Nevin Manimala

Womens Health (Lond). 2025 Jan-Dec;21:17455057251331700. doi: 10.1177/17455057251331700. Epub 2025 Sep 7.

ABSTRACT

BACKGROUND: Endometriosis symptoms have multifaceted manifestations, and there are few approved nonsurgical treatment options. Gonadotropin-releasing hormone (GnRH) agonists/antagonists for endometriosis vary on efficacy, safety profile, and out-of-pocket (OOP) cost, among other features.

OBJECTIVES: This study quantified the importance that women with endometriosis in the United States (US) placed on pain and non-pain features that differ among these medications.

DESIGN: English-speaking, 18 to 50 years (premenopausal) US women with healthcare coverage for the past 3 years, who self-reported a laparoscopy-confirmed endometriosis diagnosis, were recruited via healthcare research panels to complete a cross-sectional survey.

METHODS: A discrete choice experiment (DCE) with a surgery opt-out option assessed preferences for eight GnRH agonist/antagonist attributes (reducing different types of pain, treatment administration, impact on daily activities, etc.). Best-worst scaling (BWS) assessed preferences for 11 non-pain medication attributes (dosage flexibility, short treatment onset, reversible side effects, etc.). Relative importance (RI) was estimated for each attribute.

RESULTS: Overall, 300 women were included (mean age 33.0 years; 76.7% White). Across DCE choice tasks, GnRH agonist/antagonist was chosen over surgery 46.7% of the time. Non-menstrual pelvic pain relief (RI = 23.1%), reducing monthly OOP cost (RI = 22.1%), and relief of dyspareunia (RI = 21.4%) and dysmenorrhea (RI = 12.9%) were most important for GnRH treatment choice. Among non-pain attributes in the BWS, short onset of treatment effect (RI = 13.1%), long-term safety (RI = 12.9%), and reducing fatigue (RI = 11.2%) were most important to women when choosing a pharmacologic endometriosis treatment.

CONCLUSION: Relieving the three types of endometriosis pain and reducing cost are the most important considerations for women when selecting GnRH agonist/antagonist treatment. Women with endometriosis strongly prefer a medication that can be safely taken for longer periods of time, takes effect within a few menstrual cycles, and can reduce endometriosis-related fatigue. Findings can inform discussions between patients and healthcare providers to better align endometriosis treatment decision-making with patients’ individual needs and preferences.

PMID:40914891 | DOI:10.1177/17455057251331700

Mil Med. 2025 Sep 7:usaf415. doi: 10.1093/milmed/usaf415. Online ahead of print.

ABSTRACT

INTRODUCTION: Submarine environments pose unique challenges to maintaining physical activity and exercise routines due to confined spaces, demanding schedules, and limited resources. This study investigated submariners’ physical activity patterns, sleep quality, and perceived exercise barriers in both land- and sea-based settings, with the goal of informing targeted health interventions.

MATERIALS AND METHODS: Ethics approval was granted by the Defence Science and Technology Group and Edith Cowan University review panels. This cross-sectional study surveyed 21 Royal Australian Navy submariners (25-48 years; 18 male) using a modified version of the International Physical Activity Questionnaire. Participants reported weekly engagement in general physical activity (e.g., walking, moderate- and vigorous-intensity activity) and structured exercise training (high-intensity interval training, moderate-intensity continuous training, and resistance training [RT]), as well as sitting time and sleep duration. Additional items assessed perceived barriers and motivations to exercise, time spent on land and at sea over the past 12 months (9 ± 3 and 3 ± 3 months, respectively), and their longest continuous deployment. Descriptive statistics and paired t-tests were used to compare outcomes between land and sea environments.

RESULTS: Total physical activity was lower (P < .001) at sea (118 ± 30 minutes/week) compared to land (745 ± 60 minutes/week), with the greatest reductions observed in walking (-86%, P < .001) and moderate-intensity cardiovascular training (-95%, P = .002). High-intensity interval training declined by 81% (P = .006), and RT dropped by 84% (P = .045). Reported barriers at sea included water usage restrictions (57%), limited space (43%), inadequate facilities (43%), time constraints (38%), fatigue (38%), and noise restrictions (19%). Sleep quality declined by 37% at sea (P < .001), though changes in sleep duration were not statistically significant. Sitting time increased by 51% on workdays (P = .014).

CONCLUSIONS: Sea deployments are associated with substantial declines in physical activity and sleep quality among submariners, accompanied by increased sitting time and widespread behavioral disengagement. These findings highlight the need for practical strategies to support health, well-being, and operational readiness in constrained environments. Strengths of the study include context-specific survey design and rich participant engagement, as reflected by detailed qualitative responses. Limitations include small sample size, variability in responses, potential recall bias, and the inability to assess survey reliability because of ethical constraints. Future research should prioritize longitudinal designs and explore implementable interventions to promote physical activity and sleep during deployment. These findings may also apply to other constrained environments, such as naval surface ships, remote field sites, or mining operations, where similar occupational barriers exist. Overall, these results offer valuable insight into how deployment conditions shape health behaviors in submariners and provide a foundation for developing evidence-based strategies to improve activity and well-being in this and similar populations.

