Nevin Manimala

Eur J Med Res. 2025 Aug 21;30(1):786. doi: 10.1186/s40001-025-03065-6.

ABSTRACT

BACKGROUND: Epilepsy is a neurological disorder that can affect individuals of all genders and ages. Recent studies have indicated that the Mediterranean diet exerts a neuroprotective effect through its anti-inflammatory and antioxidant properties in non-Mediterranean regions. However, the association between the Mediterranean diet and epilepsy requires further elucidation.

METHODS: A total of 14,259 participants were enrolled in this study from the National Health and Nutrition Examination Survey (NHANES) database, spanning the period from 2013 to 2018. Weighted logistic regression analysis assessed the association between Mediterranean diet adherence and epilepsy. Random forest analysis was conducted to evaluate the relative importance of diet components. Furthermore, mediation analysis with bootstrapping was employed to explore the mediating role of epilepsy.

RESULTS: After adjusting for all potential covariates, higher Mediterranean diet adherence was associated with a lower risk of epilepsy (OR = 0.50, 95% CI 0.27-0.95, P = 0.033). Moreover, whole grain was identified as a pivotal component. Mediation analysis revealed that stroke functioned as a potential mediating factor in the association between Mediterranean diet adherence and epilepsy (mediation proportion = 6.49%, P = 0.034). In addition, interaction analysis suggested an interaction between the Mediterranean diet and diabetes (P = 0.029).

CONCLUSIONS: These novel findings suggested that higher adherence to the Mediterranean diet was linked with a lower risk of epilepsy, with stroke having a potential mediating role in the association. Promoting the Mediterranean diet may be a strategy for epilepsy management, supporting the need for further longitudinal studies.

PMID:40842033 | DOI:10.1186/s40001-025-03065-6

BMC Psychol. 2025 Aug 21;13(1):953. doi: 10.1186/s40359-025-03304-9.

ABSTRACT

BACKGROUND: The Dental Anxiety Scale (DAS) is a well-established instrument for assessing dental anxiety. While numerous cross-sectional studies have examined the DAS, longitudinal research investigating age-related changes, reliability, validity over time, associations with mental and physical health, and demographic determinants remains limited. Furthermore, the possibility of longitudinal changes in its factor structure has received limited attention.

METHODS: In 2013/2014, N = 329 German adults (53.6% female, mean age 40.20 years) and in 2019/2020, N = 323 adults (55.7% female, mean age 47.15 years) completed questionnaires, including the DAS, Oslo Social Support Scale (OSSS-3), Health-Score (G-Score), Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Screener (GAD-2), Short Scale for General Life Satisfaction (L-1), and oral health behavior items. DAS reliability was assessed using Cronbach’s alpha and McDonald’s omega, and factor structure via principal component analyses (PCA). Longitudinal dynamics were analyzed using McNemar’s test. Associations between dental anxiety and independent variables were investigated using correlational analyses and Wilcoxon signed-rank tests.

RESULTS: DAS significantly declined from 2013/2014 (M = 9.47) to 2019/2020 (M = 9.21). Internal consistency was excellent (α/Ω = 0.93), and a correlation of dental anxiety across waves was high (rs = 0.79). PCA revealed a stable one-factor structure (2013/2014: 82.25%, 2019/2020: 82.86% explained variance). McNemar test indicated no significant changes in the proportion of subjects with or without dental anxiety over time. Higher dental anxiety was significantly correlated with lower levels of: life satisfaction, perceived influence over health, condition of health, physical and mental health, and social support in both waves (all rs ≥ 0.14; p ≤ 0.015). A significant decrease in dental anxiety over time was observed in participants with frequent tooth brushing, no indication for depression, and at least moderate social support (all z ≤ -2.07, all p ≤ 0.019).

CONCLUSIONS: This study provides evidence for DAS’s reliability, temporal stability, and construct validity. Although dental anxiety showed a statistically significant decline it remains relatively stable for most participants. Findings indicate meaningful associations with psychosocial, behavioral, and health-related factors, supporting the potential value of interdisciplinary approaches that include psychological support in oral health care.

