Tag: nevin manimala

BMJ Open. 2025 Nov 13;15(11):e105355. doi: 10.1136/bmjopen-2025-105355.

ABSTRACT

INTRODUCTION: Mistreatment and obstetric violence constitute significant human rights violations with profound implications for maternal mental health. These detrimental practices persist globally, particularly in contexts where underfunded health systems, workforce shortages and entrenched gender inequalities intersect, depriving women of adequate psychosocial support and culturally sensitive mental healthcare. Although awareness of the immediate harms of mistreatment is increasing, its cumulative effects throughout the maternal care continuum remain insufficiently understood. This review will synthesise evidence on the impact of mistreatment on perinatal mental health, identify critical gaps and advocate for systemic change.

METHODS AND ANALYSIS: This systematic review and meta-analysis protocol complies with the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A thorough literature search will be executed across multiple electronic databases, including CINAHL-Cumulative Index to Nursing and Allied Health Literature, Embase via Ovid, MEDLINE, PsycInfo, PubMed, Scopus, as well as other significant or specialised databases and grey literature. The review will incorporate only non-randomised study types and observational studies (cohort, cross-sectional, case-control), along with mixed-method and qualitative studies. Abstract and full-text screening will be performed by two reviewers using Covidence. The methodological quality of the included studies will be assessed using the Newcastle-Ottawa Scale for observational studies, the Risk of Bias in Non-Randomised Studies of Interventions, the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. Statistical heterogeneity will be evaluated using the Higgins test. Meta-analysis will be conducted using R statistical software V.4.4.4, employing random effects models to determine the weights. The study results will be reported sequentially, beginning with primary outcomes, followed by secondary outcomes and significant subgroup outcome analyses.

ETHICS AND DISSEMINATION: Ethical approval is not required as no original data will be collected. The findings of this review will be disseminated through publication and conference presentations.

PROSPERO REGISTRATION NUMBER: CRD420251044379.

PMID:41248398 | DOI:10.1136/bmjopen-2025-105355

BMJ Open. 2025 Nov 4;15(11):e105026. doi: 10.1136/bmjopen-2025-105026.

ABSTRACT

OBJECTIVES: Current prediction models for disease progression to AIDS in people living with HIV primarily rely on traditional statistical methods. This study aimed to develop and compare four machine learning models and to create a clinically applicable nomogram for identifying risk factors associated with AIDS progression.

DESIGN: A retrospective cohort study conducted from January 2013 to December 2022.

SETTING: Yining City, Xinjiang, China.

PARTICIPANTS: Newly diagnosed HIV-infected patients (aged 18-60 years) who received antiretroviral therapy and had not progressed to AIDS at baseline.

PRIMARY OUTCOME MEASURES: Progression from HIV infection to AIDS, as defined by the Chinese Center for Disease Control and Prevention criteria.

RESULTS: Among the 2305 patients included, 652 progressed to AIDS. The cohort was predominantly male, with a mean baseline CD4 cell count of 384 cells/μL. Four machine learning models-Support Vector Machine, Random Forest, Logistic Regression and Extreme Gradient Boosting (XGBoost)-were developed. The XGBoost model demonstrated the best predictive performance (area under the curve, AUC: 0.877). Univariate and multivariate analyses identified WHO clinical stages, CD4 cell count, HIV transmission route, platelet count and haemoglobin level as significant predictors. The developed nomogram achieved an AUC of 0.840. Its calibration curve, after bias correction, showed good agreement with the ideal curve, and decision curve analysis indicated potential clinical utility.

CONCLUSIONS: In this cohort, the XGBoost model showed superior performance for predicting AIDS progression. The proposed nomogram may serve as a practical tool to facilitate rapid risk assessment in similar clinical settings. These findings suggest that enhanced monitoring and regular follow-up might be beneficial for patients with low CD4 counts for timely intervention and to improve outcomes.

PMID:41248391 | DOI:10.1136/bmjopen-2025-105026

BMJ Open. 2025 Nov 16;15(11):e102980. doi: 10.1136/bmjopen-2025-102980.

ABSTRACT

OBJECTIVE: The under-5 mortality rate (U5MR) is a crucial global health metric for evaluating public health interventions, and further reductions in U5MR are essential for achieving the Sustainable Development Goals (SDGs). This study analyses the trends of U5MR globally from 2000 to 2021 and explores the quantitative impact of health resources on U5MR reduction.

