Tag: nevin manimala

JMIR Public Health Surveill. 2025 Nov 3;11:e73731. doi: 10.2196/73731.

ABSTRACT

BACKGROUND: Chronic kidney disease and end-stage renal disease are major contributors to the disease burden in low- and middle-income countries, including Indonesia. Despite the expansion of universal health coverage through Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, Indonesia’s national health insurance program, disparities in access to hemodialysis persist across different socioeconomic and geographic groups. Understanding these inequities is critical to advancing equitable health care access.

OBJECTIVE: This study aimed to examine disparities in hemodialysis claim patterns as a proxy for access among adult patients with renal failure enrolled in BPJS, focusing on differences by membership type, sex, age, geographic region, urbanicity, and facility ownership.

METHODS: We conducted a cross-sectional analysis of 38,383 anonymized health insurance claims between 2017 and 2022 for patients with renal failure who were aged ≥18 years. The primary outcome was receipt of hemodialysis. We used multivariate logistic regression to estimate adjusted odds ratios (aORs) for receiving hemodialysis across BPJS membership types and other covariates. Subgroup analyses were performed by sex, facility ownership, urbanicity, and geographic region. Robust SEs and probability weights were applied to account for the sample design.

RESULTS: Of the total renal failure claims, 75.6% (29,017/38,383) involved hemodialysis. Compared with individuals in the lowest income group (ie, members subsidized under the national government budget), informal workers (aOR 1.56, 95% CI: 1.34-1.82); P<.001) and members subsidized under the local government budget (aOR 1.31, 95% CI: 1.05-1.63); P=.017) had higher odds of receiving hemodialysis, while formal sector workers had lower odds (aOR 0.81, 95% CI: 0.68-0.98); P=.028). Disparities were more pronounced in rural areas and among women; for example, in rural regions, locally subsidized members had more than twice the odds of receiving hemodialysis compared with nationally subsidized members (aOR 2.40, 95% CI: 1.78-3.23). Men had higher odds than women (aOR 1.17, 95% CI: 1.04-1.32), and younger patients were more likely to receive treatment than older ones. Regional disparities were stark, with patients in Java or Bali having much greater access (aOR 8.30, 95% CI 5.33-12.94) compared with those in eastern Indonesia (Papua, Maluku, and Nusa Tenggara). Patients treated at private facilities (aOR 1.30, 95% CI 1.13-1.50) and in outpatient settings (aOR 3.74, 95% CI 3.36-4.17) were more likely to receive hemodialysis, whereas those in lower-level hospitals or clinics were less likely to access care.

CONCLUSIONS: Substantial disparities in hemodialysis claim patterns (as a proxy for access) exist within Indonesia’s national health insurance system, particularly affecting low-income populations, rural residents, women, and those in less advantaged regions. Policy efforts to enhance health infrastructure, improve service distribution, and reduce geographic and socioeconomic barriers are urgently needed to support equitable access to renal care services and achieve universal health coverage goals.

PMID:41183316 | DOI:10.2196/73731

JMIR Form Res. 2025 Nov 3;9:e80458. doi: 10.2196/80458.

ABSTRACT

BACKGROUND: Stroke has become a global public health problem due to its high incidence, disability, and mortality. In China, TikTok and Bilibili, as mainstream video-sharing platforms, serve as key sources of getting stroke-related information for people, yet their videos’ content quality and reliability remain insufficiently evaluated.

OBJECTIVE: This cross-sectional study aimed to analyze the content and quality of stroke-related videos on Chinese video-sharing platforms.

METHODS: In March 2025, stroke-related videos were retrieved from TikTok and Bilibili using the search term “” (Chinese for stroke). Eligible videos were analyzed for metadata and content indicators. Researchers assessed video quality using validated tools: the Global Quality Scale (GQS), modified DISCERN (mDISCERN), and Patient Education Materials Assessment Tool (PEMAT). Statistical analyses were performed with Python, including descriptive statistics, group comparisons (Kruskal-Wallis tests), and Spearman’s rank correlation to evaluate variable associations, with all P values adjusted for multiple comparisons using the Bonferroni method. A binary classification predictive model was developed using the random forest algorithm, accompanied by feature importance analysis.

