Nevin Manimala

Ann Gen Psychiatry. 2025 Jun 21;24(1):40. doi: 10.1186/s12991-025-00576-8.

ABSTRACT

OBJECTIVES: This study aimed to investigate the association between sleep problems and suicidal behaviors as well as healthcare utilization in Canadian adults with chronic diseases, while also examining the mediating role of mental illness.

METHODS: Data were drawn from the 2015-16 cycle of the Canadian Community Health Survey, specifically from Ontario, Manitoba, and Saskatchewan – the provinces that included the optional sleep module. A total of 22,700 participants aged ≥ 18 years and diagnosed with at least one chronic disease were included in the analysis. Sleep problems were defined as extreme sleep durations (either < 5 or ≥ 10 h) and insomnia. Mental illness was classified as a self-reported mood or anxiety disorder.

RESULTS: Participants with extreme sleep durations (compared to 7 to < 8 h) and those with insomnia (compared to no insomnia) showed a higher prevalence of suicidal ideation, suicidal plans, and increased healthcare utilization. After adjusting for multiple covariates, both extreme sleep durations and insomnia remained significantly associated with increased odds of suicidal ideation, suicidal plans, and healthcare utilization. Mediation analyses indicated that mental illness partially mediated these associations.

CONCLUSIONS: Both extreme sleep durations and insomnia were independently associated with higher odds of suicidal behaviors and increased healthcare utilization in adults with chronic diseases, with mental illness playing a partial mediating role in these relationships.

PMID:40544278 | DOI:10.1186/s12991-025-00576-8

J Health Popul Nutr. 2025 Jun 21;44(1):221. doi: 10.1186/s41043-025-00970-8.

ABSTRACT

BACKGROUND: Evidence from behavioral economics has shown that framing health information can impact the demand for screening. We examined the effect of promotional message framing on mammography demand by estimating willingness to pay (WTP).

METHODS: This experimental study was conducted in 2024 over a period of 3 months. The interesting outcome was a WTP for mammography. 354 women were randomly selected and randomly assigned between the two study arms. The intervention involved the presentation of health information in two frames of gain and loss. The mammography demand has been estimated using robust standard error Logistic regression. Demand rate of mammography has been compared between two types of information framing using the chi-square test. Finally, the monetary value of willingness to pay (WTP) for mammography was estimated using the methodology developed by López-Feldman. All analyses were done using STATA 17.

RESULTS: The price and income elasticity of mammography demand were estimated as – 0.19 and 0.24, respectively (P < 0.01). The higher demand rate in the loss frame compared to the gain frame (38.7% vs. 25.1%) was statistically significant, and its effect size was estimated to be 0.282 (p < 0.01). The value of WTP in the loss frame (10.68 US$) was estimated to be more significant than in the gain frame (4.74 US$) (p < 0.01).

CONCLUSION: This study suggests that health educators consider the message’s persuasiveness with the type of health action before designing health messages. Moreover, health practitioners should use health messages with a loss frame to increase the demand for screening services such as mammography.

PMID:40544270 | DOI:10.1186/s41043-025-00970-8

AIDS Res Ther. 2025 Jun 21;22(1):64. doi: 10.1186/s12981-025-00761-5.

ABSTRACT

BACKGROUND: Weight gain has been associated with the use of antiretrovirals in people with HIV, especially with integrase inhibitors or tenofovir alafenamide, and among women. In 2018, doravirine became the latest non-nucleoside reverse transcriptase inhibitor to be approved in the US. We assessed changes in weight over time among virologically suppressed individuals who switched to a regimen containing doravirine (DOR).

METHODS: From the US-based OPERA cohort, treatment-experienced adults with HIV who switched to a DOR-containing regimen between 30AUG2018-30NOV2022 with a viral load < 50 copies/mL were included (followed through 31MAY2023). The study population was characterized and a linear mixed model was used to estimate rates of weight change on DOR. Results were stratified by sex, by patterns of efavirenz (EFV) and/or tenofovir disoproxil fumarate (TDF) use before/after switch to DOR, and by integrase inhibitor (INSTI) & tenofovir alafenamide (TAF) use combination (restricted to individuals who maintained the same combination before/after switch).

