Category: Nevin Manimala

Am J Trop Med Hyg. 2025 Feb 25:tpmd240321. doi: 10.4269/ajtmh.24-0321. Online ahead of print.

ABSTRACT

The WHO has a simplified grading system for assessing trachoma. However, even for experts, it can be difficult to classify certain cases as strictly positive or negative for a given grade. Given the absence of a true gold standard, we performed a Latent Class Analysis (LCA) on a set of 200 graded photos of the superior tarsal conjunctiva. Ten trained graders assessed the presence of two trachoma grades: trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI). The LCA was modeled in two different ways: first with two classes (presence/absence), and then with three classes, with the extra class presumed to represent a more discrepant “borderline” case. Cohen’s κ-statistics measuring agreement between graders were calculated for TF and TI grades (separately) before and after removing the third latent class. The κ-statistic increased by 0.10 (95% CI = 0.72-0.85; P <0.001) for TF and 0.13 (95% CI = 0.81-0.90; P <0.001) for TI, indicating that the third latent class represented a discrepant-case borderline class. The identification of borderline grading cases using a three-class LCA may be useful in creating balanced grader certification examinations that represent the full spectrum of disease. Additionally, a multiclass LCA could act as a probabilistic gold standard used to train and analyze future convolutional neural network models.

PMID:39999453 | DOI:10.4269/ajtmh.24-0321

Am J Trop Med Hyg. 2025 Feb 25:tpmd240161. doi: 10.4269/ajtmh.24-0161. Online ahead of print.

ABSTRACT

A critical impediment to efficient outbreak response is the availability of timely and complete data on cases and their linkage to care. To inform solutions to this issue, this study investigated the utility of self-testers reporting their coronavirus disease 2019 results using a mobile health platform. Our study has demonstrated that the mobile health platform is feasible; it achieved a 74.5% reporting rate, indicating a strong likelihood of data entry into the unstructured supplementary service data platform. Support from community health workers (CHWs) and healthcare professionals, particularly nurses, contributed to this success, especially among users with limited digital literacy. Specifically, 44.9% of self-test results were submitted by study participants themselves, 24.7% were submitted with the assistance of healthcare professionals, and 30.4% were submitted with the assistance of CHWs. The platform broadens the population base by increasing access and equity, allowing participation even among users without smartphones. Additionally, it integrates rapid antigen diagnostic tests with digital reporting, simplifying data processing and enabling standardized screening, real-time data capture, and effective patient follow-up. This technology also lays a foundation for pandemic preparedness in low- and middle-income countries by demonstrating the feasibility of fully integrating response loops for disease management and interventions. Future response loops could leverage artificial intelligence, machine learning, and integration with existing health surveillance systems, directly benefiting users through enhanced support.

PMID:39999452 | DOI:10.4269/ajtmh.24-0161

JMIR Mhealth Uhealth. 2025 Feb 25;13:e60115. doi: 10.2196/60115.

ABSTRACT

BACKGROUND: Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice.

OBJECTIVE: The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL).

METHODS: Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence-driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band-based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients’ HR reached the target zone (HR_resting + [HR_max – HR_resting] × [≈40%-60%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL.

RESULTS: A total of 40 (85%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (-0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (-8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (-0.31, SD 0.44 vs -0.05, SD 0.29; P=.048), and daytime dysfunction (-0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period.

CONCLUSIONS: The 5-month, digital therapeutics-based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594.

PMID:39999435 | DOI:10.2196/60115

J Med Internet Res. 2025 Feb 25;27:e68462. doi: 10.2196/68462.

ABSTRACT

BACKGROUND: Regular exercise may counteract obesity-related health risks, but adherence is low among individuals with obesity. Personal trainers may positively influence exercise behavior by providing motivational support. Individuals who receive regular exercise coaching are more likely to adhere to their exercise routine, compared with those who exercise individually. However, investing in personalized exercise guidance, such as a personal trainer, can be expensive for the individual. Thus, integrating web-based coaching could be a more economically sustainable option, offering both flexibility and reduced costs compared with in-person coaching only. Yet, research is needed to assess the effect of hybrid models in improving psychosocial factors among women with obesity.

OBJECTIVE: This 20-week, pragmatic randomized controlled trial aimed to investigate the effect of weekly in-person coaching compared with 2 combinations of in-person and web-based coaching on 5 psychosocial factors in women with obesity (BMI ≥30 kg/m²).

