Category: Statistics

JMIR Res Protoc. 2025 Nov 5;14:e65012. doi: 10.2196/65012.

ABSTRACT

BACKGROUND: Evidence suggests that the communication of type 2 diabetes (T2D) genetic risk alone has limited effectiveness on facilitating behavioral changes among individuals of European descent. Although the use of wearable devices has been associated with changes in behavior, the effects of combining personalized precision medicine with wearable devices on behaviors related to T2D prevention remain unclear. This study aims to assess the novel effects of T2D genetic risk communication and wearable device functions on objectively measured moderate to vigorous physical activity (MVPA) time among East Asian individuals with overweight or obesity.

OBJECTIVE: The objectives of this study are to (1) investigate the effects of communicating T2D genetic risk and (2) examine the effects of combining T2D genetic risk communication with wearable device functions such as step goal setting and activity prompts on objectively measured MVPA time among East Asians with overweight or obesity.

METHODS: In this parallel-group randomized controlled trial, 355 East Asians with overweight or obesity aged between 40 and 60 years are allocated to 1 of 3 groups: 1 control and 2 intervention groups. Blood samples are used for estimation of T2D genetic risk and tested for metabolic risk markers. T2D genetic risk is estimated based on 113 single nucleotide polymorphisms associated with T2D among East Asians using an established method. All 3 groups receive a Fitbit device. Both intervention groups will receive T2D genetic risk estimates along with lifestyle advice, but one of the intervention groups will receive additional Fitbit functions: step goal setting and prompt functions. The intervention materials are delivered weekly using WhatsApp and monthly via email. The primary outcome is MVPA time, which is objectively measured with the built-in accelerometer of the Fitbit Inspire 3 and will be assessed at baseline, immediately after the intervention, 12 months after the intervention, and at 6-month follow-up. Secondary outcomes include other parameters, such as sedentary time, BMI, systolic and diastolic blood pressure, 5 metabolic risk markers, handgrip strength, sleep, activity calories, self-reported physical activity, self-reported fruit and vegetable consumption, smoking status, and psychological variables.

RESULTS: This study was funded in January 2023. Data collection for baseline assessments began in February 2023. Formal data analysis started in April 2025 after the 6-month follow-up assessments were completed.

CONCLUSIONS: To the best of our knowledge, this study will be the first randomized controlled trial to combine T2D genetic risk communication with wearable device functions in any population. Novel findings will be used to inform future lifestyle modification strategies for T2D. We plan to provide a comprehensive report on this study by publishing this analysis plan before the completion of data collection.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05524909; https://www.clinicaltrials.gov/study/NCT05524909.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/65012.

PMID:41191904 | DOI:10.2196/65012

JMIR Hum Factors. 2025 Nov 5;12:e75855. doi: 10.2196/75855.

ABSTRACT

BACKGROUND: Latinas are one of the largest and fastest-growing female ethnic groups in the United States and have high levels of physical inactivity and sedentary behavior (SB), contributing to a disproportionate burden of chronic health conditions. An ecological momentary assessment (EMA) involves the use of smartphone-based data collected in real time to assess health behaviors and outcomes.

OBJECTIVE: We examined the feasibility, validity, and acceptability of an EMA protocol assessing physical activity (PA) and SB in Latina adults.

METHODS: For 7 days, 67 Latinas (average age 39 years, SD = 13.6; n=37, 55.2% earning less than US $50,000/year; n=53, 79.1% foreign-born; and n=49, 73.1% of Mexican or Mexican American origin) completed a signal-contingent EMA protocol with 3 prompts per day and wore an ActiGraph GT3X accelerometer to measure levels of PA and SB. EMA prompts inquired about current behavior, feelings, beliefs, social conditions, and contexts.

RESULTS: Latinas completed 69.7% (892/1279) of EMA prompts. They were more likely to respond to EMA prompts when engaged in more SB (odds ratio [OR] 1.04, 95% CI 1.01-1.06) and less light-intensity PA (OR 0.97, 95% CI 0.94-0.99) in the 30 minutes around the prompt. Accelerometer data validated self-reported occasions of PA and SB via EMA. The majority of participants (>70%) were satisfied with the protocol and expressed interest in participating in future studies.

CONCLUSIONS: EMA is a feasible, valid, and acceptable methodology for capturing movement behaviors among Latinas, which can provide insights into the antecedents and consequences of these behaviors in their daily lives.

PMID:41191874 | DOI:10.2196/75855

JMIR Aging. 2025 Nov 5;8:e79731. doi: 10.2196/79731.

