Tag: nevin manimala

J Public Health Manag Pract. 2026 Jan-Feb 01;32(1S Suppl 1):S49-S55. doi: 10.1097/PHH.0000000000002276. Epub 2025 Nov 18.

ABSTRACT

CONTEXT: Large local health departments (LHDs) serve diverse, high-need communities and are uniquely positioned to influence public health policy and practice locally, regionally, and nationally.

OBJECTIVE: The purpose of this study is to investigate policy engagement as a reported training need in the 2024 Public Health Workforce Interests and Needs Survey within large LHDs, highlighting gaps and opportunities to strengthen policy capacity.

DESIGN: Cross-sectional analysis of 2024 Public Health Workforce Interests and Needs Survey data using descriptive statistics and weighted logistic regression.

SETTING: Large LHDs, serving populations of 250 000 or more, across the US.

PARTICIPANTS: Study sample included 24 121 responses from individuals working in large LHDs.

MAIN OUTCOME MEASURES: Descriptive and regression-based statistics for training needs, self-identified skill-building interests, and predictors of reporting a policy engagement training need.

RESULTS: Nearly 40% of staff at large LHDs reported a training need in policy engagement, the only domain to show an increase in need since 2021. Women had significantly higher odds of reporting a policy training need (odds ratios [OR] = 1.67; P < .001), as did supervisors (OR = 2.09; P < .001) and managers (OR = 1.78; P < .001) compared to nonsupervisors, while those with master’s (OR = 0.64; P < .001) or doctoral degrees (OR = 0.40; P < .001) had lower odds compared to bachelor’s-level staff.

CONCLUSIONS: Large LHDs are well positioned to advance public health policy given their scale and connection to local communities. Targeting policy engagement training to workforce segments with the highest reported need offers a strategic opportunity to strengthen policy capacity across the US public health workforce.

PMID:41248529 | DOI:10.1097/PHH.0000000000002276

J Public Health Manag Pract. 2026 Jan-Feb 01;32(1S Suppl 1):S33-S44. doi: 10.1097/PHH.0000000000002248. Epub 2025 Nov 18.

ABSTRACT

CONTEXT: The Public Health Workforce Interests and Needs Survey (PH WINS) was fielded in 2014, 2017, and 2021. In the last 10 years, it has provided participating health departments and the field with data to improve recruitment and retention, strengthen workforce development efforts, guide strategic planning, and raise critical funds to improve public health infrastructure. It captures individual perspectives on engagement and satisfaction, intention to leave, training needs, and workplace infrastructure. This article describes the methods used for the 2024 administration of PH WINS.

PH WINS: PH WINS 2024 was fielded to a nationally representative sample of staff in State Health Agency Central Offices (SHA-CO) and local health departments (LHDs) from September 9, 2024, to January 17, 2025. The instrument was revised to improve the actionability of the results, reduce respondents’ cognitive burden, and align with existing standards or survey questions. PH WINS 2024 had 12 sampling frames, compared with the 3 in previous years: SHAs, members of the Big Cities Health Coalition (BCHC), and LHDs in each of the 10 Health and Human Services (HHS) Regions. All participating agencies were surveyed using a census approach.

PARTICIPATION: Overall, staff lists for 48 SHAs, 1,178 LHDs were collected, and the survey was sent to 159 627 individuals. PH WINS received a total of 56 595 responses, a 37% of eligible respondents. The SHA frame received responses from 29% of eligible respondents, BCHC members received 33%, and all other LHDs received 51%. The nationally representative SHA-CO frame included a total of 18 110 individuals, and the nationally representative LHD frame included 38 485 individuals from all 1178 LHDs. For the first time, the national sample of LHDs included small LHDs.

REFLECTIONS: With the 2024 administration of PH WINS, all state and local public health departments in the United States had the opportunity to participate, yielding a nationally representative sample of small LHDs for the first time. State and local health department leaders should be empowered to use the results for workforce development and other planning. Questions were modified to become more action-oriented, rigorous, and stable over time to maximize the utility of PH WINS for years to come. Given the changing public health landscape associated with new outbreaks, disasters, and the political environment, these changes are critical.

