Nevin Manimala

Syst Rev. 2025 Jul 10;14(1):144. doi: 10.1186/s13643-025-02894-0.

ABSTRACT

BACKGROUND: While the oral glucose tolerance test (OGTT) is the gold standard for diagnosing gestational diabetes mellitus (GDM), hemoglobin A1c (A1C), glycated albumin (GA), and fructosamine (Fruc) have the potential to conveniently classify pregnant women as having or not having GDM because two or more measurements are not necessary, unlike with OGTT. Compared with A1C, GA or Fruc, which reflects more recent glycemic indices, may more accurately detect GDM. This meta-analysis compared the diagnostic ability of GDM between GA or Fruc and A1C.

METHOD: Comprehensive literature searches were performed for studies published up to Sep.11, 2023. Selected studies were limited to those that attempted to identify GDM using both GA and/or Fruc and A1C to compare these indicators. Two authors extracted the data. Disagreements were resolved by a third author. Study quality was assessed by a revised tool for quality assessment of diagnostic accuracy in studies (QUADUS-2). The dataset consisting of true-positives, false-positives, false-negatives, and true-negatives was pooled with a bivariate between-study model and hierarchical summary receiver operating characteristic model. Pooled relative sensitivity and specificity based on a random-effects model were calculated to compare the diagnostic ability of A1C and GA and/or Fruc for GDM.

RESULT: There were 20 eligible studies. Pooled positive and negative likelihood ratios with 95% confidence intervals (CI) were 5.11 (2.30-11.37) and 0.53 (0.40-0.71), respectively, if GA or Fruc was used and 3.75 (2.61-11.39) and 0.53 (0.42-0.66), respectively, if A1C was used. Relative sensitivity and specificity (95% CI) for GA or Fruc compared with A1C was 1.00 (0.94-1.07) and 0.99 (0.97-1.01), respectively.

CONCLUSION: The insufficiently low value of the negative likelihood ratio did not support the single use of GA/Fruc or A1C in screening for GDM suggesting the necessity of combining other risk factors with glycemic indicators. Although there was no statistically significant difference in diagnostic ability between GA or Fruc and A1C, the value of the positive likelihood ratio indicated that GA or Fruc was somewhat more useful than A1C as a rule-in test for the diagnosis of GDM.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023461975.

PMID:40640901 | DOI:10.1186/s13643-025-02894-0

J Orthop Surg Res. 2025 Jul 10;20(1):637. doi: 10.1186/s13018-025-06091-6.

ABSTRACT

BACKGROUND: Vitamin D deficiency is a global public health concern, particularly among adolescents. While its skeletal effects are well-established, evidence on its extraskeletal roles in muscle and adipose tissue during this critical developmental period remains limited, especially using direct body composition measures.

METHODS: We analyzed 3,648 participants aged 12-19 years from NHANES data (2011-2018), stratifying vitamin D status as deficiency, insufficiency, or sufficiency. Multivariable linear regression models evaluated associations with appendicular lean mass index (ALMI), visceral adipose tissue area (VATA), and total bone mineral density (BMD). Subgroup analyses explored age, sex, and racial/ethnic variations.

RESULTS: Vitamin D deficiency/insufficiency affected 40.1% of participants. Higher serum vitamin D status correlated with positive body composition: lower VATA (β = -0.092, 95% CI: -0.124 to -0.061), and higher ALMI (β = 0.005, 95% CI: 0.004 to 0.006) and BMD (β = 0.0008, 95% CI: 0.0006 to 0.0010). Subgroup analyses revealed stronger ALMI associations in older boys and Mexican Americans, while VATA reductions were most pronounced in younger girls. BMD benefits were consistent across subgroups.

CONCLUSIONS: Vitamin D deficiency is prevalent among adolescents and independently associated with unfavorable body composition, modulated by demographic factors. These findings highlight the need for targeted interventions to optimize musculoskeletal and metabolic health during this developmental window.

PMID:40640884 | DOI:10.1186/s13018-025-06091-6

BMC Sports Sci Med Rehabil. 2025 Jul 10;17(1):192. doi: 10.1186/s13102-025-01238-8.

ABSTRACT

BACKGROUND: Recent advances in sport physiology have shown, that higher fatigue resistance predicts outstanding performance in endurance sport. However, so far there is no clear consensus on how to test durability in the field or in a laboratory. Protocols of the few existing studies are only suitable for professional male cyclists while most coaches work primarily with amateur athletes. Moreover, it is currently unclear whether durability is dependent on traditional parameters of endurance performance, such as functional threshold power (FTP) or maximal oxygen uptake (VO₂ max).

