Nevin Manimala

Ital J Pediatr. 2025 Jul 15;51(1):222. doi: 10.1186/s13052-025-02074-9.

ABSTRACT

BACKGROUND: Socioeconomic inequality remains a critical determinant of health outcomes worldwide, particularly in low- and middle-income countries. In Kenya, one of the most pressing maternal and child health challenges is the high prevalence of low birth weight (LBW), which is a key indicator of infant health and a strong predictor of neonatal and child morbidity and mortality. Therefore, exploring socioeconomic inequality and the determinants of LBW in Kenya is essential for developing effective policies and interventions.

METHODS: A cross-sectional study was conducted using secondary data from the 2022 Kenyan Demographic and Health Survey. A weighted total sample of 4717 live births in the two years prior to the survey was included in the study. The concentration index and concentration curve were used to investigate socioeconomic inequality in LBW among newborns. In addition, a multilevel regression model was used to identify the determinants, and the adjusted odds ratio with a 95% confidence interval was used to determine statistical significance.

RESULTS: The prevalence of low birth weight among live births in Kenya was 8.71%. It was inequitably distributed across socioeconomic groups, with a concentration index of (-0.0295), with a higher concentration of LBW infants among mothers living in the lowest socioeconomic quintile. Mothers without formal education, poor wealth index, female sex, multiple births, and antenatal care visits were all significant predictors of LBW.

CONCLUSION: This study highlights that LBW remains a significant issue in Kenya, disproportionately concentrated in households in the lowest socioeconomic quintile. Factors such as lack of maternal education, poverty, being female, being a twin, and inadequate antenatal care visits were significant predictors. To address these issues, it is important to improve maternal education, economic prosperity, healthcare accessibility, gender-sensitive approaches, and specialized care for multiple pregnancies, and encourage regular antenatal care visits for better birth outcomes and to reduce LBW prevalence. Hence, Kenyan governments and non-governmental organizations should address the complex factors to improve birth outcomes and reduce LBW.

PMID:40660282 | DOI:10.1186/s13052-025-02074-9

Nutr J. 2025 Jul 14;24(1):110. doi: 10.1186/s12937-025-01133-5.

ABSTRACT

BACKGROUND: Impaired growth, accompanied by low lean mass and poor bone mineralization in undernourished children, is linked to adverse short- and long-term health outcomes. Oral nutritional supplements (ONS) promote catch-up growth, but their efficacy in improving lean mass and bone mineralization remains uninvestigated. This study aims to compare the efficacy of long-term ONS with dietary counseling (DC) versus DC alone on growth, body composition, bone mineralization, and health outcomes in children with or at risk of undernutrition.

METHODS: Children (n = 330) aged 24-60 months with WHO Growth Standard z-scores of weight-for-age < – 1, height-for-age < – 1, and weight-for-height < 0 were randomized in a multisite controlled trial to receive two servings of a complete and balanced ONS formula with DC, or DC-only, for 240 days. Anthropometric measurements, dietary intake, and parent-reported measures of illness-related and other health outcomes were assessed at baseline and days 30, 120, and 240. Dual X-ray absorptiometry-assessed body composition and bone mineralization, and nutritional blood biomarkers were measured at baseline and day 240.

RESULTS: ONS supplementation augmented growth in height and weight through day 240, with increasing between-group differences over visits (P < 0.01 for treatment-by-visit interaction in height, weight, height-for-age and weight-for-age z-scores). Energy and protein intake levels were 26% and 22% higher, respectively, in the ONS + DC compared to the DC-group at day 240 (both P < 0.001). The ONS + DC group also had a higher lean mass index of 11.06 (0.05) versus 10.92 (0.05) kg/m2 (P = 0.048) and total body less head bone mineral density of 0.407 (0.003) versus 0.399 (0.003) g/cm2 (P = 0.03) at day 240, with no differences in fat mass index compared to DC. The ONS + DC group also had better serum vitamin D and K status, fewer sick and missed school days, better parent-reported sleep habits, appetite, energy, and physical activity levels versus DC-group (all P < 0.05).

CONCLUSION: Adding ONS to DC for 8 months improved linear catch-up growth and supported quality growth, as evidenced by greater lean mass and bone mineral accretion. These findings, alongside parent-reported improvements in child health, suggest that improved nutrient intake with ONS improves multiple domains of child health and well-being.

TRIAL REGISTRATION: This clinical trial was registered on ClinicalTrials.gov (registration number: NCT05239208) on 14 February 2022. Video Abstract.

PMID:40660276 | DOI:10.1186/s12937-025-01133-5

Harm Reduct J. 2025 Jul 14;22(1):119. doi: 10.1186/s12954-025-01268-y.

