Nevin Manimala

J Health Popul Nutr. 2025 Jul 11;44(1):248. doi: 10.1186/s41043-025-00964-6.

ABSTRACT

BACKGROUND: The assessment of pilgrims’ knowledge and practices regarding food and water safety during Hajj may contribute to a reduction in foodborne disease (FBD) cases. Thus, the food safety knowledge and practices of consumers during Hajj and its association with FBD and demographic information were investigated in this study.

METHODS: A cross-sectional study was conducted among pilgrims during Hajj 2023. A self-reported questionnaire comprising 4 sections (demographic data, pilgrims’ food safety knowledge and practice, and FBD) was distributed for data collecting. Statistical tests performed including one-way ANOVA, independent samples t-tests, Chi-square, and Pearson’s correlation.

RESULTS: Out of 409 pilgrims, 58% were females and 41% were males with a mean age of 38.9 years. The overall food safety knowledge level among pilgrims was above-average, while their overall food safety practice level was below-average. Those with higher education and employed had the highest knowledge score. Male and unemployed pilgrims had the highest practice score. FBD symptoms were associated with knowledge and practice (p = 0.002 and 0.0001, respectively).

CONCLUSIONS: The findings confirmed the above-average level of pilgrims’ food safety knowledge. Nevertheless, some risky practices during Hajj were reported. FBD and some factors were significantly associated with food safety knowledge and practices. This study suggests educational interventions to enhance pilgrims’ behaviors and practices towards food before and during Hajj.

PMID:40646665 | DOI:10.1186/s41043-025-00964-6

Infect Dis Poverty. 2025 Jul 11;14(1):66. doi: 10.1186/s40249-025-01320-w.

ABSTRACT

BACKGROUND: Malaria is a major worldwide health concern that impacts many individuals worldwide. P. falciparum is Africa’s main malaria cause. However, P. vivax share a large number in Ethiopia than any other countries in Africa, followed by the closest countries. This research aims to examine the spatiotemporal trends in the risk of malaria caused by P. falciparum and P. vivax in Ethiopia and other countries that share borders between 2011 and 2020.

METHODS: This study was carried-out in seven East African countries in 115 administration level 1 (region) settings. We used secondary data on two plasmodium parasites, P. falciparum, and P. vivax, between 2011 and 2020 from the Malaria Atlas Project. This study used a Bayesian setup with an integrated nested Laplace approximation to adopt spatiotemporal models.

RESULTS: We analyzed P. falciparum and P. vivax malaria incidence data from 2011 to 2020 in 115 regions. Between 2011 and 2020, all of South Sudan’s areas, Ethiopia’s Gambella region, and Kenya’s Homa Bay, Siaya, Busia, Kakamega, and Vihita regions were at a higher risk of contracting P. falciparum malaria than their neighbors in seven East African nations. However, the Southern Nations, nationalities, and people, as well as the Oromia, Harari, Afar, and Amhara areas in Ethiopia, and the Blue Nile in Sudan, are the regions with a higher risk of P. vivax malaria than their bordering regions. For both P. falciparum and P. vivax, the spatially coordinated main effect and the unstructured spatial effect show minimal fluctuation across and within 115 regions during the study period. Through a random walk across 115 regions, the time-structured effect of P. falciparum malaria risk shows linear increases, whereas the temporally structured effect of P. vivax shows increases from 2011 to 2014 and decreases from 2017 to 2020.

CONCLUSIONS: The global malaria control and eradication effort should concentrate particularly on the South Sudan and Ethiopia regions to provide more intervention control to lower the risk of malaria incidence in East African countries, as both countries have high levels of P. falciparum and P. vivax, respectively.

PMID:40646656 | DOI:10.1186/s40249-025-01320-w

Diabetol Metab Syndr. 2025 Jul 11;17(1):263. doi: 10.1186/s13098-025-01846-x.

ABSTRACT

BACKGROUND: Nutrient interactions with the gut microbiome modulate the development of metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular disease. The dietary index for gut microbiota (DI-GM) is an innovative and comprehensive diet index to assess quality for health of gut microbiota.

METHOD: This is a cohort study from the interview date to the date of death or the end of follow-up (December 31, 2019). Involving 13,390 participants in National Health and Nutrition Examination Survey (NHANES), including 3538 with MASLD and 9852 without MASLD. DI-GM was calculated using 14 foods and nutrients with clear positive or negative impacts on gut microbiota, and MASLD was assessed based on liver steatosis and cardiometabolic risk factors, with all-cause and cardiovascular mortality determined through probabilistic matching and death certificate review. Restricted Cubic Spline (RCS) analysis and Cox regression were palyed for the DI-GM-mortality correlation. Subgroup analyses to identify the interactive factors that influence their relationship in MASLD. Six sensitivity analyses reinforced findings.

