Tag: nevin manimala

J Health Popul Nutr. 2025 Feb 1;44(1):24. doi: 10.1186/s41043-025-00770-0.

ABSTRACT

BACKGROUND: Even though maternal nutrition has improved, food taboos and poor dietary practices during pregnancy can still lead to nutrient deficiencies, increasing the risk of complications for both mothers and children. Therefore, this study aimed to generate pooled evidence from across different countries in Sub-Saharan Africa to inform effective prevention actions. This meta-analysis aims to determine the pooled prevalence of food taboo practices and identify associated factors among pregnant women in Sub-Saharan Africa.

METHODS: This study systematically reviewed relevant articles and reports from databases including Embase, MEDLINE, Science Direct, PubMed, Google, and Google Scholar. The Newcastle-Ottawa Scale assessed article quality. Data extraction and analysis were done using Excel and STATA 17, respectively. Heterogeneity was assessed using Cochran’s Q test and the I² statistic, with a random effects model employed for meta-analysis. Publication bias was evaluated and addressed using Duval and Tweedie’s Trim and Fill analysis.

RESULTS: A total of fifty-eight studies with 20,262 pregnant women were included in this meta-analysis. The pooled proportion of food taboo practices reported by the 58 studies was 41% (95% CI: 34, 48%). In the subgroup analysis, the pooled proportion of food taboo practices for studies conducted in urban areas was 40% (95% CI: 32, 48%), while it was 43% (95% CI: 32, 56%) among rural residents. Factors associated with food taboo practices among pregnant women included being unable to read and write (AOR = 2.64%; 95% CI: 1.79-3.90; I² = 56.9%), not receiving antenatal care follow-up (AOR = 3.73%; 95% CI: 2.83-3.90; I² = 55.1%), and poor maternal nutrition knowledge (AOR = 3.33%; 95% CI: 1.56-7.09; I² = 84.3%).

CONCLUSION: According to this review, over two out of every five pregnant mothers practiced food taboos in the region. The educational status of the mother, antenatal care follow-up, and maternal nutrition knowledge were factors affecting food taboo practices among pregnant women. Therefore, emphasis should be given to the uptake of antenatal care follow-up to improve maternal nutrition knowledge and nutritional status.

PMID:39893470 | DOI:10.1186/s41043-025-00770-0

Trials. 2025 Feb 1;26(1):37. doi: 10.1186/s13063-025-08749-2.

ABSTRACT

BACKGROUND: The euglycemic clamp test stands as the best method for assessing the pharmacokinetic and pharmacodynamic properties of long-acting insulin. However, despite its widespread use, there remains a notable absence of an established gold standard for evaluating the test’s quality. Existing recommendations from regulatory agencies lack specific threshold values, particularly concerning long-acting insulin. This study aimed to determine the evaluation criteria for assessing the quality of the long-acting insulin euglycemic glucose clamp test and to improve the overall quality of this testing method.

METHODS: Fifty-three healthy volunteers were administered a single dose of insulin degludec (0.4 IU/kg) and underwent a 24-h euglycemic clamp test. Blood samples were collected to evaluate the pharmacokinetics and pharmacodynamics of insulin degludec. Volunteers were separated into group A (coefficient of variation in blood glucose [CVBG] ≤ 3.5%) and group B (CVBG > 3.5%). The quality difference of the clamp test between the groups was assessed using various quality control indices. Volunteers were also categorized into group C (C-peptide reduction rate < 50%) and group D (C-peptide reduction rate ≥ 50%). The clamp test quality, pharmacokinetics, and pharmacodynamics of groups C and D were compared.

RESULTS: According to CVBG, group A had a mean CVBG of 2.95%, group B had a mean CVBG of 4.15%, and group A had a significantly lower CVBG than group B (p < 0.001). CVBG was positively correlated with other quality control indicators, such as the percentage of glucose excursion from the target range (GEFTR), duration of GEFTR, and area under the curve (AUC) of GEFTR. According to the reduction of C-peptide levels: group D had significantly higher C-peptide reduction than group C (p < 0.001). Groups C and D had CVBG < 3.5%. The quality of groups C and groups D was evaluated by the quality control indicators of the clamp test. Only the AUC of GEFTR was statistically different between Groups C and D (p = 0.043, < 0.05), and there was no statistical difference in other indicators between the two groups.

