Category: Statistics

JCO Clin Cancer Inform. 2025 Jul;9:e2500111. doi: 10.1200/CCI-25-00111. Epub 2025 Jul 11.

ABSTRACT

PURPOSE: Consumer wearable devices provide new opportunities for measuring patterns of objective daily physical activity throughout cancer treatment. In addition to capturing step counts, these devices can also measure gait cadence and activity fragmentation, two metrics that may reflect functional capacity. The goal of the current study was to examine whether step count, gait cadence, and activity fragmentation predicted overall survival in patients with solid tumors.

METHODS: We enrolled patients (N = 213) receiving outpatient chemotherapy for any solid tumor into an observational cohort study. Patients wore a consumer wearable device to measure continuous physical activity patterns for up to 90 days and were followed for a median of 2.53 years, during which 42% of the sample died. Univariable and multivariable Cox proportional hazards regression analyses were used to evaluate associations between wearable device physical function metrics and survival.

RESULTS: In univariable analyses, higher step count (hazard ratio (HR), 0.87; P = .007), less activity fragmentation (HR, 1.03; P < .001), and faster peak gait cadence (HR, 0.81; P < .001) were significantly associated with lower mortality risk. Associations with activity fragmentation and gait cadence persisted after adjustment for age and cancer type and stage and after additional adjustment for clinician-rated performance status and patient-reported physical function.

CONCLUSION: Activity fragmentation and gait cadence metrics derived from consumer wearable devices were associated with overall survival in patients receiving chemotherapy for any solid tumor. These associations remained statistically significant after adjustment for covariates, including clinician-rated performance status and patient-reported physical function. These findings suggest that wearable devices may capture important prognostic information about physical function independent of what clinicians and patients perceive.

PMID:40644640 | DOI:10.1200/CCI-25-00111

Am J Clin Hypn. 2025 Jul 11:1-17. doi: 10.1080/00029157.2025.2517170. Online ahead of print.

ABSTRACT

Patients with ischemic heart disease exhibit lower subjective well-being. Although hypnosis involving imagery may enhance their well-being, its implementation remains inadequately investigated. Therefore, this feasibility study assessed the feasibility and acceptability of an online hypnotic guided imagery intervention for improving subjective well-being and the occurrence of adverse events in these patients. Ten sex-matched participants were randomly assigned to an experimental group receiving three hypnotic sessions or a control group getting two non-hypnotic sessions, followed by a delayed hypnosis intervention after the posttest. Hypnotic sessions encompassed induction, guided imagery problem-solving, and reinforcement of positive change. The feasibility, acceptability, and potential effects on subjective well-being were evaluated through qualitative feedback and descriptive statistics. The results revealed that online hypnosis was feasible, with the therapist successfully delivering online hypnosis without issues and participants experiencing relaxation, emotional release, and better sleep. The descriptive statistics showed that the experimental group demonstrated greater enhancement in subjective well-being than the control group. While two subjects reported mild dizziness, no serious adverse events were reported. The findings suggest that online hypnosis may be a promising intervention for promoting subjective well-being in ischemic heart disease patients. However, these discoveries require confirmation with larger samples and evaluation of unfavorable effects.

PMID:40644637 | DOI:10.1080/00029157.2025.2517170

JMIR Mhealth Uhealth. 2025 Jul 11;13:e70219. doi: 10.2196/70219.

ABSTRACT

BACKGROUND: Mobile health (mHealth) interventions are increasingly used to reduce risk and promote health in real-time, real-life contexts. Engagement is critical for effectiveness of mHealth interventions but may be challenging for young people experiencing depressive symptoms.

OBJECTIVE: We examined engagement with the 4-week mHealth component of a counseling-plus-mHealth intervention to reduce sexual and reproductive health (SRH) risk among young people with depression (Momentary Affect Regulation – Safer Sex Intervention [MARSSI]) to determine (1) mHealth engagement patterns over time and (2) how sociodemographic characteristics, SRH risks, and depressive symptom severity were associated with these engagement patterns.

METHODS: We undertook secondary analysis of data collected from June 2021 to September 2023 in a randomized controlled trial of MARSSI versus a breast health podcast. Eligibility included age 16-21 years, ability to become pregnant, smartphone ownership, English fluency, past-3-month penile-vaginal sex ≥1x/week and ≥1 SRH risk, and Patient Health Questionnaire-8 item score ≥8. Intervention participants received one-on-one telehealth counseling and then used an app for 4 weeks, responding to surveys (3 prompted at quasi-random, 1 scheduled daily) about affect, effective contraception and condom use self-efficacy, sexual and pregnancy desire, and recent sex, and receiving tailored messages reinforcing the counseling. We computed mHealth engagement days (responding to ≥1 app survey) by week and overall. Latent trajectory analysis identified engagement patterns over the 4 mHealth weeks among participants with any engagement. Using regression analysis, we examined the associations of sociodemographic characteristics, SRH risks, and depressive symptom severity with mHealth engagement patterns and examined moderation by depressive symptom severity. Of the 201 intervention participants, 194 (96.5%) enrolled in the app.

