Nevin Manimala

BMC Nurs. 2025 Jul 8;24(1):883. doi: 10.1186/s12912-025-03442-w.

ABSTRACT

BACKGROUND: Nowadays, declining fertility rates are a significant societal challenge that particularly affects working women. While research has examined a variety of contributing factors, there is a significant lack of studies specifically on nurses, whose demanding clinical schedules and work environments may significantly influence their childbearing intentions. This study, using the theory of planned behavior, examines these factors for nurses in Yazd teaching hospitals. The results provide valuable data for policymakers to design targeted strategies and support systems to encourage nursing professionals to pursue parenting responsibilities and ultimately reduce the negative effects of low fertility rates.

METHODS: This cross-sectional study was conducted on female nurses working in teaching hospitals in Yazd, Iran (2024). To do so, 190 nurses were selected using stratified proportional random sampling and a 14-item questionnaire developed by Nakhaei et al. study was completed. Data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics including independent samples T-test, one-way ANOVA, Mann-Whitney test, Kruskal-Wallis, Pearson correlation coefficient, Spearman correlation coefficient, and logistic regression.

RESULTS: Based on our findings, 35% of nurses intended to have children in the next three years. Based on the results of the Pearson correlation coefficient test, a significant inverse correlation was observed between the subjective norm towards having children and the number of children (P < 0.001, r=-0.450). A statistically significant difference was reported in the mean score of perceived control over childbearing in terms of childbearing intention (P = 0.019); besides, a statistically significant difference was observed regarding childbearing in terms of age group (P = 0.004). Multivariate regression analysis with the effect of background variables considered constant, only the number of children had a significant effect on subjective norm (P < 0.001), meaning that for each added child, the score of subjective norm towards childbearing decreased meanly by 1.657 points.

CONCLUSIONS: Given the negative impact of increasing age on perceived control and childbearing intention, health policymakers and hospital administrators can help ameliorate perceived control and foster the childbearing intention by creating more flexible working conditions and incentive policies, including financial support for female nurses. Moreover, programs that focus on encouraging childbearing in younger women can be more effective.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40629307 | DOI:10.1186/s12912-025-03442-w

BMC Nurs. 2025 Jul 8;24(1):878. doi: 10.1186/s12912-025-03530-x.

ABSTRACT

BACKGROUNDS: Understanding how nurses perceive anxiety and stress during an epidemic is essential for curbing the spread of disease and implementing effective public health strategies. This study aims to evaluate the levels of epidemic anxiety, perceived stress, and compliance with isolation measures among nurses working in Turkey in relation to monkeypox.

METHODS: This descriptive, cross-sectional study was conducted with a sample of 335 nurses employed at a hospital in Izmir, Turkey. Data were collected through face-to-face interviews between September 15 and November 30, 2024, using a structured questionnaire. The data collection instruments included a Demographic Information Form, the Epidemic Anxiety Scale, the Perceived Stress Scale, and the Compliance with Isolation Precautions Scale.

RESULTS: The mean age of the nurses was 28.41 ± 6.26 years. The average total score was 79.37 ± 10.01 on the Compliance with Isolation Precautions Scale, 49.16 ± 15.44 on the Epidemic Anxiety Scale, and 26.39 ± 7.76 on the Perceived Stress Scale. Statistically significant differences in the total scores of the Compliance with Isolation Precautions Scale were observed based on gender, prior experience working in a pandemic-designated hospital, and current department of employment (p <.005). A statistically significant but weak negative correlation was found between the Compliance with Isolation Precautions Scale and both the Epidemic Subscale (r = -.124; p =.031) and the Economic Subscale (r = -.129; p =.023). Additionally, a statistically significant moderate positive correlation was identified between the Perceived Stress Scale and the Epidemic Anxiety Scale (r =.399; p <.001).

