Category: Statistics

JMIR Ment Health. 2025 Feb 19;12:e64716. doi: 10.2196/64716.

ABSTRACT

BACKGROUND: The early detection of mild cognitive impairment is crucial for providing treatment before further decline. Cognitive challenge tests such as the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) can identify individuals at highest risk for cognitive deterioration. Performance on elements of the LASSI-L, particularly proactive interference, correlate with the presence of critical Alzheimer disease biomarkers. However, in-person paper tests require skilled testers and are not practical in many community settings or for large-scale screening in prevention.

OBJECTIVE: This study reports on the development and initial validation of a self-administered computerized version of the Loewenstein-Acevedo Scales for Semantic Interference (LASSI), the digital LASSI (LASSI-D). A self-administered digital version, with an artificial intelligence-generated avatar assistant, was the migrated assessment.

METHODS: Cloud-based software was developed, using voice recognition technology, for English and Spanish versions of the LASSI-D. Participants were assessed with either the LASSI-L or LASSI-D first, in a sequential assessment study. Participants with amnestic mild cognitive impairment (aMCI; n=54) or normal cognition (NC; n=58) were also tested with traditional measures such as the Alzheimer Disease Assessment Scale-Cognition. We examined group differences in performance across the legacy and digital versions of the LASSI, as well as correlations between LASSI performance and other measures across the versions.

RESULTS: Differences on recall and intrusion variables between aMCI and NC samples on both versions were all statistically significant (all P<.001), with at least medium effect sizes (d>0.68). There were no statistically significant performance differences in these variables between legacy and digital administration in either sample (all P<.13). There were no language differences in any variables (P>.10), and correlations between LASSI variables and other cognitive variables were statistically significant (all P<.01). The most predictive legacy variables, proactive interference and failure to recover from proactive interference, were identical across legacy and migrated versions within groups and were identical to results of previous studies with the legacy LASSI-L. Classification accuracy was 88% for NC and 78% for aMCI participants.

CONCLUSIONS: The results for the digital migration of the LASSI-D were highly convergent with the legacy LASSI-L. Across all indices of similarity, including sensitivity, criterion validity, classification accuracy, and performance, the versions converged across languages. Future studies will present additional validation data, including correlations with blood-based Alzheimer disease biomarkers and alternative forms. The current data provide convincing evidence of the use of a fully self-administered digitally migrated cognitive challenge test.

PMID:39970376 | DOI:10.2196/64716

Folia Med Cracov. 2024 Dec 26;64(3):155-163. doi: 10.24425/fmc.2024.152176.

ABSTRACT

OBJECTIVE: Our study aimed to evaluate the association between single nucleotide polymorphism of IL-6-174G/C and the disease course in patients with ulcerative colitis (UC) and Crohn’s disease (CD).

METHODS: 105 patients (aged 18-75 years) with diagnosed inflammatory bowel disease (IBD), 50 with CD, and 55 with UC, were involved in the study. The controls consisted of 124 healthy individuals. In all patients, the following parameters were evaluated: disease duration, location, presence of complications, and past surgical procedures. Morphology, biochemical parameters, fibrinogen, interleukin 6 (IL-6) level, and IL-6 single nucleotide (174 G/C) polymorphism were assessed in all subjects. Associations of those markers with disease activity, location, complications, and inflammatory markers were evaluated.

RESULTS: No statistically significant differences in IL-6 single nucleotide (174 G/C) polymorphism were observed between patients with UC, CD, and controls. In IBD patients with the GG genotype, a higher mean IL-6 level was noticed than in patients with other genotypes (4.685 ± 5.9 vs. 2.715 ± 5.1 in GC and 3.186 ± 3.6 in CC). A positive correlation was found between IL-6 and fibrinogen levels and CRP in UC and CD patients with GG and GC genotypes. In IBD patients with CC genotype, no correlation between IL-6 and fibrinogen was found (p = 0.48).

CONCLUSIONS: The risk of developing IBD appears not connected with IL-6 polymorphism. However, IL-6 variation might influence the course of the disease in UC patients.

