Nevin Manimala

Stat Med. 2025 Sep;44(20-22):e70255. doi: 10.1002/sim.70255.

ABSTRACT

This article addresses the problem of determining whether the dose response relationships between subgroups and the full population in a multiregional trial are similar. Similarity is assessed in terms of the maximal deviation between the dose response curves. We consider a parametric framework and develop two powerful bootstrap tests: one for assessing the similarity between the dose response curves of a single subgroup and that of the full population, and another for comparing the dose response curves of multiple subgroups with that of the full population. We prove the validity of these tests, investigate their finite sample properties through a simulation study and illustrate the methodology with a case study.

PMID:40922064 | DOI:10.1002/sim.70255

Matern Child Nutr. 2025 Sep 8:e70105. doi: 10.1111/mcn.70105. Online ahead of print.

ABSTRACT

Despite economic growth and poverty reduction, child undernutrition is still widespread in Bangladesh. This study aimed to evaluate both the burden and correlates of undernutrition among children under five in Bangladesh using the Composite Index of Anthropometric Failure (CIAF). Data were obtained from the 2019 Multiple Indicator Cluster Survey (MICS), comprising a weighted sample of 21,885 children collected through a nationally representative cross-sectional survey between January and June 2019. The study applied a two-stage stratified cluster sampling technique. To determine the factors influencing CIAF, a generalized linear mixed model (GLMM) was employed, accounting for clustering effects. The adjusted odds ratio (AOR) was derived, accompanied by its corresponding 95% CI, and a significance threshold of p < 0.05 was used to identify significant predictors of CIAF. The study revealed an overall CIAF prevalence of 37.2% (95% CI: 36.6%-37.9%). The prevalence of combined stunting and underweight was 11.9%, wasting and underweight 4.2%, and concurrent stunting, wasting and underweight 3.3%. Children aged 24-59 months, multiple births, birth size smaller than average, children of mothers with below primary education (AOR: 2.02; 95% CI: 1.59-2.57), received no ANC visits (AOR: 1.23; 95% CI: 1.04-1.46), children delivered at home, and children from lower socio-economic families had significantly higher odds of undernutrition compared with other counterparts (AOR: 1.70; 95% CI: 1.37-2.11). In Bangladesh, more than one-third of under-five children suffer from undernutrition, hindering the potential of millions. Urgent policy action is needed to address undernutrition, particularly among socio-economically disadvantaged children and those in the Sylhet division. Strengthening nutritional programs, maternal education, financial stability and healthcare access is crucial. The study recommends adopting CIAF as a national indicator to measure child undernutrition and guide comprehensive strategies to achieve the Sustainable Development Goals.

PMID:40922060 | DOI:10.1111/mcn.70105

Influenza Other Respir Viruses. 2025 Sep;19(9):e70152. doi: 10.1111/irv.70152.

ABSTRACT

BACKGROUND: Few studies have evaluated COVID-19 vaccine effectiveness (VE) in middle-income countries, particularly in eastern Europe. We aimed to estimate COVID-19 VE against SARS-CoV-2-confirmed hospitalizations and severe outcomes in Kosovo.

METHODS: We conducted a test-negative case-control study using data from Kosovo’s severe acute respiratory infection (SARI) sentinel surveillance system from January 2022 to June 2024. We enrolled adult patients aged ≥ 18 years hospitalized with SARI. From all patients, we collected clinical data, vaccination history, and a nasopharyngeal specimen, which was tested for SARS-CoV-2 using RT-PCR. SARS-CoV-2-positive patients were cases; those testing negative were controls. We estimated VE overall and against severe outcomes (requiring oxygen, intensive care admission, or in-hospital death) using logistic regression, adjusting for age, sex, and comorbidities, calculating VE as (1-adjusted odds ratio) × 100.

RESULTS: We included 564 SARI patients; 218 (39%) tested positive for SARS-CoV-2. Overall, 24% of SARI patients had received at least one COVID-19 vaccine dose in the previous 12 months. VE against SARS-CoV-2-confirmed SARI hospitalization among all adults was 72% (95% CI: 30%-89%) at 14-179-day postvaccination, and 26% (95% CI: -33%-59%) at 180-364 days. In adults ≥ 60 years, VE was 52% (95% CI:-31%-82%) at 14-179-day postvaccination, and -36% (95% CI: -190%-36%) at 180-364 days. VE against severe outcomes was 67% (95% CI: -14%-91%) at 14-179 days, and 17% (95% CI:-111%-67%) at 180-364 days.

