Author: Nevin Manimala

J Med Internet Res. 2023 May 31;25:e46721. doi: 10.2196/46721.

ABSTRACT

BACKGROUND: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years.

OBJECTIVE: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer.

METHODS: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design.

RESULTS: The prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed.

CONCLUSIONS: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty.

PMID:37256672 | DOI:10.2196/46721

JMIR Aging. 2023 May 31;6:e46976. doi: 10.2196/46976.

ABSTRACT

BACKGROUND: Pain is prevalent and poorly managed in older adults. Although pain self-management strategies are helpful, adoption and access are limited; thus, technology provides an opportunity for intervention delivery. Mobile health (mHealth) is feasible to use in older adults; however, we have yet to understand the effect of mHealth pain self-management interventions on pain outcomes in older adults.

OBJECTIVE: The purpose of this scoping review is to examine the characteristics of mHealth interventions and their efficacy on pain outcomes in older adults with musculoskeletal pain.

METHODS: With the assistance of a medical librarian, keywords and subject headings were generated, including but not limited to mobile health application, mHealth, digital, pain, pain management, and older. A search was conducted for papers in journal databases, including PubMed, Embase, CINAHL, Scopus, and IEEE Xplore, between 2000 and 2022. Papers were screened according to predetermined inclusion and exclusion criteria, and reference lists were reviewed for additional paper inclusion. Three authors appraised the methodology of papers independently, then collaboratively to synthesize the evidence.

RESULTS: Six publications were included in the scoping review. The design and methodology ranged widely from pilot studies to a comparative effectiveness trial. Older participants in the studies reported a variety of musculoskeletal conditions. Delivery of the mHealth pain self-management interventions incorporated mobile devices, such as a smartphone or tablet. Most mHealth-delivered interventions were multicomponent and incorporated elements of in-person and telephone access to an interventionist. The findings suggested mHealth interventions may reduce pain intensity; however, pain interference and other pain-related conditions did not have a statistically significant reduction.

CONCLUSIONS: Research that has explored mHealth for pain self-management is beginning to move beyond feasibility. The few experimental studies conducted in older adults are heterogeneous, and the interventions are mostly multicomponent. It is premature to conclude the interventions’ significant effect on pain or pain-related symptoms. As technology continues to integrate into health care, more experimental research is warranted to examine the efficacy of mHealth interventions on a variety of pain outcomes in older adults.

PMID:37256667 | DOI:10.2196/46976

JMIR Form Res. 2023 May 31;7:e45908. doi: 10.2196/45908.

ABSTRACT

BACKGROUND: Promoting pulse consumption in schools could improve students’ healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food.

OBJECTIVE: This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan.

METHODS: Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis.

RESULTS: In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use.

CONCLUSIONS: Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students.

PMID:37256666 | DOI:10.2196/45908

Am J Phys Med Rehabil. 2023 May 24. doi: 10.1097/PHM.0000000000002297. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the quality, readability, content, accessibility, and structure of online resources for patients with upper-extremity spasticity.

DESIGN: This was a cross sectional study examined internet searches across three search engines related to patient resources for upper extremity spasticity. Search phrases for either hand or upper-extremity spasticity were used. The top 20 websites from each search were evaluated using the four-readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software.

RESULTS: Thirty-six websites and thirty-three videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the websites was 11.7 ± 3.1, showing low website readability. According to this index, only two websites were written at the suggested 6th-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both websites and videos scored in the “good” range (53.5 ± 8 and 50.5 ± 6.6), respectively.

CONCLUSION: Current online resources for upper extremity spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand.

PMID:37256662 | DOI:10.1097/PHM.0000000000002297

Am J Phys Med Rehabil. 2023 May 29. doi: 10.1097/PHM.0000000000002300. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.

DESIGN: This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Multiple binary logistic regression was used to identify systemic side effect and complication risk factors.