PMID:39970364 | DOI:10.24425/fmc.2024.152176

Folia Med Cracov. 2024 Dec 26;64(3):119-127. doi: 10.24425/fmc.2024.152172.

ABSTRACT

Complex regional pain syndrome (CRPS) is a descriptive term for a complex of symptoms and signs, including pain, swelling and vasomotor disturbances. The disease causes also functional impairment of the affected extremity and limitation in daily activities. Even after effective treatment, the condition frequently leaves residual symptoms and impairment of the limb. The objective of this study was assessment of the level of functional impairment in patients who got over CRPS. Materials and Methods: Fifty-two patients, 45 women (86%) and 7 men (14%) in a mean age of 57 years who were got over CRPS were asked to fill 2 questionnaires for assessment of function of their upper limbs in daily living. The questionnaires included the Raadboud Skills Questionnaire (the RASQ) and the Disability of Arm, Shoulder and Hand (the DASH). Results of this study show statistically significant differences in functional impairment of the limbs between the groups with different recovery status and duration of CRPS: the patients with longer lasting disease and those, who did not feel recovered showed greater functional impairment of their limbs than remaining patients. Conclusion: These results suggest that, in spite of a satisfactory outcome of treatment, significant long- term sequelae of the disease impair function of the affected limbs and reduce quality of life in a proportion of patients.

PMID:39970360 | DOI:10.24425/fmc.2024.152172

Folia Med Cracov. 2024 Dec 26;64(3):81-90. doi: 10.24425/fmc.2024.152168.

ABSTRACT

Temporomandibular disorder (TMD), occurring in the form of articular disc displacement with- out reduction is one of the most serious and common forms of dysfunction. The aim of this article was to present a complete sequence of procedures and intervention that consequently led to the resolution of symptoms in most patients, associated with disc displacement without reduction and the resolution of joint’s pain, as well as favorable results of treatment of disc displacement with reduction.

MATERIAL AND METHODS: A group of 128 patients (86 females, 42 males) aged 20 to 42 years old, diagnosed with disc displacement without reduction undertook treatment at the Prosthodontics Clinic of the University Dental Clinic in Krakow, in period January 2020 – June 2024. Diagnosis of the condition was made on the basis of the DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) questionnaire axis I (reduction in mouth opening <35 mm, oblique lowering path of mandibular motion, pain of the joint) and the results of ultrasonography (USG) of the temporomandibular joints. 121 patients reported experiencing intrinsic pain and 7 patients presented for treatment without feeling pain.

RESULT: Analysis of the results of the carried-out tests (maximal mouth opening, mandibular lowering trajectory deviation and pain intensity VAS + VNRS scale indicate that the displaced articular disc was unblocked and a statistically significant improvement in the clinical condition of the temporomandibular joints was achieved.

CONCLUSION: The proposed sequence of procedures carried out is an effective treatment for displacement of the articular disc with no reduction.

PMID:39970356 | DOI:10.24425/fmc.2024.152168

J Med Internet Res. 2025 Feb 19;27:e69109. doi: 10.2196/69109.

ABSTRACT

BACKGROUND: Cognitive impairment is an important public health challenge among older adults, particularly in long-term care facilities (LTCFs), where prevalence is higher due to staffing shortages, limited resources, and difficulty maintaining structured exercise programs. Furthermore, older adults often lose interest in repetitive interventions. The exergame “WarioWare: Move It!” (Nintendo) offers a novel solution by combining aerobic exercise, motor coordination, balance training, and cognitive engagement into an immersive experience.

OBJECTIVE: This study aimed to assess the clinical efficacy of an exergame-based training program delivered via “WarioWare: Move It!” in improving physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in older adults living in LTCFs.

