Category: Nevin Manimala

JMIR Mhealth Uhealth. 2025 Aug 8;13:e65260. doi: 10.2196/65260.

ABSTRACT

BACKGROUND: Adherence to weight management strategies may be undermined where lengthy strategy explanations limit engagement and understanding, weakening intervention efficacy. By contrast, implementation intentions have been shown to promote adherence across various health behaviors.

OBJECTIVE: This study aimed to investigate the impact of explanation length and implementation intentions on adherence to brief weight management strategies.

METHODS: Participants (N=200) with a BMI above 25 and an interest in losing weight were recruited from a commercial digital weight management service provider. Participants received information about 1 of 4 weight management strategies on a smartphone app in either a brief or detailed format and were asked to plan their use of the strategy with implementation intentions or were given tips on strategy use. Participants received daily prompts over a 2-week period to report whether they used their assigned strategy. Proposed moderators (need for cognition and planning skills) were measured at baseline.

RESULTS: Strategy adherence was greater with brief information (mean 74%, SD 23%) compared with detailed information (mean 69%, SD 23%); however, this small effect size (Cohen d=0.24) was not statistically significant (P=.13). There was no moderation by need for cognition (P=.25). Adherence did not differ significantly between implementation intentions (mean 71%, SD 27%) and tips (mean 72%, SD 21%; P=.73); however, there was moderation by planning skills (P=.04). As predicted, adherence was greater with implementation intentions compared with tips among those with poorer planning skills.

CONCLUSIONS: Shorter explanation length and implementation intentions (in poorer planners) may enhance adherence to brief weight management strategies, and further investigation is required to confirm these effects.

PMID:40779769 | DOI:10.2196/65260

JMIR Form Res. 2025 Aug 8;9:e73713. doi: 10.2196/73713.

ABSTRACT

BACKGROUND: Quan is a workplace well-being digital platform that supports employees, teams, and organizations in measuring, understanding, and improving their well-being. It is important to develop a validated measurement instrument that enables users to assess and track their well-being over time. Currently, no digital measurement instrument comprehensively evaluates well-being across both personal and professional domains.

OBJECTIVE: We detail the development and validation of the Quan Well-being Index, a new digital self-report measure for assessing well-being in personal life and at the workplace.

METHODS: We performed 3 studies. The first study involved the conceptualization of 6 initial factors, the generation of 51 items, and the steps of face and content validity. In the second study, revised items were presented to a UK sample. In the third study, an independent UK sample completed the final assessment along with a battery of well-being and personality questionnaires. A subsample of participants from the third study retook the assessment approximately 2 weeks after initial completion.

RESULTS: In the first study, after face and content validity processes, the number of items was reduced to 45. In the second study, exploratory factor analysis on data from 1020 participants (age: mean 43.06, SD 12.98 years; 525 female participants) identified a 4-factor solution with 35 items (Kaiser-Meyer-Olkin value=0.98; Bartlett test: χ²₉₉₀=37063.54; P<.001), accounting for 64% of variance. The 4 factors were thrive and connect in personal life, thrive and connect at work, mental health, and physical health. In the third study, confirmatory factor analysis on data from 966 participants (age: mean 44.4, SD 12.52 years; 480 female participants) tested 4 structural models. A hierarchical model (model 1) where the general factor influenced the 4 group factors demonstrated the best fit (χ²₅₂₁=3467.00; Bentler comparative fit index=0.906; Tucker-Lewis index=0.892; root mean square error of approximation=0.077; standardized root mean square residual=0.048; ΔAkaike information criterion=0.0; ΔBayesian information criterion=0.0). Internal reliability was high across subscales (Cronbach α=.88-.93; McDonald ω total=0.89-0.94; Guttman λ6=0.86-0.92). Convergent validity was demonstrated by strong correlations with the Warwick-Edinburgh Mental Well-being Scale (r=0.45-0.85; P<.001) and Flourishing-at-Work Scale (r=0.80-0.84; P<.001). Divergent validity was supported through weak or negative correlations with Big Five Personality Inventory traits (eg, neuroticism: r=-0.29; P<.001). Test-retest reliability assessed in a subset of 275 participants (age: mean 52.12, SD 9.56 years; 170 female participants) over a 2-week interval was strong to very strong across factors (r=0.74-0.81; P<.001).