RESULTS: Of 388 included individuals, 21% were women, 33% were Black, and 78% were obese or overweight at DOR switch. Overall, people who switched to DOR lost an average of 0.80 kg/year (95% CI: -1.32, -0.28). Both women and men experienced statistically significant weight loss; women (70% Black, 70% aged ≥ 40 years) lost weight at a rate of -1.67 kg/year (95% CI: -3.32, -0.02) and men at a rate of -0.60 kg/year (95% CI: -1.12, -0.08). When EFV and TDF were absent before and after switch to DOR, statistically significant weight loss was observed. Among those who had the same INSTI and TAF combination throughout and had any INSTI or TAF use, a statistically non-significant trend toward weight loss was observed.

CONCLUSIONS: In one of the first real-world analyses of weight changes among virologically suppressed individuals who switched to a DOR-containing regimen in the US, DOR was associated with statistically significant weight loss. Patterns of use of other antiretrovirals did not fully explain the observed weight loss. These findings are clinically meaningful given that most individuals included were overweight or obese at switch to DOR and that women were predominantly of perimenopausal or menopausal age.

PMID:40544263 | DOI:10.1186/s12981-025-00761-5

J Health Popul Nutr. 2025 Jun 21;44(1):218. doi: 10.1186/s41043-025-00862-x.

ABSTRACT

BACKGROUND: This study investigates the role of economic growth, healthcare investment, immunization coverage, and malnutrition in reducing under-five mortality rates (U5MR) in Sri Lanka. Understanding how these factors interact within socio-economic ecosystems is essential to formulating sustainable strategies to improve child survival outcomes.

METHODS: This study employs multiple linear regression to analyze the statistical associations between economic growth, healthcare investment, immunization, malnutrition, and under-five mortality in Sri Lanka. Using secondary data from the World Bank and UNICEF (2000-2021), U5MR was modeled against economic growth (per capita GDP), government healthcare expenditure (GHE), immunization coverage (DTP1), and malnutrition (MLN), with significance assessed through p-values and model fit via R².

RESULTS: The multiple linear regression model demonstrated strong explanatory power, accounting for 85% of the variation in under-five mortality (R² = 0.85). Economic growth and immunization coverage were negatively associated with U5MR and found to be statistically significant (p < 0.05 and p < 0.10 respectively), indicating their potential role in reducing child mortality. Malnutrition showed a strong positive association (p < 0.01), emphasizing its continued threat to child health. Although government healthcare expenditure had a negative association, it was not statistically significant, suggesting possible inefficiencies in resource utilization.

CONCLUSION: The study highlights the significant role of economic growth, healthcare expenditure, immunization coverage, and nutrition in shaping U5MR trends in Sri Lanka. The findings emphasize the need for targeted policy interventions to enhance child health outcomes and ensure sustainable progress in reducing child mortality.

PMID:40544255 | DOI:10.1186/s41043-025-00862-x

BMC Prim Care. 2025 Jun 21;26(1):200. doi: 10.1186/s12875-025-02881-3.

ABSTRACT

BACKGROUND: Managing patients with chronic non-cancer pain (CNCP) in outpatient healthcare is challenging. Long-term opioid therapy is an option for treatment responders with guideline recommended indications. However, opioid use poses risks of severe side effects, including misuse, and therefore needs to be integrated into a high-quality healthcare process. This analysis evaluates the association between healthcare quality according to the evidence-based Chronic Care Model (CCM) in the treatment process of patients receiving long-term opioid therapy for chronic back and/or arthrosis pain, and patient-related or healthcare related variables.

METHODS: A cross-sectional patient survey was sent to a random sample of 3,037 individuals with long-term opioid therapy and chronic back and/or arthrosis pain insured by a large nationwide German statutory health insurance. Healthcare quality according to the CCM was assessed by the Patient Assessment of Chronic Illness Care (PACIC-5A) questionnaire. Internal reliability of the assessment instrument was determined using Cronbach’s α. Descriptive analysis of the outcome scales were conducted, alongside subgroup analyses considering patient characteristics, patient’s health situation, and pain treatment aspects. Testing for statistical significance was performed by Mann-Whitney U test and Kruskal-Wallis test. Effect sizes, namely Eta and Spearman’s Rank correlation coefficient, were calculated.

