Nevin Manimala

BMC Public Health. 2025 Feb 3;25(1):431. doi: 10.1186/s12889-025-21568-z.

ABSTRACT

INTRODUCTION: Global evidence suggests that natural disasters are on the rise, and that earthquake harm disproportionally impacts developing countries. To mitigate these harms, disaster preparedness is an important behavioral strategy in earthquake risk mitigation. However, there is limited evidence about the levels of preparedness in developing countries, especially Iran. Therefore, this study aimed to investigate earthquake preparedness among the general public, using the Theory of Planned Behavior (TPB) as a theoretical framework.

METHOD: This methodological study was conducted in Iran in 2022, involving 302 participants selected through stratified random sampling. Data was collected using a valid and reliable questionnaire. Structural equation modeling (SEM) was employed to analyze TPB constructs, including attitudes, subjective norms, perceived behavioral control, and intentions, in relation to earthquake preparedness behaviors. The statistical analyses encompassed descriptive statistics, t-tests, ANOVA, correlation coefficients, confirmatory factor analysis, and structural equation modeling.

RESULTS: Results show that attitudes toward disaster preparedness, subjective norms, and perceived behavioral control significantly (< 0.05) influenced residents’ disaster preparedness intentions. Additionally, there was good model fit of the TPB in explaining earthquake preparedness behavior. For confirmatory factor analysis (CFA) of TPB model the fit indices were CMin/df = 1.35 (< 3), RMSEA = 0.03 (< 0.05); CFI = 0.96 (> 0.95); TLI = 0.95 (= 0.95), and for SEM model they were CMin/df = 1.36 (< 3), RMSEA = 0.03 (< 0.05); CFI = 0.96 (> 0.95); TLI = 0.96 (> 0.95).

CONCLUSION: The overall fit indexes were acceptable indicating the TPB model is a valid and reliable measurement model for screening population-level readiness for earthquake preparedness, developing and/or implementing health promotion interventions. The findings also suggest that disaster education programs should emphasize the importance of attitudes, subjective norms, and perceived behavioral control in promoting disaster preparedness.

PMID:39901211 | DOI:10.1186/s12889-025-21568-z

J Orthop Surg Res. 2025 Feb 3;20(1):130. doi: 10.1186/s13018-025-05539-z.

ABSTRACT

PURPOSE: The purpose of this study was to introduce and evaluate the Descriptive Ankle Fracture Classification (DAFC) system, a novel alphanumeric method for categorizing ankle fractures and fracture dislocations, and to assess its reliability and prognostic value compared to traditional classification systems (AO/OTA, Weber, and Lauge-Hansen).

MATERIALS AND METHODS: A retrospective review was conducted on 90 patients who underwent surgical treatment for ankle fractures. Four observers of varying experience levels classified the fractures using the DAFC, AO/OTA, Weber, and Lauge-Hansen classification systems. Interobserver and intraobserver reliability were evaluated using Fleiss’ Kappa coefficient. Functional outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) and Olerud Molander Ankle Score (OMAS) systems, and comparisons were made across classification systems to determine prognostic value.

RESULTS: The DAFC system demonstrated superior interobserver reliability, particularly for medial malleolus fractures (Kappa = 0.935-0.954) and syndesmotic injuries (Kappa = 0.873-0.891), compared to the other systems. Intraobserver reliability was consistently high across all categories in the DAFC system, with Kappa values ranging from 0.967 to 1.000. Functional outcomes revealed significant associations with the DAFC classification: patients with complete dislocation (D2) had significantly lower AOFAS and OMAS scores than those without dislocation (D0) (P = 0.011), and those with larger posterior malleolus fractures (P2) had poorer OMAS scores (P = 0.014). No statistically significant differences in AOFAS or OMAS scores were observed across AO/OTA, Weber, or Lauge-Hansen classifications.

CONCLUSIONS: The DAFC system offers a reliable and comprehensive framework for ankle fracture classification, with the added benefit of prognostic insights, particularly regarding dislocation and posterior malleolus involvement. Its high interobserver and intraobserver reliability, even among observers with varying experience, suggests that the DAFC system is valuable for clinical use. Future research should focus on validating these findings in larger cohorts and assessing the DAFC system’s impact on long-term patient outcomes.

LEVEL OF EVIDENCE: Level IV, Retrospective cohort.

PMID:39901191 | DOI:10.1186/s13018-025-05539-z

BMC Nurs. 2025 Feb 3;24(1):122. doi: 10.1186/s12912-025-02753-2.

ABSTRACT

BACKGROUND: Lower back pain (LBP) is the main cause of workplace impairment and a significant contributor to absenteeism. Implementing relaxation techniques in the workplace can be considered an investment because it can eventually lower the incidence of chronic LBP (chronic lower back pain).