CONCLUSIONS: The Quan Well-being Index provides a comprehensive assessment of well-being at the workplace and in personal life, and is anticipated to be a valuable digital tool, enabling individuals, teams, and organizations to gain insights, monitor progress, and implement appropriate interventions for a healthier workforce.

PMID:40779765 | DOI:10.2196/73713

J Med Internet Res. 2025 Aug 8;27:e75792. doi: 10.2196/75792.

ABSTRACT

BACKGROUND: Traditional mobile health interventions for physical activity (PA) primarily rely on reflective self-regulatory processes, often neglecting the role of affective associations in sustaining long-term engagement. The WalkToJoy intervention addresses this gap by applying the affective-reflective theory to enhance intrinsic motivation for PA among adults aged ≥40 years through affective message framing, evaluative conditioning, and belief updating.

OBJECTIVE: This proof-of-concept study evaluated the feasibility of the message-based WalkToJoy intervention package and examined the impact of its 3 components-walking suggestion prompts, salience messages, and planning prompts-on affective and behavioral outcomes related to walking.

METHODS: We conducted a fully remote, 6-week full factorial experiment with an embedded microrandomized trial (MRT) involving 49 adults aged ≥40 years. Statistical analyses, including paired t tests and generalized estimating equations, assessed pretest-posttest changes and the effects of smile-inducing walking suggestion prompts with short animated images (GIF images), salience messages, and planning prompts on weekly affective measures and daily step counts. In addition, MRT analyses evaluated the proximal effects of these components. Poststudy interviews were thematically analyzed to contextualize participants’ experiences and engagement with the intervention.

RESULTS: Significant pretest-posttest improvements were observed across affective outcomes on a 7-point Likert scale-affective attitudes improved by 0.547 points (P<.001), affective valuations improved by 0.718 points (P<.001), affective reflection improved by 0.692 points (P<.001), and anticipated affect improved by 0.692 points (P<.001). While the average daily steps showed a nonsignificant pretest-posttest increase of 80 steps (P=.79), further analysis revealed an increase of 506 steps (P=.07) when comparing baseline to the average of weeks 4 to 6. Among the intervention components, GIF prompts significantly increased anticipated affect by 0.345 points (P=.046) and average daily step count by 1834 steps (P=.05) compared to identical text-only prompts. However, MRT analysis found no significant increase in 4-hour step counts following the walking suggestion prompts (P=.55), which was explained by qualitative findings suggesting that participants interpreted messages as flexible day-long reminders rather than immediate calls to action. Salience and planning prompts did not yield substantial quantitative effects but were positively received by participants for promoting mindfulness and personalized engagement.

CONCLUSIONS: The WalkToJoy intervention is a feasible and promising approach for improving affective associations with walking. Walking suggestion prompts were particularly effective in boosting engagement and mitigating message fatigue, highlighting the potential of affect-driven interventions to enhance PA motivation and adherence.

PMID:40779759 | DOI:10.2196/75792

JMIR Form Res. 2025 Aug 8;9:e76958. doi: 10.2196/76958.

ABSTRACT

BACKGROUND: Technology-enhanced learning (TEL) has become increasingly vital in global medical education, offering significant advantages in knowledge acquisition, communication, motivation, and student engagement. In Syria, a country facing prolonged crises, there is an urgent need to evaluate the integration of technology within medical education to address institutional limitations and support student learning.

OBJECTIVE: The aim of this study is to evaluate the awareness, perceived challenges, and needs regarding the integration of technology in medical education from the perspectives of students and faculty at Syrian medical colleges.

METHODS: A cross-sectional survey was conducted during the 2023-2024 academic year across Syrian universities. Stratified random sampling was used to recruit 500 medical students and 200 faculty members. Two tailored, self-administered questionnaires were used, covering motivation, perceived benefits, challenges, and suggestions for technology integration. Validity was assessed through expert review and pilot testing (n=30), and internal consistency was confirmed (Cronbach α=0.6-0.7). Quantitative data were analyzed using descriptive statistics, t tests, ANOVA, and Kruskal-Wallis tests.