RESULTS: The analysis included 661 individuals. Participants were predominantly female (76%) with an average age of 69 years (SD 12.5). PACIC-5A score ratings across all (sub)scales were low, with a summary score rating of 2.4 (on a scale ranging from 1 (worst) to 5 (best)). Positive correlations with treatment quality were observed in the subgroup analysis concerning guideline-compliant pain treatment aspects such as setting therapy goals or a comprehensive treatment concept. Patient characteristics showed little to no correlations, except for a positive correlation between higher PACIC-5A rating and both lower age and higher education. Patient’s health situation presented a mixed picture, with no clear correlation between pain intensity/impairment, and PACIC-5A scores.

CONCLUSIONS: The provision of healthcare for patients with long-term opioid therapy for CNCP seems to be inadequate according to the CCM. Guideline-recommended pain treatment aspects exhibited a positive correlation with healthcare quality according to CCM. Enhancing the implementation of the CCM in the outpatient healthcare process may improve healthcare quality.

TRIAL REGISTRATION: German Clinical Trials Register, DRKS00024854. Registered 04/28/2021.

PMID:40544254 | DOI:10.1186/s12875-025-02881-3

BMC Oral Health. 2025 Jun 21;25(1):955. doi: 10.1186/s12903-025-06345-z.

ABSTRACT

OBJECTIVES: This study aims to evaluate the quality and quantity of gained and maintained bone width after Ridge splitting utilizing autogenic bone wedge versus mixed bone particles for horizontal ridge augmentation in the anterior aesthetic zone.

MATERIALS AND METHODS: This randomized clinical trial included 20 patients with horizontally deficient anterior maxillary alveolar ridges. Patients were divided equally into two groups. Group I received an autogenous bone wedge harvested from the chin area to be placed intercotically after ridge splitting (intervention group). Group II received mixed bone particles of autogenic and xenogeneic bone placed intercortically after ridge splitting (control group). Radiographic assessment of gained and maintained alveolar bone width at three vertical levels was performed using CBCT at three-time intervals (preoperative, immediate postoperative, and 6 months postoperative). Histologic and histomorphometric analysis of core biopsy harvested immediately before implant placement was also performed to assess bone quality and % of newly formed bone area using H&E and Mansons trichrome stains. Collected data were conducted for statistical analysis.

RESULTS: The outcome of the studied grafts showed a significant increase of the immediate postoperative bone width in the control group more than the intervention group, with a mean difference from the preoperative bone width (2.17 ± 1.10) mm for the control group and only (1.44 ± 0.66) for the intervention group. In contrast, the 6-month postoperative bone width was decreased in both groups with a mean difference from the immediate postoperative bone width (1.21 ± 0.54) in the control group (p-value < 0.001) compared to only (0.41 ± 0.50) in the intervention group (p value = 0.135); this statistical data revealed that the bone wedge technique of the intervention group helped to maintain the gained bone width more than the packed bone particles of the control group. Moreover, the intervention group showed higher value and quality of newly formed mature bone with well-formed havarsian canals than the control group, which showed lower bone quality of osteoid and fibrous tissue with remnants of xenogenic bone particles microscopically.

CONCLUSIONS: The two-stage ridge-splitting procedure using an interposition bone wedge is an effective method for horizontal ridge augmentation in the horizontally deficient anterior maxilla.

CLINICAL RELEVANCE: The two-stage Ridge splitting with an inter-positional bone wedge ensures better bone width maintenance and quality.

TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov on 24/07/2024 under the registry number “NCT06529653”. It adhered to the Declaration of Helsinki on medical research ethics and received approval from the Institutional Research Ethics Committee of the Faculty of Dentistry, Cairo University (IRB number: 161022).