PMID:40842032 | DOI:10.1186/s40359-025-03304-9

Chiropr Man Therap. 2025 Aug 21;33(1):34. doi: 10.1186/s12998-025-00596-x.

ABSTRACT

BACKGROUND: Continuing education (CE) for chiropractors is mandated by state licensing boards to ensure ongoing learning and to maintain professional excellence. While incorporating research into CE programs is crucial for practitioners to remain dynamic and evidence-based, conducting research and academic pursuits is necessary for further development of the profession. We hypothesized that fewer U.S. states would provide CE credit for the completion of research or higher-education teaching activities within the chiropractic profession compared to other health professions.

METHODS: Internet searches of publicly available state board websites for each profession was undertaken with a cross-sectional study design between 12/19/2024 and 03/01/2025. Data extraction focused on whether CE was granted for research (publication and/or peer review) as well as academic pursuits (higher education and/or CE instruction). Descriptive statistics determined the frequency of states allowing CE while Fisher’s Exact test and one-way ANOVA was performed to compare states granting CE credits for research and teaching as well as comparisons among the professions.

RESULTS: Only 16 US states allow DCs to claim research activities for CE credit while 50% allow teaching for CE credit. This is significantly lower (p < 0.001) than ATs, DOs, and MDs where teaching and research activities are accepted for CE credit in all states.

CONCLUSIONS: Precluding research and higher-education teaching opportunities for CE presents a potential barrier to chiropractic academic and research development at present and in the future.

PMID:40842019 | DOI:10.1186/s12998-025-00596-x

BMC Oral Health. 2025 Aug 21;25(1):1353. doi: 10.1186/s12903-025-06745-1.

ABSTRACT

BACKGROUND: Green dentistry promotes sustainable practices in oral healthcare. As environmental challenges intensify, integrating eco-friendly principles into dental education and practice becomes increasingly important. To advance sustainability in oral health settings, it is crucial to comprehend the knowledge, attitudes, and practices (KAP) of dental professionals and students. Despite growing interest, there is scarcity of research on green dentistry and a lack of standardized, validated tools to measure KAP makes it more difficult to compare studies. The rationale for this study was to conduct a psychometric analysis of a KAP questionnaire designed to assess eco-friendly clinical dental practices among dental school personnel and students in a dental school of Karachi.

METHOD: A 43-item questionnaire on green dentistry, adapted from existing green models and literature, and further validated through expert consultation and psychometric analysis, covers knowledge, attitudes, and practices. This cross-sectional pilot study involved 150 dental school personnel and students from the clinical side of an institution, using a self-administered, web-based questionnaire based on the Green Dental Model (GDM). The construct validity of ‘knowledge’ and ‘practice’ sections of the questionnaire was assessed using Partial Least Squares- Structural Equation Modeling (PLS-SEM) whereas Exploratory Factor Analysis (EFA) to uncover the latent factor structure of the ‘attitude’ section.

RESULTS: Findings indicate that the model was identified as formative, with VIF values (< 5) indicating no multicollinearity. Through careful decision-making, almost all formative indicators were retained based on outer loads > 0.5. In EFA, factor loadings for the three extracted factors exceeded the reliability threshold. Factor 1 dealt with digital radiography and energy and water conservation; factor 2 involved waste management, recycling, and sterilization; and factor 3 represented green practices as a financial burden.

CONCLUSION: The instrument’s construct validity and feasibility makes it a valuable resource for sustainability focused researchers and dental professionals. This study uses advanced statistical techniques intended to address the questionnaire’s formative and reflective elements, improving the validity of assessment, a factor that was frequently overlooked in other studies on green dentistry. The distinctive contribution of this novel approach to the existing body of literature could facilitate potential research on the tool’s responsiveness to interventions on KAP change.

PMID:40842016 | DOI:10.1186/s12903-025-06745-1

BMC Womens Health. 2025 Aug 21;25(Suppl 1):398. doi: 10.1186/s12905-025-03945-3.