METHODS: 20 well trained amateur road cyclist completed a home-based test on two occasions. The first time, after a standardized warm-up, a 5-minute and a 20-minute cycling test were carried out. The second test was preceded by a fatigue protocol which, after the warm-up, consisted of cycling at 80% of their initial 20-minutes power under fresh condition until 1000 kJ of work was completed, followed by 5-minutes and 20-minutes all-out tests.

RESULTS: The performance significantly decreased with 10,1 ± 6,5% in the 20-minutes test and with 10,8 ± 7,8% in 5-minutes in fatigue state in compare with fresh state. No significant correlations were found between better durability and VO₂ max or relative FTP.

CONCLUSION: We showed that durability is a parameter independent of traditional physiological measures of cycling performance. Looking at durability then working backwards can help identify what coaches need to work on in so many areas that are important to all aspects of racing in cycling sport.

PMID:40640875 | DOI:10.1186/s13102-025-01238-8

Trials. 2025 Jul 11;26(1):241. doi: 10.1186/s13063-025-08915-6.

ABSTRACT

Reports of the results of clinical studies are integral to regulatory decision making. They are used to support marketing authorization, to substantiate labeling information, and to inform academic publications, trial postings, and promotional messages intended to communicate study results to doctors and patients. Therefore, beyond summarizing the study design, methods, and data, study reports should provide clear descriptions of the benefits and risks of an intervention for a given medical condition. The ICH E9(R1) addendum on estimands and sensitivity analysis in clinical trials provides a framework aiming for more clarity about the reported “treatment effects.” In practice, stakeholders are still learning how to embrace the estimand framework and how it impacts the reporting of study results in the most value-adding manner. This paper provides recommendations and considerations for implementing the estimand framework in the reporting of results to realize its full potential of increased transparency for interpretation and decision-making. These recommendations are based on practical experiences of working with clinical trial teams through the reporting process following implementation of the estimand framework in the protocol. As illustrated by two case studies, the primary application is in reporting studies for the scientific evaluation of medicines by regulatory agencies, directly impacting clinical study reports and submission documents, and will also extend to publications in scientific journals.

PMID:40640873 | DOI:10.1186/s13063-025-08915-6

Int J Equity Health. 2025 Jul 10;24(1):202. doi: 10.1186/s12939-025-02555-7.

ABSTRACT

BACKGROUND: Transgender and gender-diverse (TGD) individuals face substantial health disparities as a result of discrimination and poor provider competence in understanding their health needs. Relatively little work has been done studying educational interventions targeted toward increasing residents’ knowledge and ability to treat TGD individuals with sensitivity. We studied the effectiveness of implementing a lecture series on transgender health in preparing internal medicine residents to care for the TGD population.

METHODS: Both study and control participants were recruited through their affiliated internal medicine residency programs. The study design was a pre-post controlled educational study. A lecture series was developed at Riverside University Health System as the educational intervention. We used a Transgender Assessment survey developed for the study to determine changes in the residents’ knowledge, self-confidence, and knowledge of barriers to care during the study period from January to June 2022. The data were statistically analyzed to assess the differences between pre- and post- and study and control groups.

RESULTS: Similar demographics were noted between the study and control groups. Compared with the control group, residents in the study group tended to have more exposure to transgender health education prior to the study. Residents in the study group demonstrated increased knowledge and self-confidence after completing the curriculum. The study group’s average knowledge score increased from 4.8 to 6.1 post-intervention (p = 0.004). Self-confidence scores in providing gender-specific care rose from an average of 13.7 to 17.9 post-intervention (p < 0.001). The study group had higher post-intervention scores compared to the control group, particularly in knowledge of gender-affirming therapies (post 4.3 vs. pre 3.4, p = 0.01) and self-confidence in providing gender-specific care (post 17.9 vs. pre 12.3, p=0.004). No significant changes were observed in knowledge of barriers to care for both groups.

CONCLUSIONS: Our study demonstrates the effectiveness of a curriculum focused on TGD health in improving residents’ knowledge and confidence. Further research is needed on the durability of these effects and the curriculum’s impact on awareness of barriers to care. Implementing such curricula at other institutions could reinforce educational programs in medical schools to improve provider competence and address the healthcare needs of TGD individuals.

PMID:40640870 | DOI:10.1186/s12939-025-02555-7

Parasit Vectors. 2025 Jul 10;18(1):277. doi: 10.1186/s13071-025-06921-w.

