Category: Nevin Manimala

J Psychiatr Res. 2025 May 24;188:243-251. doi: 10.1016/j.jpsychires.2025.05.057. Online ahead of print.

ABSTRACT

Existing evidence suggested a potential link between mental health problems in children and adolescents and an increased odds of developing gaming disorder (GD). However, the relationship between emotional and behavioral problems (EBP) and GD remains unknown. This cross-sectional study, involving a sample size of 201,906 students aged 6-18 years from Guangzhou city, aims to investigate this association. The assessment of GD was performed using the Gaming Disorder Test, while EBP was evaluated via parent-reported Strength and Difficulty Questionnaire. Statistical analyses, including multiple logistic regression, subgroup analyses, and sensitivity analyses, were employed to examine the association between EBP and GD. The prevalence rate of GD was 11.4 %, with higher rates observed among adolescents and boys. After adjusting for covariates, children and adolescents with border or abnormal levels of total difficulties, internalizing problems, externalizing problems, emotional symptoms, conduct problems, hyperactivity/inattention problems, and pro-social behaviors exhibited a significantly increased odds of developing GD. This study suggests that Chinese children and adolescents with EBP may be more vulnerable to developing GD. Further longitudinal researches are needed to better understand this association.

PMID:40460467 | DOI:10.1016/j.jpsychires.2025.05.057

Int J Pediatr Otorhinolaryngol. 2025 May 29;195:112404. doi: 10.1016/j.ijporl.2025.112404. Online ahead of print.

ABSTRACT

OBJECTIVES: Peripheral vestibular disease primarily involves the part of the inner ear that controls balance and may affect the physical and psychological well-being of children. Peripheral vestibular disease can be challenging to assess in children due to the difficulty of patients with verbalization of symptoms, variety of clinical presentations, and the involvement of other organ systems of balance. This cross-sectional study aimed to identify clinical factors that are associated with vertigo and migraine in pediatric patients.

METHODS: The clinical records of 292 children seen at the specialty clinic for an assessment of dizziness were reviewed for demographic variables, medical history, imaging, and audiovestibular symptoms and tests. Standard statistical testing was performed.

RESULTS: Logistic regression analysis showed that having abnormal MRI findings (odds ratio [OR] = 0.74; p = 0.001), a previous referral diagnosis of “nystagmus” (OR = 0.58; p = 0.04), attention deficit hypersensitivity or autism spectrum disorder (OR = 0.70; p = 0.007), and migraine (OR = 0.71; p = 0.0004) were associated with a less likely diagnosis of peripheral vertigo. On the other hand, cardiovascular conditions (OR = 2.64; p = 0.02) were associated with migraine in patients with vertigo.

CONCLUSION: Our findings suggest that thorough evaluation for neurologic and cardiovascular disorders is important in order to improve diagnosis and management of vertigo and dizziness in children.

PMID:40460462 | DOI:10.1016/j.ijporl.2025.112404

JMIR Diabetes. 2025 Jun 3;10:e70380. doi: 10.2196/70380.

ABSTRACT

BACKGROUND: Adherence to type 1 diabetes mellitus (T1DM) treatment regimens decreases during adolescence. While comorbid depression and health insurance disparities are individually known to potentiate this risk, technological devices for T1DM appear to be protective.

OBJECTIVE: We examined whether technology use impacted the association between depression and poorer health outcomes in T1DM. Given established insurance-based disparities based on technology access, we also studied whether the protective effects of T1DM technology differed among publicly and privately insured youth.

METHODS: Data were prospectively collected from pediatric patients with T1DM across 3 California medical centers. We used linear and negative binomial regression analyses to examine whether technology use was related to diabetes outcomes and whether this differed based on depression status (technology-by-depression interaction) and health insurance type (technology-by-insurance interaction).

RESULTS: Across 1573 patients aged 12 to 25 years (mean age 15.9, SD 2.9 years; n=1050, 66.4%, non-Hispanic White; n=745, 47.0% female), those with a depression diagnosis had higher hemoglobin A1c (HbA1c; mean 9.1%, SD 2.1% vs 10.1%, SD 2.2%) and more frequent diabetic ketoacidosis (DKA) events per year (mean 0.10, SD 0.36 vs 0.24, SD 0.66) than those without (P=.003). Patients using both a continuous glucose monitor (CGM) and pump had lower HbA1c levels and fewer DKA events per year (mean HbA1c 8.2%, SE 0.1%; mean DKA events per year 0.05, SE 0.01) than those using one device (mean HbA1c 9.0%, SE 0.1%; mean DKA events 0.08, SE 0.1%) or none (mean HbA1c 10.0%, SE 0.1%; mean DKA events 0.19, SE 0.1%; P<.001). While youth with public insurance had significantly higher HbA1c levels than those with commercial insurance (mean 9.3%, SD 2.1% vs 9.0%, SD 2.0%, P<.001), those using a CGM had no reliable decrease in HbA1c compared to their commercially insured peers (P=.35).