PMID:40544250 | DOI:10.1186/s12903-025-06345-z

Diabetol Metab Syndr. 2025 Jun 21;17(1):237. doi: 10.1186/s13098-025-01801-w.

ABSTRACT

BACKGROUND AND AIMS: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with dietary habits and the gut microbiota. The dietary index for the gut microbiota (DI-GM) is a newly proposed index that reflects gut microbial diversity based on dietary intake. However, its relationship with NAFLD remains unclear. This study aimed to explore the association between DI-GM and the risk of NAFLD.

METHODS: In this cross-sectional study, we utilized data from the NHANES 2009-2018. Multivariable logistic regression, restricted cubic spline curves (RCS), subgroup analysis, and mediation analysis were used to evaluate the association between DI-GM and the risk of NAFLD.

RESULTS: A total of 4,923 participants were included in the study. According to the fully adjusted model, a significant inverse association was observed between DI-GM and NAFLD (OR = 0.883, 95% CI: 0.835-0.932, P < 0.001). After stratification by quartiles, compared with participants in the first quartile of DI-GM score, those in the fourth quartile had a 36.5% lower odds of developing NAFLD (OR = 0.635, 95% CI: 0.481-0.839, P = 0.002). Mediation analysis revealed that 72.69% of the association between DI-GM and NAFLD was mediated by BMI (P < 0.001). Subgroup analysis suggested that the association between DI-GM and NAFLD might be influenced by race (P for interaction < 0.05). RCS analysis revealed a linear correlation between DI-GM and NAFLD (P for nonlinear = 0.883).

CONCLUSIONS: DI-GM is negatively associated with NAFLD risk, with BMI mediating this relationship and race being a significant influencing factor.

PMID:40544245 | DOI:10.1186/s13098-025-01801-w

Biomed Eng Online. 2025 Jun 21;24(1):75. doi: 10.1186/s12938-025-01410-8.

ABSTRACT

BACKGROUND: Plastic bronchitis (PB) is a rare but potentially life-threatening condition that requires particular attention in pediatric patients, specifically those presenting with severe Mycoplasma pneumoniae pneumonia (SMPP). This study aimed to identify risk factors associated with PB in children with SMPP and develop a comprehensive risk factor scoring system.

METHODS: A retrospective analysis was conducted on SMPP patients who underwent bronchoscopy between January 2018 and October 2023. Based on bronchoscopic and pathological examination results, patients were categorized into PB (n = 142) and non-PB (n = 274) groups. Clinical manifestations, laboratory data, and imaging findings were analyzed. Risk factors for PB in SMPP children were identified through univariate and multivariate logistic regression analyses. A nomogram model incorporating independent risk factors was developed, and a PB risk factor scoring system was established. Model validation was performed through a prospective validation study.

RESULTS: Among 416 SMPP children (197 males, 219 females), mean age at disease onset was 6.9 ± 2.9 years and 6.6 ± 2.8 years in the PB and Non-PB groups, respectively. Multivariate logistic regression analysis identified eight independent predictors of PB in SMPP children: dyspnea, decreased breath sounds, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), mean platelet volume to platelet ratio (MPV/PLT), pleural effusion, ≥ 2/3 lobe consolidation, and atelectasis. The nomogram prediction model demonstrated excellent discriminative ability (AUC = 0.92, 95% CI 0.892-0.948, P < 0.005) and strong calibration between predicted and observed outcomes. In the prospective validation cohort (n = 565), the scoring system effectively stratified patients into risk categories: high-risk (71.62% PB incidence), intermediate-risk (59.79%), and low-risk (5.33%), with statistically significant inter-group differences (P < 0.001). The PB group exhibited significantly longer hospitalization durations, extended glucocorticoid treatment periods, higher proportions of glucocorticoid therapy utilization, and a greater frequency of bronchoscopy interventions (≥ 2 sessions) compared to the Non-PB group (all P < 0.05).

CONCLUSIONS: In this study, we developed and validated a nomogram to PB in children with SMPP. This model serves as a clinically practical tool for early PB identification, enabling physicians to initiate timely interventions and optimize disease management strategies.