RESULTS: Among medical students, 94% (470500) agreed that integrating technology into medical education is essential, with similar agreement from 93.5% (187200) of faculty. No significant differences were found in student responses based on specialization (P=.32) or university type (P=.11). Likewise, faculty perspectives did not significantly differ by academic qualification or years of experience (P>.05). There were several perceived benefits; for instance, 93.2% (n=466) of students reported that technology kept them up to date with new developments, 88% stated it enhanced research skills, and 86.8% found TEL more enjoyable than traditional learning methods. Most respondents (95% n=475) said TEL created a flexible, interactive environment. Among faculty, 77% (n=154) agreed TEL improves clinical skill development. Respondents noted there were some challenges; specifically, 57% (n=285) of students cited poor internet service, 33% (n=165) noted the financial burden, and 82.2% (n=411) called for behavioral guidelines. Among faculty, 85.5% (n=171) cited lack of institutional support and 90% (n=180) emphasized the need for training. Both groups supported the development of communication platforms, curriculum revisions, and faculty development programs.

CONCLUSIONS: There is a strong consensus among Syrian medical students and faculty on the value and necessity of integrating technology in medical education. Despite infrastructure and administrative challenges, both groups recognize TEL as a powerful tool for improving clinical competencies, student motivation, and academic engagement. Institutional commitment, curricular reform, and tailored training are essential to achieving sustainable, effective technology integration.

PMID:40779753 | DOI:10.2196/76958

Traffic Inj Prev. 2025 Aug 8:1-9. doi: 10.1080/15389588.2025.2531410. Online ahead of print.

ABSTRACT

OBJECTIVES: While the prevalence of posttraumatic stress disorder (PTSD) after road traffic accidents (RTA) has been widely studied, there is a gap in research in the context of China. Therefore, this study aimed to provide a pooled estimation of PTSD prevalence after RTA based on Chinese data and compare it to existing international prevalence.

METHODS: A systematic literature search of English and Chinese databases was performed from their inception dates to December 31, 2024. Chinese patients admitted to a hospital or emergency department after RTA, and without traumatic brain injury following RTA or without PTSD before RTA were included, regardless of type of RTA and whether fracture was sustained. Subgroup analyses were performed on the basis on demographics, assessment methods, income, and comorbidity.

RESULTS: The inclusion criteria were met by 21 studies. The pooled prevalence of acute stress disorder (ASD) and PTSD was 30% (95% CI, 22%-37%) and 27% (95% CI,22%-32%), respectively, which is higher than the global prevalence of 16% ASD and 22% PTSD. The transition rate of ASD to PTSD was 77% (95% CI, 63%-91%). Females, older adults, and those with lower income had a higher prevalence of PTSD. In addition, the prevalence of PTSD increased with age. Older survivors with comorbidities including anxiety, depression, complication (such as pain, hemorrhagic shock, hypoxemia), diabetes, and hypertension were more likely to suffer from PTSD than older survivors without those comorbidities.

CONCLUSIONS: PTSD after RTA is common, with more than one in four RTA survivors reporting PTSD. Pooled prevalence was higher than that of meta-analysis that had no restrictions on world region.

PMID:40779750 | DOI:10.1080/15389588.2025.2531410

Traffic Inj Prev. 2025 Aug 8:1-10. doi: 10.1080/15389588.2025.2530074. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to enhance the accuracy and stability of traffic accident loss prediction in China by utilizing machine learning techniques. Specifically, it explores the application of the Extra Trees model combined with feature importance screening to predict key accident indicators such as the number of accidents, deaths, injuries, and property losses.

METHODS: Relevant transportation industry indicators were collected from national statistical sources. A two-step feature screening approach was employed based on average importance and importance ratio to reduce dimensionality and improve model performance. The Extra Trees algorithm was used for prediction modeling, and prediction accuracy was evaluated across multiple experimental runs to assess stability. Additionally, correlation, regression effects, and global importance scores were calculated to quantify the influence of each indicator. Polynomial fitting was conducted to explore the relationship between key indicators and predicted values.

RESULTS: The proposed feature screening approach improved both the accuracy and interpretability of the prediction model. The average prediction errors for the number of accidents, deaths, injuries, and property losses were 4.66%, 1.92%, 10.03%, and 5.01%, respectively. Among all targets, the number of deaths showed the highest predictive accuracy. Polynomial fitting confirmed a strong relationship between selected indicators and predicted values, with a quadratic fit achieving an R² of 0.957. The analysis identified 30 influential indicators, of which 12 had multi-target effects. Highway mileage, grade highway mileage, and average freight distance emerged as the most impactful indicators, with global importance scores exceeding 9.5%. Furthermore, the study demonstrated that prediction stability could be maintained across different data intervals, with error fluctuations remaining within acceptable bounds.

