Nevin Manimala

JMIR Public Health Surveill. 2025 Sep 10;11:e73318. doi: 10.2196/73318.

ABSTRACT

BACKGROUND: In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States.

OBJECTIVE: This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua.

METHODS: Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research.

RESULTS: The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research).

CONCLUSIONS: As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.

PMID:40929715 | DOI:10.2196/73318

JMIR Public Health Surveill. 2025 Sep 10;11:e68437. doi: 10.2196/68437.

ABSTRACT

BACKGROUND: Scrub typhus (ST), also known as tsutsugamushi disease, is a common febrile vector-borne illness in South Korea, transmitted by trombiculid mites infected with Orientia tsutsugamushi, with rodents serving as the main hosts. Although vector-borne diseases like ST require both a One Health approach and a spatiotemporal perspective to fully understand their complex dynamics, previous studies have often lacked integrated analyses that simultaneously address disease dynamics, vectors, and environmental shifts.

OBJECTIVE: We aimed to explore spatiotemporal trends, high-risk areas, and risk factors of ST by simultaneously incorporating host and environmental information.

METHODS: ST cases were extracted from the 2013-2019 Korea National Health Insurance Service data at 250 municipal levels and by epidemiological weeks (International Classification of Diseases, Tenth Revision, Clinical Modification code: A75.3). Data on potential risk factors, including the maximum probability of rodent presence, area of dry field farming, forest coverage, woman farmer population, and financial independence, were obtained from publicly available sources. In particular, the maximum rodent presence probability was estimated using a maximum entropy model incorporating ecological and climate variables. Spatial autocorrelation was assessed using Global Moran I statistics with 999 Monte Carlo permutations. Spatial and temporal clusters were identified using Getis-Ord Gi* and hot and cold spot trend analyses. Bayesian hurdle models with a spatiotemporal interaction term, accounting for zero-inflated Poisson distribution, were used to identify associations between ST incidence and regional factors. Stratification analyses by gender and age group (0-39, 40-59, 60-79, and ≥80 years) were performed.

RESULTS: Between 2013 and 2019, 95,601 ST patients were reported. ST incidence had positive spatial autocorrelation (I=0.600; P=.01), with spatial expansion from southwestern to northeastern regions. Spatiotemporal models demonstrated better fit compared with spatial and temporal models, as indicated by lower Watanabe-Akaike information criterion (WAIC) values. Municipalities with higher rodent suitability (β coefficient=0.618; 95% credible interval [CrI] 0.425-0.812) and lower financial independence from central government (β coefficient=-0.304; 95% CrI -0.445 to -0.163) had higher likelihoods of increased ST incidence, even after adjusting for spatiotemporal autocorrelation. However, risk factors varied by age group: among individuals aged 40 years or older, ST incidence was positively associated with rodent suitability, while patients in the 0-39 years age group showed no association with rodent suitability (β coefficient=0.028; 95% CrI -0.072 to 0.126), and ST incidence was negatively associated with the women farmer population (β coefficient=-0.115; 95% Crl=-0.223 to -0.006).

CONCLUSIONS: This is the first study to investigate ST in South Korea using a spatiotemporal framework grounded in a holistic One Health perspective. We elucidated the critical role of spatiotemporal dynamics in ST distribution, highlighting rodent suitability and economic independence as key drivers of disease distribution. Our findings lay the groundwork for evidence-based, region-specific intervention strategies and may inform targeted public health strategies in South Korea and other settings with similar ecological conditions.

PMID:40929714 | DOI:10.2196/68437

Neuro Endocrinol Lett. 2025 Sep 2;46(2):77-85. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the hotspots and frontiers in the field of subarachnoid hemorrhage using the bibliometrics method and providing references for academic research.

