Tag: nevin manimala

JMIR Mhealth Uhealth. 2025 Sep 24;13:e71213. doi: 10.2196/71213.

ABSTRACT

BACKGROUND: Consumer wearable technology quantifies physical activity; however, the association between these metrics and cardiometabolic health requires further elucidation.

OBJECTIVE: This study identified latent factors derived from Fitbit heart rate metrics and their relationship with cross-sectional cardiovascular phenotypes.

METHODS: This cross-sectional analysis included 457 participants from the SingHEART study, a multiethnic, population-based study of Asian individuals aged 21 to 69 years recruited in Singapore. Participants wore the Fitbit Charge HR for 7 days, and data on physical activity metrics, self-reported physical activity index (PAI), blood tests, coronary artery calcium scores, and cardiac magnetic resonance imaging were collected. Exploratory factor analysis identified latent factors from Fitbit metrics, and multivariate regression analysis assessed associations with blood and cardiovascular imaging phenotypes.

RESULTS: Higher levels of self-reported PAI were significantly associated with a higher number of calories burned (P=.008), number of steps and floors climbed, distance, number of activity calories, and number of very active minutes (P<.001). However, there was no association between PAI and other Fitbit metrics. Using exploratory factor analysis, we identified three latent factors measured by Fitbit metrics: (1) elevated metabolic equivalents of task (METs; calories burned per day, minutes per day spent fairly active in 3-6 METs and very active in ≥6 METs, and activity calories), (2) total activity (steps per day, distance in kilometers per day, and number of floors per day), and (3) others, all with a Cronbach α of >0.7. Higher total activity was associated with increased high-density lipoprotein levels (β=0.06; P<.001), decreased triglyceride levels (β=-0.10; P=.006), and lower BMI (β=-0.63; P<.001) after adjustment for age, gender, systolic blood pressure, total cholesterol, and family history of heart disease. The interaction between total activity and elevated METs was associated with lower fasting glucose (β=-0.07; P=.004). Elevated METs were associated with higher log(coronary artery calcium+1) and higher BMI (P<.001). Total activity was significantly associated with higher indexed biventricular systolic (P=.01 for left and P=.006 for right) and diastolic volumes (P<.001) and higher indexed left ventricular mass (P=.005).

CONCLUSIONS: We identified 3 groups of wearable metrics with distinct characteristics. While total activity had a significant relationship with self-reported PAI, most metrics of elevated METs did not. Total activity had a consistent and favorable association with lipid and glucose profiles and a dose-dependent association with cardiac remodeling. Elevated METs alone did not appear to have a significant association with favorable cardiovascular profiles. This study suggests that the total activity metrics are robust and dependable when interpreting an individual’s activity levels, with construct validity according to self-reported PAI and a positive association with lipid and glucose profiles, and demonstrate dose-dependent associations with cardiac remodeling after adjustment for demographics and risk factors. Findings related to elevated METs may be due to the Hawthorne effect and require further studies.

PMID:40991940 | DOI:10.2196/71213

Mil Med. 2025 Sep 24:usaf472. doi: 10.1093/milmed/usaf472. Online ahead of print.

ABSTRACT

INTRODUCTION: U.S. Active duty Service members (ADSMs) experience barriers to sexual and reproductive healthcare (SRH). Enhancing patient-centered SRH services is essential to empowering ADSMs to achieve their health goals, which may, in turn, contribute to improved military readiness. This study aimed to assess the feasibility and acceptability of a clinician-led group educational intervention developed to improve ADSMs’ awareness of availability of SRH services and self-efficacy to access this care, in order to guide future refinement and implementation of this program.

MATERIALS AND METHODS: A series of standardized 20-minute, interactive group educational sessions on SRH topics was delivered over a 12 month period to groups of ADSMs at a large military installation. This pretest-posttest study was conducted without a control group to assess feasibility. The primary outcomes were changes in perceived SRH knowledge and intention to seek future SRH, and were evaluated with McNemar’s tests. Logistic regression evaluated the influence of demographic characteristics on these changes.