CONCLUSIONS: CVBG could be used as a standard for evaluating the quality of long-acting insulin euglycemic glucose clamp test, and the test quality was superior with a CVBG ≤ 3.5%. A C-peptide reduction ratio ≥ 50% indicated sufficient endogenous insulin inhibition; however, when the glucose fluctuation is small (CVBG is maintained at a low level) during the clamp test, even if the clamp test quality is slightly different, it is not sufficient to interfere with endogenous insulin secretion.

PMID:39893469 | DOI:10.1186/s13063-025-08749-2

AIDS Res Ther. 2025 Feb 1;22(1):9. doi: 10.1186/s12981-024-00690-9.

ABSTRACT

BACKGROUND: In January 2021, the United States (US) Food and Drug Administration (FDA) approved the first long-acting injectable antiretroviral therapy (LAI ART) regimen for the treatment of HIV providing an alternative to daily oral regimens. We analyzed electronic health records (EHRs) to provide real-world evidence of demographic and clinical characteristics associated with the receipt of LAI ART among people with HIV (PWH).

METHODS: Leveraging EHRs from a large clinical research network in the Southern US – OneFlorida + linked with Medicaid (updated to 08/2022) – we identified a cohort of PWH who have been prescribed at least one dose of LAI ART since January 2021 and characterized their demographics, clinical characteristics, and HIV care outcomes.

RESULTS: A total of 233 LAI ART recipients were identified: 56.7% female, 45.1% aged 30 to 44, 51.3% non-Hispanic Black, 78.1% on Medicaid and 4.7% on private insurance. Approximately three-quarters of injections (71.2%) were received within 37 days of the previous dose, and 84.4% were received within 67 days. About 8% of LAI ART recipients did not have optimal care engagement the year before LAI ART initiation; one in five recipients had a diagnosis of alcohol or substance use disorder in lifetime. All achieved viral suppression (< 50 copies/mL) before starting LAI ART. Of a subset of patients with HIV viral load test records, only 1 record of virologic failure (viral load > 200 copies/ml) was observed after the initiation of LAI ART.

DISCUSSION: There has been an increasing trend of LAI ART initiation since approval. People with suboptimal care engagement and with substance use disorder in lifetime were not excluded from LAI ART treatment.

PMID:39893464 | DOI:10.1186/s12981-024-00690-9

Malar J. 2025 Feb 1;24(1):32. doi: 10.1186/s12936-025-05273-1.

ABSTRACT

BACKGROUND: Malaria burden remains high in some Peruvian regions, especially in the Northeast Amazon rainforest state of Loreto and the tropical coastal state of Tumbes. Novel non-invasive diagnostic tools for malaria are being developed, and formative research in malaria-endemic areas with community members and health professionals who would potentially use these devices is vital for this process. This study aimed to examine the acceptability and feasibility of four new non-invasive malaria diagnostic tools in development in two regions of Peru with significant malaria burden.

METHODS: The research team conducted focus group discussions and key informant interviews in Spanish to assess acceptability and ascertain questions and concerns regarding the non-invasive diagnostic tools. Focus group discussions included a range of community members (pregnant women, parents), professionals (health, education), and community leaders in Loreto. Vector control authorities and health professionals from Loreto, Tumbes, and Lima participated as key informants.

RESULTS: Participants were initially enthusiastic about all non-invasive diagnostic tools. However, as discussions proceeded, high enthusiasm remained for two devices that were easy to use, acceptable for the communities they were intended for, feasible to carry in remote areas, and did not require new supplies nor generate waste: the skin scan and the skin odour test. The breath and saliva tests were considered less hygienic. They were less acceptable to community members and health professionals due to concerns of disease transmission and other environmental and cultural concerns. Health professionals felt the finger scan test and the skin odour test would help triage community members in endemic sites and would be valuable in remote regions with difficult access to health facilities or laboratories.

CONCLUSIONS: Novel non-invasive malaria diagnostic tools can be valuable in malaria-endemic settings. As manufacturers evaluate the efficacy and effectiveness of these non-invasive diagnostic tools, international recommendations should be created to ensure their agile integration into national malaria programmes.