PMID:41248527 | DOI:10.1097/PHH.0000000000002248

J Med Internet Res. 2025 Nov 17;27:e67320. doi: 10.2196/67320.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that requires management of blood glucose. According to previous studies, the Dario Digital Diabetes Solution (DDS) is a nonprescription digital health intervention with a smartphone app that has been shown to improve blood glucose control in adults with T2DM.

OBJECTIVE: This study aims to investigate the effects of DDS on health care resource use (HCRU) rates, charges, and estimated costs for adults with T2DM.

METHODS: In this retrospective cohort study, patient-level claims data of adults with T2DM were obtained from the Symphony Health Integrated Dataverse, a database containing both inpatient and outpatient claims, including diagnoses and procedures. Using exact and propensity score matching, DDS users and nonusers were matched in a 1:3 ratio. For the primary outcome measure (all-cause HCRU rates, defined as inpatient hospitalization and emergency room visits) and secondary outcome measures (all-cause outpatient visit rates, all-cause HCRU charges, and diabetes mellitus-related HCRU rates and charges), baseline, follow-up, and changes in values were summarized using descriptive statistics, and a multivariable generalized linear model or a 2-part model (including a generalized linear model) was applied. Additional exploratory outcome measures were analyzed. In a sensitivity analysis, a cost-to-charge ratio was calculated and applied to medical claims to estimate medical costs.

RESULTS: Following matching, cohorts consisted of 2445 DDS users and 7334 nonusers with similar demographic and baseline characteristics. The all-cause HCRU event rate was 9.3% lower in DDS users compared with nonusers at the 12-month follow-up from the index date. The mean number of events was estimated to be significantly lower in DDS users (0.48 per patient per year [PPPY]; 95% CI 0.44-0.52) than nonusers (0.52 PPPY; 95% CI 0.50-0.55), resulting in an incidence rate ratio of 0.91 (P=.04). Inpatient hospitalization was 23.5% lower in the DDS user cohort compared with the nonuser cohort, with emergency room visit and outpatient visit rates being similar across both cohorts. DDS users were numerically less likely to incur all-cause HCRU charges than nonusers (odds ratio 0.91, 95% CI 0.82-1.01; P=.07). All-cause HCRU charges were 26% lower for DDS users than for nonusers (US $ 12,552 PPPY savings; P<.001). When applying the cost-charge-ratio to the charges, the total estimated cost saving for DDS users was US $5077, of which US $4513 PPPY was attributed to all-cause HCRU and US $564 to all-cause office visits.

CONCLUSIONS: In this retrospective cohort study of adults in the United States with T2DM, DDS users were found to have lower all-cause HCRU rates than nonusers, driven by significantly lower inpatient hospitalization rates (P<.001). All-cause HCRU charges and estimated costs were shown to be lower for DDS users compared with nonusers.

PMID:41248488 | DOI:10.2196/67320

JCO Clin Cancer Inform. 2025 Nov;9:e2500140. doi: 10.1200/CCI-25-00140. Epub 2025 Nov 17.

ABSTRACT

PURPOSE: Direct pediatric information to inform chemotherapy emetogenicity in pediatric patients is limited. Therefore, the framework for antiemetic selection is uncertain. This study classified the acute emetogenicity of chemotherapy regimens in pediatric patients using data extracted from the electronic health record (EHR).

METHODS: This retrospective, single-institution study extracted data from the EHR of patients age 0 to 18 years who received chemotherapy during an inpatient admission from July 1, 2018, through February 29, 2024. Data were organized by patient and chemotherapy block including patient demographics; date, time, and route of chemotherapy and antiemetic administration; and date and time of vomiting. When at least 30 patients received the same chemotherapy and antiemetics during a chemotherapy block, the proportion of chemotherapy blocks where patients experienced complete, partial, or failed chemotherapy-induced vomiting control was determined. Chemotherapy regimen emetogenicity was assigned using a revision of an accepted pediatric chemotherapy emetogenicity classification framework that adjusted for antiemetic administration.

