Tag: nevin manimala

BMC Health Serv Res. 2025 Jul 8;25(1):942. doi: 10.1186/s12913-025-12998-x.

ABSTRACT

BACKGROUND: There is growing appreciation of the role health literacy plays in population health and health care design. Health literacy encompasses an individual’s capacity to manage their health and the responsiveness of the health system. Our aim was to identify the health literacy strengths and challenges in an Australian cohort living with motor neurone disease (MND), including both people living with the disease and their carers.

METHODS: This study used the Health Literacy Questionnaire and eHealth Literacy Questionnaire for health literacy assessment. Using a secure online platform, an anonymous survey was disseminated which included demographic data and clinical measurements. Descriptive statistical analysis and cluster analysis were employed to describe the sample and to identify different health literacy patterns in subgroups of people living with MND and their carers.

RESULTS: A total of 227 people participated (171 people living with MND and 56 carers). Cluster analysis generated fifteen cluster profiles for the cohort living with MND and seven cluster profiles for carers. The variability and potential significance of patterns of health literacy strengths and challenges within the MND community are described. There was extensive diversity within the sampled population, with a mix of sociodemographic backgrounds across each cluster profile.

CONCLUSIONS: The health literacy cluster profiles created from this study provide insight into the full spectrum of where the challenges and strengths exist for individuals and subgroups of people managing this fatal disease. The results from this study pave the way for generating system wide interventions that address health literacy diversity, to create more enabling health care environments for all those affected by MND.

PMID:40629298 | DOI:10.1186/s12913-025-12998-x

J Public Health Manag Pract. 2025 Jul 7. doi: 10.1097/PHH.0000000000002181. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to identify rural counties across the United States that experience combined high prevalence of chronic diseases and low socioeconomic status (SES), categorizing them as high-need areas. We analyze the geographic and sociodemographic profiles of these counties and examine differences in access to care for high-need rural counties.

METHODS: We used the 2023 PLACES dataset from the Centers for Disease Control and Prevention for chronic disease prevalence estimates and the 2020 American Community Survey for SES indicators. Counties were classified into tertiles based on disease prevalence and SES indicators, creating an overall composite score identifying counties as low, moderate, or high need. We used ArcGIS Pro to map the distribution of high-need counties across the United States with statistical analyses of geographic distribution and health care access conducted through quantile regression and spatial autocorrelation methods.

FINDINGS: A total of 1934 rural counties, representing nearly 99% of rural counties, were included in this analysis, identifying 534 high-need counties, primarily in the southeastern United States. These counties had significantly higher proportions of non-Hispanic Black residents. Significant spatial autocorrelation indicated that counties with similar levels of chronic disease and SES are geographically clustered. High-need counties faced greater distances to health care facilities compared to their lower-need counterparts, highlighting substantial barriers to accessing care.

CONCLUSION: This analysis identified geographic variation in chronic disease burden and socioeconomic status across rural US counties, with high-need areas concentrated in the Southeast. The findings demonstrate the value of a simple, replicable framework for identifying rural counties facing overlapping health and socioeconomic challenges. This approach can support efforts to prioritize resource allocation and guide future research and policy aimed at improving access and outcomes in underserved rural communities.

PMID:40627866 | DOI:10.1097/PHH.0000000000002181

Scand J Pain. 2025 Jul 8;25(1). doi: 10.1515/sjpain-2025-0015. eCollection 2025 Jan 1.

ABSTRACT

OBJECTIVE: The aim of this study is to assess the clinical impression of health professionals at the Pain and Rehabilitation Centre, Linköping University Hospital, Sweden, according to whom patients have gradually become more complex and “difficult” over time.

METHODS: This is a repeated cross-sectional study. Over 8,000 patients assessed between 2009 and 2022 answered questionnaires from the Swedish quality registry for pain rehabilitation. Patient-reported outcome measures were analysed with multivariate data analysis such as principal component analysis.

