Nevin Manimala

BMC Med Inform Decis Mak. 2025 Jan 8;25(1):12. doi: 10.1186/s12911-024-02837-0.

ABSTRACT

OBJECTIVE: The objective of this study was to examine the causal relationship between the usage of patient portals and patients’ self-care self-efficacy and satisfaction in care outcomes in the context of cancer care.

METHODS: The National Institute’s HINTS 5 Cycle 1-4 (2017-2020) data were used to perform a secondary data analysis. Patients who reported being ever diagnosed with cancer were included in the study population. Their portal usage frequency was considered as an intervention. Patient’s self-care self-efficacy and satisfaction in care were the primary outcomes considered and they were measured by survey respondents’ self-reported information. A set of conditional independence tests based on the causal diagram was developed to examine the causal relationship between patient portal usage and the targeted outcomes.

RESULTS: A total of 2579 were identified as patients with cancer or cancer survivors. We identified patient portals’ impact on strengthening patients’ ability to take care of their own health (P = .02, for the test rejecting which is necessary for the expected causal relationship, ie, the portal usage impacts the target outcome; P = .06, for the test rejecting which is necessary for the reverse causal relationship), and we identified heterogenous causal relationships between frequent patient portal usage and patients’ perceived quality of care (P = .04 and P = .001, for the tests rejecting both suggests heterogeneous causal relationships). We could not conclusively determine the causal relationship between patient portal usage and patients’ confidence in getting advice or information about health or cancer care related topics (P > .05 for both tests, suggesting inconclusive causal directions).

CONCLUSIONS: The results advocate patient portals and promote the need to provide better support and education to patients. The proposed statistical method exploits the potential of national survey data for causal inference studies.

PMID:39780146 | DOI:10.1186/s12911-024-02837-0

BMC Cancer. 2025 Jan 8;25(1):40. doi: 10.1186/s12885-024-13414-z.

ABSTRACT

BACKGROUND: Our goal is to develop a nomogram model to predict overall survival (OS) for elderly esophageal squamous cell carcinoma (ESCC) patients receiving definitive radiotherapy (RT) or concurrent chemoradiotherapy (CRT), aiding clinicians in personalized treatment planning with a risk stratification system.

METHODS: A retrospective study was conducted on 718 elderly ESCC patients treated with RT or CRT at 10 medical centers (3JECROG) from January 2004 to November 2016. We identified independent prognostic factors using univariate and multifactorial Cox regression to construct a nomogram model. Its effectiveness was evaluated using concordance statistics (C-index), area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI), and compared against the AJCC staging. Additionally, decision curve analysis (DCA) assessed the model’s clinical benefit. Patients were stratified into low, intermediate, and high-risk groups using the nomogram, and their prognoses in various disease stages were analyzed.

RESULTS: Significant prognostic factors identified included diabetes, tumor volume (GTVp), tumor length, location, and clinical stages (T, N, M), and RT response. Multivariate analysis confirmed these as independent factors for OS. The nomogram outperformed AJCC staging in prediction accuracy and discrimination, evidenced by a higher C-index, better AUC, and significant NRI and IDI values. Patients categorized by the nomogram demonstrated distinct 5-year OS rates, with a higher C-index than AJCC staging (0.597 vs. 0.562) .

CONCLUSIONS: The study identified key prognostic factors for elderly ESCC patients receiving RT or CRT. The nomogram model, based on these factors, showed enhanced prediction performance, discrimination, and clinical utility compared to AJCC staging. This risk stratification provided more accurate survival predictions and aided in personalized risk management.

PMID:39780142 | DOI:10.1186/s12885-024-13414-z

J Neuroeng Rehabil. 2025 Jan 8;22(1):4. doi: 10.1186/s12984-024-01522-7.

ABSTRACT

BACKGROUND: Motion complexity is necessary for adapting to external changes, but little is known about trunk motion complexity during seated perturbation in individuals with spinal cord injury (SCI). We aimed to investigate changes following SCI in trunk segmental motion complexity across different perturbation directions and how they affect postural control ability in individuals with SCI.