RESULTS: Among those responding to app surveys (167/194, 86.1%), the median engagement was 14 (IQR 4-23) days; 32.9% (55/167) responded on ≥20 days. Overall app engagement (median) declined from 5 (IQR 3-7) days in week 1 to 1 (IQR 0-5) day in week 4. On latent trajectory analysis, 4 patterns of app engagement emerged: high-throughout (48/167, 28.7%), high-then-declining (40/167, 23.9%), mid-then-declining (47/167, 28.1%), and low-throughout (33/167, 19.7%). Participants identifying gender other than female and those perceiving higher socioeconomic status were more likely to have high-throughout or high-then-declining engagement. Asian or Black non-Hispanic participants and those using low-effectiveness contraception were more likely to have no engagement. In the multivariable model, Asian (adjusted odds ratio [AOR] 0.28, 95% CI 0.10-0.81), Black non-Hispanic (AOR 0.28, 95% CI 0.12-0.66), and higher perceived socioeconomic status (AOR 1.24, 95% CI 1.05-1.48) remained significantly associated with engagement. Engagement patterns showed no differences by depressive symptom severity and no significant moderation.

CONCLUSIONS: Young people with depressive symptoms showed initial high engagement with the intervention’s mHealth app to reduce adverse SRH outcomes. Methods to increase and sustain mHealth engagement and differences in engagement by sociodemographic characteristics warrant further studies to optimize the reach of mHealth interventions.

PMID:40644628 | DOI:10.2196/70219

JMIR Hum Factors. 2025 Jul 11;12:e68813. doi: 10.2196/68813.

ABSTRACT

BACKGROUND: Strengthening shared decision-making in mental health care may improve the quality of services and treatment outcomes, but its implementation in services for severe mental disorders is currently lacking.

OBJECTIVE: This study aims to explore the feasibility and acceptability of iTandem (University of Oslo), a mobile app designed to promote shared decision-making in the treatment of psychotic disorders. In addition, the study aims to investigate mechanisms that potentially contribute to the intended effect of the app. iTandem is a therapy supplement that facilitates patient involvement in decisions regarding treatment goals and focus areas. It is designed for personalized use and contains 8 optional modules: sleep, medication, recovery, mood, psychosis, activity, substance use, and feedback concerning therapy.

METHODS: Patients undergoing assessment or treatment for psychotic disorders and their clinicians were recruited for the study. Patients and clinicians jointly used iTandem as part of standard treatment in a 6-week trial. We used a mixed-methods study design with a clear emphasis on qualitative methods. Feasibility and acceptability were assessed through descriptive statistics based on preintervention and postintervention questionnaires and app usage data, in addition to text responses to open-ended items. We conducted a reflexive thematic analysis of postintervention interviews to elaborate these measures and to explore mechanisms potentially contributing to achieving shared decision-making when using iTandem.

RESULTS: A total of 9 patients and 8 clinicians completed the trial. The participants evaluated iTandem as a user-friendly and acceptable tool, but there were considerable variations in how the app was integrated into treatment and in perceptions of its clinical value. The thematic analysis suggests that iTandem has the potential to facilitate shared decision-making through supporting cognition and shifting the patient’s role. We also identified scaffolding structures, an analogy of personalized support, as a precondition for these mechanisms and for the overall feasibility and acceptability of iTandem.

CONCLUSIONS: iTandem was generally perceived as a feasible and acceptable tool in the treatment of patients with psychotic disorders. Our findings suggest that nonclinical aspects, such as support structures, are important to the feasibility and acceptability of such digital interventions and patients’ aptness for digitalized treatment in general. Future research should explore related nonclinical aspects further instead of defining potential target groups based on diagnoses and symptom severity alone.

PMID:40644621 | DOI:10.2196/68813

Rheumatology (Oxford). 2025 Jul 11:keaf382. doi: 10.1093/rheumatology/keaf382. Online ahead of print.

