Tag: nevin manimala

Pediatr Infect Dis J. 2025 Sep 11. doi: 10.1097/INF.0000000000004991. Online ahead of print.

ABSTRACT

BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections in children. Early antibiotic treatment may prevent complications. Empirical treatment requires up-to-date knowledge of the local epidemiology. This study aims to describe trends in resistance rates in community-acquired UTI between 2017 and 2023, assess whether current recommendations for empirical treatment are valid and identify risk factors for resistance.

METHODS: Data were collected retrospectively from the computerized system of Maccabi Health Services for all children under 18 years old diagnosed with a UTI in 2017, 2022 and 2023. Data was evaluated using chi-square tests and regression models to identify resistance trends and associated risk factors.

RESULTS: A total of 24,592 urinary samples were included in the study. Escherichia coli was the most frequently isolated pathogen (76%-78%), with higher prevalence among females than males (78.3% vs. 59.3%, P < 0.001). Sensitivity to first-generation cephalosporins improved significantly (73% in 2017 to 82% in 2022, P < 0.001), while second- and third-generation cephalosporins showed minor fluctuations. Resistance to fluoroquinolones increased markedly, from 7% to 20% (P < 0.001). Female gender, older age, prior antibiotic use and urinary tract abnormalities were significant risk factors for resistance.

CONCLUSIONS: The increased resistance rate observed for most pathogens and antibiotics was statistically significant. Nevertheless, due to small absolute changes, the recommendations for empirical antibiotic treatment in Israel are still valid. Fluoroquinolones, which are not recommended as empirical treatment, should be avoided due to high levels of resistance.

PMID:40966754 | DOI:10.1097/INF.0000000000004991

J Pediatr Endocrinol Metab. 2025 Sep 16. doi: 10.1515/jpem-2025-0329. Online ahead of print.

ABSTRACT

OBJECTIVES: Testosterone therapy is recommended for management of puberty from the age of 12 years in boys with Duchenne muscular dystrophy (DMD). Height measurement is problematic in these adolescent boys as lower limb contracture can be common and estimated height from segmental body part measurements may over-estimate height.

METHODS: Bone growth was assessed using metacarpal and phalangeal measurements from hand radiographs. Raw length measurements were converted to Z-scores based on published normative data and compared by calculating the mean of each patient as ‘composite bone length Z-score’. Biochemical data was also collected to monitor the safety of testosterone therapy.

RESULTS: A total of 22 boys with DMD on daily glucocorticoid were included in the study. Mean age at commencement of testosterone therapy was 14.05 (SD 1.20). 13 boys were commenced on intramuscular testosterone therapy and nine were commenced on topical testosterone therapy. At baseline, 20/22 (91 %) were pre-pubertal (G1). At follow-up, 16/22 (77.3 %) were at early stages of puberty (G2 or G3) and 6/22 (22.7 %) were at late stages of puberty (G4 or G5). At baseline and follow up, composite bone length Z-scores for chronological age were significantly lower than zero, -2.7 (SD 1.07) (p<0.001 vs. zero) and -3.3 (SD 1.17), (p<0.001 vs. zero), respectively. There were no statistically significant differences between the topical and IM group at baseline (p=0.61) or 1 year (p=0.40).

CONCLUSIONS: Measurements of metacarpophalangeal bone length confirms that testosterone therapy enhanced long bone growth in boys with DMD but does not achieve full catch-up growth. Both IM and topical testosterone effectively promote secondary sexual characteristics with no significant side effects.

PMID:40966753 | DOI:10.1515/jpem-2025-0329

N Z Med J. 2025 Sep 19;138(1622):66-79. doi: 10.26635/6965.7025.

ABSTRACT

AIM: The aims of this study are to describe the current status of the heart failure nursing workforce in Aotearoa New Zealand, identify key challenges and provide recommendations.

METHOD: In March 2023, a survey coordinated by the Cardiac Society of Australia and New Zealand and the New Zealand Regional Heart Failure Working Group was distributed to all district health boards in Aotearoa New Zealand. The survey collected data on heart failure nursing resources, including full-time equivalent (FTE) per population, clinical versus non-clinical time, scope of practice, nurse-led services, and performance measures.

