Tag: nevin manimala

JMIR Res Protoc. 2025 Dec 12;14:e67193. doi: 10.2196/67193.

ABSTRACT

BACKGROUND: Globally, around 800,000 people die by suicide annually, with 77% of these deaths occurring in low- and middle-income countries. Suicidal ideation, frequently observed among adolescents, is directly linked to suicide attempts. Pakistan has witnessed a marked escalation in suicide rates in recent years, with Gilgit-Baltistan (GB) reporting the highest incidence. Extensive research indicates that tailored suicide prevention strategies can mitigate suicidal ideation, attempts, and related fatalities.

OBJECTIVE: This study aims to validate and evaluate the efficacy of suicide prevention programs, RAAHI (the guide) and safeTALK, tailored to the cultural and social context of GB, Pakistan, in preventing suicidal ideation and improving the mental well-being of school-going adolescents.

METHODS: The investigation will assess the efficacy of the RAAHI intervention among 267 adolescents across 4 private schools in GB using an interrupted time-series design with a pre-post test framework. The first intervention, RAAHI, a suicide literacy module, is designed to empower participants with the knowledge and skills to recognize signs of suicidal ideation, engage them empathetically, and connect individuals in crisis with appropriate support. The second intervention, safeTALK, a 4-hour educational workshop, incorporates presentations, videos, discussions, and interactive sessions to teach participants the tell, ask, listen, and keep safe steps. Outcome measures include changes in knowledge, confidence, willingness to intervene, and help-seeking behaviors, analyzed using descriptive statistics, 2-tailed paired t tests, and ANOVA. Ethics approval was granted by the Aga Khan University Ethics Review Committee (2023-8509-24844).

RESULTS: As of April 2025, 267 participants have been recruited from 2 of the 4 schools; data collection commenced in March 2025 and is projected to conclude in August 2025. Final results are expected to be published by February 2026.

CONCLUSIONS: This study will offer critical insights into the adaptation and effectiveness of the RAAHI suicide prevention intervention in a low-resource, culturally specific setting. The findings are anticipated to inform scalable suicide prevention initiatives in school settings across Pakistan and similar low- and middle-income contexts, ultimately contributing to reduced suicidal ideation and attempts among adolescents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/67193.

PMID:41385277 | DOI:10.2196/67193

Eur J Ophthalmol. 2025 Dec 12:11206721251406426. doi: 10.1177/11206721251406426. Online ahead of print.

ABSTRACT

PurposeThis study aimed to develop a reproducible manual segmentation method using a computer-assisted technique and to (1) compare extraocular muscle volumes between TED patients and healthy controls and (2) assess the intra- and inter-observer reliability of this method.MethodsA retrospective study of MRI scans was performed on 13 patients previously diagnosed with TED and 16 healthy controls. Image segmentation and the derived muscle volume measurements were performed by two independent observers using the software 3D slicer. The groups compared muscle volumes, and intra- and inter-observer reproducibility was assessed.ResultsA statistically significant difference in muscle volume was demonstrated; the mean medial and lateral recti volumes in the TED group were 1342.75 and 1066.7 mm³, respectively, compared to 787.67 and 764.3 mm³ in the control group. The segmentation protocol appears to have good inter-observer reliability. The intraclass correlation coefficient was good for inter-observer measures of the medial recti and intra-observer measures of both horizontal recti.ConclusionThis volumetric analysis verifies that structural MRI contains useful information regarding muscle volume in patients with TED compared to healthy controls. Building a dataset of segmented MRI volumes will help facilitate the creation of supervised machine-learning models for automated volumetric analysis of the extraocular muscles.

PMID:41385270 | DOI:10.1177/11206721251406426

Med Care. 2026 Jan 1;64(2S Suppl 2):S149-S154. doi: 10.1097/MLR.0000000000002212. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND: Gulf War illness is a chronic multisymptom illness impacting Veterans of the 1990-1991 Persian Gulf War. Toxic exposures are believed to be associated with the condition, but little is known about how multiple types of exposures can impact the disease. The aim of this study is to determine if a positive association exists between the multiplicity of exposure types and symptom severity score.

METHODS: A cross-sectional survey design was used in which Persian Gulf Veterans completed a questionnaire with items related to symptom severity and types of self-reported toxic exposures. Linear regression models were used to examine the association between the number of types of toxic exposures and symptom severity scores. We also examined the association between each type of reported exposure and symptom severity score.

