Nevin Manimala

BMC Pulm Med. 2025 Aug 30;25(1):414. doi: 10.1186/s12890-025-03883-8.

ABSTRACT

BACKGROUND: The COVID-19 pandemic and related public health restrictions have substantially altered healthcare access and delivery, particularly for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the impact of the COVID-19 pandemic and lockdown measures on COPD-related symptoms and hospital admissions, and to compare these outcomes with the pre-pandemic period.

METHODS: This multicenter cross-sectional study was conducted between July 2021 and February 2022 across ten tertiary pulmonary outpatient clinics in Turkey. A total of 347 COPD patients were included. Data on demographics, spirometry, symptom progression, medication access, COVID-19 history, and hospital admissions were collected via structured questionnaire and medical records. Pandemic-related outcomes were compared with data from the pre-pandemic year (March 2019-March 2020). Additional multivariable regression analyses were performed to identify predictors of hospital admission and COVID-19-related hospitalization.

RESULTS: The mean number of hospital admissions significantly decreased during the pandemic compared to the pre-pandemic period (p < 0.001), while patient-reported respiratory symptoms increased over time. Hospital admissions were lowest during the first pandemic period, when restrictions were most intense. Regression analyses showed that lower FEV₁, advanced GOLD stage, and inhaled corticosteroid (ICS) use were independently associated with increased hospital admissions. COVID-19 was diagnosed in 21.1% of patients. Lower FEV₁, GOLD stage, and smoking were significantly associated with COVID-19-related hospitalization.

CONCLUSION: Although COPD-related hospital admissions decreased during the pandemic, respiratory symptoms progressively worsened. These findings reflect the complex interplay between public health measures, healthcare accessibility, and chronic disease management. Disease severity and airflow limitation were key determinants of adverse outcomes. Maintaining access to routine care and adopting personalized approaches in COPD management are essential during public health emergencies.

PMID:40885974 | DOI:10.1186/s12890-025-03883-8

BMC Public Health. 2025 Aug 30;25(1):2975. doi: 10.1186/s12889-025-24273-z.

ABSTRACT

BACKGROUND: In South Korea, the prognosis of avoidable hospitalization in diabetes has not been evaluated, even though the incidence rate is considerably high compared to the Organization for Economic Co-operation and Development average. This study investigated the association between diabetic avoidable hospitalization after the diagnosis of type 2 diabetes mellitus and short- and long-term all-cause mortality.

METHODS: Participants were type 2 diabetes mellitus patients aged 60 years and older and gathered through the National Health Insurance Services Senior cohort data from 2008 to 2019. The outcome measures included five-year and overall period all-cause mortality. The main independent variable was the first-year experience of diabetic avoidable hospitalization after type 2 diabetes mellitus diagnosis. Regression analysis was performed using the Cox proportional hazard model. To enhance the robustness of the study results, a sensitivity analysis and inverse probability of treatment weighting method were conducted.

RESULTS: Among 27 005 participants, 2099 (7.8%) died within five-year of type 2 diabetes mellitus diagnosis and 4693 (17.4%) died in the overall study period after type 2 diabetes mellitus diagnosis. Participants who experienced diabetic avoidable hospitalization one year after being diagnosed with type 2 diabetes mellitus had a higher risk of all-cause mortality compared to those who did not (inverse probability of treatment weighted, Five-year: hazard ratio 1.24, 95% confidence interval 1.14-1.36; Overall period: hazard ratio 1.41, 95% confidence interval 1.33-1.50).

CONCLUSIONS: Enhancing accessibility and quality of primary care to prevent avoidable hospitalization in older patients with type 2 diabetes mellitus is necessary.

PMID:40885973 | DOI:10.1186/s12889-025-24273-z

BMC Public Health. 2025 Aug 30;25(1):2974. doi: 10.1186/s12889-025-24365-w.

ABSTRACT

OBJECTIVE: To synthesize and determine the relative effectiveness of diverse opioid agonist treatment (OAT) medications, including injectables, for opioid use disorder (OUD).

METHODS: We searched EMBASE, PubMed, and CENTRAL for Randomised Controlled Trials (RCTs) (CRD42018109469) and previously published systematic reviews of head-to-head trials of OAT medications. The primary outcome was treatment retention, and secondary outcomes included days of opioid use, days of cocaine use, and proportion of participants involved in criminalized activities. We calculated odds ratios (ORs) and mean differences (MDs) and corresponding 95% credible intervals (CrI) using Bayesian network meta-analyses (NMAs) to indirectly compare treatments at varying lengths of follow-up (3 to 12 months). Sensitivity analyses examined influence of follow-up duration and other trial factors.