CONCLUSIONS: Our findings suggest that COVID-19 vaccination in Kosovo offered substantial protection against hospitalization and severe outcomes within 6 months, though confidence intervals were wide for some subgroups. Effectiveness waned after 6 months, highlighting the need for periodic booster doses.

PMID:40922048 | DOI:10.1111/irv.70152

Int J Health Plann Manage. 2025 Sep 8. doi: 10.1002/hpm.70018. Online ahead of print.

ABSTRACT

BACKGROUND: Since 2017, Japan has been establishing a community-based integrated mental health care system, which includes first-line consultations provided by local authorities (i.e., municipalities). This study aimed to (1) investigate factors related to the challenge municipalities encounter when providing mental health consultations, and (2) identify collaboration patterns between municipalities and public health agencies.

METHODS: Data were obtained from a nationwide municipal survey and publicly available government statistics. Municipal staff difficulty in providing mental health consultations was measured using a four-point scale, and its association with local psychiatric and social care resources and collaboration activities across local institutions was examined by ordinal logistic regression analysis. Latent class analysis was also conducted based on how the municipality collaborated with public health agencies.

RESULTS: Lower difficulty providing mental health consultations was associated with the existence of municipally established public health centres (OR 0.22, 95% CI 0.09 to 0.53, p = 0.001), which minimises the organisational barrier between the two entities, and frequent meetings with local service providers (OR 0.65, 95% CI 0.44 to 0.96, p = 0.032). Variables indicating local psychiatric and social care resources showed no significant associations. Municipalities were classified into four latent classes based on collaboration patterns: Overall frequent (18.1%), Overall infrequent (22.0%), Frequent for individual support (49.1%), and Infrequent for individual support (10.8%).

CONCLUSIONS: The difficulty faced by local authorities in providing mental health consultations may be reduced by fostering collaboration with other institutions, specifically public health agencies, and by hosting frequent meetings with local service providers.

PMID:40922045 | DOI:10.1002/hpm.70018

J Obstet Gynaecol Res. 2025 Sep;51(9):e70068. doi: 10.1111/jog.70068.

ABSTRACT

AIM: This study aimed to compare short- and long-term surgical outcomes between robotic sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy (LSC), performed with concomitant total hysterectomy, in patients with symptomatic pelvic organ prolapse (POP).

METHODS: This retrospective cohort study included 167 women who underwent RSC (n = 113) or LSC (n = 54) with hysterectomy for uterine prolapse at Kawasaki Medical University between March 2020 and December 2024. Perioperative parameters, complications (Clavien-Dindo classification), and POP recurrence were assessed. The POP-Q was used for anatomical evaluation. Long-term outcomes such as recurrence, urinary incontinence, and mesh erosion were monitored over a median follow-up of 30 (RSC) and 52.5 (LSC) months.

RESULTS: The patients in the RSC group were significantly younger and had a higher incidence of diabetes. RSC had longer operative times (median 175 min vs. 152 min; p < 0.01) but comparable blood loss, complication rates, and hospital stay. POP-Q showed greater cervical elevation in the RSC group at one month (p < 0.05). The long-term recurrence rate was low and similar between the groups (RSC, 2.7%; LSC, 3.7%; p = 0.71). Mesh erosion, urinary incontinence, and organ prolapse were rare and did not differ significantly between the groups.

CONCLUSIONS: RSC with concomitant hysterectomy is a safe and effective alternative to LSC with comparable short- and long-term outcomes. Despite longer operative times, RSC offers anatomical benefits without increasing the risk of postoperative complications or recurrence.

PMID:40922044 | DOI:10.1111/jog.70068

Int J Epidemiol. 2025 Aug 18;54(5):dyaf140. doi: 10.1093/ije/dyaf140.

ABSTRACT

BACKGROUND: Coinciding with the SARS-CoV-2 pandemic, malaria cases and malaria-related deaths increased globally between 2020 and 2022. However, evidence linking the pandemic to increased malaria burden remains ambiguous. We assessed the extent to which an observed malaria resurgence in Lambaréné, Gabon, can be associated with pandemic-related disruptions in malaria control programmes.

METHODS: Using observational data from two tertiary referral hospitals, spanning 2018 to early 2023, we applied autoregressive integrated moving average (ARIMA) models in an interrupted time series (ITS) framework to test for changes in trends and levels following the onset of the pandemic. The primary outcome is the monthly malaria diagnosis rate (per 1000 all-cause hospital diagnoses). As a sub-analysis, we focused on monthly maternal malaria incidence.

