Nevin Manimala

JMIR Form Res. 2025 Jan 8. doi: 10.2196/58262. Online ahead of print.

ABSTRACT

BACKGROUND: After suffering for an average of 7 years before diagnosis, endometriosis patients are usually left with more questions than answers about managing their symptoms in the absence of a cure. To help women with endometriosis after their diagnosis, we developed an online support program combining user research, evidence-based medicine, and clinical expertise. Structured around CBT and the quality-of-life metrics from the EHP score, the program is designed to guide participants over a 3-month and is available in France.

OBJECTIVE: This cohort study was designed to measure the impact of a digital health program on the symptom and quality of life levels of women with endometriosis.

METHODS: Ninety-two participants were included in the pilot study, among a total of 146 program participants who volunteered and assessed for eligibility for this research. They were recruited either free of charge through employer health insurance or via individual direct access. A control group of women with endometriosis who did not follow the program was recruited (n=404) through social media and mailing campaign. Questionnaires assessing quality of life and symptom levels were sent to program participants and controls at baseline and at three months via email. The control group was sampled according to initial pain level in order to obtain a similar pain profile between controls and program participants (n=149). Descriptive statistics and statistical tests (Chi-square, Fisher’s exact, Wilcoxon, Mann-Whitney U, Student t-tests) were used to analyze intra- and inter-group differences, with Cohen’s D measuring effect size for significant results.

RESULTS: Over three months, global symptom burden, the general level of pain, anxiety, depression, dysmenorrhea, dysuria, chronic fatigue, neuropathic pain, and endobelly levels improved significantly among program participants. These improvements were significantly different from the control group for global symptom burden (mean±SD: participants=-0.7±1.6, controls=-0.3±1.3, P=.048, small d), anxiety (participants=-1.1±2.8, controls=0.2±2.5, P<.001, medium d) and depression levels (participants=-0.9±2.5, controls=0.0±3.1, P=.04, small d), neuropathic pain (participants=-1.0±2.7, controls=-0.1±2.6, P=.004, small d), and endobelly (participants=-0.9±2.5, controls=-0.3±2.4, P=.03, small d). Participant quality of life evolution between baseline and three months improved and significantly differed from the control group for the core part of the EHP-5 (participants=-5.9±21.0, controls=1.0±14.8, P=.03, small d) and the EQ-5D (participants=0.1±0.1, controls=-0.0±0.1, P=.001, medium d). Perceived knowledge of endometriosis was significantly greater at three months among participants than in controls (P<.001).

CONCLUSIONS: The results from this pilot study suggest that a digital health program providing medical and scientific information about endometriosis and multidisciplinary self-management tools may be useful to reduce global symptom burden, anxiety, depression, neuropathic pain, and endobelly while improving knowledge on endometriosis and quality of life among participants.

PMID:39791286 | DOI:10.2196/58262

Hum Brain Mapp. 2025 Jan;46(1):e70084. doi: 10.1002/hbm.70084.

ABSTRACT

The human brain connectome is characterized by the duality of highly modular structure and efficient integration, supporting information processing. Newborns with congenital heart disease (CHD), prematurity, or spina bifida aperta (SBA) constitute a population at risk for altered brain development and developmental delay (DD). We hypothesize that, independent of etiology, alterations of connectomic organization reflect neural circuitry impairments in cognitive DD. Our study aim is to address this knowledge gap by using a multi-etiologic neonatal dataset to reveal potential commonalities and distinctions in the structural brain connectome and their associations with DD. We used diffusion tensor imaging of 187 newborns (42 controls, 51 with CHD, 51 with prematurity, and 43 with SBA). Structural weighted connectomes were constructed using constrained spherical deconvolution-based probabilistic tractography and the Edinburgh Neonatal Atlas. Assessment of brain network topology encompassed the analysis of global graph features, network-based statistics, and low-dimensional representation of global and local graph features. The Cognitive Composite Score of the Bayley scales of Infant and Toddler Development 3rd edition was used as outcome measure at corrected 2 years for the preterm born individuals and SBA patients, and at 1 year for the healthy controls and CHD. We detected differences in the connectomic structure of newborns across the four groups after visualizing the connectomes in a two-dimensional space defined by network integration and segregation. Further, analysis of covariance analyses revealed differences in global efficiency (p < 0.0001), modularity (p < 0.0001), mean rich club coefficient (p = 0.017), and small-worldness (p = 0.016) between groups after adjustment for postmenstrual age at scan and gestational age at birth. Moreover, small-worldness was significantly associated with poorer cognitive outcome, specifically in the CHD cohort (r = -0.41, p = 0.005). Our cross-etiologic study identified divergent structural brain connectome profiles linked to deviations from optimal network integration and segregation in newborns at risk for DD. Small-worldness emerges as a key feature, associating with early cognitive outcomes, especially within the CHD cohort, emphasizing small-worldness’ crucial role in shaping neurodevelopmental trajectories. Neonatal connectomic alterations associated with DD may serve as a marker identifying newborns at-risk for DD and provide early therapeutic interventions. Trial Registration: ClinicalTrials.gov identifier: NCT00313946.