ABSTRACT

BACKGROUND: Naloxone, a life-saving medication that reverses opioid overdoses, was available in the United States only by prescription until March 2023, when the federal government approved nasal-spray formulations for over the counter sales to expand access. We assessed the availability of naloxone in a sample of pharmacies across the state of Connecticut.

METHODS: Between September 15 and November 24, 2024, trained community-based volunteers surveyed a convenience sample of pharmacies throughout the state, focusing on naloxone signage, availability, cost, and in-store location. Pharmacies were categorized into three groups: chain pharmacies, pharmacies within grocery stores, and independent pharmacies. Summary statistics for the full sample and the three subgroups were tabulated, and differences between groups were analyzed using Fisher’s exact tests.

RESULTS: A total of 162 pharmacies across all Connecticut counties were evaluated. While naloxone was available in most pharmacies, it was predominantly kept behind the pharmacy counter (n = 111, 73.5%) or the general checkout counter (n = 46, 30.5%). Fewer than 20% of pharmacies (n = 29) had naloxone easily accessible on an aisle shelf. Pricing was often high (≥ $60), particularly in independent pharmacies (n = 7, 22.6%; p < 0.001). Additionally, fewer than 20% of pharmacies (n = 31) displayed signage related to naloxone availability, and all signage was exclusively in English.

CONCLUSIONS: Despite widespread availability, naloxone access was restricted by its in-store location, high cost, and inadequate signage. This highlights a notable discrepancy between naloxone availability and accessibility, suggesting a lag in the effective implementation of policy in intended settings.

PMID:40660265 | DOI:10.1186/s12954-025-01268-y

J Med Internet Res. 2025 Jul 14;27:e71527. doi: 10.2196/71527.

ABSTRACT

BACKGROUND: Health care systems are increasingly facing challenges posed by the aging of populations. In particular, hospitalization, both initial and subsequent, is often observed among older adult patients. However, research suggests that nearly 23% of all hospitalizations could be avoided. In this perspective, remote patient monitoring (RPM) systems are emerging as a promising solution, enabling professionals to detect and manage patient complexities early within home-based care settings.

OBJECTIVE: This study aims to provide additional analyses regarding the impact of the EPOCA RPM system for polypathological older adult patients on the total number of unplanned hospitalization days and admissions, as well as emergency department (ED) visits. In a prior study, we evaluated the impact when the operator of the RPM system is a geriatrician. In this study, we assess the impact when the general practitioner is the operator.

METHODS: We used a retrospective, before-and-after cohort design. Polypathological older adult patients aged 70 and older, who benefited from the EPOCA RPM system for at least 1 year (between February 2022 and August 2024), were included in the analysis. We compared the outcomes between the previous year (Y-1) and the follow-up year (Y) by the EPOCA RPM system. Statistical analyses were significant at P value <.05.

RESULTS: In total, 80 patients were included in the analysis, with an average age of 87. The results showed a significant reduction (P<.001) between Y-1 and Y in the total number of unplanned hospital admissions (by 57%), hospitalization days (by 49%), and ED visits (by 62%). Our findings reflected a significant decrease per patient from 0.99 to 0.42 in hospital admissions, from 0.99 to 0.37 in ED visits, and a reduction of 9.7 hospitalization days per year (P<.001). Additional analyses stratifying by hospitalization history, disability level, and caregiver status showed that the greatest effect of the RPM system was on patients with high risk and severe disability. Finally, there was no observed increase in mortality or transfers to intensive care units.

CONCLUSIONS: Our findings are consistent with our previous results regarding the potential benefits of the EPOCA RPM system in managing care for polypathological older adult patients, this time with general practitioners as system operators. They also support existing evidence on the promise of RPM in improving care and health outcomes for older adult patients while alleviating hospital burdens by reducing unplanned hospitalizations and ED visits. It is, therefore, essential to incorporate reimbursement policies for these RPM initiatives so as to facilitate their adoption within health care systems and enhance their impact on health outcomes.

PMID:40658993 | DOI:10.2196/71527

J Bras Nefrol. 2025 Jul-Sep;47(3):e20240178. doi: 10.1590/2175-8239-JBN-2024-0178en.

ABSTRACT

INTRODUCTION: Graduate studies in Brazil have experienced significant growth since the 1990s. Over a 40-year period, the Graduate Program in Nephrology at Unifesp has qualified 261 master’s graduates, 111 doctors and 146 individuals who completed both a master’s and a doctoral degree. Of these, 278 hold a degree in Medicine. Medical postgraduates were responsible for 124 master’s dissertations and 243 doctoral theses completed.

