Nevin Manimala

Trials. 2025 Dec 27. doi: 10.1186/s13063-025-09407-3. Online ahead of print.

ABSTRACT

BACKGROUND: Current analgesic options for hip arthroscopy include fascia iliaca block and peripheral nerve block of the hip. Although the latter provides effective analgesia with reduced motor impairment compared with the fascia iliaca approach, motor blockade still occurs in ≥ 25% of patients. This study aimed to investigate whether administering low-volume local anesthetic for peripheral nerve blockade in the hip reduces the incidence of postoperative quadriceps weakness while maintaining adequate pain control.

METHODS: A total of 90 patients who underwent hip arthroscopy were randomly assigned to one of three groups. The first group was administered a fascia iliaca compartment block (FICB), the second group was administered a pericapsular nerve group (PENG) block with 20 ml of local anesthetic, and the third group was administered a PENG block with 10 ml of local anesthetic. The primary outcome measure was postoperative quadriceps muscle strength, whereas the secondary outcome measures were the postoperative 2-h Numeric Rating Scale (NRS) score, intraoperative changes in blood pressure and heart rate, NRS score at one day after surgery, intraoperative and postoperative opioid consumption, postoperative complications, length of hospital stay, patient satisfaction, pain experience, and quality of recovery.

RESULTS: No evidence of a difference were observed in the basic statistical parameters among the three patient groups. Moreover, no significant discrepancies were identified in the NRS scores at the 2-h or 1-day post-operative intervals. However, a marked difference in quadriceps muscle strength was evident among the three groups at the 2-h post-operative mark (PENG 10 ml = 3.43 ± 0.45, PENG 20 ml = 2.43 ± 1.81, FICB = 0.57 ± 0.82; p < 0.001). There was a difference in the quality of postoperative recovery (PENG 10 ml = 125.57 ± 4.70, PENG 20 ml = 123.53 ± 5.45, FICB = 120.80 ± 3.34; p < 0.01), with no significant difference in any other outcome.

CONCLUSIONS: In patients undergoing hip arthroscopy, preoperative FICB, PENG (10 mL), and PENG (20 mL) blocks resulted in comparable intraoperative stress responses and provided comparable, satisfactory postoperative analgesia.However, patients who received low-volume PENG blocks demonstrated superior postoperative preservation of quadriceps muscle strength and a statistically significant improvement in the quality of recovery. Notably, the magnitude of this improvement in recovery quality did not exceed the minimal clinically important difference.

TRIAL REGISTRATION NUMBER: ChiCTR2400091099. Date: October 21, 2024; retrospectively registered. URL: https://www.chictr.org.cn/.

PMID:41454400 | DOI:10.1186/s13063-025-09407-3

J Health Popul Nutr. 2025 Dec 26. doi: 10.1186/s41043-025-01151-3. Online ahead of print.

ABSTRACT

BACKGROUND: Despite global efforts to improve maternal health outcomes, many regions, including Uganda, continue to face challenges in achieving optimal maternal healthcare utilization. This study aims to investigate how restricted autonomy in household decision-making by significant others affects inadequate use of maternal healthcare services among married women in Uganda. Inadequate use of maternal healthcare services refers to not meeting all four WHO-recommended standards for ANC timing, ANC visits, place of delivery, and PNC timing.

METHODS: Secondary data from the latest 2016 Uganda Demographic and Health Survey (UDHS 2016) were used for this study. Data from 7906 married women of childbearing age were analyzed using a multilevel binary logistic regression approach.

RESULTS: The inadequate use of maternal healthcare services was estimated to be 39.1%. The odds of inadequate use were 17% higher among women with moderate restricted autonomy in household decision-making by significant others compared to women with low restrictions [Adjusted Odds Ratio (AOR) = 1.17, 95% Confidence Interval (CI) = 1.02-1.34]. Inadequate use of MHCS decreases with an increase in the household wealth index. Women from the richest household [(AOR) = 0.52, 95% CI = 0.39,0.70] were less likely to report Inadequate use of maternal healthcare services compared to the poorest. Employed women were less likely [AOR = 0.73, 95% CI = 0.62-0.84] to report inadequate use of maternal healthcare services. Women who reside in the northern region of Uganda were significantly less likely [AOR = 0.72, 95% CI = 0.52-0.99] to report inadequate use of maternal healthcare services compared to those who reside in the central region.