PMID:39893463 | DOI:10.1186/s12936-025-05273-1

J Med Internet Res. 2025 Jan 31;27:e65967. doi: 10.2196/65967.

ABSTRACT

BACKGROUND: Health systems are increasingly offering patient portals as tools for patients to access their health information with the goal of improving engagement in care. However, understanding health care providers’ perspectives on patient portal implementation is crucial.

OBJECTIVE: This study aimed to understand health care providers’ experiences of implementing the MyChart patient portal, perspectives about its impact on patient care, clinical practice, and workload, and opportunities for improvement.

METHODS: Using an explanatory sequential mixed methods approach, we conducted a web-based questionnaire and semistructured individual interviews with health care providers at a large Canadian community hospital, 6 months after MyChart was first offered to patients. We explored perspectives about the impact of MyChart on clinical practice, workload, and patient care. Data were analyzed using descriptive statistics and thematic analysis.

RESULTS: In total, 261 health care providers completed the web-based questionnaire, and 15 also participated in interviews. Participants agreed that patients should have access to their health information through MyChart and identified its benefits such as patients gaining a greater understanding of their own health, which could improve patient safety (160/255, 62%). While many health care providers agreed that MyChart supported better patient care (108/258, 42%), there was limited understanding of features available to patients and expectations for integrating MyChart into clinical routines. Concerns were raised about the potential negative impacts of MyChart on patient-provider relationships because sensitive notes or results could be inappropriately interpreted (109/251, 43%), and a potential increase in workload if additional portal features were introduced. Suggested opportunities for improvement included support for both patients and health care providers to learn about MyChart and establishing guidelines for health care providers on how to communicate information available in MyChart to patients.

CONCLUSIONS: While health care providers acknowledged that MyChart improved patients’ access to health information, its implementation introduced some friction and concerns. To reduce the risk of these challenges, health systems can benefit from engaging health care providers early to identify effective patient portal implementation strategies.

PMID:39888658 | DOI:10.2196/65967

JAMA Netw Open. 2025 Jan 2;8(1):e2457341. doi: 10.1001/jamanetworkopen.2024.57341.

ABSTRACT

IMPORTANCE: Ultraprocessed foods (UPF), characterized as shelf-stable but nutritionally imbalanced foods, pose a public health crisis worldwide. In adults, UPF consumption is associated with increased obesity risk, but findings among children are inconsistent.

OBJECTIVES: To examine the associations among UPF intake, anthropometric adiposity indicators, and obesity status in Canadian children.

DESIGN, SETTING, AND PARTICIPANTS: In the CHILD Cohort Study, one of the largest prospective, multicenter, population-based pregnancy cohorts in Canada, diet was assessed during the 3-year visit (September 2011 to June 2016), and anthropometric measurements were assessed at the 5-year visit (December 2013 to April 2018). Data analysis was performed between July 1, 2023, and June 30, 2024.

EXPOSURE: Diet intake was assessed using a semiquantitative food frequency questionnaire at 3 years of age. UPFs were identified using the NOVA classification system.

MAIN OUTCOMES AND MEASURES: Anthropometric adiposity indicators were measured at 5 years of age and used to calculate age- and sex-standardized z scores for body mass index (BMI), waist to height ratio, and subscapular and triceps skinfold thicknesses, and obesity, which was defined using BMI z score cutoffs. Multivariable-adjusted regression analyses were used to examine the associations of UPF with adiposity and obesity development, accounting for parental, birth, and early-childhood factors.

RESULTS: Among 2217 participants included in this study, median age at the outcome assessment was 5.0 (IQR, 5.0-5.1) years, and 1175 (53.0%) were males. At 3 years of age, UPF contributed 45.0% of total daily energy intake. UPF energy contribution was higher in males vs females (46.0% vs 43.9%; P < .001). Among all participants, higher UPF intake at 3 years of age was associated with higher anthropometric adiposity indicators at 5 years of age, primarily driven by males. In males, every 10% UPF energy increase was associated with higher adiposity indicator z scores for BMI (β, 0.08; 95% CI, 0.03-0.14), waist to height ratio (β, 0.07; 95% CI, 0.01-0.12), and subscapular (β, 0.12; 95% CI, 0.06-0.18) and triceps (β, 0.09; 95% CI, 0.03-0.15) skinfold thickness and higher odds of living with overweight or obesity (odds ratio, 1.19; 95% CI, 1.03-1.36). No significant associations were observed among females.