RESULTS: During 2009-2022, the first principal component did not change statistically over time (p = 0.177), and it did not correlate to the year (rho = -0.014; p = 0.21). Patients were divided into three groups (2009-2012, 2013-2016, and 2017-2022), and a partial least squares-discriminant analysis model with group belonging as the Y-variable did not reveal any relevant differences (R ² = 0.048; Q ² = 0.045). For the period 2016-2022, additional data were available, enabling the comparison of pre- vs post-pandemic data by discriminant analysis. No clinically relevant difference was found.

CONCLUSIONS: It was not possible to confirm the clinical impression of health care personnel. While it is important to listen to “clinical hunches” emitted by experienced clinicians, it is also essential not to be too quick to equate such impressions with a true state of affairs.

PMID:40627864 | DOI:10.1515/sjpain-2025-0015

J Low Genit Tract Dis. 2025 Jul 8. doi: 10.1097/LGT.0000000000000903. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify factors with uniquely high prevalence in vulvodynia-Ehlers-Danlos syndrome comorbid patients in order to identify patients who may need referral and to better understand management of this population.

METHODS: Cross-sectional study conducted in January 2025 using the TriNetX Platform Global Collaborative Network Database with statistical comparison of vulvodynia-Ehlers-Danlos comorbid cohort and vulvodynia non-Ehlers-Danlos cohort. Bonferroni correction was performed due to analysis of 100 demographic, associated condition, and treatment factors with statistical significance at p = .0005.

RESULTS: Five hundred seventy vulvodynia-Ehlers-Danlos patients and 49,457 vulvodynia non-Ehlers-Danlos patients were identified with a mean age of 39 and 48 (p < .0001), respectively. Vulvodynia-Ehlers-Danlos comorbid patients had more frequent chronic pain, musculoskeletal, neurologic, gynecologic, immune, and psychiatric conditions. Vulvodynia-Ehlers-Danlos patients had higher rates of most nonsurgical interventions but similar vaginal estrogen (p = .0412) and vulvar surgery rates (p = .4249). Vulvodynia-Ehlers-Danlos patients had signs of more frequent medical contact with more post-op visits, vaccines, and inpatient admissions (p < .0001). Study limitations are those inherent to the TriNetX database, with ability to see associations but not causation.

CONCLUSIONS: Clinicians treating genital pain have a role in the treatment of vulvodynia-Ehlers-Danlos patients given the array of prevalent pelvic conditions. Clinicians should keep the high rate of muscular, neurologic, and immune conditions in mind when evaluating the vulvodynia etiology in this population, as well as the higher rate of gynecologic comorbidities, which could result in hormone-mediated etiology from chronic estrogen use. With a higher rate of mood disorders, mental health inquiry is also important.

PMID:40627862 | DOI:10.1097/LGT.0000000000000903

J Am Acad Orthop Surg. 2025 Jul 3. doi: 10.5435/JAAOS-D-24-00604. Online ahead of print.

ABSTRACT

BACKGROUND: Dorsal wrist spanning plate (DWSP) fixation is a technique used to treat distal radius fractures with severe metaphyseal comminution, diaphyseal extension, and other complex fracture patterns. One concern of this technique is the potential risk of stiffness due to prolonged immobilization. The purpose of our study was to examine the association of DWSP duration on range of motion (ROM) outcomes after plate removal.

METHODS: Patients who underwent DWSP fixation for distal radius fracture with greater than 6 months of follow-up after DWSP removal at a single institution were retrospectively identified. Patients with a concomitant upper extremity injury were excluded. The primary outcome of interest was ROM. Secondary outcomes included visual analog scale pain scores and radiographic measurements. A piecewise regression analysis was run to evaluate for a nonlinear relationship between DWSP duration and ROM.