RESULTS: Participants included 1,077 ADSMs (72% male, 89% junior enlisted). Exposure to the intervention was associated with increased awareness of contraceptive options (pre = 81%/post = 96%), available SRH services (pre = 60%/post = 96%), how to obtain emergency contraception (pre = 57%/post = 96%), human immunodeficiency virus (HIV) pre-exposure prevention (pre = 40%/post = 92%), and how to request sexually transmitted infection (STI) screening (pre = 51%/post = 96%), (ps < 0.001). Participants indicated increased intent to schedule an appointment for STI screening (pre = 8%/post = 17%, P < .001) and contraception (female participants pre = 18%/post = 26%, P = .008). Of those who did not agree that they were comfortable discussing SRH with a military clinician on the pre-intervention questionnaire, 77% reported that they were more encouraged to use SRH services on a military base, and 76% reported that they were more comfortable seeking SRH services in a military clinic after the intervention. Logistic regression showed no statistically significant effects of demographic characteristics on responses to the intervention. One-third of participants requested an appointment after the intervention using an appointment request card. Almost all participants (i.e., 87%) reported plans to share the content.

CONCLUSIONS: This patient-centered initiative is feasible and acceptable to ADSMs, may be scalable, and has the potential to reduce barriers and empower ADSMs in optimizing their SRH goals.

PMID:40991924 | DOI:10.1093/milmed/usaf472

Mil Med. 2025 Sep 24:usaf429. doi: 10.1093/milmed/usaf429. Online ahead of print.

ABSTRACT

INTRODUCTION: Exertional heat illness (EHI) is a threat to force health and readiness. EHI recovery can entail lengthy periods of lost duty time as providers ensure that patients have completely recovered and that the risk for recurrent EHI is low. Although EHI recurrence is a common concern, there is little research to inform or predict EHI recurrence. Here we describe characteristics associated with EHI duty restrictions and use them to predict EHI recurrence and prognosis.

MATERIALS AND METHODS: We studied a retrospective cohort of 1,742 US Army soldiers who received EHI duty restrictions because of a recent EHI diagnosis between July 2014 and April 2017. We used EHI complications, medical history, and demographics to predict EHI recurrence. The study protocol was approved by the Naval Medical Center Portsmouth Institutional Review Board.

RESULTS: 4.4% of soldiers had recurrent EHI. Among soldiers receiving an EHI profile, a history of another prior EHI was rare (5.6%) but was strongly associated with recurrent EHI (HRadj: 7.37, 95% CI: 4.24-12.81). These associations were consistent across heat exhaustion (HE), heat injury (HI), and heat stroke (HS) cases. Shorter profile durations were associated with reduced risk for recurrence, but this association was mostly attributable to milder EHI events. Based on total duty restriction days, HI represented a greater disease burden than HS or HE. Recurrent EHI was more common among soldiers who had been on an HI (4.6%) or HS (6.1%) profile than an HE profile (3.7%), although these differences were not statistically significant. Clinical complications (e.g., kidney injury, rhabdomyolysis, respiratory/cardiovascular distress, inpatient/ICU admission) were not associated with EHI recurrence.

CONCLUSIONS: Among soldiers on EHI duty restrictions, prior EHI is rare but strongly associated with risk for yet another EHI. The clinical characteristics (e.g., profile duration, complications) of a prior EHI were not associated with risk for recurrent EHI. Further research should characterize the role of EHI severity in return to duty and validate HI as a diagnostic category.

PMID:40991920 | DOI:10.1093/milmed/usaf429

J Neuropathol Exp Neurol. 2025 Sep 24:nlaf104. doi: 10.1093/jnen/nlaf104. Online ahead of print.