METHODS: Participants were invited through Facebook and Instagram advertisements posted by various fitness clubs across rural and urban locations in Norway (7 different counties and 12 different municipalities). Women with low activity (n=188; <150 minutes of moderate-intensity physical activity/week; 42.7, SD 10.5 years; mean BMI of 35.1, SD 6.9 kg/m²) were allocated into 3 groups of in-person coaching-weekly (n=47), twice weekly (n=47), and once monthly (n=47)-and as controls (n=47). Those with twice weekly and once monthly in-person coaching received web-based coaching of 15 minutes during weeks without in-person coaching. Data included background variables, motivation (Behavioral Regulation in Exercise Questionnaire-2), barriers, self-efficacy (The Self-Efficacy Survey), social support (Social Support Questionnaire), and health-related quality of life (36-Item Short Form Health Survey [SF-36]).

RESULTS: A total of 120 (64%) out of 188 participants completed baseline and postintervention assessments. A minor difference was observed in one item of the SF-36, where all intervention groups reported a greater “change in health last year” than the control group (mean difference: 14.2-17.1, 95% CI 2.04-29.5; g=0.79-1.14; P≤.01). No other effects were found on the selected psychosocial factors. It should be noted that controls reported higher intrinsic motivational regulation at baseline than intervention groups (mean difference: 0.43-0.93; P≤.05). All intervention arms exercised more frequently than controls (mean difference: 1.1-1.5; P≤.001), with no differences in weekly exercise frequency between the 3 intervention arms (P=.30).

CONCLUSIONS: We found no effects on motivation, barriers, self-efficacy, perceived social support, or other health domains compared with controls. All intervention groups reported a slight improvement in self-perceived health in 1 of the 8 subscales of the SF-36. Combined in-person and web-based coaching may give a minor improvement in self-perceived health in women with obesity. However, the lack of impact on motivation, barriers, and self-efficacy warrants further research.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05792657; https://clinicaltrials.gov/study/NCT05792657.

PMID:39999434 | DOI:10.2196/68462

Neurology. 2025 Mar 25;104(6):e213445. doi: 10.1212/WNL.0000000000213445. Epub 2025 Feb 25.

ABSTRACT

OBJECTIVES: The aim of the study was to assess US inpatient and emergency department (ED) charges for functional neurologic disorder (FND), investigate subtype variations, and compare costs with research funding.

METHODS: We used 2009-2019 Healthcare Cost and Utilization Project data to assess adult and pediatric inpatient/ED stays and associated charges in 2019 inflation-adjusted dollars, for ICD-10-defined FND (F.44.4-F44.7) vs neurologic comparators neuroinflammatory/demyelinating diseases, refractory epilepsy, and anterior horn cell diseases. NIH research funding (2017-2023) was assessed using NIH RePORTER.

RESULTS: Inpatient charges in 2019 were $1,614.1 million (95% CI $1,492.8-1,735.4 million) for adult FND, a 47% increase since 2017, higher than for comparators, and $105.7 million (95% CI $83.5-127.8 million) for pediatric FND, a 37% increase since 2012, lower than for comparators. ED charges in 2019 were $257.9 million (95% CI $230.1-285.8 million) for adult FND, a 67% increase since 2017, exceeding those of all comparators except refractory epilepsy, and $257.9 million (95% CI $230.1-285.8 million) for pediatric FND, a 108% increase, greater than for comparators. Functional seizures accounted for most FND costs while motor/mixed FND had the highest per-patient costs. Inpatient/ED charges in 2019 for adult/pediatric FND were $2.0 billion, a 49% increase since 2017. The relative proportion of NIH funding to total inpatient/ED charges was lowest for FND vs all neurologic comparators.

DISCUSSION: Rising inpatient/ED costs of FND care surpass those of similarly complex neurologic conditions, yet FND receives minimal research funding relative to health care costs.

PMID:39999398 | DOI:10.1212/WNL.0000000000213445

Med Sci Sports Exerc. 2025 Feb 25. doi: 10.1249/MSS.0000000000003686. Online ahead of print.

ABSTRACT

OBJECTIVES: Cooling interventions mitigating heat-related declines in autonomic nervous system (ANS) function are understudied in American football.