RESULTS: A total of 23 hospital responded, yielding a 100% response rate and revealing varied resource allocation across district health boards. While FTE rates have generally increased, nearly half of the boards reported less than one FTE per 100,000 population, with only three reaching the recommended two FTE per 100,000 as endorsed by the British Society for Heart Failure.

CONCLUSION: This foundational survey highlights the current status of the heart failure nursing workforce in Aotearoa New Zealand. It suggests that increasing the number of specialised nursing staff, particularly nurse practitioners (NP), to meet international standards would improve access to timely, effective and equitable treatment for all heart failure patients. Increasing NP FTE across hospital and community settings is likely to enhance healthcare and social outcomes, especially in under-served regions. Further research focussing on ethnicity, geographic distribution and workforce participation is recommended to guide targeted workforce development.

PMID:40966700 | DOI:10.26635/6965.7025

N Z Med J. 2025 Sep 19;138(1622):56-65. doi: 10.26635/6965.7003.

ABSTRACT

AIM: To evaluate the impact of the COVID-19 pandemic on New Zealand ophthalmology surgical training, focusing on surgical volume, case-mix, trainee involvement and gender disparities.

METHODS: Analysis of logbook data for New Zealand based trainees of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) from 1 January 2017 to 31 December 2022 was conducted comparing trainee-involved and trainee-performed case volumes between pre-pandemic (2017-2019) and pandemic (2020-2022) years, normalised by full-time equivalents (FTE).

RESULTS: Analysis of 41,370 trainee-involved surgeries revealed that while the total number of trainee-involved procedures remained stable during the pandemic, trainee-performed surgeries decreased significantly by 11.8%. This was driven by a significant gender disparity (p=0.045), with a 24.9% decline for female trainees, concentrated among those in urban centres, while male trainee numbers remained stable (+0.74%). Provincial trainees performed twice as many surgeries as urban counterparts. A significant case-mix shift also occurred, with greater glaucoma (+27.6%) and fewer oculoplastic (-20.8%) surgeries.

CONCLUSION: The pandemic was associated with a significant gender disparity in surgical training, driven by a reduction in procedures performed by female trainees predominantly in urban centres. The findings underscore the need to ensure equitable access to surgical training.

PMID:40966699 | DOI:10.26635/6965.7003

N Z Med J. 2025 Sep 19;138(1622):32-55. doi: 10.26635/6965.6952.

ABSTRACT

BACKGROUND: Copying results to a patient’s primary care provider confers a medico-legal responsibility to take action, which can complicate transfer of care. This practice contributes to administrative burden and creates uncertainty around the continuity of patient care. We aimed to survey primary care, with a focus on general practitioners (GPs), regarding their medico-legal awareness, preferences regarding receiving copied results, views on when transfer of care should happen, work-life balance, career pathway and the administrative burden (non-patient-facing clinical time) within their total clinical work hours.

METHODS: This was an anonymous, cross-sectional survey for clinically active primary care clinicians (GPs, urgent care physicians, nurse practitioners [NPs]) in the Northern region of Aotearoa New Zealand. The survey link was open from August to October 2023 and distributed via email, promoted during webinars and shared on social media.

RESULTS: A total of 470 eligible responses were collected: 428 GPs, 15 urgent care physicians, 18 NPs and 9 doctors that identify as “other primary care”. Across the professions, 34% were unaware of the medico-legal responsibilities of being copied into results they did not initiate. With the exception of NPs, most primary care clinicians prefer to not be copied to radiology, histology, microbiology, haematology and biochemistry results they did not order. Four out of five participants agreed that any results copied to primary care should involve prior discussion and acceptance by a relevant clinician. Although GPs and NPs reported poorer work-life balance, lower job satisfaction and higher rates of burnout compared with the other primary care professions, all professions have seen reductions in their patient-facing hours in the past 5 years, with increased administrative burden identified as a major contributing factor. Indeed, 47.7% of the GPs surveyed stated their intent to leave primary care within the next 5 years. The median proportion of non-patient-facing clinical hours as part of total clinical hours was 31% for GPs, 17% for urgent care physicians, and 31% for both NPs and other primary care professionals. Among GPs, a higher proportion of non-patient-facing clinical work was associated with older age, female gender, other non-European ethnicity, holding vocational registration in general practice, more years of general practice experience, having a personal list of enrolled patients and working in a non-Very Low Cost Access practice. However, medico-legal awareness of copied results was not associated with an increased proportion of non-patient-facing clinical work.