RESULTS: Seven thousand two hundred ninety-six chemotherapy blocks in 1,386 patients were identified. The emetogenicity of 25 chemotherapy regimens was classified: highly (7), moderately (5), low (10), and minimally (3) emetogenic. For 19 of these, no direct pediatric information was previously available. In five, our findings confirm the previous pediatric emetogenicity classification. Relative to emetogenicity classifications for adults, our findings led to classifications that were higher (seven regimens), lower (one regimen), or the same (four regimens).

CONCLUSION: We have applied a novel method, EHR data extraction, to provide direct pediatric evidence to classify chemotherapy emetogenicity. Increasing the certainty of chemotherapy emetogenicity facilitates effective antiemetic selection for pediatric patients. This method may be applied in multi-institution studies to increase the number of chemotherapy regimens whose emetogenicity is classified using direct pediatric evidence.

PMID:41248450 | DOI:10.1200/CCI-25-00140

J Craniofac Surg. 2025 Nov 17. doi: 10.1097/SCS.0000000000012172. Online ahead of print.

ABSTRACT

Secondary synostosis of initially patent cranial sutures is a rare but recognized phenomenon following cranial surgery, particularly in syndromic cases. However, its incidence and risk factors in nonsyndromic patients remain unclear. This study aimed to investigate the occurrence and causes of secondary synostosis following surgical correction of lambdoid synostosis, with a focus on posterior vault distraction. Medical records of patients who underwent surgical treatment for unilateral or bilateral lambdoid synostosis between 2015 and 2024 at Keio University Hospital were retrospectively reviewed. Patients with syndromic craniosynostosis were excluded. Postoperative cranial computed tomography at 1 year was assessed for secondary synostosis. Surgical approaches included single-stage cranial remodeling and posterior distraction. Statistical analyses were performed using the Mann-Whitney U and Fisher exact tests, with logistic regression applied to identify significant risk factors. Thirteen patients underwent surgery: 7 with bilateral lambdoid and sagittal synostosis (BLSS) and 6 with unilambdoid synostosis. 9 patients underwent single-stage cranial remodeling, and 4 underwent posterior distraction. Secondary coronal synostosis developed in all 4 patients who underwent posterior distraction but in none of those who underwent single-stage remodeling. Logistic regression analysis identified posterior distraction as the strongest risk factor for secondary coronal synostosis, while BLSS was associated with secondary sagittal synostosis. One patient required reoperation due to elevated intracranial pressure. Posterior vault distraction in nonsyndromic lambdoid synostosis is associated with a high risk of secondary coronal synostosis. These findings highlight the importance of careful long-term monitoring and judicious surgical planning, particularly when distraction is considered.

PMID:41248444 | DOI:10.1097/SCS.0000000000012172

J Craniofac Surg. 2025 Nov 17. doi: 10.1097/SCS.0000000000012132. Online ahead of print.

ABSTRACT

The large availability of high-resolution CT scans leads to the collection of vast amounts of 3D volumetric data on craniofacial malformations, as well as on normal patients of all ages. A precise analysis of deformities occurring in craniofacial malformations can be gained from comparison with a normal skull. Doing such a comparison with a single case may be considered a bias. We have utilized a function in the 3DSlicer application, known as DeCA (Dense Correspondence Analysis), which calculates a statistical mean 3D model from a set of models. From 184 CT scans, allegedly normal. We created 19 models named “Skull Atlas ###-###d” (###-### for the range of age in days). The statistical value of those models is verified using another function in 3Dslicer, named GPA, which draws equiprobable ellipses for the markups. We explain how to superpose the reference Skull Atlas with the skull of interest. We used the vestibular orientation for aligning the models.

PMID:41248433 | DOI:10.1097/SCS.0000000000012132

J Craniofac Surg. 2025 Nov 17. doi: 10.1097/SCS.0000000000012128. Online ahead of print.

