Tag: nevin manimala

Altern Ther Health Med. 2025 Oct 8:AT11654. Online ahead of print.

ABSTRACT

BACKGROUND: Digital media has transformed health communication, with TikTok emerging as a key platform for disseminating herbalism-related content. Reliance on such content, particularly among young adults, necessitates a critical examination of the presentation and engagement of such information online.

PRIMARY STUDY OBJECTIVE: This study investigates the representation of herbal wellness on TikTok, examining the relationship between content typologies, influencer credibility, user engagement metrics, and their implications for public health communication.

METHODS/DESIGN: A cross-sectional, descriptive analysis was conducted using the first 120 videos under the #herbalism hashtag, captured on January 30, 2025. Two independent reviewers employed a coding scheme adapted from established methodologies to classify content into themes (e.g., personal experiences, spiritual health, and educational). Statistical analyses, including Mann-Whitney U tests and Spearman’s correlation, were performed to evaluate differences and associations in engagement metrics.

SETTING: The study was performed on TikTok, a social media platform characterized by short-form videos and use among young adults.

SAMPLE: 120 videos were analyzed. Although detailed demographic data of viewers was unavailable, the content primarily targeted a young adult audience.

INTERVENTION: This observational study involved no direct intervention; instead, it systematically categorized and analyzed naturally occurring digital content.

PRIMARY OUTCOME MEASURES: Engagement was quantified using metrics such as likes, comments, views, saves, and shares. These were correlated with specific content themes and influencer attributes.

RESULTS AND DISCUSSION: Videos referencing spiritual health exhibited higher engagement across multiple metrics, while those featuring personal experiences witnessed lower user interaction. The correlation analyses corroborated these trends, highlighting the influential role of thematic content in shaping audience responses.

CONCLUSION: Findings underscore the dominance of influencer-driven, spiritually resonant herbalism content on TikTok, and raise concerns about frequent uncredentialed expert input. These insights suggest opportunities for integrating evidence-based messaging into digital health communications to mitigate misinformation and enhance public engagement.

KEYWORDS: herbalism, TikTok, content analysis, social media, digital health communication, public health.

PMID:41056388

J Surg Orthop Adv. 2025 Fall;34(3):156-160.

ABSTRACT

The purpose of this study was to compare the incidence of various short-term complications and healthcare utilization between traditional and computer-assisted total knee arthroplasty (CA-TKA). Traditional TKA and CA-TKA cases were extracted from the American College of Surgeons’ National Surgical Quality Improvement Program. Patients were matched using patient and demographic variables. Outcomes were compared between the two patient groups after exact matching. Multivariate logistic regression was performed to identify independent risk factors for various outcome measures. The authors identified 159,521 patients that underwent traditional TKA and 3,464 patients that underwent CA-TKA. After matching, CA-TKA patients were more likely to have a nonhome discharge and a hospital length of stay greater than 2 days. Other outcome measures-readmission, reoperation, mortality, and surgical/medical complications-were comparable between groups. Patients undergoing computer-assisted TKA were more likely to have a nonhome discharge and a hospital length of stay greater than 2 days. (Journal of Surgical Orthopaedic Advances 34(3):156-160, 2025).

PMID:41056383

J Surg Orthop Adv. 2025 Fall;34(3):152-155.

ABSTRACT

Racial differences have been reported in the utilization of total knee arthroplasty (TKA), and there exists differences in pain management between African American and Caucasian patients. There are insufficient data concerning racial differences in perioperative pain management for patients after TKA for osteoarthritis of the knee. This is a retrospective study of 804 African American patients who had primary TKA between 2013 and 2022 at a single academic medical center. Patients were matched, 2:1, to Caucasian patients having TKA using American Society of Anesthesiologists score, age, gender, and body mass index. Demographic data and perioperative variables, including pain scores, morphine equivalents required at multiple time points, operative time, length of stay, and opioid refills were evaluated. A significantly higher proportion of African American than Caucasian patients had opioid medication prescribed within 90 days preoperatively (38% African American vs. 22% Caucasian patients). African American patients had significantly higher preoperative pain scores (3.28 vs. 2.26) than Caucasian patients and received significantly higher doses of morphine equivalents both preoperatively and postoperatively. The proportion of African American patients with opioid medication refills within 90 days postoperatively was significantly higher than Caucasian patients (73% vs. 33%). However, African American patients received significantly less intraoperative morphine equivalents. The reasons for the racial differences in perioperative pain management after TKA at one medical center are unknown and require additional study. However, these results suggest that pain management protocols, including standardized opioid medication, be implemented for patients of all races after primary TKA. (Journal of Surgical Orthopaedic Advances 34(3):152-155, 2025).

PMID:41056382

J Surg Orthop Adv. 2025 Fall;34(3):142-151.

