Nevin Manimala

J Rural Health. 2025 Sep;41(4):e70095. doi: 10.1111/jrh.70095.

ABSTRACT

PURPOSE: The purposes of this study were to (1) identify predictors of sedentary time and (2) determine whether sociodemographic risk factors associated with sedentary time are mediated by sleep disturbances in younger (<60) and older (≥60) depressed rural patients with CVD.

METHODS: Depressed rural patients with CVD completed surveys and wore ActiGraph GT9X Link monitors to measure sedentary time and sleep parameters (total sleep time and wake-after-sleep-onset [WASO]). Hierarchical regression analysis was conducted to identify factors associated with sedentary time, followed by a multi-group path analysis to examine how significant factors identified in the regression were associated with sedentary time, comparing the two age groups, and whether this association was mediated by parameters reflecting sleep disturbances.

FINDINGS: Participants (n = 222) were predominantly White with an average age of 58 years and 52% were unemployed due to illness. Age, employment status, and WASO were significantly associated with sedentary time. Path analysis showed a significant mediating effect of age on sedentary time through WASO in the younger group (n = 115). However, the mediating effect of WASO on the relationship between age and sedentary time was not significant in the older group (n = 107).

CONCLUSIONS: The findings highlight the critical roles of age and sleep disturbances in promoting physical inactivity, with sleep disturbances being particularly influential in younger patients. Tailoring interventions by age groups may enhance strategies to mitigate CVD risk associated with inactivity.

PMID:41277370 | DOI:10.1111/jrh.70095

Am Surg. 2025 Nov 24:31348251399200. doi: 10.1177/00031348251399200. Online ahead of print.

ABSTRACT

BackgroundRecent studies suggest that general surgery (GS) residents perform more operations related to their future specialty compared with their peers. In this multi-institutional study, we examined the process of early specialization among GS residents pursuing a career in vascular surgery (VS).MethodsData from the US Resident OPerative Experience (ROPE) Consortium, comprising 20 Accreditation Council for Graduate Medical Education (ACGME)-accredited GS residency programs across the United States, were queried. Case volume and type were compared between GS residents pursuing vs fellowship and all other residents. Effect size was evaluated using Cohen’s d statistic. Effect size was considered large if d > 0.8, moderate if 0.5 ≤ d < 0.8, small if 0.2 ≤ d < 0.5, and inconsequential if d < 0.2.ResultsA total of 1343 GS residents graduated from 2010-2020 across all programs participating in ROPE, of which 135 (10.1%) pursued vs fellowship. Total major vascular case volume was significantly greater among residents pursuing vs fellowship (138 [100-207] vs 100 [80-139], P < 0.0001) with a large effect size (d = 1.81). Vascular cases reported in a surgeon chief role (27 [9-53] vs 10 [2-29], P < 0.0001, d = 0.76, moderate effect) and surgeon junior role (107 [79-154] vs 88 [62-118], P < 0.0001, d = 1.00, large effect) were also greater among GS residents pursing a vs specialty. Nearly all vascular operative categories demonstrated similar trends (P < 0.01 each).ConclusionsGS residents pursuing a vs fellowship perform more vascular cases compared with their peers. Given the differences in both surgeon chief and surgeon junior roles, career focus may begin as early as the junior resident years.

PMID:41277369 | DOI:10.1177/00031348251399200

Turk Kardiyol Dern Ars. 2025 Nov 24. doi: 10.5543/tkda.2025.47364. Online ahead of print.

ABSTRACT

Adjunctive vein of Marshall ethanol infusion (EIVOM) during atrial fibrillation (AF) ablation has emerged as a promising technique with the potential to significantly improve procedural outcomes. Despite the existing body of evidence, a comprehensive evaluation focusing on mitral isthmus block, AF recurrence, and procedural duration has not yet been conducted. This meta-analysis aims to rigorously assess the benefits of EIVOM combined with radiofrequency ablation (EIVOM-RF) compared with radiofrequency ablation alone (RF-only) in patients undergoing catheter ablation for AF or related arrhythmias. We systematically reviewed both randomized controlled trials and observational studies that compared EIVOM-RF with RF-only approaches, encompassing a total of 1,406 patients in the EIVOM-RF group and 1,849 in the RF-only group. The primary outcomes assessed included the rate of successful mitral isthmus ablation, recurrence of atrial arrhythmias, and overall procedure time. Patients treated with EIVOM-RF demonstrated a significantly lower likelihood of atrial arrhythmia recurrence compared to those receiving RF-only treatment. Furthermore, EIVOM-RF was associated with an impressive increase in the success rate of achieving mitral isthmus block. While total procedure time tended to be longer with EIVOM-RF, this difference was statistically significant and showed considerable variability. These findings compellingly indicate that EIVOM enhances procedural efficacy, albeit at the cost of increased procedural duration. In conclusion, EIVOM combined with RF ablation represents a transformative approach that markedly improves procedural success rates and significantly reduces arrhythmia recurrence in patients undergoing ablation for AF.