ABSTRACT

BACKGROUND: The self-administration of the subcutaneous depot medroxyprogesterone acetate (DMPA-SC) has the potential to empower women and improve contraceptive use. Several studies have demonstrated the acceptability of the provider-administered DMPA-SC, for private, public, or community-based health providers, but less is known about self-injection training from community pharmacists (CPs) and Patent and Proprietary medicine Vendors (PPMVs) (also known as drug shops). The purpose of this study was to examine the factors associated with the acceptance of DMPA-SC self-injection training when provided by trained CPs and PPMVs in Lagos and Kaduna states.

METHODS: A cross-sectional study was conducted among 186 women of reproductive age (18-49 years) who received self-injection training on DMPA-SC from trained CPs and PPMVs between August and September 2019, and between May 2022 and June 2023. Women who selected DMPA-SC, opted for self-injection, and were trained by a CP or a PPMV were invited to participate in the study. Quantitative telephone interviews were conducted with eligible clients within six (6) weeks of obtaining DMPA-SC commodities for self-injection from a trained CP or PPMV. Bivariate chi-square test and multivariate logistic regression were used to examine factors associated with acceptability and continued self-injection of DMPA-SC at home. The results were considered significant at a p value < 0.05.

RESULTS: More than half of the women had used a contraceptive in the past (55%), and 73% received information on DMPA-SC from a CP or PPMV. Using a family planning method prior to visiting the provider (Odds ratio (OR) = 4.31; 95% Confidence Intervals (CIs): 1.05, 17.69; p = 0.04), receiving information on DMPA-SC from friends/relative (OR = 5.08; 95% CI: 1.01, 25.62; p = 0.05), perceived high-quality care (OR = 7.72; 95% CI: 2.52, 23.61; p = 0.00) and middle-quality care (OR = 3.35; 95% CI: 1.16, 9.69; p = 0.03) were significantly associated with the likelihood of continued DMPA-SC self-injection at home. A high level of acceptance of training in DMPA-SC self-injection was significantly associated with service from PPMVs (OR = 4.94; 95% CI = 1.46, 16.75; p = 0.01) and perceived high-quality care (OR = 4.23; 95% CI = 1.62, 11.05; p = 0.00).

CONCLUSIONS: The results are promising for expanding DMPA-SC self-injection service delivery in Nigeria through increased method choice, and empowered users. The provision of counseling and DMPA-SC self-injection training by CPs and PPMVs is acceptable among women in Lagos and Kaduna states.

PMID:40842014 | DOI:10.1186/s12905-025-03945-3

Malar J. 2025 Aug 21;24(1):272. doi: 10.1186/s12936-025-05406-6.

ABSTRACT

BACKGROUND: Long-lasting insecticidal nets (LLINs) have been distributed and installed in the Dominican Republic since 2008, and they remain the main vector control intervention used to pursue malaria elimination in the country. However, LLIN performance remains unclear due to a lack of monitoring over the past decade.

METHODS: A cross-sectional household survey was conducted to monitor LLIN coverage, access, use, physical integrity, washing and drying practices, and the time people go to bed and wake up in the two main malaria foci of the country: Azua (4-6 months post-distribution and installation) and San Juan (one year post-distribution and installation).

RESULTS: The percentage of sleeping spaces that could be covered with a LLIN given the LLINs present in the household was 64% in Azua and 63% in San Juan; with any net, coverage was 75% in Azua and 80% in San Juan. Reported LLIN retention was 88.4% in Azua and 80.9% in San Juan. The percentage of people who had access to sleeping under an LLIN was 58.8% in Azua and 65.4% in San Juan. Among people with LLIN access (people with enough LLINs to cover all sleeping spaces in their household), use was 48.8% in Azua and 75% in San Juan; and overall, LLINs use was 32.3% in Azua and 50.5% in San Juan. Most LLINs remained in serviceable physical condition (Azua: 96.4%, San Juan: 88.9%) but those with holes were not repaired. Most LLINs were washed with aggressive products (Azua: 65%, San Juan: 86%), at a frequency that suggests they will be washed more than twenty times in three years (Azua: 52%, San Juan: 73%), and dried under the sun (Azua: 75%, San Juan: 90%).