RESULTS: Twenty-four RCTs were included. Diacetylmorphine plus oral methadone and injectable hydromorphone plus oral methadone had similar retention compared to one another (OR: 1.05; 95%CrI: 0.27, 4.10). Diacetylmorphine plus oral methadone had similar or statistically favourable retention versus low, medium, and high doses of conventional OATs: buprenorphine (OR: 13.55; 95%CrI: 4.51, 42.52; OR: 5.07; 95%CrI: 2.03, 12.47; OR: 2.21; 95%CrI: 0.18, 21.54) and methadone (OR: 5.88; 95%CrI: 2.34, 16.33; OR: 3.66; 95%CrI: 1.57, 8.82; OR: 3.67; 95%CrI: 1.83, 8.35). Similarly, injectable hydromorphone plus oral methadone also showed favourable or similar retention relative to conventional OATs. Limiting analyses to trials that included only OAT-experienced patients, that offered no extra participation incentive, and/or with 6 months (± 0.5) of follow-up generally did not change the direction of the findings. Injectable hydromorphone plus oral methadone was also statistically favoured in terms of reduced days of opioid use relative to methadone, but mean differences in days of cocaine use were similar. Diacetylmorphine plus oral methadone was associated with a smaller proportion of participation in criminalized activities relative to methadone alone.

CONCLUSION: Both diacetylmorphine and injectable hydromorphone supplemented with methadone showed favourable retention compared to methadone and buprenorphine, depending on the strength of the OAT being co-prescribed or being compared to. These results provide further support for alternatives to conventional OATs such as diacetylmorphine or injectable hydromorphone for treatment retention.

PMID:40885969 | DOI:10.1186/s12889-025-24365-w

BMC Womens Health. 2025 Aug 30;25(1):415. doi: 10.1186/s12905-025-03965-z.

ABSTRACT

BACKGROUND: Globally, female genital mutilation (FGM) remains a significant public health concern. The practice is disproportionately high in African countries. In Tanzania, FGM poses serious health risks to both women, girls and children. However, there is limited empirical literature on the factors associated with FGM in Tanzania. This study intended to fill the gap.

METHODS: In this study, we analysed secondary data from a cross-sectional survey, involving a weighted sample of 7,678 women aged 15-49 from the 2022 Tanzania Demographic and Health Survey (TDHS). In this study, the binary dependent variable indicates whether the respondent is mutilated or not mutilated while the independent variables include various demographic characteristics of women, such as age, education level, socioeconomic status, and region of residence. Bivariate and multivariable logistic regression analyses were conducted. A threshold of p-value < 0.05 at 95% Confidence Interval (CI) was used to determine a statistically significant association.

RESULTS: The prevalence of FGM in Tanzania is 8.2% and types I and II (a cut with or without removal of flesh) were the dominant types of FGM practice by 89.2%. After controlling for other variables, higher odds of being mutilated was reported in; older ages 45-49 years (adjusted Odds Ratio(aOR));3.09, 95%CI: 1.72, 5.54), in rural areas (aOR;2.30, 95%CI:1.4,3.6), in women in unions (aOR;1.60, 95%CI:1.20,2.10), in Northern zone (aOR;9.10, 95%CI: 4.60, 17.80), those who ever heard about FGM had 2.27 times (aOR; 2.27, 95%CI: 0.82, 6.29), those who said FGM required by religion had 8.3 times (aOR; 8.30, 95%CI: 4.30,16.03), those who supported FGM had 5.29 times (aOR; 5.29, 95%CI: 2.69, 10.40) higher odds of reporting having undergone FGM compared to those who said the practice should be stopped. Conversely, lower odds of experiencing FGM was reported in; women with at least secondary education (aOR;0.40, 95%CI:0.20,0.60), those from richest households (aOR;0.40, 95%CI: 0.20, 0.60) and those who said distance to a health facility was not a big problem (aOR;0.70, 95%CI: 0.50, 0.90).

CONCLUSION: Our study found that prevalence of FGM in Tanzania is 8.2%. The factors associated with experiencing FGM included woman’s socio-demographic factors like older age, rural residency, lower or no education, poorest wealth quintile, supporting FGM to continue and being in unions. This calls for collaborative efforts between the government and other stakeholders to design targeted interventions as ending FGM require a multisectoral approach addressing aforementioned determinants across multiple levels including education and wealth creation programs particularly to uneducated and poorest women from rural areas.

PMID:40885968 | DOI:10.1186/s12905-025-03965-z

World J Emerg Surg. 2025 Aug 30;20(1):72. doi: 10.1186/s13017-025-00645-z.