PMID:41277368 | DOI:10.5543/tkda.2025.47364

Food Funct. 2025 Nov 24. doi: 10.1039/d5fo03652f. Online ahead of print.

ABSTRACT

Aging is accompanied by a gradual decline in immune function. Previously, we demonstrated that daily intake of 4 g plant stanols, provided as fatty-acid esters, increased antibody titre responses following different vaccinations. Effects of lower intakes, however, are unknown. We therefore evaluated whether daily consumption of 2, 3 or 4 g of plant stanols, provided as fatty-acid esters, improved immune responses following influenza vaccination in older adults. A double-blind, randomized, placebo-controlled parallel trial was performed. Older participants (59-87 years) consumed products with added plant stanols (2, 3 or 4 g d^-1 provided as fatty-acid esters) or control products for approximately 14 days prior to vaccination until 4 weeks post-vaccination. Antibody titres, serum metabolic risk markers, and haematological and immunological parameters were measured and statistically evaluated using linear mixed models. Data of 128 participants were analysed. Changes in IgM and IgG concentrations did not differ significantly between the control and plant stanol groups. Also, changes in Hemagglutination Inhibition (HI) antibody titres were not significantly different between the groups for either the Phuket or Victoria strains. Serum LDL-cholesterol concentrations decreased significantly in the 4 g d^-1 and 3 g d^-1 groups compared with control. Serum LDL-cholesterol concentrations in the 2 g d^-1 group were also lowered, but did not reach statistical significance. No between-group differences in haematological and immunological parameters were observed. Daily consumption of 2, 3 or 4 g of plant stanols provided as fatty-acid esters, did not improve vaccination responses following annual influenza vaccination in men and women aged 60 years or older.

PMID:41277360 | DOI:10.1039/d5fo03652f

Neurourol Urodyn. 2025 Nov 24. doi: 10.1002/nau.70191. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates the correlation between clinical characteristics, ultrasound measurements, and the severity of stress urinary incontinence (SUI) in women, aiming to identify key transperineal ultrasound measurements that can guide clinical management of SUI.

METHODS: The study was conducted with 519 women diagnosed with urinary incontinence from three hospitals in Fujian Province, China, who underwent clinical assessment and transperineal ultrasound examination from November 2019 and May 2024. Ultrasound measurements, including temporal and morphological metrics, were analyzed in relation to SUI severity, categorized as slight, moderate, or severe. Statistical analyses included Spearman’s rank correlation and logistic regression.

RESULTS: Among the 314 women with SUI, significant correlations were found between ultrasound measurements and SUI severity. The duration of maximum contraction showed the strongest correlation with severity, followed by twitch count during sustained contraction. Logistic regression revealed that age (OR = 1.052, p = 0.018) and larger differences in LHA between Valsalva and rest (OR = 1.227, p = 0.035) were risk factors for moderate-to-severe SUI, while longer the duration of maximum contraction reduced the risk (OR = 0.924, p < 0.001).

CONCLUSION: Transperineal ultrasound was proved to be a noninvasive, objective method for the evaluation and management of SUI. Key findings underscored the potential of ultrasound in advancing pelvic floor health and guiding personalized pelvic floor muscle training. Further research is needed to standardize these measurements and validate their clinical utlity.

PMID:41277356 | DOI:10.1002/nau.70191

J Hum Nutr Diet. 2025 Dec;38(6):e70169. doi: 10.1111/jhn.70169.

ABSTRACT

INTRODUCTION: Promoting healthy aging is a public health goal, especially in regions with a high proportion of older adults, such as Greece. This cross-sectional study investigated the association of fish n-3 PUFA intake with indicators of healthy aging among older Greek Peloponnesian adults.

METHODS: In total, 449 individuals > 60 years of age were enroled. Sociodemographic, anthropometrical, medical, mobility, balance, lifestyle, dietary, cognitive and mental characteristics were assessed through validated questionnaires and procedures.

