Tag: nevin manimala

Glob Health Action. 2025 Dec;18(1):2586278. doi: 10.1080/16549716.2025.2586278. Epub 2025 Nov 17.

ABSTRACT

BACKGROUND: Adolescents in low- and middle-income countries often struggle to access sexual and reproductive health services (SRHS). To address this, the Ministry of Health, with support from Partners In Health, implemented Youth Corners in selected health facilities in Neno District to improve the utilisation of Youth-Friendly Health Services (YFHS).

OBJECTIVE: This study examines the role of Youth Corners in enhancing YFHS usage in Neno District, Malawi.

METHODS: A descriptive cross-sectional study was conducted by extracting data from Youth Corner registers and DHIS2 from health facilities between October 2022 and September 2023. Population estimates were obtained from the National Statistical Office projections. Descriptive statistics and chi-square tests were used to describe service utilization patterns, and binary logistic regression was used to assess the association between distance and service attendance.

RESULTS: During the study period, 1,877 young people aged 10-24 accessed YFHS, with 45% (n = 852) aged 15-19 and 57% (n = 1,063) female. They completed 2,869 visits, all receiving information and counselling. The utilisation rate was 829 visits per 1,000 young people aged 10-24. An association was found between distance, age, and attendance (p < 0.05). Adolescents aged 15-19 were less likely to attend youth corners (OR = 0.57, p = 0.003), and those living more than 10 km from facilities participated less frequently (OR = 0.59, p = 0.011).

CONCLUSION: While Youth Corners are highly suggested as a way for improving YFHS uptake among young people, their impact in Neno District was found to be suboptimal.

PMID:41243736 | DOI:10.1080/16549716.2025.2586278

J Forensic Sci. 2025 Nov 17. doi: 10.1111/1556-4029.70227. Online ahead of print.

ABSTRACT

Elevated beta-hydroxybutyrate (BHB) is a marker for ketoacidosis. Post-mortem values for the diagnosis of fatal ketoacidosis and the associated clinical and histologic findings are limited in the pediatric population. A retrospective case series of pediatric autopsy records and histology slides was conducted. Deaths occurring between 2010 and 2022 of children (ages<18 years) with an elevated BHB level (vitreous BHB >2 mmol/L or blood >200 mg/L) were analyzed. Histology of the heart, lung, liver, and kidneys was reviewed and scored. Five hundred twelve pediatric autopsies were conducted during the study period, of which 20 cases (3.9%) met the inclusion criteria. The age ranged from stillborn to 17 years, with a mean age of 6.3 years and a median age of 3.5 years. The mean concentration of vitreous BHB was 3.9 mmol/L (median 2.69; range 2.0-11.86 mmol/L; n = 17 cases) and the blood BHB had a mean of 416 mg/L (median 291; range from <50 mg/L to 1188 mg/L; n = 9 cases). Death was attributed to diabetic ketoacidosis, infection, malignancy, trauma, congenital heart disease, and drug toxicity. Histological changes were seen in all tissues examined in this pediatric population including hepatic steatosis (n = 17), glycogenated hepatocyte nuclei (n = 5), renal tubular vacuoles (n = 7) and heart vacuoles (n = 9). The only statistically significant correlation was found between vitreous BHB and renal tubular vacuoles (p = 0.014). Overall, elevated BHB levels were identified in blood and/or vitreous in fatal diabetic and non-diabetic cases, including infection. Diabetic ketoacidosis had the highest level of BHB at 11.86 mmol/L.

PMID:41243723 | DOI:10.1111/1556-4029.70227

Int J Psychol. 2025 Dec;60(6):e70123. doi: 10.1002/ijop.70123.