RESULTS: MASLD participants exhibited lower DI-GM levels, which were statistically associated with higher mortality. Each DI-GM unit increase in MASLD was associated with a 13% lower all-cause mortality (HR = 0.87, 95% CI 0.78-0.98) and a 19.5% lower cardiovascular mortality (HR = 0.805, 95% CI 0.690-0.938). In advanced fibrosis MASLD, this increase was linked to a 20% lower cardiovascular mortality risk (HR = 0.800, 95% CI 0.691-0.927). Age and prediabetes significantly modified DI-GM’s effect on mortality risk.

CONCLUSIONS: The study revealed a significant inverse correlation between the DI-GM and all-cause/cardiovascular mortality in patients with MASLD, which provide dietary suggestions and guidance for MASLD patients in preventing early mortality. However, limitations such as the cross-sectional design, potential residual confounding, and population-specific generalizability should be considered when interpreting these findings.

PMID:40646653 | DOI:10.1186/s13098-025-01846-x

J Forensic Sci. 2025 Jul 11. doi: 10.1111/1556-4029.70131. Online ahead of print.

ABSTRACT

Biological evidence from sexual assaults frequently includes few male cells (i.e., spermatozoa) and numerous female cells (i.e., epithelial cells). In practice, their genetic analysis typically involves separating the victim’s cells from the perpetrator’s sperm using conventional differential extraction or advanced cell enrichment/capturing techniques. A descriptive study on simulated sexual assault samples was carried out by the recruitment of 10 heterosexual, monogamous couples. Post-coital swabs were collected before and after consensual sexual intercourse, with a sampling period of up to 96 h, and subjected to analysis to detect, quantify, and genotype adhering sperm by three distinct cell-separation techniques: differential extraction, laser capture microdissection, and DEPArray™. Methods differed in sperm detection and genotyping efficacy, while foreign DNA was identifiable up to 96 h. Time since intercourse and individuals were statistically significant factors (p ≤ 0.05) on male DNA yields, while hygienic behavior was not. Prior sperm enrichment was pivotal for cell capture technologies to counteract the abundance of epithelial cells, achieved by a prior mild digestion step for laser microdissection. Evaluating the advantages and disadvantages of standard and advanced methods provided a novel, comprehensive understanding of their merits, postulating that modern applications can assist conventional ones in challenging crime samples.

PMID:40646640 | DOI:10.1111/1556-4029.70131

Eur J Med Res. 2025 Jul 11;30(1):613. doi: 10.1186/s40001-025-02868-x.

ABSTRACT

BACKGROUND: Stress hyperglycemia ratio (SHR) refers to the ratio of blood glucose levels to glycated hemoglobin (HbA1c) levels upon admission. As a non-invasive and easily obtainable indicator, there is no systematic evidence-based medical evidence to support the value of SHR in predicting the poor prognosis of critically ill patients at present.

METHODS: PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched with a December 20, 2024 deadline. Prospective and retrospective cohort studies were included. Two investigators independently screened studies and extracted data. The Newcastle-Ottawa scale was applied to appraise the risk of bias in the studies included. Statistical analysis was executed by means of Stata 15.1 software. Study heterogeneity was assessed with the I² statistic. A restricted cubic spline model was leveraged for dose-response analysis. Sensitivity analyses were implemented to verify the stability of the results using the one-by-one exclusion method, and subgroup analyses were conducted with disease types.

RESULTS: 39 studies involving 102,414 patients were included. The meta-analysis revealed that SHR exhibited a noticeable positive link with major adverse cardiovascular events (MACE), 30-day mortality, one-year mortality, cardiovascular mortality (CVM), and all-cause mortality (ACM) in critically ill patients. Dose-response analysis showed that a positive link of SHR with multiple mortality was noted in critically ill patients.

CONCLUSION: SHR is an independent predictor of mortality in critically ill patients, and its dynamic monitoring could provide essential support for early clinical risk stratification and intervention strategies.

PMID:40646634 | DOI:10.1186/s40001-025-02868-x

Arch Public Health. 2025 Jul 11;83(1):183. doi: 10.1186/s13690-025-01673-6.

ABSTRACT

BACKGROUND: Regular dental visits are essential for oral health, yet disparities between regions exist due to socioeconomic and geographic factors. While national surveys provide valuable data on dental care utilization, they generally lack sufficient sample sizes at the local level to generate reliable county-level estimates. Small area estimation techniques, such as multilevel regression and post-stratification (MRP), can help address this gap by producing robust estimates for smaller geographic areas. However, the MRP approach relies on detailed population data in the form of joint distributions and cannot be applied when only marginal distributions are available.