RESULTS: Analyses revealed that n-3 PUFA intake was associated with fewer depression symptoms (p < 0.001), higher cognition levels (p = 0.012) and levels of healthy aging (p < 0.001), derived from Successful Aging Index (SAI). In parallel, n-3 PUFA intake was associated with higher adherence to the Mediterranean diet (p < 0.001). Additionally, n-3 PUFA intake was inversely correlated with the presence of long COVID-19 symptomatology (p = 0.036). No association of n-3 PUFA intake with mobility or physical performance and balance (all ps> 0.05) was detected.

CONCLUSION: The results underscore the significance of nutrition in older adults, highlighting the possible protective impact of n-3 PUFAs on maintaining functionality. Future prospective studies may validate these associations and contribute to the development of targeted nutritional strategies for older adults.

PMID:41277355 | DOI:10.1111/jhn.70169

J Hum Nutr Diet. 2025 Dec;38(6):e70171. doi: 10.1111/jhn.70171.

ABSTRACT

BACKGROUND: Dietetic education should reflect evidence on current practice and demands of the profession yet information regarding the employment profile of dietitians in Ireland is limited. The study aimed to establish the employment profile of graduate dietitians in Ireland and assess their perceived preparedness for employment.

METHODS: A mixed methods design was used. Individuals who graduated from dietetic degrees in Ireland between 2020 and 2024 were invited to participate. An online survey was used to collect information on employment profile and perceived preparedness for employment. Semi-structured interviews explored graduate experiences during their dietetic education and employment in more depth. Interview data were analysed to construct thematic domains.

RESULTS: The online survey had a 49% response rate (132/271). The majority of graduates were employed in hospital dietetics for their first role postgraduation (67%, n = 90) and for their current employment (58%, n = 76). Nondietetic related roles (19%, n = 25) was the second most common current employment followed by community dietetics (12%, n = 16). At the time of survey completion, 29% (n = 37) were living outside Ireland. Most graduates felt slightly (40%, n = 51) or very prepared (46%, n = 59) for their first employment. Four themes were identified from the 13 semi-structured interviews: (1) the value of placement, (2) narrow career preparedness, (3) struggling with the transition to employment and (4) workplace support.

CONCLUSION: This is the first study to establish the employment profile and perceived preparedness of Irish dietetic graduates. Continued graduate tracking and research on solutions to the challenges highlighted in this study could provide evidence to support curricula alignment with workforce demands.

PMID:41277351 | DOI:10.1111/jhn.70171

Biol Sex Differ. 2025 Nov 23. doi: 10.1186/s13293-025-00793-6. Online ahead of print.

ABSTRACT

Many systematic reviews have summarized evidence on the association between behavioural factors and incident cancers. To date, there has been little synthesis of heterogeneity by sex/gender of this evidence.An umbrella review was conducted of systematic reviews with quantitative synthesis (meta-analysis, meta-regression) examining the exposures of body size; physical activity; wholegrains, vegetables, fruit and beans; “fast foods”; red and processed meat; sugar sweetened drinks; dietary supplements; alcohol; tobacco; and sun exposure with incident non-sex-specific cancers. A search of Ovid MEDLINE, Ovid Embase, and Cochrane library from database inception to May 2023 was conducted. We calculated the proportion of systematic reviews that provided quantitative sex/gender findings (e.g., subgroup analyses) and summarized findings narratively. Methodological quality was appraised with the AMSTAR-2 tool.From 13,227 records, 705 full-text systematic reviews were identified as meeting inclusion criteria. Of these, 361 (51.2%) reported quantitative sex/gender findings. The terms “sex” and “gender” were used interchangeably by 36.3% of the 361 systematic reviews and none reported findings for transgender, gender-diverse, or non-binary individuals. Overall, 98.6% (356/361) of systematic reviews were rated “critically low” with the AMSTAR-2 tool. Most of the 361 systematic reviews with quantitative sex/gender findings reported no statistically significant differences by sex/gender.This umbrella review found conflation of sex and gender in systematic reviews of behavioural factors and non-sex-specific cancers and a lack of research among non-cisgender individuals. The existing evidence base is of critically low quality and our findings of no sex/gender-specific trends must be interpreted with caution.

PMID:41276857 | DOI:10.1186/s13293-025-00793-6

Arch Public Health. 2025 Nov 24. doi: 10.1186/s13690-025-01796-w. Online ahead of print.

ABSTRACT

BACKGROUND: Exclusive breastfeeding (EBF) promotes optimal growth and health in infants. Despite national and global initiatives, EBF rates in Malaysia remain below the 70% target set for 2030. This study evaluated the impact of structured breastfeeding education supplemented with WhatsApp follow-up on infant feeding practices, growth, and health outcomes.