CONCLUSIONS: This study confirms the effectiveness of integrating feature importance screening with the Extra Trees model for predicting traffic accident losses. The methodology not only enhances prediction accuracy but also ensures stable performance across different accident indicators. The quantitative assessment of indicator importance offers valuable insights into the factors contributing to accident severity and provides a data-driven foundation for traffic safety policy and planning.

PMID:40779748 | DOI:10.1080/15389588.2025.2530074

J Med Internet Res. 2025 Aug 8;27:e72637. doi: 10.2196/72637.

ABSTRACT

BACKGROUND: Attitude-targeted interventions are important approaches for promoting vaccination. Educational approaches alone cannot effectively cultivate positive vaccine attitudes. Artificial intelligence (AI)-driven chatbots and motivational interviewing (MI) techniques show high promise in improving vaccine attitudes and facilitating readiness for vaccination.

OBJECTIVE: This study aimed to evaluate the effectiveness of a theory and evidence-based, MI-oriented AI digital assistant in improving COVID-19 vaccine attitudes among adults in Hong Kong.

METHODS: This 2 parallel-armed randomized controlled trial was conducted from October 2022 to June 2024. Hong Kong adults (N=177) who were vaccine-hesitant were randomly assigned into 2 study groups. The intervention group (n=91) interacted with the AI digital assistant over 5 weeks, including receiving a web-based education program comprising 5 educational modules and communicating with an AI-driven chatbot equipped with MI techniques. The control group (n=86) received WhatsApp (Meta) messages directing them to government websites for COVID-19 vaccine information and knowledge, with the same dosage as the intervention group. Primary outcomes included vaccine hesitancy. Secondary outcomes included vaccine readiness, confidence, trust in government, and health literacy. Outcomes were measured at baseline, postintervention, 3-month, and 6-month follow-up. Focus group interviews were conducted postintervention. Intervention effects were analyzed using the generalized estimating equation model. Interview data were content analyzed.

RESULTS: Decreases in vaccine hesitancy were observed while no statistically significant time-by-group interaction effects were found. The intervention showed significant time-by-group interaction effects on vaccine readiness (P=.04), confidence (P=.02), and trust in government (P=.04). Significant between-group differences with medium effect sizes were identified for vaccine readiness (Cohen d=0.52) and trust in government (Cohen d=0.54) postintervention, respectively. Increases in vaccine-related health literacy were observed, and a significant time effect was found (P=.01). In total, three categories were summarized from interview data: (1) improved vaccine literacy, confidence, and trust in government; (2) hesitancy varied while readiness improved; and (3) facilitators, barriers, and recommendations of modifications on the intervention.

CONCLUSIONS: The intervention indicated promising yet significant effects on vaccine readiness while the effects on vaccine hesitancy require further confirmation. The qualitative findings; however, further consolidate the significant effects on participants’ attitudes toward vaccines. The findings provide novel evidence to encourage the adoption and refinement of a MI-oriented AI digital assistant in vaccine promotion.

PMID:40779743 | DOI:10.2196/72637

J Clin Oncol. 2025 Aug 8:JCO2500618. doi: 10.1200/JCO-25-00618. Online ahead of print.

ABSTRACT

PURPOSE: New therapies for glioblastoma are needed, especially MGMT-unmethylated (uMGMT) disease. NRG Oncology BN002 (phase I) demonstrated safety and suggested efficacy of ipilimumab (ipi) with nivolumab (nivo) in newly diagnosed glioblastoma, leading to this phase II/III trial.

METHODS: Adults with newly diagnosed uMGMT glioblastoma and Karnofsky performance status (KPS) ≥70 were randomly assigned to radiotherapy with either immunotherapy (ipi and nivo) or temozolomide (TMZ), stratified by recursive partitioning analysis (RPA) class and intention to use tumor treating fields. With 95% power to detect a hazard ratio (HR) ≤0.58 for progression-free survival (PFS) at a one-sided significance level (P) of .15, superior PFS with immunotherapy in phase II would lead to phase III overall survival (OS) testing. Corticosteroids were disallowed when starting immunotherapy. Diagnosis, biomarkers, and PFS were centrally assessed.