DESIGN AND PARTICIPANTS: This study used WHO public data from 2000 to 2021 to investigate the temporal trend of U5MR through Joinpoint regression analysis. A two-way fixed-effect model was used to investigate the relationship between U5MR and health resources.

PRIMARY OUTCOME MEASURES: Data on U5MR and health resources (including six vaccine-related indicators and eight health expenditure-related indicators) were obtained from the WHO Global Health Observatory, encompassing 200 countries and regions from 2000 to 2021.

RESULTS: Globally, U5MR declined, though at a slower pace (annual average percentage change: -3.259, p<0.001), while vaccination coverage and health expenditures increased (p<0.05). We found a significant negative correlation of global polio vaccination coverage (β=-0.489, p<0.05) and current health expenditure (CHE) as percentage of gross domestic product and U5MR (β=-0.762, p<0.05) with U5MR. In G20 countries, domestic general government health expenditure as percentage of CHE was negatively correlated with U5MR (β=-0.553, p<0.05). Health resources contributed to 65.01% of U5MR reduction in G20 countries, with vaccines accounting for 23.86%. Globally, health resources contributed 37.26% to U5MR reduction, with vaccines accounting for 72.69%.

CONCLUSION: Global U5MR has declined from 2000 to 2021, but progress remains insufficient to fully achieve the SDGs. Immunisation played a dominant role in the global reduction of U5MR, underscoring the critical need to prioritise vaccination in health resource allocation strategies.

PMID:41248390 | DOI:10.1136/bmjopen-2025-102980

BMJ Open. 2025 Nov 4;15(11):e101586. doi: 10.1136/bmjopen-2025-101586.

ABSTRACT

OBJECTIVES: To investigate patterns of sustainable working life, defined as a few or no interruptions from paid work due to sickness absence, unemployment or disability pension among Swedish twins with and without common mental disorders (CMDs). We also sought to examine the role of baseline sociodemographic factors for the identified patterns.

DESIGN: Prospective cohort study.

SETTING: Population-based sample of twins born in Sweden.

PARTICIPANTS: The sample of 5529 CMDs, discordant twin pairs between ages 18 and 59 years at baseline in 1998 (50% women) were followed annually for working life statuses using data obtained from national registers until 2020.

PRIMARY OUTCOME: Sustainable working life.

MEASURES: Group-based trajectory modelling was applied to identify distinct trajectory groups. Multinomial logistic regression models estimating ORs were performed.

RESULTS: For those with CMDs, a three-trajectory solution was the best-fitting model, while for those without CMDs, a two-trajectory solution had best fit; in both groups, sustainable working life constituted the largest trajectory group (71% and 83%, respectively). No sustainable working life yielded 14.5% and 17% in those with CMDs and those without CMDs, respectively, whereas, among those with CMDs, another 14.5% had a trajectory with decreasing sustainable working life. Higher education was associated with a lower likelihood (OR 0.12-0.47) and being single (with or without children, OR 2.23-2.51) with a higher likelihood of belonging to those trajectories characterised by no sustainable working life.

CONCLUSION: A small cluster among those with CMDs tended to follow a decreasing sustainable working life pattern, while a minority with or without CMDs had no sustainable working life. Although a sustainable working life seems common, those with CMDs should be identified early for preventive actions and support to remain in paid work.

PMID:41248389 | DOI:10.1136/bmjopen-2025-101586

BMJ Open. 2025 Nov 4;15(11):e099209. doi: 10.1136/bmjopen-2025-099209.

ABSTRACT

OBJECTIVES: To assess the relationship of infant growth, feeding practices and tummy time to their motor development at 12 months, with a special focus on how maternal physical activity during late pregnancy relates to infants’ motor skills.

DESIGN: Longitudinal study.

SETTING: Rural city in the Mid-Southern USA.

PARTICIPANTS: 16 singleton pregnant women in the third trimester and their term infants were recruited, excluding mother-infant pairs with health issues that impact infants’ motor development and restrict mothers’ physical activity.

PRIMARY AND SECONDARY OUTCOME MEASURES: Maternal physical activity and sedentary time during the third trimester were measured using Actigraph activity monitors. Labour nurses measured neonatal birth weight and length using standard procedures. Infants’ motor percentiles at 4 and 12 months were measured respectively using the Alberta Infant Motor Scale and Peabody Developmental Motor Scales II test by a licensed paediatric physical therapist. Feeding practices, infants’ time spent in different positions and family composition were evaluated separately at 4 and 12 months using a study-specific survey.