CONCLUSIONS: Technology use in pediatric T1DM appears protective for both youth with a history of depression and those who are publicly insured. These data underscore the importance of universal access to technology to mitigate disparities based on comorbid mental health issues and differential access to care.

PMID:40460446 | DOI:10.2196/70380

JMIR Serious Games. 2025 Jun 3;13:e67250. doi: 10.2196/67250.

ABSTRACT

BACKGROUND: Age-related physiological changes in older adults involve a rapid decline in motor exercise ability; some older adults may also experience difficulties in maintaining focus, memory loss, and a decline in reaction time, which consequently impair their ability to perform dual tasks. Motor-cognitive training (MCT) refers to a blend of motor activity and cognitive training that occurs simultaneously and can assist older adults in enhancing their physical function, cognitive abilities, and dual-task performance. In recent years, the use of technology for delivering MCT has become increasingly popular in research. This has been achieved through various technologies that simplify MCT for older adults.

OBJECTIVE: This study aimed to systematically examine the feasibility and effectiveness studies on technology-assisted MCT among older adults.

METHODS: This rapid review was conducted following the updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards, and the Synthesis Without Meta-analysis (SWiM) in systematic reviews reporting guideline. Four databases were searched, including CINAHL, Embase, PubMed, and Scopus, from January 2013 to March 2025. Search strategies were constructed based on three main topics: (1) older adults, (2) MCT, and (3) technology. Inclusion criteria followed the population, intervention, comparator, outcome, and study design framework as follows: older adults (population); technology-assisted MCT (intervention); standard treatment control, active control, partial intervention control, placebo control, and dose-response control (comparator); various measures of physical, cognitive, and dual-task performance (outcome); and randomized controlled trials (RCTs) and pilot RCTs (study design). The Cochrane Risk of Bias Tool was applied for quality appraisal of the included studies. The feasibility of the included studies was assessed using completion rates and attrition rates. Descriptive statistics were used to describe the demographic and clinical characteristics of the groups, while narrative methods were used to categorize and synthesize their effectiveness.

RESULTS: In total, 20 studies were included, comprising 16 RCTs and 4 pilot RCTs, most of which were conducted within a 6-week period. Each session typically lasted between 10 and 30 minutes and was held 2 to 3 times per week. Feasibility analysis showed that technology-assisted MCT was generally feasible. While the workload was high, the perceived usability was also high, with a considerable amount of positive feedback and very few reported adverse events. The types of MCT varied in terms of components, duration, and frequency. The majority of studies (18/20, 90%) demonstrated statistically significant improvements in physical, cognitive, and dual-task performance because of technology-assisted MCT.

CONCLUSIONS: The feasibility of technology-assisted MCT among older adults was high regardless of the perceived high workload, and most studies showed statistical effectiveness in improving physical, cognitive, and dual-task performance.

TRIAL REGISTRATION: Open Science Foundation (OSF) Registries 10.17605/OSF.IO/5SRCQ; https://osf.io/5srcq.

PMID:40460432 | DOI:10.2196/67250

J Med Internet Res. 2025 Jun 3;27:e71169. doi: 10.2196/71169.

ABSTRACT

BACKGROUND: Parkinson disease (PD) presents motor and nonmotor challenges that significantly affect quality of life. Telemedicine has emerged as a promising approach to deliver interventions, including exercise performed through remote equipment (e-Exercise), cognitive behavioral training sessions conducted remotely (e-Cognitive), and consultations conducted through remote devices (e-Visits), yet their comparative effectiveness remains unclear.

OBJECTIVE: This paper aimed to evaluate the effectiveness of telemedicine interventions on motor and nonmotor outcomes in PD and compare the efficacy of e-Exercise, e-Cognitive, and e-Visits.