ABSTRACT

Down syndrome (DS) is the most common chromosomal disorder worldwide, characterized by congenital anomalies, distinctive facial morphology, and developmental delays. Although phenotypic features vary, many individuals with DS exhibit consistent craniofacial traits. In this study, we evaluated the morphometric characteristics of the ears, nose, and the second-to-fourth digit ratio (2D:4D) in children with DS, and examined their relationship with age, sex, and lateralization. The sample included 40 children with DS (20 girls and 20 boys), aged 2 to 13 years, attending rehabilitation centers in Konya. Anthropometric and photogrammetric methods were used to measure nasal width, length, height, alare-pronasale and alare-subnasale distances, nasal root width, nasofrontal angle, and nasal tip angle. Ear dimensions, including width, length, earlobe size, and concha measurements, were recorded. The 2D:4D digit ratio was also calculated. Statistical analyses revealed that the 2D:4D ratio differed significantly between sexes (P < 0.05), while no significant lateral differences were observed. All parameters were positively correlated with age. These findings contribute to the understanding of craniofacial development in DS and may inform clinical applications such as early diagnosis, genetic counseling, surgical planning, and the customization of assistive devices like glasses and hearing aids.

PMID:41248432 | DOI:10.1097/SCS.0000000000012128

BMJ Open. 2025 Nov 4;15(11):e108220. doi: 10.1136/bmjopen-2025-108220.

ABSTRACT

INTRODUCTION: Detecting cancer earlier improves treatment options and long-term survival. A multicancer early detection test that reliably picks up early-stage cancer would potentially save lives and reduce the cost of treating cancer. One promising candidate is the Enlighten test, which applies machine learning to plasma amino acid concentrations to detect cancer. In a cohort of 77 patients recently diagnosed with breast, colorectal, pancreatic or prostate cancer, 60 (78%) were detected by the test (sensitivity), with no false positives in 20 healthy controls. The MODERNISED study will further develop the Enlighten test to detect 10 different cancers by adding bladder, lung, melanoma, oesophageal, ovarian and renal cancer to the test.

METHODS AND ANALYSIS: MODERNISED (ISRCTN17299125) is a multicentre prospective, non-interventional, case-control study. We aim to recruit 1000 adult participants with a recent cancer diagnosis, 250 adult participants with symptoms of cancer where a cancer diagnosis was ruled out by the National Health Service (NHS) standard of care and 100 healthy adult volunteers. Cancer tissue of origin (ToO) will include bladder, breast, colorectal, lung, melanoma, oesophageal, ovarian, pancreatic, prostate and renal. Participants in the two non-cancer cohorts who are later diagnosed with cancer will be moved to the cancer cases cohort. The primary aim is to train and validate a machine learning algorithm to detect cancer, which will be evaluated by AUROC. Secondary aims include training and validating an algorithm to predict ToO and stage of cancer, exploring differences in performance by demographics and estimating how sensitivity varies across specificity cut-offs of 95%, 99% and 99.9%. These results will provide a statistically powered estimate of how well the Enlighten test can discriminate between individuals with and without cancer, which can then be validated for clinical use in further research.

ETHICS AND DISSEMINATION: This study is sponsored by University Hospital Southampton NHS Foundation Trust and has been approved by the Health Research Authority and Health and Care Research West Midlands (24/WM/0234). Results will be presented at scientific meetings and published in international peer-reviewed journals. Lay summaries of study progress and findings will be published on the Southampton Clinical Trial Unit’s website.

TRIAL REGISTRATION NUMBER: ISRCTN17299125.

PMID:41248417 | DOI:10.1136/bmjopen-2025-108220

BMJ Open. 2025 Nov 4;15(11):e105455. doi: 10.1136/bmjopen-2025-105455.

ABSTRACT

OBJECTIVE: To ascertain the clinical impact, prevalence and associated determinants of delayed treatment intensification, defined as delaying the escalation of treatment plans for individuals with type 2 diabetes mellitus who fail to attain ideal glycaemic control, at the University of Gondar Comprehensive Specialised Hospital in Northwest Ethiopia.

DESIGN: A mixed-methods study.

SETTING: University of Gondar Comprehensive Specialised Hospital.

PARTICIPANTS: 420 patients with type 2 diabetes mellitus with poor glycaemic control after the index date were included in this study. A simple random sampling technique was employed to select the required sample size. Data were collected retrospectively and entered into EpiData V.4.6 and exported to Stata V.14.2 for analysis.