CONCLUSIONS AND RELEVANCE: In this cohort study of Canadian children, high UPF consumption during early childhood was associated with obesity development, primarily in males. These findings can inform targeted public health initiatives for early childhood centers and caregiver education programs to reduce UPF intake and prevent obesity.

PMID:39888617 | DOI:10.1001/jamanetworkopen.2024.57341

JAMA Netw Open. 2025 Jan 2;8(1):e2457506. doi: 10.1001/jamanetworkopen.2024.57506.

ABSTRACT

IMPORTANCE: While national guidelines recommend avoidance of hypoxia, hypotension, and hypocarbia in the prehospital care of traumatic brain injury (TBI), limited data validate the association of these adverse physiologic events with TBI outcomes.

OBJECTIVE: To validate the associations of prehospital hypoxia, hypotension, and hypocarbia with TBI outcomes in a US national trauma network.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined data from 8 level I trauma centers and their affiliated ground and air emergency medical services (EMS) agencies in the Linking Investigations in Trauma and Emergency Services (LITES) Network from January 1, 2017, to June 30, 2021. Adult patients (aged ≥18 years) with confirmed TBI (head Abbreviated Injury Score [AIS] of 1-6) and Injury Severity Score (ISS) of at least 9 were included. Interfacility transfers and patients who underwent prehospital cardiopulmonary resuscitation were excluded. Data were analyzed between April 20, 2022, and November 27, 2023.

EXPOSURES: Adverse prehospital TBI events, including hypoxia, hypotension, or hypocarbia.

MAIN OUTCOMES AND MEASURES: The primary outcomes were death in the emergency department (ED), hospital death, and unfavorable discharge disposition. Log-binomial regression models were used to estimate the association between adverse TBI events and outcomes, adjusting for sex, race and ethnicity, age, study site, transport mode, initial Glasgow Coma Scale, ISS, head AIS score, injury mechanism, and multiple trauma.

RESULTS: The analytic cohort included 14 994 patients (median [IQR] age, 47 [31-64] years; 71% male; median [IQR] head AIS, 3 [2-4]). Patients with adverse TBI events included 12% (1577 of 13 604) with hypoxia, 10% (1426 of 14 842) with hypotension, and 61% (650 of 1068) with hypocarbia among those with advanced airway management. Patient outcomes included 2% (259 of 14 939) who died in the ED, 12% (1764 of 14 623) who died in the hospital, and 25% (3705 of 14 623) with an unfavorable discharge disposition. Hypoxia (adjusted relative risk [ARR], 2.24; 95% CI, 1.69-2.97), hypotension (ARR, 2.05; 95% CI, 1.54-2.72), and hypocarbia (ARR, 7.99; 95% CI, 2.47-25.85) were associated with increased risks of ED death. Each adverse TBI event exposure was also associated with higher risks of hospital death and unfavorable discharge disposition.

CONCLUSIONS AND RELEVANCE: In this multicenter cohort study, prehospital hypoxia, hypotension, and hypocarbia were associated with poorer TBI outcomes. These results underscore the importance of optimal oxygenation, ventilation, and perfusion in prehospital TBI care.

PMID:39888614 | DOI:10.1001/jamanetworkopen.2024.57506

Geroscience. 2025 Jan 31. doi: 10.1007/s11357-025-01525-9. Online ahead of print.