METHODS: This paper introduces a hybrid approach combining multilevel modeling with the raking procedure. We used individual-level data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and census data from American Community Survey to estimate county-level dental care utilization among adults in California.

RESULTS: The county-level dental care utilization in California ranged from 52.5 to 73.1%, with a median of 63.1%. Our model-based estimates matched direct BRFSS estimates at metropolitan and micropolitan statistical area levels. Furthermore, we found significantly positive correlations between our model-based estimates and direct estimates from the California Health Interview Survey for 41 counties (Pearson coefficient: 0.801, P < 0.001).

CONCLUSIONS: The proposed approach accounts for individual- and area-level factors while overcoming data constraints that limit the application of MRP. The findings demonstrate the feasibility of this approach in generating county-level estimates, supporting public health planning and targeted interventions to reduce disparities in dental care utilization.

PMID:40646604 | DOI:10.1186/s13690-025-01673-6

BMC Nurs. 2025 Jul 11;24(1):904. doi: 10.1186/s12912-025-03561-4.

ABSTRACT

BACKGROUND: Patient safety is a critical indicator of healthcare quality. The professional self-efficacy and skills of nursing students regarding patient safety should be developed and assessed throughout their education. This study aimed to evaluate the impact of e-learning and high-fidelity simulation methods on the self-efficacy of nursing students.

METHODS: A comparative quasi-experimental study was conducted with 52 senior nursing students enrolled at a state university in Ankara. Participants completed a pre-test and were randomly assigned to either a high-fidelity simulation group or an e-learning group, with 26 students in each. Both groups were exposed to five standardized case scenarios. The high-fidelity group participated in face-to-face simulations, while the e-learning group engaged in online discussions centered on the same scenarios. Following these sessions, both groups underwent debriefing before undertaking the first post-test. Subsequently, all students undertook a 3-week clinical placement focused on Patient Safety and Quality, followed by a second post-test. Data were collected using a demographic questionnaire, the Health Professionals’ Education in Patient Safety Survey, and the Patient Safety Competency Self-Efficacy Scale. Data analysis involved descriptive statistics for sociodemographic characteristics, independent samples t-tests and Mann-Whitney U tests for between-group comparisons, and analysis of variance and Friedman test for within-group comparisons.

RESULTS: The e-learning and high-fidelity simulation interventions both resulted in statistically significant improvements in students’ scores on the Patient Safety Competency Self-Efficacy Scale and its subscales, as well as the Health Professionals’ Education in Patient Safety Survey. However, no significant difference was observed between the two groups.

CONCLUSION: Both high-fidelity simulation and e-learning methods focusing on patient safety were equally effective in improving nursing students’ self-efficacy. These results suggest that either method or a combination of both, using case scenarios that reflect real clinical situations, can be effectively employed to improve students’ self-efficacy in patient safety.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40646597 | DOI:10.1186/s12912-025-03561-4

Diabetol Metab Syndr. 2025 Jul 11;17(1):261. doi: 10.1186/s13098-025-01832-3.

ABSTRACT

BACKGROUND: The stress hyperglycemia ratio (SHR) is a clinical index that quantifies acute stress-induced hyperglycemia by comparing immediate blood glucose levels with chronic glucose control (reflected by HbA1c). It is especially valuable in cardiovascular disease and surgical prognosis. However, there is still a lack of research on the relationship between SHR and new-onset atrial fibrillation (AF) in patients after coronary artery bypass grafting (CABG). This study investigates the impact of postoperative SHR on AF risk following CABG.

METHODS: This study is a retrospective cohort analysis conducted through the MIMIC-IV database, which included adult patients who underwent CABG and were admitted to the ICU. These patients were categorized into three distinct groups according to the tertiles of the baseline SHR level, and the primary outcome was the incidence of postoperative atrial fibrillation (POAF). We employed logistic regression models, restricted cubic splines (RCS), threshold effect analysis, ubgroup analysis, Boruta algorithm, lasso algorithm, and receiver operating characteristics (ROC) to analyze the relationship between SHR and POAF incidence comprehensively.

