Nevin Manimala

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

JMIR Res Protoc. 2025 Jul 10;14:e67511. doi: 10.2196/67511.

ABSTRACT

BACKGROUND: Detained adolescents exhibit high rates of behavioral health needs, yet few receive treatment during detention or community re-entry. Once adolescents are released into the community, caregivers must mobilize significant resources and overcome barriers to facilitate their treatment engagement. Parenting stress is often heightened during this forced separation and the re-entry transition. Parenting stress is associated with greater perceived barriers to treatment and, for adolescents who begin treatment, less therapeutic change and premature treatment dropout. Interventions designed to support caregivers of detained adolescents in managing their stress while navigating the juvenile legal system are urgently needed, and mobile health (mHealth) interventions offer promising, scalable approaches. RAISE (Reducing pArentIng StrEss) is a web-based application co-designed with caregivers of detained adolescents to reduce caregiver stress and promote postrelease adolescent behavioral health services use.

OBJECTIVE: This study will evaluate the effectiveness of RAISE in reducing caregiver stress and promoting adolescent behavioral health services use following release from detention.

METHODS: A randomized controlled trial with 60 caregivers of detained adolescents (ages 12-17 years) across the United States will be conducted. Caregivers will be recruited through passive and active techniques and randomized to receive RAISE (intervention) or an informational brochure (comparison). Self-assessment questionnaires will be completed at baseline and 3- and 6-month follow-up timepoints. The fully automated RAISE intervention includes an 8-week stress reduction intervention, self-monitoring and affirmational SMS text messaging, and resources related to navigating the juvenile legal system. Assessments include empirically validated measures of parenting stress, mindful parenting, parenting self-efficacy, adolescent services use, motivation for youth treatment, caregiver behavioral health, sociodemographics, and RAISE usability (intervention only). Caregivers will also participate in a semistructured qualitative exit interview at the 3-month (postintervention) timepoint. Descriptive statistics will examine recruitment, randomization, assessment, retention, and application usability. Independent samples t tests and chi-square analyses will determine whether randomization was successful based on multiple background variables; group differences will be accounted for in outcome analyses. Regression analyses will be used for outcome analyses, with an intent-to-treat design; analyses will include intervention group as a predictor and control for the baseline level of the outcome, application usage, and demographic characteristics. Potential moderators and mediators of intervention effects will be explored.

RESULTS: We propose the enrollment of 60 caregivers by April 2025, final data collection by September 2025, and submission of main findings for publication in December 2025.

CONCLUSIONS: This study will provide empirical evidence regarding the impact of an mHealth stress reduction intervention co-designed with caregivers of detained adolescents. Findings will be informative for legal systems regarding how best to support caregivers of detained adolescents and the impact of reducing caregiver stress on adolescents’ linkage to behavioral health services following their release into the community.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05032742; https://clinicaltrials.gov/study/NCT05032742.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/67511.

PMID:40638918 | DOI:10.2196/67511

Am J Ther. 2025 Jul 11. doi: 10.1097/MJT.0000000000001950. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension is a serious health problem, and resistant hypertension occurs when blood pressure (BP) is uncontrolled despite at least 3 optimal-dosed agents of different pharmacologic classes. Aprocitentan is a novel pharmacological agent approved in early 2024 for treatment of hypertension, in patients whom BP is not adequately controlled while on other antihypertensive medications.

MECHANISM OF ACTION, PHARMACODYNAMICS AND PHARMACOKINETICS: Aprocitentan acts as a dual endothelin receptor antagonist, inhibiting both ETa and ETb. It is postulated that low-renin models and salt-sensitive models of hypertension, consistent with resistant hypertension, exhibit increased levels of plasma ET-1. Thus, inhibition of ET-1 at ETa receptors inhibits vasoconstriction effects. The oral bioavailability of aprocitentan is currently unknown. Maximum plasma concentrations reaching a Cmax is within 4-5 hours with an effective half-life of 41 hours. Plasma concentrations increase in a dose-proportional manner and reach steady state within 8 days. The volume of distribution is 20 L, highly protein bound, primarily to albumin, and undergoes both renal and hepatic metabolism via UGT1A1- and UGT2B7-mediated N-glycosylation and nonenzymatic hydrolysis.

