Nevin Manimala

BMC Res Notes. 2025 Jul 24;18(1):322. doi: 10.1186/s13104-025-07371-4.

ABSTRACT

The ongoing COVID-19 pandemic has seen the emergence of numerous SARS-CoV-2 variants, each posing distinct public health challenges. The XEC variant, a recombinant Omicron subvariant, has rapidly gained prevalence globally, raising critical questions about its potential implications on health systems and public policy. This paper examines the emergence, spread, and unique characteristics of XEC, especially in the context of the global decline of KP.3.1.1, another significant Omicron lineage. We discussed the public health implications, including vaccine effectiveness, genomic surveillance, and healthcare system preparedness, underscoring the need for adaptive strategies in response to evolving SARS-CoV-2 variants.

PMID:40708011 | DOI:10.1186/s13104-025-07371-4

J Health Popul Nutr. 2025 Jul 24;44(1):266. doi: 10.1186/s41043-025-01018-7.

ABSTRACT

BACKGROUND: Obesity is a significant manifestation of Circadian Syndrome (CircS), and the Body Roundness Index (BRI) is one of the anthropometric indicators associated with obesity. However, it remains unclear whether BRI is linked to the risk of CircS.

METHODS: In this population-based cross-sectional study, data from adults aged ≥ 20 years from the 2009-2018 National Health and Nutrition Examination Survey (NHANES) database were analyzed. Logistic regression analysis was employed to investigate the relationship between BRI and CircS after adjusting for various covariates. To further explore the trend of association between different BRI levels and CircS, BRI was categorized into four classes to enhance the robustness of the results. Restricted cubic spline (RCS) analysis was utilized to illustrate the dose-response relationship between BRI and CircS. Additionally, subgroup analyses were performed to assess the consistency and stability of the study results.

RESULTS: This study included 8,024 participants aged 20 years and older, of whom 2,634 had CircS. In fully adjusted models, BRI was positively associated with the prevalence of CircS (OR = 2.821, 95% CI: 2.038-3.768). When BRI was transformed from a continuous to a categorical variable, higher levels of BRI were correlated with a higher prevalence of CircS compared to the lowest quartile of BRI. RCS analyses demonstrated a positive association between BRI and CircS prevalence, with threshold effect analyses identifying a threshold value of BRI at 5.91. To the left of this threshold, each one-unit increase in BRI elevated the prevalence of CircS by a factor of 2.681 (OR = 2.681, 95% CI: 2.524-2.851). Stratified factorial subgroup analyses indicated that the positive association between BRI and CircS persisted.

CONCLUSION: The findings of our cross-sectional study indicate a significant positive correlation between elevated BRI and increased prevalence of CircS.

PMID:40708006 | DOI:10.1186/s41043-025-01018-7

BMC Nurs. 2025 Jul 24;24(1):969. doi: 10.1186/s12912-025-03618-4.

ABSTRACT

BACKGROUND: The leadership behaviours and practices of nurse managers play a pivotal role in shaping staff performance, retention, and the overall quality of patient care, making them critical components of healthcare system efficiency and outcomes. These behaviours and practices are attributed to different management strategies and leadership styles, which have a strong influence on how leaders act and make decisions.

AIM: This study aims to assess the leadership behaviours and practices of nurse managers within Riyadh Second Health Cluster.

METHODOLOGY: A cross-sectional quantitative study was conducted using the Leadership Practices Inventory (LPI), a validated 30-item self-assessment tool. A total of 342 nurse managers working in Riyadh Second Health were recruited using convenience sampling. Data were analyzed using descriptive statistics, independent t-tests, and ANOVA to examine differences across their demographics.

RESULTS: Significant differences were found in leadership behavior scores across gender, nationality, age, education, and experience, with female, non-Saudi, mid-career, and bachelor’s-prepared nurse managers demonstrating higher self-reported leadership practices across all domains. Nurse managers exhibited very high leadership scores across all five domains of the leadership practices (average M = 4.57); Model the Way (M = 4.57), Inspire a Shared Vision (M = 4.56), Challenge the Process (M = 4.56), Enable Others to Act (M = 4.57), and Encourage the Heart (M = 4.57).

CONCLUSION: The results indicated a very high level of all leadership practices among the nurse managers in Riyadh Second Health Cluster. The study findings highlight a strong leadership abilities among the nurse managers, emphasizing the need for continued investment in leadership training and development programs to enhance staff performance, retention, and quality of care.

PMID:40707968 | DOI:10.1186/s12912-025-03618-4

Hum Resour Health. 2025 Jul 24;23(1):36. doi: 10.1186/s12960-025-01011-5.

