Category: Statistics

Issues Ment Health Nurs. 2024 Aug 9:1-11. doi: 10.1080/01612840.2024.2381128. Online ahead of print.

ABSTRACT

Adolescents with subclinical depression are at high risk of developing mental disorders. Early interventions are effective but expensive. Affordable and accessible mental health services are needed. This multimethod study obtained its sample from the database of the Finnish national chat room service and describes the usage of the service among young people in Finland. All chats between 1.1-31.12.2018 were extracted and analysed using quantitative and qualitative methods. The usage frequency was analysed with descriptive statistics, while the specific content of the chat topics was first categorised with content analysis and then quantified and analysed using descriptive statistics. The association between the demographic characteristics and the usage were analysed. A total of 839 young people used chat room services. The great majority of the chat users were girls, and half were 12-14 years old. The use of the chat room varied in terms of the number of words and the duration of the chat discussions. Based on the chat room topics, young people had complex life situations with psychological distress, difficulties related to their social living environment, or they were involved in risky behaviour. The gender and the age of the users influenced their chat room usage. The results of this study can be used in the development of mental health services for young people.

PMID:39121493 | DOI:10.1080/01612840.2024.2381128

Dis Colon Rectum. 2024 Sep 1;67(9):1107-1119. doi: 10.1097/DCR.0000000000003268. Epub 2024 Aug 7.

ABSTRACT

BACKGROUND: Although surgery is commonly regarded as the primary curative treatment for colorectal cancer, it could potentially be associated with postoperative morbidity and mortality.

OBJECTIVE: To determine the pooled effect of exercise and multidisciplinary prehabilitation interventions on postoperative hospital length of stay and functional capacity in patients undergoing resection of colorectal cancer.

DATA SOURCES: A systematic search was conducted in MEDLINE (via PubMed) and Web of Science databases from inception to November 2022.

STUDY SELECTION: The original systematic search retrieved 2005 studies. After the removal of duplicates and screening by title and abstract, 77 eligible full-text documents were evaluated for final inclusion in the meta-analysis. A total of 12 randomized controlled trials, 5 nonrandomized controlled trials, and 3 uncontrolled before-and-after studies were selected.

MAIN OUTCOME MEASURES: Postoperative hospital length of stay (in days) and functional capacity (assessed with the peak of oxygen consumption [VO2 peak] and 6-minute walking test) were the outcome measures.

RESULTS: The meta-analysis was conducted on 20 studies (3805 participants). Randomized controlled trials and nonrandomized controlled trials showed significant reductions in postoperative hospital length of stay (d = -0.10, nearly 2 days) and significant incremental improvements in VO2 peak (d = 0.27) and 6-minute walking test (d = 0.31). Regarding the before-and-after studies, the pooled effect of multidisciplinary prehabilitation interventions was positively significant for VO2 peak (d = 0.29) and 6-minute walking test (d = 0.29). There was no risk of publication bias (Egger test: p > 0.05), with a score of 0.71 (0-1) on average.

LIMITATIONS: There was a high between-studies heterogeneity, and several outcomes did not have the required number of studies for a desirable statistical power.

CONCLUSIONS: These findings suggest that multidisciplinary prehabilitation interventions might be effective at decreasing postoperative hospital length of stay (nearly 2 days) and improving functional capacity.

REGISTRATION: PROSPERO registration number CRD42022373982.

PMID:39121485 | DOI:10.1097/DCR.0000000000003268

JMIR Res Protoc. 2024 Aug 9;13:e59224. doi: 10.2196/59224.

ABSTRACT

BACKGROUND: Stigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma.

OBJECTIVE: This paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs.

METHODS: We designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one’s recovery, (3) maintaining one’s recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one’s substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews.

RESULTS: This pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals.

CONCLUSIONS: To the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59224.

PMID:39121478 | DOI:10.2196/59224

Endocr Regul. 2024 Aug 9;58(1):153-157. doi: 10.2478/enr-2024-0017. Print 2024 Jan 1.