RESULTS: Veterans with a greater number of self-reported toxic exposures reported higher scores on symptom severity. While no individual exposure type reached a statistically significant association with symptom score, radiation and biological agent exposures showed the strongest association.

DISCUSSION: We found a positive association between the number of toxic exposure types and total symptom severity. Veterans who self-reported having Gulf War Illness also reported more types of toxic exposures compared with Veterans who did not report having Gulf War Illness. Radiation and biological agent exposure showed the strongest positive association with symptom scores, yet very few Veterans reported isolated exposure of these types. Our findings suggest that cumulative exposure to multiple types of toxins could be associated with the development and severity of Gulf War Illness symptoms.

PMID:41385260 | DOI:10.1097/MLR.0000000000002212

Indian J Ophthalmol. 2025 Dec 12. doi: 10.4103/IJO.IJO_676_25. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the effect of fluorescein on intraocular pressure (IOP) measurements using Goldmann applanation tonometry (GAT). The study compared IOP readings with and without fluorescein to determine its influence on measurement accuracy in clinical practice.

METHODS: This cross-sectional study included 39 patients (78 eyes). IOP was measured three times under each condition: fluorescein-free with green light and fluorescein-aided with cobalt blue light. The prespecified primary comparison was between the first fluorescein-free reading and the first fluorescein-aided reading, separated by approximately 1 minute (the time needed to apply fluorescein). Statistical analysis (repeated-measures ANOVA for within-series change; Wilcoxon signed-rank tests for paired comparisons) was used to compare measurements, while corneal astigmatism, keratometry, and central corneal thickness were assessed for their potential influence on discrepancies. A sensitivity analysis excluding patients with >3.0 D corneal astigmatism was conducted.

RESULTS: No significant difference was found between the first fluorescein-free and first fluorescein-aided IOP measurements (Wilcoxon P = 0.75; mean difference +0.04 mmHg). Consecutive measurements showed significant IOP reductions within each group, attributed to mechanical effects of the tonometer (repeated-measures ANOVA P < 0.01). Corneal parameters, including central corneal thickness and keratometry, did not significantly affect the differences. Results were unchanged after excluding patients with >3.0 D astigmatism.

CONCLUSIONS: Fluorescein does not significantly affect IOP measurements using GAT, supporting fluorescein-free measurement as a viable alternative in routine practice. Further research is needed to evaluate its application in cases of high astigmatism or altered corneal geometry.

PMID:41385238 | DOI:10.4103/IJO.IJO_676_25

JAMA Netw Open. 2025 Dec 1;8(12):e2548211. doi: 10.1001/jamanetworkopen.2025.48211.

ABSTRACT

IMPORTANCE: Advances in medical care and clinician experience have lowered the gestational age at which resuscitation is considered for extremely premature infants. Some centers now offer trials of resuscitation at 21 weeks’ gestational age. Minimal data are available to guide this practice.

OBJECTIVE: To describe morbidities and outcomes of resuscitated infants at 21 weeks’ gestational age.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series included all infants born at 21 weeks’ gestational age in a single-center level IV academic neonatal intensive care unit (NICU) at the University of Iowa from January 1, 2020, through February 28, 2025. Data were analyzed from April 1 to August 15, 2025.

EXPOSURE: Extremely preterm birth at a gestational age of 21 weeks.

MAIN OUTCOMES AND MEASURES: Demographic characteristics, therapies, morbidities, and test results were collected throughout hospitalizations from electronic medical records for extremely premature infants who received any attempted resuscitation and their mothers, including hourly cardiorespiratory data for the first 72 hours for infants admitted to the NICU. Postdischarge outcomes through the end of the study period were collected as available.