METHODS: This study exposed fifty, collegiate male athletes during their 2023 season to two bouts of cold air via air-conditioning prior to (60 mins) and during (5 min) training sessions in a hot and humid climate. Armband monitors, (Warfighter MonitorTM, Tiger Tech Solutions, Inc., Miami, FL, USA), were used to continuously measure core temperature (°C) during training and baseline heart rate (HR), HR recovery and HR variability (HRV) 24 hours post training. Two HRV time-domain indices were estimated: root mean square of the standard deviation of the NN interval (rMSSD) and the standard deviation of the NN interval (SDNN). These data (2023) were then compared to data collected throughout the previous season (2022) during which players were not provided a cold-air intervention. As such, the 2022 cohort served as a “control” group.

RESULTS: Linear regression models no statistically significant associations at the following core temperature thresholds: ≥ 37.0 °C (baseline HR: p = 0.74; HR recovery: p = 0.71, rMSSD: p = 0.74; SDNN: p = 0.78), ≥ 38.0 °C baseline HR: p = 0.74; HR Recovery: p = 0.74; rMSSD: p = 0.68 and SDNN: p = 0.89) and ≥ 39.0 °C: baseline HR: p = 0.75; HR Recovery: p = 0.82; rMSSD: p = 0.78 and SDNN: p = 0.83). Compared to the 2022 season, the athletes spent considerably less time training under the higher core temperature thresholds (≥ 38 °C: 19.5 min vs 9.7 min; ≥ 39 °C: 10.5 min vs 0.9 min), respectively, despite longer overall training duration, (161.1 min vs 187.4 min).

CONCLUSIONS: Our findings suggest that incorporating bouts of cold air exposure when training in high heat and humidity may mitigate the established heat-related deterioration in ANS function.

PMID:39999367 | DOI:10.1249/MSS.0000000000003686

J Foot Ankle Res. 2025 Mar;18(1):e70039. doi: 10.1002/jfa2.70039.

ABSTRACT

INTRODUCTION: The lateral longitudinal arch (LLA) is an essential structure of the foot. However, LLA evaluation methods remain underexplored compared to those of the medial longitudinal arch (MLA). This study sought to develop a method for measuring the cuboid height, the keystone of the LLA, using ultrasonography and to verify its correlation with radiography, as well as intrarater and interrater reliability.

METHODS: This cross-sectional study included 21 university students (14 males and seven females). The cuboid height was measured using radiography and ultrasonography. The validity of ultrasonographic measurements was assessed through correlation with radiographic measurements and Bland-Altman analysis. Intrarater and interrater reliabilities were evaluated using intraclass correlation coefficients (ICCs).

RESULTS: A strong correlation was observed between cuboid heights measured using radiography and ultrasonography (r = 0.98, p < 0.01). The Bland-Altman analysis revealed a fixed bias of -0.71 mm (95% confidence interval [95% CI]: -0.96 to -0.46 mm). Intrarater and interrater reliability for ultrasonographic measurements were almost perfect, with ICCs of 0.98 and 0.99, respectively.

CONCLUSIONS: Cuboid height measurements using ultrasonography demonstrated high validity and reliability. This method offers a noninvasive and cost-effective alternative to radiography, with potential clinical applications in the evaluation of LLA and related conditions such as cuboid syndrome and lateral foot injuries.

PMID:39999351 | DOI:10.1002/jfa2.70039

JMIR Mhealth Uhealth. 2025 Feb 25;13:e64527. doi: 10.2196/64527.

ABSTRACT

BACKGROUND: Mobile health technologies show promise in addressing metabolic syndrome, but their comparative effectiveness in large-scale public health interventions remains unclear.

OBJECTIVE: This study aims to compare the effectiveness of wearable devices (wearable activity trackers) and mobile app-based activity trackers (built-in step counters) in promoting walking practice, improving health behaviors, and reducing metabolic syndrome risk within a national mobile health care program operated by the Korea Health Promotion Institute.

METHODS: This retrospective cohort study analyzed data from 46,579 participants in South Korea’s national mobile health care program (2020-2022). Participants used wearable devices for 12 weeks, after which some switched to built-in step counters. The study collected data on demographics, health behaviors, and metabolic syndrome risk factors at baseline, 12 weeks, and 24 weeks. Outcomes included changes in walking practice, health behaviors, and metabolic syndrome risk factors. Metabolic syndrome risk was assessed based on 5 factors: blood pressure, fasting glucose, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Health behaviors included low-sodium diet preference, nutrition label reading, regular breakfast consumption, aerobic physical activity, and regular walking. To address potential selection bias, propensity score matching was performed, balancing the 2 groups on baseline characteristics including age, gender, education level, occupation, insurance type, smoking status, and alcohol consumption.