RESULTS: Following an initial drop (-47.32, P = 0.031), potentially due to risk-averse behaviours, the malaria diagnosis rate gradually and concavely increased (linear term: 7.32, P = 0.001; squared term: -0.19, P = 0.001) to a peak above pre-pandemic levels. Additional analyses suggest that this resurgence was likely driven by disruptions to malaria control activities and a waning efficacy of malaria control tools administered pre-pandemic. Conversely, a resurgence in maternal malaria incidence was not estimated.

CONCLUSION: Findings align with several national and global descriptive reports, but add a more detailed understanding of underlying dynamics, therefore reinforcing the importance of maintaining malaria control in the general population. The absence of a meaningful increase in maternal malaria provides some reassurance that malaria in pregnancy-specific control remained unchanged during the SARS-CoV-2 pandemic. However, observed peaks in post-pandemic maternal malaria incidence should raise concerns given the risks that malaria poses to this group.

PMID:40922028 | DOI:10.1093/ije/dyaf140

Radiat Oncol. 2025 Sep 8;20(1):139. doi: 10.1186/s13014-025-02719-3.

ABSTRACT

BACKGROUND: Stereotactic Body Radiotherapy (SBRT) has been proven to be a safe and effective alternative to surgery in patients with metastatic primary sarcoma. However, data describing tumor response in relation to the given radiotherapy dose is lacking. Therefore, this study aims at analyzing efficacy and dose-response relationship in a retrospective cohort.

METHODS: Patients with metastatic sarcoma treated with ablative SBRT and followed up at the Karolinska University Hospital between 2008 and 2021 were included. SBRT was delivered using an inhomogeneous dose distribution resulting in higher median doses within the planning target volume (PTV) than the dose prescribed. Local control (LC), progression-free survival (PFS), overall survival (OS), adverse events and dose-response relationship were assessed. Statistical analysis was performed to identify variables that correlate to outcome.

RESULTS: Forty-three patients with a total of 83 lesions were treated. The most frequent histology was leiomyosarcoma (44%). The most common site of metastases was the lung (84%), followed by the liver (11%). The median prescription dose was 45 Gy (range 30-56 Gy) delivered in 3 fractions (range 2-8) with a planned median CTV mean dose of 309 Gy in EQD₂ with α/β = 3 Gy. The local control at 1-year, 2-year and 5-year from SBRT treatment was 97, 93 and 84%, respectively. For tumors with a planned mean CTV dose above EQD₂ 278.8 Gy (corresponding to 60.3 Gy in 3 fractions) the 1, 2 and 5-year local control was 100, 100 and 93%, respectively. Tumors planned with a lower dose than EQD₂ 278.8 Gy (α/β = 3 Gy) had a 1, 2 and 5-year local control of 90, 70 and 52%, respectively. The difference in local control between the high dose and low dose groups was statistically significant (p < 0.001). The median OS for all patients was 43 months. When respecting dose constraints, there were only limited number of mild side effects.

CONCLUSION: In this analysis a strongly significant dose-response relationship with excellent LC rates and limited side effects for patients with metastatic lesions of sarcoma were seen. These results could be related to the inhomogeneous dose distribution of SBRT treatments utilized in this study.

PMID:40922018 | DOI:10.1186/s13014-025-02719-3

BMC Geriatr. 2025 Sep 8;25(1):687. doi: 10.1186/s12877-025-06244-6.

ABSTRACT

BACKGROUND: Hospital admissions occur frequently in nursing homes and are often preventable. Inappropriate hospitalisations due to nursing home-sensitive conditions pose significant risks to residents, place additional strain on emergency departments and hospitals, and thus lead to substantial healthcare costs. In light of demographic changes- characterised by an aging and increasingly multimorbid nursing home population- combined with ubiquitous lack of health care professionals, new strategies are urgently needed to ensure adequate medical care in nursing homes. Telemedicine presents a promising and innovative solution, particularly for rural regions, to improve access to timely medical attention. In this study, we evaluated whether the implementation of regular televisits, in addition to on-site visits, can help decrease unplanned hospitalisations.

METHODS: In 2021, a nursing home in rural Germany introduced televisits with a cooperating general practitioner. Data on unplanned hospital admissions was collected for the years 2021/22 and 2018/19, the latter serving as a pre-intervention comparison. Hospital admissions were then compared between the two time periods, as well as between residents of 2021/22 who did or did not receive regular televisits.