CLINICAL TRIALS: In a phase 3, multicenter-study in adult patients (N = 730) with systolic blood pressure ≥140 mm Hg with a run-in placebo and standard background BP therapy continued throughout the study, placebo or aprocitentan (12.5, 25 mg) were randomized at various stages. Aprocitentan 12.5 mg was superior to placebo in reducing sitting (sitting systolic blood pressure) at week 4, and a persistence of the BP-lowering effect was demonstrated (sitting systolic blood pressure was maintained and was statistically superior at week 40) when aprocitentan 25 mg were rerandomized to placebo.

THERAPEUTIC ADVANCE: Aprocitentan is a novel endothelin receptor antagonist approved for the treatment of resistant hypertension. It is a welcome development in the arsenal to fight against resistant hypertension for those with difficulty to manage with conventionally available antihypertensive medications.

PMID:40638911 | DOI:10.1097/MJT.0000000000001950

J Med Internet Res. 2025 Jul 10;27:e70674. doi: 10.2196/70674.

ABSTRACT

BACKGROUND: One of the main challenges with COVID-19 has been that although there are known factors associated with a worse prognosis, clinicians have been unable to predict which patients, with similar risk factors, will die or require intensive care unit (ICU) care.

OBJECTIVE: This study aimed to develop a personalized artificial intelligence model to predict the patient risk of mortality and ICU admission related to SARS-CoV-2 infection during the initial medical evaluation before any kind of treatment.

METHODS: It is a population-based, observational, retrospective study covering from February 1, 2020, to January 24, 2023, with different circulating SARS-CoV-2 viruses, vaccinated status, and reinfections. It includes patients attended by the reference hospital in Fuenlabrada (Madrid, Spain). The models used the random forest technique, Shapley Additive Explanations method, and processing with Python (version 3.10.0; Python Software Foundation) and scikit-learn (version 1.3.0). The models were applied to different epidemic SARS-CoV-2 infection waves. Data were collected from 11,975 patients (4998 hospitalized and 6737 discharged). Predictive models were built with records from 4758 patients and validated with 6977 patients after evaluation in the emergency department. Variables recorded were age, sex, place of birth, clinical data, laboratory results, vaccination status, and radiologic data at admission.

RESULTS: The best mortality predictor achieved an area under the receiver operating characteristic curve (AUC) of 0.92, sensitivity of 0.89, specificity of 0.82, positive predictive value (PPV) of 0.35, and mean negative predictive value (NPV) of 0.98. The ICU admission predictor had an AUC of 0.89, sensitivity of 0.75, specificity of 0.88, PPV of 0.37, and NPV of 0.98. During validation, the mortality model exhibited good performance for the nonhospitalized group, achieving an AUC of 0.95, sensitivity of 0.88, specificity of 0.98, PPV of 0.21, and NPV of 0.99, predicting the death of 30 of 34 patients who were not hospitalized. For the hospitalized patients, the mortality model achieved an AUC of 0.85, sensitivity of 0.86, specificity of 0.74, PPV of 0.24, and NPV of 0.98. The model for predicting ICU admission had an AUC of 0.82, sensitivity of 1.00, specificity of 0.59, PPV of 0.05, and NPV of 1.00. The models’ metrics presented stability along all pandemic waves. Key mortality predictors included age, Charlson value, and tachypnea. The worse prognosis was linked to high values in urea, erythrocyte distribution width, oxygen demand, creatinine, procalcitonin, lactate dehydrogenase, heart failure, D-dimer, oncological and hematological diseases, neutrophil, and heart rate. A better prognosis was linked to higher values of lymphocytes and systolic and diastolic blood pressures. Partial or no vaccination provided less protection than full vaccination.

CONCLUSIONS: The artificial intelligence models demonstrated stability across pandemic waves, indicating their potential to assist in personal health services during the 3-year pandemic, particularly in early preventive and predictive clinical situations.

PMID:40638909 | DOI:10.2196/70674

Online J Public Health Inform. 2025 Jul 10;17:e68977. doi: 10.2196/68977.