ABSTRACT

The current study examined cross-sectional and longitudinal associations between nocturia and frailty in a cohort of men and women aged 60 years and older, as evidence on this topic was lacking. We analyzed baseline and follow-up data (n = 1671) from the Berlin Aging Study II (BASE-II), a prospective longitudinal cohort study focusing on the factors associated with “healthy” vs. “unhealthy” aging. Self-reported nocturia was dichotomized into < / ≥ 2 micturitions per night, and frailty was assessed using the Fried frailty phenotype. Covariables were identified a priori based on a review of the existing literature. At baseline, 70.2% of the participants were robust, 28.9% were pre-frail, and 0.9% were frail; 254 participants (23.6%) had self-reported nocturia. In longitudinal analyses, the prevalence and incidence of frailty at follow-up significantly increased when nocturia was present at baseline. Over a median follow-up of 7.1 years, there were 41 incident frailty cases (IR 5.6, 95%-CI 3.9-7.2 per 1000 person-years). After adjusting for age, sex, morbidity burden, and baseline frailty status, baseline nocturia was associated with a 2.23-fold increased risk (95%-CI 1.17-4.18) of frailty at follow-up. Nocturia is associated with an increased risk of developing or progressing in frailty in older adults, and may serve as an early clinical marker for the progression of frailty.

PMID:39888584 | DOI:10.1007/s11357-025-01525-9

Geroscience. 2025 Jan 31. doi: 10.1007/s11357-025-01537-5. Online ahead of print.

ABSTRACT

Dietary restriction (DR) is widely considered to be one of the most potent approaches to extend healthy lifespan across various species, yet it has become increasingly apparent that DR-mediated longevity is influenced by biological and non-biological factors. We propose that current priorities in the field should include understanding the relative contributions of these factors to elucidate the mechanisms underlying the beneficial effects of DR. Our work conducted in two laboratories represents an attempt to unify DR protocols in Drosophila and to investigate the stochastic effects of DR. Across 64 pairs of survival data (DR/ad libitum, or AL), we find that DR does not universally extend lifespan. Specifically, we observed that DR conferred a significant lifespan extension in only 26.7% (17/64) of pairs. Our pooled data show that the overall lifespan difference between DR and AL groups is statistically significant, but the median lifespan increase under DR (7.1%) is small. The effects of DR were overshadowed by stochastic factors and genotype. Future research efforts directed toward gaining a comprehensive understanding of DR-dependent mechanisms should focus on unraveling the interactions between genetic and environmental factors. This is essential for developing personalized healthspan-extending interventions and optimizing dietary recommendations for individual genetic profiles.

PMID:39888582 | DOI:10.1007/s11357-025-01537-5

Ir J Med Sci. 2025 Jan 31. doi: 10.1007/s11845-025-03872-0. Online ahead of print.

ABSTRACT

BACKGROUND: Lab users should display an understanding of microbiology tests and avoid inappropriate requests which may yield negative clinical consequences. Our research addressed diagnostic stewardship education and the perspectives of paediatric hospital doctors on their (1) self-perceived knowledge, (2) motivators for test ordering, (3) proposed educational interventions and (4) preferred teaching modalities.

METHODS: An anonymous, mixed-methods, 34-item online questionnaire was distributed to paediatric doctors across three Irish hospital sites from March to May 2023. Descriptive statistics summarised Likert-scale responses and inductive thematic analysis was used to analyse open-ended items. Subgroup analyses examined differences between consultants and non-consultant hospital doctors (NCHDs).

RESULTS: The analysis included 100 respondents (n = 45 consultants, n = 55 NCHDs, 24% response rate). Consultants scored higher than NCHDs in self-perceived knowledge (p < 0.001). Patient comorbidity, clinical status, local guidelines and accuracy of microbiological tests were the strongest motivators for test-ordering. Consultants were more likely to be influenced by accuracy (p = 0.03), costs (p = 0.01) and laboratory workload (p = 0.01). Only 27% reported formal teaching on diagnostic stewardship. NCHDs demonstrated increased willingness to engage in educational interventions (p = 0.024), and a comparatively higher interest in in-person teaching (p = 0.002) and gamification (p = 0.02). Respondents indicated a preference for formal guidelines on microbiology testing, in-person teaching, cost familiarisation and e-learning modules. Novel methods (peer-to-peer programmes, simulation and gamification) were less favoured. Dominant themes included; collaborative learning, increased microbiology presence, accessibility to education, barriers and administrative issues.

CONCLUSION: Formal diagnostic stewardship educational programmes should be integrated into post-graduate curriculums for both NCHDs and consultants. Focuses for educational interventions include; development of local diagnostic stewardship guidelines, teaching on the cost and accuracy of microbiology tests, senior supervision and role-modelling.

PMID:39888580 | DOI:10.1007/s11845-025-03872-0