PMID:40544237 | DOI:10.1186/s12938-025-01410-8

Neuropsychopharmacology. 2025 Jun 21. doi: 10.1038/s41386-025-02147-7. Online ahead of print.

ABSTRACT

While numerous studies have examined the subjective response to alcohol as an intermediate phenotype to understand its variability, heritability, and predictive capacity for alcohol-related disorders, in-depth analyses linking alcohol reactivity indicators to genetic factors within a large cohort have been absent. Our study aimed to quantify the exact contribution of each genetic variant relevant to the alcohol metabolism to the variability in alcohol response. Specifically, we focused on two primary genes involved in alcohol metabolism (ALDH2 and ADH1B) and three additional loci (ALDH1B1, ALDH1A1, and GCKR) that have been shown to have significant associations with drinking behaviors in Japanese individuals. We conducted the first study to assess the relationship between subjective response to alcohol (SR), evaluated by various assessment subscales, and genetic factors using an intravenous clamp technique in 429 healthy Japanese young adults. By reducing the dimensionality of the data to assess similarity structures, we identified three distinct clusters of SRs and participants. Each participant cluster exhibited a distinct alcohol response profile shaped by specific genetic contributions. Participant cluster 1 demonstrated the strongest response, followed by participant cluster 2, and then participant cluster 3. Participant cluster 1 may also be the most strongly influenced by the allelic status of ALDH2 and ADH1B. SR patterns varied accordingly, and the enrichment of the ALDH2*2 and ADH1B*2, differed across both participant and subscale clusters. Notably, the three participant clusters closely aligned with the three subscale clusters, highlighting a consistent genotype-phenotype relationship. Furthermore, the proportion of variance explained by these genes also varied across subscale clusters. Contrary to known functions, ADH1B showed associations at later timings when ALDH2 associations attenuate. Our three-cluster classification may improve prevention by enabling early identification of individuals at health risk.

PMID:40544219 | DOI:10.1038/s41386-025-02147-7

Ann Surg Oncol. 2025 Jun 21. doi: 10.1245/s10434-025-17664-4. Online ahead of print.

ABSTRACT

BACKGROUND: Lynch syndrome (LS) is an inherited disorder associated with an increased risk of colorectal and extracolonic malignancies, including gastric cancer (GC). This study quantifies the association between specific risk factors and GC development in patients with LS.

PATIENTS AND METHODS: We searched the PubMed and Scopus databases for prospective and retrospective cohort studies that evaluated patients with genetically confirmed LS and reported associations between demographic, clinical, or genetic characteristics and GC. We conducted a meta-analysis to pool risk ratios (RR) for key risk factors, including sex, genetic mutations, family history of GC, and Helicobacter pylori (HP) infection. We assessed heterogeneity using Cochran’s Q test and the I² statistic.

RESULTS: A total of 14 studies comprising 29,170 patients with LS met the inclusion criteria, of which 13 were included in the meta-analysis. Male sex (RR 2.8; 95% CI 2.2, 3.6; p < 0.001; I² = 0%), MLH1 (RR 1.8; 95% CI 1.4, 2.3; p < 0.001; I² = 0%) and MSH2 variants (RR 2.5; 95% CI 2.0, 3.2; p < 0.001; I² = 0%), family history of GC (RR 3.5; 95% CI 2.0, 5.8; p < 0.001; I² = 0%), and HP infection (RR 2.8; 95% CI 1.2, 6.8; p = 0.023; I² = 12.8%) were associated with increased GC risk. In contrast, the MSH6 variant was associated with lower GC risk (RR 0.6; 95% CI 0.4, 0.8; p = 0.006; I² = 0%).

DISCUSSION: Our findings confirm that male sex, MLH1 and MSH2 variants, family history of GC, and HP infection are significant risk factors for GC in individuals with LS. These findings support the need for individualized surveillance strategies and targeted risk-reduction measures to improve early detection and patient outcomes.

PMID:40544206 | DOI:10.1245/s10434-025-17664-4