ABSTRACT

Objective. Genetic factors substantially contribute to the development and duration of arterial hypertension. The study of the A1166C polymorphism of the angiotensin II type 1 receptor gene (AGTR1) in arterial hypertension is an auspicious area for assessing the relationship between heredity, hypertension development, and adipokines, but it still remains debatable. The purpose of the current study was to investigate serum adipokines levels depending on the AGTR1 A1166C polymorphism. Methods. A total of 86 patients with arterial hypertension were examined, who underwent the evaluation of the allelic A1166C polymorphism of AGTR1 by polymerase chain reaction with electrophoretic detection and determination of serum adipokines levels using enzyme-linked immunosorbent assay. Results. In the group of patients with arterial hypertension, a significant increase in serum adipokines (resistin, adiponectin, and leptin) levels was found against the background of a decrease in the antianorexic hormone ghrelin with a predominance of CC genotype carriers compared with AA genotype carriers of the AGTR1. A statistically significant decrease in ghrelin and an increase in serum adipokines (resistin, adiponectin, and leptin) in CC genotype carriers compared with AA genotype carriers of the AGTR1 were found suggesting that CC genotype carriers may be predictors of the development of arterial hypertension in our patients. Conclusions. Statistically significant decrease in ghrelin and increase in serum adipokines (resistin, adiponectin, and leptin) were found in CC genotype carriers compared with AA genotype carriers of the AGTR1, which suggests that carriers of the CC genotype are predictors of the arterial hypertension development in our patients.

PMID:39121476 | DOI:10.2478/enr-2024-0017

Endocr Regul. 2024 Aug 9;58(1):158-167. doi: 10.2478/enr-2024-0018. Print 2024 Jan 1.

ABSTRACT

Objective. The hormonal balance is dependent on the internal and external stimuli. The baseline cortisol (BC) and thyroid stimulating hormone (TSH) levels have been observed to vary and have a predictive value in critical illness settings. Few reports have studied their variation in non-severe acute illness. The present study aims to describe the variation of BC and TSH levels and to determine the factors influencing BC and TSH levels in patients admitted with non-severe acute illness. Patients and Methods. This is a cross-sectional study of patients admitted to Infectious Diseases and Endocrinology units at the Department of Endocrinology-Diabetology and Internal Medicine at Tahar Sfar University Hospital between March 15th and September 15th, 2020. BC and TSH levels were obtained during the hospitalization. Results. A total of 143 patients were included in this study with 75 presenting with infection. All infections were community-acquired and predominantly non-severe. The BC levels were higher in patients with infection (p=0.004), especially those admitted via the emergency department (p=0.009) with a fever (p=0.015). The BC positively correlated with the temperature (p=0.002, r’=0.350), CRP levels (p=0.002, r’=0.355), neutrophil to lymphocyte ratio (p=0.045, r’=0.235), and SOFA score (p=0.023, r’=0.262). On the other hand, TSH levels were comparable in the presence of infection (p=0.400). TSH levels did not correlate with the fever, the severity of infection, or inflammation biomarkers. Both BC and TSH did not predict unfavorable outcomes in non-severe infected patients. Conclusion. In patients admitted with critical acute infections, the BC levels seem to indicate a relatively more severe infectious state. On the other hand, TSH levels did not show significant variations in these patients.

PMID:39121474 | DOI:10.2478/enr-2024-0018

JMIR Res Protoc. 2024 Aug 9;13:e55558. doi: 10.2196/55558.

ABSTRACT

BACKGROUND: Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TGD children experiences gender dysphoria, that is, distress that arises from the incongruence between gender identity and sex registered at birth. A lack of consensus exists regarding care for prepubertal TGD children due, in part, to a dearth of empirical research on longitudinal developmental trajectories of gender identity, role behavior, and gender dysphoria (when present).

OBJECTIVE: The objective of this National Institutes of Health-funded study is to provide evidence to inform clinical care for prepubertal TGD children by establishing a US longitudinal cohort (N=248) of prepubertal TGD children and their caregivers that is followed prospectively at 6-month intervals across 18 months.

