Tag: nevin manimala

Front Public Health. 2025 Aug 18;13:1627464. doi: 10.3389/fpubh.2025.1627464. eCollection 2025.

ABSTRACT

INTRODUCTION: Structured, well-being interventions are under-researched in non-Western workplaces. This study evaluates The Good Life training program-a participatory, multi-component training intervention-on employee well-being, engagement and stress in South Africa.

METHODS: Employing an exploratory, quasi-experimental, explanatory sequential mixed-methods design, we collected quantitative data from 50 South African respondents across three delivery formats (four half-days online, two full-days in classroom, and four half-days in classroom) at pre-training and 3 months post-training using five validated scales (PSS-4, UWES-3, SWLS, FS, WEMWBS-14). No concurrent control group was retained due to attrition and contamination; thus, causal inferences are cautious. Qualitative data were gathered via semi-structured interviews with a purposive subsample of 15 participants to elucidate mechanisms of change.

RESULTS: Two full-day workshops led to significant improvements in overall well-being and work engagement, whereas the online format produced a significant boost in well-being only. The half-day format showed no statistically significant changes. Qualitative findings highlighted immersive peer interaction, structured reflection and managerial support as core drivers of impact.

DISCUSSION: Immersive, HR-facilitated training shows promise for enhancing well-being and engagement in South African workplaces. Future research should employ randomized controlled designs, larger samples and objective measures (e.g., absenteeism, physiological indicators) to substantiate and extend these preliminary findings.

PMID:40900692 | PMC:PMC12399526 | DOI:10.3389/fpubh.2025.1627464

Health Sci Rep. 2025 Sep 1;8(9):e71202. doi: 10.1002/hsr2.71202. eCollection 2025 Sep.

ABSTRACT

BACKGROUND AND AIMS: Frailty is one of the most common syndromes in old age. This syndrome, associated with adverse health outcomes and increased economic costs, can affect the quality of life of elderly people. This study investigates the prevalence and determinants of frailty in community-dwelling Iranian older adults.

METHODS: This analytical cross-sectional study was conducted over 5 months among the retired elderly people (> 60 years) in Isfahan. The tools used in this study included a demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), an assessment of polypharmacy, and the Edmonton Frail Scale. Data were analyzed using statistical tests in SPSS software.

RESULTS: The prevalence of frailty, based on the Edmonton Frail Scale, was 17.4%. No statistically significant difference in mean frailty scores was observed between men and women (p = 0.286). Logistic regression analysis showed that older age (B = 0.067, OR = 1.07, 95% CI: 1.01-1.15), lower education (B = -2.66, OR for MSc = 0.07, 95% CI: 0.00-0.74), polypharmacy (B = 1.82, OR = 6.16, 95% CI: 2.8-13.50), and poor sleep quality (B = 0.59, OR = 1.80, 95% CI: 0.88-3.78) were significantly associated with a higher likelihood of frailty (p < 0.05).

CONCLUSION: This study’s results indicated that age, education, polypharmacy, and poor sleep quality are associated with an increased risk of frailty in Iranian elderly people. Therefore, timely screening and intervention are recommended to identify these factors and prevent their irreversible physical, psychological, and financial consequences.

PMID:40900684 | PMC:PMC12399986 | DOI:10.1002/hsr2.71202

Adv Neonatal Care. 2025 Sep 2. doi: 10.1097/ANC.0000000000001289. Online ahead of print.

ABSTRACT

BACKGROUND: Feeding intolerance can hinder enteral nutrition in infants, often necessitating transpyloric tube feeding. However, the success of transpyloric tube placement varies.

PURPOSE: To compare the rate of correct transpyloric tube placement in infants with and without gastric air insufflation, and to assess complications associated with postpyloric feeding.

METHODS: A randomized controlled trial was conducted in a tertiary neonatal unit of a public teaching hospital. The estimated sample size included 11 participants in the intervention group (IG) and 11 in the control group (CG). In the IG, transpyloric tube insertion was aided by gastric air insufflation. Correct positioning was defined as the distal end of the tube reaching the third or fourth portion of the duodenum, as confirmed by radiography.