METHODS: A total of 17 individuals with SCI and 18 healthy controls participated in challenging sagittal-seated perturbations with hand protection. Upper arm activation was measured using surface electromyography for trial consistency. Motion complexity parameters, quantified across three degrees of freedom, was assessed using relative angular acceleration from six trunk segments obtained through motion capturing system. Motion performance parameters were assessed using center of pressure (CoP) measurements from a force plate, including settling time, maximum CoP displacement (MD) variability, and steady-state error. Statistical analyses examined group and direction differences, while complexity-performance relationships were evaluated using multiple response least partial squares regression.

RESULTS: Compared to healthy controls, individuals with SCI showed significantly lower motion complexity in the lumbar and upper thoracic segments (approximately10% – 20%), with identical settling time and higher MD variability. Backward perturbations, as opposed to forward perturbations, resulted in reduced complexity in the aforementioned segments and increased steady-state error. Lower lumbar rotation complexity negatively correlated with MD variability (β = -0.240) and steady-state error (β = -0.485) in individuals with SCI, while showing a minor positive correlation with settling time (β = 0.152) during backward perturbation.

CONCLUSION: Simplified motion control in individuals with SCI may arise from uncoordinated lumbar and overactive thoracic neuromuscular control, compromising stability despite maintaining speed. Increasing lumbar motion complexity could enhance postural stability and accuracy during backward perturbation, representing a potential target for developing seated balance rehabilitation strategies and promoting more adaptive trunk control.

PMID:39780141 | DOI:10.1186/s12984-024-01522-7

BMC Nurs. 2025 Jan 8;24(1):26. doi: 10.1186/s12912-024-02666-6.

ABSTRACT

BACKGROUND: College-aged students are at risk for experiencing negative events that may influence their future health and life. Those negative events or stressors may vary in type and severity. Stress and bullying are prevalent among nursing students that may affect their academic motivation. Our aim was to examine the gender differences in acute and perceived stress, bullying, and academic, motivation among nursing and midwifery students in Saudi Arabia.

METHODS: A cross-sectional design was utilized in this study to examine 391 nursing and midwifery students in four different universities in Saudi Arabia. The following scales were used to collect data: the college students acute stress scale, perceived stress scale, bullying behaviors in nursing education, and short version of academic motivation scale.

RESULTS: Students reported relatively low acute stress and moderate perceived stress. Students did not generally experience considerable bullying. Only female students reported that they experience significant bullying in form of attacking academic motivation. Academic motivation among participating students were relatively high. Female students reported higher scores than male students on all variables; all differences are statistically significant except for bullying.

CONCLUSION: The findings of this study contribute to the literature on the prevalence of stress and bullying among nursing and midwifery students and their influence on academic motivation. Also, the results provide further evidence to the gender differences in stress, bullying, and academic motivation among them. The study highlights the importance of supporting nursing and midwifery students, specifically female student, by providing supportive and encouraging environment to help them succeed in their study and love their future career.

PMID:39780140 | DOI:10.1186/s12912-024-02666-6

BMC Med Educ. 2025 Jan 8;25(1):32. doi: 10.1186/s12909-024-06523-7.

ABSTRACT

BACKGROUND: The dental industry is associated with significant environmental impacts so there is a growing need for eco-friendly practices in dentistry. This study aimed to assess dental interns’ knowledge and practices regarding eco-friendly dentistry before and after the implementation of the environmental educational program.

METHODS: An interventional quasi-experimental study (one group pre-test-post-test design) was conducted on 69 intern dentists at the Faculty of Dentistry Alexandria University. Assessment of knowledge and practices related to eco-friendly dentistry was performed three times: before, after two months, and after four months of the educational program.

RESULTS: The mean age of participants was 23.72 years; 56.5% were males; 89.9% hadn’t received prior training on eco-friendly dentistry; and 40.6% obtained their green dentistry information from online websites. The educational program significantly improved their knowledge (median score percentage went from 50% before the intervention to 81.82% and 81.82% after two and four months of the conducting of the educational program, respectively.) and eco-friendly practices (median score percentage increased from 58.33% before the intervention to 75% and 66.67% after two and four months of the intervention, respectively) and the differences were statistically significant (p < 0.05). Significant positive correlations were noticed between knowledge and practice either before or after the training program (p < 0.05).