RESULTS: Twenty-two infants were born alive at 21 weeks’ gestational age during the study period, and an additional 230 were stillborn. Resuscitation was attempted in 17 (77%) of the infants born alive; of these, 6 (35%) survived to discharge from the NICU (earliest in 2021; youngest, 21 weeks, 0 days; birth weight, 285-430 g), 1 (6%) remained hospitalized, and 10 (59%) died. All births were inborn vaginal deliveries. Infants who survived (including the infant who remained hospitalized) were less likely part of a multiple gestation compared with those who did not (1 of 7 [14%] vs 6 of 10 [60%]) and more likely exposed to a complete course of antenatal corticosteroids (3 of 7 [43%] vs 0 of 10). Most of the infants who survived had early cardiorespiratory instability treated with vasoactive medications and/or inhaled nitric oxide (5 [71%]). Three (43%) had no or grade 1 intraventricular hemorrhage (IVH), 2 (29%) had grade 2 IVH, and 2 had severe (grade 3) IVH (29%); none required neurosurgical intervention. The 6 infants who were discharged received low-flow supplemental oxygen, and none required tracheostomy. Rates of resuscitation increased during the study period.

CONCLUSIONS AND RELEVANCE: In this case series of infants born alive at 21 weeks’ gestational age, selective resuscitation resulted in 35% survival to discharge, in some cases with minimal morbidities. These descriptive data may prompt prospective study and reporting at this gestational age. Long-term outcome data are needed.

PMID:41385227 | DOI:10.1001/jamanetworkopen.2025.48211

JAMA Netw Open. 2025 Dec 1;8(12):e2548936. doi: 10.1001/jamanetworkopen.2025.48936.

ABSTRACT

IMPORTANCE: Studies of nursing home (NH) residents show lower than expected antiretroviral therapy (ART) use, but it is unclear whether ART use changes across the transition from the community to long-term NH stay.

OBJECTIVE: To examine changes in ART use across the transition from the community to long-term NH stay.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined long stays in US NHs for people with HIV in a sample of 5% of Medicare claims from 2014 to 2019. Stays were at least 30 days long, had at least 3 months between multiple stays, and were for those continuously enrolled in Medicare for the stay and 6 months before. Analysis was completed in May 2025.

EXPOSURES: Admission year demographics included age, race and ethnicity (non-Hispanic Black, non-Hispanic White, and other [American Indian or Alaska Native, Asian or Pacific Islander, other, and unknown]), binary sex, Medicaid eligibility, whether the stay was preceded by a skilled nursing stay, and whether disability was Medicare original eligibility. NH characteristics included for-profit status, census region, and facility quality rating.

MAIN OUTCOMES AND MEASURES: Linear regression estimated changes in the proportion of days covered by 3-drug ART, and hierarchical multinomial logistic regression estimated the risk of never having, losing, or gaining ART vs always having it, across the transition from the community to long-term NH stay.

RESULTS: There were 713 long NH stays for 657 people with HIV (mean [SD] age, 61.0 [11.4] years) across 598 facilities; 271 stays (38%) were for people aged 65 years and older. Only 23 individuals lost ART (3%), 97 individuals (14%) gained ART, 185 individuals (26%) never had ART, and 408 individuals (57%) always had ART across the transition. Excluding those who lost ART, all other groups were mostly men (never, 132 men [71%]; always, 289 men [71%]; gained, 72 men [74%]) and Black (never, 85 individuals [46%]; always, 237 individuals [58%]; gained, 58 individuals [60%]). There was an increase in the proportion of days covered (mean intercept α = 13.92; 95% CI, 9.57-18.29). Compared with always having ART, Black race (relative risk [RR], 0.52; 95% CI, 0.35-0.77), polypharmacy (RR, 0.41; 95% CI, 0.23-0.74), and disability as original Medicare eligibility (RR, 0.47; 95% CI, 0.29-0.77) were associated with lower risk of never having ART. For-profit facilities were associated with higher risk (RR, 1.63; 95% CI, 1.03-2.59) of never having ART. Polypharmacy was associated with lower risk of gaining ART (RR, 0.15; 95% CI, 0.05-0.49).

CONCLUSIONS AND RELEVANCE: These findings suggest that long-term NH stays may be associated with improved ART use among people with HIV because most stays without ART never had ART before admission.

PMID:41385225 | DOI:10.1001/jamanetworkopen.2025.48936

JAMA Netw Open. 2025 Dec 1;8(12):e2549457. doi: 10.1001/jamanetworkopen.2025.49457.

ABSTRACT

IMPORTANCE: Hospitalization in older adults leads to a decline in daily living activities, and countries experiencing demographic aging face an increase in hospitalization rates and health care costs. Health care systems that can reduce the probability of ambulatory care-sensitive condition (ACSC) hospitalization among older populations are needed.

