Nevin Manimala

BMC Pediatr. 2025 Nov 5;25(1):909. doi: 10.1186/s12887-025-06215-1.

ABSTRACT

BACKGROUND: The under-five children mortality rate (U5CM) is still a global public health concern, especially in Ethiopia and other countries in Sub-Saharan Africa (SSA). Unfortunately, the issue is notably underestimated and underreported, making it difficult to fully assess the severity of the crisis in the nation-state’s emerging regions. Regrettably, no research has been done to determine the time-to-death and its predictors for children under five in the developing regions of Ethiopia. Thus, the aim of this study was to determine the time-to-death and its predictor factors among children under five years old in the developing regions of Ethiopia from March 21, 2019, to June 28, 2019.

METHODS: This is a secondary analysis of data collected in a cross-sectional study that was done among under-five children in the developing regions of Ethiopia between March 21, 2019, and June 28, 2019. The Kaplan-Meier (K-M) survival curve was utilized to display the statistically significant variance across categorical variables, and the survival time was evaluated using the log-rank test. The Cox Proportional Hazards (PH) regression model analysis of bivariable and multivariable variables was fitted to identify the predictor factors of time-to-death. The investigation’s findings were presented utilizing tables, text, graphs, and charts. The degree of significance was determined using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI) and a p-value less than 0.05.

RESULTS: In the study, a total of 2,019 children under five were included. The overall under-five child mortality rate in developing regions of Ethiopia was 8.1% (95% CI 7.0%, 9.4%). In the multivariable Cox PH regression model analysis, multiple birth type (AHR: 2.9, 95% CI: 1.34, 6.46), mothers being AntiNatal Care (ANC) follow-up (AHR: 2.0; 95% CI: 1.08, 3.87), not initiating exclusive breastfeeding (AHR: 2.7, 95% CI: 1.23, 5.78), the female sex of the child (AHR: 0.56, 95% CI: 0.333, 0.934), and the head of household being female (AHR: 0.47, 95% CI: 0.236, 0.923) were recognized as main predictors of time-to-death among under five-children.

CONCLUSIONS: The study highlights an important under-five child mortality rate of 8.1% in the developing regions of Ethiopia. Important predictors identified through multivariable Cox Proportional (PH) regression model analysis include multiple birth type, lack of mother’s antenatal care (ANC) follow-up, the child’s sex, gender of household head, and failure to begin exclusive breastfeeding. Therefore, in order to decrease the high rate of mortality among children under five, the government should emphasize improvement of the ANC services, promote exclusive breastfeeding, make a targeted intervention for multiple births, and support female households in the developing regions of Ethiopia.

PMID:41194207 | DOI:10.1186/s12887-025-06215-1

J Eat Disord. 2025 Nov 5;13(1):248. doi: 10.1186/s40337-025-01433-5.

ABSTRACT

BACKGROUND: Orthorexia Nervosa is a condition characterized by an obsession with healthy eating that can negatively impact an individual’s psychosocial functioning. The risk of developing orthorexia nervosa increases during adolescence due to environmental influences like social media and cultural norms. It is indicated that low self-esteem is linked to orthorexia nervosa, causing individuals to potentially use their fixation on healthy eating to seek social acceptance. This study aims to explore the connection between orthorexia nervosa and self-esteem among high school students.

METHODS: In this cross-sectional study, the Ortho Scale and the Rosenberg Self-Esteem Scale were used to assess the relationship between Orthorexia Nervosa tendencies and high school students’ self-esteem. The sample was selected through stratified random sampling. Descriptive statistics, correlation analyses, and multiple linear regression analysis were applied to analyze the data. The effects of variables such as gender, age, body mass index, diet history, physical activity habits, and attitudes towards organic nutrition on Orthorexia Nervosa were assessed using multiple linear regression analysis.

RESULTS: The study’s findings revealed a significant relationship between tendencies toward Orthorexia Nervosa and self-esteem. The overall Ortho Scale score was lower among overweight individuals, upper-class students, those dissatisfied with their weight, individuals who had previously dieted, regular exercisers, those who believed in the benefits of organic nutrition, and those with low self-esteem. A significantly small positive correlation was observed between the total score of the Ortho Scale and the total score of the Rosenberg Self-Esteem Scale.