PMID:39791277 | DOI:10.1002/hbm.70084

Pest Manag Sci. 2025 Jan 10. doi: 10.1002/ps.8629. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying robust integrated pest management (IPM) strategies requires the testing of multiple factors at the same time and assessing their combined effects e.g., on disease control. This makes field-based experiments large, resource intensive and expensive. Hence, there are limits to the number of treatment combinations that can be practically tested under field conditions. Taguchi approach to design of experiments (DOE) or the Taguchi approach is commonly employed to enhance the quality of industrial products. It uses smaller experiments than classical DOE but its applicability to late blight research, and agricultural research, has not been widely evaluated.

RESULTS: Two existing datasets, following the same protocol and investigating the effectiveness of different IPM treatments to control late blight, caused by Phytophthora infestans, on potato, were used to test the Taguchi approach. Disease severity was quantified as area under the disease progress curve (AUDPC). The method could accurately predict the performance of a cultivar and fungicide-based integrated disease management strategy from a small dataset and identified cultivar as a key factor for disease control. Linear regression demonstrated a strong and statistically significant relationship between AUDPC values collected during the original experiments and the predicted disease severity values generated using the Taguchi method.

CONCLUSIONS: The Taguchi approach can accurately predict disease severity, with predicted values similar to those collected during the original experiments. Moreover, associated analyses identified the most effective treatment combinations and the factors that exert the greatest influence on disease control. The relevance of this approach when designing and interpreting IPM strategies is discussed. © 2025 Society of Chemical Industry.

PMID:39791274 | DOI:10.1002/ps.8629

J Hypertens. 2024 Dec 9. doi: 10.1097/HJH.0000000000003938. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients with advanced chronic kidney disease suffer from hypertension, and kidney transplantation (KT) has potential to induce hypertension resolution. We hypothesized that hypertension resolution after KT is associated with better KT outcomes.

METHODS: We identified KT recipients (2006-2015) who had pretransplant hypertension. They were categorized into two groups based on their hypertension status after KT: persistent vs. resolved hypertension, using data from the Korea National Health Insurance System. Cox proportional hazard analyses were performed to assess the risk of graft failure and mortality, adjusting for various clinical factors.

RESULTS: Among 11 317 KT recipients with pretransplant hypertension, 7269 (64%) remained hypertensive, while 4048 (36%) experienced hypertension resolution. Recipients with resolved hypertension exhibited a lower prevalence of delayed graft function and major comorbidities, including diabetes, ischemic heart disease, and stroke. Graft failure and mortality rates were significantly lower in resolved hypertension group. After adjusting for multiple covariates, hazard ratios of resolved hypertension were 0.61 (95% confidence interval 0.52-0.72) for graft failure and 0.68 (0.56-0.81) for all-cause mortality.

CONCLUSIONS: A significant proportion of patients experienced hypertension resolution after KT, which is associated with improved graft and overall survival. The post-KT hypertension resolution can be used as a prognostic indicator for predicting better KT outcomes.

PMID:39791265 | DOI:10.1097/HJH.0000000000003938

Clin Trials. 2025 Jan 10:17407745241302488. doi: 10.1177/17407745241302488. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: When conducting a randomised controlled trial in surgery, it is important to consider surgical learning, where surgeons’ familiarity with one, or both, of the interventions increases during the trial. If present, learning may compromise trial validity. We demonstrate a statistical investigation into surgical learning within a trial of cleft palate repair.

METHODS: The Timing of Primary Surgery compared primary surgery, using the Sommerlad technique, for cleft palate repair delivered at 6 or 12 months of age. Participating surgeons had varying levels of experience with the intervention and in repair across the age groups. Trial design aimed to reduce the surgical learning via pre-trial surgical technique training and balancing the randomisation process by surgeon. We explore residual learning effects by applying visual methods and statistical models to a surgical outcome (fistula formation) and a process indicator (operation time).

RESULTS: Notably, 26 surgeons operated on 521 infants. As the trial progressed, operation time reduced for surgeons with no pre-trial Sommerlad experience (n = 2), before plateauing at 30 operations, whereas it remained stable for those with prior experience. Fistula rates remained stable regardless of technique experience. Pre-trial age for primary surgery experience had no impact on either measures.