CONCLUSION: A gap in medico-legal knowledge related to test result responsibility exists within the primary care workforce. While this deficit was not linked to increased time spent on non-patient-facing clinical work, the majority of clinicians expressed a preference to not be routinely copied into test results unless a closed loop communication process with the ordering clinician is established. Improving the viability of primary care as a profession and patient care productivity will require coordinated efforts between primary care providers and Health New Zealand – Te Whatu Ora to reform current practices and uphold the principles of “Transfer of Care and Test Results Responsibility”.

PMID:40966698 | DOI:10.26635/6965.6952

JMIR Res Protoc. 2025 Sep 18;14:e67571. doi: 10.2196/67571.

ABSTRACT

BACKGROUND: The intertwining nature of gender-based violence (GBV) and violence perpetrated against women and girls (VAWG), as well as sexual and reproductive health rights (SRHR), underlines the urgent need for the health sector to enhance the coordination of services to improve health outcomes. Importantly, GBV and VAWG are intricately linked to a spectrum of SRHR challenges, ranging from unintended pregnancies to severe maternal, gynecological, and mental health outcomes. Cumulative GBV had a more significant effect on abortion risk than associated variables. Recognizing the interplay between GBV, VAWG, and SRHR highlights the necessity for a comprehensive health sector response. A systematic review of the health sector response to GBV, VAWG, and SRHR will be conducted to understand the extent and array of health facility-based coordinated responses to GBV, VAWG, and SRHR; lessons learned; and successes and challenges in the Commonwealth and selected African countries.

OBJECTIVE: We aim to understand the context of GBV, VAWG, and SRHR by conducting a comprehensive review of health sector responses in different national, cultural, and socioeconomic contexts, and we aim to share best practices, experiences, and lessons learned.

METHODS: A mixed methods systematic review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. The population, intervention, comparison, and outcome framework will be applied to screen and select relevant sources guided by the inclusion and exclusion criteria. The review will include relevant research papers published in the last 15 years and conducted in the 24 Commonwealth and 7 selected African countries. Electronic databases to be searched will include PubMed, Google Scholar, Science Direct, EBSCOhost, Web of Science, Embase, PsycINFO, Cochrane, CINAHL, Index Medicus for the Eastern Mediterranean Region, and POPline.

RESULTS: Ethics approval will be waived as the study will use data in the public domain. The project has been commissioned by the Commonwealth Secretariat (2022-2025). The database search, data screening, and data extraction process for the review will be completed by September 2025. A manuscript will be submitted to a peer-reviewed international journal by November 2025. The initial online database searches, citations of eligible studies, and Microsoft Copilot identified 38,200 studies focusing on GBV, VAWG, and SRHR interventions. To date, 60 studies have been found eligible for inclusion in the review. The majority of these studies were conducted in eastern Africa (n=34), South Africa (n=14), and Asia (n=13). Evidence generated from this review will be made available through journal publications, seminars and workshops with key stakeholders, ministries of health, and local and international conferences.

CONCLUSIONS: The study will generate evidence to inform recommendations on addressing and mitigating the effects of GBV and VAWG on SRHR outcomes and coordinated services in the health sectors of Commonwealth and selected African countries.

TRIAL REGISTRATION: PROSPERO CRD42024520594; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024520594.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/67571.

PMID:40966689 | DOI:10.2196/67571

JMIR Res Protoc. 2025 Sep 18;14:e66326. doi: 10.2196/66326.

ABSTRACT

BACKGROUND: Black Americans are disproportionately impacted by HIV. This disparity is more profound in the Southern United States, with the highest rates being among young, Black, sexual minority men, who are also less likely to receive state-of-the-art interventions such as pre-exposure prophylaxis (PrEP). Individual-level interventions to increase PrEP uptake do not often capitalize on the opportunity to leverage the significant effects of this group’s social networks, including Black women, on attitudes, beliefs, and behaviors around HIV prevention.