RESULTS: There were 1010 participants in the GCI group and 328 in the non-GCI group. There was no statistically significant difference in the occurrence of systemic infection and decompensated heart failure between the two groups. More participants in the GCI group developed abnormal uterine bleeding and erectile dysfunction but the differences did not reach statistical significance. Female participants were 1.9 times more likely to develop systemic side effects (p < 0.001). Younger age (p < 0.001), diabetes (p = 0.012), and higher GCI doses (p = 0.024) were also associated with an increased risk of developing systemic side effects.

CONCLUSION: Identified risk factors for developing GCI systemic side effects were younger age, female sex, diabetes, tobacco use, and high GCI doses.

PMID:37256660 | DOI:10.1097/PHM.0000000000002300

JMIR Res Protoc. 2023 May 31;12:e40808. doi: 10.2196/40808.

ABSTRACT

BACKGROUND: The prevalence of nonsuicidal self-injury (NSSI) is a major concern in public health. Two main factors (individual and environmental) cause NSSI. Studies addressing NSSI often consider it as an emotion regulation strategy. Studying NSSI within the framework of attachment theory is reasonable since the capacities to regulate emotion come into existence in the framework of attachment in the first periods of a child’s growth. Primary studies addressing this topic are not frequent, and no systematic review has been conducted.

OBJECTIVE: This systematic review and meta-analysis protocol aims to investigate the relationship between NSSI and attachment style and finding its relationship based on study design, study type, different types of attachments, and gender.

METHODS: All studies on the relationship between NSSI and attachment will be included in this systematic review. We will include observational studies (cross-sectional, cohort, and case control) through searches in electronic databases via PubMed, CINAHL, Embase, Web of Science, ProQuest, Scopus, PsycINFO, and Google Scholar as complementary search. Qualitative studies, case studies, case series, and letters to the editor will be excluded. There will be no language limitation. Moreover, there will be no limitations regarding the study participants’ age, gender, nationality, sexual orientation, and psychological problems. Funnel plots were examined if 10 or more studies are included, and the Begg and Egger statistical tests were used to assess the risk of bias. All similar data will be combined through the “metan” command by Stata statistical package (StataCorp). A fixed-effects or random-effects model, considering methodological similarities or differences, will be selected to determine a combination model.

RESULTS: We will summarize the selection of the eligible studies using a flowchart. The results will be presented in a table of evidence. The results of the meta-analysis will be depicted using diagrams and tables.

CONCLUSIONS: It seems necessary to carry out such systematic and comprehensive meta-analysis to present a summary of the published articles in terms of the relationship between NSSI and attachment. The results from this review will be used to improve our knowledge of the role of the upbringing of children and NSSI behavior and will help design appropriate interventions to address NSSI.

TRIAL REGISTRATION: PROSPERO CRD42021226455; https://tinyurl.com/yc77wny8.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40808.

PMID:37256657 | DOI:10.2196/40808

J Clin Psychiatry. 2023 May 31;84(3):23f14933. doi: 10.4088/JCP.23f14933.

ABSTRACT

Statistics such as the mean difference (MD), standardized mean difference (SMD), relative risk (RR), odds ratio (OR), hazard ratio (HR), and others are meant to be examined along with their 95% confidence intervals (CIs), and their significance can be understood by viewing these CIs as compatibility intervals. The 95% CIs around the MD and SMD are easily understood because they are expressed along a linear scale. The 95% CIs around the RR, OR, and HR are harder to understand because they are expressed along an exponential scale; however, when the numbers are log-transformed, they are linearized, and understanding becomes easy. Another approach to understanding the CIs around the RR, OR, or HR is to examine the reciprocal of the lower limit of the CI; however, because the reciprocal also lies along an exponential scale, this method is inferior to the log-transformation method. These approaches may seem daunting, but the difficulty is an illusion because log transformation or reciprocal transformation takes only a few seconds when a statistical calculator is opened. All terms and concepts are explained with extreme simplification and with the help of examples.

PMID:37256636 | DOI:10.4088/JCP.23f14933

JAMA Netw Open. 2023 May 1;6(5):e2314934. doi: 10.1001/jamanetworkopen.2023.14934.