ABSTRACT

OBJECTIVES: The ASAS consensus defines “early axial spondyloarthritis (axSpA)” as symptom duration ≤2 years, a definition derived from expert opinion due to limited evidence. We performed a meta-analysis of randomized placebo-controlled trials (RCTs) of biologic and targeted synthetic DMARDs (bDMARDs/tsDMARDs) in axSpA to assess the impact of symptom duration on treatment response.

METHODS: RCTs in adult axSpA patients comparing b/tsDMARDs to placebo were identified through systematic literature reviews supporting the ASAS-EULAR management recommendations. Primary outcome was ASAS40 response, with secondary outcomes including disease activity, function and quality of life at each trial’s primary endpoint. Relative risks (RR) comparing two groups (shorter vs longer symptom duration) were calculated for efficacy outcomes for each arm and for several thresholds of symptom duration (1-5 years). RR ratios (RRR) were calculated as the ratio of RR of the b/tsDMARD and placebo arms. Pooled effects were obtained with random-effects meta-analysis.

RESULTS: Eleven bDMARD RCTs, comprising 3,272 axSpA patients, were included. No studies involving tsDMARDs met the eligibility criteria. At the 2-year threshold, pooled RR for ASAS40 response was 2.04 (95% CI, 1.48-2.84) in early axSpA and 2.28 (95% CI, 1.65-3.15) in established disease, yielding an RRR of 0.89 (95% CI, 0.63-1.26), with no statistical significance. There were no significant differences between efficacy in shorter and longer symptom duration for other outcomes or across other symptom duration thresholds (3-5 years).

CONCLUSIONS: Based on a meta-analysis of 11 trials, no significant differences were found in the efficacy of bDMARDs compared to placebo in patients with axSpA with shorter vs longer symptom duration, across thresholds from 2 to 5 years.

PMID:40644616 | DOI:10.1093/rheumatology/keaf382

Int J Periodontics Restorative Dent. 2025 Jul 11;0(0):1-22. doi: 10.11607/prd.7687. Online ahead of print.

ABSTRACT

Multiple adjacent gingival recessions are a challenge to the practitioner. Although the gold standard is still the bilaminar technique, where a coronally advanced flap (CAF) is associated with autogenous connective tissue graft (CTG), the morbidity of the procedure may lead clinicians to look for CTG substitutes. In this study, a prospective case series, 16 patients presenting multiple adjacent gingival recession were treated using CAF plus a volume stable collagen matrix (VXCM) soaked with a gel made of polynucleotides and hyaluronic acid (PNHA). Clinical measurements (probing depth, recession, attachment level, keratinised mucosa) were performed at baseline (T0), six months (T1) and twelve months (T2) post-operatively. Change in gingival thickness (dGT) was also measured using intraolar scans at T0 and T2, together with secondary variables, such as wound healing indices, patient-reported outcomes (pain, esthetics), and adverse events. Statistical analysis has been performed, setting significance with p<0.05. At one year evaluation, mean recession depth decreased of 2.42 ± 0.45, the percentage of root coverage was 96.02 + 0.09% (80.59% complete root coverage) , while gingival thickness dGT increased by 1.14 ± 0.34 mm, indicating that VXCM and PN-HA plus CAF are a suitable option for the treatment of multiple adjacent gingival recessions.

PMID:40644573 | DOI:10.11607/prd.7687

PLoS Negl Trop Dis. 2025 Jul 11;19(7):e0013319. doi: 10.1371/journal.pntd.0013319. Online ahead of print.

ABSTRACT

BACKGROUND: Worldwide, traditional medicine (TM) is an important and often underestimated part of health services. TM, of proven quality, safety, and efficacy, contributes to the goal of universal health coverage. However, no TM is approved worldwide for rabies treatment. Rabies is almost 100% fatal once symptomatic, leading to acute encephalitis. The challenges of rabies prevention and control in Ethiopia are multifaceted. Successful prevention and control of rabies requires the collaboration of important stakeholders with the One Health approach. But in Ethiopia, the one health model has missed a very important player in rabies control intervention, the traditional healers. This review aims to assess the proportion of individuals visiting traditional healers to provide evidence-based recommendation.

METHOD: We prepared a review protocol per Joanna Briggs Institute (JBI) manual for evidence synthesis and conducted a comprehensive search of PubMed, Cochrane, Google Scholar and African Index Medicus databases and grey literature from 17 December 2023-30 January 2024. The pooled proportion of traditional medicine use among rabies-exposed individuals was computed using R v 4.3.1 software. Subgroup analysis was done on sample size, geographical location and year of publication. Publication bias was assessed using a funnel plot.