CONCLUSIONS: This study showed a strong link between orthorexia nervosa tendencies and self-esteem among high school students. The results suggest that low self-esteem increases the risk of orthorexia nervosa. Additionally, factors such as dieting, dissatisfaction with weight, regular exercise, and beliefs in organic nutrition are associated with tendencies toward orthorexia nervosa.

PMID:41194204 | DOI:10.1186/s40337-025-01433-5

BMC Complement Med Ther. 2025 Nov 5;25(1):411. doi: 10.1186/s12906-025-05158-5.

ABSTRACT

BACKGROUND: Traditional medicinal plants are central to healthcare, nutrition, and cultural practices in rural Ethiopia, yet ethnobotanical knowledge is underdocumented and increasingly threatened. This study aimed to document medicinal plant diversity, usage, preference, and conservation status in Menz Keya Gebreal District, North Shewa Zone, to inform sustainable management and pharmacological research.

METHODS: Data were collected from 80 informants using semi-structured interviews, guided field walks, focus group discussions, and field observations. Quantitative ethnobotanical analyses included Informant Consensus Factor (ICF), Fidelity Level (FL), Relative Frequency of Citation (RFC), Relative Popularity Level (RPL), Rank Order Priority (ROP), Cultural Value Index (CVI), paired and preference ranking, and direct matrix ranking. Similarity with other Ethiopian districts was assessed using Jaccard’s and Rahman’s indices. Statistical analyses, including t-tests, ANOVA, correlation, and regression, were conducted using R to evaluate variation in knowledge across demographic groups.

RESULTS: A total of 121 medicinal plant species from 61 families were documented, with Asteraceae, Fabaceae, and Euphorbiaceae being the most represented. Leaves were the most frequently used plant part, and oral administration was the predominant route of remedy preparation. High ICF values were observed for skin (0.87) and digestive disorders (0.82). Hagenia abyssinica (Bruce) J.F.Gmel., Ocimum lamiifolium Hochst. ex Benth., and Echinops kebericho Mesfin exhibited high FL, RFC, and ROP values, while Clutia abyssinica Jaub. & Spach and Euphorbia abyssinica J.F.Gmel.were prioritized for hepatitis treatment. Major threats to medicinal plants included agricultural expansion, overharvesting, and firewood collection. Ethnobotanical knowledge varied significantly by informant groups (P < 0.05). RSI and JSI revealed both shared and unique knowledge patterns across regions. Knowledge transfer occurred primarily within families, while sacred groves, home gardens, and cultural practices contributed to in situ conservation.

CONCLUSION: Menz Keya Gebreal District harbors rich medicinal plant diversity and traditional knowledge, but anthropogenic pressures threaten their persistence. Integrating community-based conservation, sustainable harvesting, pharmacological validation, and youth-focused knowledge preservation is essential to safeguard this ethnobotanical heritage.

PMID:41194202 | DOI:10.1186/s12906-025-05158-5

Exp Hematol Oncol. 2025 Nov 5;14(1):129. doi: 10.1186/s40164-025-00722-8.

NO ABSTRACT

PMID:41194180 | DOI:10.1186/s40164-025-00722-8

BMC Sports Sci Med Rehabil. 2025 Nov 5;17(1):319. doi: 10.1186/s13102-025-01336-7.

ABSTRACT

INTRODUCTION: Hamstring strains commonly occur late in football matches. Hamstring injury risk rises with age and fatigue. This study investigated eccentric hamstring strength and perceived hamstring soreness after a football match in younger and older players.

METHODS: Maximal eccentric hamstring strength and perceived soreness were assessed in younger (n = 11, 20.2 ± 1.1 years, total playing time: 34.5 ± 8.8 min) and older (n = 10, 27.4 ± 3.7 years, total playing time: 44 ± 10.5 min) professional male football players before and after a friendly match aimed at selecting the primary team for the upcoming season. A two-way mixed model ANOVA was employed for statistical analyses. Furthermore, Hedges’ (adjusted) g effect sizes were calculated to evaluate the magnitude of effects.