ABSTRACT

We investigated the expression and distribution of 5 cytoadhesion receptors for the Plasmodium falciparum erythrocyte membrane protein 1 in 12 regions of post-mortem brains of 50 Malawian children, that is, 27 with the clinical and pathological diagnosis of cerebral malaria (CM) and 23 with a non-malarial cause of death. We quantified the expression of each receptor by microvascular endothelium and the colocalization of receptor-expressing microvessels with sequestered infected red blood cells (iRBC) and calculated a receptor-independent sequestration ratio. There were differences in the level of expression and regional distribution of the five receptors: ICAM-1 was the most widely expressed receptor, followed by CD36, VCAM-1, E-selectin, and thrombospondin. Receptor-expressing microvessels were most numerous in the frontal lobe and least numerous in the brainstem and cerebellum. Colocalization of receptor-expressing endothelial cells with iRBC was present in all brain regions; it was highest for ICAM-1 and CD36 and greatest in the frontal lobe. The sequestration ratios were close to 100% for all receptors across all brain regions and were similar in cerebral and extracerebral microvessels. Receptor expression and colocalization ratios were greater in the brain than in the lung, heart, liver, spleen, and subcutaneous tissue. These differences in cerebral endothelial expression of cytoadhesion receptors and their preferential regional distribution may underpin differences in iRBC sequestration and lesion development in CM. Moreover, greater expression of these receptors in the brain vs peripheral organs may explain a comparatively greater degree of iRBC sequestration in the brain.

PMID:40991892 | DOI:10.1093/jnen/nlaf104

Neurology. 2025 Oct 21;105(8):e214226. doi: 10.1212/WNL.0000000000214226. Epub 2025 Sep 24.

ABSTRACT

BACKGROUND AND OBJECTIVES: Cognitive disability-defined by the Behavioral Risk Factor Surveillance System (BRFSS) as serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition-has become the most commonly reported disability among US adults. This broad definition reflects a heterogeneous range of underlying causes and highlights the growing public health significance of cognitive disability in the population. Previous studies have identified disparities by race, age, and socioeconomic status, but few have examined how these patterns have evolved over the past decade. This study analyzes national trends in self-reported cognitive disability from 2013 to 2023 using BRFSS data, with a focus on differences across age groups, racial and ethnic populations, and key social determinants of health.

METHODS: We conducted a retrospective analysis using data from the Centers for Disease Control and Prevention’s Disability and Health Data System, which integrates nationally representative responses from US adults (aged ≥18 years) in the BRFSS from 2013 to 2023, excluding 2020 and participants who self-reported depression, to better identify nonpsychiatric cognitive impairment. The primary outcome was self-reported cognitive disability, defined as “serious difficulty concentrating, remembering, or making decisions.” Survey-weighted logistic regression was used to model prevalence trends and examine associations with demographic and socioeconomic factors.

RESULTS: From 2013 to 2023, a total of 4,507,061 responses were included in the analysis. Apart from analyses focusing on strata of age, all estimates of cognitive disability were age-adjusted. Most respondents were aged 18-39 years (36.8%), identified as non-Hispanic White (60.9%), and had completed at least a high school education (87.3%). The age-adjusted self-reported cognitive disability prevalence in the United States rose from 5.3% (95% CI 5.1%-5.4%) in 2013 to 7.4% (95% CI 7.2%-7.6%) in 2023, with statistically significant increases beginning in 2016. The prevalence of cognitive disability among younger adults aged 18-39 years nearly doubled, increasing from 5.1% (95% CI 4.8%-5.3%) to 9.7% (95% CI 9.2%-10.2%), making this age group the primary driver of the overall rise in cognitive disability in the United States.

DISCUSSION: The disproportionate growth in cognitive disability among younger adults seems to be the primary driver of the overall national trend. These findings warrant further investigation, given their potential long-term implications for population health, workforce productivity, and health care systems.

PMID:40991889 | DOI:10.1212/WNL.0000000000214226

J Clin Oncol. 2025 Sep 24:JCO2500925. doi: 10.1200/JCO-25-00925. Online ahead of print.