ABSTRACT

Successfully managing one’s unpleasant emotions despite adversities is important to help people maintain their well-being. Using daily diary assessment, we explored the role of Self-efficacy in Regulating Negative Affect (SRN) on Hedonic well-being (HWB), measured once a day over 21 days in a sample of 63 Italian young adults (mean age = 25.43, SD = 3.47; 67.7% women). Dynamic Structural Equation Modelling showed that there is a significant positive correlation between the spill-over effect from daily SRN_t-1 to HWB_t, with the carry-over effect of SRN (r = 0.625; 95% CI: [0.179, 0.850]). To explore this result more in depth, we performed a simple slope analysis that revealed that for those young adults with high carry-over of SRN over time, the spill-over effect from daily SRN_t-1 to HWB_t was positive and statistically significant (b = 0.247, 95% CI [0.032, 0.447]) compared to those young adults with low carry-over of SRN, which was nonsignificant (b = -0.092, 95% CI [-0.299, 0.137]). We discuss these findings in light of the potential role that SRN could play in people’s well-being during their everyday lives, which is in line with Bandura’s social cognitive theory. At the practical level, our results suggest that enhancing SRN might be beneficial to young adults’ HWB.

PMID:41243707 | DOI:10.1002/ijop.70123

Eur J Clin Invest. 2025 Nov 17:e70150. doi: 10.1111/eci.70150. Online ahead of print.

ABSTRACT

The C statistic, also known as the concordance index (C-index), is widely used in clinical research to assess the discriminative ability of risk prediction models. Its appeal lies in its intuitive interpretation and broad applicability, particularly in fields such as cardiovascular medicine and oncology, where accurate risk stratification is essential. However, despite its popularity, the C statistic has notable limitations that can undermine its utility in both research and clinical practice. Chief among these is its inherent conservativeness: the C statistic is often insensitive to meaningful improvements in model performance when new biomarkers or risk factors are added to an already robust model. This insensitivity stems from its rank-based nature, which focuses solely on the correct ordering of risk predictions rather than the magnitude of improvement. As a result, significant advances in risk estimation may be overlooked, potentially discouraging the adoption of clinically valuable innovations. Furthermore, the C statistic does not account for calibration-the agreement between predicted and observed outcomes-or the clinical consequences of misclassification. Alternative metrics, such as the Mean Absolute Difference (MAD), Brier score and Net Reclassification Improvement (NRI), offer complementary perspectives by capturing aspects of predictive accuracy and clinical relevance that the C statistic may miss. A comprehensive evaluation of risk models should therefore integrate these alternative measures to ensure that predictive tools are both statistically robust and clinically meaningful, ultimately advancing patient care and the practice of precision medicine.

PMID:41243705 | DOI:10.1111/eci.70150

Glob Health Action. 2025 Dec;18(1):2572010. doi: 10.1080/16549716.2025.2572010. Epub 2025 Nov 17.

ABSTRACT

BACKGROUND: Data are limited on the impact of chronic underlying conditions on COVID-19 treatment outcomes in sub-Saharan Africa.

OBJECTIVES: Determine the effect of underlying conditions on COVID-19 severity and treatment outcomes in Kenya.

METHODS: We conducted a retrospective cohort study using routine medical records from Kenya’s three large COVID-19 treatment centers. We examined two outcomes: mortality and clinical severity. Patients with lower respiratory tract illness without tachypnoea or difficulty in breathing were considered to have mild COVID-19. Underlying conditions were based on documentation in medical records. Logistic regression models assessed associations between underlying conditions and COVID-19 severity and mortality.

RESULTS: Among the 1,123 hospitalized COVID-19 patients included in the analysis, 59% (n = 664) had at least one underlying condition, 24.9% (n = 261) had severe disease, and 32.5% (n = 365) died. Hypertension (61.1%; n = 409), diabetes (38.9%; n = 258), and HIV (14.2%; n = 94) were the most common underlying conditions. Deaths were significantly higher among hospitalized COVID-19 patients with underlying conditions (35.4%) than those without (28.3%) (p = 0.01). The adjusted odds of severe COVID-19 were 50% higher among patients with hypertension (adjusted odds ratio [aOR] 1.50; 95% confidence interval [CI] 1.11-2.02). Mortality during COVID-19 hospitalization was nearly threefold higher among patients with heart disease (aOR 2.82; 95% CI 1.18-6.74) and 37% higher among patients with diabetes (aOR 1.37; 95% CI 1.00-1.88).

CONCLUSION: Patients with underlying conditions hospitalized for COVID-19 were more likely to die than those without. Hypertension was independently associated with disease severity, while heart disease and diabetes were independently associated with death during COVID-19 treatment.

