Nevin Manimala

Patient Educ Couns. 2026 Jan;142:109397. doi: 10.1016/j.pec.2025.109397. Epub 2025 Oct 20.

ABSTRACT

BACKGROUND: Health literacy plays a crucial role in traditional healthcare access, engagement, and outcomes, yet its impact within newer digital mental health (dMH) services remains unknown. This is a significant knowledge gap given that the digitalisation of mental health care is predicated on the idea of improving access and outcomes for traditionally underserved groups. This study aimed to investigate the prevalence and correlates of limited health literacy among routine care dMH service users.

METHODS: A prospective cohort study was conducted using data from 4578 adults who completed an initial assessment for a large national dMH service between January and June 2024. Limited health literacy was assessed using the Single Item Literacy Screener (SILS) (i.e., scored ≥ 3 out of 5). Analyses examined associations between limited health literacy and user characteristics, treatment enrolment and initiation.

RESULTS: At initial assessment, 11.4 % of participants reported limited health literacy, with these individuals more likely to be younger, have lower educational attainment, less proficiency in English, not be in employment nor married, and identify as Aboriginal and/or Torres Strait Islander (all ps<.001). They also reported more severe symptoms of depression and anxiety, and higher suicide risk (all ps<.001). Limited health literacy was not significantly associated with treatment enrolment nor initiation (ps = 0.322 – 0.985).

DISCUSSION: Findings indicate that a meaningful proportion of routine care dMH service users have limited health literacy, and this does not appear to impede access to the treatments provided by these services. Thus, dMH services may go some of the way to providing mental health treatment for groups who face heightened barriers to accessing healthcare. Further research is needed to ascertain whether limited health literacy impacts on users’ ongoing treatment engagement and outcomes, as well as which aspects of dMH service design and delivery may benefit users with diverse health literacy levels.

PMID:41390986 | DOI:10.1016/j.pec.2025.109397

Clin Transl Sci. 2025 Dec;18(12):e70405. doi: 10.1111/cts.70405.

ABSTRACT

The kidney benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients receiving contrast media remain unclear. This Taiwanese cohort study investigated the short- and long-term effects of SGLT2i on adverse kidney outcomes in patients receiving contrast media between January 1, 2016 and December 31, 2018. Patients who had used SGLT2i in the 90 days prior to receiving contrast media were matched with non-users. Cox proportional hazards regression was used to estimate the hazard ratio (HR) for the composite kidney outcome, which included acute kidney injury (AKI), acute kidney disease (AKD), and a sustained ≥ 30% reduction in estimated glomerular filtration rate (eGFR) confirmed after 3 months. The absolute mean change in eGFR over time was compared using a linear mixed-effects model. The final analysis included 1032 patients (SGLT2i: 344; control: 688). During follow-up, the overall composite adverse kidney event rate was 32.8%. Although the SGLT2i group had a lower event rate (29.94%) than the non-SGLT2i group (34.3%), this difference was not statistically significant (HR, 0.95; 95% CI, 0.75-1.20). Crucially, SGLT2i demonstrated a significant protective effect on long-term kidney function: the hazard for a ≥ 30% eGFR reduction was significantly lower in SGLT2i users (HR, 0.48; 95% CI, 0.29-0.81). Exploratory analyses showed that this benefit-a slower rate of kidney function deterioration-was consistent across subgroups, including men, patients under 65 years, individuals with baseline eGFR < 60 mL/min/1.73 m², and patients with diabetes. While SGLT2i showed no significant short-term protection against AKI or AKD, these findings strongly suggest that SGLT2i confers significant long-term reno-protective benefits for patients receiving contrast media.

PMID:41390985 | DOI:10.1111/cts.70405

Rheumatology (Oxford). 2025 Dec 14:keaf680. doi: 10.1093/rheumatology/keaf680. Online ahead of print.

ABSTRACT

OBJECTIVES: We tested the hypotheses that individuals with gout would have distinct circulating inflammatory biomarker patterns compared with non-gout controls and that these differences would be attenuated with highly-effective urate-lowering therapy (ULT).

METHODS: This case-control and longitudinal cohort study utilized longitudinal serum samples from a subset of participants from the STOP Gout study and non-gout controls from an institutional biobank at a single time point. Twenty pre-selected inflammatory and cardiometabolic biomarkers were measured and varimax-rotated principal component analysis (PCA) performed. An inflammatory score was generated using standardized biomarker values representing PCs associated with gout and compared between controls and gout patients, and among gout patients over time. A generalized estimating equation was used to assess interactions between clinical factors and change in inflammatory score over time.