OBJECTIVE: This study analyzed the profile and professional trajectories of graduate students from the Nephrology Graduate Program at Unifesp.

METHODS: The authors used the university’s database to establish the graduates’ profile and applied a questionnaire to identify their professional performance in academia and the job market. The graduates were divided into three groups: G1 – 1976 to 1997 (N = 127); G2 – 1998 to 2006 (N = 150); G3 – 2007 to 2015 (N = 241).

RESULTS: Regarding sex, male medical graduates were responsible for 53.6% of all completion papers; however, in the most recent period, women accounted for 61% of the works. Female participation was consistently higher among graduates from other areas, at 73.8% of the total. Among the physicians, 65.5% graduated from public universities, with the first group standing out with 73%. In the other groups, 59.5% and 59.8% came from public HEIs, respectively. The overall average income reported by master’s graduates responding to the questionnaire ranged from 5 to 10 minimum wages (MW), and for doctors, above 10 MW.

CONCLUSION: Doctoral graduates had a strong presence in academia, predominantly within the public sector.

PMID:40658958 | DOI:10.1590/2175-8239-JBN-2024-0178en

Ann Intern Med. 2025 Jul 15. doi: 10.7326/ANNALS-25-00997. Online ahead of print.

ABSTRACT

BACKGROUND: Aluminum is used as an adjuvant in nonlive vaccines administered in early childhood. Concerns persist about potential associations between vaccination with aluminum-adsorbed vaccines and increased risk for chronic autoimmunity, atopy or allergy, and neurodevelopmental disorders. Large-scale safety data remain limited.

OBJECTIVE: To assess the association between cumulative aluminum exposure from early childhood vaccination and risk for autoimmune, atopic or allergic, and neurodevelopmental disorders.

DESIGN: A cohort study linking nationwide registry data on childhood vaccinations, outcome diagnoses, and potential confounders, leveraging the variations in the aluminum content of childhood vaccines over time.

SETTING: Denmark, 1997 to 2020.

PARTICIPANTS: 1 224 176 children born in Denmark between 1997 and 2018 who were alive and residing in the country at age 2 years.

INTERVENTION: Cumulative aluminum amount received (per 1-mg increase) through vaccination during the first 2 years of life.

MEASUREMENTS: Incident events of 50 chronic disorders, including autoimmune (dermatologic, endocrinologic, hematologic, gastrointestinal, and rheumatic), atopic or allergic (asthma, atopic dermatitis, rhinoconjunctivitis, and allergy), and neurodevelopmental (autism spectrum disorder and attention deficit-hyperactivity disorder).

RESULTS: Cumulative aluminum exposure from vaccination during the first 2 years of life was not associated with increased rates of any of the 50 disorders assessed. For groups of combined outcomes, adjusted hazard ratios per 1-mg increase in aluminum exposure were 0.98 (95% CI, 0.94 to 1.02) for any autoimmune disorder, 0.99 (CI, 0.98 to 1.01) for any atopic or allergic disorder, and 0.93 (CI, 0.90 to 0.97) for any neurodevelopmental disorder. For most individually analyzed outcomes, the upper bounds of the 95% CIs were incompatible with relative increases greater than 10% or 30%.

LIMITATION: Individual medical records were not reviewed.

CONCLUSION: This nationwide cohort study did not find evidence supporting an increased risk for autoimmune, atopic or allergic, or neurodevelopmental disorders associated with early childhood exposure to aluminum-adsorbed vaccines. For most outcomes, the findings were inconsistent with moderate to large relative increases in risk, although small relative effects, particularly for some rarer disorders, could not be statistically excluded.

PRIMARY FUNDING SOURCE: None.

PMID:40658954 | DOI:10.7326/ANNALS-25-00997

Chaos. 2025 Jul 1;35(7):073125. doi: 10.1063/5.0273619.