CONCLUSIONS: There was a significant improvement in knowledge and practices of the participants after the implementation of eco-friendly educational program. The successful educational program in early career is important in reducing waste generation and resource consumption, as well as potential cost savings on the long run.

CLINICAL TRIAL REGISTRATION NUMBER: PACTR202405544685014. Date: 20 May 2024, “retrospectively registered”.

PMID:39780135 | DOI:10.1186/s12909-024-06523-7

BMC Cancer. 2025 Jan 8;25(1):43. doi: 10.1186/s12885-025-13430-7.

ABSTRACT

OBJECTIVE: Sarcopenia, a condition characterized by the gradual decline of muscle mass, strength, and function, is a key indicator of malnutrition in cancer patients and has been linked to poor prognoses in oncology. Sarcopenia is commonly assessed by measuring the skeletal muscle index (SMI) of the third lumbar spine (L3) using computed tomography (CT). This meta-analysis aimed to explore the relationship between low SMI and clinicopathological features, as well as prognosis, in individuals with endometrial cancer (EC).

METHODS: Data from various databases including PubMed, Embase, Cochrane, Medline, and Web of Science were searched up until October 20th, 2024. Studies that investigated the association of low SMI and EC survival or clinicopathological characteristics were included. Pooled effect sizes were reported as hazards ratio (HR), odds ratios (ORs) or weighted mean difference (WMD). The quality and risk of bias in the studies were evaluated using the Newcastle-Ottawa Scale (NOS) and the Quality In Prognosis Studies (QUIPS), and the study was registered on PROSPERO (CRD42024509949) before commencing the search.

RESULTS: A total of 218 studies were identified across all five databases, with 11 studies meeting the criteria for qualitative and quantitative analysis, involving 1588 patients. The findings of our meta-analysis demonstrated a significant link between low SMI and progression-free survival [P = 0.002; HR: 1.62, 95% CI: 1.20-2.17]. Low SMI was also associated with a BMI < 25 (P < 0.00001; OR: 4.55, 95% CI: 3.01-6.87), FIGO stage (P = 0.04; OR: 1.33, 95% CI: 1.01-1.75), pathology grades (P = 0.001; OR: 1.77, 95% CI: 1.26-2.49), and the endometrioid pathological type (P = 0.01; OR: 0.68, 95% CI: 0.51-0.92). However, no significant correlation was found between low SMI and 5-year overall survival, serous pathological type, recurrence, length of hospital stay, intraoperative complications, and postoperative complications. All the included studies scored ≥ 7 on the NOS, indicating relatively high-quality evidence.

CONCLUSIONS: The meta-analysis highlighted the association between low SMI and unfavorable clinical features and outcomes in EC patients, emphasizing the importance of early diagnosis and appropriate management of sarcopenia assessed by low SMI to enhance prognoses in EC patients.

PMID:39780132 | DOI:10.1186/s12885-025-13430-7

BMC Cancer. 2025 Jan 9;25(1):44. doi: 10.1186/s12885-024-13401-4.

ABSTRACT

BACKGROUND/AIMS: Gastric cancer (GC) is a significant global health issue with high incidence rates and poor prognoses, ranking among the top prevalent cancers worldwide. Due to undesirable side effects and drug resistance, there is a pressing need for the development of novel therapeutic strategies. Understanding the interconnectedness of the JAK2/STAT3/mTOR/PI3K pathway in tumorigenesis and the role of Astaxanthin (ASX), a red ketocarotenoid member of xanthophylls and potent antioxidant and anti-tumor activity, can be effective for cancer treatments. This study aimed to investigate the effect of ASX-loaded nanoparticles on the survival of MKN-45 GC cells and the expression of JAK2/STAT3/mTOR/PI3K, offering insights into potential targeted therapies for GC.

METHODS: The growth status and survival rate of MKN-45 GC cell lines were determined using the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide(MTT) assay, and the optimal IC50 concentration of ASX, PLGA, and ASX + PLGA was estimated. Also, the clonogenic assay was performed to determine the reproductive power and colony formation of under-treatment cells. Apoptosis and necroptosis of cells were evaluated using acridine orange (AO) staining. The western blot assessed the protein’s level of expression and intensity (JAK2/STAT3/mTOR/PI3K). SPSS version 16 software was used for statistical analysis, P-value was considered lower than 0.05.