RESULTS: Infant motor percentiles at 4 months were positively associated with their 12-month motor percentiles (r=0.649, p=0.009). For each additional percentile at 4 months, the mean 12-month percentile increased by 0.4. Motor percentiles at 12 months were also positively associated with infants’ birth weight (r=0.553, p=0.026) and length (r=0.637, p=0.008), but not significantly associated with tummy time (r=-0.069, p=0.840). Infant motor percentiles at 12 months were not associated with time spent sedentary (r=-0.134, p=0.634), light activity (r=0.213, p=0.447) or moderate activity (r=-0.050, p=0.858) during the third trimester. At 12 months, breastfeeding status (p=0.576) and having siblings (p=0.230) were not related to motor scores.

CONCLUSIONS: Motor percentiles at 4 months, birth weight and length correlated with motor skills at 12 months, whereas tummy time, siblings, and breastfeeding were not significant predictors. Physical activity during pregnancy did not significantly correlate to motor skills at 12 months.

PMID:41248387 | DOI:10.1136/bmjopen-2025-099209

BMJ Open. 2025 Nov 13;15(11):e105613. doi: 10.1136/bmjopen-2025-105613.

ABSTRACT

OBJECTIVE: Studying issues related to stroke medication non-adherence is essential for secondary prevention of stroke. This study aimed to identify the prevalence of medication non-adherence and risk factors among stroke survivors. The reasons behind this are that some patients may not follow stroke medication plans, and potential ways to help patients adhere better to medication plans.

DESIGN: This study employed a cross-sectional patient survey.

SETTING: The study was conducted in 20 public and private healthcare facilities in a resource-constrained setting, in Punjab, the largest province of Pakistan.

PARTICIPANTS: We included 6538 stroke survivors aged 21-75 years with at least a 6 month history of stroke who were prescribed one or more anti-stroke medications and met the inclusion criteria.

PRIMARY OUTCOME MEASURES: The main outcome was medication non-adherence, measured by the Self-Efficacy for Appropriate Medication Scale (SEAMS) and self-reported pill count. Descriptive statistics were used to summarise study variables. chi-square (χ²)/Fisher’s exact test and independent t-test/ANOVA were employed. A generalised linear model (logit model using multivariable logistic regression shows that several factors are associated with medication non-adherence and adherence. Odds ratio (OR) plots were generated using Seaborn and Matplotlib.

RESULTS: Non-adherence based on pill counts was 49.7%, while the mean SEAMS score (31.3±7.7) showed moderate self-reported adherence. After adjusting for age, gender, marital status, education, income, health insurance, smoking status, comorbidities, stroke type, disease duration, blood pressure control, number of medications, dosing frequency, physiotherapy continuation, perceived side effects and doctor-patient satisfaction, we found that female gender (vs male: AOR 0.31, 95% CI 0.27 to 0.35), lower income (10k-25k PKR vs >100k PKR: AOR 0.31, 95% CI 0.23 to 0.41; 26k-50k PKR vs >100k PKR: AOR 0.57, 95% CI 0.47 to 0.68), primary/secondary education (vs postgraduate: AOR 0.74, 95% CI 0.64 to 0.87), controlled BP (vs uncontrolled: AOR 0.66, 95% CI 0.59 to 0.73), longer disease duration (≥5 years vs <5 years: AOR 0.43, 95% CI 0.37 to 0.49), one time per day dosing (vs three times per day: AOR 0.25, 95% CI 0.21 to 0.29) and fewer medications (<5 vs 10+: AOR 0.50, 95% CI 0.43 to 0.58; 5-9 vs 10+: AOR 0.71, 95% CI 0.61 to 0.83) significantly reduced non-adherence odds (all p<0.001). Married status (vs other: AOR 1.22, 95% CI 1.02 to 1.45, p=0.028) and diabetes (vs obesity: AOR 1.29, 95% CI 1.09 to 1.53, p=0.003) increased non-adherence risk.

CONCLUSION: This study addresses the significant issue of medication non-adherence in stroke patients in Pakistan, reflecting global patterns yet remaining under-explored locally. It emphasises the critical role of adherence in managing chronic conditions such as stroke, where consistent use of preventive therapies is vital for reducing recurrence and improving outcomes. While the non-adherence rates are consistent with global trends, there is a notable lack of observational studies and epidemiological data in the Pakistani context. Our findings support a comprehensive approach to enhance medication adherence, taking into account the complex connections among social, behavioural and clinical factors. It also highlights the importance of maintaining detailed records to monitor adherence trends, identify high-risk groups and inform targeted public health interventions.