METHODS: All published studies related to subarachnoid hemorrhage published in the Web of Science core database from 1 January 2016 to 25 September 2021 were retrospectively identified using VOSviewer and CiteSpace software. Visualization VOSviewer and CiteSpace software were used to perform statistical and cluster analyses on authors, countries, institutions, keywords, and co-cited documents. Knowledge graphs were drawn.

RESULTS: A total of 7151 research papers related to subarachnoid hemorrhage were included for analysis. The number of papers on subarachnoid hemorrhage research showed an upward trend. The leading countries in subarachnoid hemorrhage research were the United States, China, and Japan. In addition, the Harvard Medical School, the Mayo Clinic, and the Capital Medical University were leading authorities subarachnoid hemorrhage research. The common keywords formed 7 clusters. There were 13 clusters of citations.

CONCLUSIONS: Research hotspots and directions in subarachnoid hemorrhage research were identified, such as cerebral aneurysm, early brain injury, vasospasm, and prognosis model.

PMID:40929706

J Craniofac Surg. 2025 Sep 10. doi: 10.1097/SCS.0000000000011907. Online ahead of print.

ABSTRACT

An expander capsule is a fibrous membrane that forms around an expander after tissue expansion. However, whether the capsule should be removed after the expander is removed remains controversial. The authors aimed to investigate the efficacy and safety of cervical capsulectomy for improving neck mobility and appearance after expanded flap transfer. We retrospectively analyzed patients with cervical scar contractures who underwent expanded flap transfer at our hospital between September 2018 and December 2023. Depending on whether capsulectomy was performed simultaneously with expander removal, the patients were divided into the capsule-retaining (n=50) and capsule-resecting (n=24) groups. The preoperative and postoperative cervicomental angles, neck extension range of motion, postoperative appearance satisfaction, cervical pulling sensation, cervical capsular contracture cords, and postoperative complication rates were compared between the 2 groups to evaluate the efficacy and safety of cervical capsulectomy. Complication rates were not significantly different between the groups (P>0.05). The postoperative improvements in the neck extension range of motion and cervicomental angle were significantly greater, and the appearance satisfaction score was higher in the capsule-resecting group than in the capsule-retaining group. In the capsule-retaining group, 18 (36.0%) patients experienced a significant pulling sensation during neck extension, and 10 (20.0%) patients had capsular contracture cords. The differences between the 2 groups were statistically significant (P<0.05). Cervical capsulectomy is safe and effective for improving neck mobility and appearance after expanded flap transfer.

PMID:40929700 | DOI:10.1097/SCS.0000000000011907

Ocul Immunol Inflamm. 2025 Sep 10:1-14. doi: 10.1080/09273948.2025.2552919. Online ahead of print.

ABSTRACT

PURPOSE: To describe differences in the expression of selected host biomarkers, by analysing the aqueous humour (AH), cerebrospinal fluid (CSF) and serum of patients with ocular syphilis, both with and without neurosyphilis and HIV infection, to support the diagnosis of ocular syphilis.

METHODS: A prospective observational descriptive study was conducted at Tygerberg Academic Hospital in Cape Town, South Africa, from February 1, 2018, to January 31, 2021. The study included all patients aged 18 years or older who presented to the eye clinic with ocular syphilis, provided they had a positive serum Treponema pallidum antibodies (TPA) test, an RPR titre of ≥ 8 and confirmed ocular inflammation. The HIV status of each patient was determined and the CRP, IL-2, IL-6, IL-10, IL-12 p70, MIP-1β and IFN-γ were measured in their AH, CSF and serum samples using a multiplex immunoassay platform. All patients received treatment.

RESULTS: The mean concentrations of biomarkers IL-2, IL-10, MIP-1β, IL-6, IL-12 p70 and IFN-γ were consistently higher in the AH compared to the CSF and serum in patients with ocular syphilis, irrespective of their HIV status and the presence or absence of concurrent neurosyphilis.