CONCLUSION: The study revealed that nurses experienced a moderate level of epidemic-related anxiety. Moreover, it was found that a substantial majority of nurses (95.8%) had not received any formal training on monkeypox. The findings also indicated that nurses’ perceived stress levels increased in parallel with their levels of epidemic anxiety.

PMID:40629306 | DOI:10.1186/s12912-025-03530-x

BMC Pediatr. 2025 Jul 8;25(1):539. doi: 10.1186/s12887-025-05897-x.

ABSTRACT

AIM: This study aimed to investigate the effects of a coordination-based training program on physical fitness, motor competence, and inhibition control in preschool children.

METHOD: Fifty-one preschool children aged 5 to 6 years (M = 6.03, SD = 0.30), were randomly assigned to either an exercise group (EG; n = 26), which received a coordination-based training program, or a control group (CG; n = 25), which continued their routine activities. All participants were recruited from a preschool. Physical fitness (PF) was assessed through agility, static and dynamic balance, and vertical jump tests. Motor competence (MC) was measured using the Körperkoordinationstest für Kinder 3+ (KTK3+), and inhibition control (IC) was evaluated via the Go/No-Go test.

RESULT: The group-time interaction showed that the exercise group’s score increase was significantly higher than that of the CG in vertical jumping (F_(1-49) = 14.569, p < 0.001, η_p² = 0.229) and KTK Balancing Backwards (F_(1-49) = 14.051, p < 0.001, η_p² = 0.223) variables. Also, CG’s score increase was significantly higher than that of the EG in KTK Moving Sideways (F_(1-49) = 9.984, p < 0.01, η_p² = 0.169). However, statistically significant differences were not found in the comparison of group x time interaction in all other variables (p > 0.05).

CONCLUSION: The coordination-based training provided to the exercise group led to significant improvements in vertical jump performance (an indicator of lower extremity strength) and KTK Balancing Backwards scores (an indicator of dynamic balance) compared to the control group. These findings suggest that coordination-based training can enhance lower extremity strength and dynamic balance in preschool children.

PMID:40629304 | DOI:10.1186/s12887-025-05897-x

BMC Health Serv Res. 2025 Jul 8;25(1):942. doi: 10.1186/s12913-025-12998-x.

ABSTRACT

BACKGROUND: There is growing appreciation of the role health literacy plays in population health and health care design. Health literacy encompasses an individual’s capacity to manage their health and the responsiveness of the health system. Our aim was to identify the health literacy strengths and challenges in an Australian cohort living with motor neurone disease (MND), including both people living with the disease and their carers.

METHODS: This study used the Health Literacy Questionnaire and eHealth Literacy Questionnaire for health literacy assessment. Using a secure online platform, an anonymous survey was disseminated which included demographic data and clinical measurements. Descriptive statistical analysis and cluster analysis were employed to describe the sample and to identify different health literacy patterns in subgroups of people living with MND and their carers.

RESULTS: A total of 227 people participated (171 people living with MND and 56 carers). Cluster analysis generated fifteen cluster profiles for the cohort living with MND and seven cluster profiles for carers. The variability and potential significance of patterns of health literacy strengths and challenges within the MND community are described. There was extensive diversity within the sampled population, with a mix of sociodemographic backgrounds across each cluster profile.

CONCLUSIONS: The health literacy cluster profiles created from this study provide insight into the full spectrum of where the challenges and strengths exist for individuals and subgroups of people managing this fatal disease. The results from this study pave the way for generating system wide interventions that address health literacy diversity, to create more enabling health care environments for all those affected by MND.

PMID:40629298 | DOI:10.1186/s12913-025-12998-x

J Public Health Manag Pract. 2025 Jul 7. doi: 10.1097/PHH.0000000000002181. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to identify rural counties across the United States that experience combined high prevalence of chronic diseases and low socioeconomic status (SES), categorizing them as high-need areas. We analyze the geographic and sociodemographic profiles of these counties and examine differences in access to care for high-need rural counties.