METHOD: Multivariable logistic regression was used to identify factors associated with delayed treatment intensification. A p value of 0.05 in the multivariable analysis was considered statistically significant. Qualitative data were collected through in-depth interviews with eight selected healthcare providers, and thematic analysis was undertaken to identify the underlying barriers to timely treatment intensification.

PRIMARY OUTCOME: Delayed treatment intensification.

RESULTS: The prevalence of delayed treatment intensification was 51.4% (95% CI 46.6% to 56.2%), with a median delay of 14 months (IQR: 7.5-42 months) from the index date. Among those experiencing delayed treatment intensification, 43.1% developed new chronic diabetic complications, including retinopathy (18.1%), neuropathy (14.4%) and nephropathy (6.0%). Other complications (hypertension, stroke, heart failure and diabetic foot ulcer) accounted for 4.64% of the cases. Significant predictors of delayed treatment intensification included longer duration of diabetes (adjusted ORs (AOR) 1.68; 95% CI 1.13 to 2.5), presence of comorbidities (AOR 1.83; 95% CI 1.04 to 3.2) and use of cardioprotective medications (AOR 1.59; 95% CI: 1.04 to 2.43). The qualitative findings revealed additional barriers contributing to delayed treatment intensification, including financial limitations, insufficient patient awareness and non-adherence among patients. Additionally, healthcare provider-related factors, including professional fatigue and knowledge gaps, as well as health institution-related factors such as inadequate healthcare infrastructure.

CONCLUSIONS: This study found a high prevalence of delayed treatment intensification (51.4%), associated with comorbidities, longer disease duration, low patient awareness, cardioprotective drug use and barriers related to the system and providers. To address these gaps, priorities should include strengthening patient education, scheduling regular reviews for high-risk patients and improving clinical decision support tools for timely treatment intensification. Enhancing healthcare infrastructure, such as medication supply and diagnostic services, and offering refresher training to reduce provider fatigue, are also crucial for improving the delivery of diabetes care.

PMID:41248414 | DOI:10.1136/bmjopen-2025-105455

BMJ Open. 2025 Nov 16;15(11):e106013. doi: 10.1136/bmjopen-2025-106013.

ABSTRACT

OBJECTIVES: This study examined factors associated with the use of Indonesia’s National Health Insurance (NHI) among its beneficiaries in Maluku province.

DESIGN: Cross-sectional study.

SETTING: The individual-level data were derived from the 2021 Social Health Insurance Sample Data. National health reports of Indonesia were used to provide the district-level variables. We performed multivariable logistic regression analyses to identify factors associated with NHI use among its beneficiaries in Maluku province.

PARTICIPANT: Data were collected from 31 517 NHI beneficiaries registered in Maluku.

PRIMARY OUTCOME: The primary outcome was the use of NHI insurance when accessing healthcare services (yes/no).

RESULTS: Only 14.79% of NHI beneficiaries in Maluku had ever used their insurance for healthcare services. Individual factors associated with higher NHI use included being under 60 years, females (adjusted OR (aOR)=1.29, p<0.001), married (aOR=1.83, p<0.001) and having non-subsidised insurance (aOR=1.12, p<0.001). At the district level, higher usage was associated with increased rates of joint diseases (aOR=1.19, p<0.001), hypertension (aOR=1.81, p<0.001), diarrhoea (aOR=1.24, p<0.001) and a higher doctor-to-population ratio (aOR=1.01, p<0.001). A reduced likelihood of NHI use was found in beneficiaries living in the districts with high rates of acute respiratory infections (aOR=0.86, p<0.001) and with a high fiscal capacity (aOR=0.14, p<0.001).

CONCLUSION: Strengthening primary healthcare accessibility, improving the distribution of healthcare workers and addressing socioeconomic and geographical disparities are essential to ensure that the NHI scheme achieves equitable use across all regions in Maluku and other areas with similar settings.

PMID:41248413 | DOI:10.1136/bmjopen-2025-106013