METHODS: A systematic review and network meta-analysis were conducted by searching PubMed, MEDLINE, Embase, Cochrane CENTRAL, and Web of Science through November 2024. Randomized controlled trials comparing telemedicine interventions with usual care were included. Outcomes assessed included total motor symptoms, quality of life, cognitive function, depressive and anxiety symptoms, fear of falling, 6-minute walk test, walking velocity, balance ability, and timed up and go. Two investigators independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane risk of bias 2 tool. Data synthesis included (1) pairwise meta-analyses using random-effects models to calculate standardized mean differences (SMDs) and mean differences; and (2) Bayesian network meta-analysis integrating direct and indirect comparisons to rank intervention efficacy, with transitivity and inconsistency evaluated. Evidence quality was graded using GRADE (Grading of Recommendations, Assessment, Development and Evaluation), incorporating risk of bias, heterogeneity (I²>50% indicating substantial heterogeneity), precision, and publication bias (Egger test). Statistical heterogeneity was quantified by τ² and I².

RESULTS: A total of 23 studies involving 1330 participants were included. Pairwise meta-analyses demonstrated that telemedicine significantly improved total motor symptoms (SMD=-0.61, 95% CI -1.19 to -0.4), cognitive function (SMD=0.58, 95% CI 0.15-1.01), depressive symptoms (SMD=-0.46, 95% CI -0.88 to -0.04), anxiety symptoms (SMD=-0.57, 95% CI -1.10 to -0.03), fear of falling (SMD=-0.48, 95% CI -0.77 to -0.19), and 6-minute walk test performance (mean difference=18.98, 95% CI 16.06-21.90 meters). The network meta-analysis revealed that e-Exercise was most effective for improving total motor symptoms (SMD=-1.01, 95% credible interval [CrI] -1.96 to -0.05) and 6-minute walk test performance. e-Cognitive was most effective for enhancing quality of life (SMD=0.39, 95% CrI 0.06-0.73) and cognitive function (SMD=1.02, 95% CrI 0.38-1.66), and reducing depressive (SMD=-1.28, 95% CrI -1.61 to -0.96) and anxiety symptoms (SMD=-1.07, 95% CrI -1.40 to -0.75). e-Visits had a limited impact across outcomes. Evidence quality was moderate or high for motor symptoms, quality of life, and depression, but low or very low for other outcomes.

CONCLUSIONS: Telemedicine is effective for improving motor and nonmotor outcomes in PD. e-Exercise is optimal for motor function and physical performance, while e-Cognitive is most effective for psychological and cognitive challenges. These findings highlight the importance of tailoring telemedicine programs to address specific therapeutic needs in PD management.

TRIAL REGISTRATION: PROSPERO CRD42024628687; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628687.

PMID:40460428 | DOI:10.2196/71169

J Med Internet Res. 2025 Jun 3;27:e68091. doi: 10.2196/68091.

ABSTRACT

BACKGROUND: Digital patient portals (PPs) are platforms that enhance patient engagement and promote active involvement in health care by providing remote access to personal health data. Although many hospitals are legally required to offer these portals, adoption varies widely among patients, often influenced by sociodemographic and socioeconomic determinants. Evidence suggests that higher income, education, employment status, and specific age groups correlate with increased portal usage, highlighting a digital divide. This study aims to analyze sociodemographic and socioeconomic determinants affecting digital PP usage, addressing inconsistencies in existing research and contributing to strategies for reducing digital health disparities.

OBJECTIVE: This study aimed to conduct a meta-analysis of the sociodemographic and socioeconomic factors contributing to the digital divide in the usage of digital PPs.

METHODS: A systematic review with meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in PubMed, Web of Science Core Collection, and EBSCOhost. Screening involved 3 reviewers with consensus meetings to resolve discrepancies. Data on sociodemographic and socioeconomic factors and statistical outcomes were extracted, and study quality was assessed using the Mixed Methods Appraisal tool. Results were visualized using forest and funnel plots to assess heterogeneity and publication bias.

RESULTS: A total of 2225 studies were identified through a systematic review, and after title and abstract screening, 17 studies were included in the quantitative and qualitative analysis. The qualitative analysis revealed that younger patients (younger than 65 y) were significantly more likely to use the digital PP, while the meta-analysis revealed that women had a 16% higher likelihood of using the digital PP than men. The relationship between income and digital PP usage was inconsistent, due to different scaling in different studies. A higher level of education was significantly associated with a 37% greater likelihood of using the digital PP in the meta-analysis. In addition, employed patients were 23% more likely to use the digital PP, while married patients had a 13% higher likelihood of using it than unmarried patients. Marital status and employment can be considered as measurable factors of social relationships.

CONCLUSIONS: The review confirms that sociodemographic and socioeconomic factors significantly influence the usage of digital PP in hospital care. Marital status shows that social support plays a vital role, with married patients 13% more likely to engage with digital PPs. It is worth noting that social support through connections to society via work or work colleagues can also play an important role as like as a partner at home, with employed individuals being 22% more likely to use digital PPs. Overall, sociodemographic factors, like marital status, primarily affect usage patterns, while socioeconomic factors, like employment, enable access, emphasizing the need for comprehensive support systems to bridge the digital divide in health care.