ABSTRACT

IMPORTANCE: Prenatal perfluoroalkyl and polyfluoroalkyl substances (PFAS) have been linked to adverse birth outcomes. Previous research showed that higher folate concentrations are associated with lower blood PFAS concentrations in adolescents and adults. Further studies are needed to explore whether prenatal folate status mitigates PFAS-related adverse birth outcomes.

OBJECTIVE: To examine whether prenatal folate status modifies the negative associations between pregnancy PFAS concentrations, birth weight, and gestational age previously observed in a US cohort.

DESIGN, SETTING, AND PARTICIPANTS: In a prospective design, a prebirth cohort of mothers or pregnant women was recruited between April 1999 and November 2002, in Project Viva, a study conducted in eastern Massachusetts. Statistical analyses were performed from May 24 and October 25, 2022.

EXPOSURE: Plasma concentrations of 6 PFAS compounds were measured in early pregnancy (median gestational week, 9.6). Folate status was assessed through a food frequency questionnaire and measured in plasma samples collected in early pregnancy.

MAIN OUTCOMES AND MEASURES: Birth weight and gestational age, abstracted from delivery records; birth weight z score, standardized by gestational age and infant sex; low birth weight, defined as birth weight less than 2500 g; and preterm birth, defined as birth at less than 37 completed gestational weeks.

RESULTS: The cohort included a total of 1400 mother-singleton pairs. The mean (SD) age of the mothers was 32.21 (4.89) years. Most of the mothers were White (73.2%) and had a college degree or higher (69.1%). Early pregnancy plasma perfluorooctanoic acid concentration was associated with lower birth weight and birth weight z score only among mothers whose dietary folate intake (birth weight: β, -89.13 g; 95% CI, -166.84 to -11.42 g; birth weight z score: -0.13; 95% CI, -0.26 to -0.003) or plasma folate concentration (birth weight: -87.03 g; 95% CI, -180.11 to 6.05 g; birth weight z score: -0.14; 95% CI, -0.30 to 0.02) were below the 25th percentile (dietary: 660 μg/d, plasma: 14 ng/mL). No associations were found among mothers in the higher folate level groups, although the tests for heterogeneity did not reject the null. Associations between plasma perfluorooctane sulfonic acid and perfluorononanoate (PFNA) concentrations and lower birth weight, and between PFNA and earlier gestational age were noted only among mothers whose prenatal dietary folate intake or plasma folate concentration was in the lowest quartile range. No associations were found among mothers in higher folate status quartile groups.

CONCLUSIONS AND RELEVANCE: In this large, US prebirth cohort, early pregnancy exposure to select PFAS compounds was associated with adverse birth outcomes only among mothers below the 25th percentile of prenatal dietary or plasma folate levels.

PMID:37256622 | DOI:10.1001/jamanetworkopen.2023.14934

JAMA Netw Open. 2023 May 1;6(5):e2315315. doi: 10.1001/jamanetworkopen.2023.15315.

ABSTRACT

IMPORTANCE: Extremely preterm infants who develop bronchopulmonary dysplasia (BPD) are at a higher risk for adverse pulmonary and neurodevelopmental outcomes. In the National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) Hydrocortisone Trial, hydrocortisone neither reduced rates of BPD or death nor increased rates of neurodevelopmental impairment (NDI) or death.

OBJECTIVE: To determine whether estimated risk for grades 2 to 3 BPD or death is associated with the effect of hydrocortisone on the composite outcomes of (1) grades 2 to 3 BPD or death and (2) moderate or severe NDI or death.

DESIGN, SETTING, AND PARTICIPANTS: This secondary post hoc analysis used data from the NICHD NRN Hydrocortisone Trial, which was a double-masked, placebo-controlled, randomized clinical trial conducted in 19 US academic centers. The NICHD HRN Hydrocortisone Trial enrolled infants born at a gestational age of less than 30 weeks who received mechanical ventilation for at least 7 days, including at the time of enrollment, and who were aged 14 to 28 postnatal days. Infants were enrolled between August 22, 2011, and February 4, 2018, with follow-up between 22 and 26 months of corrected age completed on March 29, 2020. Data were analyzed from September 13, 2021, to March 25, 2023.