RESULTS: Five PCs statistically differed in gout (n = 278) at baseline vs. controls (n = 275) after accounting for covariates. Mean inflammatory scores of gout cases at all three time points were increased vs. controls (p < 0.001). There was a decrease in inflammatory scores at both 24- (p = 0.01) and 48-weeks (p < 0.001) vs. baseline among gout cases. Higher baseline score and time were associated with reductions in inflammatory score, whereas hypertension and higher baseline serum urate were associated with an increased inflammatory score.

CONCLUSION: Gout is characterized by distinct patterns of circulating inflammatory biomarkers and these appear to change over time with treat-to-target ULT to approximate controls. This study supports the importance of treat-to-target ULT in gout management not only for flare prevention, but also to mitigate systemic inflammation.

PMID:41390970 | DOI:10.1093/rheumatology/keaf680

Gerontologist. 2025 Dec 14:gnaf302. doi: 10.1093/geront/gnaf302. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Compared with people in any other age group, older adults worldwide have more suicidal ideation; however, their suicidal ideation is easily overlooked. Social support is currently one of the most widely researched social resources for preventing suicide. Currently, the impact of social support on suicidal ideation in this population is still uncertain. This study aimed to explore the impact of social support on suicidal ideation in older adults.

RESEARCH DESIGN AND METHODS: A comprehensive literature search was conducted across multiple databases, including the Web of Science, PubMed, EMBASE, CINAHL, Cochrane Library and Scopus databases. Two independent researchers selected the studies, extracted the data and evaluated their quality. Statistical analysis was performed using STATA version 18.0.

RESULTS: This review identified 23 studies, and 14 eligible studies were included in the meta-analyses. High social support was significantly associated with a low risk of suicidal ideation (OR, 0.75; 95% CI, 0.67 to 0.84; I 2 = 93.1%; P < 0.001). Social support is more effective in reducing the risk of SI in women than in men. Social support from families is most effective at reducing suicidal ideation in older adults, and social support can also influence suicidal ideation through mediating factors.

DISCUSSION AND IMPLICATIONS: Social support is significantly correlated with suicidal ideation in older adults. Medical staff or researchers can prioritise social support from families and develop targeted interventions to more effectively reduce the risk of suicidal ideation in older adults.

PMID:41390965 | DOI:10.1093/geront/gnaf302

Gerontologist. 2025 Dec 14:gnaf303. doi: 10.1093/geront/gnaf303. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Population aging underscores the need for a comprehensive understanding of the multi-level factors that support aging in place. Physical environments are closely linked to social environments, and caregivers often observe how these environmental features shape the everyday experience of people with memory problems. This study examines how caregivers’ perceptions of neighborhood built environments are associated with their perceptions of the social inclusion of people with memory problems in communities.

RESEARCH DESIGN AND METHODS: A statewide survey was conducted in Texas, involving 95 caregivers of individuals with memory problems (defined as having significant memory impairment that impacts daily functioning). Descriptive statistics summarized neighborhood characteristics and caregivers’ perception of the community’s social inclusion. Logistic regression predicted two target outcomes of social inclusion for people with memory problems: (1) respect and support and (2) intergenerational exchange (e.g., age-integrated social interactions).

RESULTS: For neighborhood characteristics, legibility-related environmental features were more commonly present than those related to accessibility or safety. For social inclusion, caregivers perceived positive community respect and support for people with memory problems but limited intergenerational interaction. Legibility of neighborhood environments was positively associated with caregivers’ perceptions of respect and support for people with memory problems, while accessibility was associated with intergenerational exchange.

DISCUSSION AND IMPLICATIONS: The findings underscore the role and potential of neighborhood environments for improving social inclusion for people living with memory problems. They suggest that improving legibility and accessibility of neighborhood environments can foster respect and social support and intergenerational exchanges central to aging in place.

PMID:41390960 | DOI:10.1093/geront/gnaf303

Aliment Pharmacol Ther. 2025 Dec 14. doi: 10.1111/apt.70490. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) reactivation is a serious complication in patients receiving chronic immunosuppression. Anti-CD20 agents such as Rituximab are considered high risk for HBV reactivation (> 10%); therefore, antiviral prophylaxis is recommended for all anti-HBc positive patients. Some studies have suggested that patients with resolved HBV infection and higher hepatitis B surface antibody (anti-HBs) titer have a higher level of protection against reactivation.