METHODS: The training program was conducted across multiple rural LTCFs in Shanxi Province, China. Participants were randomly assigned to the intervention or control group. The intervention protocol encompassed two 60-minute sessions per week over 12 weeks, using motion-sensing exercises such as waving, jumping, arm swinging, rotational movements, and object-mimicking postures with Joy-Con controllers. Primary outcome measures were derived through clinical tests, including the sit and reach test, shoulder flexibility test, trunk rotation flexibility test, shoulder and elbow range of motion, figure-of-8 walk test, standing balance test, hand dexterity test, and cognitive function tests. Statistical analysis was performed using mixed ANOVA, with time as the within-participant factor and intervention group as the between-participant factor, to assess the training effects on the various outcome measures.

RESULTS: A total of 232 participants were recruited, including 32 (13.8%) patients with mild dementia, 18 (7.8%) with moderate dementia, and 182 (78.4%) with mild cognitive impairment, all of whom completed the study. The mixed ANOVA revealed significant group × time interactions across multiple physical flexibility assessments, including the remaining distance between the hands and toes during the forward bend (F_2,156=8.484; P<.001; η²=0.098), the distance between the hands clasped behind the back (F_2,156=3.666; P=.04; η²=0.045), and the angle formed by trunk rotation to the left and right (F_2,156=17.353; P<.001; η²=0.182). Significant group × time interactions also emerged for shoulder joint forward flexion (F_2,156=17.655; P<.001; η²=0.185), abduction (F_2,156=6.281; P=.004; η²=0.075), and elbow flexion (F_2,156=3.298; P=.049; η²=0.041). In addition, the time to complete the figure-of-8 walk test (F_2,156=11.846; P<.001; η²=0.132) and the number of blocks moved within 1 minute (F_2,156=4.016; P=.02; η²=0.049) showed significant interactions. Finally, all scale-based measures exhibited statistically significant group × time interactions (all P values <.001).

CONCLUSIONS: The “WarioWare: Move It!” intervention significantly improved physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function among older adults with mild cognitive impairment or dementia residing in rural LTCFs. The intervention offers an innovative and feasible approach for promoting the health of older adults in resource-limited settings, demonstrating its potential for widespread application in diverse low-resource environments.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06717971; https://clinicaltrials.gov/study/NCT06717971.

PMID:39969990 | DOI:10.2196/69109

Eur J Cardiothorac Surg. 2025 Feb 19:ezaf049. doi: 10.1093/ejcts/ezaf049. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the study was to evaluate the outcomes of aortic valve repair techniques using cusp patch-plasty with CardioCel.

METHODS: Between September 2014 and June 2021, a total of 167 patients underwent aortic valve reconstruction using cusp repair. In all patients CardioCel patch was used exclusively. An isolated cusp repair was performed in 117 patients (70%), while 50 patients with concomitant aortopathy needed a combined valve and root repair. Seventy-two patients (43%) presented with tricuspid valve. The mean age of the entire cohort was 54.3 ± 12.3 years , 143 patients being males.

RESULTS: Early (30-day/in-hospital) mortality was 0.6%. The survival at 2, 4, and 6 years was 98.8%, 96.8%, and 95.7%, respectively. During the mean follow-up of 4.2 ± 1.7 years (resulting in 697 patient-years), a relevant aortic insufficiency occurred in 10 patients (8 of them presenting with bicuspid valve). All the patients underwent a valve replacement, resulting in a 7.8 ± 2.5% cumulative risk of aortic valve reoperation and/or insufficiency ≥3+ at 6 years. The causes of reoperation were cusp tear at the suture line, progressive valve pathology, endocarditis, and unknown in 4, 4, 1, and 1, respectively. Degeneration and/or calcification of the CardioCel has not been observed.

CONCLUSIONS: The intermediate results of aortic cusp repair using CardioCel are good. Anatomo-pathology of the aortic valve and quality of the cusps seem to be main reason of repair failure. Further investigations are needed to assess the long-term durability of CardioCel patch-plasty as an alternative to biological valve replacement in specific aortic valve pathologies.

PMID:39969987 | DOI:10.1093/ejcts/ezaf049

JMIR Form Res. 2025 Feb 19;9:e57512. doi: 10.2196/57512.