PMID:41243672 | DOI:10.1080/16549716.2025.2572010

ACS Appl Mater Interfaces. 2025 Nov 17. doi: 10.1021/acsami.5c14008. Online ahead of print.

ABSTRACT

Domain-wall dynamics in ferroelectric materials are strongly position-dependent, since each polar interface is locked into a unique local microstructure. This necessitates spatially resolved studies of wall pinning using scanning-probe microscopy techniques. The pinning centers and pre-existing domain walls are usually sparse within the image plane, precluding the use of dense hyperspectral imaging modes and requiring time-consuming human experimentation. Here, a large-area epitaxial PbTiO₃ film on cubic KTaO₃ was investigated to quantify the electric-field-driven dynamics of the polar-strain domain structures using ML-controlled automated piezoresponse force microscopy. Analysis of 1500 switching events reveals that domain-wall displacement depends not only on field parameters but also on the local ferroelectric-ferroelastic configuration. For example, twin boundaries in polydomains regions, like a₁^–/c⁺∥a₂^–/c^–, stay pinned up to a certain level of bias magnitude and change only marginally as the bias increases from 20 to 30 V, whereas single-variant boundaries, like the a₂⁺/c⁺∥a₂^–/c^– stack, are already activated at 20 V. These statistics on the possible ferroelectric and ferroelastic wall orientations, together with the automated high-throughput AFM workflow, can be distilled into a predictive map that links domain configurations to pulse parameters. This microstructure-specific rule set forms the foundation for the design of ferroelectric memories.

PMID:41243655 | DOI:10.1021/acsami.5c14008

Int J Circumpolar Health. 2025 Dec 31;84(1):2580100. doi: 10.1080/22423982.2025.2580100. Epub 2025 Nov 16.

ABSTRACT

Northern regions of Canada have the highest reported incidence of childhood rickets in the country, yet this public health problem remains poorly described. The goal of this research was to explore the food and vitamin D supplementation experiences in pregnancy and infancy and examine associations with rickets diagnosis. Data were collected systematically through a retrospective chart review of Inuit children from 18 communities in Nunavut born from 2010-2013. Although most pregnant people reported consuming country food daily or weekly, one in three pregnant people reported being food insecure. Fewer than half of infants were reported to have received daily vitamin D supplement at two months of age, and frequency of supplement use declined with age. Rickets diagnosis was present in 1.63% of children (95% CI = 1.20%-2.20%). The odds of rickets diagnosis were higher for children whose mothers experienced food insecurity during pregnancy than for those whose mothers had never experienced food insecurity (OR = 5.279; 95% CI = 1.248-16.191). Enhanced support for food security, breastfeeding and vitamin D supplementation in early life is needed. In the context of social determinants of health, this study highlights the far-reaching and negative impacts of food insecurity on the health of Inuit children in Nunavut.

PMID:41243114 | DOI:10.1080/22423982.2025.2580100

Aust Health Rev. 2025 Dec 4;49(6):AH25105. doi: 10.1071/AH25105.

ABSTRACT

OBJECTIVE: The study analysed how the proportion of general practitioners (GPs) working in different practice sizes and how co-located health services changed over time in Australia, including the differences in these variables across different geographic and socioeconomic areas.

METHODS: A secondary analysis of University of Sydney’s Bettering the Evaluation and Care of Health dataset, a continuous cross-sectional study of GP activity in Australia, was performed. We analysed changes in practice size; changes in co-location of GP practices with other health services (e.g. physiotherapy, psychology, pathology, imaging); changes in practice nurses employed within GP practices; and changes in GP and practice characteristics (including GP sex, GP age, GP hours worked, and practice after-hours arrangements) from April 2000 to March 2016.

RESULTS: The average practice size increased from 4.6 (95% confidence interval (CI) 4.4-4.9) GPs in 2000-2001 to 7.5 (95% CI 7.2-7.8) GPs in 2015-2016. The proportion of GPs working at practices with co-located health services increased from 66.3% (95% CI 63.4-69.2) in 2008-2009 to 94.0% (95% CI 92.5-95.5) in 2015-2016. The proportion of GPs at practices with practice nurses significantly increased from 60.1% (95% CI 56.9-63.2) in 2004-2005 to 84.7% (95% CI 82.4-87.0) in 2015-2016. There were no significant differences across these variables in different geographic and socioeconomic areas, except for practice nurses.