ABSTRACT

BACKGROUND: The World Health Organization (WHO) recommends mass distribution of insecticide-treated nets (ITNs) to prevent malaria transmission. Unfortunately, resistance to pyrethroids affects the efficacy of standard ITNs. To overcome this resistance and continue to protect the population, the WHO has recommended new types of ITNs that combine a pyrethroid insecticide with either a synergist (PBO) or a second insecticide, such as chlorfenapyr. This study examines the baseline characteristics of malaria vectors prior to the distribution of three types of insecticide-treated nets as part of a three-arm randomised controlled trial: Interceptor G2 (pyrethroid-chlorfenapyr), VEERALIN (pyrethroid-PBO), and MAGNet (pyrethroid only).

METHODS: The study was carried out in 40 villages (grouped into 33 clusters) of Tiébissou district in central Côte d’Ivoire. To assess biting rate and biting behaviour, human landing catches were conducted hourly indoors and outdoors in six randomly selected houses in each cluster, starting at 18:00 and continuing until 08:00 the next morning. Adult mosquitoes collected were morphologically identified, and a subset of Anopheles gambiae sensu lato (s.l.) and An. funestus s.l. were speciated by quantitative PCR (qPCR). Plasmodium sporozoite infections were detected by qPCR to estimate infection rates. The entomological inoculation rate was calculated as the product of the mosquito biting rate and the sporozoite infection rate.

RESULTS: Among the 10,698 mosquitoes collected, An. gambiae s.l. was the predominant species, accounting for 62.5% (n = 6683) of the catch, followed by An. funestus s.s., which accounted for 19.8% (n = 2120). Of the sub-sample of An. gambiae s.l. processed by PCR, 79.0% (n = 1291/1635) were An. coluzzii and the remaining were Anopheles gambiae s.s. Malaria vectors were highly aggressive, with an average of 14.8 bites/person/night for An. coluzzii, 2.0 b/p/n for An. gambiae s.s. and 5.4 b/p/n for An. funestus, representing an overall average of 22.2 b/p/n (95% CI 17.2-27.2 b/p/n). No significant difference was found in biting activity between indoor and outdoor environments (Z = -0.25, P = 0.803). Plasmodium sporozoite infection rate was 2.4% (95% CI 1.3-3.6%) for An. coluzzii, 1.5% (95% CI 0.3-2.6%) for An. gambiae s.s. and 2.7% (95% CI 1.2-4.3%) for An. funestus. The estimated overall entomological inoculation rate was 0.4 infected b/p/n (95% CI 0.3-0.6) and varied between 0.0 and 0.2 infective bites/person/night according to species. There was no difference observed in entomological infection rate (EIR) between capture locations (indoors versus outdoors; Z = 1.521, P = 0.128).

CONCLUSIONS: This study shows that An. coluzzii and An. funestus were the main malaria vectors and showed similar biting patterns both indoors and outdoors. Anopheles funestus was found in high density in a limited number of villages. Malaria transmission was high despite universal distribution of pyrethroid-ITN in the district.

PMID:40640866 | DOI:10.1186/s13071-025-06921-w

Mar Pollut Bull. 2025 Jul 9;220:118394. doi: 10.1016/j.marpolbul.2025.118394. Online ahead of print.

ABSTRACT

Driftwood is a ubiquitous component of coastal environments, yet its functional role in trapping marine litter remains poorly understood, particularly in tropical systems. This study investigates the relationship between driftwood abundance and litter accumulation across seven remote beaches of the central Caribbean coast of Colombia. A standardized quadrant-based field protocol was applied to quantify and classify 12,129 items, including 3990 driftwood pieces and 8139 litter items. Plastics represented 92 % of total litter, with foam sponge, caps, and fragmented packaging as dominant types. Driftwood indices showed strong spatial variation and were positively correlated with total litter and plastic densities. Sites with greater driftwood presence consistently exhibited higher litter accumulation, suggesting a passive retention mechanism. Multivariate ordination and cluster analyses revealed that driftwood-rich beaches formed distinct assemblages dominated by lightweight, floatable plastic items. Although Indicator Species Analysis did not yield statistically significant item-driftwood associations, qualitative patterns supported selective entrapment. These findings position driftwood as a key modulator of litter retention in remote beach systems. Beyond its ecological role, driftwood also holds predictive potential: linear relationships and derived ratios (LDR, PDR) offer scalable metrics for identifying pollution hotspots.