ABSTRACT

BACKGROUND: Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions.

METHODS: This retrospective, multicenter study used 2014-2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7).

PRIMARY OUTCOMES: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events.

RESULTS: Among 9,330 patients (median age 37 (26-54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42-0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62-0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings.

CONCLUSIONS: In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.

PMID:40885959 | DOI:10.1186/s13017-025-00645-z

BMC Public Health. 2025 Aug 30;25(1):2983. doi: 10.1186/s12889-025-24466-6.

ABSTRACT

BACKGROUND: We aimed to comprehensively analyze the impact of both maternal age and birth spacing on adverse maternal and neonatal outcomes.

METHODS: A total of 151,301 pregnancies in China from January 1, 2010, to December 31, 2021 were included, and 8,222 subjects matched their primary and second pregnancy information. Join point regression was used to analyze the temporal trends of adverse outcomes with maternal age and birth spacing.

RESULTS: The mean maternal age at delivery rose from 27.1 years to 28.5 between 2010 and 2021, and the average annual percentage change in advanced maternal age (≥ 35 years) was 1.2%. The optimal childbearing age (with the fewest adverse outcomes) appears to be 27 years. Compared with women aged 27 years, both those aged < 27 years and those aged > 27 years exhibited a significantly higher risk of anemia, low birth weight (LBW), preeclampsia, and preterm birth. In addition, we found that the optimal primiparous childbearing age was 26 years old and birth spacing was 3 years, < 3 years increased the risk of FGR, oligohydramnios, placenta previa, preeclampsia, LBW, preterm birth and premature rupture of membranes (PROM). While birth spacing > 3 years significantly increased the risks of anemia, gestational diabetes mellitus (GDM), placenta previa, preeclampsia, thyroid dysfunction (TD), preterm birth and PROM. The subgroup analysis revealed that the common adverse outcomes increased with longer birth spacing in pregnant women < 26 years, while these adverse outcomes showed lowest prevalence rates at 3-year birth spacing in pregnant women > 26 years.

CONCLUSIONS: The age of childbearing continues to be delayed, and we are in favor of having children at relatively optimal ages and spacing.

PMID:40885958 | DOI:10.1186/s12889-025-24466-6

Food Chem. 2025 Aug 26;493(Pt 4):146044. doi: 10.1016/j.foodchem.2025.146044. Online ahead of print.

ABSTRACT

This study compares spontaneous and yeast-inoculated mead fermentations, analyzing their effects on sensory and chemical profiles. Using advanced instrumental techniques: untargeted analysis of odorants, quantitation of odor-active compounds, and flow cytometry-this research identifies key fermentation-driven changes. Untargeted analysis revealed a more complex volatile profile in spontaneous fermentation, with a higher number of unique compounds (27) from groups classified as fruity (esters), spices (ex. pentane-2,3-dione) and off-flavors (2-furanyl)methanol, octan-1-ol, ethyl 3-methylsulfanylpropanoate, 2-phenylacetonitrile, dodecan-1-ol, 3-methylpentanoic acid, and 3-methyl-1H-indole). Yeast-inoculated samples were characterized by only 8 unique compounds, with more predictable odor profile and fewer off-flavors (2-pentylfuran, pyridine, (E)-oct-2-enal). Statistical analysis identified distinct compounds linked to fermentation type and stage, with microbial dynamics influencing odor-active compound formation. Bacterial content correlated with ethyl hexanoate (0.63), furan-2-carbaldehyde (0.33), and phenylacetic acid (0.49), while yeasts displayed correlations with 2-phenylacetaldehyde (0.37), ethyl hexanoate (-0.59), phenylacetic acid (-0.50), and furan-2-carbaldehyde (-0.47).

PMID:40884928 | DOI:10.1016/j.foodchem.2025.146044

Vaccine. 2025 Aug 29;63:127681. doi: 10.1016/j.vaccine.2025.127681. Online ahead of print.

ABSTRACT

BACKGROUND: In 2015, Argentina introduced the monovalent rotavirus vaccine into its National Immunization Program with a two-dose schedule at 2 and 4 months of age. This study assessed the impact of the universal rotavirus vaccination program on the burden of diarrheal disease in children under five years of age over a ten-year period, including the effects of the COVID-19 pandemic.

METHODS: A mixed ecological time-trend analysis was conducted using national and regional secondary data from surveillance and health information systems. Six indicators were evaluated: outpatient acute diarrhea cases, hospitalizations due to diarrhea, diarrhea-related deaths, intussusception hospitalizations in infants, laboratory-confirmed rotavirus cases, and rotavirus vaccine coverage. Trends were compared across four periods: pre-vaccination (2010-2014), post-vaccination pre-COVID-19 (2016-2019), during COVID-19 (2020-2021), and post-COVID-19 (2022-2024).