ABSTRACT

In the POLARIX study (ClinicalTrials.gov identifier: NCT03274492), polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) showed a significant progression-free survival (PFS) benefit versus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with previously untreated intermediate- or high-risk diffuse large B-cell lymphoma (DLBCL; median follow-up: 28 months). In this 5-year update, sustained PFS benefits favoring Pola-R-CHP were observed. In the global intention-to-treat population (N = 879; median follow-up: 64.1 months), Pola-R-CHP demonstrated a significant PFS benefit over R-CHOP (hazard ratio [HR], 0.77 [95% CI, 0.62 to 0.97]), with 5-year PFS rates of 64.9% (95% CI, 59.8 to 70.0) and 59.1% (95% CI, 53.9 to 64.3), respectively. Although not statistically significant, overall survival analysis showed a HR of 0.85 (95% CI, 0.63 to 1.15) at the 5-year data cut compared with 0.94 (95% CI, 0.67 to 1.33) at the 2-year data cut. In the expanded population, 46 and 62 patients had lymphoma-related deaths in the Pola-R-CHP and R-CHOP arms, respectively. Exploratory analyses showed favorable 5-year survival rates with Pola-R-CHP in high-risk subgroups, including activated B-cell DLBCL and International Prognostic Index score 3-5. Long-term tolerability was similar between treatment arms. Findings confirm Pola-R-CHP represents a standard of care for frontline treatment of DLBCL.

PMID:40991874 | DOI:10.1200/JCO-25-00925

J Trop Pediatr. 2025 Aug 8;71(5):fmaf038. doi: 10.1093/tropej/fmaf038.

ABSTRACT

Childhood drowning is a major cause of morbidity and mortality with significant economic and social implications, especially in low- and middle-income countries. Despite this, there is a lack of good-quality epidemiological data on childhood drowning. We report the epidemiology of fatal and non-fatal unintentional childhood drowning in Malaysia between the years 2000 and 2022. Data about childhood drowning were obtained from a hospital-based registry gathered by the National Health Informatics Centre, the Ministry of Health, Malaysia. Child population data were downloaded from the Malaysian Census. Overall incidence rates (IRs), case fatality rates (CFRs), and IR and CFR by age, sex, race, and region were calculated. Binary logistic regression was used to determine the factors associated with fatality. Between the years 2000 and 2022, a total of 4247 cases of drowning were reported. IR was significantly higher among children aged 0-9, boys, Bumiputera, and the East Coast and Borneo regions. Overall CFR was 3.7%. Age, year of hospitalization, and Bumiputera were associated with CFR. The site of drowning was unspecified in 84% of cases, while for those recorded, natural water sources and swimming pools accounted for most sites. While the annual incidence of drowning has remained nearly constant throughout the years, the fatality rate has increased between 2010 and 2022. Our report provides leads for further research data requirements to understand childhood drowning epidemiology better and improve preventive measures.

PMID:40991872 | DOI:10.1093/tropej/fmaf038

Medwave. 2025 Sep 24;25(8):e3111. doi: 10.5867/medwave.2025.08.3111.

ABSTRACT

INTRODUCTION: Hip and knee osteoarthritis are common causes of disability, with high social and economic impact. Total hip and knee arthroplasties are cost-effective interventions that significantly improve quality of life. However, timely access to these surgeries in the Chilean public healthcare system remains limited. Since 2019, the Diagnosis-Related Groups (DRG) system has enabled the financing of hospital surgical procedures by adjusting payments according to case complexity. The objective of our study was to describe the hospital volume, clinical profile of patients, and financing situation of arthroplasties performed between 2019 and 2023 in public hospitals operating under the Diagnosis-Related Groups system.

METHODS: Observational, cross-sectional, and retrospective study. All procedures coded as primary total hip arthroplasty or total knee arthroplasty recorded in the Diagnosis-Related Groups database of the National Health Fund (FONASA) between January 2019 and September 2023 were analyzed. Clinical, demographic, geographic, and economic variables were extracted. Comorbidities were identified using the International Classification of Diseases, 10th revision (ICD-10).

RESULTS: A total of 29 409 primary and 1993 revision arthroplasties were performed. Surgical volume decreased in 2020 and recovered progressively. Hospital productivity varied across regions. One-third of the total hip arthroplasties were performed in patients under 65 years old. The most frequent comorbidities were hypertension (43.4%) and diabetes (16.6%). The average reimbursement for revision surgeries was similar to that of primary procedures.

