Category: Statistics

JMIR Res Protoc. 2025 Oct 31;14:e75501. doi: 10.2196/75501.

ABSTRACT

BACKGROUND: Youth of color who live in urban communities face disproportionate anxiety levels due to systemic inequities, including exposure to violence, economic instability, and neighborhood disadvantage. Despite increased need, these communities often lack accessible mental health interventions.

OBJECTIVE: This study presents a protocol for an anxiety prevention intervention developed through a community-based participatory approach that is tailored to urban youth of color using community-based participatory research methods.

METHODS: The intervention, co-developed with a community partner and guided by a youth advisory board, includes 5 structured weekly sessions on psychoeducation, coping skills, and role-playing exercises. Facilitators trained in social work or psychology will deliver the intervention, with at least 1 facilitator from the target community ensuring cultural relevance. Recruitment will occur through collaboration with a local high school, with counselors identifying high-risk youth. We will enroll a sample of 30 high school-aged youth at minimum (maximum 50 youth) into the study. Two cohorts of youth will participate in the study. The groups will be separated by sex (male and female). The primary outcome is reduction in anxiety, measured by the Generalized Anxiety Disorder-7 scale. Data will be collected at baseline, after the intervention, and during follow-up assessments (3 months after). Statistical analyses will include parametric tests (eg, repeated measures ANOVA and 1-tailed t tests) to compare anxiety reduction across groups.

RESULTS: This pilot intervention is a part of a larger study that began in September 2020 and ended in August 2025. Enrollment for the pilot intervention began in May 2025. The anxiety intervention is expected to reduce anxiety among a high-risk group of youth. Methods to improve facilitator fidelity to the intervention model are expected to support high fidelity to the curriculum.

CONCLUSIONS: This study highlights the development of a new anxiety intervention using a community-based participatory approach. Findings will be reported and used to scale up the pilot intervention into a larger clinical trial to serve a larger population of youth in the targeted community. In addition, the results will contribute to knowledge on improving mental health accessibility for marginalized youth. If effective, this model could be expanded to support youth in other underresourced communities.

PMID:41172343 | DOI:10.2196/75501

Br J Dermatol. 2025 Oct 31:ljaf416. doi: 10.1093/bjd/ljaf416. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a chronic inflammatory skin disease associated with an increased risk of developing cardiovascular disease. Various environmental factors contribute to disease development in genetically susceptible individuals. Although infections have been associated with disease initiation and recurrence, the consequences of early exposure to infections, many years before disease manifestation, is unexplored.

OBJECTIVE: To investigate the effect of exposure to infections during formative years on the incidence of psoriasis through to early adulthood.

METHODS: ABIS is a large birth cohort in which parents of participating children have answered comprehensive questionnaires on exposure to infections and medication at different age intervals of the children. Information regarding psoriasis was obtained from the Swedish National Patient Register, while data on medication was obtained from the National Prescribed Drug Register. Statistical analyses were performed with custom-written R scripts.

RESULTS: Logistic regression analysis on one-year follow-up data revealed that influenza was associated with an increased risk of developing psoriasis later in life (OR 2.47, CI 1.32-4.39; P= 0.006). In line with this, at the third-year evaluation, we found that participants who had tonsillitis at least once during the first three years of life had almost three times greater risk of developing psoriasis into early adulthood compared to controls (OR 2.90, CI 1.46-5.56; P= 0.003). In contrast, at the eight-year evaluation, we found that psoriasis was less frequent in children who had experienced gastroenteritis episodes between ages six and eight, compared to controls (OR 0.42, CI 0.20-0.92; P =0.0028).

CONCLUSION: We demonstrate for the first time the effect of exposure to infections during the first years of life, and their role in the subsequent development of psoriasis extending into early adulthood. Our study indicates that early exposure to infections may influence the development of the adaptive immune system during formative years. This modulation is evidenced by the higher incidence of psoriasis observed in early adulthood, several years after the initial exposure.

PMID:41172339 | DOI:10.1093/bjd/ljaf416

JMIR Res Protoc. 2025 Oct 31;14:e78600. doi: 10.2196/78600.

ABSTRACT

BACKGROUND: Social media use among adolescents and young adults has increased exponentially over the last decade, with TikTok being one of the most popular platforms. In Spain, 61% of adolescents use TikTok, spending an average of 1.5 hours daily on the app. This phenomenon coincides with an alarming increase in the prevalence of self-harm and suicidal behavior among adolescents and young adults. Moreover, suicidal behavior is one of the leading causes of morbidity and mortality in this age group.