PMID:40638947 | DOI:10.1016/j.marpolbul.2025.118394

N Z Med J. 2025 Jul 11;138(1618):83-95. doi: 10.26635/6965.6887.

ABSTRACT

AIM: To analyse hospital resource utilisation at Christchurch Hospital in New Zealand during two mass-casualty incidents (MCIs) in 2019: the Christchurch mosque shootings and the Whakaari (White Island) volcanic eruption.

METHODS: A cross-sectional retrospective analysis was conducted to assess hospital resource utilisation during the two MCIs.

RESULTS: A total of 45 patients from the mosque MCI and eight patients from the Whakaari MCI were admitted to Christchurch Hospital. The total length of stay was mosque MCI: 15,054 hours (average 335 hours per patient) and Whakaari MCI: 1,841 hours (average 230 hours per patient). Mean surgeon time (operative length multiplied by number of surgical staff) was mosque MCI: 6.5 hours and Whakaari MCI: 14.7 hours. Burns represented a significantly greater surgical workload per operative event. There were notable differences in staffing, investigations, consumables, blood products, theatre time and the number of operative events between the MCI cohorts.

CONCLUSION: The studied MCIs had significant effects on hospital resource utilisation. Burn trauma was more resource intensive than non-burn trauma, despite most patients being repatriated within days of the index event. An analysis of resourcing, surge capacity and funding models in New Zealand is required to ensure trauma centres can effectively respond to future crises.

PMID:40638932 | DOI:10.26635/6965.6887

N Z Med J. 2025 Jul 11;138(1618):48-59. doi: 10.26635/6965.6875.

ABSTRACT

AIM: A facility-specific, prehospital trauma destination matrix has been implemented in the Te Manawa Taki (TMT)/Midland Region of Aotearoa New Zealand to support decisions on the most appropriate destination hospital for injured patients. This study evaluates the implementation of this policy.

METHODS: Injury data obtained from the TMT Trauma Registry were linked with Global Positioning System (GPS) data from Hato Hone St John and Land Information New Zealand Data Service for trauma events within the region from 1 January to 31 December 2023. Analysis of spatial relationships between injury location, specific injuries and hospital admission was performed using ArcGIS and R statistical programming.

RESULTS: A total of 214 trauma events met the TMT Matrix criteria, of which 163 (76.1%) were transported to a hospital consistent with the destination specified. Lowest consistency (43.8%) of prehospital transport was seen with severe traumatic brain injury likely to require neurosurgery among adults aged >15 years. Approximately 32% of patients with matrix conditions requiring direct transport were lower severity (Injury Severity Score [ISS] <13). When the specified destination was that closest to the incident, there was 93.9% TMT Matrix consistency. Patients with a TMT Matrix condition who did not go directly to the defined facility and had a subsequent transfer took a median 10.5 hours to reach the defined facility.

CONCLUSIONS: The majority of trauma patient transports were consistent with the TMT prehospital matrix. A primary influence on compliance was the distance from point of injury to designated facility. This study prompts further exploration of factors associated with appropriate prehospital triage and refinement of TMT prehospital destination policy.

PMID:40638929 | DOI:10.26635/6965.6875

N Z Med J. 2025 Jul 11;138(1618):30-47. doi: 10.26635/6965.6729.

ABSTRACT

AIM: The 1737 Need to Talk telehealth service (mental health call and text helpline) was launched in Aotearoa New Zealand in June 2017, providing the public with the ability to call or text when they need mental health support. The aim of this research is to describe the utilisation of the 1737 Need to Talk telehealth service. We describe the patterns of 1737 contacts over time and describe the contact users, including the most at-risk contacts (defined as those contacts who trigger the “Break Glass” procedure).

METHODS: This is a retrospective observational study analysing 1737 Need to Talk data over 5 years and 7 months from June 2017 through to December 2022. A total of 719,904 contacts to the service were analysed.

RESULTS: This research found that contacts to the 1737 Need to Talk service (by call or text) increased until the end of 2021 and then plateaued from 2022. The average proportion of at-risk service users was 0.43% of 1737 Need to Talk contacts, and this grew minimally over the period investigated. Service users most at risk were found to be of the female gender, in the 13-19-year-old age group, and those residing in Whanganui and MidCentral districts.

CONCLUSION: This study details the growth in the number of specific demographics reaching out for mental health support to 1737 and may be indicative of the need for increasing mental health support.

PMID:40638928 | DOI:10.26635/6965.6729