METHODS: A quasi-experimental study was conducted at six public health clinics in Gombak District, Selangor. Mothers of healthy-term infants were assigned to either an intervention group (structured education with WhatsApp follow-up) or a comparison group (routine care). A total of 500 mother-infant pairs were enrolled. Data on feeding practices, anthropometric indicators, length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length z-scores (WLZ) and common illnesses, including upper respiratory tract infection (URTI), gastroenteritis (GE), contact dermatitis (CD), bowel disorders (BD), and other illnesses (OI), were collected at Months 1, 3, and 6. Analyses included descriptive statistics, linear mixed-effects models, and generalised logistic mixed models.

RESULTS: Of the 602 mothers screened, 500 were enrolled across six purposively selected clinics, and 460 (220 in the comparison group and 240 in the intervention group) were included in the final analysis. Baseline maternal and infant characteristics were comparable between groups. EBF prevalence was initially higher in the comparison group but increased more significantly in the intervention group by Month 6. Although some baseline z-scores were negative, descriptive trends showed modest, non-significant improvements in LAZ, WAZ, and WLZ over time, indicating overall upward growth trajectories. Linear mixed-effects models confirmed significant time effects, but no group-by-time interactions were observed. Illness prevalence decreased with age, with significant reductions observed for GE and OI and a borderline improvement for URTI in the intervention group. Overall, the intervention improved EBF practices and selected morbidity outcomes but did not significantly alter growth trajectories.

CONCLUSIONS: Structured breastfeeding education, combined with WhatsApp follow-up, effectively enhanced exclusive breastfeeding practices and reduced certain infant illnesses, but showed no significant short-term effects on growth. Longer-term follow-up is warranted to assess the sustained effects on growth and health.

PMID:41276849 | DOI:10.1186/s13690-025-01796-w

Chin Med. 2025 Nov 24;20(1):199. doi: 10.1186/s13020-025-01258-z.

ABSTRACT

BACKGROUND: Chlorhexidine is widely used as a chemical antibacterial mouthwash, but its potential side effects have spurred interest in safer natural alternatives.

PURPOSE: This study aimed to evaluate the anticariogenic efficacy and inhibitory effects of a functional mouthwash containing Clematis chinensis Osbeck (C. chinensis Osbeck) extract in a randomized controlled clinical trial.

STUDY DESIGN AND METHODS: In this randomized, double-blind, controlled clinical trial conducted at Busan M Dental Clinic, 69 participants were randomly assigned to three groups: saline gargle (n = 23), chlorhexidine gargle (n = 23), and C. chinensis Osbeck extract gargle (n = 23). Participants used 15 mL of the assigned mouthwash four times daily for 2 weeks. The oral environment was standardized with professional scaling and a 1-week recovery period before the intervention. Clinical outcomes were evaluated using the O’Leary index and the Cariview™ test kit (AIOBIO Co. Ltd., Seoul, South Korea) at baseline, 1 week, and 2 weeks, respectively, to evaluate dental plaque acidogenicity and user satisfaction. Saliva tests (including cariogenic bacterial counts, acidogenicity, and buffering capacity) were performed using the SillHa Oral Wellness System (ARKRAY Inc., Kyoto, Japan). Subgingival plaque samples were analyzed by quantitative real-time polymerase chain reaction (PCR) analysis to detect cariogenic bacteria (Streptococcus mutans [S. mutans] and Gram-positive cariogenic bacteria [GS group], comprising S. mitis, S. sobrinus, and Lactobacillus casei). Statistical analyses were performed using analysis of variance (ANOVA) and Duncan’s post hoc test, with significance set at P < 0.05.

RESULTS: The C. chinensis Osbeck extract gargle group showed reductions in the O’Leary index score and cariogenic activity, alongside a progressive increase in user satisfaction. Saliva analysis revealed significant decreases in caries-causing bacterial numbers and acid production and improved buffering capacity, enhancing salivary defense. Only the C. chinensis Osbeck extract gargle group showed a significant reduction in S. mutans and the GS group. Compared with the saline and chlorhexidine groups, this group demonstrated a continuous decrease in caries risk over the 2 weeks.

CONCLUSION: C. chinensis Osbeck extract significantly improved clinical parameters related to dental caries, suggesting its potential as a safe and effective natural alternative to chemical antibacterial agents for caries prevention and oral health maintenance.

TRIALS REGISTRATION: ClinicalTrials.gov, KCT0008539. Registered on June 21, 2023, https://cris.nih.go.kr/cris/search/detailSearch.do/23816 ).

PMID:41276841 | DOI:10.1186/s13020-025-01258-z