RESULTS: The success rate of correct tube placement was the same in both groups (45.4% vs 45.4%, P = 1.000). Two infants experienced complications (necrotizing enterocolitis and jejunal perforation), neither of which were related to the procedure.

IMPLICATIONS FOR PRACTICE AND RESEARCH: There were no significant differences between the IG and CG in terms of birth weight (1030 g vs 985 g, P = .895), gestational age (27 weeks vs 28 weeks, P = .973), or age at the time of the procedure (28 days vs 39 days, P = .224). The rate of jejunal tube placement was also statistically similar (27.7% vs 9.1%, P = .269). Gastric air insufflation did not increase the rate of successful transpyloric tube placement. Observed complications were not attributable to the procedure.

PMID:40900658 | DOI:10.1097/ANC.0000000000001289

JAMA Netw Open. 2025 Sep 2;8(9):e2530123. doi: 10.1001/jamanetworkopen.2025.30123.

ABSTRACT

IMPORTANCE: Children born very preterm have increased health care use. However, there is a lack of research using contemporary national data quantifying hospitalizations after neonatal discharge to inform counseling of families and health care provision.

OBJECTIVE: To examine hospital admissions after neonatal discharge and before 2 years of age among children born at less than 32 weeks’ gestation and assess associations between hospitalization and neonatal morbidities.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from all neonatal units and admitting hospitals in England and Wales supplied from the National Neonatal Research Database, linked with the Hospital Episode Statistics Admitted Patient Care database in England and the Patient Episode Database for Wales. Participants were children born at 22 through 31 weeks’ gestation from January 1, 2013, to December 31, 2018, who were admitted to neonatal units and discharged home. Analysis was performed from June 26, 2024, to June 3, 2025.

EXPOSURES: Gestational age; sex; small-for-gestational-age status; season at time of neonatal discharge; neonatal morbidities, including bronchopulmonary dysplasia (BPD), severe necrotizing enterocolitis (NEC), and neonatal brain injury; and number of morbidities.

MAIN OUTCOMES AND MEASURES: Prevalence of hospital admission and total calendar days hospitalized across all admissions. Negative binomial regression was used to calculate the adjusted incidence rate ratio (AIRR) for total calendar days hospitalized, adjusting for gestational age, sex, small for gestational age, and season of neonatal discharge.

RESULTS: Among the 39 413 children included (21 360 [54.2%] male; median gestational age at birth, 29 weeks [IQR, 27-31 weeks]), 26 276 (66.7%) did not have major neonatal morbidities. A total of 26 498 children (67.2%) had at least 1 episode of hospitalization between neonatal discharge and the age of 2 years. This ranged from 6138 of 10 444 children born at 31 weeks’ gestation (58.8%) to 450 of 517 born at less than 24 weeks (87.0%). The median number of total calendar days hospitalized across admissions increased from 1 day (IQR, 0-5 days) for children born at 31 weeks’ gestation to 8 days (IQR, 3-21 days) for those born at less than 24 weeks. Neonatal morbidities were associated with increased total days hospitalized; the AIRR for total hospitalization days for children with vs without BPD was 1.80 (95% CI, 1.72-1.88), for those with vs without severe NEC was 1.88 (95% CI, 1.65-2.15), and for those with vs without neonatal brain injury was 1.46 (95% CI, 1.36-1.57). Combinations of morbidities were associated with total expected days hospitalized: the model estimated that a child born at less than 24 weeks’ gestation with 3 morbidities would have 40.6 days (95% CI, 34.8-44.3 days) of hospitalization before age 2 years.

CONCLUSIONS AND RELEVANCE: In this cohort study of children born very preterm discharged from neonatal care in England and Wales, most children experienced hospitalization before their second birthday, and hospitalizations were associated with lower gestational age and neonatal morbidities. These findings can aid counseling and suggest that further research should investigate interventions to prevent hospitalization in this population.