CONCLUSION: The study concluded that the restricted autonomy in household decision-making by significant others plays a crucial role in the use of maternal healthcare services among married women in Uganda. Factors such as maternal age, household wealth index, employment status, and region of residence were also associated with inadequate use of maternal healthcare services. Therefore, to achieve Sustainable Development Goal (SDG) 3.1, the government and policymakers should engage significant others in maternal health programs, promote regional equity, female labor force participation, education, and autonomy in health decision-making.

PMID:41454391 | DOI:10.1186/s41043-025-01151-3

Arthritis Res Ther. 2025 Dec 26. doi: 10.1186/s13075-025-03716-3. Online ahead of print.

ABSTRACT

BACKGROUND: The influence of physical activity (PA) patterns on gout risk is unclear. We investigated the associations of accelerometer-derived PA patterns, specifically regularly active (RA) and weekend warrior (WW), with incident gout.

METHODS: We analyzed 97,387 gout-free UK Biobank participants with 7-day wrist-worn accelerometer data. Participants were categorized as inactive (< 150 min/week moderate-to-vigorous PA [MVPA]), WW (≥ 150 min MVPA with ≥ 50% concentrated in 1-2 days), or RA (≥ 150 min MVPA, not meeting WW criteria). Multivariable Cox models estimated hazard ratios (HRs) for incident gout.

RESULTS: During a median 8.0 years’ follow-up, 833 gout cases occurred. In minimally adjusted models, both RA (HR = 0.67, 95% CI: 0.55-0.83, P < 0.001) and WW (HR = 0.76, 95% CI: 0.65-0.89, P < 0.001) patterns showed reduced risk compared to inactive pattern. However, results diverged after further adjustment for baseline sUA: the RA pattern maintained a robust protective association (HR = 0.79, 95% CI: 0.65-0.98, P = 0.029), whereas the association for the WW pattern was attenuated and lost statistical significance (HR = 0.93, 95% CI: 0.79-1.08, P = 0.331). Subgroup analyses revealed significant interactions with comorbidities (P for interaction < 0.01), where the WW pattern showed no inverse association in participants with hypertension or chronic kidney disease, while RA remained protective. These findings were robust across sensitivity analyses and genetic risk strata.

CONCLUSION: While any moderate-to-vigorous physical activity is beneficial, the regularly active pattern demonstrates a more robust inverse association with gout than the weekend warrior pattern. Regularity in physical activity appears crucial for gout risk reduction, particularly for metabolically vulnerable individuals, as the sporadic nature of the weekend warrior pattern may be insufficient to counteract established metabolic risks.

PMID:41454374 | DOI:10.1186/s13075-025-03716-3

Malar J. 2025 Dec 26. doi: 10.1186/s12936-025-05751-6. Online ahead of print.

ABSTRACT

BACKGROUND: Malaria remains a major public health challenge in sub-Saharan Africa, and its burden may be influenced by access to clean water, sanitation, and childhood vitamin A supplementation. Understanding how these indicators relate to malaria incidence can help inform targeted prevention strategies.

METHODS: Country-level data from global health databases were analyzed using nonparametric statistical tests and machine learning models. The Kruskal-Wallis test and Dunn’s post hoc comparisons were used to assess differences in malaria incidence across categories of water and sanitation access. Cliff’s delta was used to measure effect sizes. Tree-based machine learning models and logistic regression were trained to evaluate the predictive strength of the three indicators.

RESULTS: Significant differences in malaria incidence were found across water and sanitation access groups, with the lowest access groups consistently exhibiting the highest incidence. Cliff’s delta indicated large effect sizes, particularly between low and high access categories. Vitamin A supplementation showed statistically significant group differences, though effect sizes were generally small. Tree-based machine learning models showed moderate predictive performance and outperformed logistic regression in classification accuracy and recall.

CONCLUSIONS: Access to clean water and adequate sanitation are strongly associated with lower malaria incidence, underscoring their importance in malaria control efforts. While vitamin A supplementation shows weaker associations, it may still interact with broader health conditions. These findings highlight the essential role of basic infrastructure in reducing malaria burden and demonstrate the potential of predictive modeling to support future global health research.

PMID:41454365 | DOI:10.1186/s12936-025-05751-6

BMC Public Health. 2025 Dec 26. doi: 10.1186/s12889-025-26055-z. Online ahead of print.

NO ABSTRACT

PMID:41454364 | DOI:10.1186/s12889-025-26055-z

J Health Popul Nutr. 2025 Dec 26;44(1):426. doi: 10.1186/s41043-025-01192-8.