AIM: The purpose of the current study was to evaluate the effect of relaxation techniques on the quality of working life, pain and disability level, with nurse-led interventions among occupational workers with chronic lower back pain (CLBP).

METHOD: A quasi-experimental design with a pre- and post-test method was used.

SETTING: The study took place at a yarn and textile factory in Kafr El-Sheikh City, Kafr El-Sheikh Governorate, Egypt.

SAMPLE: A purposive sample of 100 industrial workers with persistent LBP was chosen. The participants were matched and sorted into two equal groups: the study group and the control group.

INSTRUMENTS: The study used a structured interview questionnaire, the Visual Analogue Scale (VAS), the Quality of Working Life Scale (QWL), and the Oswestry Disability Index.

RESULTS: Participants’ average age was 41.4 ± 8.7 years in the study group and 40.5 ± 7.8 years in the control group. Following the relaxation technique intervention, the study group’s pain intensity, frequency, and duration were significantly lower than in the control group. Following the intervention, the study group’s overall quality of working life improved statistically significantly, with the mean score rising from 72% in the pretest to 93.3% in the post-test. The research group’s daily activities and the overall quality of working life improved dramatically when compared to the control group. Furthermore, after the intervention, the study group’s disability levels decreased significantly, with only 46% having a disability compared to 86% before the intervention.

CONCLUSIONS: The implementation of relaxation techniques greatly improved the quality of working life in the study group when compared to the control group. There was a notable and statistically significant difference in pain intensity between the study group and the controls. Following the intervention, industrial workers’ daily living activities improved, despite persistent LBP.

RECOMMENDATION: Health education and awareness programs should be conducted to improve the quality of life for industrial workers with LBP. Additionally, occupational health nurses’ roles in the early detection and referral of LBP patients in diverse industrial settings should be strengthened.

PMID:39901190 | DOI:10.1186/s12912-025-02753-2

BMC Psychol. 2025 Feb 3;13(1):95. doi: 10.1186/s40359-025-02398-5.

ABSTRACT

The dual-factor model (DFM) of mental health has received increasing support in recent years. However, researchers have limited knowledge regarding the longitudinal changes in the DFM of mental health. This study considered the dual-factor mental health among adolescents using latent profile analysis (LPA). It explored the impact of childhood maltreatment on mental health using latent transition analysis (LTA). The sample comprised adolescents who reported depression, anxiety, and life satisfaction. An interpretable LTA solution identified three classes: flourishing, moderately mentally healthy, and troubled. The flourishing class displayed the most stable mental health, followed by the moderately mentally healthy class. The troubled class was the least stable. In examining the effects of maltreatment experiences, we found that previous physical neglect was a risk factor for suboptimal mental health. The study’s findings emphasize the importance of regular monitoring of adolescents’ dual-factor mental health to inform mental health promotion.

PMID:39901184 | DOI:10.1186/s40359-025-02398-5

Int J Equity Health. 2025 Feb 3;24(1):35. doi: 10.1186/s12939-025-02399-1.

ABSTRACT

BACKGROUND: Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluchestan Province in southeast Iran.

METHODS: This study employed the enhanced two-step floating catchment area (E2SFCA) method to create an overall composite spatial accessibility index for healthcare facilities and services in Sistan and Baluchestan Province, southeast Iran. Spatial accessibility for general practitioners, nursing, dentistry, midwifery, pharmacy, medical laboratory, nutrition, public health, radiology, psychology, environmental health, rural health workers, inpatient hospital beds, and five medical specialty services were calculated. Spatial accessibility scores were normalized from 0 to 1 (no access = 0, low = 0.01 to 0.33, moderate = 0.331 to 0.66, high = 0.661 to 1) and aggregated into overall indices of primary, secondary, and overall healthcare accessibility for each district. Inequality was assessed using the Lorenz curve and Gini coefficient analysis.

RESULTS: Low geographic accessibility was found across Sistan and Baluchestan Province, especially in rural areas. Almost 75% of the population had low/no access to overall primary care services within a 30-minute drive time. For secondary care, nearly 45% had low/no access to hospital inpatient beds within a 30-minute drive time, and around 40% had low/no access to specialists within a 60-minute drive time. Just 11.6% of the population had high overall healthcare access. The calculated Gini coefficient of 0.517 for the overall spatial accessibility index to healthcare services in Sistan and Baluchestan Province highlights a highly unequal distribution of healthcare services.

CONCLUSIONS: This study demonstrates a useful replicable methodology that combines individual service accessibility metrics into an overall spatial healthcare access index. Furthermore, this study provides evidence of major shortfalls in healthcare access across Sistan and Baluchestan Province. Targeted strategies are required to increase the availability and capacity of services in underserved communities. Improving geographic access is key for progressing towards universal coverage and better population health.

