Tag: nevin manimala

Tunis Med. 2025 Dec 27;103(10):1501-1510. doi: 10.62438/tunismed.v103i10.6153.

ABSTRACT

INTRODUCTION: Governments faced efficiency crises in healthcare between the 1980s and 1990s, leading to the adoption of Public-Private Partnerships (PPPs) as innovative solutions. This study explores evaluation methodologies, criteria, and research gaps in the healthcare sector.

METHODS: The study utilized Arksey and O’Malley’s framework to conduct a scoping review of public-private partnerships in the health sector, identifying gaps, suggesting new research directions, and clarifying complex concepts using various databases and dictionaries.

RESULTS: A study screened 21 255 papers for inclusion in an analysis, resulting in 26 studies selected for final review. The aim was to understand the contribution of Public-Private Partnerships (PPPs) to healthcare service quality, operational efficiency, and accessibility. The studies were categorized into four: access to quality care, strengthening health programs, improving communication, information, and awareness, and strengthening leadership and financial management. The studies were conducted in various countries, including Africa, Europe, Asia, North America, and South America.

DISCUSSION: Public-private partnerships (PPPs) play a crucial role in the healthcare sector, improving efficiency and quality. They provide greater access to healthcare, especially for lowincome populations, and reduce financial burdens. However, their success depends on effective governance, accountability, and equitable cost-sharing arrangements. Effective communication and promotion are essential for PPP success. Resilient strategies are needed to overcome service disruptions and ensure transparency.

PMID:41879703 | DOI:10.62438/tunismed.v103i10.6153

Tunis Med. 2025 Dec 27;103(10):1488-1494. doi: 10.62438/tunismed.v103i10.5906.

ABSTRACT

INTRODUCTION: Tunisia is affected by the nutritional and dietary transition.

AIM: To compare dietary habits and nutritional profiles between a rural agricultural area Sidi Ali Ben Aoun and an urban area Grand Tunis.

METHODS: This is a comparative cross-sectional study conducted on a sample of 220 participants, including 110 from Ben Aoun and 110 from Grand Tunis. Data were collected based on a pre-established questionnaire about dietary lifestyle and habits survey. Validated scores were used: Alimentary Diversity of Households (SDAM), the Food Consumption Assessment score (SCAM), MEDI-LITE and IPAQ.

RESULTS: The mean age was 37.2±15.3 years for the urban population versus 38.7±13.8 years for the rural population (p=0.43). In the rural population, males were 54.5% vs 48.2%; p=0.34. The occurrence of non-communicable diseases was lower in Ben Aoun (p<0.001). The adopted diet in the region of Ben Aoun aligned with the principles of the Mediterranean diet (MEDI-LITE score was 13.2±1.76 versus 7.35±2.65 in Grand Tunis, p<0.001). Both studied regions had a similar level of food security as assessed by the SDAM (p=0.006). However, household dietary diversity was more present in the rural region: the average SCAM was 11.4±0.79 in the rural group compared to 10±1.31 in the urban group (p<0.001).

CONCLUSION: The rural region (Sidi Ali Ben Aoun) was characterized by a healthier and more diverse diet compared to the urban region (Grand Tunis).

PMID:41879701 | DOI:10.62438/tunismed.v103i10.5906

Tunis Med. 2025 Dec 27;103(10):1474-1479. doi: 10.62438/tunismed.v103i10.5657.

ABSTRACT

INTRODUCTION: The establishment and preservation of optimal oral health in children are largely contingent upon the active participation of their parents and caregivers. These primary figures are instrumental in shaping children’s preventive practices and facilitating necessary treatment, highlighting a critical interface for health interventions. The aim of the study was to evaluate the knowledge of parents in Monastir city, Tunisia, toward their children’s oral health care and prevention of tooth decay and to determine the influence of parental socio-demographic variables on knowledge.

METHODS: A cross-sectional study was conducted in the pediatrician’s waiting room in Monastir, Tunisia. Ethical Clearance was obtained. The sample was made up of 195 parents. The questionnaire was completed to obtain information regarding demographic and education variables, knowledge about oral health prevention, parents’, children’s oral hygiene habits, and risk behaviors. The data collected were subjected to statistical analysis using the Pearson chi-square test and the ANOVA test.