ABSTRACT

BACKGROUND: Given the rapid development of the digital economy and the sustained proliferation of the internet, digital engagement in older adults has garnered mounting attention from the academic community. However, research has yet to systematically examine the impact of digital engagement on sleep in this demographic.

OBJECTIVE: This study aims to examine the association of digital engagement-operationalized as digital access and internet use duration-with the sleep schedules (nocturnal sleep duration, afternoon nap duration, and sleep onset time) of older adults in China, using longitudinal data and robust statistical modeling to explore longitudinal associations and potential mechanisms.

METHODS: Data were derived from 4 waves (2014, 2016, 2018, and 2020) of the China Family Panel Studies, involving 16,784 older adults (≥60 y). We used panel fixed effects models and a random-effects ordered logit model to analyze the effects on continuous outcomes (nocturnal and nap sleep duration), controlling for time-invariant individual characteristics. As sleep onset time is an ordinal variable, a random-effects ordered logit model was used for this outcome. Moderation analyses were conducted by introducing interaction terms (digital engagement×sex and digital engagement×residence) into the models to examine heterogeneity across subgroups (urban or rural, men or women). Mediation analyses were performed using the Sobel test with year-fixed effects and the nonparametric bootstrap method (1000 resamples) to assess the significance of indirect effects via mechanistic pathways (nonfarm employment, protein intake, memory, depressive mood, and instrumental activities of daily living).

RESULTS: The study included a total of 16,784 older adults, with an average age of 69 (SE 6.946) years, including 9100 (54.22%) women and 7684 (45.78%) men. The results showed that both digital access (β=-.15, 95% CI -.25 to -.06; P=.002) and internet use time (β=-.07, 95% CI -.13 to -.01; P=.027) were significantly associated with significantly shorter sleep duration of older adults. Digital access was significantly associated with a significant reduction in the length of afternoon naps among older adults, while internet use did not have this effect; both digital access and internet use were significantly associated with a significant delay in older adults’ sleep onset time. Digital access was associated with older adults’ sleep schedules through its correlations with nonfarm employment, protein intake, memory, depressive mood, and instrumental activities of daily living. Digital access had a greater and more significant impact on men and urban older adults, while internet use had a greater and more significant impact on women and urban older adults.

CONCLUSIONS: The study indicates that digital engagement, such as the use of electronic devices, is associated with a reduction in both daily and nap sleep duration, as well as a delay in sleep onset, among older adults.

PMID:41191871 | DOI:10.2196/79731

JMIR Cardio. 2025 Nov 5;9:e68022. doi: 10.2196/68022.

ABSTRACT

BACKGROUND: Remote care technology has been used to bridge the gap between health care in a clinical setting and in the community, all the more essential post-COVID. Patients with chronic conditions may benefit from interventions that could provide more continuous and frequent monitoring of their disease process and support self-management. A common barrier, however, is the lack of engagement with technological interventions or devices that provide care remotely, which could lead to loss of resources invested and reduced quality of care.

OBJECTIVE: This discrete choice experiment elicits the preferences of patients with heart failure with regard to potential remote care technologies that they would be willing to engage with and, in turn, creates a hierarchy of factors that can affect engagement for use within future technology design.

METHODS: A survey was created using discrete choice design and with input from a patient and public involvement group. It was distributed online via social media to patients with heart failure and to patient support groups. The attributes used for the experiment were based on a previous systematic review looking at factors that affect engagement in remote care and which generated five central themes, each of which was assigned to an attribute directly: communication (increasing interaction between patients and health care staff/carers/other patients), clinical care (improving the quality of care compared to established practice), education (providing tailored information to help with self-care and reduce uncertainty), ease of use (the technical aspects of the intervention are easy to handle without issues), and convenience (the intervention fits well around the patient’s lifestyle and requires minimal effort). Each of the five themes had two levels, positive and negative. The survey presented participants with multiple forced-choice two-alternative scenarios of remote care, which allowed them to trade attributes according to their preference. The results were analyzed using binary logit to obtain preference weights for each attribute.

RESULTS: A total of 93 completed responses were entered into the analysis. The results of the binary logit created coefficients for each attribute, which equated to the relative preference of the associated themes: clinical care, 2.022; education, 1.252; convenience, 1.245; ease of use, 1.155; communication, 1.040. All calculated coefficients were statistically significant (P<.01).

CONCLUSIONS: The results show that, in this cohort of patients with heart failure, the most preferred factor, clinical care, has enough value to be traded for approximately any two other factors. It also shows that the factor of communication is the least preferred attribute. Technology designers can use the associated preference weights to determine the relative increase of value perceived by patients by adding in certain attributes, with the greatest gains achieved by prioritizing clinical care. This would result in increased engagement in a chronic heart failure population that would benefit most from remote care.