ABSTRACT

BACKGROUND: Despite advancements in the use of maternity care services, certain nations in sub-Saharan Africa continue to record unacceptable rates of maternal and perinatal morbidity and mortality, particularly in the postnatal period. This study aimed to assess the level of postnatal care service utilisation and associated factors among multiparous women in Buyamba County, Rakai District, Uganda.

METHOD: A community-based cross-sectional study involving women who had two or more children was conducted in four sub-counties of Buyamba County. Study participants were recruited using a systematic sampling technique. A structured and pre-tested questionnaire was used to gather data. Descriptive, bivariate and modified poisson regressions were computed using STATA version 14. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by prevalence ratios with 95% confidence intervals.

RESULT: Out of 321 women who participated in the study, (81.9%) were married, (30.8%) were aged 35-44 years, (71.0%) attended antenatal care (ANC) during their previous pregnancy, (94.7%) delivered normally, and (94.4%) utilised postnatal care (PNC) services of which (67.2%) received immunisation for the children, (26.2%) acquired family planning counseling and (70.3%) had four or more PNC visits. Attending antenatal care (aPR = 1.750; 95% CI: 1.029-2.981), being aware of PNC services (aPR = 1.380; 95% CI: 1.016-1.875), receiving PNC education (aPR = 1.421; 95% CI: 1.048-1.923), having a normal delivery (aPR = 1.538; 95% CI: 1.055-2.241), and residing within 5 km of a health facility (aPR = 1.282; 95% CI: 1.006-1.632) were significantly associated with a higher likelihood of utilising postnatal care services. In contrast, being younger in age (aPR = 0.511; 95% CI: 0.347-0.752) and having a husband without formal education (aPR = 0.622; 95% CI: 0.454-0.853) were significantly associated with a lower likelihood of postnatal care services utilisation.

CONCLUSION: The study identified several maternal, spousal, and accessibility factors influencing postnatal care utilisation. Enhancing maternal health education, improving facility access, involving partners, and strengthening antenatal counseling and community sensitisation can increase PNC utilisation and improve maternal and neonatal health outcomes.

PMID:41454360 | DOI:10.1186/s41043-025-01192-8

BMC Musculoskelet Disord. 2025 Dec 26. doi: 10.1186/s12891-025-09408-y. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: The Ponsetimethod has been popularized for treating recurrent idiopathic clubfoot and, more recently, recurrent clubfoot following posteromedial (PMR) or posterior (PR) release. A retrospective study was performed to determine the functional outcome in Ponseti treatment of recurrent idiopathic clubfoot after PMR or PR. The study also aimed to determine whether clinical scoring systems (Pirani and Dimeglio scores) could be predictive for the initial numbers of casts, Achilles tenotomy, ankle dorsiflexion after initial treatment, relapse, and functional outcomes following the Ponseti method of treatment.

METHODS: This was a retrospective study of 17 consecutive patients (27 feet) treated with the Ponseti method for recurrent clubfoot after PMR or PR. Clinical charts were reviewed for sex, laterality, age at initial visit to our institution, age at the first surgery, initial number of casts, undergoing a percutaneous Achilles tenotomy (PAT) or not, clinical presentation, Pirani and Dimeglio scores, range of motion of ankle dorsiflexion after initial treatment, the International Clubfoot Study Group (ICFSG) rating system, and recurrences following the Ponseti method of treatment. We conducted descriptive statistical analyses between patients who rated as excellent, or good and fair in the ICFSG rating system following the Ponseti method of treatment. Outcome and demographic data were analyzed using an independent student’s t-test for means and Fisher exact test for proportional data.

RESULTS: Dimeglio and Pirani scores were not helpful in predicting whether or not a PAT was performed (p > 0.01), ankle dorsiflexion after initial treatment (p > 0.01), and relapse after initial treatment (p > 0.01). There was no statistical correlation between functional outcomes and the number of serial casts (p > 0.01), undergoing a PAT or not, (p > 0.01), ankle dorsiflexion (p > 0.01), and relapse (p > 0.01) after initial treatment. We found a statistical relationship between the initial clinical severity and the number of casts required for clubfoot correction (p = 0.005), and a significant statistical correlation between the initial scores of Pirani (p = 0.001) and Dimeglio (p < 0.001) with the final scores of the ICFSG rating system.