CONCLUSION: This research confirms that GP practice size, co-location of health services, and the number of nurses employed within general practices have increased significantly from 2000 to 2016. We suggest that further data sources are required to explore the implications of these findings and to inform policy.

PMID:41243108 | DOI:10.1071/AH25105

BMC Oral Health. 2025 Nov 16;25(1):1787. doi: 10.1186/s12903-025-07165-x.

ABSTRACT

BACKGROUND: Primary teeth are necessary for mastication, speech, and guiding the eruption of permanent teeth. Dental caries often requires pulpectomy treatment to preserve these teeth. The success of pulpectomy depends on root canal obturation quality. This study aimed to compare the filling quality of zinc oxide-eugenol (ZOE) and Endoflas using lentulo and reverse rotary techniques, assessed by micro-computed tomography.

METHODS: An in vitro study was conducted on 32 extracted human primary mandibular second molars. Teeth were randomly divided into four groups (n = 8) based on obturation material (ZOE or Endoflas) and technique (lentulo spiral or reverse rotary file). After standard canal preparation, obturation was performed. Micro-computed tomography assessed the quality of obturation by measuring the percentage of void and filling volume. Statistical analysis was performed using analysis of variance (ANOVA) test (p < 0.05).

RESULTS: The lowest total void percentage was observed in the (ZOE + Lentulo) group (22.61 ± 9.00), and the highest in the (Endoflas|+Lentulo) group (35.97 ± 5.90). ZOE obturation resulted in lower voids (24.09 ± 8.50) compared to Endoflas (30.70 ± 8.50). The reverse rotary technique showed non significant lower voids (25.50 ± 7.60) than Lentulo (29.29 ± 10.10) (p = 0.181). A significant interaction effect was observed between material and technique in term of total voids (p = 0.021). (ZOE + Lentulo) group showed the highest filling volume (76.50 ± 9.10), while (Endoflas + Lentulo) had the lowest (64.02 ± 5.90). ZOE yielded higher filling volume (75.47 ± 8.50) compared to Endoflas (69.22 ± 8.50), with a significant material effect (p = 0.034), but no significant effect of technique (p = 0.138).

CONCLUSION: ZOE + Lentulo technique provided the most root canal obturation quality, while Endoflas + Lentulo showed the least quality. The root canal filling quality was more influenced by the obturation material than the technique used.

PMID:41243100 | DOI:10.1186/s12903-025-07165-x

Pharmacoepidemiol Drug Saf. 2025 Nov;34(11):e70269. doi: 10.1002/pds.70269.

ABSTRACT

PURPOSE: Self-medication carries the potential for significant adverse events when practiced irresponsibly. The indiscriminate use of medicines notably intensified during the COVID-19 pandemic. This study aimed to investigate the epidemiological profile of exogenous intoxications due to self-medication among Brazilians from 2014 to 2023.

METHODS: This was a cross-sectional, descriptive, and exploratory study utilizing secondary data from the Brazilian Ministry of Health’s Notifiable Diseases Information System. Confirmed cases of self-medication intoxication reported between 2014 and 2023 were included. Descriptive analysis, incidence and lethality rate calculations, chi-squared tests (p ≤ 0.05), and Multiple Correspondence Analysis (MCA) were performed to explore potential associations between sociodemographic and clinical variables.

RESULTS: A total of 23 859 cases were analyzed. The study observed a predominance of adults (20-59 years), women (70.8%), and individuals self-identifying as White or Brown (mixed-race). Most cases resulted from an acute-single exposure to the medication and resolved with complete recovery without sequelae. There was a national increase in incidence, particularly in 2022 and 2023, and significant variations among Brazilian Federative Units. The MCA identified associations between advanced age and the type of exposure (repeated or chronic) and the severity of outcomes. It also revealed changes in the sociodemographic profile of self-medication intoxications during the COVID-19 pandemic.

CONCLUSIONS: These findings underscore the pandemic’s impact on self-medication patterns and intoxication notifications. The study highlights the need for public policies focused on health education, appropriate medicine use, and strengthening the culture of reporting in Brazil.

PMID:41243099 | DOI:10.1002/pds.70269