PMID:41191865 | DOI:10.2196/68022

JMIR Form Res. 2025 Nov 5;9:e70341. doi: 10.2196/70341.

ABSTRACT

BACKGROUND: Pediatric obesity continues to be a national health crisis. Parents play a critical role in obesity interventions. Digital health interventions, such as personal activity trackers, can help better engage parents in pediatric obesity interventions and improve outcomes.

OBJECTIVE: This study aimed to (1) assess the feasibility and acceptability of implementing personal activity trackers as part of a comprehensive family-based lifestyle intervention for pediatric obesity (BodyWorks) in a Federally Qualified Health Center; (2) evaluate the impact of personal activity trackers on parents’ engagement, participant anthropometrics, and the overall program; and (3) examine the associations between steps per day and usage (minutes) with body composition outcomes.

METHODS: A total of 158 families were randomized to the control (BodyWorks) or intervention (BodyWorks + physical activity tracker) arm. Mean levels of weight-by-height outcomes, including BMI, BMI z scores, and BMI percent of the 95th percentile, were compared between the 2 groups.

RESULTS: There were no differences between study arms at baseline. After adjustment, there was a significant group difference in children’s BMI z scores from baseline to the postintervention time point (P for interaction=.01).

CONCLUSIONS: Families in the intervention group that completed the program had slightly better weight outcomes than the controls. Engaging parents through digital health interventions may be an effective way to enhance existing pediatric obesity intervention programs.

PMID:41191864 | DOI:10.2196/70341

Inorg Chem. 2025 Nov 5. doi: 10.1021/acs.inorgchem.5c04626. Online ahead of print.

ABSTRACT

Strategies for molecular sorting aim to allow the predictable formation of complex molecules or systems. Here, we report a series of ditopic bis-bidentate ligands, where each bidentate site has one internal hydrogen-bond acceptor or donor. When combined with palladium(II), both homoleptic and heteroleptic combinations show predictable behavior in assembly to maximize favorable hydrogen bonds and, importantly, minimize unfavorable hydrogen:hydrogen or lone-pair:lone-pair clashes. A variety of combinations give narcissistic or statistical sorting, but most interestingly, two low-symmetry [Pd₂(L)(L’)]⁴⁺ macrocycles form integratively, even though both contain unfavorable interactions. This is because their homoleptic counterparts are even more disfavored. We have developed a scoring system based on these results that can be used in the future to effectively predict the behavior of similar palladium(II)-based assemblies.

PMID:41191845 | DOI:10.1021/acs.inorgchem.5c04626

Can Urol Assoc J. 2025 Oct 27. doi: 10.5489/cuaj.9284. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite increased risk of adverse events and overdose associated with sustained-release opioids, evidence is lacking to support the short-term use of a low-dose, sustained-release opioid for acute pain control in a monitored setting. Both immediate-release and sustained-release opioids are used clinically in postoperative analgesia. We hypothesized that short-term use of low-dose, sustained-release hydromorphone combined with immediate-release hydromorphone as required would facilitate earlier ambulation after major urologic surgeries compared to immediate-release opioid alone.

METHODS: Following ethics approval and patient consent, patients undergoing elective open abdominal urologic surgeries were randomized into two groups: sustained-release hydromorphone on a regular basis for two days, with immediate-release hydromorphone available on an as-required basis; or immediate-release hydromorphone on an as-required basis only. The primary outcome measure was the time to get up and walk three steps.

RESULTS: A total of 66 participants were included in the data analysis. There was no statistically significant difference in the time to first mobilization, opioid consumption, or pain scores at any time point between the two groups. There were trends toward more nausea on postoperative days 1, 2 and 3, as well as more severe loss of sleep the first night after surgery in the immediate-release group, although the differences did not reach statistical significance.

CONCLUSIONS: Our study showed that patients receiving short-term, low-dose, sustained-release hydromorphone immediately postoperatively did not mobilize sooner compared to those only receiving immediate-release hydromorphone. There was no difference in the pain score or opioid consumption.

PMID:41191835 | DOI:10.5489/cuaj.9284

Can Urol Assoc J. 2025 Oct 27. doi: 10.5489/cuaj.9258. Online ahead of print.

ABSTRACT

INTRODUCTION: Upregulation of hypoxia-inducible factors (HIF) is an important pathologic feature shared by clear-cell renal cell carcinoma (ccRCC) and obstructive sleep apnea (OSA). It is unclear whether OSA alters ccRCC pathogenesis via HIF expression. This study aimed to characterize differences in HIF expression in ccRCC tumors in patients with and without OSA. We hypothesized that a diagnosis of OSA was associated with increased HIF expression.