INTERVENTION: Infants were randomized to 10 days of hydrocortisone or placebo treatment.

MAIN OUTCOMES AND MEASURES: Infants’ baseline risk of grades 2 to 3 BPD or death was estimated using the NICHD Neonatal BPD Outcome Estimator. Differences in absolute and relative treatment effects by baseline risk were evaluated using interaction terms in models fitted to the efficacy outcome of grades 2 to 3 BPD or death and the safety outcome of moderate or severe NDI or death by follow-up.

RESULTS: Among the 799 infants included in the analysis (421 boys [52.7%]), the mean (SD) gestational age was 24.9 (1.5) weeks, and the mean (SD) birth weight was 715 (167) g. The mean estimated baseline risk for grades 2 to 3 BPD or death was 54% (range, 18%-84%) in the study population. The interaction between treatment group and baseline risk was not statistically significant on a relative or absolute scale for grades 2 to 3 BPD or death; the size of the effect ranged from a relative risk of 1.13 (95% CI, 0.82-1.55) in quartile 1 to 0.94 (95% CI, 0.81-1.09) in quartile 4. Similarly, the interaction between treatment group and baseline risk was not significant on a relative or absolute scale for moderate or severe NDI or death; the size of the effect ranged from a relative risk of 1.04 (95% CI, 0.80-1.36) in quartile 1 to 0.99 (95% CI, 0.80-1.22) in quartile 4.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial, the effect of hydrocortisone vs placebo was not appreciably modified by baseline risk for grades 2 to 3 BPD or death.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01353313.

PMID:37256621 | DOI:10.1001/jamanetworkopen.2023.15315

JAMA Netw Open. 2023 May 1;6(5):e2316060. doi: 10.1001/jamanetworkopen.2023.16060.

ABSTRACT

IMPORTANCE: Rates of pediatric hospitalizations following an injury while riding an all-terrain vehicle (ATV) are increasing. Few studies have compared the rates of severe injuries among children, adolescents, and adults.

OBJECTIVES: To investigate whether younger ATV riders are at risk for more severe ATV-related injuries.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted using administrative data from hospitals in 9 provinces in Canada. Participants included patients admitted to hospitals with ATV-related injuries between 2002 and 2019. Statistical analysis was performed from June 2020 to September 2021.

EXPOSURES: The primary exposure was age younger than 16 years. Comparison groups were youths aged 16 to 20 years and adults aged 21 years and older.

MAIN OUTCOMES AND MEASURES: The main outcomes of interest were death, spinal cord injury, and an Injury Severity Score (ISS) greater than 25. Secondary outcomes were less severe injuries, including head injuries, crush type injuries, and fractures.

RESULTS: Among 52 745 patients with complete data, 15% were youths younger than 16 years, 13% were youths aged 16 to 20 years, 82% were male, and 47% lived in rural areas. After adjusting for covariates, the odds of dying were higher among youths aged 16 to 20 years (adjusted odds ratio [aOR], 1.64; 95% CI, 1.04-2.60) compared with those younger than 16 years. Youths aged 16 to 20 years also had higher odds of spinal cord injury (aOR, 2.72; 95% CI, 1.80-4.20) and an injury severity score greater than 25 (aOR, 1.63; 95% CI, 1.36-1.96) compared with youths 16 years of age or less. Sex-specific analyses revealed these associations were greater for male youths aged 16 to 20 years (spinal cord injury: aOR, 3.81; 95% CI, 1.38-11.10, and dying in a hospital: aOR, 4.37; 95% CI, 1.19-21.02) than female youths aged 16 to 20 years.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of patients hospitalized for ATV injuries in Canada, youths aged 16 to 20 years and adults aged 21 years and older were at an increased risk of death and severe injuries compared with youths younger than 16 years. The increased risk of death and severe injuries was most evident among male patients.

PMID:37256619 | DOI:10.1001/jamanetworkopen.2023.16060