PMID:39901168 | DOI:10.1186/s12939-025-02399-1

BMC Med. 2025 Feb 4;23(1):65. doi: 10.1186/s12916-025-03910-9.

ABSTRACT

BACKGROUND: Antenatal steroid (ANS) therapy is given to women at risk of preterm delivery to accelerate fetal lung maturation. However, the benefit of ANS therapy is variable and how maternal and fetal factors contribute to this observed variability is unknown. We aimed to test the degree of concordance in preterm lung function, and correlate this with genomic, transcriptomic, and pharmacokinetic variables in preterm dizygotic twin ovine fetuses.

METHODS: Thirty-one date-mated ewes carrying twin fetuses at 123 ± 1 days’ gestation received maternal intramuscular injections of either (i) 1 × 0.25 mg/kg betamethasone phosphate and acetate (CS1, n = 11 twin pairs) or (ii) 2 × 0.25 mg/kg betamethasone phosphate and acetate, 24 h apart (CS2, n = 10 twin pairs) or (iii) 2 × saline, 24 h apart (negative control, n = 10 twin pairs). Fetuses were surgically delivered 24 h after their final treatment and ventilated for 30 min.

RESULTS: ANS-exposed female fetuses had lower arterial partial pressure of carbon dioxide (PaCO₂) values than male fetuses (76.5 ± 38.0 vs. 97.2 ± 42.5 mmHg), although the observed difference was not statistically significant (p = 0.1). Only 52% of ANS-treated twins were concordant for lung maturation responses. There was no difference in fetal lung tissue or plasma steroid concentrations within or between twin pairs. Genomic analysis identified 13 single-nucleotide polymorphisms (SNPs) statistically associated with ANS-responsiveness, including in the proto-oncogene MET and the transcription activator STAT1.

CONCLUSIONS: Twin fetal responses and ANS tissue levels were comparable with those from singleton fetuses in earlier studies. Twin ovine fetuses thus benefit from ANS in a similar manner to singleton fetuses, and a larger dose of betamethasone is not required. Assuming no difference in input from the placental or maternal compartments, fetal lung responses to ANS therapy in dizygotic twin preterm lambs are dependent on the fetus itself. These data suggest a potential heritable role in determining ANS responsiveness.

PMID:39901164 | DOI:10.1186/s12916-025-03910-9

Clin Neurol Neurosurg. 2025 Jan 29;249:108767. doi: 10.1016/j.clineuro.2025.108767. Online ahead of print.

ABSTRACT

BACKGROUND: Central nervous system (CNS) infections represent life-threatening conditions. Emerging evidence suggests cerebrospinal fluid (CSF) presepsin (sCD14) as a promising biomarker for these infections. However, its diagnostic accuracy remains controversial. This study aimed to systematically evaluate the reliability of CSF presepsin in diagnosing CNS infections through a comprehensive meta-analysis.

METHODS: A systematic search of PubMed, Scopus, and Web of Science databases was conducted up to November 2024. Five prospective studies involving 384 participants were included. CSF presepsin levels were compared between infected and non-infected patients. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive predictive value (PPV), and negative predictive value (NPV) were calculated using a random-effects model. Publication bias and clinical utility were assessed through Deek’s funnel plot and Fagan’s nomogram, respectively.

RESULTS: Infected patients exhibited significantly higher CSF presepsin levels (mean difference: 760.16 pg/mL; 95 % confidence interval (CI): 426.26-1094.05, p < 0.01). Pooled sensitivity and specificity were 87 % (95 % CI: 82-91 %) and 67 % (95 % CI: 60-74 %), respectively, with a DOR of 13.04 (95 % CI: 7.51-22.64). The pooled PPV and NPV were 79 % (95 % CI: 73-84 %) and 79 % (95 % CI: 71-85 %), respectively. The area under the curve of the summary receiver operating characteristic curve was 86 %, emphasizing high diagnostic accuracy. No statistically significant publication bias was detected (P = 0.12).

CONCLUSION: CSF presepsin demonstrated potential as a diagnostic biomarker for CNS infections, demonstrating high sensitivity and moderate specificity. Further large-scale studies are needed to refine its clinical applicability and establish standardized thresholds.

PMID:39899927 | DOI:10.1016/j.clineuro.2025.108767

Drug Alcohol Depend. 2025 Jan 29;268:112586. doi: 10.1016/j.drugalcdep.2025.112586. Online ahead of print.

ABSTRACT

PURPOSE: To assess real-world access to buprenorphine treatment in Philadelphia and measure adoption of policies and practices that facilitate buprenorphine access.