METHODS: We used the 2023 PLACES dataset from the Centers for Disease Control and Prevention for chronic disease prevalence estimates and the 2020 American Community Survey for SES indicators. Counties were classified into tertiles based on disease prevalence and SES indicators, creating an overall composite score identifying counties as low, moderate, or high need. We used ArcGIS Pro to map the distribution of high-need counties across the United States with statistical analyses of geographic distribution and health care access conducted through quantile regression and spatial autocorrelation methods.

FINDINGS: A total of 1934 rural counties, representing nearly 99% of rural counties, were included in this analysis, identifying 534 high-need counties, primarily in the southeastern United States. These counties had significantly higher proportions of non-Hispanic Black residents. Significant spatial autocorrelation indicated that counties with similar levels of chronic disease and SES are geographically clustered. High-need counties faced greater distances to health care facilities compared to their lower-need counterparts, highlighting substantial barriers to accessing care.

CONCLUSION: This analysis identified geographic variation in chronic disease burden and socioeconomic status across rural US counties, with high-need areas concentrated in the Southeast. The findings demonstrate the value of a simple, replicable framework for identifying rural counties facing overlapping health and socioeconomic challenges. This approach can support efforts to prioritize resource allocation and guide future research and policy aimed at improving access and outcomes in underserved rural communities.

PMID:40627866 | DOI:10.1097/PHH.0000000000002181

Scand J Pain. 2025 Jul 8;25(1). doi: 10.1515/sjpain-2025-0015. eCollection 2025 Jan 1.

ABSTRACT

OBJECTIVE: The aim of this study is to assess the clinical impression of health professionals at the Pain and Rehabilitation Centre, Linköping University Hospital, Sweden, according to whom patients have gradually become more complex and “difficult” over time.

METHODS: This is a repeated cross-sectional study. Over 8,000 patients assessed between 2009 and 2022 answered questionnaires from the Swedish quality registry for pain rehabilitation. Patient-reported outcome measures were analysed with multivariate data analysis such as principal component analysis.

RESULTS: During 2009-2022, the first principal component did not change statistically over time (p = 0.177), and it did not correlate to the year (rho = -0.014; p = 0.21). Patients were divided into three groups (2009-2012, 2013-2016, and 2017-2022), and a partial least squares-discriminant analysis model with group belonging as the Y-variable did not reveal any relevant differences (R ² = 0.048; Q ² = 0.045). For the period 2016-2022, additional data were available, enabling the comparison of pre- vs post-pandemic data by discriminant analysis. No clinically relevant difference was found.

CONCLUSIONS: It was not possible to confirm the clinical impression of health care personnel. While it is important to listen to “clinical hunches” emitted by experienced clinicians, it is also essential not to be too quick to equate such impressions with a true state of affairs.

PMID:40627864 | DOI:10.1515/sjpain-2025-0015

J Low Genit Tract Dis. 2025 Jul 8. doi: 10.1097/LGT.0000000000000903. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify factors with uniquely high prevalence in vulvodynia-Ehlers-Danlos syndrome comorbid patients in order to identify patients who may need referral and to better understand management of this population.

METHODS: Cross-sectional study conducted in January 2025 using the TriNetX Platform Global Collaborative Network Database with statistical comparison of vulvodynia-Ehlers-Danlos comorbid cohort and vulvodynia non-Ehlers-Danlos cohort. Bonferroni correction was performed due to analysis of 100 demographic, associated condition, and treatment factors with statistical significance at p = .0005.

RESULTS: Five hundred seventy vulvodynia-Ehlers-Danlos patients and 49,457 vulvodynia non-Ehlers-Danlos patients were identified with a mean age of 39 and 48 (p < .0001), respectively. Vulvodynia-Ehlers-Danlos comorbid patients had more frequent chronic pain, musculoskeletal, neurologic, gynecologic, immune, and psychiatric conditions. Vulvodynia-Ehlers-Danlos patients had higher rates of most nonsurgical interventions but similar vaginal estrogen (p = .0412) and vulvar surgery rates (p = .4249). Vulvodynia-Ehlers-Danlos patients had signs of more frequent medical contact with more post-op visits, vaccines, and inpatient admissions (p < .0001). Study limitations are those inherent to the TriNetX database, with ability to see associations but not causation.