AIM: The purpose of this study was to systematically review the role of anti-HBs titer on HBV reactivation in patients on rituximab while not on antiviral therapy/prophylaxis.

METHODS: We systematically reviewed all studies that discussed HBV reactivation in patients on rituximab therapy with resolved HBV infection, defined as HBsAg negative and anti-HBc positive, which discussed anti-HBs titer. The search was conducted in PubMed, Embase via Elsevier, Scopus, and Cochrane CENTRAL inclusive July 2025. We evaluated the incidence of HBV reactivation from cohort studies that described anti-HBs categorically based on anti-HBs titer: ‘negative’ (titer < 10 iU/L), ’10-100 iU/L’, or ‘> 100 iU/L’. Meta-analysis statistics describe the proportion and risk difference for different anti-HBs levels.

RESULTS: The overall reactivation rate was 12.6%. There was a significant difference in HBV reactivation depending on titer: anti-HBs negative 27.3% (51/195) (20.0%-36.0%), titer < 100 iU/L 13.8% (47/379) (8.8%-20.8%), and titer > 100 iU/L 3.5% (8/339) (1.8%-6.9%).

CONCLUSIONS: Those with anti-HBs titer > 100 iU/L can be considered lower risk for HBV reactivation and may not require antiviral therapy, but monitoring with initiation of antiviral therapy if titer falls below 100 iU/L.

PMID:41390946 | DOI:10.1111/apt.70490

Scand J Psychol. 2025 Dec 14. doi: 10.1111/sjop.70060. Online ahead of print.

ABSTRACT

Major depressive disorder (MDD) is associated with reduced quality of life and relapse risk. However, few studies have investigated how quality of life is associated with cognitive deficits following MDD and is affected by cognitive training. This study investigated the long-term effects of computer-based working memory training (CWMT) on health-related quality of life (HRQL) in remitted MDD, and the association between executive functions (EF) and HRQL. Twenty-nine remitted participants (M age 36.21, SD = 10.8) were included in a pre-post pilot study of CWMT with 1- and 2-year follow-up. Twenty participants completed 5 weeks of CWMT, 12 participants were included at the 1-year follow-up, and 10 participants returned for the 2-year follow-up. The 36-item Short-Form Health Survey was used to assess HRQL. Associations between subjective and objective cognitive EF and HRQL were measured by the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) and a neuropsychological test battery of EF. Significant moderate improvements were found in aspects of HRQL after 2 years (d = 0.66). There were negative correlations between HRQL and BRIEF-A pre-intervention (r = 0.47-0.65). However, the study did not find significant associations between improved EF and improved HRQL. Preliminary results indicate long-term improvements in HRQL following CWMT. Subjective EF deficits were associated with poorer HRQL. However, due to limitations including small sample size and multiple statistical comparisons, larger controlled studies are needed to investigate and replicate the potential effects of CWMT on HRQL.

PMID:41390937 | DOI:10.1111/sjop.70060

Med Sci Monit. 2025 Dec 14;31:e951084. doi: 10.12659/MSM.951084.

ABSTRACT

BACKGROUND This study sought to evaluate the diagnostic performance of the non-invasive fibrosis scores Fibrosis-4 Index (FIB-4) and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) in predicting liver fibrosis among patients with chronic hepatitis B (CHB) in immune-tolerant, inactive, and gray zone phases. MATERIAL AND METHODS This retrospective cross-sectional study included 230 patients with CHB, as determined by laboratory and clinical criteria, and who underwent liver biopsy. Patients were grouped based on FIB-4 and APRI fibrosis scores of <3 and ≥3. The FIB-4 and APRI scores were calculated, and their diagnostic accuracy was assessed, using receiver operating characteristic (ROC) curve analysis. RESULTS The mean age of the patients was 44.4±12.2 years, and 53.9% were female. A total of 37.4% (86/230) of the patients met the criteria for treatment. Both FIB-4 (1.53±0.90 vs 0.91±0.55, P=0.003) and APRI (0.44±0.23 vs 0.29±0.15, P=0.001) scores were significantly higher in patients with fibrosis score ≥3. The area under the curve (AUC) was 0.70 (cut-off >1.06) for FIB-4 and 0.68 (cut-off >0.38) for APRI. Both scores had a negative predictive value of 87%. The difference between AUC values was not statistically significant (P=0.80). CONCLUSIONS FIB-4 and APRI are helpful non-invasive tools for ruling out advanced fibrosis in CHB patients. However, due to their limited diagnostic power, they should be considered as supportive tools rather than definitive alternatives to liver biopsy.