RESULTS: Sixty-three percent of parents who participated in the study had an insufficient knowledge score (score<50%). The mean knowledge score among mothers was slightly greater than fathers. The parents having fewer than three children have better knowledge, and the parents with one child have better scores. Similar results with a higher educational level were statistically significant. The majority of parents recognized many preventive dental aspects like the number of daily brushings, the nature of toothbrush of the child’s dental, effective brushing time, and caries as an infectious disease. However, it was revealed that there was limited knowledge among parents about the importance of early oral health prevention.

CONCLUSION: The oral health knowledge among the participants was relatively low. Parents should get better education in oral health knowledge in order to influence their children to gain better oral health.

PMID:41879699 | DOI:10.62438/tunismed.v103i10.5657

Cardiol Young. 2026 Mar 25:1-7. doi: 10.1017/S1047951126111913. Online ahead of print.

ABSTRACT

BACKGROUND: Non-code dose boluses of epinephrine are utilised in critically ill paediatric patients during periods of hemodynamic deterioration, often with the hopes of preventing a cardiac arrest. Data regarding the physiologic effects of these administrations are limited. The primary aim of this study was to use high-fidelity physiologic data to characterise the effects of intravenous non-code dose bolus epinephrine.

METHODS: Paediatric patients in the cardiac ICU who received non-code dose bolus epinephrine were identified. Those who received fluid boluses or chest compressions within 2 minutes of bolus epinephrine were excluded. Autoregressive integrated moving average analyses with exogenous variables were conducted to characterise the time-dependent changes in hemodynamic indices. Cluster analyses were then conducted to determine patterns in hemodynamic changes associated with bolus epinephrine.

RESULTS: A total of 71 non-code dose bolus epinephrine administrations were included in the final analyses. Heart rate, blood pressure, and renal near infrared spectroscopy all demonstrated statistically significant changes after bolus epinephrine administration. Peak change in each was 40%, 52%, and 9%, respectively, with peaks occurring between 60 seconds and 120 seconds after administration. Three response-based clusters were identified.

CONCLUSION: Non-code dose bolus epinephrine is associated with a significant increase in heart rate, blood pressure, and systemic oxygen delivery. Cluster analysis using the peak change identified distinct clinical clusters.

PMID:41878889 | DOI:10.1017/S1047951126111913

Cancer Control. 2026 Jan-Dec;33:10732748261433284. doi: 10.1177/10732748261433284. Epub 2026 Mar 25.

ABSTRACT

IntroductionThis study investigates the cumulative association between adverse childhood experiences and lung cancer risk and analyzes whether a healthy lifestyle could modify this association.MethodsUsing the UK Biobank, we analyzed 156,798 participants who completed a baseline Mental Health Questionnaire. Lung cancer risk from age 30 was recorded, classifying childhood adversity severity using cumulative categories (none, mild [1-2 types], and severe [≥3 types]). We used multi-variable Cox regression and competing risk models to estimate hazard ratios (HR) between childhood adversity and lung cancer risk. Mediation analyses assessed the role of smoking.ResultsDuring a median follow-up of 41 years from age 30, 677 participants were diagnosed with lung cancer, and 401 died. Lung cancer risk increased progressively with increasing childhood adversity severity. Compared with individuals without childhood adversity, those who experienced any adversity had a 37% higher risk of lung cancer (HR 1.37, 95% CI 1.15-1.63), while those with severe adversity had an 82% higher risk (HR 1.82, 95% CI 1.27-2.62), demonstrating a clear summative effect. Participants who experienced any form of adversity had a 18% increased risk of dying from lung cancer (HR 1.18 [1.05-1.32]). Smoking severity was higher among participants with childhood adversity and accounted for approximately 40% of the observed association. Timely smoking cessation was associated with a substantially lower risk of lung cancer (approximately 75%). However, in the severe adversity group, smoking cessation did not provide a protective effect (HR 0.47 [0.20-1.09]). Smoking cessation significantly reduced lung cancer mortality regardless of adversity level.ConclusionChildhood adversity was associated with a higher risk of lung cancer in a cumulative manner, even after accounting for non-cancer death. Smoking accounted for a substantial proportion of the association between childhood adversity and lung cancer risk, and smoking cessation was associated with lower lung cancer risk across adversity levels. The association between childhood adversity and lung cancer remained robust, warranting further research to explore additional mediating pathways.

PMID:41878887 | DOI:10.1177/10732748261433284

J Am Heart Assoc. 2026 Mar 25:e045411. doi: 10.1161/JAHA.125.045411. Online ahead of print.