PMID:40914885 | DOI:10.1093/milmed/usaf415

Nutr Rev. 2025 Sep 7:nuaf153. doi: 10.1093/nutrit/nuaf153. Online ahead of print.

ABSTRACT

CONTEXT: Cardiovascular protective properties of berries have been reported in numerous studies. Berries and their bioactive compounds may also be effective for improving body composition and anthropometric indices.

OBJECTIVE: This systematic review and meta-analysis were aimed to investigate the effect of berries on anthropometric markers.

DATA SOURCES: A systematic search for studies published before June 2024 was conducted in 4 electronic databases-PubMed, Scopus, Web of Science and Google Scholar-to find randomized controlled trials that used berries or their extract as the intervention.

DATA EXTRACTION: Data from 42 intervention arms from 38 studies were included in the analysis.

DATA ANALYSIS: The meta-analysis revealed a statistically significant decrease in body mass index (weighted mean difference [WMD] = -0.13 [95% CI, -0.22 to -0.04]; P = .004) and in body fat percentage (WMD = -0.50 [95% CI, -0.77 to -0.23]; P = .000) and body fat mass (WMD = -0.67 [95% CI, -1.19 to -0.16]; P = .010). No significant changes were observed in weight, waist circumference, hip circumference, waist-to-hip ratio, or fat-free mass.

CONCLUSION: The results indicate the potential of berries to improve body mass index and body fat percentage; however, due to limited data, more well-designed studies are recommended.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42024556011.

PMID:40914881 | DOI:10.1093/nutrit/nuaf153

Mil Med. 2025 Sep 7:usaf386. doi: 10.1093/milmed/usaf386. Online ahead of print.

ABSTRACT

INTRODUCTION: An estimated 5.6 million individuals in the U.S. experience limb loss and absence, but national estimates exclude Military Health System (MHS) beneficiaries. The purpose of this study is to characterize MHS beneficiaries with limb loss and absence and estimate incidence and prevalence.

MATERIAL AND METHODS: We conducted a retrospective cohort study using data from the MHS Information Platform. Descriptive statistics were used to characterize the study population, including demographics, level of limb loss and absence, and etiology. Bivariate analyses between demographic characteristics and level of limb loss were conducted using analysis of variance and chi-square tests. The sample includes MHS beneficiaries diagnosed with limb loss or absence from 2005 to 2023. The study was determined exempt human subjects research by the Uniformed Services University of the Health Sciences Institutional Review Board.

RESULTS: The cohort (118,587) was 64.6% male and 35.4% female, with mean age 58 years (SD = 23.4). Racial distribution included 49.8% White, 6.4% Black, and approximately 42.1% other or unknown. Service branches were Army (41.0%), Air Force (26.7%), Navy (19.7%), Marine Corps (7.0%), other (3.9%), Coast Guard (1.7%), and Space Force (0%). The majority were retired (46.2%) or other (32.0%), with a smaller portion active duty (12.0%) and dependents (9.9%). Levels of limb loss were 72% lower limb, 26.1% upper limb, and 2% unspecified. Causes included acquired absence (53.8%), traumatic amputation (34%), and congenital absence (12.1%). Bivariate analysis showed significant associations between demographics and limb loss levels (P = .000). Incidence (z = -2.43, P = .015) and prevalence (z = -13.69, P = .000) rates declined over 19 and 8 years, respectively.

CONCLUSION: This study highlights demographic characteristics, causes, and declining rates of limb loss and absence among MHS beneficiaries, providing a foundation for future research and informing clinical practices and policies to enhance care and resource allocation.

PMID:40914878 | DOI:10.1093/milmed/usaf386

Inflamm Bowel Dis. 2025 Sep 7:izaf172. doi: 10.1093/ibd/izaf172. Online ahead of print.

ABSTRACT

BACKGROUND: The infliximab (IFX) biosimilar, CT-P13, is available as an intravenous (IV) and subcutaneous (SC) formulation. Although current indications allow the transition from IV CT-P13 to SC CT-P13 after two IV administrations, some clinicians prefer to postpone switching until stable clinical remission has been achieved.

METHODS: We evaluate the endoscopic response, treatment persistence, clinical remission, endoscopic remission, and safety profile after one year of treatment with IFX in patients switched from IV to SC after 6 weeks (early switch group) or after 6 months (late switch group).