RESULTS: Fifty-one patients were included for analysis. DWSP removal occurred at a mean of 110 days (range, 59-182 days). Median duration of follow-up after DWSP removal was 11.7 months (interquartile range = 8.2 months to 1.8 years). No significant association was observed between DWSP duration and visual analog scale (P = 0.11), complication rate (P = 0.45), radial inclination (P = 0.57), radial height (P = 0.74), or volar tilt (P = 0.13). Piecewise regression demonstrated a statistically significant reduction in supination (P = 0.001), pronation (P = < 0.001), and wrist flexion (P = 0.014) for DWSP >120 days when controlling for age, sex, polytrauma, duration of follow-up, and additional fixation.

DISCUSSION: There is a nonlinear association between DWSP duration and wrist ROM (flexion, supination, and pronation). When DWSP duration is longer than 120 days, there is a negative correlation with ROM when controlling for covariates. When DWSP duration is less than or equal to 120 days, there is no correlation with ROM. Our findings suggest that patients with longer duration of DWSP duration (>120 days) are more likely to have range-of-motion limitations; additional research is necessary to determine whether implant retention longer than 120 days by itself or fracture or patient-specific factors which require longer implant retention are the causative agents for this motion limitation.

LEVEL OF EVIDENCE: Retrospective cohort, Level IV.

PMID:40627859 | DOI:10.5435/JAAOS-D-24-00604

JMIR Res Protoc. 2025 Jul 8;14:e74018. doi: 10.2196/74018.

ABSTRACT

BACKGROUND: The incidence of postoperative pancreatic fistula following distal pancreatectomy is as high as 30%-50%. Postoperative pancreatic fistula can be a major cause of perioperative morbidity, resulting in prolonged hospital stays and increased health care costs. The management of the pancreatic stump is one of the key factors influencing the occurrence of postoperative pancreatic fistula after distal pancreatectomy, but the optimal management approach remains debatable. The main methods for pancreatic stump closure include manual suturing and stapler closure. However, both methods are associated with a high risk of postoperative pancreatic fistula, which may be related to the balance between providing sufficient pancreatic duct burst pressure and ensuring blood supply to the stump. Ligation of the pancreatic stump has been attempted to reduce the risk of postoperative pancreatic fistula following distal pancreatectomy, but its efficacy remains limited by the challenge of achieving the optimal ligation force.

OBJECTIVE: This study aims to investigate whether ligation of the pancreatic stump with a quantified force can decrease the risk of postoperative pancreatic fistula following distal pancreatectomy.

METHODS: In this nonrandomized controlled clinical study at a tertiary center in China, the major eligibility criterion is the presence of lesions planned for distal pancreatectomy. Sixty patients will be allocated to the experimental or control group according to their choice. Recruitment for either group will be discontinued upon reaching the predefined sample size of 30 participants. In the experimental group, the pancreas will be ligated 5 mm from the pancreatic stump with a quantified force to provide a pancreatic duct burst pressure of approximately 40-70 mm Hg. The ligation force will be provided by a 3.2-mm-diameter silicone ring. During pancreatic stump ligation, this silicone ring will be stretched to 15 mm, generating an applied force of 1.3 N. The pancreas will be severed using energy-based devices before or after the ligation. In the control group, the pancreatic stump will be managed by manual suturing or stapling closure according to the surgeon’s clinical judgment and preference. Postoperative regular follow-up examinations will be conducted. The primary outcomes include postoperative pancreatic fistula and postoperative hospital stay, and the secondary outcomes include intra-abdominal infection, incision infection, and postoperative treatment costs. The primary and secondary outcomes of patients in this cohort will be statistically compared using appropriate tests.

RESULTS: This study started in February 2025, and the recruitment period is from February to September 2025.

CONCLUSIONS: This protocol proposes a novel approach for pancreatic stump management aimed at preventing postoperative pancreatic fistula following distal pancreatectomy. The research team established the optimal ligation force for the pancreatic stump to ensure adequate burst pressure for the pancreatic duct while preventing acute stump necrosis, thereby theoretically reducing the risk of postoperative pancreatic fistula.

TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2500097781; https://www.chictr.org.cn/showproj.html?proj=247008.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/74018.

PMID:40627856 | DOI:10.2196/74018

J Am Acad Orthop Surg. 2025 Jul 3. doi: 10.5435/JAAOS-D-24-01334. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between testosterone replacement therapy (TRT) and hip fractures remains underexplored. This study aims to investigate this relationship. We hypothesize that patients prescribed TRT experience a lower rate of hip fractures compared with a control group.

METHODS: The PearlDiver Mariner165 data set was used to obtain two random cohorts of 500,000 patients. The experimental group received TRT for at least 3 months and the control group did not. We used one-to-one matching to evaluate the effects of TRT in 301,724 patients. The incidence of hip fractures was assessed over a 2-year follow-up using the International Classifications of Disease codes. Multivariable logistic regression identified the association between TRT and hip fractures. Statistical significance was set at P < 0.05.

RESULTS: The patients in the TRT group were associated with a lower incidence of hip fractures compared with the control group (0.13% vs. 0.25%, P < 0.001). The multivariable analysis showed that TRT use was associated with a decreased incidence of hip fractures with an adjusted odds ratio (aOR) of 0.58 (95% confidence interval [CI], 0.51 to 0.66, P < 0.001). After stratifying by sex, the multivariable analysis showed that TRT use in male patients was associated with a decreased incidence of hip fractures with an aOR of 0.61 (95% CI, 0.53 to 0.72, P < 0.001); in female patients, it was associated with a decreased incidence of hip fractures with an aOR of 0.49 (95% CI, 0.38 to 0.63, P < 0.001).

CONCLUSION: Patients prescribed TRT had a 1.9 times lower likelihood of sustaining hip fractures. Further investigation into the association of TRT and fragility fractures garners continued interest. In addition, this can provide insight into the potential benefits of TRT use and maintaining bone health to improve bone mass and improve results of orthopaedic interventions.

LEVEL OF EVIDENCE: III.

PMID:40627853 | DOI:10.5435/JAAOS-D-24-01334

JMIR Res Protoc. 2025 Jul 8;14:e66396. doi: 10.2196/66396.

ABSTRACT

BACKGROUND: Women who experience intimate partner violence (IPV) are more likely to develop disabling chronic pain (CP). However, there is little information on what it means to live with CP while being exposed to IPV. In addition, despite well-established risk and protective factors for CP and its health outcomes, there are no data on whether these factors differ in women who have experienced IPV compared to those who have not.

OBJECTIVE: Our aims are to understand the meaning and implications of living with CP for women who have experienced IPV compared to women with CP alone and to identify possible differences in risk and protective factors as well as health outcomes.

METHODS: We have designed 2 studies to be conducted in 2 phases. The first phase will involve a qualitative study with a descriptive and exploratory design. Individual semistructured interviews will be conducted with at least 10 women with CP alone and with 10 women with CP who have experienced IPV. Reflexive thematic analysis will be used to examine participants’ experiences, meanings, and realities. In the second phase, a cross-sectional study will be conducted with women with CP affected by IPV, including those currently experiencing IPV and those with past exposure to IPV, as well as women with CP who have never experienced IPV. A total of 359 women will complete various scales assessing risk and protective factors (eg, pain-related worrying and activity patterns) and health outcomes (eg, legal and illegal drug use and health care use). Data analysis will involve inferential statistics and machine learning.

RESULTS: As of May 2025, we had contacted relevant associations to present the project and begin recruiting voluntary participants. We have conducted the pilot study to assure the adequacy of the questionnaire and usability or technical functionality of the web-based platform. The results are expected to be published starting in January 2026.

CONCLUSIONS: This research addresses two urgent needs in pain research identified by the European Pain Federation: (1) expanding knowledge on CP management in relation to contextual factors; and (2) identifying specific psychosocial, self-management, and health profiles among women with CP who have experienced IPV and those who have not. This could provide valuable insights for personalizing pain management treatments. In addition, the findings may help identify women experiencing IPV who present to health care settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/66396.