OBJECTIVE: To comprehensively assess the association between regional factors and the probability of ACSC hospitalization among older adults and the extent to which regional factors explain this probability.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study in Hokkaido prefecture, Japan, focused on participants aged 65 years or older who were covered by community-based or older-age health insurance (all adults aged 72 years and older) and had at least 2 medical visits between July and December 2022. The patients were followed up until December 2023.

EXPOSURE: Explanatory variables included municipal-level factors of residence categorized according to the Andersen behavioral model, which conceptualizes health service use as a function of predisposing, enabling, and need factors. At the municipal level, 9 predisposing, 11 enabling, and 10 need factors were included.

MAIN OUTCOMES AND MEASURES: The primary outcome was the binary variable of whether an individual was hospitalized for ACSCs between January and December 2023.

RESULTS: Among the 1 272 960 participants (median [IQR] age, 78 [73-84] years; 762 118 [59.9%] women), 51 623 (4.1%) had ACSC hospitalizations: 9492 for acute conditions, 41 271 for chronic conditions, and 3779 for vaccine-preventable conditions. A multilevel logistic regression analysis with individuals for level 1 and municipalities for level 2 revealed that 6.0% of the variance was attributable to municipal factors. Lower odds of hospitalization were associated with more clinics (odds ratio [OR], 0.933; 95% CI, 0.881-0.988), long-term care rehabilitation beds (OR, 0.996; 95% CI, 0.993-0.999), and higher financial power (OR, 0.359; 95% CI, 0.236-0.548); home care support clinics showed a similar direction (OR, 0.807; 95% CI, 0.636-1.024). Higher odds were associated with more nursing home beds (OR, 1.004; 95% CI, 1.000-1.009), a higher proportion of older adults living alone (OR, 1.073; 95% CI, 1.032-1.116), and a higher income (OR, 1.0004; 95% CI, 1.0001-1.0006).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults in Japan, ACSC hospitalizations were less likely in municipalities with more outpatient, in-home, and rehabilitation care resources and stronger financial capacity and more likely in those with more nursing home beds, greater social isolation, and higher income levels.

PMID:41385224 | DOI:10.1001/jamanetworkopen.2025.49457

JAMA Netw Open. 2025 Dec 1;8(12):e2549463. doi: 10.1001/jamanetworkopen.2025.49463.

ABSTRACT

IMPORTANCE: There is widespread enthusiasm about generative artificial intelligence (AI), but no systematic evidence on its implementation across health care organizations.

OBJECTIVE: To describe adoption of generative AI integrated with the electronic health record (EHR) by nonfederal acute care hospitals, how adoption relates to experience using and evaluating predictive AI, and hospital characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This survey study of nonfederal acute care US hospitals used the 2024 American Hospital Association (AHA) Information Technology (IT) Supplement survey. The survey was completed by individuals most knowledgeable about health IT at the participating hospitals.

EXPOSURES: Experience with predictive AI, source of predictive AI, local evaluation practices (evaluation for accuracy and bias as well as postdeployment evaluation), and EHR developer were collected from the 2024 AHA IT Supplement. Hospital characteristics, including critical access hospital status, multihospital system membership, and teaching status, were collected from the 2024 AHA Annual Survey. Hospital operating margins, uncompensated care burden, and percentage of discharges from Medicaid were collected from the 2022 Medicare Cost Report.

MAIN OUTCOMES AND MEASURES: Whether the hospital was an early adopter of generative AI integrated with their EHR (currently used generative AI), fast follower (planned to use in the next year), or delayed adopter (planned to use in 5 years, no plans, or do not know).