RESULTS: Based on the results, increasing concentrations of ASX and ASX + PLGA led to a decrease in the viability of MKN-45 cells compared to the control group (P < 0.001). This value was lower for cells treated with ASX + PLGA (P = 0.003). The IC50 values for each of the studied groups (ASX, ASX + PLGA, and PLGA) were 81.45 µg/ml, 51.45 µg/ml, and 3.383 mg/ml, respectively. The levels of expression and intensity of JAK2, STAT3, and mTOR proteins in the Western blotting analysis under ASX + PLGA treatment increased compared to the control group. Conversely, the levels of expression and intensity of P-JAK2, P-STAT3, and P-mTOR proteins in the ASX + PLGA treatment group decreased by 41%, 34%, 37%, and 43%, respectively, compared to the control group. Protein expression levels and intensities of JAK2, STAT3, and mTOR significantly increased when treated with PLGA, ASX, and ASX + PLGA compared to the control group (P < 0.001).

CONCLUSIONS: The encapsulation of ASX in PLGA nanoparticles enhances drug stability, enables targeted delivery, and allows for sustained release. This study highlights the therapeutic potential of ASX-loaded nanoparticles in targeting JAK2/STAT3/mTOR/PI3K pathways in GC treatment. Further research is needed to understand the mechanisms and clinical applications of this novel immunotherapy strategy.

PMID:39780129 | DOI:10.1186/s12885-024-13401-4

BMC Public Health. 2025 Jan 8;25(1):80. doi: 10.1186/s12889-024-21242-w.

ABSTRACT

BACKGROUND: In The Gambia, existing research to understand and address malnutrition among adolescent girls is limited. Prior to the conduct of large-scale studies, formative research is needed. The aim of this mixed methods, cross-sectional study was to explore cultural contexts relevant to nutritional status, feasibility and appropriateness of recruitment and data collection methods (questionnaires and anthropometric measures), and plausibility of data collected.

METHODS: The study took place in May-June 2021 in an urban conurbation in Brikama local government area (LGA) and two rural villages in Mansakonko LGA, The Gambia. The purposive sampling frame of the all-female sample included residence in the selected urban or rural settings and being aged 10-14 or 15-19 years. Thirty-two girls aged 10 to 19 years, with equal numbers in urban and rural settings were recruited. Four focus groups discussions (FGDs), with eight participants in each, were held to understand perspectives on cultural practices; concepts of under- and overweight, and research recruitment methods. The same participants completed questionnaires on socioeconomic circumstances, health, access to community resources, nutrition knowledge, sleep, and physical activity, and had anthropometric measures taken. FGDs were then reconvened to discuss the feasibility and acceptability of the questionnaires and anthropometric measures, and views on providing biological samples in the future. FGD data were analysed using thematic analysis. Body mass index (BMI)-for-age and height-for-age z-scores, mid-upper arm circumference, and waist: hip ratios were assessed and descriptive statistics used to explore the data obtained.

RESULTS: Five themes were identified in the focus group discussions: 1. Cultural norms: harmful vs. beneficial to nutrition-related health; 2. Concepts of healthy diet and weight; 3. Approaches to tackling under- and overnutrition; 4. Study recruitment: barriers and facilitators; 5. Study questionnaires and proposed measures are mostly feasible and acceptable. Questionnaire data highlighted limited access to resources (e.g. food markets and electricity) as important individual, household and community factors influencing malnutrition in rural settings. The anthropometric measures reflected the double burden of malnutrition in The Gambia, with the presence of stunting (41%), underweight (31%), and living with overweight or obesity (10%). A higher proportion of participants were underweight in rural compared to urban settings (50% vs 12.5% respectively, p = 0.03). Over 70% of those classified as underweight perceived their weight as normal.

CONCLUSION: This exploratory study provides novel data to inform larger-scale research to understand and address malnutrition among adolescent females in The Gambia. Urban-rural variance in the double burden of malnutrition, factors influencing malnutrition, and in the barriers to and facilitators of adolescents taking part in research, are key considerations.

PMID:39780121 | DOI:10.1186/s12889-024-21242-w

BMC Med Educ. 2025 Jan 8;25(1):30. doi: 10.1186/s12909-024-06621-6.