RESULTS: Compared to the pre-vaccination period, acute diarrhea rates declined by 59.6%, hospitalizations by 47.6%, and mortality by 59.7%. Laboratory-confirmed rotavirus positivity fell by 55.2%, with the most pronounced reductions observed in infants under one year of age. Although partial rebounds were noted post-COVID-19, all indicators remained below baseline levels. Intussusception hospitalizations in infants decreased by over 30% nationally, and no region showed rates exceeding pre-vaccine levels. Vaccine coverage declined during the pandemic and showed incomplete recovery. Statistical analyses confirmed significant differences by age group and period for most indicators, particularly highlighting the persistent vulnerability of infants to severe outcomes.

CONCLUSIONS: Ten years after the introduction of universal rotavirus vaccination in Argentina, a substantial and sustained reduction in the burden of diarrheal disease was observed across multiple indicators. While regional variability and post-pandemic fluctuations were noted, the overall benefit-risk profile of the vaccine remains strongly favorable. Continued efforts to strengthen vaccine coverage and surveillance systems are essential for consolidating these gains and ensuring timely detection of potential adverse trends.

PMID:40884908 | DOI:10.1016/j.vaccine.2025.127681

Neural Netw. 2025 Aug 20;193:108007. doi: 10.1016/j.neunet.2025.108007. Online ahead of print.

ABSTRACT

Pan-sharpening, fusing high-resolution panchromatic (PAN) images with low-resolution multispectral (LRMS) to generate high-resolution multispectral (HRMS) images, is critical for enhancing remote sensing image quality. Despite significant advancements in deep learning methods, research on the image upsampling process remains limited. Existing approaches either fail to effectively utilize the information from PAN images or struggle to balance spectral and spatial information, thereby constraining the performance of these models. To alleviate these problems, we propose a novel Spatial-Frequency Domain Aggregation Upsampling (SFAU) method. Our method consists of three core modules: the Dual-Domain Nonlinear Fusion (DDNF), Region-Specific Attention Mechanism (RSAM), and Adaptive Feature Fusion Gate (AFFG). The DDNF module integrates Frequency-Aware Feature Aggregation (FAFA) and Spatial Domain Enhancement techniques, enabling the capture of high-frequency features while refining local structural details. The RSAM module adaptively refines feature representations and preserves spatial-spectral correlations. Finally, the AFFG module effectively combines the outputs from the DDNF and RSAM modules, ensuring a balanced integration of spatial and spectral information. Extensive experiments demonstrate that our method outperforms other popular upsampling techniques and significantly enhances the performance of many leading pan-sharpening models, particularly in high-contrast and spectrally complex regions. Additionally, our approach shows strong generalization in real-world scenarios, highlighting its potential for practical remote sensing applications. Code is available at https://github.com/zacianfans/SFAU.

PMID:40884893 | DOI:10.1016/j.neunet.2025.108007

Health Place. 2025 Aug 29;95:103542. doi: 10.1016/j.healthplace.2025.103542. Online ahead of print.

ABSTRACT

For gay, bisexual, and other sexual minority men (SMM), geo-social exposures in residential and non-residential places are important to consider for health, as home, social, sexual, substance use, and healthcare-related locations may be different. We use survey data from a sample of 219 Black and Hispanic SMM within Los Angeles County to examine the places that individuals visit for eight specific activities, categorized as either lifestyle or healthcare-related. Spatial clustering techniques are used to identify hotspots, or places where individual’s activities are clustered in space, for each activity. We then use descriptive statistics to characterize each hotspot based on the socio-demographic characteristics of individuals who engaged in activities within the hotspot, and then assess whether activity-based hotspots overlap in space. We find unique spatial patterns of hotspots, distinct by activity. Additionally, lifestyle activity space hotspots are spatially patterned by socio-demographic characteristics, primarily along race and ethnic categories, whereas healthcare-related hotspots are not. The overlap, or spatial congruence of hotspots, is higher than we hypothesized, as hotspots of residential locations contained the majority of sex hotspots and substance use hotspots. Our work ultimately identifies four distinct areas of Los Angeles County in which activities are clustered among men in the sample, and health interventions can be tailored to the individuals and their activities in those places. Our findings demonstrate the importance of geographically and demographically targeted interventions, at a fine spatial scale, for health promotion among SMM, as interventions and policy to provide equitable care to reduce racial disparities in health among SMM are sorely needed.

PMID:40884879 | DOI:10.1016/j.healthplace.2025.103542