CONCLUSIONS: We identified regional inequities in access to total hip and knee replacements. We also found possible underreporting of comorbidities and underfunding of revisions, which highlights the need for specific adjustments to the Diagnosis-Related Groups system. In the future, it will be necessary to improve the quality of coding, expand financial coverage for patients excluded from the Explicit Health Guarantees, and incorporate technological adjustments that adequately reflect the costs of revisions, to move toward equitable and sustainable access to these surgeries.

PMID:40991867 | DOI:10.5867/medwave.2025.08.3111

J Clin Child Adolesc Psychol. 2025 Sep 24:1-15. doi: 10.1080/15374416.2025.2562520. Online ahead of print.

ABSTRACT

OBJECTIVE: Substance use, violence, and HIV/AIDS (i.e. SAVA) are three adversities known to cluster and contribute to other poor health outcomes among marginalized communities due to structural factors including racism and poverty. Most research on SAVA has focused on negative outcomes (e.g. psychopathology) among those directly affected. To address important gaps in the literature, the current study explored how child gender moderates the associations between maternal SAVA severity and child individual, relational, community, and cultural resilience.

METHOD: Participants included 263 children (M_age = 12.11, SD = 2.77; 59% girls; 82% Black) and their maternal caregivers. SAVA severity was examined as a continuous latent variable and resilience levels were calculated via confirmatory factor analysis based on manifest variables.

RESULTS: After adjusting for covariates, linear regression analyses indicated that, among girls but not boys, lower maternal SAVA severity was associated with higher individual (β = -0.22, p = .04, d = 0.01) and community (β = -0.27, p = .02, d = 0.02) level resilience. Further, across all children, lower maternal SAVA severity was associated with higher cultural resilience (β = -0.24, p < .001, d = 0.04). The association between maternal SAVA and relational resilience was not statistically significant.

CONCLUSIONS: Maternal SAVA impacts child resilience, but this effect is not uniform, as findings illustrated differential effects of SAVA by child gender and resilience level. This work emphasizes the critical need to assess and understand unique drivers of child resilience in order to intervene effectively on co-occurring adversities.

PMID:40991863 | DOI:10.1080/15374416.2025.2562520

J Am Acad Orthop Surg. 2025 Sep 24. doi: 10.5435/JAAOS-D-25-00582. Online ahead of print.

ABSTRACT

INTRODUCTION: As limb lengthening techniques have evolved from external fixation to motorized internal lengthening nails (MILN), it is anticipated that the length of stay (LOS) required and the readmission rates reported after these procedures will improve. The primary aim of this study was to describe the length of stay and readmission rates in a contemporary lengthening cohort. The secondary aim was to explore variables associated with LOS and readmission rates.

METHODS: This was a retrospective cohort study analyzing 213 limb lengthening events at a single center between October 2016 and June 2022. Most patients were male (145/213; 68%), White (126/213; 59%), and privately insured (183/213; 86%). Linear regression, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze the effects of independent variables on LOS. Binary logistic regression or Pearson Chi-square test were used to analyze the effects of independent variables on readmission (postdischarge hospitalization of >24 hours).

RESULTS: The median LOS was 3 days (IQR 2 to 3 days). The mode LOS was 2 days occurring after 89 of 213 procedures (41.8%). Increasing age (P = 0.002), patient-reported ethnicity (P = 0.037), and surgical day of the week (P < 0.001) were associated with increased length of stay. Patient sex (P = 0.317), insurance status (P = 0.166), concurrent deformity correction (P = 0.811), and bilateral lengthening (P = 0.314) were not associated with LOS. Overall, 30 readmission events (14.1%) were reported; most commonly delayed union requiring fixation exchange in 16 of 30 readmissions (53%). The only variable statistically significantly associated with readmission was increasing age (P = 0.003).

CONCLUSION: The median length of stay was 3 days with a mode of 2 days. The readmission rate was 14.1%. Increasing age, patient ethnicity, and surgical day of the week were associated with increased LOS, whereas readmission was associated with increasing age. This characterization may help as a guide when counseling patients on the expected postoperative course for a limb lengthening procedure.

PMID:40991862 | DOI:10.5435/JAAOS-D-25-00582