ABSTRACT

OBJECTIVE: This study examines a novel teaching model that integrates the development and use of a Medical Cloud Dictionary with project-based learning (PBL). We investigate whether this integrated approach improves teaching effectiveness, enhances student learning outcomes, and reduces teaching pressure compared to traditional PBL.

METHODS: One hundred student volunteers were randomly assigned to an experimental group (n = 50) and a control group (n = 50). Both groups studied seven respiratory-disease-related modules over a single semester (4 months). The experimental group utilized a PBL approach enhanced by the Medical Cloud Dictionary, which provided organized, up-to-date medical information and facilitated collaboration. The control group received traditional PBL-based teaching. Student performance was assessed using theoretical exams, comprehensive case analyses, and clinical practice reports. Feedback questionnaires and interviews were conducted with the experimental group’s students and teachers. Statistical analyses included a Mann-Whitney U-test and chi-square tests to compare outcomes between groups.

RESULTS: The experimental group demonstrated significantly higher overall scores than the control group (Mann-Whitney U = 22037.5, p < 0.001). Their pass rate reached 100% vs. 98.6% in the control group (χ²=10.145, p < 0.05), and their excellence rate was 22.9% vs. 2.9% (χ²=62.477, p < 0.001). Feedback indicated improved learning efficiency, enhanced independent learning, and reduced teaching pressure. Both students and teachers expressed a desire to continue and expand the integrated mode.

CONCLUSION: Integrating a Medical Cloud Dictionary with PBL can stimulate students’ academic engagement, improve their mastery of medical knowledge and practical skills, and foster a stronger desire for independent learning. It also qualitatively enhances teaching quality and strengthens teacher-student relationships. Overall, this integrated teaching model can improve the quality and effectiveness of medical education, benefiting both teachers and students.

PMID:39780120 | DOI:10.1186/s12909-024-06621-6

BMC Oral Health. 2025 Jan 8;25(1):42. doi: 10.1186/s12903-024-05345-9.

ABSTRACT

BACKGROUND: A comprehensive analysis of the occlusal plane (OP) inclination in predicting anteroposterior mandibular position (APMP) changes is still lacking. This study aimed to analyse the relationships between inclinations of different OPs and APMP metrics and explore the feasibility of OP inclination in predicting changes in APMP.

METHODS: Overall, 115 three-dimensional (3D) models were reconstructed using deep learning-based cone-beam computed tomography (CBCT) segmentation, and their accuracy in supporting cusps was compared with that of intraoral scanning models. The anatomical landmarks of seven OPs and three APMP metrics were identified, and their values were measured on the sagittal reference plane. The receiver operating characteristic curves of inclinations of seven OPs in distinguishing different anteroposterior skeletal patterns and correlations between inclinations of these OPs and APMP metrics were calculated and compared. For the OP inclination with the highest area under the curve (AUC) values and correlation coefficients, the regression models between this OP inclination and APMP metrics were further calculated.

RESULTS: The deviations in supporting cusps between deep learning-based and intraoral scanning models were < 0.300 mm. The improved functional OP (IFOP) inclination could distinguish different skeletal classification determinations (AUC _{Class I VS Class II} = 0.693, AUC _{Class I VS Class III} = 0.763, AUC _{Class II VS Class III} = 0.899, all P values < 0.01) and the AUC value in skeletal Classes II and III determination was statistically higher than the inclinations of other OPs (all P values < 0.01). Moreover, the IFOP inclination showed statistical correlations with APMP metrics (r_APDI = -0.557, r_ANB = 0.543, r_AF-BF = 0.731, all P values < 0.001) and had the highest correlation coefficients among all OP inclinations (all P values < 0.05). The regression analysis models of IFOP inclination and APMP metrics were y_APDI = -0.917x + 91.144, y_ANB = 0.395x + 0.292, and y_AF-BF = 0.738x – 2.331.

CONCLUSIONS: Constructing the OP using deep learning-based 3D models from CBCT data is feasible. IFOP inclination could be used in predicting the APMP changes. A steeper IFOP inclination corresponded to a more retrognathic mandibular posture.

PMID:39780117 | DOI:10.1186/s12903-024-05345-9