OBJECTIVE: The primary aim of this study is to evaluate the existing evidence on the association of TikTok use with self-harm and suicidal behavior in the adolescent population.

METHODS: This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to ensure transparency, rigor, and reproducibility. Original studies that evaluate the impact of TikTok use on self-harm and suicidal behavior will be selected. The primary outcome will be the occurrence and prevalence of self-harm and suicidal behavior related to TikTok use among adolescents and young adults. Health science literature databases, including PubMed/MEDLINE, Cochrane, Web of Science, PsycINFO, and Scopus, will be searched. Two researchers will independently select studies that meet the predefined eligibility criteria, and they will extract data from each included study. The risk of bias and methodological quality of the included studies will be assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Joanna Briggs Institute tools, respectively. The methodological characteristics, association measures, and qualitative conclusions of the reviewed studies will be analyzed, and a descriptive synthesis will be presented through tables and graphs.

RESULTS: This systematic review formally began in July 2025, although it has been planned since September 2024. The final systematic review will be performed and reported according to this protocol and the PRISMA guidelines. Initially, the search returned 6126 records, and 3664 records are currently being screened for eligibility. Data from the final included studies will be extracted, collated, and analyzed. The risk of bias and quality of evidence will be determined. A narrative synthesis will be used to summarize the results of the systematic review. When possible, statistical analyses will be presented using graphs and figures. The final systematic review is expected to be published in December 2025.

CONCLUSIONS: This systematic review will help to better understand the relationship between TikTok use and self-harm and suicidal behavior among adolescents and young adults. Our findings may support future research, recommendations, and policies in this field, emphasizing the need to incorporate the digital environment as a key factor in adolescent mental health.

TRIAL REGISTRATION: Open Science Framework MX5CJ; https://osf.io/MX5CJ.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/78600.

PMID:41172321 | DOI:10.2196/78600

Adv Gerontol. 2025;38(3):413-420.

ABSTRACT

A retrospective cohort study was conducted to evaluate the effectiveness of teledermatology in primary care for the diagnosis and treatment of skin diseases in patients of all age groups, with a focus on the population over 60 years. The study, conducted in Ufa from September 2023 to September 2024, included 1 590 patients over 60 years old with 3 214 registered skin lesions. The results demonstrate that teledermatology consultations allowed GPs to independently manage 67% of cases (2 153/3 214), minimizing the need for referral to a dermatologist. Indications for an in-person consultation with a dermatologist and biopsy were 42,80% (681/1 590) and 8,23% (131/1 590) of cases, respectively. The dominant diagnoses were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevi, benign skin lesions, actinic keratosis, epidermoid cysts, leukoderma and viral warts. A statistically significant positive correlation was found between patient age and the incidence of skin malignancies requiring biopsy. Emollients were the most frequently prescribed group of drugs (30,90%, 275/890). The findings suggest the potential of teledermatology to optimize patient routing, reduce the workload of dermatologists and increase the availability of specialized dermatological care, especially for elderly patients.

PMID:41172315

JMIR Res Protoc. 2025 Oct 31;14:e66489. doi: 10.2196/66489.

ABSTRACT

BACKGROUND: Bioactive compounds, such as human milk oligosaccharides (HMOs), impact the development of the intestinal microbiome and immune maturation in early life. They have been shown to result in positive benefits, including improved gut health, reduced frequency of infections, and age-appropriate growth when added to infant formula. However, data supporting the added value of including these HMOs in early-stage infant formula is currently lacking among Chinese infants.

OBJECTIVE: In this double-blind randomized controlled trial including a nonrandomized reference breastfed group, we will test the efficacy of ready-to-feed infant formula containing 2 HMOs (2-fucosyllactose and lacto-N-neotetraose) on Bifidobacteria abundance, gut microbiome, gut and immune health, growth, and quality of life.

METHODS: Healthy infants will be enrolled between 3 and 14 days after birth at 5 sites in China and randomized to either the experimental group (fed ready-to-feed infant formula containing 2 HMOs) or the control group (fed the same ready-to-feed infant formula without the 2 HMOs), using a dynamic allocation algorithm with double blinding. Infants will receive trial formula until age 6 months and will be followed up until age 12 months. The breastfed group will serve as a reference. The primary end point will be Bifidobacteria abundance in fecal samples at 3 months, measured via quantitative polymerase chain reaction. Secondary end points will include fecal microbiome (including taxonomy, diversity, functionality, and metabolites), fecal markers of immune health, gastrointestinal tolerance, stooling patterns, immune competence (overall state of the immune system), sleep quality, growth, quality of life, medication use, and physician-reported adverse events. A 2-sided test at the 5% significance level will be used for statistical testing.