RESULT: The pooled proportion of traditional medicine use following rabies exposure was 0.57 at 95% CI (0.45-0.69) for the random effects model with I2 = 98% and p < 0.01. To investigate the source of heterogeneity, sub-group analysis has been done on sample size, study area, and year of publication. All the above-listed variables were significant sources of statistical heterogeneity. Of which year of publication from 2019-2023 (I2 = 99%, p < 0.01), Studies from Oromia regional state (I2 = 99%, p < 0.01) and study sample size >500 (I2 = 99%, p < 0.01) were the highest source of heterogeneity.

CONCLUSION: More than half of rabies-exposed individuals visit traditional healers. This implies that significant healthcare demand related to rabies is addressed by traditional healers, even though the quality is not yet audited. The EMOH in collaboration with partners should work on the integration of traditional healers for rabies prevention and control interventions as One Health stakeholder.

PMID:40644528 | DOI:10.1371/journal.pntd.0013319

PLoS One. 2025 Jul 11;20(7):e0327395. doi: 10.1371/journal.pone.0327395. eCollection 2025.

ABSTRACT

The effectiveness of the q-rung ortho-pair fuzzy multi-attribute decision-making method is primarily influenced by the q-rung ortho-pair fuzzy number ranking method. This paper conducts an in-depth analysis of the shortcomings of eight existing q-rung ortho-pair fuzzy number ranking methods. A refined approach to ranking q-rung ortho-pair fuzzy numbers is proposed, wherein the method synthesizes the effects of the q-power transformation applied to both membership and non-membership degrees, alongside an exponential adjustment component. This formulation ensures greater discrimination power and robustness in uncertain environments. This method addresses the issues of poor robustness and the inability to achieve a complete ranking in existing approaches. Finally, the proposed ranking approach is incorporated into a q-rung orthopair fuzzy multi-attribute decision-making framework and is subsequently employed to address a practical case involving the selection of an optimal warehouse location for an e-commerce enterprise.

PMID:40644524 | DOI:10.1371/journal.pone.0327395

Rev Esc Enferm USP. 2025 Jul 11;59:e20240407. doi: 10.1590/1980-220X-REEUSP-2024-0407en. eCollection 2025.

ABSTRACT

OBJECTIVE: To analyze the attitudes of nursing professionals towards structural and process factors that may predispose to adverse events in neonatal and pediatric intensive care units.

METHOD: Cross-sectional study carried out in two public hospitals in Northeast Brazil in 2019. A sociodemographic/professional questionnaire and the Adverse Events Predisposition Scale were applied to 100 nursing professionals. The tests ANOVA, Tukey and of Student’s t were used to compare the means of the ideal and real scales, according to the sociodemographic variables, adopting p < 0.05.

RESULTS: Most professionals demonstrated low and medium perception of structure and process factors. A statistically significant association was found in the process dimension with: age group of 40-49 years, neonatal unit/hospital 2, and relation with a cooperative.

CONCLUSION: Nursing professionals in neonatal/pediatric intensive care units have low and medium perception of factors predisposing to adverse events, which deserves investment from leaders to avoid that inadequate perceptions result in harm to patients.

PMID:40644518 | DOI:10.1590/1980-220X-REEUSP-2024-0407en

PLoS Comput Biol. 2025 Jul 11;21(7):e1012882. doi: 10.1371/journal.pcbi.1012882. Online ahead of print.

ABSTRACT

Trends in infectious disease incidence provide important information about epidemic dynamics and prospects for control. Higher-frequency variation around incidence trends can shed light on the processes driving epidemics in complex populations, as transmission heterogeneity, shifting landscapes of susceptibility, and fluctuations in reporting can impact the volatility of observed case counts. However, measures of temporal volatility in incidence, and how volatility changes over time, are often overlooked in population-level analyses of incidence data, which typically focus on moving averages. Here we present a statistical framework to quantify temporal changes in incidence dispersion and to detect rapid shifts in the dispersion parameter, which may signal new epidemic phases. We apply the method to COVID-19 incidence data in 144 United States (US) counties from January 1st, 2020 to March 23rd, 2023. Theory predicts that dispersion should be inversely proportional to incidence, however our method reveals pronounced temporal trends in dispersion that are not explained by incidence alone, but which are replicated across counties. In particular, dispersion increased around the major surge in cases in 2022, and highly overdispersed patterns became more frequent later in the time series. These increases potentially indicate transmission heterogeneity, changes in the susceptibility landscape, or that there were changes in reporting. Shifts in dispersion can also indicate shifts in epidemic phase, so our method provides a way for public health officials to anticipate and manage changes in epidemic regime and the drivers of transmission.

PMID:40644513 | DOI:10.1371/journal.pcbi.1012882