate ( > 2.5 mmol/L), and hematocrit outside 30-37%. Model alerts would occur two to four hours before vasopressor initiation, providing actionable lead time for clinicians.

CONCLUSIONS: This proof-of-concept study shows that routinely collected ICU data can predict impending vasopressor initiation with clinically interpretable outputs. However, these findings reflect internal validation only and should be interpreted with caution. External validation on multi-center retrospective cohorts, followed by silent-mode prospective evaluation, is warranted to confirm generalisability and to assess the real-world impact on time-to-vasopressor, fluid balance, and patient outcomes.

PMID:41398250 | DOI:10.1186/s12911-025-03274-3

BMC Med Educ. 2025 Dec 15. doi: 10.1186/s12909-025-08457-0. Online ahead of print.

ABSTRACT

BACKGROUND: Anatomy is a cornerstone of medical education, requiring hands-on and interactive learning for effective comprehension. Armed conflicts, however, pose substantial threats to educational continuity. In 2023, Sudan’s ongoing conflict severely disrupted medical education, particularly anatomy instruction, due to displacement, infrastructure damage, and limited access to practical training.

OBJECTIVES: This study aimed to explore the challenges faced by Sudanese medical students in anatomy education during the 2023 armed conflict, including access to practical sessions, use of online learning platforms, and overall satisfaction with alternative educational methods.

METHODS: A descriptive cross-sectional survey was conducted among 109 first- to third-year medical students from 20 institutions affected by the conflict. Data were collected using an online questionnaire distributed via student networks. Descriptive statistics were generated using SPSS version 29.

RESULTS: The majority of students (70.91%) reported no access to practical anatomy sessions, and 56.36% rated educational infrastructure as poor. Technology integration was limited or absent in 94.55% of cases, and 52.73% faced difficulties accessing online platforms. Although 55.45% of students resorted to self-study and 41.82% used online resources, only 10% were satisfied with online anatomy learning, with students outside Sudan reporting higher satisfaction (p-value 0.001). Qualitative feedback emphasized the need for improved internet access, development of virtual anatomy tools, and establishment of safe practical training centers.

CONCLUSION: The 2023 conflict in Sudan has severely disrupted anatomy education, particularly the availability of practical training. While students demonstrated resilience through self-directed learning, significant investment in digital infrastructure, alternative training solutions, and institutional support is critical to preserving educational quality in conflict-affected regions.

PMID:41398249 | DOI:10.1186/s12909-025-08457-0

BMC Public Health. 2025 Dec 15. doi: 10.1186/s12889-025-25823-1. Online ahead of print.

ABSTRACT

Syphilis remains a significant global public health challenge, with over seven million new adult infections each year despite the availability of effective treatment. Its continued persistence, particularly among high-risk and underserved populations, highlights the need for robust analytical models to understand transmission dynamics and inform targeted control strategies. This study presents a novel sex-structured compartmental model that captures the biological and behavioral complexity of syphilis transmission, incorporating multiple infection stages (primary, secondary, and latent), gender-specific progression, treatment, natural recovery, and reinfection. The population is stratified by sex and disease stage, allowing detailed analysis of transmission pathways between males and females. We established the positivity and boundedness of model solutions and derived the basic reproduction number ([Formula: see text]) using the next-generation matrix approach. Stability analysis showed that the disease-free equilibrium is locally asymptotically stable when ([Formula: see text]). Notably, the model exhibits backward bifurcation, indicating that reducing [Formula: see text] below unity may not guarantee disease elimination. Sensitivity analysis using Latin Hypercube Sampling and Partial Rank Correlation Coefficients identified transmission probabilities as the most influential parameters sustaining infection, while treatment and recovery rates substantially reduced transmission. Numerical simulations demonstrated that integrated control strategies combining early diagnosis, treatment coverage above 85%, partner notification, and behavioral interventions can reduce syphilis prevalence by up to 80%. The study presents a comprehensive and biologically realistic modeling framework that enhances understanding of syphilis dynamics. The findings provide actionable insights for public health policy, emphasizing that multifaceted, gender-inclusive interventions are essential for achieving sustained control and eventual elimination of syphilis.

PMID:41398247 | DOI:10.1186/s12889-025-25823-1

BMC Public Health. 2025 Dec 15;25(1):4250. doi: 10.1186/s12889-025-25376-3.

ABSTRACT

BACKGROUND: Smoking is the largest behavioral risk factor for loss of healthy life years. Many smokers intend and try to quit, but have trouble realizing their behavioral health goals. When workplace cessation-support is accompanied by incentives, this can increase its effectiveness. Based on principles from behavioral economics and psychology, regret lotteries have supported the realization of other health behaviors. Regret lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. This study builds on previous applications of regret lotteries to test its potential, using a novel combination of incentives, the workplace as a context and smoking as the target behavior.

METHODS: We compared a workplace group cessation training (control arm) to the same training plus regret lotteries (intervention arm). To test its effect on smoking cessation, we performed a cluster randomized trial with 13 organizations and 111 participants, followed for 52 weeks. Participants in the intervention arm additionally participated in 13 weekly lotteries, followed by a long-term lottery after 26 weeks. In each lottery, winners were drawn from all participants in a group. Winners were promised to always learn the outcome of the lotteries. However, the winners could only claim their prize if they did not smoke. The primary outcome of interest was continuous smoking abstinence at 52 weeks from the quit date, self-reported and biochemically validated with a carbon monoxide measurement and a cut-off point of ≤ 9 parts per million. A multi-level logistic regression analysis was performed to estimate the treatment effects after 52 weeks, while accounting for the clustered data pattern within organizations. We adjusted for Fagerström nicotine dependence score, education level, income, age and gender. Secondary outcomes were abstinence at weeks 13 and 26 after the quit-date.

RESULTS: At the 52-week primary outcome point of this trial, in the control arm, 23.9% of participants were continuously abstinent opposed to 43.2% in the intervention arm (OR = 3.25; 95% CI, 0.99-10.70). Thirteen weeks after the quit date, in the control arm, 35.8% of participants were continuously abstinent opposed to 68.2% in the intervention arm (OR = 3.66; 95% CI, 1.47-9.16). After 26 weeks, in the control arm, 25.4% of participants were continuously abstinent opposed to 54.6% in the intervention arm (OR = 3.24; 95% CI, 1.27-8.22).

CONCLUSIONS: Although differences were only statistically significant up to 26 weeks, we found meaningful and practically relevant increases in smoking cessation due to the lottery intervention at the main outcome point. The intervention design was rooted in behavioral economics and builds on previous successful applications. Therefore, the results show enough potential to theorize and further apply this method in a field setting, that can benefit from the theoretical, methodological and practical lessons learned in this trial.

TRIAL REGISTRATION: The trial protocol and materials were reviewed and approved by the Radboud University Ethical Review Board (ECSW-2019-114). The study was registered in the Dutch Trial Register (trial registration number: NTR NL84632, 17 March 2020) and lottery drawings were performed by an independent notary.

PMID:41398243 | DOI:10.1186/s12889-025-25376-3