ABSTRACT

BACKGROUND: Mortality in adults with congenital heart disease (CHD) is strongly driven by disease complexity. Social determinants of health (SDOH) influence adult CHD (ACHD) health outcomes but their impact on mortality is unclear. This study examined the influence of clinical factors and SDOH on all-cause mortality in patients with ACHD.

METHODS: Single-center retrospective cohort study of patients with ACHD in the Mayo ACHD Registry who had a verifiable residential address between January 1, 2004 and December 31, 2023. Clinical and SDOH indicators were extracted, including insurance type, language, rural-urban commuting area code, and a housing-based socioeconomic index, an individual-level measure of socioeconomic status derived from 4 objective housing characteristics and categorized into quartiles (Q1-Q4). Cox proportional-hazards models were fitted to evaluate associations with mortality, incorporating CHD severity, arrhythmias, SDOH indicators, and other comorbidities. County of residence was included as a random effect, and model discrimination was assessed using the concordance statistic.

RESULTS: Among 6134 patients with ACHD, the mean age was 38±16 years; 51% were male; 78.7% were White and 44.9% had rural residence. Independent predictors of mortality included cyanotic CHD (adjusted hazard ratio [aHR], 5.70 [95% CI, 2.90-11.23]), Fontan palliation (aHR, 4.98 [95% CI, 2.56-9.70]), ventricular tachycardia (aHR, 1.71 [95% CI, 1.16-2.52]), older age at first visit (aHR, 1.05 per year [95% CI, 1.04-1.05]), male sex (aHR, 1.19 [95% CI, 1.03-1.39]), public insurance (aHR, 1.60 [95% CI, 1.35-1.90]), rural residence (aHR, 1.25 [95%, CI 1.06-1.47]), and non-English language (aHR 1.75 [95% CI 1.38-2.23]). The housing-based socioeconomic index quartile was not associated with mortality. The final model achieved a concordance statistic of 0.77.

CONCLUSIONS: Mortality in patients with ACHD is strongly influenced by both clinical factors and SDOH, independent of socioeconomic status. Addressing barriers to care such as language, insurance, and geography is essential for improving ACHD survival particularly in those at increased mortality risk.

PMID:41878868 | DOI:10.1161/JAHA.125.045411

J Am Heart Assoc. 2026 Mar 25:e045222. doi: 10.1161/JAHA.125.045222. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital length of stay (LOS) among patients with heart failure (HF) is relevant for patients, payers, and hospitals. Risk adjustment of LOS supports fair and equitable reimbursement for facilities that may experience more complex cases, oftentimes serving marginalized populations. We aimed to assess factors contributing to HF LOS, building on commonly available information across a wide range of facilities.

METHODS: A Fine and Gray Cox proportional hazards model was fitted to assess hospital LOS using a large US cohort of 89 621 patients with HF hospitalized during the fourth quarter of 2023, controlling for censoring among patients leaving against medical advice and for competing risks of in-hospital all-cause mortality. In our primary aim, we risk-adjusted HF LOS for patient-level sociodemographic and clinical episode characteristics as well as facility-level factors. Model performance was assessed via concordance statistics across derivation and validation cohorts, and risk adjustments were reported as subdistribution hazard ratios. As a secondary aim, we explored facility-level risk-adjusted idiosyncratic differences in LOS.

RESULTS: Sociodemographic, clinical episode, and facility-level characteristics can explain differences in hospital LOS among patients with HF, with most variables being statistically significant. The model exhibited moderate performance with similar results across the derivation (C=0.686 [95% CI, 0.682-0.691]) and validation (C=0.691 [95% CI, 0.686-0.695]) cohorts.

CONCLUSIONS: Excess LOS can be attributed to multiple characteristics at the sociodemographic, clinical episode, and facility levels. We demonstrate a HF LOS risk-adjustment method that does not rely on, though can be expanded with, extensive patient clinical information, supporting more equitable assessments of facility performance and reimbursement.

PMID:41878833 | DOI:10.1161/JAHA.125.045222

Appl Neuropsychol Adult. 2026 Mar 25:1-12. doi: 10.1080/23279095.2026.2645975. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was designed to examine the potential of process variables within the Hopkins Verbal Learning Test – Revised (HVLT-R) to serve as embedded performance validity tests (PVTs).

METHOD: Archival data were collected from 52 adults referred for neuropsychological testing. Performance validity was psychometrically operationalized using a combination of free-standing and embedded PVTs.