RESULTS: There were no statistical differences between the two groups after one year in terms of endoscopic response (71.4% vs 70.8%, P = .95), steroid-free clinical remission (62.5% vs 68.7%, P = .51), or IFX retention rate (75.0% vs 66.7%, P = .35). We observed higher endoscopic remission rates in early switch patients as compared to late switch patients; however, this trend was not significant (69.6% vs 52.1%, P = .07). A return to IV-IFX was required in 1 of 43 early switch patients and in 3 of 44 late switch patients (2.3% vs 6.8%, P = .31). Clinical indexes, fecal calprotectin and C-reactive protein (CRP) levels significantly decreased after one year regardless of group. Adverse events were also comparable between groups (4.5% vs 8.3%, P = .46).

CONCLUSIONS: Our study has shown that early switch from IV-IFX to SC-IFX at 6 weeks is effective in terms of clinical and endoscopic remission at one year yielding similar results to late switch at 6 months.

PMID:40914876 | DOI:10.1093/ibd/izaf172

Disabil Rehabil. 2025 Sep 7:1-16. doi: 10.1080/09638288.2025.2554305. Online ahead of print.

ABSTRACT

PURPOSE: Initial studies identified the Perceive, Recall, Plan and Perform Assessment (PRPP-A) as a cognitive assessment with potential for culturally safe use with Aboriginal and Torres Strait Islander peoples with neurocognitive impairments in the Northern Territory of Australia. This study examines construct and concurrent validity of the PRPP-A.

METHODS: Data were collected from a medical record review. Construct validity was examined using multifaceted Rasch analysis on 44 PRPP-A scores. Concurrent validity was evaluated using Pearson’s product-moment correlation to examine relationships between the PRPP-A and Functional Independence Measure Cognitive subscale (FIM Cognition).

RESULTS: PRPP-A test items demonstrate good fit with the Rasch model, supporting unidimensionality. A hierarchy of cognitive strategies was generated. Ordering of test items was representative of the information processing skills required for task performance. There was a statistically significant, positive correlation between PRPP-A Total scores with FIM Cognition scores (r = 0.60, p = 0.003). The strongest relationship was identified between the PRPP-A Plan Quadrant and FIM Cognition scores (r = 0.68, p < 0.001). The strength of the relationship suggests evidence for concurrent validity.

CONCLUSIONS: The findings present emerging evidence supporting the construct and concurrent validity of PRPP-A when used with Aboriginal and Torres Strait Islander peoples in the Northern Territory with neurocognitive impairment.

PMID:40914866 | DOI:10.1080/09638288.2025.2554305

Urol J. 2025 Sep 6. doi: 10.22037/uj.v22i.8540. Online ahead of print.

ABSTRACT

Purpose Clear cell renal cell carcinoma (ccRCC), the dominant subtype of renal malignancy, has a rising global incidence and mortality. While surgery is the standard of care for localized cases, adjuvant therapy aims to improve outcomes in high-risk postoperative patients. To quantify the clinical value of adjuvant pharmacotherapy, this systematic review and meta-analysis assesses its effect on overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) in patients with ccRCC. Materials and Methods A comprehensive search of the Web of Science, Embase, Cochrane Library, and PubMed databases was conducted for articles published up to October 2024. The search used the English keywords “clear cell renal cell carcinoma,” “adjuvant drug therapy,” and “randomized controlled trials,” combined with a free-word search. Randomized controlled trials (RCTs) assessing the effectiveness of at least one adjuvant drug therapy in patients with ccRCC were included. Results The meta-analysis showed that adjuvant drug therapy did not result in a statistically significant improvement for OS or PFS compared to the control group. There was also no statistically significant difference in DFS (P > 0.05). This systematic review provides evidence on the impact of adjuvant targeted therapy on OS, DFS, and PFS for patients with clear cell renal cell carcinoma. Conclusion This study summarizes the effects of adjuvant drug therapy on OS, PFS, and DFS in ccRCC patients. The evidence from this meta-analysis can inform clinical decision-making, support risk-stratification strategies, and encourage the integration of OS-driven endpoints in future trial designs, thereby providing valuable data for the treatment of ccRCC.

PMID:40914837 | DOI:10.22037/uj.v22i.8540

Nutr Clin Pract. 2025 Sep 7. doi: 10.1002/ncp.70022. Online ahead of print.

ABSTRACT

BACKGROUND: Esophagectomy causes anatomical changes that can lead to rapid food transit and reactive hypoglycemia (RH). Patients are advised on eating patterns postesophagectomy to prevent RH, but its true incidence and the impact of dietary recommendations remain under-researched.

MATERIALS AND METHODS: Individuals >12 months postesophagectomy were recruited from the National Centre for Oesophageal and Gastric Cancer at St James’s Hospital in Dublin, Ireland. Over 7 days, continuous glucose monitoring (CGM) captured glucose readings, with food and symptom diaries documenting dietary intake and symptoms. The nutrition composition of meals was calculated, and food diaries were coded for the following eating patterns: leaving >3 h between meals, simple sugars with meals, fluid with meals, and alcohol with meals. Data analysis compared eating patterns preceding asymptomatic and symptomatic RH events. In all cases, P < 0.05 was considered statistically significant.