RESULTS: Among the stroke-related videos from Bilibili (n=157) and TikTok (n=149), popular science education content predominated (204/306, 66.7%). Bilibili videos were primarily categorized as professional lectures (83/157, 52.9%), while most TikTok videos were popular science education (139/149, 93.3%). TikTok videos demonstrated significantly higher median likes and comments (P<.001) and shorter durations compared to Bilibili (P<.001). No significant differences were observed in median GQS (4) or mDISCERN scores (3) between platforms (P>.05). Videos produced by professional teams exhibited significantly higher GQS and PEMAT-A/V scores than those created by independent content creators (P<.05). Popular science education videos achieved higher PEMAT-A/V actionability scores than professional lectures (P<.001), while videos addressing treatment options scored lowest in GQS (P<.05). Strong positive correlations were identified among user engagement parameters (likes, shares, comments; ρ=0.81-0.90, P<.001), but only weak correlations were found between engagement and quality scores (ρ<0.3). Machine learning modeling (AUC=0.58) identified video duration (importance score: 0.15) and uploader subscriber count (importance score: 0.13) as key predictors of content quality.

CONCLUSIONS: The quality of stroke-related videos on TikTok and Bilibili remains suboptimal. Content uploaded by certified physicians and institutions received higher GQS/mDISCERN scores, confirming that medical authority is a key quality indicator. Our exploratory random-forest model, which used only basic metadata (duration, likes, subscriber count), achieved an area under the curve of 0.58, indicating that surface engagement metrics alone are insufficient to discriminate high- from low-quality material. Consequently, future screening algorithms should incorporate content-based features (eg, captions, medical keywords, visual cues) and creator credentials rather than relying solely on readily available interaction parameters. Multi-platform, larger-scale datasets are warranted to develop clinically useful prediction tools.

PMID:41183313 | DOI:10.2196/80458

J Nurs Educ. 2025 Oct 29:1-4. doi: 10.3928/01484834-20250625-04. Online ahead of print.

ABSTRACT

BACKGROUND: Critical thinking may be enhanced by emotional intelligence (EI) and mindfulness (MF). This study explored the influence of reflective practice and mindful breath and movement exercises on EI and MF among baccalaureate nursing students.

METHOD: Using a mixed-methods design, participants (n = 24) responded to reflective prompts and engaged in mindful breath and movement exercises. Participants completed EI and Mindful Attention Awareness Scale (MAAS) pre- and posttests. A paired-samples t test examined the difference in mean scores. In vivo and focused coding was used for qualitative analysis.

RESULTS: Analysis revealed statistically significant increases in EI (7.5) and MAAS (10.38) mean scores from time 1 to time 2. Qualitative analysis revealed three themes: (1) awareness of self; (2) awareness of other people; and (3) awareness of self-growth.

CONCLUSION: Results suggest that integrating EI-building strategies into nursing curricula may positively influence EI and MF among students. This is important since emotional competencies support nurses’ critical thinking skills in providing safe patient care.

PMID:41183287 | DOI:10.3928/01484834-20250625-04

JMIR Cancer. 2025 Nov 3;11:e70603. doi: 10.2196/70603.

ABSTRACT

BACKGROUND: The growing importance of real-world data (RWD) as a source of evidence for drug effects has led to increased interest in clinical research utilizing secondary use data from electronic medical record systems. Although immune checkpoint inhibitors and targeted therapies have advanced lung cancer treatment, managing complications such as interstitial lung disease (ILD) remains challenging. Early detection and prevention of ILD are crucial for improving patient prognosis and quality of life; however, predictive biomarkers have yet to be established. Therefore, methods to identify ILD risk factors and enable early detection using RWD are needed.

OBJECTIVE: This exploratory study aimed to identify associated factors and prodromal symptoms of ILD onset using clinical data stored in a hospital information system.