PMID:40900591 | DOI:10.1001/jamanetworkopen.2025.30123

Sao Paulo Med J. 2025 Sep 1;143(6):e20252853. doi: 10.1590/1516-3180.2025.2853.13062025. eCollection 2025.

ABSTRACT

BACKGROUND: Functional constipation is characterized by a set of symptoms including hardened stools, abdominal discomfort, a tendency to retain stools, and eventual fecal incontinence. This condition negatively affects the quality of life of the affected individuals and has potential psychosocial repercussions.

OBJECTIVES: To assess the epidemiological, clinical, and therapeutic aspects of functional constipation in patients treated at a pediatric gastroenterology outpatient clinic.

DESIGN AND SETTING: Descriptive observational study with a quantitative approach using secondary data collected from the medical records of a pediatric gastroenterology outpatient clinic in Criciúma between 2018 and 2023.

METHODS: This study was approved by the Human Research Ethics Committee of the Universidade do Extremo Sul Catarinense (Unesc) under number 6.788.465. Sociodemographic, clinical, and therapeutic variables were evaluated in 67 patients aged 0-18 years who were diagnosed with Functional Constipation (ICD K590) during the study period. Data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS), version 25.0.

RESULTS: There was a predominantly female profile (36; 53.7%), with an average age at diagnosis of 7.75 years (± 3.96). The main symptoms included abdominal pain (52, 77.6%) and hardened stools (42, 62.7%), with an average interval of 4 days between bowel movements. Treatment consisted of macrogol prescriptions (60, 89.6%), with most patients showing complete symptom improvement (49, 73.1%).

CONCLUSION: Analysis of medical records highlighted the need for continuous monitoring and targeted interventions, considering the variability of symptoms and individual characteristics of patients.

PMID:40900577 | DOI:10.1590/1516-3180.2025.2853.13062025

JAMA Psychiatry. 2025 Sep 3. doi: 10.1001/jamapsychiatry.2025.2039. Online ahead of print.

ABSTRACT

IMPORTANCE: Lithium augmentation is an effective treatment for patients with major depression after inadequate antidepressant response, but therapeutic outcomes vary considerably between individuals. Molecular studies may provide novel insights into treatment prediction and guide personalized therapy.

OBJECTIVE: To investigate the association of polygenic risk scores (PRS) for schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BIP) with clinical outcomes after lithium augmentation.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed prospectively assessed treatment outcomes in patients who underwent lithium augmentation. Disorder-specific PRS were calculated using well-powered genome-wide association study summary statistics. Participants were recruited from 13 psychiatric hospitals, primarily in the greater Berlin area, between 2008 and 2020. They were patients with MDD who showed inadequate response to at least 1 antidepressant, a baseline score of 12 or more on the 17-item Hamilton Depression Rating Scale (HAMD-17), adequate treatment duration (≥4 weeks), and no diagnostic or co-medication changes. Data analysis was conducted between June 2022 and November 2023.

EXPOSURE: Polygenic risk scores for MDD, SCZ, or BIP.

MAIN OUTCOMES AND MEASURES: Response was defined as a 50% or greater reduction in HAMD-17 score, remission as a HAMD-17 score of 7 or less. Cox proportional hazards models, adjusted for ancestry, demographic, and clinical covariates, were used to estimate hazard ratios (HRs) for favorable outcomes.

RESULTS: Among 193 patients (mean [SD] age, 49.5 [13.4] years; 118 [61.1%] female and 75 [38.9%] male), higher BIP-PRS were associated with both response (HR, 1.29; 95% CI, 1.02-1.63; P = .03) and remission (HR, 1.52; 95% CI, 1.14-2.04; P = .004), explaining 2.51% and 4.53% of the variability in treatment outcomes, respectively. Individuals in the highest tertile of the BIP-PRS distribution had a 2.02-fold (95% CI, 1.15-3.53) higher likelihood of response and a 2.26-fold (95% CI, 1.17-4.36) higher chance of remission compared with those in the lowest tertile. Additionally, lower MDD-PRS was associated with better response to lithium augmentation (HR, 0.81; 95% CI, 0.66-1.00; P = .048; Nagelkerke R2 = 1.99%). No significant associations were observed between SCZ-PRS and response (HR, 1.00; 95% CI, 0.80-1.24; P = .97) or remission (HR, 1.12; 95% CI, 0.85-1.48; P = .42).