ABSTRACT

The purpose of this study is to determine if differences exist in patient-reported outcome measures (PROMs), revision rates, and postoperative health care utilization between individuals that have a history of taking anti-estrogen medication prior to total joint arthroplasty (TJA) and those who have not in matched cohorts. Patients undergoing primary TJA from 2015 to 2023 were reviewed retrospectively. Demographics, history of medication use, PROMs pre- and post-TJA, revision TJA history, and post-TJA hospital utilization were extracted from medical records. Propensity score matching was then performed at 10:1 control to patients with a history of taking anti-estrogen medication prior to TJA accounting for age, race, American Society of Anesthesiologists physical status classification, and body mass index. Patient PROMs, revision rate, and post-TJA hospital utilization were then compared. After applying exclusion criteria, stratifying the groups into total hip arthroplasty (THA) and total knee arthroplasty (TKA), and propensity score matching, the outcomes of 345 THAs and 549 TKAs were analyzed. Patients taking anti-estrogen medications who underwent THA had significantly higher Patient-Reported Outcome Measures Information System (PROMIS) Pain Interference scores; PROMIS Physical Function scores at 6 weeks, lower PROMIS Physical Function at 1 year; and higher rates of readmission at 90 days. There was no difference in PROMs or hospital utilization between groups in patients that underwent TKA. Patients with a history of taking anti-estrogen medications had meaningful improvement after THA and TKA. Although PROMs were similar between groups after TKA, PROMs suggest that patients taking anti-estrogen medication may have worse pain early after THA as well as worse overall function. (Journal of Surgical Orthopaedic Advances 34(3):142-151, 2025).

PMID:41056381

Eur J Psychotraumatol. 2025 Dec;16(1):2562724. doi: 10.1080/20008066.2025.2562724. Epub 2025 Oct 7.

ABSTRACT

Background: Borderline personality disorder (BPD) is less understood in adolescents than in adults. The extent to which BPD can be conceptualised as a trauma-related disorder remains an ongoing debate. Most existing studies relied on Western adult samples.Objectives: This study examined BPD features and their relationship with trauma-related factors (i.e. adverse experiences and post-traumatic and dissociative symptoms) in a sample of Chinese adolescents.Methods: A total of 1,147 Chinese adolescents from two public schools (mean age = 16.4; 54.6% female) completed the Adverse Childhood Experiences Questionnaire, the Self-Report Dissociative Disorders Interview Schedule-Borderline Personality Disorder, the International Trauma Questionnaire, and the Dissociative Experiences Scale-Taxon.Results: In this sample, 9.9% endorsed ≥5 BPD features on a screening tool (sensitivity = 95.2%; specificity = 64.9%). Most (89%) participants with ≥5 BPD features reported childhood abuse/neglect, compared to 21.3% for those with <5 BPD features. Among participants with ≥5 BPD features, 64.9% screened positive for dissociative symptoms (52.6%) and/or ICD-11 PTSD/CPTSD (41.2%). Trauma-related factors explained 52.9% of the variance in BPD features, which were most strongly associated with disturbances in self-organisation (DSO) symptoms (β = .306, p < .001), emotional abuse (β = .145, p < .001), PTSD symptoms (β = .137, p < .001), and dissociative symptoms (β = .136, p < .001).Conclusion: BPD features are not rare among Chinese adolescents, warranting public health attention. Moreover, given the high rates of childhood abuse/neglect (89%) and dissociation/PTSD/CPTSD (64.9%) in adolescents with ≥5 BPD features, and considering the close relationship between trauma-related factors and BPD features, prevention and treatment of BPD features among young people should take trauma-related factors into consideration.

PMID:41055930 | DOI:10.1080/20008066.2025.2562724

J Back Musculoskelet Rehabil. 2025 Oct 7:10538127251384096. doi: 10.1177/10538127251384096. Online ahead of print.

ABSTRACT

BackgroundExtracorporeal shock wave therapy (ESWT) and Kinesio taping (KT) are used for musculoskeletal disorders (MSKDs). Despite limited supporting evidence and misalignment with contemporary rehabilitation approaches, they endure in practice to relieve pain and enhance function; however, their comparative effectiveness remains uncertain.ObjectivesThis systematic review aimed to compare the effects of ESWT versus KT on pain, functionality, strength, and quality of life (Qol) in individuals with MSKDs.MethodsSystematic searches of randomized clinical trials (RCTs) were performed across six databases from inception to June 2025. Two researchers independently screened titles, abstracts, and full-text articles. Risk of bias was assessed using the revised Cochrane Collaboration tool (RoB 2.0). Meta-analysis was conducted using RevMan 5.4 software, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.ResultsFifteen RCTs (n = 907) were included. Comparative analysis revealed no statistically significant difference between ESWT and KT in improving pain 0.12 (95% CI: -0.17, 0. 41, p = 0.41), function 0.04 (95% CI: -0.43, 0.51; P = 0.86), strength 0.68 (95% CI: -7.46, 8.81; P = 0.87), or Qol (P >> 0.05) in the short-term. However, medium-term favored ESWT in pain -1.15 (95% CI: -1.52, -0.78, p < 0.00001) and function -0.89 (95% CI: -1.35, -0.42; P = 0.0002) over KT. The certainty of evidence for all outcomes was very low.ConclusionsVery low-quality evidence indicates no difference between ESWT and KT in improving pain, function, strength, and Qol in patients with MSKDs in the short-term, with a possible medium-term advantage for ESWT in improving pain and function. Our findings should be placed within the context of limited and geographically narrow evidence. High-quality, long-term RCTs are warranted.Other: No funding was received for this review. PROSPERO registration number (CRD42024559635).