ABSTRACT

BACKGROUND: The turnover rate of newly graduated nurses is very high, and their turnover intention is affected not only by individual-level factors, but also by organizational-level factors. However, the multilevel factors reflecting the characteristics of newly graduated nurses in Generation Z and their turnover intention have not been identified previously.

OBJECTIVE: To identify the individual- and organizational-level factors that affect the turnover intention of newly graduated nurses in Generation Z.

METHODS: This study was a cross-sectional questionnaire survey. Online survey was performed from August to November 2022. Participants were a total of 283 newly graduated nurses and 45 nurse managers to respond to each individual and organization-level questionnaire. The collected data were analyzed for frequency, descriptive statistics, and multilevel analysis.

RESULTS: The multilevel analysis indicated that the individual-level factors that affected the lower turnover intention of newly graduated nurses in Generation Z were higher work-life balance (β = – 0.320, p < 0.001), higher organizational commitment (β = – 0. 384, p < – 0.001), and desired nursing unit placement (β = – 0.209, p < 0.001). The organization-level factors associated with lower turnover intention were lower average number of night shifts per month (β = 0.303, p < 0.05), higher salary (β = – 0.263, p < 0.05), longer orientation period (β = – 0.612, p < .01), preceptor-preceptee ratio of 1:1 (β = – 0.409, p < 0.05), and existence of a mentoring program (β = – 0.318, p < 0.05). Furthermore, the nursing work environment was the most influential factor, and a supportive environment for nursing work (β = – 0.630, p < 0.01), efficient computer-related environment (β = – 0.251, p < 0.05), and recognition and respect (β = – 0.564, p < 0.05) were associated with lower turnover intention.

CONCLUSIONS: The findings indicate that improvements to the nursing work environment and human resources of the organization should be prioritized to prevent the turnover of newly graduated nurses in Generation Z.

PMID:40707967 | DOI:10.1186/s12960-025-01011-5

J Intensive Care. 2025 Jul 24;13(1):40. doi: 10.1186/s40560-025-00811-0.

ABSTRACT

BACKGROUND: Prolonged mechanical ventilation is associated with an increased incidence of complications and higher mortality rates. Therefore, it is crucial to wean patients from mechanical ventilation as soon as possible. Recently, diaphragmatic ultrasound has been used in this decision-making process. This systematic review evaluated the effectiveness of diaphragmatic ultrasound to improve ventilator liberation outcomes.

METHODS: We searched three databases – MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomized control trials that compared the use of diaphragmatic ultrasound to standard care in adult patients on mechanical ventilation via tracheal intubation. We assessed risk of bias for included trials with the Cochrane Risk of Bias Tool and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation tool. For dichotomous outcomes, we reported risk ratios (RRs) with 95% confidence intervals (CIs). For continuous outcomes, we reported mean differences (MD) with 95% CIs if all retrieved records provide data on the same scale. The primary outcome was incidence of reintubation within 48 h of extubation and the secondary outcomes included duration of mechanical ventilation, incidence of reintubation rate after 48 h, ICU length of stay, and adverse events.

RESULTS: We found five relevant randomized controlled trials involving a total of 508 participants on mechanical ventilation in ICU following respiratory failure or surgery. Three studies (268 participants) provided data on the incidence of reintubation within 48 h of extubation. Using diaphragmatic ultrasound to guide extubation decisions led to a significant reduction in the risk of reintubation within 48 h (RR 0.62, 95% CI 0.41 to 0.95, low certainty of evidence). No significant differences were found in the duration of mechanical ventilation (MD – 1.39 h, 95% CI – 17.5 to 14.71 h, three studies, 268 participants, very low certainty of evidence) or reintubation after 48 h (RR 0.38, 95% CI 0.11-1.29, two studies, 240 participants, moderate certainty of evidence). However, ICU length of stay was significantly reduced in the diaphragmatic ultrasound group (MD – 1.0 days, 95% CI – 1.74 to – 0.26 days, one study, 130 participants, low certainty of evidence).

CONCLUSION: Using diaphragmatic ultrasound in addition to standard clinical criteria to guide decisions around ventilator use and liberation resulted in a reduced risk of reintubation within 48 h of extubation when compared to standard clinical criteria alone.

SYSTEMATIC REVIEW REGISTRATION: This systematic review was registered with the Open Science Framework: https://osf.io/cn8xf .

PMID:40707960 | DOI:10.1186/s40560-025-00811-0

BMC Nurs. 2025 Jul 24;24(1):967. doi: 10.1186/s12912-025-03626-4.

ABSTRACT

BACKGROUND: Enteral nutrition (EN) is essential for ICU patients, but EN-associated diarrhea (ENAD) affects 48.6-89.0% of them, increasing complications and healthcare costs. ICU nurses’ knowledge, attitudes, and behavior in ENAD management significantly influence patient outcomes.