CONCLUSIONS: Clinicians treating genital pain have a role in the treatment of vulvodynia-Ehlers-Danlos patients given the array of prevalent pelvic conditions. Clinicians should keep the high rate of muscular, neurologic, and immune conditions in mind when evaluating the vulvodynia etiology in this population, as well as the higher rate of gynecologic comorbidities, which could result in hormone-mediated etiology from chronic estrogen use. With a higher rate of mood disorders, mental health inquiry is also important.

PMID:40627862 | DOI:10.1097/LGT.0000000000000903

J Am Acad Orthop Surg. 2025 Jul 3. doi: 10.5435/JAAOS-D-24-00604. Online ahead of print.

ABSTRACT

BACKGROUND: Dorsal wrist spanning plate (DWSP) fixation is a technique used to treat distal radius fractures with severe metaphyseal comminution, diaphyseal extension, and other complex fracture patterns. One concern of this technique is the potential risk of stiffness due to prolonged immobilization. The purpose of our study was to examine the association of DWSP duration on range of motion (ROM) outcomes after plate removal.

METHODS: Patients who underwent DWSP fixation for distal radius fracture with greater than 6 months of follow-up after DWSP removal at a single institution were retrospectively identified. Patients with a concomitant upper extremity injury were excluded. The primary outcome of interest was ROM. Secondary outcomes included visual analog scale pain scores and radiographic measurements. A piecewise regression analysis was run to evaluate for a nonlinear relationship between DWSP duration and ROM.

RESULTS: Fifty-one patients were included for analysis. DWSP removal occurred at a mean of 110 days (range, 59-182 days). Median duration of follow-up after DWSP removal was 11.7 months (interquartile range = 8.2 months to 1.8 years). No significant association was observed between DWSP duration and visual analog scale (P = 0.11), complication rate (P = 0.45), radial inclination (P = 0.57), radial height (P = 0.74), or volar tilt (P = 0.13). Piecewise regression demonstrated a statistically significant reduction in supination (P = 0.001), pronation (P = < 0.001), and wrist flexion (P = 0.014) for DWSP >120 days when controlling for age, sex, polytrauma, duration of follow-up, and additional fixation.

DISCUSSION: There is a nonlinear association between DWSP duration and wrist ROM (flexion, supination, and pronation). When DWSP duration is longer than 120 days, there is a negative correlation with ROM when controlling for covariates. When DWSP duration is less than or equal to 120 days, there is no correlation with ROM. Our findings suggest that patients with longer duration of DWSP duration (>120 days) are more likely to have range-of-motion limitations; additional research is necessary to determine whether implant retention longer than 120 days by itself or fracture or patient-specific factors which require longer implant retention are the causative agents for this motion limitation.

LEVEL OF EVIDENCE: Retrospective cohort, Level IV.

PMID:40627859 | DOI:10.5435/JAAOS-D-24-00604

JMIR Res Protoc. 2025 Jul 8;14:e74018. doi: 10.2196/74018.

ABSTRACT

BACKGROUND: The incidence of postoperative pancreatic fistula following distal pancreatectomy is as high as 30%-50%. Postoperative pancreatic fistula can be a major cause of perioperative morbidity, resulting in prolonged hospital stays and increased health care costs. The management of the pancreatic stump is one of the key factors influencing the occurrence of postoperative pancreatic fistula after distal pancreatectomy, but the optimal management approach remains debatable. The main methods for pancreatic stump closure include manual suturing and stapler closure. However, both methods are associated with a high risk of postoperative pancreatic fistula, which may be related to the balance between providing sufficient pancreatic duct burst pressure and ensuring blood supply to the stump. Ligation of the pancreatic stump has been attempted to reduce the risk of postoperative pancreatic fistula following distal pancreatectomy, but its efficacy remains limited by the challenge of achieving the optimal ligation force.