METHODS: Clinical data of patients diagnosed with stage IV lung cancer between November 2011 and December 2018 were extracted from the hospital information system of the National Cancer Center Hospital in Japan. A total of 3 patient groups were defined: the ILD Set, based on laboratory test results and radiological records; the ILD-GC Set, which added glucocorticoid treatment to the ILD Set; and the No ILD Set, for patients without ILD. The primary endpoint was the frequency of Japanese words extracted from electronic medical records, specifically from notes in the Problem-Oriented System/Subjective, Objective, Assessment and Plan format. Noun frequencies were compared between the ILD or ILD-GC Sets and the No ILD Set. Free-text data were processed using morphological analysis, and terms were categorized using the Patient Disease Expression Dictionary or the World Health Organization Drug Dictionary. Key terms were extracted from physician and nurse records based on the descending order of ranking differences to identify associated factors and prodromal symptoms.

RESULTS: The analysis included 674 cases (105 in the ILD Set [including 12 in the ILD-GC Set] and 569 in the No ILD Set). Baseline characteristics showed no apparent differences across groups. In the 30 days prior to ILD onset, notable differences in word frequencies per 1000 notes between the ILD-GC Set and No ILD Set were observed in the following term categories: respiratory symptoms (eg, breathlessness, shortness of breath, oxygen), ranging from 170.59 to 46.51; pain or analgesics (eg, Lyrica [pregabalin], soreness, precordial pain, opioids), ranging from 462.88 to 45.16; and appetite-related terms (eg, inappetence, food intake, queasiness, Novamin [prochlorperazine]), ranging from 102.23 to 51.90.

CONCLUSIONS: Terms related to respiratory symptoms, pain or analgesics, and appetite were identified as associated factors for ILD onset in patients with stage IV lung cancer using RWD from acute care institutions for malignant tumors. These findings may support the early detection of ILD and underscore the potential of RWD to generate real-world evidence that informs drug discovery and pharmaceutical development.

PMID:41183283 | DOI:10.2196/70603

JMIR Ment Health. 2025 Nov 3;12:e73815. doi: 10.2196/73815.

ABSTRACT

BACKGROUND: Social anxiety disorder (SAD) and agoraphobia are common, impairing conditions often treated with cognitive behavioral therapy (CBT) conducted in groups. In CBT, exposure therapy is a core element. However, in-vivo exposure therapy is logistically challenging and aversive for both patient and therapist, especially in a group context, often leading to exposure being skipped altogether in clinical practice. Virtual reality exposure (VRE), in which phobic stimuli are presented through immersive virtual reality technology, has shown promise as a flexible alternative to in-vivo exposure. We thus hypothesized that using VRE would result in more overall exposure and more individualized exposure, resulting in statistically significant symptom reduction compared with a group using in-vivo exposure.

OBJECTIVE: This trial evaluated the efficacy of group CBT with VRE (VR-CBT) versus CBT with in-vivo exposure for treating SAD and agoraphobia in clinical settings.

METHODS: In this randomized, parallel-group, assessor-blinded trial, 177 participants with SAD (n=150) or agoraphobia (n=27) as a primary diagnosis were assigned to either VR-CBT (n=81) or traditional CBT (n=96) across 5 Danish mental health outpatient clinics. Both groups received 14 weekly group sessions. The difference between the 2 treatments was that the VR-CBT group received exposure therapy via head-mounted displays (HMDs) displaying 360° videos of anxiogenic situations for individuals with SAD (eg, presenting at work) and agoraphobia (eg, faulty elevator), while the CBT group conducted traditional in-vivo exposure exercises (eg, presenting to the group, using the clinic elevator). Primary outcomes were phobic anxiety reductions, measured by the Liebowitz Social Anxiety Scale and the Mobility Inventory for Agoraphobia at baseline, posttreatment, and 1-year follow-up (from baseline). Secondary outcomes included work and social functioning, depressive symptoms, and quality of life.

RESULTS: Both groups showed significant reductions in primary, secondary, and exploratory outcomes, with no significant differences between groups at posttreatment (d=-0.026) and 1-year follow-up (d=0.097). Baseline characteristics and attrition rates were balanced across the groups.