CONCLUSION: Managing learning effects through design was not fully achieved but balanced between trial arms, and residual effects were minimal. This investigation explores the presence of learning, within a randomised controlled trial that may be valuable for future trials. We recommend such investigations are undertaken to aid trial interpretation and generalisability, and determine success of trial design measures.

PMID:39791255 | DOI:10.1177/17407745241302488

Worldviews Evid Based Nurs. 2025 Feb;22(1):e12765. doi: 10.1111/wvn.12765.

ABSTRACT

BACKGROUND: Coronary artery disease (CAD) is a major health problem of atherosclerotic cardiovascular (CV) disease and early intervention is regarded important. Given the proven effect of a lifestyle intervention with nursing telephone counselling and mHealth use in health care, yet the comparisons of both support are lacking, this study is proposed.

OBJECTIVES: This study aimed to compare the effects of a coronary artery disease (CAD) support program using a mobile application versus nurse phone advice on exercise amount and physical and psychological outcomes for clients at risk of CAD.

METHODS: A prospective randomized controlled trial was conducted. Ethical approval was obtained. Two-hundred and twenty-six clients were screened, and a total of 168 clients who were at risk of CAD and routinely used smartphones were randomized into the app support group (App group) or the nurse phone advice (NPA) group. Although all participants received the same health talk delivered by a cardiac nurse at the community center, the App group received additional CAD app support, whereas the NPA group received nurse phone advice for 20 min monthly. The app content comprised (1) CAD knowledge in 10 modules, (2) individual exercise records with their own goals and health measures, and (3) a chest pain action list. The intervention lasted for 3 months. Health outcome data were collected at baseline (T0) and after 1 (T1) and 3 (T2) months. The outcomes were the total amount of exercise (primary outcome), self-efficacy in illness management, perceived stress, and CAD risk profile (body weight, body mass index, and lipid concentration). Generalized estimating equation models were used to assess differential changes in all outcomes within 3 months.

RESULTS: The attrition rates at 3 months were 3.49% and 9.30% for the App and NPA groups, respectively. The App support group was superior to the NPA group in significantly increasing total exercise amount and reducing body weight, waist circumference, triglycerides, and increased self-efficacy in illness management.

LINKING EVIDENCE TO ACTION: The result provides further insights of app development to support health promotion programs for community-dwelling adults at risk of CAD.

PMID:39791254 | DOI:10.1111/wvn.12765

JMIR Public Health Surveill. 2025 Jan 9;11:e60022. doi: 10.2196/60022.

ABSTRACT

BACKGROUND: High response rates are needed in population-based studies, as nonresponse reduces effective sample size and bias affects accuracy and decreases the generalizability of the study findings.

OBJECTIVE: We tested different strategies to improve response rate and reduce nonresponse bias in a national population-based COVID-19 surveillance program in England, United Kingdom.

METHODS: Over 19 rounds, a random sample of individuals aged 5 years and older from the general population in England were invited by mail to complete a web-based questionnaire and return a swab for SARS-CoV-2 testing. We carried out several nested randomized controlled experiments to measure the impact on response rates of different interventions, including (1) variations in invitation and reminder letters and SMS text messages and (2) the offer of a conditional monetary incentive to return a swab, reporting absolute changes in response and relative response rate (95% CIs).

RESULTS: Monetary incentives increased the response rate (completed swabs returned as a proportion of the number of individuals invited) across all age groups, sex at birth, and area deprivation with the biggest increase among the lowest responders, namely teenagers and young adults and those living in more deprived areas. With no monetary incentive, the response rate was 3.4% in participants aged 18-22 years, increasing to 8.1% with a £10 (US $12.5) incentive, 11.9% with £20 (US $25.0), and 18.2% with £30 (US $37.5) (relative response rate 2.4 [95% CI 2.0-2.9], 3.5 [95% CI 3.0-4.2], and 5.4 [95% CI 4.4-6.7], respectively). Nonmonetary strategies had a modest, if any, impact on response rate. The largest effect was observed for sending an additional swab reminder (SMS text message or email). For example, those receiving an additional SMS text message were more likely to return a completed swab compared to those receiving the standard email-SMS approach, 73.3% versus 70.2%: percentage difference 3.1% (95% CI 2.2%-4.0%).

CONCLUSIONS: Conditional monetary incentives improved response rates to a web-based survey, which required the return of a swab test, particularly for younger age groups. Used in a selective way, incentives may be an effective strategy for improving sample response and representativeness in population-based studies.

PMID:39791251 | DOI:10.2196/60022

Anat Histol Embryol. 2025 Jan;54(1):e70012. doi: 10.1111/ahe.70012.