OBJECTIVE: To increase PrEP use, an intervention, PrEP US NoW, was designed to engage young, Black, sexual minority men’s social networks in discussions with supportive Black female facilitators and ultimately enhance their social capital.

METHODS: First, qualitative information on core health-promoting elements of social capital bonds was captured among young, Black, sexual minority men and Black women in extant social support networks. This information was then applied to adapt an existing, evidence-based mobile health app to create the PrEP US NoW pilot through an unblinded randomized controlled trial. Six social network groups (5 young, Black, sexual minority men + 1 Black woman) will participate in the intervention arm. These will be recruited through a network-based approach and will undergo tailored training (mobile-based and face-to-face) for app usage. At baseline, men will undergo HIV testing and both men and women will complete a sociodemographic survey. The groups in the intervention arm will engage in four 60-minute discussions led by Black women through the modified mobile health app. After the intervention, young, Black, sexual minority men will complete surveys electronically at 1 and 3 months (accompanied by HIV testing) on additional factors such as experiences of discrimination and PrEP stigma. The Black women will complete an electronic survey at 1 month, measuring feasibility and acceptability, and will participate in web-based qualitative interviews at 3 months to gain more knowledge on the PrEP US NoW facilitation process. Participants in the control arm will not engage in Black women-facilitated group discussions and will use a control version of the app. The baseline and follow-up surveys and HIV testing will be documented similarly to the intervention arm.

RESULTS: Phase 1 (development) of PrEP US NoW research activities lasted from November 2019 to June 2024. Data collection for the phase 2 randomized controlled trial began in August 2024 and is expected to be completed in December 2025. The findings will capture the intervention’s feasibility and acceptability and changes in PrEP uptake among young, Black, sexual minority men.

CONCLUSIONS: The development and pilot implementation trial of the PrEP US NoW intervention is thought to leverage essential social capital among young, Black, sexual minority men, which may promote engagement in PrEP care, thus decreasing the overall number of HIV diagnoses.

TRIAL REGISTRATION: ClinicalTrials.gov NCT07024745; https://clinicaltrials.gov/study/NCT07024745.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/66326.

PMID:40966683 | DOI:10.2196/66326

JMIR Aging. 2025 Sep 18;8:e67312. doi: 10.2196/67312.

ABSTRACT

BACKGROUND: Self-management is critical for older adults with type 2 diabetes mellitus (T2DM); however, its practice remains suboptimal. Social media has become an accessible and effective stimulus source for the public, which has the potential to promote health behaviors, but its effect on the self-management of older adults with T2DM remains unknown.

OBJECTIVE: We aimed to investigate the relationship between social media exposure, specifically time exposure and content exposure, and the self-management of older adults with T2DM.

METHODS: In this cross-sectional study, we enrolled 257 older adults with T2DM who used short-form video apps from community health care centers. We assessed subjective and objective time and content exposure. We transformed text-based content exposure into diabetes-related content exposure encompassing irrelevant, harmful, hypobeneficial, and hyperbeneficial categories using Q-methodology. Self-management was assessed through a validated questionnaire. We used restricted cubic splines and linear regression models to model the relationships between time exposure and content exposure and self-management, respectively.

RESULTS: Of 257 older adults with T2DM, the median age was 69 (IQR 65-72) years, 53.3% (n=137) were women, the mean sum score of self-management was 35.7 (SD 10.4), the median subjective time exposure was 120 (IQR 60-120) minutes, and 61.1% (n=157) of them were exposed to hyperbeneficial content. There was an approximate L-shaped dextrorotatory relationship between time exposure and self-management, with a decline in self-management when time exposure surpassed 139.8 minutes daily. Exposure to hyperbeneficial content was positively associated with the overall self-management (B=3.46, 95% CI 0.71-6.21). For participants exposed for more than 139.8 minutes daily, this positive association remained robust (B=7.27, 95% CI 1.54-13.00). In subdimensional analyses, hyperbeneficial content exposure was positively associated with general diet (B=1.51, 95% CI 0.54-2.49) and blood glucose testing (B=1.31, 95% CI 0.25-2.38).