RESULTS: The study received ethical approval in March 2024 and will be completed by the end of 2026, which will be followed by a publication in a peer-reviewed journal.

CONCLUSIONS: The Starter Liquid Infant Formula Trial (STARLIT) will be one of the first to assess the efficacy of these 2 HMOs among Chinese infants on gut and immune health, in addition to clinically relevant outcomes such as quality of life, growth, and adverse events. This study should help to demonstrate that an increase in the growth of beneficial Bifidobacteria in response to intake of 2-fucosyllactose and lacto-N-neotetraose may have a broader impact on overall gut microbiome composition and infant gut and immune health.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06361719; https://clinicaltrials.gov/study/NCT06361719.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/66489.

PMID:41172301 | DOI:10.2196/66489

JMIR Form Res. 2025 Oct 31;9:e80654. doi: 10.2196/80654.

ABSTRACT

BACKGROUND: Approximately half of US veterans receive care outside of US Department of Veterans Affairs (VA) Veterans Health Administration facilities-a proportion expected to rise due to the Promise to Address Comprehensive Toxics Act and expanded use of VA-purchased community care.

OBJECTIVE: This paper describes the structure and impact of the Veterans Care Coordination in Community Settings (VetCoor) program. VetCoor was implemented in 2 non-VA community health centers, and we explored setting, staffing, and treatment targets to enhance veteran care and inform broader dissemination.

METHODS: VetCoor embedded a coordinator within community-based, non-VA health care settings to improve veteran identification and address unmet medical needs. Coordinators also connected veterans with VA and local resources addressing health-related social needs. VetCoor included training on veteran needs and military culture. It also held a monthly community of practice call where coordinators shared best practices and met with facility representatives to learn about VA services.

RESULTS: From May 2021 to September 2023, a total of 220 veterans participated, engaging in 773 sessions. Of these 220 veterans, 73 (33.2%) received VA enrollment assistance; 54 (24.5%) were referred for medical care; and 82 (37.3%) received care coordination, including medication reconciliation assistance. They also received assistance with transportation (46/220, 20.9%) nutrition and food access (42/220, 19.1%), housing and repair (42/220, 19.1%), and utility payment support (31/220, 14.1%). Common barriers to veterans seeking care were perceptions that enrolling in the VA took resources from veterans more in need and confusion regarding discharge papers required for enrollment.

CONCLUSIONS: VetCoor supported rural veterans’ health care and health-related social needs using dedicated coordinators. This model addresses resource gaps, fosters VA-community collaboration, and aligns with the VA’s expanding benefits under the Promise to Address Comprehensive Toxics Act.

PMID:41172298 | DOI:10.2196/80654

JMIR Form Res. 2025 Oct 31;9:e78657. doi: 10.2196/78657.

ABSTRACT

BACKGROUND: Experiences of unfair treatment on college campuses are linked to adverse mental and physical health outcomes, highlighting the need for interventions. However, detecting such experiences relies mainly on self-reports. No prior research has examined the feasibility of using mobile sensing via smartphones and wearables for the passive detection of these experiences.

OBJECTIVE: This pilot study explores the potential of using passive sensing to detect daily experiences of perceived unfair treatment (PUT) after they occur. It aims to develop and evaluate machine learning models against naive baselines and establish a benchmark for future research.

METHODS: We analyzed data from 201 undergraduate students collected over two 10-week academic terms in 2018. PUT was self-reported at the daily level via ecological momentary assessment (EMA) surveys, with 413 of 9629 (4.3%) total responses indicating unfair treatment. We implemented two modeling approaches with distinct training schemes: (1) supervised classification models trained in a user-independent manner using data from different individuals, and (2) anomaly detection models trained in a user-dependent manner using historical data from the same individuals. Classification performance was assessed using stratified group 5-fold cross-validation for user-independent models and a chronological train-test split for user-dependent models.