CONCLUSIONS: Due to insufficient recruitment and substantial missing data, no definitive conclusions can be drawn regarding group differences between VR-CBT and traditional CBT in group settings. The feasibility issues encountered suggest that careful consideration of the benefits and limitations of VR technology is essential before implementation in clinical practice.

PMID:41183277 | DOI:10.2196/73815

J Contin Educ Nurs. 2025 Nov;56(11):484-492. doi: 10.3928/00220124-20250911-02. Epub 2025 Nov 1.

ABSTRACT

BACKGROUND: Nurse residency programs (NRPs) are designed to support new graduate nurses in their transition from academia to professional practice and also improve job satisfaction and retention. Many studies highlight these benefits within the first year of nursing practice. The goal of this study is to show the longer-term effect of NRPs at 1, 2, and 3 years.

METHOD: This retrospective cohort study compared two Midwestern hospitals, one with a 12-month compulsory NRP and one without, using data from 2018 to 2020 to minimize academic disruptions related to coronavirus disease 2019.

RESULTS: The hospital with an NRP had a significantly higher 3-year retention rate (55%) versus the hospital without an NRP (35.2%), suggesting that NRPs help improve retention, reduce turnover costs, and promote workforce stability.

CONCLUSION: The study found that NRPs significantly improve new graduate nurse retention and ease the academic to practice transition. Enhanced retention may reduce costly turnover, saving hospitals millions in recruitment and training expenses. Therefore, NRPs are a cost-effective investment in nursing workforce strength and care quality.

PMID:41183267 | DOI:10.3928/00220124-20250911-02

Neurology. 2025 Nov 25;105(10):e214319. doi: 10.1212/WNL.0000000000214319. Epub 2025 Nov 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Evidence on levetiracetam for poststroke seizures is limited. Understanding whether levetiracetam effectively manages poststroke seizures is important for improving prognosis and preventing further complications in stroke patients. The aim of this study was to assess the risk of seizure rehospitalization between levetiracetam and valproic acid in patients with poststroke seizures.

METHODS: Using data from Taiwan’s National Health Insurance Research Database, this observational retrospective cohort study followed the target trial emulation framework to emulate a hypothetical randomized trial estimating the effect of levetiracetam for poststroke seizure management. Eligible patients were those who were hospitalized for their first seizure event (index seizure) between January 1, 2012, and December 31, 2020, and were newly prescribed levetiracetam or valproic acid monotherapy before discharge. Patients should have had a stroke-related hospitalization within 2 years before the seizure. Patients prescribed levetiracetam were assigned to the exposure group, whereas those prescribed valproic acid were assigned to the reference group, based on their first prescription after the index seizure. Inverse probability-weighted marginal structural models were used to assess outcomes between levetiracetam and valproic acid, including seizure rehospitalization as the primary outcome. Secondary outcomes included all-cause mortality and a composite of seizure rehospitalization and all-cause mortality. Both baseline and time-varying confounders were adjusted in the models.

RESULTS: The final sample included 740 levetiracetam users (48.5%) and 786 valproic acid users, with a mean age of 67.2 years in both groups and a similar proportion of men (59.9% for levetiracetam; 61.3% for valproic acid). In the primary outcome analysis, levetiracetam use was associated with a lower risk of seizure rehospitalization compared with valproic acid (hazard ratio 0.78; 95% CI 0.64-0.95). In secondary outcome analyses, no significant differences were observed in all-cause mortality or the composite of seizure rehospitalization and all-cause mortality.

DISCUSSION: Levetiracetam was associated with a lower risk of seizure rehospitalization, with no significant difference in the risk of all-cause mortality. These findings support levetiracetam as a potentially suitable treatment option for patients with poststroke seizures. As this study focused on monotherapy, future investigations should further explore combination antiseizure medication regimens involving levetiracetam.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that levetiracetam is associated with a lower risk of seizure rehospitalization compared with valproic acid in patients with post-stroke seizures.

PMID:41183250 | DOI:10.1212/WNL.0000000000214319

Health Aff (Millwood). 2025 Nov;44(11):1330-1335. doi: 10.1377/hlthaff.2025.01073.