METHODS: At each timepoint, clinical and behavioral data are collected via web-based visit from child and caregiver reporters. Latent class analysis, among other methods, is used to identify subgroups and longitudinally characterize the gender identity and gender-role behavior of TGD children. These models will define longitudinal patterns of gender identity stability and characterize the relationship between TGD classes and mental and behavioral health outcomes, including the moderating role of social gender transition (when present), on these associations.

RESULTS: Baseline data collection (N=248) is complete, and the identification of TGD subgroups based on gender identity and expression using latent class analysis is anticipated in 2024. The completion of all 4 waves of data collection is anticipated in July 2024, coinciding with the start of a no-cost study extension period. We anticipate longitudinal analyses to be completed by winter 2024.

CONCLUSIONS: Through a longitudinal observational design, this research involving prepubertal TGD children and their caregivers aims to provide empirical knowledge on gender development in a US sample of TGD children, their mental health symptomology and functioning over time, and how family initiated social gender transition may predict or alleviate mental health symptoms or diagnoses. The research findings have promise for clinicians and families aiming to ensure the best developmental outcome for these children as they develop into adolescents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55558.

PMID:39121472 | DOI:10.2196/55558

Interact J Med Res. 2024 Aug 9;13:e56452. doi: 10.2196/56452.

ABSTRACT

BACKGROUND: A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers’ burden, and lower health care cost.

OBJECTIVE: In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions.

METHODS: Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD.

RESULTS: A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89%), while there were fewer studies (from 5/38, 13% to 11/38, 29%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated.

CONCLUSIONS: The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system.

PMID:39121471 | DOI:10.2196/56452

JMIR Public Health Surveill. 2024 Aug 9;10:e51242. doi: 10.2196/51242.

ABSTRACT

BACKGROUND: The incidence of herpes zoster (HZ) is rapidly increasing, causing both clinical and economic burdens in China. Very little is known about Chinese residents’ HZ vaccine preferences and willingness to pay (WTP) for each vaccination attribute.

OBJECTIVE: This study aims to elicit the preferences of Chinese urban adults (aged 25 years or older) regarding HZ vaccination programs and to calculate WTP for each vaccination attribute.

METHODS: In this study, we interviewed 2864 residents in 9 cities in China. A discrete choice experiment was conducted to investigate the residents’ preferences for HZ vaccination and to predict the uptake rate for different vaccine scenarios. A mixed logit model was used to estimate the preferences and WTP for each attribute. Seven attributes with different levels were included in the experiment, and we divided the coefficients of other attributes by the coefficient of price to measure WTP.

RESULTS: Vaccine effectiveness, protection duration, risk of side effects, place of origin, and cost were proven to influence Chinese adults’ preferences for HZ vaccination. The effectiveness of the HZ vaccine was the attribute that had the most predominant impact on residents’ preferences, followed by protection duration. The residents were willing to pay CN ¥974 (US $145) to increase the vaccine effectiveness from 45% to 90%, and they would barely pay to exchange the vaccination schedule from 2 doses to 1 dose. It is suggested that the expected uptake could be promoted the most (by 20.84%) with an increase in the protection rate from 45% to 90%.

CONCLUSIONS: Chinese urban adults made trade-offs between vaccine effectiveness, protection duration, place of origin, side effects, and cost of HZ vaccination. Vaccine effectiveness was the most important characteristic. The residents have the highest WTP (CN ¥974; US $145) for enhancing the effectiveness of vaccines. To maximize HZ vaccine uptake, health authorities should promote vaccine effectiveness.

PMID:39121469 | DOI:10.2196/51242

J Med Internet Res. 2024 Aug 9;26:e56413. doi: 10.2196/56413.

ABSTRACT

BACKGROUND: Patient complaints are a perennial challenge faced by health care institutions globally, requiring extensive time and effort from health care workers. Despite these efforts, patient dissatisfaction remains high. Recent studies on the use of large language models (LLMs) such as the GPT models developed by OpenAI in the health care sector have shown great promise, with the ability to provide more detailed and empathetic responses as compared to physicians. LLMs could potentially be used in responding to patient complaints to improve patient satisfaction and complaint response time.