CONCLUSIONS AND RELEVANCE: Individuals carrying a higher polygenic burden for BIP and lower polygenic risk for MDD are more likely to benefit from lithium augmentation. Our findings suggest that disease-related PRS may aid in developing treatment prediction models for lithium augmentation response in depression, potentially informing clinical decision-making.

PMID:40900576 | DOI:10.1001/jamapsychiatry.2025.2039

JAMA Surg. 2025 Sep 3. doi: 10.1001/jamasurg.2025.3221. Online ahead of print.

ABSTRACT

IMPORTANCE: Traumatic rib fractures are associated with significant morbidity, including pulmonary complications and prolonged opioid use. Identifying adjunctive treatments that can reduce opioid consumption without compromising safety remains a clinical priority, particularly in nonintubated trauma patients.

OBJECTIVE: To evaluate whether adding dexmedetomidine to standard multimodal analgesia reduces opioid consumption in nonintubated patients in the intensive care unit (ICU) with traumatic rib fractures. It was hypothesized that adjunctive dexmedetomidine would reduce opioid use and improve numerical pain scores.

DESIGN, SETTING, AND PARTICIPANTS: This prospective, randomized, double-blind, placebo-controlled clinical trial was conducted from July 2021 to October 2023. Data were analyzed during January 2024. The study took place at a single academic level I trauma center ICU. Participants included nonintubated adult trauma patients (18 years or older) with 3 or more rib fractures who were admitted to the ICU. Exclusion criteria included a Glasgow Coma Scale score less than 14, bradycardia, hypotension, pregnancy, cirrhosis, chronic opioid use, or inability to consent. Of 41 enrolled patients, 19 received dexmedetomidine (46.3%).

EXPOSURE: Continuous intravenous infusion of dexmedetomidine (0.4 to 0.6 µg/kg per hour) or placebo (normal saline) for up to 48 hours, in addition to standard multimodal pain management.

MAIN OUTCOMES AND MEASURES: The primary outcome was the numerical pain score (NPS) over 48 hours. Secondary outcomes included oral morphine equivalents (OME) at 24 and 48 hours and pulmonary complications.

RESULTS: Among 41 patients (median age, 62 years; median injury severity score, 20), no significant differences were found in baseline characteristics between groups. Mean OME at 24 hours was 59.2 mg (dexmedetomidine) vs 54.9 mg (placebo) and 125.5 mg vs 87.1 mg at 48 hours. Median NPS was 4 in both groups. Pulmonary complication rates and ICU length of stay were also similar. Dexmedetomidine was discontinued in 47.4% of patients due to adverse events or patient request.

CONCLUSIONS AND RELEVANCE: Adjunctive dexmedetomidine did not reduce opioid consumption, improve pain scores, or lower pulmonary complication rates in nonintubated patients in the ICU with traumatic rib fractures. These findings do not support routine use of dexmedetomidine for analgesia in this patient population.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05321121.

PMID:40900569 | DOI:10.1001/jamasurg.2025.3221

Eur J Gastroenterol Hepatol. 2025 Jul 14. doi: 10.1097/MEG.0000000000003030. Online ahead of print.