ABSTRACT

In Los Angeles, California, predictive analytics help identify high-risk patients who receive intense care management to avert hospital admissions.

PMID:41183240 | DOI:10.1377/hlthaff.2025.01073

J Agromedicine. 2025 Nov 3:1-12. doi: 10.1080/1059924X.2025.2579637. Online ahead of print.

ABSTRACT

OBJECTIVES: Roughly 70% agricultural nursery workers report musculoskeletal dysfunction and fall-related injuries. Exercise has been shown to improve musculoskeletal health and fall risk, but the literature on the benefits of exercise in nursery workers is rare. This mixed-methods feasibility study aimed to elucidate the benefits of an employee-sponsored exercise class for nursery workers.

METHODS: Twenty-five workers were randomized into either the Stay Strong, Stay Healthy (SSSH) resistance training program (n = 14) or control group (n = 11) for 8 weeks. Those assigned to SSSH performed eight exercises twice weekly at their workplace during business hours, while controls were asked to maintain their habits. Pre/post eight-week measures included health, pain, and sleep surveys and functional performance tests of static and dynamic balance, strength, and flexibility. Finally, interviews were conducted pre/post to gauge participants’ perceptions of barriers and facilitators for health behaviors such as exercise. Statistical analyses included independent t-tests to assess baseline differences and two-way, mixed repeated measures analyses of variance models to observe interactions and main effects of time and group for all measures, α ≤ 0.05. Inductive thematic analysis was conducted on interview data.

RESULTS: There were no baseline differences between SSSH and controls (all p ≥ .061). Participants were on average 39 years old, had a BMI of 25.5 kg/m², reported poor sleep quality (PSQI 6.2), and 220 min/wk of physical activity. Over time, timed-up-and-go, 5 sit-to-stand, hand grip strength, and lower-body flexibility improved (all p ≤ .019). Post-hoc analyses revealed pre/post-performance changes only in the SSSH group (all p ≤ .035). Further, qualitative interviews suggest that employee-sponsored SSSH programming improved many areas of nursery workers’ physical, interpersonal, and psychological health. Specifically, four themes emerged, which included labor-intensive job demands as a barrier to exercise engagement, multidimensional health benefits of SSSH, improved job performance after SSSH, and inspiration and insufficiency of SSSH. For example, those in the SSSH group noted improved personal confidence to complete work-related tasks. Conclusion: Employee-sponsored SSSH improved physical performance associated with falls and injury risk and most participants noted a general enjoyment of and benefits from SSSH pointing to the potential value of it to improve nursery workers’ injury risk and health.

PMID:41178692 | DOI:10.1080/1059924X.2025.2579637

J Vet Diagn Invest. 2025 Nov 3:10406387251387786. doi: 10.1177/10406387251387786. Online ahead of print.

ABSTRACT

Bone marrow (BM) samples in dogs are typically acquired from hematopoietically active trabecular BM at appendicular skeletal sites, such as the proximal humerus and femur, or axial skeletal sites, such as pelvis, sternum, and rib. Suitability for in vivo biopsy varies by site, but equivalency of BM composition at different sites is uncertain. We sought to determine whether the composition of BM is comparable in humerus, ilium, rib, and sternum. Samples from each site were obtained within 24 h after death from 30 dogs with spontaneous disease submitted for postmortem examination. Tissues were fixed in acetic acid-zinc-formalin, demineralized with EDTA, and assessed by 4 independent raters for hematopoietic cellularity, granulocytic:erythrocytic (G:E) cell ratio, megakaryocyte (MKC) number, and presence of hemosiderin. Statistical analysis showed lower cellularity, MKC number, and hemosiderin in ilium than in rib, higher cellularity in rib and sternum than in humerus and ilium, and lower G:E cell ratio in rib than in humerus (p < 0.05). Analysis of covariance indicated that most differences between sites were attributable to individual animal variation rather than site or rater. Differences overall were of small magnitude, and values for each parameter were similar to those reported in healthy younger dogs. We concluded that samples from any of the 4 sites are suitable to approximate composition of BM at the other sites.

PMID:41178663 | DOI:10.1177/10406387251387786