PMID:40627849 | DOI:10.2196/66396

Folia Biol (Praha). 2025;71(2):73-78. doi: 10.14712/fb2025071020073.

ABSTRACT

Medulloblastoma (MB) in children is associated with distinct molecular subgroups, reflecting substantial biological heterogeneity. The presence of isocitrate dehydrogenase 1 (IDH1) and IDH2 mutations in paediatric MB has been rarely reported and not routinely investigated. Our study included 23 samples from paediatric patients diagnosed with MB. Hotspot alterations at codons IDH1 R132 and IDH2 R172 were examined using Sanger sequencing following polymerase chain reaction (PCR). The mean age of the patients was 10 years (SD: 4.25), comprising 17 males and 6 females. All cases exhibited classical histological features of MB. β-Catenin expression was observed in four cases (17.4 %), while 19 cases (82.6 %) showed no expression. No statistically significant differences in progression-free survival (PFS) were found between MBs with positive or negative β-catenin expression (P = 0.6). Radiotherapy alone was administered to four patients (17.4 %), while 19 patients (82.6 %) received combined radiotherapy and chemotherapy. The median PFS was 383 days (1 year and 18 days). IDH1 R132 or IDH2 R172 hotspot mutations were not detected in any of the samples. The absence of IDH1 or IDH2 mutations in paediatric MB may be attributed to differences in mutational profiles and cellular origins in childhood MB, despite its histomolecular similarities with adult MB.

PMID:40627836 | DOI:10.14712/fb2025071020073

JMIR Cardio. 2025 Jul 8;9:e68817. doi: 10.2196/68817.

ABSTRACT

BACKGROUND: Heart failure management involves comprehensive lifestyle modifications such as daily weights, fluid and sodium restriction, and blood pressure monitoring, placing additional responsibility on patients and caregivers, with successful adherence often requiring extensive counseling and understandable patient education materials (PEMs). Prior research has shown PEMs related to cardiovascular disease often exceed the American Medical Association’s fifth- to sixth-grade recommended reading level. The large language model (LLM) ChatGPT may be a useful tool for improving PEM readability.

OBJECTIVE: We aim to assess the readability of heart failure-related PEMs from prominent cardiology institutions and evaluate GPT-4’s ability to improve these metrics while maintaining accuracy and comprehensiveness.

METHODS: A total of 143 heart failure-related PEMs were collected from the websites of the top 10 institutions listed on the 2022-2023 US News & World Report for “Best Hospitals for Cardiology, Heart & Vascular Surgery.” PEMs were individually entered into GPT-4 (version updated July 20, 2023), preceded by the prompt, “Please explain the following in simpler terms.” Readability was assessed using the Flesch Reading Ease score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. The accuracy and comprehensiveness of revised GPT-4 PEMs were assessed by a board-certified cardiologist.

RESULTS: For 143 institutional heart failure-related PEMs analyzed, the median FKGL was 10.3 (IQR 7.9-13.1; high school sophomore) compared to 7.3 (IQR 6.1-8.5; seventh grade) for GPT-4’s revised PEMs (P<.001). Of the 143 institutional PEMs, there were 13 (9.1%) below the sixth-grade reading level, which improved to 33 (23.1%) after revision by GPT-4 (P<.001). No revised GPT-4 PEMs were graded as less accurate or less comprehensive compared to institutional PEMs. A total of 33 (23.1%) GPT-4 PEMs were graded as more comprehensive.

CONCLUSIONS: GPT-4 significantly improved the readability of institutional heart failure-related PEMs. The model may be a promising adjunct resource in addition to care provided by a licensed health care professional for patients living with heart failure. Further rigorous testing and validation is needed to investigate its safety, efficacy, and impact on patient health literacy.

PMID:40627825 | DOI:10.2196/68817