RESULTS: Seven HVLT-R process variables individually correctly classified on average 77-79% of the sample. The process variables were combined into a single validity composite (PRO-7), which produced statistically and clinically superior signal detection performance, correctly classifying 83-85% of the sample. The PRO-7 was unrelated to performance on tests of cognitive ability but had extremely strong linear relationship with composite PVTs. Male sex and lower levels of education was associated with failing the PRO-7.

CONCLUSIONS: HVLT-R process variables were statistically and clinically significant predictors of psychometrically operationalized invalid performance and were associated with implausibly low (non-credible) scores on a range of neuropsychological tests. The PRO-7 is a promising alternative approach to traditional PVTs based on the method of threshold. Generalizability of the findings is constrained by the small sample size. Replications are needed to further examine the utility of HVLT-R process variables as PVTs.

PMID:41878828 | DOI:10.1080/23279095.2026.2645975

J Leukoc Biol. 2026 Mar 25:qiag042. doi: 10.1093/jleuko/qiag042. Online ahead of print.

ABSTRACT

Gut microbiota have been increasingly implicated in osteoarthritis (OA), but causal pathways remain unclear. Using the Gut-Immune-Joint Axis framework, we analyzed publicly available genome-wide association study (GWAS) summary statistics from one primary and two secondary datasets to evaluate genetically predicted associations between gut microbiota and OA and to test immune cells as potential mediators. Bidirectional Mendelian randomization (MR) identified five bacterial genera genetically associated with OA in the primary dataset, with no evidence of reverse causality. Two-step MR highlighted Bilophila and the immune cell subtype CD45 on CD33dim HLA DR+ CD11b- as being associated with OA (P < 0.05), and multivariable MR suggested partial mediation by this immune cell (20.0%, P = 0.003). In secondary analyses, two genera were associated with knee OA (KOA) and five with hip OA (HOA), again without reverse genetic effects. Terrisporobacter, the HLA DR+ CD4+ to T cell ratio, and the HLA DR+ CD4+ to lymphocyte ratio were associated with KOA (all P < 0.05), with mediation by the HLA DR+ CD4+ to T cell ratio (-12.0%, P = 0.001). Roseburia and Myeloid DC AC were associated with HOA (all P < 0.05). Collectively, these findings support causal links between specific gut microbial genera and OA and implicate immune-cell traits as mediators, strengthening the Gut-Immune-Joint Axis concept and highlighting potential therapeutic targets.

PMID:41878816 | DOI:10.1093/jleuko/qiag042

Folia Morphol (Warsz). 2026;85:e01726031. doi: 10.5603/fm.110558.

ABSTRACT

BACKGROUND: To evaluate the morphological characteristics of the pterygoid process – including pneumatization and sclerosis – alongside vidian canal (VC) type and length in patients with nasopharyngeal carcinoma (NPC) compared to healthy controls using computed tomography (CT).

MATERIALS AND METHODS: This retrospective study included 200 subjects, comprising 38 patients with histopathologically confirmed NPC and 162 age- and sex-matched healthy controls. All CT scans were acquired using a standardized protocol with thin-slice axial images and multiplanar reconstructions. Evaluated features included pterygoid process pneumatization and sclerosis, VC type (classified as Type 1-3), and VC length bilaterally.

RESULTS: Pterygoid process pneumatization showed no statistically significant difference between the NPC and control groups (right: 21.1% vs 24.7%, p = 0.794; left: 21.1% vs 18.5%, p = 0.898). In contrast, right-sided pterygoid plate sclerosis was significantly more frequent in NPC patients (68.4%) than in controls (4.9%) (p < 0.005). Significant differences in VC types were found between groups. Type 3 canals were more common in NPC patients (right: 39.5%, left: 39.5%) than in controls (right: 21.0%, left: 23.5%), while Type 2 was reduced in the NPC group (right and left: 15.8%) vs controls (right: 33.3%, left: 34.6%); significant for both sides (right: p = 0.024; left: p = 0.038). VC length was also significantly greater in the NPC group (right: 14.18 mm; left: 13.08 mm) compared to controls (right: 12.25 mm; left: 12.35 mm). The VC length positively correlated with age (right: r = 0.267; left: r = 0.339).

CONCLUSIONS: Sclerosis of the right pterygoid plate and an increased prevalence of Type 3 VCs were significantly associated with NPC. Anatomical variations in VC type and length may have diagnostic implications in radiological interpretation and radiotherapy planning in NPC patients.

PMID:41878812 | DOI:10.5603/fm.110558