CONCLUSION: Our findings showed significant differences in certain cytokine levels across the AH, CSF, and serum, with notably higher concentrations in the AH. This indicates that ocular syphilis triggers a unique immune response within the eye. As a result, further analysis of AH biomarkers is needed to determine if these may enhance the diagnosis of ocular and neurosyphilis.

PMID:40929698 | DOI:10.1080/09273948.2025.2552919

Ann Am Thorac Soc. 2025 Sep 10. doi: 10.1513/AnnalsATS.202501-052OC. Online ahead of print.

ABSTRACT

Background Although advances in care have improved cystic fibrosis (CF) outcomes in higher-income countries (HICs), the situation remains alarming in lower-income countries (LICs). Methods People with CF (pwCF) enrolled in the European Cystic Fibrosis Society Patient Registry (ECFSPR) and carrying at least one F508del variant allele were evaluated in 2017 and in 2022 for predicted percent forced expiratory volume (ppFEV1), underweight status, and chronic Pseudomonas aeruginosa (Pa) infection, according to the gross national income (GNI) per capita divided into three terciles (low-income countries, LICs; middle-income countries, MICs; and high-income countries, HICs). Survival was evaluated in the periods 2013-2017 and 2018-2022. Generalized linear models and Cox regression models were fitted. Findings From the 31,723 pwCF reported in ECFSPR in 2022, 13.5% lived in LICs, 19.9% in MICs, and 66.6% in HICs. PwCF living in LICs had a significantly lower median survival age, reduced ppFEV1, and higher prevalence of Pa infection and underweight status compared with pwCF from MICs and HICs. Data modeling indicated that avoiding underweight status and Pa infection would increase survival by 42 years for pwCF living in LICs. Access to CFTR modulators would further increase their survival by 15 to 29 years depending on their nutrition and infection status, resulting in a survival up to 82 years in the best-case scenario. Interpretation Access to CFTR modulators equalizes survival between LICs and higher income countries within Europe. Optimizing care practices and social determinants of health remains crucial in LICs.

PMID:40929684 | DOI:10.1513/AnnalsATS.202501-052OC

Am J Public Health. 2025 Oct;115(10):1631-1641. doi: 10.2105/AJPH.2025.308144.

ABSTRACT

Objectives. To examine how one’s community connectedness may act as a source of resilience and promote HIV prevention and care behaviors among transgender women of color. Methods. We analyzed survey data from 313 transgender women of color living in New York City collected from August 2020 to November 2022. The Community Connectedness Scale asks participants about their baseline feelings of connection, feelings of inclusion, feelings of belonging, feelings of isolation, and feelings of being unlike in relation to the transgender community. The HIV prevention and care outcomes of interest were measured at 6-month follow-up and included consistent condom usage, recent testing for sexually transmitted infections (STIs), current preexposure prophylaxis use, and HIV viral load suppression. Results. Those with a high (compared to low) community connectedness were 62% more likely to consistently use condoms and 16% more likely to test for STIs. Conclusions. Community connectedness was associated with a greater likelihood of HIV prevention behaviors. Public Health Implications. Future interventions could include strategies to strengthen community connectedness to improve HIV status neutral care continuums. (Am J Public Health. 2025;115(10):1631-1641. https://doi.org/10.2105/AJPH.2025.308144).

PMID:40929666 | DOI:10.2105/AJPH.2025.308144

J Craniofac Surg. 2025 Sep 10. doi: 10.1097/SCS.0000000000011930. Online ahead of print.

ABSTRACT

BACKGROUND: With the development of artificial intelligence, obtaining patient-centered medical information through large language models (LLMs) is crucial for patient education. However, existing digital resources in online health care have heterogeneous quality, and the reliability and readability of content generated by various AI models need to be evaluated to meet the needs of patients with different levels of cultural literacy.

OBJECTIVE: This study aims to compare the accuracy and readability of different LLMs in providing medical information related to gynecomastia, and explore the most promising science education tools in practical clinical applications.