METHODS: A cohort of adults who underwent nephrectomy for ccRCC was identified. OSA diagnosis was determined with preoperative STOP-BANG scores or polysomnography, selecting 20 individuals with and 20 without OSA. Tumor sections were immunohistochemically stained for HIF-1α & HIF-2α and assessed by an expert uropathologist.

RESULTS: The OSA group exhibited a higher prevalence of hypertension (95% vs. 50%, p=0.001) and greater median body mass index (BMI) (34.8 vs. 29.05, p=0.006). Tumor grades were higher in the OSA group (p=0.039). No differences were noted in tumor stages. Samples of ccRCC tumors in the OSA group demonstrated a higher prevalence of HIF-1α positivity (80% vs. 50%, p=0.048), although median histoscores were not different (4 vs. 2.5, p=0.260). Neither median HIF-2α histoscores (1 vs. 2, p=0.306) nor expression (histoscore >0; 74% vs. 75%, p=0.927) was statistically significant.

CONCLUSIONS: In OSA patients, ccRCC tumors exhibited higher HIF-1α positivity and tumor grades; however, no significant differences in median HIF histoscores, HIF-2α expression, or tumor stage was found. Future studies can use our results to perform formal sample size calculations and elucidate the role of OSA in the pathogenesis of ccRCC.

PMID:41191832 | DOI:10.5489/cuaj.9258

Can Urol Assoc J. 2025 Oct 27. doi: 10.5489/cuaj.9286. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric and adult reconstructive urology remain underrepresented in global surgical efforts, despite their critical role in restoring genitourinary function. This global surgery initiative aimed to address the gap in specialized urologic care in low- to middle-income countries (LMICs) through a longitudinal, mentorship-based approach integrating augmented reality (AR) telementoring.

METHODS: This report describes an approach used to enhance global surgical expertise in LMICs and summarizes data documenting impact. A Global Surgery Partnership Initiative was launched by an academic surgeon from the University of Toronto to address the lack of specialized pediatric and reconstructive urologic training. Through collaboration with local institutions in the Philippines and Vietnam, the program employed a mixed-method approach that delivered longitudinal mentorship, combining virtual case conferences, in-person surgical mentoring, pilot of AR-supported telementoring, and continuous postoperative coaching. Patient outcomes were assessed and mentees self-reported pre- and post-intervention surveys evaluating comfort and technical understanding. Descriptive statistics and paired t-tests were used to analyze outcomes.

RESULTS: Thirty-eight pediatric and adult reconstructive urology cases were performed. Over time, operative times and length of stay decreased, with low complication rates (6/38, 12.7%) and Clavien-Dindo ≥3 complications (3/38, 8%). Mentee comfort and understanding significantly improved (mean comfort score: 3.06 to 6.77; technical understanding: 4.77 to 8.43; p<0.001). AR-assisted mentoring, introduced in 2022 and expanded in 2024, showed feasibility, with further enhanced intraoperative feedback and sustainability.

CONCLUSIONS: This structured, mixed-method model effectively improved surgical competencies and system-level capacity in LMICs. Unlike short-term missions, this initiative emphasized continuity, adaptability, and sustainability. It presents a scalable framework for integrating reconstructive urology into global health programs while leveraging AR to overcome geographic and resource limitations.

PMID:41191829 | DOI:10.5489/cuaj.9286

J Nerv Ment Dis. 2025 Nov 5. doi: 10.1097/NMD.0000000000001858. Online ahead of print.

ABSTRACT

INTRODUCTION: Epilepsy is associated with increased schizophrenia risk, but few large studies account for key factors. This study analyzed cohort data from Korea to assess schizophrenia risk postepilepsy diagnosis.

METHODS: Epilepsy patients were age-matched and sex-matched with controls. Schizophrenia was the primary outcome. Cox regression estimated adjusted hazard ratios (HRs), accounting for demographics and lifestyle factors (smoking, BMI, cholesterol, and income). Kaplan-Meier curves and log-rank tests assessed cumulative schizophrenia incidence.

RESULTS: The study included 2,770 epilepsy patients and 27,700 matched controls. The overall adjusted HR for schizophrenia among epilepsy patients was 9.44 (95% CI, 6.72-13.25). Subgroup analysis indicated the highest HR in men under 60 years at 13.44 (95% CI, 5.53-32.66), and in women aged 60 and older at 13.16 (95% CI, 7.09-24.44).

CONCLUSIONS: Epilepsy increases the risk of schizophrenia, especially in younger men and older women, highlighting the need for targeted mental health monitoring and early intervention.

PMID:41191815 | DOI:10.1097/NMD.0000000000001858