RESULTS: Both wearable activity tracker and built-in step counter groups exhibited significant improvements across all evaluated outcomes. The improvement rates for regular walking practice, health behavior changes, and metabolic syndrome risk reduction were high in both groups, with percentages ranging from 45.2% to 60.8%. After propensity score matching, both device types showed substantial improvements across all indicators. The built-in step counter group demonstrated greater reductions in metabolic syndrome risk compared to the wearable device group (odds ratio [OR] 1.20, 95% CI 1.05-1.36). No significant differences were found in overall health behavior improvements (OR 0.95, 95% CI 0.83-1.09) or walking practice (OR 0.84, 95% CI 0.70-1.01) between the 2 groups. Age-specific subgroup analyses revealed that the association between built-in step counters and metabolic syndrome risk reduction was more pronounced in young adults aged 19-39 years (OR 1.35, 95% CI 1.09-1.68). Among Android use subgroups, built-in step counters were associated with a higher reduction in health risk factors (OR 1.20, 95% CI 1.03-1.39).

CONCLUSIONS: Both wearable devices and built-in step counters effectively reduced metabolic syndrome risk in a large-scale public health intervention, with built-in step counters showing a slight advantage. The findings suggest that personalized device recommendations based on individual characteristics, such as age and specific health risk factors, may enhance the effectiveness of mobile health interventions. Future research should explore the mechanisms behind these differences and their long-term impacts on health outcomes.

PMID:39999338 | DOI:10.2196/64527

Pediatrics. 2025 Mar 1;155(3):e2024066367. doi: 10.1542/peds.2024-066367.

ABSTRACT

OBJECTIVE: Antibiotics are the most frequently prescribed pharmacologic agents in the neonatal intensive care unit (NICU). Antibiotic treatment for suspected or culture-negative sepsis surpasses that for culture-proven infection. Therefore, we sought to reduce our overall antibiotic utilization rate (AUR), defined by total antibiotic days per 1000 patient days (DOT/1000-PD), by 20% within a 4-year period (by December 2023).

METHODS: A multidisciplinary team was convened to develop an antibiotic stewardship quality improvement initiative in our 39-bed level IV NICU. Consensus guidelines for antibiotic duration for common indications were developed. Interventions included educational sessions, antibiotic stop dates, and antibiotic necessity documentation in the electronic health record to standardize provider justification for antibiotic prescription and duration.

RESULTS: A total of 552 infants were included in the analysis, 137 in the baseline and 415 in the postintervention period. Overall AUR decreased by 50% from 278 to 140 DOT/1000-PDs. AUR related to culture-negative sepsis diagnoses decreased by 64% from 22 to 8 DOT/1000-PDs. The percent of antibiotic therapy reinitiation within 2 weeks remained unchanged.

CONCLUSION: Implementation of NICU antibiotic consensus guidelines supported by evidence-based education on culture-negative sepsis diagnosis can effectively reduce antibiotic use in a safe manner, despite a heterogenous, high acuity, level IV NICU population. Multidisciplinary team support and standardization of antibiotic justification in the electronic health record can be coupled to reinforce compliance with established guidelines to promote long-lasting antibiotic reduction.

PMID:39999320 | DOI:10.1542/peds.2024-066367

J Eval Clin Pract. 2025 Feb;31(1):e70031. doi: 10.1111/jep.70031.

ABSTRACT

OBJECTIVES: To establish and validate a short scale of critical thinking ability for dental residents based on the Byrnes theory.

MATERIALS AND METHODS: Two hundred and thirty-four dental residents in total from Stomatological Hospital of Chongqing Medical University were divided into development group and validation group randomly. In the development phase, the content validation and the initial reduction was underwent by the modified Delphi method. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and reliability test was used to validate the scale in the evaluation phase.

RESULTS: We developed a 21 items scale after two rounds of expert consultation via Delphi method. In the evaluation phase, no significant sociodemographic difference was found among the 234 participants. Fifteen items extracted three factors and CFA results indicated acceptable goodness-of-fit indices of this scale. The scale was with a good internal consistency and reliability.

CONCLUSIONS: This version of critical thinking scale for the Chinese dental residents was considered to be more feasible for application in the clinical practice and dental education.

PMID:39999223 | DOI:10.1111/jep.70031