METHODS: This study selected 10 most frequently searched questions about gynecomastia from PubMed and Google Trends. Responses were generated using 3 LLMs (DeepSeek-R1, OpenAI-O3, Claude-4-Sonnet), with text quality assessed using the DISCERN-AI and PEMAT-AI scales. Text readability and legibility were comprehensively evaluated through metrics including word count, syllable count, Flesch-Kincaid Grade Level (FKGL), Flesch Kincaid Reading Ease (FKRE), SMOG index, and Automated Readability Index (ARI).

RESULTS: In terms of quality evaluation, among the 10 items of the DISCERN-AI scale, only the overall content quality score showed a statistically significant difference (P = 0.001), with DeepSeek-R1 demonstrating the best performance at a median score of 5 (5,5). Regarding readability, DeepSeek-R1 exhibited the highest average word count and syllable count, both with P-values of 0.000. The 3 models showed no significant differences in FKGL, FKRE, or automatic readability indices. Specifically, the averaged FKGL scores of DeepSeek-R1 was 14.08, OpenAI-O3 was 14.1, and Claude-4-sonnet was 13.31. The SOMG evaluation revealed that Claude-4-sonnet demonstrated the strongest readability, the average value is 11 with a P-value of 0.028.

CONCLUSION: DeepSeek-R1 demonstrated the highest overall quality in content generation, followed by Claude-4-sonnet. Evaluations using FKGL, SMOG index, and ARI all indicated that Claude-4-sonnet exhibited the best readability. Given that improvements in quality and readability can enhance patient engagement and reduce anxiety, these 2 models should be prioritized for patient education applications. Future efforts should focus on integrating these advantages to develop more reliable large-scale medical language models.

PMID:40929657 | DOI:10.1097/SCS.0000000000011930

Hum Reprod. 2025 Sep 10:deaf169. doi: 10.1093/humrep/deaf169. Online ahead of print.

ABSTRACT

STUDY QUESTION: Does weight loss from a hypocaloric dietary intervention improve antral follicle dynamics in women with PCOS?

SUMMARY ANSWER: During a 3-month hypocaloric dietary intervention, women with PCOS who experienced clinically meaningful weight loss showed more organized antral follicle development including fewer recruitment events, but no change in the overall frequency of selection, dominance, or ovulation.

WHAT IS KNOWN ALREADY: There is a spectrum of disordered antral follicle development in women with PCOS including excessive follicle recruitment and turnover, decreased frequency of selection and dominance, and failure of ovulation. Lifestyle intervention aimed at weight loss is recommended to improve metabolic health in women with PCOS yet benefits on ovarian follicle development and ovulation are unclear.

STUDY DESIGN, SIZE, DURATION: This was a prospective, single-arm lifestyle intervention study conducted over 4 months including a 1-month baseline assessment period and 3-month hypocaloric dietary intervention. Twenty women were allocated to the intervention with 0% attrition.

PARTICIPANTS/MATERIALS, SETTING, METHODS: Females, ages 18-38 years, with PCOS and obesity (BMI > 30 kg/m2) underwent every-other-day transvaginal ultrasonography and venipuncture at an academic clinical research unit for 4 months. The number and size of all follicles were evaluated at each study visit, with individual growth profiles plotted retrospectively for follicles that grew to at least 7 mm. Gonadotropin and ovarian steroid hormone concentrations were measured every-other-day. Reproductive, anthropometric, and metabolic status markers were assessed at baseline and at the end of the intervention.