ABSTRACT

BACKGROUND: Smartphones have become an indispensable part of people’s lives, and the fear of being without them, what has been termed “no mobile phone phobia” (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored.

OBJECTIVE: This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively.

METHODS: During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels.

RESULTS: Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual’s Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone.

CONCLUSIONS: Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies.

PMID:39969982 | DOI:10.2196/57512

J Med Internet Res. 2025 Feb 19;27:e66802. doi: 10.2196/66802.

ABSTRACT

BACKGROUND: Recovery of upper limb function after stroke secondary to ischemia or hemorrhage is crucial for patients’ independence in daily living and quality of life. Virtual reality (VR) is a promising computer-based technology designed to enhance the effects of rehabilitation; however, the results of VR-based interventions remain equivocal.

OBJECTIVE: This study aims to review the plausible factors that may have influenced VR’s therapeutic effects on improving upper limb function in patients with stroke, with the goal of synthesizing an optimal VR intervention protocol.

METHODS: The databases PubMed, EMBASE, Web of Science, and Cochrane Library were queried for English-language papers published from May 2022 onward. Two reviewers independently extracted data from the included papers, and discrepancies in their findings were resolved through consensus during joint meetings. The risk of bias was assessed using the Physiotherapy Evidence Database Scale and the Methodological Index for Non-Randomized Studies. Outcome variables included the Action Research Arm Test, Box-Block Test, Functional Independence Measure, Upper Extremity Fugl-Meyer Assessment, and Wolf Motor Function Test. The plausible factors examined were age, total dosage (hours), trial length (weeks), session duration (hours/session), frequency (sessions/week), and VR content design. The Bonferroni adjustment was applied to P values to prevent data from being incorrectly deemed statistically significant.

RESULTS: The final sample included 15 articles with a total of 1243 participants (age range 48.6-75.59 years). Participants in the VR therapy (VRT) group (n=455) demonstrated significantly greater improvements in upper limb function and independence in activities of daily living compared with those in the conventional therapy group (n=301). Significant factors contributing to improved outcomes in upper limb function were younger age (mean difference [MD] 5.34, 95% CI 2.18-8.5, P<.001; I2=0%), interventions lasting more than 15 hours (MD 9.67, 95% CI 4.19-15.15, P<.001; I2=0%), trial lengths exceeding 4 weeks (MD 4.02, 95% CI 1.39-6.65, P=.003; I2=15%), and more than 4 sessions per week (MD 3.48, 95% CI 0.87-6.09, P=.009; I2=0%). However, the design of the VR content, including factors such as the number of features (eg, offering exercise and functional tasks; individualized goals; activity quantification; consideration of comorbidities and baseline activity level; addressing patient needs; aligning with patient background such as education level; patient-directed goals and interests; goal setting; progressive difficulty levels; and promoting self-efficacy), did not demonstrate significant effects (MD 3.89, 95% CI -6.40 to 1.09; effect Z=1.36, P=.16).

CONCLUSIONS: Greater VR effects on improving upper limb function in patients with stroke were associated with higher training doses (exceeding 15 hours) delivered over 4-6 weeks, with shorter sessions (approximately 1 hour) scheduled 4 or more times per week. Additionally, younger patients appeared to benefit more from the VR protocol compared with older patients.

PMID:39969977 | DOI:10.2196/66802

JMIR Form Res. 2025 Feb 19;9:e65302. doi: 10.2196/65302.

ABSTRACT

BACKGROUND: Medication nonadherence is a serious problem in cancer, potentially impacts patients’ health outcomes and health care costs. Although technology-based medication adherence (MA) interventions have emerged, evidence supporting their quality and effectiveness remains limited.

OBJECTIVE: This study tested the acceptability, feasibility, and potential effects of Safety and Adherence to Medications and Self-care Advice in Oncology (SAMSON), a digital solution designed to support MA and self-management in cancer.