METHODS: We used an audit (“secret shopper”) design to survey all programs providing longitudinal, outpatient buprenorphine in Philadelphia from 9/2022-1/2023 (n = 130). After validating eligibility, a research coordinator posing as a case manager called eligible programs to inquire about appointment availability and treatment policies. We used descriptive statistics to analyze the data and compared practices between primary and subspecialty treatment providers.

RESULTS: We reached 107 programs with audit calls (82 % response rate). 56 (52 %) were primary care offices and 51 (48 %) were specialty addiction providers. 96 (90 %) accepted new patients for buprenorphine treatment, and 83 (78 %) accepted insurance. Median time-to-appointment was 3 business days (range 0-120), and 42 % of visits were offered with a single call. Only 42 % of programs could confirm the possibility of a buprenorphine prescription at an initial visit. 48 % of programs could not provide information about requirements for counseling or behavioral health, and few could provide information about policies for patients with ongoing substance use. Specialty models were more likely than primary care programs to provide information about medication availability at the first visit but also were more likely to require counseling and abstinence.

CONCLUSIONS: Our study provides a simulation of real-world experiences accessing buprenorphine, revealing significant variability in treatment access and persistence of practice-level barriers to treatment. These findings can inform efforts to increase engagement and retention in treatment and better align care with evidence.

PMID:39899919 | DOI:10.1016/j.drugalcdep.2025.112586

Clin Exp Optom. 2025 Feb 3:1-6. doi: 10.1080/08164622.2025.2461233. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Since inflammation plays an important role in the pathogenesis of diabetic retinopathy, serum biomarkers and retinal imaging aimed at evaluating the presence of inflammation have emerged as useful tools to monitor the appearance and progression of diabetic retinopathy.

BACKGROUND: This study aims to investigate the value of YKL-40 levels in patients with diabetes mellitus with different stages of diabetic retinopathy and without diabetic retinopathy, and to compare those findings with results from healthy individuals without diabetes mellitus.

METHODS: This prospective cross-sectional study included 67 diabetic patients with or without diabetic retinopathy who underwent cataract surgery and 23 patients (control group) having no ocular and systemic disease other than senile cataract. Participants with diabetes mellitus were separated into three subgroups: the first group consisted of 26 patients without diabetic retinopathy, the second group included 21 patients with non-proliferative diabetic retinopathy and the third group included 20 patients with proliferative diabetic retinopathy. Serum and aqueous humour YKL-40 levels were analysed and compared between the groups.

RESULTS: The mean serum (p < 0.001) and aqueous humour (p < 0.001) YKL-40 levels were statistically significantly lower in control subjects compared to patients with diabetes mellitus. The aqueous humour YKL-40 levels showed statistically significant elevations with the progression of diabetic retinopathy. Duration of diabetes mellitus was significantly correlated with aqueous humour YKL-40 levels (p = 0.001, r = 0.384).

CONCLUSION: Both serum and aqueous humour YKL-40 levels are higher in patients with diabetes mellitus compared to healthy subjects. Levels of YKL-40 in aqueous humour increase with the progression of diabetic retinopathy.

PMID:39899896 | DOI:10.1080/08164622.2025.2461233

Int J Med Educ. 2025 Jan 30;16:11-20. doi: 10.5116/ijme.676f.ce30.

ABSTRACT

OBJECTIVES: This study was aimed at improving clarity regarding the goals underlying motivation for attendance at international meetings to accommodate evolving needs.

METHODS: We performed a case study of a large international medical conference by undertaking (a) semi-structured interviews with 13 multi-disciplinary stakeholders, which underwent thematic analysis, and (b) surveys of 1229 conference attendees, which underwent descriptive statistical analysis and directed content analysis.

RESULTS: Interviews suggested scientific updates and networking are priorities for in-person formats whereas flexibility and reduced travel are priorities for virtual formats. Surveys suggested motivations for attending both in-person and virtual conferences included: scientific updates (81.3% and 85.4%, respectively) and advancements in patient care (76.6%, 78.2%). Social interaction (e.g., to meet experts 80.6% and make/deepen professional connections 69.3%) was highly rated for in-person meetings, but not virtual meetings (51.0% and 30.8%, respectively). 58.9% of attendees prefer future meetings to be hybrid, including both in-person and virtual formats.

CONCLUSIONS: We found a disconnect between attendees’ preferences and recommendations currently put forward as socially responsible in terms of climate, equity and diversity. Meeting organisers may need to educate others about the value and costs involved in hybrid formats. When hybrid formats are possible, our data provide guidance on what to prioritize during in-person components and how to combine those with the benefits of global accessibility and flexibility enabled by virtual technology.

PMID:39899888 | DOI:10.5116/ijme.676f.ce30