MAIN RESULTS AND THE ROLE OF CHANCE: Hypocaloric dietary intervention resulted in an average weight loss of 8 ± 3% with significant reductions in all anthropometric markers assessed including BMI, waist circumference, total percent fat, and trunk fat mass (all P < 0.05). Of the glucoregulatory and cardiovascular risk markers assessed, only diastolic blood pressure (P = 0.040) and 2-h insulin concentrations following a glucose challenge (P = 0.029) were decreased post-intervention. Antral follicle development appeared more cyclic following the intervention with the frequency of recruitment (P = 0.043), and number of follicles recruited per cohort (P < 0.0001), decreasing with weight loss. By contrast, the frequency of selection, dominance, and ovulation did not change with weight loss (all P < 0.05). When ovulation occurred during the intervention, the size at selection for ovulatory follicles decreased with weight loss (P < 0.0001), whereas maximum luteal progesterone levels increased with weight loss (P = 0.036). Participants (35%) who responded to the intervention with a shortened inter-menstrual interval had lower baseline trunk fat mass (P = 0.048), fasting insulin (P = 0.022), and homeostatic model assessment for insulin resistance (P = 0.017) compared to non-responders.

LIMITATIONS, REASONS FOR CAUTION: The duration of the intervention may not have been sufficient to capture an impact of weight loss on ovulatory cyclicity. Analyses were limited to the antral stages of follicle development and any impact of hypocaloric dietary intervention on pre-antral folliculogenesis was not evaluated. The small study sample limits statistical power and generalizability of the findings.

WIDER IMPLICATIONS OF THE FINDINGS: Short-term hypocaloric dietary intervention did not consistently improve ovulation frequency in women with PCOS despite clinically meaningful weight loss. Counseling related to the benefits of short-term hypocaloric dietary intervention on reproductive health outcomes should be tempered as improvements in ovulation are likely only in those with a more favorable metabolic profile at the onset. Improvements in the early stages of antral follicle development with weight loss suggest potential for longer dietary interventions to improve ovulatory cyclicity in women with PCOS.

STUDY FUNDING/COMPETING INTEREST(S): This research was supported by funds from the President’s Council of Cornell Women, United States Department of Agriculture (Grant No. 8106), and National Institutes of Health (R01-HD0937848, R56-HD089962). F.E.C., B.Y.J., and H.V.B. were supported by doctoral training awards from the National Institutes of Health (5 T32-HD087137, T32-DK007158) and Canadian Institutes of Health Research (Grant No. 146182), respectively. The authors have no competing interests.

TRIAL REGISTRATION NUMBER: NCT01785719.

PMID:40929646 | DOI:10.1093/humrep/deaf169

Eur J Gastroenterol Hepatol. 2025 Sep 1. doi: 10.1097/MEG.0000000000003041. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies have implicated diabetes as a risk factor for pancreatic cancer, yet the impact of diabetes progression on pancreatic cancer incidence remains unclear. We aim to assess pancreatic cancer risk across different stages of diabetes.

METHODS: Employing a predefined search strategy, we conducted a literature review of electronic databases up to 29 February 2024. Extracting odds ratios (OR) and 95% confidence intervals (CIs) relevant to diabetes, we aimed to evaluate pancreatic cancer risk among diabetic patients and conduct subgroup analyses.

RESULTS: Our systematic review comprised 29 observational cohort studies with 25 million participants. We observed a 2.13-fold higher likelihood of pancreatic cancer among diabetic individuals compared with nondiabetic counterparts. Specifically, males with diabetes exhibited a greater pancreatic cancer risk than females; however, regional disparities in pancreatic cancer risk among diabetic patients were NS. Regarding diabetes duration, pooled ORs (95% CI) for pancreatic cancer risk were 2.41 (2.07-2.81) for 1-4 years, 1.67 (1.50-1.85) for 4-10 years, and 2.01 (1.81-2.22) for over 10 years.

CONCLUSION: The results of this study confirm a significant association between diabetes and pancreatic cancer. Although there was no statistically significant difference in risk between different diabetes duration groups, diabetic patients overall face a higher risk of pancreatic cancer. Therefore, diabetic patients should undergo regular pancreatic cancer screening and take appropriate management measures to detect potential pancreatic cancer at an early stage.

PMID:40929644 | DOI:10.1097/MEG.0000000000003041