ABSTRACT

In this study, we investigate the dynamic mechanisms of tumor progression in response to fluctuations and uncertainties within the tumor-immune microenvironment. Utilizing temporal single-cell data, we develop a novel stochastic reaction-convection model that captures the spatiotemporal dynamics of macrophage responses to tumor cells subjected to both multiplicative and additive noise generated by non-homologous microenvironmental fluctuations. We prove the existence and uniqueness of a global positive solution for the proposed stochastic model. Then, by combining the stochastic Lyapunov analysis and the comparison theorem, we explore the moment boundaries for cell populations, as well as the asymptotic behavior at the boundary equilibrium points; sufficient conditions for driving sustained tumor growth and clearance are derived by employing the ergodicity theorem and are interestingly found to be only related to multiplicative noise. Furthermore, we employ an upwind finite difference scheme to simulate the effects of different noise types on a cell population distribution and the persistence of tumor growth. Results show that while additive noise influences the multimodal distribution of early tumor cell phenotypes, it has minimal impact on the mean density of tumor cells, indicating that additive noise acts primarily as a diffusion factor. In contrast, increasing multiplication noise effectively inhibits the development without altering the number of peaks in a phenotypic distribution. Interestingly, when additive and multiplicative noises are correlated, stronger additive noise can have dual effects on the steady-state distribution of tumor cells, with increased correlation positively influencing tumor cell elimination. These results provide novel insight into the tumor-immune microenvironment dynamics.

PMID:40658932 | DOI:10.1063/5.0273619

Chaos. 2025 Jul 1;35(7):073124. doi: 10.1063/5.0274274.

ABSTRACT

We explore the behavior of statistical complexity as a possible indicator of the crossover between classical and quantum behaviors in thermodynamic systems. Using the López-Ruiz, Mancini, and Calbet statistical complexity measure C, along with the disequilibrium D, we analyze both the ideal and van der Waals gases as they approach regimes where quantum statistics become significant. We find that C reaches a well-defined maximum at a characteristic temperature Tc in all cases considered. Interestingly, the numerical value of C at this temperature is the same across these models. While the underlying reason for this behavior is not yet fully understood, it suggests that statistical complexity may capture structural changes in the system’s phase space that are associated with the emergence of quantum effects. The shift of Tc in the van der Waals case, depending on the excluded volume parameter b, reflects the influence of interactions on this crossover behavior. These results indicate that C might serve as a useful proxy for detecting the changes in the statistical structure of many-body systems as they transition from classical to quantum regimes.

PMID:40658929 | DOI:10.1063/5.0274274

Clin Orthop Relat Res. 2025 Jun 25. doi: 10.1097/CORR.0000000000003602. Online ahead of print.

ABSTRACT

BACKGROUND: In most patients, a soft tissue sarcoma is sporadic and not related to a specific known cause; however, demographic, environmental, and lifestyle factors may be linked to its development. Alcohol consumption, a major risk factor for oncogenesis, has increased, particularly among females, and it might be a risk factor for soft tissue sarcoma, with potential differences in the association based on the biological differences between males and females. Nevertheless, there is a lack of research data to determine the association between alcohol consumption and soft tissue sarcoma. Because soft tissue sarcoma often has poor oncologic and functional outcomes once it develops, identifying controllable factors for prevention would be beneficial.

QUESTIONS/PURPOSES: (1) Is there a dose-response association between overall alcohol consumption and the incidence of soft tissue sarcoma? (2) Are there associations between the amount of alcohol consumption per occasion and drinking frequency with the incidence of soft tissue sarcomas?

METHODS: This was a retrospective, population-based comparative study using the National Health Insurance Service database, which offers large-scale data from a relatively ethnically homogeneous Korean population, along with comprehensive health information. The database includes demographic, socioeconomic, health checkups, social behavior surveys, and claims data. We screened 4,234,415 people 20 years or older who underwent health checkups in 2009. Soft tissue sarcoma was defined as ICD-10 codes C47 or C49 and the registration code for cancer (V193), with at least two outpatient claims or more than one inpatient claim per year. Among the screened individuals, we excluded 7% (286,384) because of incomplete data, and we excluded 0.02% (198) with soft tissue sarcoma diagnosed before the index year. To better explore the association, we excluded 0.2% (10,088) of patients who died or developed soft tissue sarcoma in the index year. Finally, we included 3,937,745 participants (2,148,348 males and 1,789,397 females) and followed them until December 31, 2020 (mean follow-up 10 ± 1 years). The mean daily alcohol consumption was calculated using the drinking frequency (number of days per week) and the mean amount consumed on each occasion (the number of glasses [8 grams of ethanol per glass]), based on the concept of a standard drink in Korea. Based on the ethanol consumption, alcohol drinking levels were divided into three categories: individuals who did not drink, those who drank < 30 grams per day of ethanol, and those who drank ≥ 30 grams per day of ethanol. The soft tissue sarcoma incidence was calculated by dividing the number of events by the total person-years of follow-up. To address our primary study question, which was about the association of soft tissue sarcoma incidence and overall alcohol consumption, the analysis model was adjusted for age (years), smoking status (nonsmoker, past smoker, and current smoker), regular exercise (yes versus no), and metabolic syndrome (yes versus no). To address our secondary outcome, which was about associations between the amount of alcohol consumption per occasion and drinking frequency with the incidence of soft tissue sarcomas, alcohol consumption was divided into drinking frequency and amount of alcohol intake per occasion. Among the participants, 969 (males n = 550, females n = 419) were diagnosed with soft tissue sarcoma during the follow-up period, resulting in an incidence of 2.43 (males 2.55, females 2.30) per 100,000 person-years. To identify a monotonic dose-response association, we considered not only the statistical significance for individual exposure groups, but also the overall consistent directional trend in association across all groups.