PMID:41390934 | DOI:10.12659/MSM.951084

Eur J Cardiothorac Surg. 2025 Dec 13:ezaf444. doi: 10.1093/ejcts/ezaf444. Online ahead of print.

ABSTRACT

OBJECTIVES: Dynamic compression bracing (DCB) systems have been proven safe and effective for a non-surgical treatment of Pectus Carinatum (PC). This study aimed to identify potential prognostic factors for PC correction using DCB.

METHODS: From 2011 to 2020, all patients treated with DCB for PC at the University Hospital of Saint-Etienne were retrospectively reviewed. The primary outcome was a reduction ≤ 50% in pectus height (PH) at 6 months follow-up, measured by radiation-free imaging. Two statistical models adjusted for compliance with treatment were used.

RESULTS: A total of 297 patients were treated with DCB (mean age: 15.4 ± 3.9 years). 42% of deformities were symmetrical. Baseline mean PH and pressure for initial correction (PIC) were 2.97 ± 1.02 cm and 6.5 ± 2.0 psi, respectively. The median total treatment duration was 13.1 months (9.2-17.9). Among the 114 (46.5%) patients with available PH data, the median decrease in PH was -35.8% (-62.4% to -10.0%) after 6 months of DCB, with 61 patients (53.5%) achieving a reduction ≥ 50% in PH. In multivariate analysis, only PIC (OR = 1.34; 95% CI: 1.09 to 1.64; p = 0.005) was significantly associated with PH reduction in model 1, and PIC ≥ 7.5 psi (OR = 2.53; 95% CI: 1.13 to 5.67; p = 0.024) in model 2. Patient compliance was 85.2% at 6 months. The recurrence rate was 11.3% (n = 26).

CONCLUSIONS: The PIC value appears to be a potential prognosis factor for PH reduction after 6 months of DCB treatment. These results will be validated in an ongoing prospective study.

CLINICAL TRIAL: The study was approved by the Ethical Committee “Terres d’Ethique” (IRBN902020/CHUSTE) and registered at Clinicaltrials.gov (NCT04452721).

PMID:41390917 | DOI:10.1093/ejcts/ezaf444

Clin Rheumatol. 2025 Dec 13. doi: 10.1007/s10067-025-07771-8. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate and compare the quality and readability of patient education materials (PEM) related to ankylosing spondylitis (AS) generated by four AI-based large language models (LLMs): ChatGPT-4o, ChatGPT-3.5, DeepSeek R1, and DeepSeek V3.

METHODS: On May 1, 2025, the ten most frequently searched AS-related questions were identified using Google Trends (Turkey). These questions were posed to the four LLMs, and the responses were recorded without modification. Quality was assessed by two independent rheumatologists. The quality was evaluated using the DISCERN tool. Readability and comprehensibility were assessed using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL). Inter-rater reliability was analyzed using the intraclass correlation coefficient (ICC). Mean scores and 95% confidence intervals (CI) were reported.

RESULTS: ChatGPT-4o achieved the highest average DISCERN score (72.38), followed by DeepSeek R1 (69.76), ChatGPT-3.5 (68.82), and DeepSeek V3 (68.79). Inter-rater reliability for DISCERN was excellent (ICC, 0.931). ChatGPT-4o had the highest mean DISCERN score, although the difference was not statistically significant. For readability analysis, DeepSeek V3 had the highest FERS score (14.93). This suggested that DeepSeek V3 was more easily understandable than other LLMs. ChatGPT-3.5 received the lowest score (5.29). FKGL scores varied within a narrow range (15.33-15.93) across models. Therefore, it was interpreted that the data required university-level reading skills. Conclusion For AS, AI-generated PEMs were generally complex enough to meet the needs of highly educated patients. The responses were information-dense and complex, requiring excessive expertise regardless of the recipient’s educational level. In the future, improving the clarity and comprehensibility of the language according to personal characteristics (educational level, etc.) and providing evidence-based citations could help make LLMs more useful in clinical settings or for the public. Key Points • This study compared how different AI chatbots explain ankylosing spondylitis to patients. • Although the information quality was high, the language used was too complex for most patients. • ChatGPT-4o gave the most accurate content, while DeepSeek V3 used the easiest words. • Future AI tools should use simpler language and include reliable references to better support patient education.

PMID:41390886 | DOI:10.1007/s10067-025-07771-8