RESULTS: Thirty-two participants completed the study, with 21,504 glucose readings and 1276 meals analyzed. CGM identified 226 meals (17.7%) followed by RH events, 19 of which were symptomatic. Meals associated with RH events were higher in carbohydrate (35.3 g vs 31.7 g; P = 0.036), fiber (4.11 g vs 3.15 g; P = 0.020), and sugar (12.65 g vs 10.96 g; P = 0.048). Leaving >3 h between meals and consuming alcohol with meals also increased RH risk. Nutrient composition and eating patterns did not differentiate symptomatic from asymptomatic RH events.

CONCLUSIONS: Total carbohydrate content and specific eating patterns appeared to significantly influence RH incidence, with most RH events being asymptomatic. CGM may serve as a useful adjunct to dietary interventions in the management of RH in patients postesophagectomy.

PMID:40914827 | DOI:10.1002/ncp.70022

Mol Nutr Food Res. 2025 Sep 7:e70252. doi: 10.1002/mnfr.70252. Online ahead of print.

ABSTRACT

The relationship between dietary biotin intake and cognitive function remains unclear. This study explores the association between biotin and dementia, and the mediating role of inflammation indicators. Dietary biotin intake was assessed via the 24-h recall questionnaire. Dementia outcomes were identified through “algorithmically defined outcomes,” identified through an algorithm integrating self-reports, hospital admissions, and death certificate records. Participants aged 40-69 with complete biotin and baseline data were included. During a 11.25-year median follow-up, 1256 incident dementia cases occurred among 122 959 participants. Cox proportional hazards models showed that compared to the lowest biotin intake (Q1), biotin reduced the risk of all-cause dementia (HR: 0.75[0.64,0.88] p < 0.001 for Q2; HR: 0.68[0.58,0.81] p < 0.001 for Q3; HR: 0.67[0.56,0.81] p < 0.001 for Q4) and Alzheimer’s disease (AD) (HR: 0.74[0.58,0.96] p = 0.026 for Q2; HR: 0.65[0.49,0.85] p = 0.002 for Q3). Restricted cubic splines (RCSs) revealed an “L-shaped” nonlinear relationship between biotin and all-cause dementia (p nonlinear < 0.001) and Alzheimer’s dementia (p nonlinear = 0.004) and exhibited the saturation effect. Multicategorical mediation analysis suggested that systemic immune-inflammation index (SII), a composite inflammatory marker calculated from platelet, neutrophil, and lymphocyte counts, mediated the association partially. Subgroup and sensitivity analyses confirmed stable results. Higher dietary biotin intake may reduce the risk of dementia.

PMID:40914826 | DOI:10.1002/mnfr.70252

JPEN J Parenter Enteral Nutr. 2025 Sep 7. doi: 10.1002/jpen.70010. Online ahead of print.

ABSTRACT

BACKGROUND: Intravenous lipid emulsions are a key component of parenteral nutrition, and their fatty acid compositions may influence immune responses and clinical outcomes.

METHODS: This retrospective cohort study conducted from January 2020 to December 2022 compared clinical outcomes of hospitalized non-critical care patients receiving parenteral nutrition with either mixed oil or soybean oil lipid emulsions for at least 48 h. The primary outcome was a composite of the presence of pneumonia, urinary tract infection, or an intra-abdominal collection diagnosed within 14 days of initiating parenteral nutrition. Secondary outcomes included catheter-related bloodstream infection, length of hospital stay, duration of antibiotic therapy, in-hospital mortality, and changes in the aspartate transaminase (AST)/alanine transaminase (ALT) ratio over time.

RESULTS: Among 266 patients (mixed oil lipid emulsion: n = 130; soybean oil lipid emulsion: n = 136) there was no statistically significant difference in all-cause infections (P = 0.21). In patients receiving lipid emulsions for >7 days, the use of mixed oil lipid emulsions was associated with a shorter median antibiotic duration (4 days: interquartile range [IQR] 1-8.5 vs 7 days: IQR 5-10; P = 0.04). Additionally, patients who received mixed oil emulsions for >7 days had a significantly greater change in the AST/alkaline phosphatase ratio after 14 days compared with the soybean oil group (β = -0.51; P = 0.02).

CONCLUSION: Although there was no difference in all-cause infections between types of lipid emulsions, mixed oil lipid emulsions were associated with shorter antibiotic use and lower AST/ALT ratio in hospitalized, non-critical care patients receiving parenteral nutrition for >7 days.

PMID:40914815 | DOI:10.1002/jpen.70010