RESULTS: The older group experienced significant reductions in absolute (-20 N ± 38.5, g = 0.58, p = 0.027) and relative (-0.26 N/kg ± 0.5, g = 0.43, p = 0.038) maximal eccentric hamstring strength, while younger group showed no changes (absolute: 3 N ± 36.1, g = 0.07, p = 0.773; relative: -0.037 N/kg ± 0.54, g = 0.07, p = 0.783). There was no statistically significant difference between groups for the absolute (p = 0.195; g = 0.45) and relative (p = 0.226, g = 0.43) eccentric strength changes. On the other hand, both groups reported increases in perceived hamstring soreness after the match (older: 29% ± 14.1, p < 0.001; younger: 40% ± 14.9, p < 0.001), with the younger group reporting more significantly higher soreness changes than the older group (11% ± 17.2, p = 0.025). A significant negative association existed between age and eccentric strength changes (R = -0.447, R² = 0.2, p = 0.007).

CONCLUSIONS: The older group showed significant declines in eccentric hamstring strength after the match, with age as a predictor. Specialists should focus on enhancing eccentric strength in older players and monitor their recovery to minimise injury risk. Future psycho-physiological research should examine muscle soreness perceptions and force production in fatigued younger and older football players. The results must be interpreted with caution due to the shorter playing time, unaccounted match workload, and limited sample size. Moreover, future research is necessary, including workload and performance metrics over a longer play duration for each player, with a larger sample size to achieve more reliable conclusions.

PMID:41194178 | DOI:10.1186/s13102-025-01336-7

Cancer Imaging. 2025 Nov 5;25(1):126. doi: 10.1186/s40644-025-00942-5.

ABSTRACT

OBJECTIVE: To evaluate the efficiency of diffusion weighted imaging (DWI), the mean apparent diffusion coefficient (ADCmean) and the minimum apparent diffusion coefficient (ADCmin) values with different b-values (800 s/mm² and 1000 s/mm²) in the diagnosis and staging of endometrial carcinoma (EC).

METHODS: Preoperative DWI images of 412 patients with EC and 134 patients with benign endometrial lesions were analyzed retrospectively. The performance of DWI images, ADCmean and ADCmin values with different b-values (800 s/mm² and 1000 s/mm²) for the diagnosis and staging (deep myometrial invasion, cervical stromal invasion and lymph node metastasis) of EC was assessed by using receiver operating characteristic curve (ROC). The comparison between AUCs was performed using the DeLong test, and a P value < 0.05 was considered statistically significant.

RESULTS: The area under the curves (AUCs) of DWI protocol with b = 1000 s/mm² for qualitative assessment of EC diagnosis and staging (0.850, 0.837, 0.906, and 0.820 for diagnosis, deep myometrial invasion, cervical stromal invasion and lymph node metastasis, respectively) were higher than those of b = 800 s/mm² (0.821, 0.795, 0.860 and 0.814, respectively) (all p < 0.05). The AUCs for the quantitative assessment of EC diagnosis and staging with ADCmean and ADCmin values with b = 1000 s/mm² were higher than those of b = 800 s/mm² (all p < 0.05).

CONCLUSIONS: DWI images, ADCmean and ADCmin values with b = 1000 s/mm² had higher performance than those of b = 800 s/mm² in the assessment of EC diagnosis and staging. This study highlights the potential of using b = 1000 s/mm² as an optimized protocol for EC assessment in clinical practice.

PMID:41194176 | DOI:10.1186/s40644-025-00942-5

Trials. 2025 Nov 5;26(1):470. doi: 10.1186/s13063-025-09188-9.

ABSTRACT

BACKGROUND: Hearing loss is a prevalent condition that impacts on social, mental and physical health, and has a significant economic burden. Hearing aids can improve the quality of life for those living with hearing loss; however, low and inconsistent use remains common. Within the National Health Service (NHS), follow-up care for new hearing aid users is highly variable and often lacks structure, which may contribute to low use. The FAMOUS trial investigates whether a structured care model for follow-up, combined with evidence-based behaviour change interventions, improves hearing aid use compared to usual care.