ABSTRACT

BACKGROUND: In 2023, Cayuga County, a rural county in New York State, developed and published a publicly available, interactive overdose dashboard highlighting demographic, geographic, and time trends in suspected overdoses as well as substance use-related resources in the community. Despite the widespread use of data dashboards in the overdose crisis, there is little evidence to suggest that these dashboards can effectively disseminate data and enable public health data-driven decision-making, especially in a rural county. We conducted an evaluation of the Cayuga County Overdose Data Dashboard to fill this knowledge gap.

OBJECTIVE: Our study aimed to evaluate the Cayuga County Overdose Data Dashboard’s acceptability, use, and perceived effectiveness in disseminating overdose data and resources.

METHODS: Following the launch of the dashboard, an online Qualtrics survey collected feedback from individuals older than 18 years of age living or working in Cayuga County, asking respondents to reflect upon their experience using the dashboard. The 10-minute survey assessed usage patterns and motivations to access the dashboard as well as the dashboard’s ease of use, most valued design features, and overall perceived effectiveness in communicating information on overdoses and local resources. Data were analyzed using descriptive statistics.

RESULTS: From May to December 2023, a total of 61 individuals from Cayuga County completed the survey, including those with lived substance use experience (n=8, 13%) as well as their close contacts (n=28, 46%), health care providers (n=12, 20%), law enforcement (n=11, 18%), and local public health and mental health care professionals (n=27, 44%). The user-friendly design and frequent updates facilitate engagement, as 54% (n=33) of respondents reported accessing the dashboard at least monthly and 75% (n=46) using it to inform decision-making. Most thought that the dashboard was easy to use (n=59, 97%) and very effective in disseminating information (n=46, 76%). From the 8 different types of overdose-related information portrayed on the dashboard, the most valued were the locations of treatment and recovery services, scoring an average of 4.75 (SD 0.65) on a 5-point scale (1=”Not important” to 5=”Most important”), followed by the locations of free, publicly accessible Naloxone (mean 4.58, SD 0.89) and trends in fatal and nonfatal overdoses (mean 4.48, SD 0.81).

CONCLUSIONS: Overall, this study suggests that the Cayuga County Overdose Data Dashboard effectively disseminates information and enables data-driven decision-making in the region. When developing a community-level dashboard, our findings underscore the necessity of a user-friendly design, frequent data updates, and inclusion of key information and visuals on local overdose trends and resources.

PMID:40638856 | DOI:10.2196/68977

J Med Internet Res. 2025 Jul 10;27:e69953. doi: 10.2196/69953.

ABSTRACT

BACKGROUND: The United States is facing an opioid overdose epidemic resulting in an unprecedented number of preventable deaths. The use of medications including buprenorphine and methadone has proven effective for opioid use disorder (OUD), but many patients struggle to stay in treatment. Novel solutions, such as digital health tools, offer one option to help improve clinic management and improve treatment engagement.

OBJECTIVE: Using a mixed methods approach, we investigated facilitators and barriers to the use of a third-party digital health platform called Opioid Addiction Recovery Support (OARS) to aid OUD treatment engagement and adherence in a primary care setting.

METHODS: Patient and provider use of OARS was observed for 10 months and summarized using descriptive statistics. Differences in use were assessed using Wilcoxon signed rank tests. Additionally, key informant interviews were conducted with providers who prescribe medication for opioid use disorder (MOUD) and their case managers to understand the facilitators and barriers to implementation. Qualitative data were analyzed using a coding reliability thematic analysis approach.

RESULTS: Among 205 patients invited to use OARS, the median age was 37 (IQR 31-44) years, 130 (63.4%) identified as men, and 193 (94.1%) identified as non-Hispanic White. Of these 205 patients, 158 (77.1%) used the app at least 1 time. The median number of days the 158 patients viewed test results was 1 (IQR 1-3), progress was 1 (IQR 0-2), and educational content was 0 (IQR 0-1). The 55 patients whose providers had manually entered their results into OARS when the electronic health record (EHR) integration failed viewed test results (P=.002), progress (P<.001), and educational content (P<.001) more days than the 103 patients who could not view their results in OARS. Providers and the lead case manager reported that OARS increased patient-provider communication, allowed patients to better track their overall MOUD treatment, and enhanced providers’ ability to identify patients at risk for relapse. They also acknowledged that the lack of integration between OARS with the EHR resulted in administrative burdens, which impacted provider use of the system.