OBJECTIVE: This study aims to evaluate the performance of LLMs in addressing patient complaints received by a tertiary health care institution, with the goal of enhancing patient satisfaction.

METHODS: Anonymized patient complaint emails and associated responses from the patient relations department were obtained. ChatGPT-4.0 (OpenAI, Inc) was provided with the same complaint email and tasked to generate a response. The complaints and the respective responses were uploaded onto a web-based questionnaire. Respondents were asked to rate both responses on a 10-point Likert scale for 4 items: appropriateness, completeness, empathy, and satisfaction. Participants were also asked to choose a preferred response at the end of each scenario.

RESULTS: There was a total of 188 respondents, of which 115 (61.2%) were health care workers. A majority of the respondents, including both health care and non-health care workers, preferred replies from ChatGPT (n=164, 87.2% to n=183, 97.3%). GPT-4.0 responses were rated higher in all 4 assessed items with all median scores of 8 (IQR 7-9) compared to human responses (appropriateness 5, IQR 3-7; empathy 4, IQR 3-6; quality 5, IQR 3-6; satisfaction 5, IQR 3-6; P<.001) and had higher average word counts as compared to human responses (238 vs 76 words). Regression analyses showed that a higher word count was a statistically significant predictor of higher score in all 4 items, with every 1-word increment resulting in an increase in scores of between 0.015 and 0.019 (all P<.001). However, on subgroup analysis by authorship, this only held true for responses written by patient relations department staff and not those generated by ChatGPT which received consistently high scores irrespective of response length.

CONCLUSIONS: This study provides significant evidence supporting the effectiveness of LLMs in resolution of patient complaints. ChatGPT demonstrated superiority in terms of response appropriateness, empathy, quality, and overall satisfaction when compared against actual human responses to patient complaints. Future research can be done to measure the degree of improvement that artificial intelligence generated responses can bring in terms of time savings, cost-effectiveness, patient satisfaction, and stress reduction for the health care system.

PMID:39121468 | DOI:10.2196/56413

J Med Internet Res. 2024 Aug 9;26:e58950. doi: 10.2196/58950.

ABSTRACT

BACKGROUND: Digital health research plays a vital role in advancing equitable health care. The diversity of research teams is thereby instrumental in capturing societal challenges, increasing productivity, and reducing bias in algorithms. Despite its importance, the gender distribution within digital health authorship remains largely unexplored.

OBJECTIVE: This study aimed to investigate the gender distribution among first and last authors in digital health research, thereby identifying predicting factors of female authorship.

METHODS: This bibliometric analysis examined the gender distribution across 59,980 publications from 1999 to 2023, spanning 42 digital health journals indexed in the Web of Science. To identify strategies ensuring equality in research, a detailed comparison of gender representation in JMIR journals was conducted within the field, as well as against a matched sample. Two-tailed Welch 2-sample t tests, Wilcoxon rank sum tests, and chi-square tests were used to assess differences. In addition, odds ratios were calculated to identify predictors of female authorship.

RESULTS: The analysis revealed that 37% of first authors and 30% of last authors in digital health were female. JMIR journals demonstrated a higher representation, with 49% of first authors and 38% of last authors being female, yielding odds ratios of 1.96 (95% CI 1.90-2.03; P<.001) and 1.78 (95% CI 1.71-1.84; P<.001), respectively. Since 2008, JMIR journals have consistently featured a greater proportion of female first authors than male counterparts. Other factors that predicted female authorship included having female authors in other relevant positions and gender discordance, given the higher rate of male last authors in the field.

CONCLUSIONS: There was an evident shift toward gender parity across publications in digital health, particularly from the publisher JMIR Publications. The specialized focus of its sister journals, equitable editorial policies, and transparency in the review process might contribute to these achievements. Further research is imperative to establish causality, enabling the replication of these successful strategies across other scientific fields to bridge the gender gap in digital health effectively.

PMID:39121467 | DOI:10.2196/58950