TRIAL REGISTRATION: German register of clinical trials DRKS00033125; https://drks.de/search/de/trial/DRKS00033125 and PROSPERO CRD42024567203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567203.

PMID:40460427 | DOI:10.2196/68091

JMIR Form Res. 2025 Jun 3;9:e67964. doi: 10.2196/67964.

ABSTRACT

BACKGROUND: Depression is the top contributor to global disability. Early detection of depression and depressive symptoms enables timely intervention and reduces their physical and social consequences. Prevalence estimates of depression approach 30% among college students. Passive, device-based sensing further enables detection of depressive symptoms at a low burden to the individual.

OBJECTIVE: We leveraged an ensemble machine learning method (light gradient boosting machine) to detect depressive symptoms entirely through passive sensing.

METHODS: A diverse sample of undergraduate students (N=28; mean age 19.96, SD 1.23 y; 15/28, 54% women; 13/28, 46% Latine; 10/28, 36% Asian; 4/28, 14% non-Latine White; 11/28, 4% other) participated in an intensive longitudinal study. Participants wore 2 devices (an Oura ring for sleep and physiology data, and a Samsung smartwatch for physiology and movement data) and installed the AWARE software on their mobile devices, which collects passive sensing data such as screen time. Participants were derived from a randomized controlled trial of a positive psychology mobile health intervention. They completed a self-report measure of depressive symptoms administered weekly over a 19- to 22-week period.

RESULTS: The light gradient boosting machine model achieved an F₁-score of 0.744 and a Cohen κ coefficient of 0.474, indicating moderate agreement between the predicted labels and the ground truth. The most predictive features of depressive symptoms were sleep quality and missed mobile interactions.

CONCLUSIONS: Findings suggest that data collected from passive sensing devices may provide real-time, low-cost insight into the detection of depressive symptoms in college students and may present an opportunity for future prevention and perhaps intervention.

PMID:40460426 | DOI:10.2196/67964

J Community Psychol. 2025 Jul;53(5):e70019. doi: 10.1002/jcop.70019.

ABSTRACT

Behavior problems in young children, especially among families from disadvantaged backgrounds (e.g., facing greater risk of poverty, social exclusion, discrimination, and violence), often result in referrals to mental health clinics. However, low-income families from historically marginalized racial and ethnic backgrounds disproportionately experience barriers to accessing, engaging, and completing treatment. This study examined the recruitment and referral network of a parenting program providing Parent-Child Interaction Therapy (PCIT) in a large urban academic medical center and affiliated community-embedded clinics, as well as the impact of recruitment/referral sources on screening paperwork completion, intake attendance, and treatment completion. Data from 2510 families referred between 2018 and 2022 were analyzed, considering demographic factors and recruitment adaptations during COVID-19. Referral sources included but were not limited to community agencies, social media, and healthcare providers. Logistic regression analyses determined the likelihood of completing the screening paperwork, attending intake, and completing treatment based on recruitment/referral sources. Every recruitment/referral source increased the likelihood of screening paperwork completion (except community outreach). Every source increased the likelihood of attending intake (except previously enrolled families). Treatment completion was significantly more likely for those referred from pediatricians, friends, behavioral health, and Google. After COVID-19 (post March 2020), families were more likely to complete the screening paperwork, attend intake, and complete treatment compared to families screened before COVID-19. Effective recruitment and retention strategies are crucial for engaging families in mental health services. Findings emphasize the role of community and healthcare providers, word-of-mouth, and Google and the benefits of telehealth (indicated by post-COVID-19 results), in improving treatment access and retention, highlighting the need for flexible service delivery methods.

PMID:40460414 | DOI:10.1002/jcop.70019

PLoS One. 2025 Jun 3;20(6):e0325269. doi: 10.1371/journal.pone.0325269. eCollection 2025.

ABSTRACT

BACKGROUND: Vaccine formulations targeting contemporaneous subvariants have been developed to respond to SARS-CoV-2 virus evolution. Updated monovalent COVID-19 vaccines targeting the Omicron XBB.1.5 variant (XBB-vaccines) were administered in the province of Quebec, Canada, during 2023 autumn and 2024 spring vaccination campaigns. Our objective was to evaluate mRNA XBB-vaccine effectiveness (VE) against COVID-19 hospitalizations among adults aged ≥60 years overall during a ten-month follow-up period, by subvariant predominant period, and by time since vaccination.