RESULTS: One hundred fifty-nine participants were randomly assigned (79 immunotherapy and 80 TMZ). Arms were well balanced for age (median 60 years, range, 28-79), sex (male n = 105, 66%), KPS (90-100 n = 97, 61%), resection extent (gross total, n = 103, 65%), and RPA class (III, n = 16, 10%; IV, n = 116, 73%; V, n = 27, 17%). A preplanned analysis of phase II data conducted after 100 centrally determined PFS events showed no significant PFS improvement for ipi and nivo versus TMZ (median 7.7 months v 8.5 months, HR, 1.47 [70% CI, 1.19 to 1.83]; one-sided P = .96 [95% CI, 0.98 to 2.2]). OS is immature (>50% alive) but with no observed difference between arms (median approximately 13 months each, HR, 0.95 [95% CI, 0.61 to 1.49]; P = .36).

CONCLUSION: Ipi and nivo did not improve PFS among patients with newly diagnosed uMGMT glioblastoma versus TMZ. Accrual closed permanently; the trial will not proceed to phase III. No new safety signals were identified. Molecular correlative analyses and survival follow-up are ongoing.

PMID:40779733 | DOI:10.1200/JCO-25-00618

Am J Speech Lang Pathol. 2025 Aug 8:1-17. doi: 10.1044/2025_AJSLP-25-00029. Online ahead of print.

ABSTRACT

PURPOSE: Reading proficiency is an important life skill that contributes to improved quality of life and becoming an active member in society. This pilot randomized clinical trial tested the effects of a functional literacy intervention in young adults with intellectual and/or developmental disabilities (IDDs).

METHOD: Participants included 44 young adults with IDD between 18 and 26 years old. Participants were randomly assigned to the Functional Reading Activities to Motivate and Empower (FRAME) treatment group or a “business-as-usual” control group. Participants participated in 24 twice-weekly sessions in which they were taught reading comprehension strategies in the context of functional text stimuli or activities of daily living that require reading (e.g., text messages, e-mails). The primary outcome measure was the number of reading comprehension strategies used. Secondary outcomes included (a) multiple-choice comprehension questions, (b) text message response, (c) e-mail response, (d) summarization, and (e) verbal responses to functional text samples.

RESULTS: Young adults with IDD in the treatment group made statistically significant gains in use of reading comprehension strategies (d = 1.09, p = .002) and multiple-choice comprehension questions (d = 0.79, p = .038) as compared with the control group. There were no statistically significant differences on the remaining outcome measures.

CONCLUSIONS: This study provides preliminary support for the short-term effects of the FRAME intervention for young adults with IDD, with particular emphasis on explicit reading comprehension strategy instruction within a functional context. Therapeutic services typically end during the transition period for young adults with disabilities. However, it is essential that evidence-based literacy supports are available as this is a skill that continues to develop throughout the lifespan and has the potential to transform an individual’s transition to adulthood and independence. Future research should include a larger clinical trial and evaluate mediators of intervention effects.

PMID:40779715 | DOI:10.1044/2025_AJSLP-25-00029

J Bras Nefrol. 2025 Oct-Dec;47(4):e20250037. doi: 10.1590/2175-8239-JBN-2025-0037en.

ABSTRACT

INTRODUCTION: Infections represent a major cause of morbidity and mortality in kidney transplant recipients. Preservation fluid (PF) contamination is considered a potential infectious source; however, its clinical relevance remains controversial.

AIM: To evaluate whether PF contamination acts as a source of early post-transplant infections (within 30 days) and its association with acute rejection, graft loss, and mortality within 90 days.

METHODS: This was a retrospective, observational, and descriptive study based on medical records of patients aged ≥18 years who underwent kidney transplantation between January 2021 and December 2023. Collected variables included demographic, clinical, and post-transplant outcome data.

RESULTS: Among 246 recipients with available PF culture data, 27.6% (68/246) presented with PF contamination. Gram-positive cocci accounted for 64.7% of isolates, Gram-negative bacilli, for 35.3%, and fungi, for 2.9%. Coagulase-negative staphylococci (CoNS) were the most frequent isolate (36.8%). Microbiological concordance between PF isolates and pathogens responsible for early infection were observed in 13.23% (9/68) of cases, with Klebsiella pneumoniae being the predominant pathogen (66.6%). Although the infection rate was higher among patients with positive PF cultures (72%) compared to those with negative cultures (64%), this difference was not statistically significant (p = 0.2992). No significant associations were found with mortality (p = 1.000), graft loss (p = 0.8199), or acute rejection (p = 0.5635).

CONCLUSION: PF contamination was frequent and may contribute to early post-transplant infections, reinforcing the importance of microbiological surveillance and preventive strategies.

PMID:40779694 | DOI:10.1590/2175-8239-JBN-2025-0037en