PMID:41248386 | DOI:10.1136/bmjopen-2025-105613

Anatol J Cardiol. 2025 Nov 17. doi: 10.14744/AnatolJCardiol.2025.5649. Online ahead of print.

ABSTRACT

BACKGROUND: Calcific aortic valve stenosis (CAVS), the predominant valvular heart disease in developed countries, arises primarily from metabolic and inflammatory dysregulation. The triglyceride-glucose (TyG) index, a composite biomarker of insulin resistance and systemic inflammation, has been associated with cardiovascular diseases. However, its causal association with CAVS remains unclear. This study employs bidirectional Mendelian randomization (MR) to elucidate the potential causal relationship between the TyG index and CAVS.

METHODS: Genome-wide association study) summary statistics of TyG index and CAVS were obtained from UK-biobank cohort (n = 273 368) and FinnGen database (cases = 12 418 and controls = 487 930). Two-sample MR and multiple MR analyses were conducted to evaluate the association of TyG index with CAVS. The primary method was inverse variance weighted (IVW), complemented by MR-Egger, weighted median, and sensitivity analyses to ensure robustness.

RESULTS: The MR analysis demonstrated a significant causal effect of the higher TyG index (per 1-unit increment of TyG index) on CAVS risk (odds ratio [OR] = 1.50, P = .007, 95% CI: 1.12-2.02). Similar causal relationships were observed for triglyceride and glucose levels with CAVS. Sensitivity analyses confirmed robustness with no evidence of horizontal pleiotropy (P > .05). This association remained statistically significant in multiple MR analyses after adjusting for potential confounders (OR = 1.64, P = .003, 95% CI: 1.18-2.28). No reverse causality from CAVS to the TyG index was detected.

CONCLUSION: This MR study provides evidence supporting the causal effect of higher TyG index on CAVS.

PMID:41243889 | DOI:10.14744/AnatolJCardiol.2025.5649

Nurs Crit Care. 2025 Nov;30(6):e70241. doi: 10.1111/nicc.70241.

ABSTRACT

BACKGROUND: Delirium is a common neuropsychiatric complication in the intensive care unit (ICU), the occurrence of which is closely associated with patient prognoses.

AIM: To examine the associations between sleep quality and circadian rhythm stability measured by actigraphy and changes in delirium state in intensive care unit (ICU) patients, as well as their predictive power for mortality risk.

STUDY DESIGN: ICUs of a medical centre in Taiwan, from September 1, 2024, to January 31, 2025. A prospective observational study was conducted in adult ICU patients. Wrist-worn actigraphy was used to monitor total sleep time (TST, h), wake after sleep onset (WASO, h), and circadian rhythm stability (24-h autocorrelation coefficient, r24) for 72 consecutive hours. Delirium was assessed twice daily for three days using the Confusion Assessment Method for the ICU (CAM-ICU) and categorized as no delirium, prolonged delirium (lasting ≥ 3 days), or new-onset delirium (developed after enrollment).

RESULTS: A total of 74 ICU patients were included. Among them, 30 had no delirium, 20 had prolonged delirium, and 24 developed new-onset delirium. Mortality rates in both the prolonged delirium and new-onset delirium groups were 45%, significantly higher than in the no-delirium group (13.3%, p = 0.015). The prolonged delirium group had higher Sequential Organ Failure Assessment (SOFA) scores, longer WASO and lower r24 than the no-delirium group, with r24 significantly associated with prolonged delirium (OR = 0.001, p = 0.012). The new-onset delirium group showed higher WASO, which was significantly associated with delirium (OR = 1.04, p = 0.046). Multivariate Cox analysis identified prolonged delirium (HR = 3.92, p = 0.049) and SOFA score (HR = 1.32, p = 0.027) as independent predictors of mortality.

CONCLUSIONS: WASO and r24 were closely linked to delirium state changes. Lower r24 was strongly associated with prolonged delirium and higher mortality, while higher WASO was related to new-onset delirium.

RELEVANCE TO CLINICAL PRACTICE: Continuous monitoring of sleep continuity and circadian rhythms in ICU patients is recommended. Incorporating WASO into early delirium risk assessments may facilitate timely interventions, reduce delirium incidence and mortality and improve critical care quality.