RESULTS: Baseline characteristics were comparable between residents of 2018 and 2021, as well as between residents in the telemedical care and the control group. Unplanned hospital admissions significantly decreased (P <.0001) after implementation of regular televisits. Furthermore, a significantly lower (P =.04) number of hospital admissions was noted among residents in 2021/22 who received additional regular televisits, compared to the control group of residents that only received regular on-site visits.

CONCLUSIONS: Implementing regular televisits in the nursing home setting reduced the number of hospital admissions. This is most likely due to more frequent medical assessment, enabling early detection and timely management of deteriorations. By preventing unnecessary hospital admissions residents were spared the physical and psychological burdens connected with emergency transfers and protected from hospital-associated risks. On top of enhancing quality of care for the residents, televisits implementation in nursing homes can contribute to decrease strain on emergency services and hospitals.

TRIAL REGISTRATION: Not applicable, as no health-related intervention, modifying biomedical outcome or health-related measures in patients, took place.

PMID:40922008 | DOI:10.1186/s12877-025-06244-6

BMC Pregnancy Childbirth. 2025 Sep 8;25(1):930. doi: 10.1186/s12884-025-08061-6.

ABSTRACT

BACKGROUND: A growing body of knowledge is questioning the timing of postpartum care (PPC) and suggesting a structural change. The primary aim was to evaluate individuals’ satisfaction with additional PPC, and the secondary aim was to identify different needs postpartum.

METHODS: This comparative study was conducted in six maternity clinics in Gothenburg, Sweden 2019-2020. A total of 1159 eligible individuals were enrolled. An intervention model of care was evaluated, where the intervention group received two postpartum care compared to standard care, one visit (seven weeks postpartum) to their midwives. The participants answered questionnaires in connection to all postpartum care visits and at one-year postpartum a follow-up questionnaire was sent out.

RESULTS: The data from a total of 958 of 1159 participants (82.7%) were analysed: 447 of 554 (80.7%) in the intervention group vs 511 of 605 (84.4%) in the standard group. The participants in the intervention group reported satisfaction with the early, additional visit 413/444 (93%); where primiparous individuals reported a higher appreciation compared to parous individuals; 223/233 (95.7%) vs 190/211 (90.0%), P = 0.051. The three-weeks postpartum visit was perceived as timely, 434/441 (98.4%). Participants attending the clinic situated in a low socioeconomic status area were less likely to report a preference for additional visits. Nearly half of the participants in the standard group 201/466 (43%) expressed a preference towards an additional and early visit and this was more common among primiparous, 127/254 (50%) vs parous 74/212 (34.9%) P = 0.001. Those in the standard group who expressed a need for earlier support reported a wish for discussing abdominal/vaginal problems and experience of giving birth. Primiparous 73/127 (57.7%) were more likely than parous individuals 28/74 (37.8%) P = 0.011 to express a need for additional support with breastfeeding.

CONCLUSIONS: The results demonstrate an increased need for early and additional visits among primiparous, and important topics were abdominal/vaginal problems, experience of giving birth and breastfeeding. Information for individuals in low socioeconomic status areas needs to be expanded.

PMID:40922006 | DOI:10.1186/s12884-025-08061-6

J Urban Health. 2025 Sep 8. doi: 10.1007/s11524-025-00999-4. Online ahead of print.

ABSTRACT

The food environment (FE) is the interface where consumers interact to acquire and consume their food. Over the last two decades, the FE has changed due to lifestyle changes, globalization, economic disparities, and supermarketization. In addition, research on the food environment has focused mostly on high-income countries. Our study shows the novelty of assessing the food environment using the market food diversity (MFD) in Nairobi, a rapidly urbanizing city. We assessed the food environment of three income regions of Nairobi-using market food diversity derived from the Minimum Dietary Diversity of Women (MDD-W) tool. In August-December 2023, we used the Global Positioning System (GPS) and a list-based questionnaire to map 3548 food vendors. Descriptive statistics show that informal vendors (86%) dominated across the three income regions compared to formal vendors (14%). The high-income region was characterized by the presence of more formal vendors (24.2%) compared to the other income regions. There were statistically significant differences in food group variations among vendors. The study shows that unhealthy foods remain dominant across the three income regions. Market food diversity was highest in the high-income (3.11) region compared to the low- (2.71) and middle-income (2.35) regions. Our results underscore the need for policy implementation that supports local food environments that promote access to healthier and more nutritious diets, particularly in rapidly urbanizing cities of low- and middle-income countries (LMICs) such as Nairobi. Distinguishing income regions highlights the need for local policy officials to intervene to promote access to much healthier foods across the settlements.

PMID:40921999 | DOI:10.1007/s11524-025-00999-4