OBJECTIVE: This study aims to investigate whether ligation of the pancreatic stump with a quantified force can decrease the risk of postoperative pancreatic fistula following distal pancreatectomy.

METHODS: In this nonrandomized controlled clinical study at a tertiary center in China, the major eligibility criterion is the presence of lesions planned for distal pancreatectomy. Sixty patients will be allocated to the experimental or control group according to their choice. Recruitment for either group will be discontinued upon reaching the predefined sample size of 30 participants. In the experimental group, the pancreas will be ligated 5 mm from the pancreatic stump with a quantified force to provide a pancreatic duct burst pressure of approximately 40-70 mm Hg. The ligation force will be provided by a 3.2-mm-diameter silicone ring. During pancreatic stump ligation, this silicone ring will be stretched to 15 mm, generating an applied force of 1.3 N. The pancreas will be severed using energy-based devices before or after the ligation. In the control group, the pancreatic stump will be managed by manual suturing or stapling closure according to the surgeon’s clinical judgment and preference. Postoperative regular follow-up examinations will be conducted. The primary outcomes include postoperative pancreatic fistula and postoperative hospital stay, and the secondary outcomes include intra-abdominal infection, incision infection, and postoperative treatment costs. The primary and secondary outcomes of patients in this cohort will be statistically compared using appropriate tests.

RESULTS: This study started in February 2025, and the recruitment period is from February to September 2025.

CONCLUSIONS: This protocol proposes a novel approach for pancreatic stump management aimed at preventing postoperative pancreatic fistula following distal pancreatectomy. The research team established the optimal ligation force for the pancreatic stump to ensure adequate burst pressure for the pancreatic duct while preventing acute stump necrosis, thereby theoretically reducing the risk of postoperative pancreatic fistula.

TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2500097781; https://www.chictr.org.cn/showproj.html?proj=247008.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/74018.

PMID:40627856 | DOI:10.2196/74018

J Am Acad Orthop Surg. 2025 Jul 3. doi: 10.5435/JAAOS-D-24-01334. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between testosterone replacement therapy (TRT) and hip fractures remains underexplored. This study aims to investigate this relationship. We hypothesize that patients prescribed TRT experience a lower rate of hip fractures compared with a control group.

METHODS: The PearlDiver Mariner165 data set was used to obtain two random cohorts of 500,000 patients. The experimental group received TRT for at least 3 months and the control group did not. We used one-to-one matching to evaluate the effects of TRT in 301,724 patients. The incidence of hip fractures was assessed over a 2-year follow-up using the International Classifications of Disease codes. Multivariable logistic regression identified the association between TRT and hip fractures. Statistical significance was set at P < 0.05.

RESULTS: The patients in the TRT group were associated with a lower incidence of hip fractures compared with the control group (0.13% vs. 0.25%, P < 0.001). The multivariable analysis showed that TRT use was associated with a decreased incidence of hip fractures with an adjusted odds ratio (aOR) of 0.58 (95% confidence interval [CI], 0.51 to 0.66, P < 0.001). After stratifying by sex, the multivariable analysis showed that TRT use in male patients was associated with a decreased incidence of hip fractures with an aOR of 0.61 (95% CI, 0.53 to 0.72, P < 0.001); in female patients, it was associated with a decreased incidence of hip fractures with an aOR of 0.49 (95% CI, 0.38 to 0.63, P < 0.001).

CONCLUSION: Patients prescribed TRT had a 1.9 times lower likelihood of sustaining hip fractures. Further investigation into the association of TRT and fragility fractures garners continued interest. In addition, this can provide insight into the potential benefits of TRT use and maintaining bone health to improve bone mass and improve results of orthopaedic interventions.

LEVEL OF EVIDENCE: III.

PMID:40627853 | DOI:10.5435/JAAOS-D-24-01334