CONCLUSIONS: Social media exposure presented a double-edged sword for self-management of older adults with T2DM. Self-management declined when the daily time spent on social media exceeded 139.8 minutes. However, exposure to hyperbeneficial content was associated with better self-management of individuals, regardless of excessive time spent on social media. Future longitudinal and experimental studies that validate the multifaceted association between social media exposure and health behaviors are needed. If confirmed, these findings would support the implementation of media prescription programs by health care providers in communities.

PMID:40966679 | DOI:10.2196/67312

JMIR Cancer. 2025 Sep 18;11:e68037. doi: 10.2196/68037.

ABSTRACT

BACKGROUND: Thyroid cancer is one of the most commonly diagnosed malignancies in South Korea, with incidence rates among the highest globally. Young women, in particular, represent a high-risk group, likely due to a combination of biological, occupational, and environmental factors. However, the specific risk factors contributing to thyroid cancer development in this population remain poorly understood.

OBJECTIVE: This study aims to identify the risk factors associated with thyroid cancer among young female nurses using longitudinal survival analysis.

METHODS: This longitudinal study used data from the Korea Nurses’ Health Study (KNHS), a prospective national cohort of female nurses. Data from the first, fifth, seventh, and ninth surveys were used to construct a person-period data set. Female nurses aged in their 20s at baseline were included. Time-varying explanatory variables included age, marital status, BMI, smoking, alcohol consumption, perceived stress, sleep problems, nursing position, night shift work, working unit, and duration of radiation exposure. The dependent variable was self-reported physician-diagnosed thyroid cancer. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to examine the association between risk factors and thyroid cancer occurrence.

RESULTS: A total of 22,759 person-period cases were analyzed, and 105 thyroid cancer events were identified. Kaplan-Meier analysis showed significant associations between thyroid cancer occurrence and age (χ²₁=51.6, P<.001), marital status (χ²₁=25.1, P<.001), sleep problems (χ²₁=20.3, P<.001), night shift work (χ²₁=20.1, P<.001), working unit (χ²₁=13.0, P<.001), and duration of radiation exposure (χ²₁=91.0, P<.001). In the Cox regression model, nurses aged in their 20s had a significantly higher risk of thyroid cancer than those aged in their 30s (hazard ratio [HR] 4.602, 95% CI 1.893-11.188). Those who worked night shifts were also at an increased risk (HR 1.923, 95% CI 1.127-3.280). Compared with no exposure, radiation exposure showed a dose-response relationship: <1 year: HR 3.449, 95% CI 1.474-8.074; ≥1 year: HR 4.178, 95% CI 2.702-6.461.

CONCLUSIONS: Younger age, night shift work, and duration of radiation exposure were significantly associated with an increased risk of thyroid cancer in young female nurses. These findings highlight the importance of early screening and occupational risk management, including regular radiation monitoring and support for circadian health, in health care settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.4178/epih.e2024048.

PMID:40966677 | DOI:10.2196/68037

Oral Dis. 2025 Sep 18. doi: 10.1111/odi.70098. Online ahead of print.

ABSTRACT

INTRODUCTION: The internet is a widely used source of health information for patients with head and neck cancer. However, the quality and readability of online content remain inconsistent. This study evaluated the usefulness of web-based resources by assessing their quality and readability.

METHODS: Searches were conducted using Google, Bing, and Yahoo! with nine common anatomical terms related to head and neck cancer. The first 50 results from each search engine were screened, and eligible websites were evaluated for quality using the DISCERN instrument by three independent reviewers. Readability was assessed using the Flesch-Kincaid Reading Grade Level (FKRGL) and the Flesch Reading Ease Score (FRES). Descriptive and inferential statistics were applied.

RESULTS: A total of 285 websites met the inclusion criteria. Of these, 46% were rated as poor quality (DISCERN score = 1). The median FKRGL was 8.6, and the median FRES was 55.7, both indicating reading levels above recommended thresholds for patient education materials.

CONCLUSIONS: Online information for patients with head and neck squamous cell carcinoma is often of low quality and too complex for the average reader. Improved, accessible, and reliable web-based resources are needed to support patient understanding and informed healthcare decisions.

PMID:40966670 | DOI:10.1111/odi.70098