RESULTS: Of the 201 study participants, 110 reported experiencing unfair treatment at least once. On average, participants reported unfair treatment in 4.66% of their EMA responses (95% CI 3.13% to 6.19%). User-independent classification models showed mixed performance (AUC-ROC [area under the receiver operating characteristic curve]: 0.546-0.640, AUC-PR [area under the precision-recall curve]: 0.047-0.093, F₁-score: 0.070-0.121). Tree-based models, particularly light gradient boosting machine (LightGBM) and Random Forest, outperformed all 3 baselines in AUC-ROC and AUC-PR; LightGBM also improved the F₁-score. In comparison, user-dependent anomaly detection models performed better, with the multiday long short-term memory-AE model (50 features, 7-day window) achieving the highest recall (0.830, +73.3%, P<.001) and F₁-score (0.391, +24.9%, P<.001) without reducing precision (0.256), and improving AUC-PR by 45.9% and AUC-ROC by 21.6% relative to naive baselines (P<.001). Feature importance analysis identified key behavioral patterns for population-level detection, including increased time spent off campus, elevated evening and nighttime activity, reduced indoor mobility on campus, prolonged screen use, delayed sleep onset, and shorter sleep duration.

CONCLUSIONS: Mobile sensing shows promise for detecting daily experiences of PUT in college students and identifying associated behavioral patterns. Our findings highlight opportunities for timely interventions through mobile technology to mitigate the impact of these experiences on students’ mental health and well-being.

PMID:41172295 | DOI:10.2196/78657

J Med Internet Res. 2025 Oct 31;27:e63909. doi: 10.2196/63909.

ABSTRACT

BACKGROUND: Societies worldwide have witnessed growing rifts separating advocates and opponents of vaccinations and other COVID-19 countermeasures. With the rollout of vaccination campaigns, the European German-speaking region (Germany, Austria, and Switzerland) initially exhibited a noticeably low vaccination uptake compared to other European regions. Later, uptake increased. It remains unclear which factors contributed to these changes.

OBJECTIVE: This study aimed to shed light on the intricacies of vaccine hesitancy among the German-speaking population and the possible dynamics between policy changes and public concerns using web discourse data. These insights are valuable for policymakers tasked with making far-reaching decisions-policies need to effectively curb the spread of the virus and at the same time respect fundamental civil liberties and minimize undesired consequences.

METHODS: This study drew on data from Twitter (subsequently rebranded X). We used a hybrid pipeline to detect and analyze 191,750 German-language vaccination-related tweets using a semiautomatic seed list generation approach, topic modeling, sentiment analysis, and a minimum of social scientific domain knowledge to evaluate the discourse about vaccinations in light of the COVID-19 pandemic. We further analyzed the evolution of public attention during different phases of the pandemic and in relation to policy changes to identify potential drivers of shifts in public attention.

RESULTS: The discourse concerning vaccinations was associated with more negative sentiments than the general discourse on German-speaking Twitter (47,159/191,750, 24.59% vs 1,758,776/12,297,163, 14.3% predominantly negative tweets, respectively). The relative frequencies of the discussed themes fluctuated heavily (eg, safety and side effects was the most dominant theme in wave 3 [1,611/9,179, 17.55%] but ranked 6th in wave 5 [428/4,865, 8.8%], and effectiveness of vaccinations ranked 7th in wave 3 [711/9,179, 7.75%] and 2nd in wave 5 [831/4,865, 17.08%]). In wave 3, vaccines were authorized, and vaccinations were suspended and resumed due to safety concerns. Later, policies were implemented that restricted the freedom of unvaccinated citizens. Change points in attention aligned better with policy actions than with pandemic phases. During the later phases, vaccination uptake increased (wave 2: 5.6%, wave 3: 47%, and wave 5: 74% compared to 30%, 62%, and 78%, respectively, in the United Kingdom), and so did the attention to freedom and civil liberties (wave 2: 1,139/6,595, 17.27%; wave 5: 1,403/4,865, 28.84%). Substantially increasing negative and stronger sentiments were expressed.

CONCLUSIONS: Our analyses suggest potential interactions among policies, public attention to different topics, and associated sentiments. While vaccination uptake increased, our findings indicate that citizens’ doubts and concerns did not decrease and that, rather than being fully persuaded, they remained skeptical. This study showcases that monitoring web discourse can provide valuable insights for data-driven policymaking in highly dynamic contexts such as the COVID-19 pandemic.

PMID:41172291 | DOI:10.2196/63909

BJS Open. 2025 Oct 30;9(6):zraf099. doi: 10.1093/bjsopen/zraf099.