METHODS: FAMOUS is a multi-centre, two-arm parallel-group cluster randomised controlled trial (CRCT) with integral internal pilot, economic, and process evaluations. The trial involves 36 NHS audiology services and compares two types of follow-up for new adult hearing aid users: structured care, which includes personalised action plans, early monitoring, and routine follow-up at 6 weeks post-fitting, to usual care, which includes the offer of a follow-up 6-12 weeks after fitting. Recruitment is conducted through participating services over 3 months, with pseudo-anonymised routine data collected from electronic medical records of all patients who attend. Consent and outcomes are then collected from patients at 12 weeks post-fitting. For patients who provide consent to future contact, the primary outcome (self-reported daily hearing aid use) is collected at 12 months post-fitting. Secondary outcomes (quality-of-life (QoL), hearing-related disability, and economic measures) are collected at both timepoints. Qualitative interviews with a subset of patients and hearing professionals in the intervention arm will assess the acceptability and implementation of the intervention. Statistical analyses, including mixed-effects regression modelling, will be conducted under an intention-to-treat framework.

DISCUSSION: FAMOUS addresses a critical evidence gap regarding the potential benefits of follow-up care for new hearing aid users. If the intervention is successful, it can be rolled out nationally using existing facilities with limited impact on resources, identified in the economic analysis, and would improve hearing aid use and quality of life for those living with hearing loss.

TRIAL REGISTRATION: Prospectively registered with the International Standard Randomised Controlled Trial Number (ISRCTN) 10589817. Date of registration: 01/09/2022.

PMID:41194160 | DOI:10.1186/s13063-025-09188-9

BMC Med Educ. 2025 Nov 5;25(1):1550. doi: 10.1186/s12909-025-07972-4.

ABSTRACT

BACKROUND: Perineal injury repair skills should be taught to students in midwifery education. One of these methods is peer-supported simulation training in simulation environments. This study aimed to determine the effect of peer-assisted episiotomy and perineal injury repair simulation on midwifery students’ anxiety and self-efficacy.

METHODS: A pretest-posttest, one-group quasi-experimental design. The study was carried out with 39 third-year midwifery students studying at a foundation university. Episiotomy repair simulation was carried out peer-assisted using sponge and chicken breast. The “Introductory Information Form,” the “State-Trait Anxiety Inventory,” and the “General Self-Efficacy Scale” were used as data collection tools. In the analysis of the data, descriptive statistics and dependent group t-tests were employed to evaluate the difference between the pre-test and post-test.

RESULTS: The mean age of the students was 21.44 ± 1.68 years (Min = 20; Max = 30). According to the results, there was a significant decrease in the mean scores of the State and Trait Anxiety scales in the pre-and post-simulation periods (Pre: State Anxiety mean 34.41 ± 9.58, Trait Anxiety 44.79 ± 9.57; Post: State Anxiety mean 30.48 ± 9.31, Trait Anxiety 41.33 ± 10.82; p < 0.05). While no difference was observed between the pre-test and post-test in the total score of general self-efficacy (Pre: mean 62.48 ± 9.74; Post: mean 62.59 ± 11.92; p > 0.05) of the students, there was a significant difference in the sub-dimension of Sustaining Effort & Persistence (p < 0.05).

CONCLUSIONS: The findings of this study demonstrated that peer-assisted episiotomy repair simulation training effectively reduced students’ anxiety. It is recommended that peer support be included in pre-clinical episiotomy and perineal injury repair simulation practice.

PMID:41194158 | DOI:10.1186/s12909-025-07972-4

Asian J Psychiatr. 2025 Oct 28;114:104758. doi: 10.1016/j.ajp.2025.104758. Online ahead of print.

ABSTRACT

OBJECTIVE: This meta-analysis aimed to systematically evaluate the specific, adjunctive efficacy of repetitive transcranial magnetic stimulation (rTMS) when combined with non-pharmacological interventions-namely, transcranial direct current stimulation (tDCS), Tai Chi, or cognitive training (CT)-in patients with Alzheimer’s disease (AD) or mild cognitive impairment (MCI). The goal is to isolate the net therapeutic contribution of rTMS beyond the effects of the base interventions alone.