RESULTS: Compared with the individuals who did not drink (reference), alcohol consumption was not associated with an increased incidence of soft tissue sarcoma in overall participants who drank < 30 grams per day and those who drank ≥ 30 grams per day of ethanol (adjusted HR 1.05 [95% confidence interval (CI) 0.9 to 1.22] and adjusted HR 0.92 [95% CI 0.70 to 1.21], respectively; p = 0.58 among three groups) or in males who drank < 30 grams per day and those who drank ≥ 30 grams per day of ethanol (adjusted HR 0.84 [95% CI 0.70 to 1.01] and adjusted HR 0.75 [95% CI 0.56 to 1.00], respectively; p = 0.17 among three groups). In females, compared with individuals who did not drink (reference), soft tissue sarcoma incidence increased in those who drank < 30 grams per day and those who drank ≥ 30 grams per day of ethanol (adjusted HR 1.51 [95% CI 1.20 to 1.9]; p = 0.01 and adjusted HR 2.48 [95% CI 1.17 to 5.27]; p = 0.06, respectively). Although a drinking frequency of 1 to 2 days per week was associated with increased risk of developing a soft tissue sarcoma (adjusted HR 1.61 [95% CI 1.27 to 2.04]; p = 0.003), the HR did not increase with higher drinking frequency across all four groups (adjusted HR 1.21 [95% CI 0.66 to 2.200; p = 0.88 for 3 to 5 days and adjusted HR 1.46 [95% CI 0.47 to 4.56]; p = 0.60 for 6 to 7 days, respectively). However, for females consuming 3 to 4, 5 to 7, and ≥ 14 glasses per occasion, the adjusted HRs were 1.51 (95% CI 1.07 to 2.13; p = 0.09), 1.73 (95% CI 1.16 to 2.58; p = 0.06), and 3.70 (95% CI 1.37 to 9.98; p = 0.03), respectively, and the HR tended to increase with higher consumption levels per occasion across all six groups (adjusted HR 1.30 [95% CI 0.94 to 1.81]; p = 0.09 for 1 to 2 glasses and adjusted HR 1.73 [95% CI 0.81 to 3.68]; p = 0.38 for 8 to 13 glasses).

CONCLUSION: This nationwide population-based study demonstrated a tendency toward a dose-response relationship between the level of alcohol consumption and the incidence of soft tissue sarcoma among females. These findings suggest that strategies for individuals vulnerable to alcohol-related complications could be considered. These strategies might include campaigns, education programs, and policy interventions; social guidelines to reduce alcohol consumption may be warranted, and alcohol consumption may be considered as a screening factor for soft tissue sarcoma. To clarify whether there is a causal relationship, further research is required on the mechanisms through which alcohol consumption and drinking patterns may contribute to the development of soft tissue sarcoma.

LEVEL OF EVIDENCE: Level III, prognostic study.

PMID:40658922 | DOI:10.1097/CORR.0000000000003602

J Nurs Care Qual. 2025 Jul 9. doi: 10.1097/NCQ.0000000000000891. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative surgical site infections (SSIs) are a significant concern in cardiac surgery.

PURPOSE: To characterize clinical and perioperative factors associated with the absence of deep SSIs in a cohort of patients who underwent coronary artery bypass grafting (CABG) surgery.

METHODS: A retrospective, single-center study was conducted, analyzing data from 214 patients between August 2023 and June 2024. Perioperative care measures included adherence to an established cardiothoracic SSI prevention bundle, consisting of preoperative chlorhexidine gluconate bathing, preoperative nasal decolonization, intraoperative antibiotics, and intraoperative and postoperative glycemic control.

RESULTS: Adherence to the prevention bundle varied (82.7-98.6%). A statistically significant difference in postoperative glycemic control was observed between elective and urgent surgery cases.

CONCLUSION: This study’s findings highlight the potential effect of rigorous protocol adherence and the critical role of standardized nursing care in SSI prevention. Future research to optimize patient care and outcomes during and after CABG surgery is recommended.

PMID:40658920 | DOI:10.1097/NCQ.0000000000000891