CONCLUSIONS: Findings from this study highlight the challenges of successfully implementing OARS with patients who receive MOUD in primary care settings. Our results show a lack of OARS uptake among providers, case managers, and patients, despite positive assessments made by participants. We also show several barriers that impacted provider use, including the lack of integration between OARS and EHR. Future research is needed (1) to determine whether digital health tools like OARS are efficacious in improving OUD outcomes and, if proved efficacious, (2) to identify ways to routinize the use of digital health tools in MOUD treatment, primarily by solving technical and organizational challenges associated with EHR integration and patient engagement.

PMID:40638840 | DOI:10.2196/69953

Nucleosides Nucleotides Nucleic Acids. 2025 Jul 10:1-14. doi: 10.1080/15257770.2025.2532089. Online ahead of print.

ABSTRACT

Type 2 diabetes (T2D) is a complex multifactorial metabolic disorder characterized by progressive disease progression, involving varying degrees of insulin resistance and pancreatic islet dysfunction. Methylenetetrahydrofolate reductase (MTHFR) is a crucial enzyme regulating folate metabolism, and its polymorphisms have been associated with T2D. However, the methylation pattern of the MTHFR gene has not been previously studied. This study aimed to assess the association between T2D and the methylation profile of the MTHFR gene promotor in a Moroccan population. A total of 107 patients with T2D and 100 healthy controls were included in the study. The methylation status of CpG sites in the MTHFR gene promoter was conducted by methylation-specific PCR (MS-PCR). Statistical analyses were performed using SPSS software (version 20). The promoter region of the MTHFR gene was predominantly hyper-methylated in patients with T2D compared to healthy controls (OR: 2.924; 95% CI: 1.285-6.650; p = 0.008). The hypermethylated profile was not influenced by environmental or metabolic factors examined in this study. These findings suggest that hypermethylation of CpG sites in the MTHFR gene promoter is associated with T2D in the Moroccan population, highlighting a potential epigenetic mechanism contributing to the disease.

PMID:40638835 | DOI:10.1080/15257770.2025.2532089

Environ Technol. 2025 Jul 10:1-25. doi: 10.1080/09593330.2025.2525558. Online ahead of print.

ABSTRACT

Recycling waste plastic as a binding material and substitution of sand with quarry offers a promising alternative. This study investigates the potential of recycled waste linear low-density polyethylene (LLDPE) plastic as a sustainable alternative binder to cement in construction block production. An extrusion technique was adopted to melt the plastic and disperse and distribute quarry dust within the molten plastic to produce a composite. Waste LLDPE plastic-quarry dust composite samples were produced at varying mix ratios of 1:0, 1:1, 1:2, and 1:3. Similar ratios were used to produce cement-quarry dust composite samples. The density, morphology, compressive strength, split tensile strength, water absorption, flexural strength, ultrasonic pulse velocity, and skid resistance of the composites were evaluated. Comparative analysis was conducted, evaluating the performance of waste LLDPE plastic-quarry dust composites against cement-quarry dust composites at various mix ratios. Results revealed that the density of the waste LLDPE plastic-quarry dust composites were in the range of 1288-1571 kg/m³, and its compressive strength increased with increasing quarry dust content, reaching 18.22 MPa at a 1:3 ratio. Conversely, cement-quarry dust composites exhibited a decreasing compressive strength trend with increasing quarry dust, and the lowest strength of 17.57 MPa was obtained at a 1:3 ratio. A statistical analysis approach using post hoc analysis with Bonferroni adjustments validates the significant difference for the mix compressive strengths. Notably, the waste LLDPE plastic-quarry dust composites demonstrated promising performance characteristics, particularly at higher quarry dust ratios, suggesting a viable eco-friendly composite block.

PMID:40638813 | DOI:10.1080/09593330.2025.2525558