ABSTRACT

BACKGROUND: This study aimed to compare preperitoneal ventral mesh patch with barbed suture in ventral hernia repair, evaluating recurrence rates and complications, and to assess the safety of preperitoneal patch placement.

METHODS: In this randomized clinical trial, adult patients undergoing ventral hernia repair at Karlskoga Hospital between 2020 and 2023 were randomized 1 : 1 to either a ventral mesh patch repair group or a non-absorbable barbed suture repair group, blinded to patients and outcome assessors. The primary outcome was recurrence detected at clinical examination and CT verification 1 year after surgery. Pain (measured on a visual analogue scale and using the Ventral Hernia Pain Questionnaire), nausea, and surgical site events (including wound infection, haematoma and seroma) were assessed 4 h, 1 week, 1 month, and 4 years after operation.

RESULTS: Of 256 eligible patients, 209 were screened, and 205 were randomized to ventral mesh patch repair (103) or barbed suture repair (102). The hernia recurrence rate at 1 year was lower in the ventral patch repair group (1.9 versus 5.9%), although this was not statistically significant (P = 0.14). The surgical site infection rate at 1 month was significantly lower in the ventral patch group (0.9 versus 6.9%; P = 0.02). At 1 month, the ventral patch repair group had higher ‘pain right now’ scores on the Ventral Hernia Pain Questionnaire (P = 0.02), although this difference had disappeared by 1 year.

CONCLUSION: Preperitoneal ventral hernia patch repair is a safe and effective technique with a recurrence rate not statistically significant from that after barbed suture repair. Although postoperative pain scores at 1 month were higher after ventral patch repair, this difference had disappeared by 1 year.

PMID:41172283 | DOI:10.1093/bjsopen/zraf099

JMIR Nurs. 2025 Oct 31;8:e68048. doi: 10.2196/68048.

ABSTRACT

BACKGROUND: Mobile health (mHealth) apps enhance clinical nursing by improving access to resources and patient care. Further benefits include reduced errors, time savings, better communication, cost reduction, and training. Understanding factors driving nurses’ continued mHealth adoption is key to its sustained success.

OBJECTIVE: This study extends the expectation-confirmation model (ECM) to explore the determinants of Iranian nurses’ continuance intention to use mHealth apps in their daily clinical routines.

METHODS: A cross-sectional, descriptive-analytical study was conducted among 315 nurses from hospitals affiliated with Kashan University of Medical Sciences. The Nurses’ Mobile Health Device Acceptance Scale (NMHDA-Scale) was developed by the authors in 2022. The Intention to Continue Using Mobile Health Applications for Nurses questionnaire assesses nurses’ future willingness to use mHealth apps in their practice. This questionnaire was designed based on the ECM and the approach by Waltz et al. Its primary aim is to identify the factors that influence mHealth device acceptance, specifically among clinical nurses, as previous studies have not focused on this group and have shown inconsistent relationships between various factors. Participants completed structured questionnaires measuring perceived usefulness, perceived ease of use, social influence, habits, and technology anxiety. Data were analyzed using structural equation modeling in AMOS (version 26). The model tested relationships among confirmation, perceived usefulness, social influence, technology anxiety, and mHealth continuance behavior.

RESULTS: The analyzed sample (n=315) consisted primarily of female (252/315, 80%) and married (243/315, 77.1%) nurses, with a mean age of 35.67 (SD 1.24) years. The analysis revealed that perceived usefulness was significantly influenced by both confirmation (P<.001) and social influence (P<.001). Perceived ease of use was negatively impacted by new technology anxiety (P<.001), indicating that higher anxiety levels reduced perceived ease of use. Additionally, mHealth continuance behavior was positively associated with habits (P=.002), social influence (P<.001), and perceived security risks (P=.008). Contrary to expectations, perceived usefulness did not directly influence mHealth continuance (P=.15), suggesting that other factors, such as habits and social influence, play a more significant role in long-term use.

CONCLUSIONS: Sustained mHealth app use by nurses hinges more on social influence and confirmed expectations than perceived usefulness. Although new technology anxiety remains a barrier, habits and social influence are key to long-term adoption. Hospital leaders should prioritize strategies that foster positive social reinforcement, minimize security concerns, and reduce anxiety through training and support when integrating mHealth into nursing workflows. These findings offer critical insights for improving digital health implementation, ultimately enhancing patient care and clinical efficiency.

PMID:41172281 | DOI:10.2196/68048