ABSTRACT

Tegoprazan, a novel potassium-competitive acid blocker, has emerged as a potential alternative to proton pump inhibitors (PPIs) for the treatment of erosive esophagitis (EE), especially in light of long-term safety concerns associated with PPIs. This study aimed to assess the efficacy and safety of tegoprazan compared to PPIs in patients with EE. A systematic review and meta-analysis were conducted following preferred reporting items for systematic reviews and meta-analyses guidelines, including three randomized controlled trials with a total of 658 patients diagnosed with EE. The primary outcomes were cumulative endoscopic healing rates across 4-8 weeks and at 4 and 8 weeks, while secondary outcomes included any adverse events, drug-related treatment-emergent adverse events (TEAEs), and serious adverse events (SAEs). Tegoprazan demonstrated noninferior healing rates at 4 weeks [relative risk (RR) = 1.05, 95% confidence interval (CI): 0.96-1.16; P = 0.28; I² = 51%] and 8 weeks (RR = 1.01, 95% CI: 0.96-1.06; P = 0.73; I² = 0%) compared to PPIs. There was no statistically significant difference in the overall incidence of adverse events or SAEs (RR = 1.19, 95% CI: 0.92-1.53; P = 0.19; I² = 24%). However, a significantly higher rate of drug-related TEAEs was observed in the tegoprazan group (RR = 1.23, 95% CI: 1.03-1.48; P = 0.02; I² = 0%). In conclusion, tegoprazan is an effective treatment option for EE, with comparable efficacy to PPIs, though further studies are warranted to evaluate its long-term safety before routine clinical use.

PMID:40900566 | DOI:10.1097/MEG.0000000000003030

Eur J Gastroenterol Hepatol. 2025 Jul 14. doi: 10.1097/MEG.0000000000003031. Online ahead of print.

ABSTRACT

OBJECTIVE: Most of the existing instruments assessing quality of care (QoC) are based on the perception of healthcare providers that may differ from that of healthcare users. We aimed to measure QoC through the patient’s eyes in a Greek cohort of patients with inflammatory bowel disease (GR QUOTE-IBD) and to investigate putative sociodemographic and disease-related QoC predictors.

METHODS: GR QUOTE-IBD questionnaire was delivered to patients at their regular follow-up visit, and adequate time was offered to fill it in. The outcome of the analysis was associated with epidemiological and disease-related characteristics. Statistical analysis was performed with SPSS (version 29, SPSS Inc., Chicago, Illinois, USA).

RESULTS: GR QUOTE-IBD questionnaire was completed by 150 patients from three IBD clinics, 93 with Crohn’s disease (CD), with a median disease duration of 10 years (range 0.6-43 years). Quality Index (QI) for total care was >9 in all three hospitals. Quality deficit QI <9 was found only for accessibility to IBD care in two of three clinics. Autonomy in decision-making was rated as the least important dimension of QoC from the patients’ perspective. A positive association was found between CD diagnosis and QI scores for total care (P = 0.013). Steroid treatment over two times in lifetime was negatively associated with QI scores for total care (P = 0.019).

CONCLUSION: Total QoC from patients’ perspective is high in Crete. CD and disease severity seem to affect patients’ perceptions of IBD care. Gastroenterologists in Crete should improve accessibility to IBD care and empower patients’ involvement in shared decision-making.

PMID:40900548 | DOI:10.1097/MEG.0000000000003031

Rev Bras Enferm. 2025 Jun 27;78Suppl 1(Suppl 1):e20240245. doi: 10.1590/0034-7167-2024-0245. eCollection 2025.

ABSTRACT

OBJECTIVES: to develop and validate an educational booklet on HIV Pre-Exposure Prophylaxis (PrEP).

METHODS: quantitative validation study aimed at developing and validating an educational booklet by experts and the target audience. For validation with experts, we used the Health Education Content Validation Index developed in a virtual environment. For the target audience, we used a questionnaire with questions related to organization, writing style, appearance, and motivation.

RESULTS: thirty-two experts and 13 PrEP users participated in the study. The analysis was structured on the principles of descriptive statistics, and domains that presented a Content Validity Index equal to or greater than 0.80 were considered satisfactory. The final version of the material was made available in online and printed formats.

CONCLUSIONS: the educational booklet was developed and validated by experts and the target audience, serving as an educational tool to support self-care and awareness of HIV prevention for PrEP users.

PMID:40900539 | DOI:10.1590/0034-7167-2024-0245