RESULTS: A total of 2174 hospitals (1003 [weighted percentage, 50.4%] small; 1382 [weighted percentage, 60.8%] urban core-based; 1668 [weighted percentage, 68.8%] part of a multihospital system) responded to questions about their use of AI (51.5% response rate). Overall, 762 hospitals (weighted percentage, 31.5%) were early adopters of generative AI in 2024, 540 (weighted percentage, 24.7%) were fast followers, and 872 (weighted percentage, 43.7%) were delayed adopters. In unadjusted analyses, independent hospitals and critical access hospitals were less likely to be either early adopters or fast followers than delayed adopters. In adjusted analyses, hospitals that used predictive AI were more likely to be early adopters or fast followers than delayed adopters (difference, 26.2 [95% CI, 16.8-35.6] percentage points). Users of Epic were more likely to be early adopters and fast followers than users of other EHRs (eg, likelihood of being an early adopter or fast follower, Epic vs Oracle users: 21.9 [95% CI, 16.3-27.4] percentage points). Hospitals that reported conducting all local evaluation practices (accuracy, bias, postdeployment) were slower to adopt than hospitals that reported only 1 evaluation practice (all local evaluation processes: 12.1 [95% CI, 4.5-19.6] percentage points less likely to be early adopters than fast followers).

CONCLUSIONS AND RELEVANCE: In this survey study of US hospitals, more than half of US hospitals reported that they would likely implement generative AI by the end of 2025. Results indicate the value of providing support to ensure hospitals can adopt beneficial generative AI and the need for developing and disseminating best practices for generative AI evaluation across organizations.

PMID:41385223 | DOI:10.1001/jamanetworkopen.2025.49463

J Biomech Eng. 2025 Dec 12:1-21. doi: 10.1115/1.4070647. Online ahead of print.

ABSTRACT

Anterior cruciate ligament (ACL) reconstruction in pediatric patients has a higher graft failure rate compared to adults. Restoring joint stability and reducing graft failure is essential. However, how graft biomechanical properties change with age and affect reconstruction outcomes remains unclear. This study investigated the biomechanical development of porcine flexor tendons across skeletal growth and evaluated how graft size and stiffness influence knee biomechanics in a pediatric porcine model. Flexor tendons (n = 57) were harvested from pigs at 0.5, 1.5, 5, and 9 months of age to measure cross-sectional area (CSA), stiffness, and failure load. ACLs in nine early adolescent porcine knees were reconstructed using both 1.5- and 5-month-old (1.5mo and 5mo) grafts and tested under anterior-posterior, compressive, and varus-valgus loading at 40&#176; flexion using a robotic system. ACL and graft forces were calculated using the principle of superposition, and in situ properties were derived from force-displacement curves. Tendon CSA, stiffness, and failure load increased with age, and stiffness associated with CSA. The CSA of 5mo tendons was 57% greater than that of 1.5mo tendons, but stiffness increased only 20%. ACL reconstruction with 5mo grafts resulted in 29% less anterior-posterior tibial translation and 44% higher graft force compared to 1.5mo grafts. In situ stiffness of 5mo grafts was 51% higher than 1.5mo grafts. These findings highlight the differences between tendon size and biomechanical development, which together contribute to the improvements in joint function following ACL reconstruction.

PMID:41385220 | DOI:10.1115/1.4070647

Indian J Ophthalmol. 2025 Dec 12. doi: 10.4103/IJO.IJO_733_25. Online ahead of print.

ABSTRACT

PURPOSE: To report TON in indigenous tribal communities of Northeast India, and to explore its association with Tuibur use.

METHOD: Retrospective study undertaken in consecutive patients presenting with unexplained gradual, painless, bilateral diminution of vision. Detailed dietary and medical history was taken. Demographic profile of subjects was noted, including age, gender, ethnicity and occupation. Duration & frequency of Tuibur use per day was noted. Clinical evaluation along with visual fields, color vision, Retinal nerve fibre layer analysis was done. All patients were started on oral Vitamin B complex supplementation, including Vitamin B12 (1500 mcg) once daily for three months. The patients were called for follow up at monthly intervals for 3 months and at 6 months.

RESULT: 39 patients with bilateral involvement, mean age of 39.5 ± 11.6 years were studied. 82% were females; 97.4% belonging to tribal community. There was statistically significant improvement in visual acuity [Oculus Dexter (OD) P=0.002, Oculus Sinister (OS) P=0.007] and visual field indices after treatment.

CONCLUSION: TON may cause severe visual loss; however, timely management gives favourable results. Treatment involves replacing deficient nutrients and eliminating offending toxins. It is also important to consider contributory cultural and dietary practices. This is the first study linking a hitherto unheard-of toxic agent, liquid tobacco (Tuibur/Hidakphu) to optic neuropathy.

PMID:41385215 | DOI:10.4103/IJO.IJO_733_25