OBJECTIVE: We evaluated ICU nurses’ knowledge, attitudes, and behavior in ENAD management and explored their interrelationships using a social cognitive and behavior change framework.

METHODS: From June 2022 to March 2023, 371 ICU nurses from 11 Chinese ICUs completed a validated questionnaire. We analyzed data using descriptive statistics, regression, and structural equation modeling.

RESULTS: Knowledge (mean = 63.57, SD = 15.04), attitudes (mean = 44.19, SD = 4.76), and behaviors (mean = 56.32, SD = 9.15) were moderate. Knowledge was positively correlated with attitudes (ρ = 0.42, p < 0.001) and behaviors (ρ = 0.58, p < 0.001), and attitudes strongly correlated with behaviors (ρ = 0.65, p < 0.001). Attitudes mediated the knowledge-behavior relationship (β = 0.14, 95% CI [0.08, 0.21], p < 0.001). Master’s Degree (β = 0.10, p = 0.049), training participation (β = 0.18, p = 0.002), and frequent training (4 times/year, β = 0.22, p < 0.001) predicted better knowledge, while training and age (31-35 years) enhanced attitudes (p < 0.05).

CONCLUSION: Knowledge gaps hinder ICU nurses’ ENAD management, with attitudes critically mediating the translation of knowledge into practice. Targeted interventions, such as quarterly workshops and scenario-based simulations, are recommended to enhance knowledge, foster positive attitudes, and standardize behaviors, thereby improving patient care quality.

PMID:40707945 | DOI:10.1186/s12912-025-03626-4

Genome Biol. 2025 Jul 24;26(1):220. doi: 10.1186/s13059-025-03680-w.

ABSTRACT

Advances in single-cell technology enable large-scale generation of omics data, promising for clarifying gene regulatory networks governing different cell type/states. Nonetheless, prevailing methods fail to account for universal and reusable regulatory modules in GRNs, which are fundamental underpinnings of cell type landscape. We introduce cRegulon to infer regulatory modules by modeling combinatorial regulation of transcription factors based on diverse GRNs from single-cell multi-omics data. Through benchmarking and applications using simulated datasets and real datasets, cRegulon outperforms existing approaches in identifying TF combinatorial modules as regulatory units and annotating cell types. cRegulon offers new insights and methodology into combinatorial regulation.

PMID:40707940 | DOI:10.1186/s13059-025-03680-w

BMC Pulm Med. 2025 Jul 24;25(1):352. doi: 10.1186/s12890-025-03813-8.

ABSTRACT

BACKGROUND: Interstitial lung disease (ILD) and pulmonary sarcoidosis (PS) constitute major global health challenges, characterized by progressive respiratory symptoms and diverse epidemiological trends. Although the incidence and mortality rates of ILD and PS have increased following the COVID-19 pandemic, comprehensive research examining their burden and associated risk factors remains limited. Therefore, the present study aimed to analyze the spatiotemporal distribution, gender-specific and age-related disparities, and sociodemographic determinants of ILD and PS from 1990 to 2021 to facilitate evidence-based targeted interventions.

METHODS: By using data from the Global Burden of Disease 2021 database, we analyzed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year rate (ASDR) across 204 countries/regions. Temporal trends were evaluated using average annual percentage change (AAPC), age-period-cohort (APC), and Bayesian APC (BAPC) models. Decomposition analysis and Pearson’s correlation analysis were conducted to assess the impact of aging, population growth, and sociodemographic index (SDI). Joinpoint regression was used to identify inflection points in trends. Future disease burdens (2021-2050) were projected through BAPC modeling.

RESULTS: Global ILD and PS cases increased from 157,441.17 in 1990 to 390,267.11 in 2021, with an annual increase in ASIR, ASMR, and ASDR by 0.61%, 1.32%, and 0.83%, respectively. High-SDI regions exhibited the highest ASIR (71.4/100,000) and ASMR (25.5/100,000). Males exhibited greater disease burdens than females ASDR 57.79/100,000 vs. 39.49/100,000 in 2021), with a peak incidence in the 70-74 age group. SDI showed positive correlations with ASIR and ASMR, exhibiting U-shaped relationships in certain regions. Projections indicated stable ASMR but increasing ASIR and ASDR by 2050, particularly among males.

CONCLUSIONS: The global burden of ILD and PS has increased markedly since 1990, influenced by population aging, industrial development, and socioeconomic disparities. Prioritizing early screening (e.g., high-resolution computed tomography and serum biomarkers), minimizing environmental and occupational exposures, and implementing gender-/age-specific interventions are critical measures. Strengthening healthcare infrastructure in low-SDI regions and integrating advanced diagnostic technologies are crucial for reducing future disease burdens.