METHODS: A 12-week, 2-arm, unblinded, pragmatic pilot randomized controlled trial was conducted. Adults with hematological malignancies who started oral cancer medicines within the last 12 months were recruited from a metropolitan specialized hospital and randomized 1:1 to SAMSON or control (usual care). The SAMSON solution included a smartphone app with tailored alerts and real-time self-care advice, a web-based dashboard for health care professionals (HCPs) to monitor patients’ adherence and symptoms, and motivational interviewing (MI) teleconsultations delivered by oncology nurses and pharmacists at baseline and weeks 1, 4, 8, and 12. Primary outcomes were the patients’ acceptance of SAMSON, measured by the Unified Theory of Acceptance and Use of Technology at 12 weeks, and study feasibility, measured by predefined rates of recruitment, randomization, retention, intervention adherence, and outcome assessment completion. Secondary outcomes were comparison of MA and clinical self-assessments through online questionnaires, including adherence, toxicity self-management, anxiety and depression symptoms, and quality of life, measured at baseline and 12 weeks between the 2 arms. Data retrieved from the SAMSON app (Swinburne University of Technology) was analysed for task completion.

RESULTS: A total of 33 patients (79% of those who were approached) consented to participate in the trial. Of those, 31/33 (94%) completed baseline surveys and were randomized to SAMSON (15/31) and control arms (16/31). Of 31 patients, 28 (90%) completed the 12-week surveys (12 SAMSON and 16 control). Overall, patients rated the SAMSON solution as highly acceptable (13/15, 87% app usage; 14/15, 93% MI teleconsultation delivery). They reported that SAMSON was easy to use (10/12, 83%) and helpful in improving their MA (6/12, 50%). All study HCPs reported the SAMSON solution was helpful in supporting patients’ MA. Patients completed an average of 99 tasks over the 12-week study period (71% of scheduled tasks). Most patients (10/12, 83%) completed all 5 scheduled consultations. All study feasibility measures were higher than the predefined upper thresholds, except the rate of patients’ responses to medication reminders.

CONCLUSIONS: The results demonstrated that the SAMSON solution is acceptable, usable, and useful for oncology HCPs and patients with cancer. The SAMSON solution is feasible in real-life oncology settings. Our next steps involve refining the SAMSON solution based on participants’ feedback, conducting a large-scale randomized controlled trial to evaluate its clinical and economic effectiveness, and exploring potential commercialization.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000472673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385728.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2023-079122.

PMID:39969972 | DOI:10.2196/65302

Interdiscip Cardiovasc Thorac Surg. 2025 Feb 19:ivaf021. doi: 10.1093/icvts/ivaf021. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare outcomes of two different revascularization strategies in chronic kidney disease patients: coronary artery bypass grafting versus percutaneous coronary intervention.

METHODS: we conducted this metanalysis according to PRISMA guidelines and registered with PROSPERO (CRD42021238659), evaluated studies comparing CABG and PCI in patients with CAD and CKD (defined by KDIGO guidelines). Data were extracted from PubMed, EMBASE, and Cochrane from 2000 to 2023. The primary end-point was long-term MACCE rates, with secondary end-points including 30-day mortality, stroke, MI, and repeat revascularization. Statistical analyses included Kaplan-Meier estimations, Cox regression, and meta-regression to address heterogeneity. Publication bias was assessed via funnel plots. No funding was received, and the authors report no conflicts of interest.

RESULTS: We included 33 studies with 402,300 patients (eGFR <60 mL/min/1.73m2). The cohort comprised 132,314 coronary artery bypass graft and 269,986 percutaneous coronary intervention patients.Over three years, coronary artery bypass group provided protection against major adverse cardiac and cerebrovascular events, myocardial infarction, and repeat revascularization compared to percutaneous coronary intervention. However, percutaneous coronary intervention showed better short-term outcomes, including lower 30-day mortality. Coronary artery bypass group was linked to a higher stroke risk over the 3-year follow-up.

CONCLUSIONS: Revascularization strategies for chronic kidney disease and coronary artery disease patients should balance percutaneous coronary intervention’s short-term benefits with coronary artery bypass grafting’s long-term advantages.

PMID:39969961 | DOI:10.1093/icvts/ivaf021