METHODS: A comprehensive search of Chinese and English databases was conducted from their inception until April 26, 2025. Randomized controlled trials (RCTs) that compared “a non-pharmacological intervention plus active rTMS” versus “the same non-pharmacological intervention plus sham rTMS”.This “add-on” study design was selected to precisely isolate the effect of rTMS. The risk of bias was assessed using the PEDro scale and Cochrane tools. Statistical analyses were performed using Review Manager 5.4 software.

RESULTS: 9 studies involving 391 participants were included. The pooled analysis revealed that the adjunctive use of rTMS was significantly superior to the sham control in improving global cognitive function at the immediate post-treatment assessment (SMD=0.38, 95 %CI[0.20,0.56], P < .001, n = 9). This benefit was consistent across the MMSE (SMD=0.38, n = 6), MoCA (SMD=0.37, n = 2), and ADAS-cog (SMD=0.39, n = 3) scores. Subgroup analysis suggested that the rTMS-tDCS combination might offer a short-term advantage in improving MMSE scores (MD=4.67, P = .008). Furthermore, the adjunctive effect of rTMS was sustained, as particularly evidenced by the ADAS-cog at follow-up (SMD=0.74, P = .02). The pooled analysis indicated that rTMS combined with non-pharmacological therapy demonstrated a short-term, sustained (4-8weeks) improvement in global cognitive function (SMD=0.34, 95 % CI[0.07, 0.60], P = .01). Subgroup analysis revealed that this sustained benefit reached statistical significance on the ADAS-cog scale (SMD = 0.41, 95 %CI[0.01, 0.81], P = .04) but showed a non-significant positive trend on the MMSE (SMD=0.26, 95 %CI[-0.19, 0.72], P = .26). However, a key limitation was that most studies did not systematically report outcomes related to activities of daily living or behavioral function.

CONCLUSION: The evidence indicates that rTMS as an adjunct to non-pharmacological interventions provides a significant specific effect on global cognitive function in patients with AD and MCI shortly after treatment, which may be sustained in the short-term. However, long-term follow-up data are extremely limited, and the effect on activities of daily living remains to be validated. The combination of rTMS and tDCS shows promise,but conclusions are constrained by the small number of studies,limited sample sizes,and heterogeneity in intervention protocols. Future large-scale studies incorporating long-term, standardized follow-up and assessments of daily living abilities are warranted to confirm the specific clinical value of rTMS as an augmentative therapy.

PMID:41192010 | DOI:10.1016/j.ajp.2025.104758

Int J Rheum Dis. 2025 Nov;28(11):e70449. doi: 10.1111/1756-185X.70449.

ABSTRACT

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disorder that imposes a significant economic burden through high healthcare costs. Prior studies have explored AS-related expenditures, but a comprehensive analysis of cost-related factors is lacking. This study aims to fill this gap.

METHODS: We analyzed data from 6149 AS patients (2018-2024) at two tertiary hospitals in Guangxi, China, and classified them as surgical or non-surgical; inpatients were categorized by catastrophic health expenditures (CHE; > 50% of household income). Descriptive statistics and the Kruskal-Wallis test were used to assess patient characteristics and cost differences, whereas propensity score matching and multivariable logistic regression were used to identify independent CHE predictors.

RESULTS: A total of 6149 AS patients were included. Surgical patients were older and incurred significantly higher inpatient costs (USD 9457.21 vs. USD 1177.10 for non-surgical patients). General medical service costs, imaging examination costs, Western medicine costs, and medical supply costs are risk factors affecting CHE in hospitalized patients.

CONCLUSION: AS imposes a substantial economic burden, particularly on surgical patients. Key cost drivers, including general medical services, imaging, pharmaceuticals, and medical supplies, markedly increase the risk of catastrophic expenditures. Implementing policy reforms to enhance insurance coverage, alongside clinical cost-control strategies such as rational imaging use, adoption of generic medicines, and optimized management of medical supplies, is essential to alleviate financial strain and improve the sustainability of AS care.

PMID:41191978 | DOI:10.1111/1756-185X.70449