PMID:41055921 | DOI:10.1177/10538127251384096

JAMA Netw Open. 2025 Oct 1;8(10):e2534549. doi: 10.1001/jamanetworkopen.2025.34549.

ABSTRACT

IMPORTANCE: Asynchronous patient-portal messaging has emerged as a central component of patient-physician communication, yet disparities in response patterns remain underexplored.

OBJECTIVE: To examine variations in asynchronous messaging responses in primary care by race and ethnicity, insurance type, and primary language.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of messaging data included 795 170 adult patients receiving primary care at Mass General Brigham in 2021, 341 836 of whom sent an asynchronous patient portal message. Data were analyzed from April 17, 2023, to July 29, 2025.

EXPOSURES: Race and ethnicity, insurance status, and preferred language.

MAIN OUTCOMES AND MEASURES: Receipt of a response within 1 or 3 business days and time to first response from care team. Multivariable regression models adjusted for patient demographics, clinic, and time fixed effects.

RESULTS: The analytic sample consisted of 341 836 patients, who sent a total of 3 525 905 messages comprising 1 270 662 message threads to 1113 physicians. Among these patients (mean [SD] age, 52.2 [17.3] years), 18 442 were Asian (5.4%), 14 089 were Black or African American (4.1%), 9979 were Hispanic or Latino (2.9%), 285 919 were White (83.6%), 232 661 had commercial insurance (68.1%), and 332 004 primarily spoke English (97.1%). Characteristics of patient-threads that received a response from any care team member within 1 business day were as follows: 65.7% of threads from Black participants (32 165 of 48 983), 63.9% of threads from Hispanic or Latino (21 732 of 34 014), 68.5% of threads from White participants (743 161 of 1 085 517), 70.0% of threads from patients with commercial insurance (529 803 of 756 923), 60.9% of threads from patients with dual-eligibility (40 846 of 67 045), 68.4% of threads from patients preferring English (847 489 of 1 239 768), and 58.0% of threads from patients preferring Spanish (6898 of 11 903). Similar disparities were found in the response rate from primary care physicians. After adjustment, compared with White patients, the rate of response from any care team member within 1 day was lower for Black patients (1.1 [95% CI, 0.2-2.0] percentage points; P = .01) and Hispanic patients (1.1 [95% CI, 0.3-1.9] percentage points; P = .01). Compared with patients with commerical insurance, the response rate within 1 day was lower for dual-eligible patients (4.9 [95% CI, 4.2-5.5] percentage points; P < .001), and compared with patients who preferred English, the response rate within 1 day was lower for patients who preferred Spanish (4.1 [95% CI, 2.5-5.7] percentage points; P < .001). Adjustment for clinic and time fixed effects accounted for most of the observed disparities in response rates and timing.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of primary care patients in a single health system, there were significant disparities in the responsiveness of primary care teams to asynchronous patient-portal messages by race and ethnicity, insurance type, and language. These were partially attributable to slower response times at practices that treat underserved patients.

PMID:41055905 | DOI:10.1001/jamanetworkopen.2025.34549

JAMA Netw Open. 2025 Oct 1;8(10):e2534985. doi: 10.1001/jamanetworkopen.2025.34985.

ABSTRACT

IMPORTANCE: Kidney biopsy pathology via transmission electron microscopy (TEM) is essential for diagnosing glomerular diseases, offering critical information on glomerular basement membrane (GBM) thickness, foot process (FP) number, and electron-dense deposits (EDDs). These tasks are laborious and time-consuming.

OBJECTIVE: To develop and validate an artificial intelligence (AI) diagnostic system, TEM image-based AI-assisted device (TEM-AID), that accurately segments and measures glomerular ultrastructures (including the GBM, FPs, and EDDs) and determines glomerular disease subtypes using TEM images.

DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study used a large, multicenter cohort including 160 727 TEM images from 31 670 patients with chronic kidney disease across 6 medical centers from January 2021 to December 2023. TEM-AID was trained and validated on 26 650 patients from 1 center and tested externally on 5020 patients (5 test sets) plus a human-AI test set (454 patients representing 7 glomerular disease subtypes). Data were analyzed from January to December 2024.

EXPOSURES: TEM-AID integrates 4 modules. Segmentation combined YOLO-v8 detection, segment anything model, and human-in-the-loop refinement to segment GBMs, podocyte FPs, and EDDs. Measurement quantified GBM thickness, FP fusion degree, and EDD deposition sites. Classification used least absolute shrinkage and selection operator-selected deep learning and statistical features with a stacking classifier to diagnose 7 glomerular disease subtypes: immunoglobin A nephropathy, membranous nephropathy, lupus nephritis, diabetic nephropathy, minimal change disease, mesangial proliferative glomerulonephritis, and thin basement membrane nephropathy.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were segmentation performance (mean intersection-over-union [IOU], Dice coefficient), subtype classification accuracy, area under the receiver operating characteristic curve (AUC), and human-AI diagnostic concordance.

RESULTS: A total of 31 670 patients (mean [SD] age, 43.2 [16.5] years; 17 372 [54.9%] male) contributed 160 727 TEM images for analysis. Segmentation achieved a mean (SD) IOU of 0.835 (0.062) and Dice of 0.874 (0.023). Subtype classification accuracy was 0.911 (95% CI, 0.904-0.918) in internal validation and 0.895 to 0.914 in external tests. Macro-AUC ranged from 0.972 to 0.989 across cohorts. In human-AI testing (454 patients), TEM-AID accuracy (0.886 (95% CI, 0.859-0.912]; AUC, 0.963 [95% CI, 0.937-0.989]) exceeded clinicians’ unaided performance. Clinicians’ accuracy improved by a mean (SD) of 11.7% (5.2%) when they used TEM-AID.

CONCLUSIONS AND RELEVANCE: In this multicenter diagnostic study, TEM-AID precisely quantified glomerular ultrastructures and determined glomerular disease subtypes from TEM images, significantly enhancing diagnostic efficiency and accuracy. This system provides quantitative evaluation tools to support clinical pathologists in diagnostic workflows, demonstrating robust multicenter performance.

PMID:41055904 | DOI:10.1001/jamanetworkopen.2025.34985

JAMA Netw Open. 2025 Oct 1;8(10):e2536236. doi: 10.1001/jamanetworkopen.2025.36236.

ABSTRACT

IMPORTANCE: For many US children, the nearest hospital may be out of state. Medicaid coverage differs by state, affecting access across state lines.

OBJECTIVE: To evaluate the frequency of out-of-state acute care use for pediatric patients.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed acute care hospital data for emergent and inpatient encounters among children younger than 16 years enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in the 2021-2022 Transformed Medicaid Statistical Information System Analytic File database. Analyses were conducted January to July 2025.

EXPOSURE: Distance from a state border.

MAIN OUTCOMES AND MEASURES: The primary outcome was out-of-state care. The percentages of encounters occurring out of state were measured by state, city, and zip code. Logistic regression was used to evaluate the association of out-of-state care use with the log distance from a patient’s zip code to the border between states.

RESULTS: This analysis included 28 952 692 acute care patient encounters (median [IQR] age, 5.3 [2.0-10.8] years, 52.3% male). Out-of-state care occurred among 820 972 encounters (2.8% [95% CI, 2.8%-2.8%]). Maryland (61 468 of 389 539 [15.8% (95% CI, 15.7%-15.9%)]), Vermont (3625 of 31 101 [11.7% (95% CI, 11.3%-12.0%)]), and West Virginia (18 455 of 168 151 [11.0% (95% CI, 10.8%-11.1%)]) had the highest percentages of out-of-state care. The city from which the highest number of children accessed care out of state was Kansas City, Missouri (13 327 of 84 181 encounters [15.8% (95% CI, 15.6%-16.1%)]). Out-of-state care use was more common in rural areas (4.4% [95% CI, 4.3%-4.4%]) compared with urban areas (2.7% [95% CI, 2.7,%-2.7%]). For every 2-fold increase in distance from a state border, crossing a border for care was 34.2% (95% CI, 34.2%-34.3%) less likely. Among children within 1 mile of a state border, 10.0% (95% CI, 9.9%-10.0%) received care out of state.

CONCLUSIONS AND RELEVANCE: Findings from this cross-sectional study of Medicaid and CHIP enrollees indicated that out-of-state acute care use was uncommon overall but more common near state borders. Certain states and cities had high rates of out-of-state acute care use. Changes to Medicaid reimbursement could affect patients’ ability to access cross-border care.

PMID:41055903 | DOI:10.1001/jamanetworkopen.2025.36236