CONCLUSION: Poor washing and drying practices are prevalent in both areas, low LLIN use was observed in Azua and some LLIN coverage gaps were measured in both foci. Urgent behavioural change strategies are needed to improve LLIN care in both foci and to increase LLIN use in Azua, alongside revisions to LLIN quantification methods to ensure full coverage of all sleeping spaces in use during installation. Heterogeneities in LLINs use across foci suggest the need for monitoring use in each distribution area to identify individual gaps and promptly address them.

PMID:40842007 | DOI:10.1186/s12936-025-05406-6

BMC Endocr Disord. 2025 Aug 21;25(1):198. doi: 10.1186/s12902-025-02018-8.

ABSTRACT

BACKGROUND: Diabetes screening is one of the simpler methods for preventing and lowering the disease’s morbidity and mortality. Screening for gestational diabetes is a crucial component of obstetric care, as it negatively affects the life of both the mother and the fetus. There is a high prevalence of obesity, diabetes, high blood pressure, and tobacco use in Lesotho. This highlights the significance of bolstering prevention and treatment initiatives in the country. Therefore, this study is intended to assess diabetes screening and its associated factors among women aged 15-49 years using the 2023-24 Lesotho demographic and health survey dataset.

METHODS: A cross-sectional study was employed using data from the most recent national representative dataset. A total sample of 3,297 women aged between 15 and 49 years was included in the study. Data extracted from the Lesotho Demographic and Health Survey 2023-24 data sets were cleaned, recoded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel logistic regression was used to determine the factors associated with the outcome variable. Finally, variables with a p-value less than 0.05 were declared statistically significant.

RESULTS: In the current study, 29.18% (95% CI: 27.65%-30.75%) of women aged 15-49 years in Lesotho were screened for diabetes mellitus. Of these, 1.40% of them had high blood sugar or diabetes, and 54.35% of women were diagnosed in the last twelve months. Age of respondents [AOR = 3.53; 95% CI (2.80, 4.46)], maternal occupation [AOR = 1.38; 95% CI (1.15, 1.65)], wealth status [AOR = 1.43; 95% CI (1.07, 1.91)], and visiting a healthcare facility in the last 12 months [AOR = 1.31; 95% CI (1.09, 1.57)] were statistically significantly associated with diabetes screening.

CONCLUSION: Less than one in three women aged 15 to 49 years were screened for diabetes in Lesotho. Advanced age, working women, wealthier households, and visiting a healthcare facility in the last 12 months were associated with higher odds of diabetes screening. Therefore, women’s empowerment, regular visits to healthcare facilities, and awareness creation for young women are recommended to improve diabetes screening practices among women.

PMID:40842005 | DOI:10.1186/s12902-025-02018-8

BMC Pregnancy Childbirth. 2025 Aug 21;25(1):870. doi: 10.1186/s12884-025-08009-w.

ABSTRACT

BACKGROUND: The association between unplanned pregnancy and perinatal depression is understudied in racially and ethnically diverse and low-income populations. The present study was compromised of a secondary analysis of data from a low-income and 70% racially and ethnically minoritized sample to examine associations between unplanned pregnancy and perinatal depressive symptoms and to explore potential moderation by social factors.

METHODS: Pregnant individuals (n = 808) were enrolled in a larger study evaluating the effectiveness of a preventative intervention for postpartum depression, and self-reported depressive symptoms were collected prenatally and at 12 weeks postpartum using the 16-item Quick Inventory of Depressive Symptomatology. Multiple linear regression examined the relationship between unplanned pregnancy and maternal depressive symptoms, and the potential interactions between unplanned pregnancy and (1) race/ethnicity (2), education level (3), first-time parent status, and (4) a prenatal mental healthcare utilization. Analyses were conducted both within the sample as a whole and within racial/ethnic subgroups.

RESULTS: While bivariate regression revealed a significant association between unplanned pregnancy and prenatal depressive symptoms (β = 0.88, 95% CI [0.27, 1.49], p = 0.005), unplanned pregnancy was not significantly associated with prenatal or postpartum depression in adjusted models in the full sample. Analyses suggested different trends in racial/ethnic subgroups. Specifically, endorsing prenatal mental healthcare utilization and unplanned pregnancy was associated with higher prenatal depressive symptoms in the Latine subgroup compared to those whose pregnancies were planned (β = 4.59, 95% CI [0.60, 8.59], p = 0.025). Additionally, unplanned pregnancy was associated with higher depressive symptoms at 12 weeks postpartum compared to those with planned pregnancy also in the Latine sample (β = 1.06; 95% CI [0.10, 2.03], p = 0.031). Unplanned pregnancy was not found to be associated with prenatal depressive symptoms in the adjusted models of any other racial/ethnic subgroups.