ABSTRACT

This study investigates the gross morphological and morphometric characteristics of thoracic and lumbar intervertebral discs (IVDs) in guinea pigs, utilising micro-CT imaging and anatomical dissection. The findings reveal 13 thoracic and six lumbar IVDs were identified, with thoracic discs transitioning from rounded forms at T1-T3 to triangular and heart-shaped structures at T4-T13, while lumbar IVDs exhibited a consistently flattened heart shape. Morphometric analysis revealed statistically significant differences, with lumbar IVDs being larger in lateral and dorsoventral width, disc area, annulus fibrosus (AF) area and nucleus pulposus (NP) area, and ventral height compared to thoracic discs. Specifically, significant increases in lateral width and disc area were observed in lumbar segments L5 and L6, while thoracic IVDs demonstrated fluctuating alterations in some parameters, such as dorsal and ventral height. Histologically, both thoracic and lumbar IVDs feature a well-organised NP, AF and endplates (EP). The EP was composed of cartilaginous materials, including hyaline cartilage, fibrocartilage and calcified cartilage, and bony materials, including extensive secondary ossification centres with many large vascular channels and bone trabeculae. In conclusion, this study indicates that although thoracic and lumbar IVDs conserve key histological properties, their distinct morphological and morphometric characteristics in guinea pigs reflect their adaptations to biomechanical demands. However, due to some fundamental differences between human and guinea pig, use of this species as a model for human IVD research and interpreting the extracted data should be cautious.

PMID:39791227 | DOI:10.1111/ahe.70012

Helicobacter. 2025 Jan-Feb;30(1):e70005. doi: 10.1111/hel.70005.

ABSTRACT

BACKGROUND: As seen globally, there are up to sixfold differences in gastric cancer mortality by ethnicity in Aotearoa New Zealand, and H. pylori is the major modifiable risk factor. This study investigates whether current H. pylori testing and treatment approaches are equitable.

MATERIALS AND METHODS: The study design was a retrospective cohort analysis of linked administrative health data. Laboratory testing data and pharmacy dispensing were linked to the Northern region health user population dataset (1.9 million) from 2015 to 2018. We investigated an individual’s first test for H. pylori. Regression analyses compared ethnic differences in rates of H. pylori testing, infection, treatment, and retesting, adjusted for age, sex, and calendar year.

RESULTS: Ethnic inequities were present across the clinical pathway. Compared to sole-European, testing rates were lowest in Māori (OR 0.69) and Pacific (OR 0.81) and highest in Middle-Eastern/Latin-American/African (MELAA) (OR 2.21) and Asian (OR 2.02). Positivity rates were highest in MELAA (RR 2.96, 39%) and Pacific (RR 2.84, 38%) followed by Asian (RR 1.93, 26%) and Māori (RR 1.71, 23%). Treatment rates were similar for Asian (HR 1.05), MELAA (HR 1.03), and Māori (HR 0.98) compared to sole-European but lower in Pacific (HR 0.90). Māori and Pacific were half as likely to be retested as sole-European.

CONCLUSIONS: Despite the higher prevalence of H. pylori and gastric cancer, Māori and Pacific are relatively underserved with lower rates of testing and treatment than sole-European. Improved guidelines and the consistent application of these along with an equity-focused test and treat program are likely to be particularly beneficial for Māori and Pacific in addressing inequities.

PMID:39791223 | DOI:10.1111/hel.70005

Mol Med Rep. 2025 Mar;31(3):67. doi: 10.3892/mmr.2025.13432. Epub 2025 Jan 10.

ABSTRACT

Subarachnoid hemorrhage (SAH), a prevalent cerebrovascular condition associated with a high mortality rate, frequently results in neuronal apoptosis and an unfavorable prognosis. The adjunctive use of traditional Chinese medicine (TCM) with surgical interventions exerts a therapeutic impact on SAH, potentially by facilitating apoptosis. However, the mechanism by which TCM mediates apoptosis following SAH remains unclear. In the present study, C57BL/6J mice were subjected to the modified single‑clamp puncture method to produce an in vivo model of SAH. Treatment of these mice with notoginsenoside R1 (NGR1) prevented short‑term neurological deficits, reduced the expression levels of apoptosis‑associated proteins and mitigated brain edema. In addition, an in vitro model of SAH was established by treating HT22 mouse neuronal cells with oxyhemoglobin (OxyHb). Treatment of these cells with NGR1 resulted in attenuation of the OxyHb‑induced apoptosis. Furthermore, RNA sequencing analysis was used to examine NGR1 + OxyHb and OxyHb groups. Statistically significant changes in the expression levels of apoptosis‑associated genes in OxyHb‑stimulated HT22 cells upon administration of NGR1 were observed. The present study investigated the potential mechanism by which NGR1 mitigates neuronal apoptosis, presenting a novel therapeutic approach for treating SAH through the use of a single TCM component.

PMID:39791208 | DOI:10.3892/mmr.2025.13432