METHODS: We conducted a test-negative case-control study using Quebec population-based administrative data. Specimens collected from individuals aged ≥60 years tested at an acute-care hospital from October 2023 to August 2024 were considered test-positive cases if hospitalized for COVID-19, or controls if test-negative for SARS-CoV-2. Vaccination was defined by receipt of at least one mRNA XBB-vaccine (autumn or spring) dose. Subvariant predominant periods were defined according to whole-genome sequencing data from provincial laboratories: XBB or EG.5 and subvariants (XBB period), BA.2.86, JN.1 or subvariants (JN period), and KP.2 or KP.3 and subvariants (KP period). Multivariable logistic regression analyses estimated VE relative to several comparator groups, primarily those last-vaccinated in 2022, by subvariant period, by time since XBB-vaccination and by number of XBB-vaccine doses (KP period).

RESULTS: Participants overall and by XBB, JN and KP periods included: 5532 (4.9%) test-positive cases (1321, 1838 and 1372, respectively) and 108473 (95.1%) test-negative controls (12881, 53414 and 28595, respectively); 14584 specimens were collected during periods of subvariant cocirculation. By subvariant period, 3322 (25.8%), 27041 (50.6%) and 15401 (53.9%) controls, respectively, were considered XBB-vaccinated. Overall VE was 30% (95%CI:24-35) and by XBB, JN or KP period: 54% (95%CI:46-62), 23% (95%CI:13-32) and 0% (95%CI:-18-15), respectively. During each subvariant period, the hospitalization risk was reduced only during the first four months post-vaccination.

CONCLUSIONS: Among individuals aged 60 years or older, mRNA XBB-vaccination provided meaningful, albeit limited to first four months post-vaccination, protection against COVID-19 hospitalization due to XBB, JN and KP subvariants. Better vaccines are needed to effectively protect older adults against COVID-19 hospitalizations.

PMID:40460407 | DOI:10.1371/journal.pone.0325269

PLoS One. 2025 Jun 3;20(6):e0321636. doi: 10.1371/journal.pone.0321636. eCollection 2025.

ABSTRACT

BACKGROUND: Cuproptosis may be a new clue to illustrate the pathogenesis of the disease. There was no study focused on the relationship between the cuproptosis genes and diabetic nephropathy (DN). This study aimed to reveal the relationship between cuproptosis genes and the immune microenvironment in DN and distinguish different phenotypes to describe disease heterogeneity through consensus clustering based on cuproptosis genes.

METHODS: We downloaded RNA sequencing data sets of DN glomerular and normal renal tissue samples (GSE142025, GSE30528, and GSE96804) from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between DN and control samples were screened. Immune cell subtype infiltration and immune score were figured out via different algorithms. Consensus clustering was performed by Ward’s method to determine different phenotypes of DN. Key genes between phenotypes were identified via a machine-learning algorithm. Logistic regression analysis was applied to establish a nomogram for assessing the disease risk of DN. The role of related genes was verified by cell experiments.

RESULTS: In DN samples, NOD-like receptor thermal protein domain associated protein 3(NLRP3) and cyclin-dependent kinase inhibitor 2A Gene(CDKN2A) were positively correlated to immune score. Nuclear factor erythroid 2-related factor 2(NFE2L2), Lipoic Acid Synthetase(LIAS), Lipoyltransferase 1(LIPT1), Dihydrolipoamide dehydrogenase(DLD), Dihydrolipoamide Branched Chain Transacylase E2(DBT) and Dihydrolipoamide S-Succinyltransferase(DLST) were negatively correlated to immune score. Via Consensus clustering based on cuproptosis genes, the DN samples were divided into cluster C1 and cluster C2. Cluster C1 was characterized by low cuproptosis gene expression, high immune cell subtype infiltration, and high enrichment of immune-related pathways. Cluster C2 was on the contrary. Dicarbonyl/l-xylulose reductase (DCXR) and heat-responsive protein 12 (HRSP12) were key genes related to clinical traits and immune microenvironment, negatively correlated with most immune cell subtypes. The nomogram constructed based on DCXR and HRSP12 showed good efficiency for DN diagnosis.

CONCLUSION: Immune microenvironment imbalance and metabolic disorders may lead to the occurrence of DN. Cuproptosis genes, with the ability to regulate the immune microenvironment and metabolism, can be used for disease clustering to describe the heterogeneity and characterize the immune microenvironment. HRSP12 and DCXR, as key genes related to disease phenotypes and immune microenvironment characteristics, were jointly constructed as nomograms for DN diagnosis with high accuracy and reliability. HRSP12 and DCXR may be potential biological markers and renal protective factors.

PMID:40460381 | DOI:10.1371/journal.pone.0321636