PMID:41243871 | DOI:10.1111/nicc.70241

Clin Transplant. 2025 Nov;39(11):e70382. doi: 10.1111/ctr.70382.

ABSTRACT

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially life-saving intervention in refractory out-of-hospital cardiac arrest (OHCA). ECPR enables, in most of the treated cases, ICU admission to patients who otherwise would have died at the emergency department (ED). Still, many of them die, frequently after withdrawal of life-sustaining therapies due to irreversible critical conditions and related complications. The additional time provided by ECPR, however, might allow for the assessment of organ donor suitability. The aim of this study was to evaluate the impact of ECPR on the number of potential organ donors after refractory OHCA.

METHODS: We performed a post-hoc analysis of the multicenter INCEPTION trial, which randomized 134 OHCA patients between conventional CPR (CCPR) and ECPR. Detailed patient reports were presented to transplant physicians to determine the acceptability of the liver and kidneys for organ donation. In addition to the intention to treat analysis, we performed an “as-treated” analysis, limited to patients arriving without return of spontaneous circulation (ROSC) at the ED.

RESULTS: Out of 70 patients randomized to ECPR and 64 to CCPR, potential organ donors were identified in 14 (20%) and 4 (6%) patients, respectively (χ² test, p = 0.038). In the as-treated analysis, 15 out of 55 (27%) treated with ECPR were potential donors, compared to 0 out of 59 treated with CCPR (p < 0.001). This included five (9%) potential kidney donors and 15 (27%) potential liver donors.

CONCLUSION: Although ECPR is currently used with life-saving intentions, it may simultaneously increase the number of potential organ donors following cardiac arrest in selected patients.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03101787.

PMID:41243868 | DOI:10.1111/ctr.70382

J Pediatr Orthop. 2025 Nov 17. doi: 10.1097/BPO.0000000000003162. Online ahead of print.

ABSTRACT

BACKGROUND: Although periacetabular osteotomy (PAO) provides excellent clinical outcomes for patients with hip dysplasia, it still remains uncertain how it affects coronal and sagittal spinopelvic alignment. Therefore, this study aims to evaluate changes of coronal and sagittal spinopelvic parameters on standing AP and Lateral entire spine EOS radiographs following unilateral and bilateral PAO surgery.

METHODS: Skeletally mature patients who underwent unilateral and bilateral PAO surgery for symptomatic hip dysplasia were included in this study. Standing anteroposterior (AP) and lateral EOS spine radiographs (EOS Imaging, Paris, France) obtained preoperatively and at the last follow-up were analyzed to assess changes in coronal and sagittal plane measurements. Preoperative and postoperative radiographic outcomes were assessed using the Paired Sample t test for normally distributed variables and the Wilcoxon Signed-Rank test for non-normally distributed variables.

RESULTS: A total of 31 patients with 44 hips were included in this study following our exclusion criteria. Of those, 18 patients (58%) underwent unilateral PAO (Unilateral group) and 13 patients (42%) underwent bilateral staged PAOs (Bilateral group). The mean age of patients at first surgery was 16±3 years in the Unilateral group and 19±5 years in the Bilateral group (P>0.05). The mean preoperative Lateral Central Edge Angle (LCEA) was 13 degrees in the Unilateral group, which improved to 28 degrees at final follow-up (P<0.001). In the Bilateral group, the mean LCEA was 16 degrees preoperatively, which improved to 32 degrees at last follow-up (P<0.001). While the mean Acetabular Index (AI; Tönnis Angle) improved from 17 to 5 degrees at last follow-up in the Unilateral group (P<0.001), it improved from 9 to -1 degrees at last follow-up in the Bilateral group (P<0.001). There were no statistically significant preoperative and postoperative Pelvic Tilt, Sacral Slope, Pelvic Incidence, Lumbar Lordosis changes in the Unilateral and Bilateral groups.

CONCLUSIONS: Spinopelvic alignment did not significantly change following either unilateral or bilateral PAOs, as assessed on standing spine radiographs. Taken together with findings from previous research, our results suggest that pelvic tilt in skeletally mature patients with acetabular dysplasia is likely a fixed morphologic characteristic rather than a compensatory or reversible mechanism.

LEVEL OF EVIDENCE: Level III.

PMID:41243865 | DOI:10.1097/BPO.0000000000003162