RESULTS: 2112 patients undergoing CABG were included in this study, with a median age of 69 years (IQR: 62-76), of whom 1643 (77.79%) were male. Logistic regression results showed that the incidence of AF was significantly increased in patients in the highest third of the SHR group compared with the lowest third group (OR = 1.31, 95%CI = 1.03-1.67; P = 0.0275). SHR was an independent risk factor for the incidence of POAF (OR = 1.63, 95%CI = 1.19-2.23; P = 0.0023). At the same time, RCS analysis showed that SHR was positively and linearly correlated with the incidence of POAF in patients after cardiac surgery (P = 0.009, P for Nonliner = 0.848). Threshold effect analysis identified no significant threshold and further supported a linear relationship between SHR and POAF. In addition, SHR was double-screened by Boruta and Lasso algorithms, indicating that it was statistically and biologically significantly associated with AF after CABG.

CONCLUSION: SHR is significantly related to AF after CABG. As SHR increases, the risk of POAF increases. Incorporating SHR into post-CABG risk assessment enhances AF prediction, offering a valuable reference for clinical decision-making. It may also be a potential biomarker for studying pathological mechanisms in patients after cardiac surgery. In the future, combining multi-omics data with clinical intervention trials is necessary to verify its clinical application value further.

PMID:40646596 | DOI:10.1186/s13098-025-01832-3

BMC Nurs. 2025 Jul 11;24(1):902. doi: 10.1186/s12912-025-03565-0.

ABSTRACT

BACKGROUND: The phenomenon of “quiet quitting” performing only the minimum required duties without emotional investment-has gained prominence in both the workplace and educational settings.

AIM: This study was conducted to determine the quiet quitting levels of nursing students and to analyze how these levels vary according to gender, year of study, motivation for choosing the profession, and satisfaction with the department.

METHODS: Descriptive and cross-sectional comparative design. The study was conducted with 210 nursing students selected through stratified sampling from a total population of 511. Data were collected via a personal information form and the Quiet Quitting Scale (16 items, 4 subscales). Non-parametric statistical tests (Mann-Whitney U, Kruskal-Wallis H, Spearman correlation) were employed using SPSS 26.0.

RESULTS: The mean total score on the Quiet Quitting Scale was 50.04 ± 10.06, indicating a moderate level of disengagement. Male students reported significantly higher quiet quitting scores compared to females (p < 0.05). It was observed that self-protection subscale scores were higher among senior students (p < 0.05). Seniors scored higher on the self-protection subscale, suggesting increased risk awareness. Students who selected nursing due to internal motivation demonstrated lower levels of quiet quitting than those influenced by external factors (p < 0.05). A significant negative correlation was observed between satisfaction with nursing education and all dimensions of quiet quitting (p < 0.05).

CONCLUSIONS: Quiet quitting is notably present among nursing students and is influenced by gender, academic seniority, motivation for choosing the profession, and satisfaction with the educational experience. Curricular changes, active engagement strategies, and psychosocial support may help strengthen students’ professional identity and reduce passive disengagement. Mentorship programs, professional identity modules, and targeted support for students at higher risk of disengagement-including male students, those with low satisfaction, and those who chose nursing due to external motivations-could further address disengagement risks. These findings may inform international educational policies and contribute to the development of strategies to enhance student commitment and patient safety.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40646584 | DOI:10.1186/s12912-025-03565-0

Trials. 2025 Jul 11;26(1):243. doi: 10.1186/s13063-025-08947-y.

ABSTRACT

BACKGROUND: The StratosPHere 2 trial will evaluate the efficacy of hydroxychloroquine and phenylbutyrate in pulmonary arterial hypertension caused by mutations in BMPR2 by focussing on the novel biomarker and other endpoints including safety.

STUDY DESIGN: StratosPHere 2 is a three armed, placebo-controlled, phase 2 trial with two strata based on the mutation groups. It is response adaptive where the allocation of treatments follows a Bayesian response-adaptive randomisation algorithm. An expected number of 20 patients will be randomised in each stratum to one of the three arms containing hydroxychloroquine, phenylbutyrate and placebo. The primary outcome is a novel endpoint considering the change in the bone morphogenetic receptor type 2 (BMPR2).

METHOD: The final primary analysis on the efficacy of each active treatment against control is assessed using a one-sided nonparametric Wilcoxon test computed on the continuous biomarker data collected up to 8 weeks from the start of treatment.

DISCUSSION: This manuscript presents the key elements of the StratosPHere 2 implementation and statistical analysis plan. This is submitted to the journal before the first interim analysis to preserve the scientific integrity under a response-adaptive design framework. The StratosPHere 2 trial closely follows published guidelines for the content of Statistical Analysis Plans in clinical trials.

TRIAL REGISTRATION: The ISRCTN Registry ISRCTN10304915 (22/09/2023).

PMID:40646581 | DOI:10.1186/s13063-025-08947-y