CONCLUSIONS: These secondary analyses from a larger study suggest potentially important differences in the association between unplanned pregnancy and perinatal depressive symptoms by racial/ethnic subgroups. Future research should acknowledge the myriad stressors and protective factors experienced by low-income and racially and ethnically diverse perinatal populations when evaluating differences in outcomes among racial/ethnic subgroups.

PMID:40842004 | DOI:10.1186/s12884-025-08009-w

Glob Health Res Policy. 2025 Aug 21;10(1):36. doi: 10.1186/s41256-025-00439-5.

ABSTRACT

BACKGROUND: Optimizing the cultural accessibility of digital healthcare tools requires understanding user perspectives on usability features and cultural appropriateness.

METHODS: A cross-sectional survey of 3,030 caregivers (mean age 44.0, 52.9% female) and 2,108 inpatients (mean age 49.7, 54.0% female) at a Guangxi medical center (July-October 2024) assessed experiences with digital tools, support needs, and preferences for culturally adaptive features.

RESULTS: Caregivers reported a higher adoption of digital tools than patients (caregivers: 87.1% vs. patients: 62.0%, P-value < .001), yet 81.1% of caregivers reported unmet needs. Both groups (caregivers: 67.0%; patients: 64.0%) prioritized integrating traditional medicine over other cultural factors (language diversity, traditional medicine, folk customs, and medical resource availability). Caregivers valued interactive health management tools (73.3% vs. 66.7% among patients, P-value < .001) and user feedback mechanisms (61.2% vs. 55.0% among patients, P-value < .001) more than patients.

CONCLUSIONS: Despite high adoption, caregivers report significant gaps in culturally relevant support. Digital health interventions should prioritize user-centered designs, incorporating traditional medicine and addressing the divergent preferences of caregivers and patients.

PMID:40841989 | DOI:10.1186/s41256-025-00439-5

BMC Sports Sci Med Rehabil. 2025 Aug 21;17(1):244. doi: 10.1186/s13102-025-01299-9.

ABSTRACT

BACKGROUND: The lunge is a critical movement in badminton, facilitating rapid and efficient court coverage and enabling players to promptly reach the hitting position. While previous studies have examined the influence of lunge direction on lower limb biomechanics, the effects of gender have yet to be explored. Therefore, the purpose of this study was to investigate the combined effects of direction and gender on lower limb biomechanics during forehand and backhand forward lunges in amateur badminton players.

METHODS: 16 male and 16 female amateur players were recruited. Kinematic and kinetic data were measured synchronously using a Vicon motion capture system and a Kistler force plate. A two-way mixed-design ANOVA was used to explore the effects of different lunge directions, gender, and the interaction between the two factors on each parameter. Joint angles during the stance phase were analyzed using the statistical nonparametric mapping method.

RESULTS: Interaction effects between gender and direction were observed for the second impact of vertical ground reaction force (VGRF), knee peak external rotation moment, ankle sagittal angles and knee frontal and transverse moments during the stance phase. Compared with the females, the males showed significantly greater loading rate and impulse of VGRF, peak flexion, sagittal range of motion (ROM) and abduction moment of knee joint. The sagittal ROM of hip and knee joint and the knee flexion moment around 84% of the stance phase during backhand lunge was significantly greater than during forehand lunge. In contrast, the sagittal ROM of ankle joint and peak abduction moment of knee joint was significantly lower during backhand lunge.

CONCLUSIONS: Gender-specific biomechanical strategies influence knee loading patterns during badminton lunges, contributing to direction-dependent variations in injury risk. These findings underscore the importance of incorporating directional biomechanical demands and sex-specific neuromuscular adaptations into training and injury prevention programs to mitigate injury risks.

PMID:40841982 | DOI:10.1186/s13102-025-01299-9