PMID:40707937 | DOI:10.1186/s12890-025-03813-8

BMC Med Educ. 2025 Jul 24;25(1):1106. doi: 10.1186/s12909-025-07666-x.

ABSTRACT

BACKGROUND AND OBJECTIVE: Cultural competence intentionally enhances the quality improvement process in healthcare. Therefore, the goal of this study was to evaluate the knowledge, skills, and comfort level of cultural competence and determine the important factors contributing to health disparities among male nursing students.

METHODS: A cross-sectional, descriptive paper-based study was conducted among male nursing students at a Saudi University between March and May 2024. Data was collected using structured, pre-validated 47-item questionnaires and analyzed using the statistical package for social science version 27. For bivariate analysis, Chi-square or Fisher’s Exact test was employed. A p-value < 0.05 was considered statistically significant.

RESULTS: The response rate obtained was 86%. Approximately half of the students (50.8%; n = 131) believed they were somewhat knowledgeable about the demographics of diverse racial and ethnic groups, while only 5% (n = 13) were very knowledgeable. Lifestyle (14%) and environment (12%) were important factors contributing to health disparities. The mean score for knowledge and skills of cultural competence was 67.99 ± (SD = 16.21), while it was 31.29 ± (SD = 12.31), for cross-cultural encounters and 43.32 ± (SD = 13.72) for factors contributing to health disparities. In this study, 50.4% (n = 130) of students reported good levels of knowledge and skills of cultural competence, and 53.5% (n = 138) of students showed good attitudes towards factors contributing to health disparities. There was a significant association between students’ grade point average (GPA) and knowledge and skills in cultural competence, with those having higher GPAs demonstrating higher levels of knowledge and those with GPAs above 3.5 reporting higher levels of comfort than those with GPAs below 2 (p = 0.045). Conversely, a significant association was found between students’ age group and GPA and their attitudes regarding variables contributing to health disparities (p = 0.0001). In addition, findings reveal that there is a statistically significant linear relationship between knowledge and skills of cultural competence and comfort in dealing with cross-cultural encounters (r = 0.438, p = 0.01) and factors contributing to health disparities (r = 0.376, p = 0.01).

CONCLUSION: This study found that male nursing students demonstrated a relatively good level of cultural competence, showing comfort in interacting with diverse cultural backgrounds and awareness of social, economic, and cultural determinants of health inequities. To further enhance their preparedness for diverse patient populations, structured training programs, real-world exposure, and reflective learning are recommended.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40707933 | DOI:10.1186/s12909-025-07666-x

Confl Health. 2025 Jul 25;19(1):48. doi: 10.1186/s13031-025-00690-0.

ABSTRACT

BACKGROUND: Access to sexual and reproductive health services is an explicit element of the Sustainable Development Goals, and is critical for achieving family planning goals and broader well-being of young people. Youth (15-24 years) face many barriers to accessible, quality services, and refugees often experience additional barriers due to physical, economic, legal and/or social exclusion. This study explored these barriers in the context of Jordan, a country that has one of the highest proportions of refugees globally.

METHODS: This concurrent mixed-methods study utilizes the 2022-2023 Gender and Adolescence: Global Evidence survey data collected from 313 married female youth living in Jordan to describe utilization of contraceptives among Jordanians and Syrian refugees, exploring the role of residence (formal refugee camp, host community or informal tented settlement) and factors associated with contraceptive use among Syrian refugees. A multivariable linear probability model and qualitative data from in-depth individual interviews and focus group discussions were used to explore underlying factors driving differences in contraceptive utilization among Syrian refugee youth.

RESULTS: The survey found that 63.4% of Jordanian youth and 42.8% of Syrian refugee youth were recently using contraception, with notable differences in type of contraceptive method used by both refugee status and residence. Among Syrian refugee youth, living in a host community emerged as a key factor associated with contraceptive use, as it was associated with a 19.6 percentage point increase in the likelihood of using contraception compared to those living in refugee camps. Qualitative themes nuance these findings, suggesting that living in a refugee camp where there is more restricted access to healthcare services, more salient social norms, and limited knowledge about reproductive health present barriers to contraceptive use for Syrian refugee youth.

CONCLUSIONS: These results highlight that youth-friendly reproductive health services are having mixed efficacy in Jordan. Understanding barriers to contraception should inform family planning services for marginalized groups like Syrian refugee youth. There is a need for evidence-informed efforts to expand provision of family planning counselling and access to contraceptives for young married couples in Jordan, and especially for those living in formal refugee camps.

PMID:40707927 | DOI:10.1186/s13031-025-00690-0