CONCLUSIONS: Ponseti treatment for recurrent idiopathic clubfoot following PMR or PR achieved a satisfactory functional outcome in most patients. The Dimeglio and Pirani scoring systems provided a prognostic value for the initial number of casts and functional outcomes for clubfeet recurring after PMR or PR treated by the Ponseti method. The better functional outcomes were attributed to less initial severity of the previously operated clubfeet.

LEVEL OF EVIDENCE: Level IV, therapeutic study.

PMID:41454357 | DOI:10.1186/s12891-025-09408-y

Child Adolesc Psychiatry Ment Health. 2025 Dec 26. doi: 10.1186/s13034-025-00975-5. Online ahead of print.

ABSTRACT

BACKGROUND: Secondary schools are increasingly delivering a range of mental health interventions with varied success. This trial examined the effectiveness of two implementation strategies, allocation of class time and provision of financial incentives, on the engagement of secondary students with a universal web-based mental health service, Smooth Sailing.

METHODS: A three-arm, cluster-randomised trial was conducted over 12 weeks with Grade 8 and 9 students from 20 schools in two Australian states. Schools were randomised to: (1) the standard Smooth Sailing service, (2) the standard service plus extra class time, or (3) the standard service plus financial incentives. The primary outcome was student engagement, measured by the number of modules accessed at 12-weeks post-baseline. Secondary outcomes included uptake, retention, help-seeking intentions for mental health problems, service satisfaction, and barriers to use.

RESULTS: A total of 20 schools consented, and 1295 students participated. Students accessed a higher number of modules in the enhanced conditions compared with the standard service, but the differences were not statistically significant (p = 0.14). There were no significant differences in uptake (p = 0.55) or retention (p = 0.95) between conditions. Help-seeking intentions significantly improved at 6- and 12-weeks in the standard service and class time conditions only. Common barriers to service use among students were forgetfulness and low motivation.

CONCLUSIONS: Neither class time allocation nor financial incentives significantly increased student engagement, as measured by modules accessed, highlighting the challenges of optimising engagement with digital mental health services in schools and emphasising the need to consider the broader school context. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN12621000225819) and Universal Trial Number (U1111-1265-7440).

PMID:41454356 | DOI:10.1186/s13034-025-00975-5

Mol Autism. 2025 Dec 26. doi: 10.1186/s13229-025-00692-y. Online ahead of print.

NO ABSTRACT

PMID:41454355 | DOI:10.1186/s13229-025-00692-y

Eur J Med Res. 2025 Dec 26. doi: 10.1186/s40001-025-03707-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Aimed to reveal the complex associations between Life’s Essential 8 (LE8), depressive symptoms and nonalcoholic fatty liver disease (NAFLD), and to explore the mediating role of depressive symptoms in the pathways of LE8 components affecting NAFLD.

METHODS: Based on nationally representative data of 8908 adults ≥ 20 years from the 2005-2018 National Health and Nutrition Examination Survey (NHANES), weighted logistic, regression, restricted cubic spline(RCS), threshold effect and bootstrap mediated-effects analyses were used to assess the association between LE8, NAFLD and depressive symptoms associations, and stratified analysis reveals the heterogeneity of the association in population.

RESULTS: Each one-point increase in the LE8 was associated with a reduced risk of NAFLD, OR (95% CI) = 0.19(0.16, 0.23), with health factor score showing particularly protective effect, OR (95% CI) = 0.09 (0.07, 0.10). These associations were stronger among women, older, and PIR (poverty-to-income ratio) > 3.5. A dose-response relationship was evident, with a positive correlation between severe depression and NAFLD, OR (95% CI) = 2.01(1.05, 3.85). Crucially, depressive symptoms constituted a significant mediating pathway in health behaviors, accounting for 46.78%, 17.74%, and 5.79% of the protective effects of optimal sleep health, adequate physical activity, and diet on NAFLD, respectively. Regarding nicotine exposure, depressive symptoms exerted a partial inhibitory effect, with the mediating effect accounting for -27.55%. However, for the association between health factors and NAFLD, depressive symptoms do not play a mediating role in the association.

CONCLUSIONS: This study is the first to confirm that depressive symptoms mediate the relationships between specific LE8 components and NAFLD. LE8 components are significantly correlated with NAFLD, possibly via depression-supporting a “physiological-psychological” integrated approach to NAFLD management. Targeted interventions for depressive symptoms may augment the benefits of optimized LE8 in high-risk populations.

PMID:41454340 | DOI:10.1186/s40001-025-03707-9