Category: Statistics

BMC Palliat Care. 2025 Jun 16;24(1):165. doi: 10.1186/s12904-025-01767-6.

ABSTRACT

BACKGROUND: Intensive care unit (ICU) nurses exhibit gaps in their knowledge, attitudes, and behaviors regarding palliative care. In China, there is a lack of standardized training programs for palliative care among ICU nurses, and corresponding research on the needs and impact of such training is also limited.

OBJECTIVE: Through the investigation and analysis of ICU nurses’ knowledge, attitudes, behaviors, and training needs regarding palliative care, this study explored the specific knowledge gaps and training needs of ICU nurses in palliative care.

METHODS: A convenience sampling method was employed to survey ICU nurses at 23 tertiary (tier-A) hospitals in Anhui Province, adhering to the specified criteria, between December 2023 and April 2024. The study utilized a general demographic survey and a comprehensive questionnaire to assess ICU nurses’ knowledge, attitudes, behaviors, and training requirements in palliative care.

RESULTS: Among the 693 ICU nurses surveyed, the scores for knowledge (73.67), attitude (77.1), behavior (75.84), and training needs (78.16) regarding palliative care were all below the middle level. Multivariate linear regression analysis indicated that gender, professional rank, prior attendance at death education or palliative care training, engagement with literature on death, experience caring for patients in advanced stages, and the number of terminally ill patients cared for in the past year significantly influence nurses’ knowledge, attitudes, behaviors, and training needs in palliative care (P < 0.05).

CONCLUSION: Training and education in palliative care should be enhanced for male and lower-level ICU nurses to address the specific knowledge gaps in this area. Chinese nursing managers should implement targeted and practical palliative care training programs to meet the specific training needs of ICU nurses.

PMID:40524152 | DOI:10.1186/s12904-025-01767-6

Popul Health Metr. 2025 Jun 16;23(1):27. doi: 10.1186/s12963-025-00384-y.

ABSTRACT

Many studies have recognized that a woman’s reproductive history influences the survival status of her fetus and the newborn. In the esteemed literature of demography, abundant evidence acknowledges the linkage between maternal exposure to offspring and their associated adult outcomes and the other way around. This study examines the link between maternal risk factors at birth and long-term outcomes for daughters in India. Using national health survey data, it focuses on three maternal risks: young age, high parity, and short birth intervals. Applying regression analysis to cohort data, the study finds these early-life disadvantages are associated with daughters experiencing stunted growth, undernutrition, child mortality, and low birth weight, as well as limited education and employment. Conversely, daughters of educated mothers have better outcomes, highlighting the importance of maternal education. The pseudo-cohort approach provides valuable longitudinal insights from cross-sectional surveys. The study underscores the need for policies promoting healthy reproductive practices and education access to improve long-term outcomes for women in India.

PMID:40524148 | DOI:10.1186/s12963-025-00384-y

JMIR Mhealth Uhealth. 2025 Jun 16;13:e71022. doi: 10.2196/71022.

ABSTRACT

BACKGROUND: New technologies from the field of mobile health (mHealth) are increasingly used to improve patient monitoring during rehabilitation. While in recent years, mobile phones, health apps, personal digital assistants, and smartwatches opened up new diagnostic and monitoring opportunities for patients, the development of innovative sensor devices, such as instrumented insoles, has now reached a sufficient level of usability with promising opportunities for clinical practice. According to research on the best method for monitoring recovery after musculoskeletal injury or surgery, the Patient-Reported Outcome Measurement Information System (PROMIS) and wearables such as instrumented insoles are among the most promising newer options. However, it is unknown how a patient’s health perception and improvements in instrumented insole-derived gait parameters correlate after surgery for tibial or malleolar fractures.

OBJECTIVE: This study aimed to compare the longitudinal trajectories in separate PROMIS (sub)scores with gait and further patient-specific parameters, as well as associations between PROMIS scores and gait parameters. It was also aimed to determine the influence of anthropometric parameters and comorbidities.

METHODS: A total of 85 patients (39 women and 46 men; average age 50.8, SD 17.1 years) requiring surgery after tibial or malleolar fractures were included in this prospective longitudinal observational study. In the hospital and during follow-up visits, the patients completed the PROMIS Global Health and Pain Interference questionnaires. During the same visits, individually fitted instrumented insoles with 16 pressure sensors, an accelerometer, and a gyroscope each were used to assess the maximal force, pressure distribution, and angular velocity during walking with data being recorded at 100 Hz. Statistical analyses were conducted using linear mixed effect models, pairwise Spearman correlation coefficients, and generalized additive models.

RESULTS: The gait parameters assessed via the instrumented insoles quickly improved during the first 3 months after surgery, followed by a slowing of further improvement. After surgery, the PROMIS scores increased or decreased to extrema that were reached after 6 weeks to 3 months, followed by a return to preinjury values. Between 3 and 6 months, no significant improvements in PROMIS scores were observed. Between 6 months and 1 year, the Physical Health and Mental Health scores still improved significantly (P=.003 in both cases). Men had better Physical Health and lower Pain Interference scores than women (P=.01 and P=.03, respectively). Hypertension had a negative effect on the Physical Health score (P=.03). The associations between the PROMIS score and gait parameters were strongest at approximately 3 months after surgery, predominantly between the Pain Interference score and gait parameters.

CONCLUSIONS: The patients’ perception improved later than the objective gait parameters obtained by instrumented insoles did. When the gait pattern improved, pain perception correlated with the gait parameters.

TRIAL REGISTRATION: German Clinical Trials Registry DRKS00025108; https://drks.de/search/en/trial/DRKS00025108.

PMID:40523278 | DOI:10.2196/71022

JMIR Res Protoc. 2025 Jun 16;14:e70076. doi: 10.2196/70076.

ABSTRACT

BACKGROUND: Maternal mental health disorders are associated with adverse maternal and infant health outcomes. Despite advances in screening and treatment, disparities in maternal mental health disorders continue to disproportionately affect Black mothers and birthing persons. While there are studies that have examined maternal mental health, a gap in research remains in understanding the protective and risk factors of Black maternal mental health in Canada. Identifying the risks and protective factors is critical for advancing equitable and inclusive policies and practices that promote maternal well-being and optimal outcomes for Black perinatal populations.

OBJECTIVE: This paper presents an outline of a study protocol that seeks to identify the protective and risk factors of Black maternal mental health and to engage Black mothers and birthing persons from the Greater Toronto Area in codesigning a culturally safe and inclusive best practices model to inform policy and interventions.

METHODS: The proposed study will use an exploratory 3-phase sequential mixed methods approach underpinned by the principles of health equity and community-based participatory research. Phase 1 will involve engaging Black mothers and birth persons (n=300) in a survey to examine the psychosocial determinants of Black maternal mental health, including depression, anxiety, discrimination, strong Black women trope, attitude toward seeking mental health, support, and stigma. In phase 2, we will conduct 6 focus groups and individual interviews (n=60) to explore the stressors in the context of Black mothers and birth persons’ everyday lives, psychosocial and support needs, and conditions that promote their resilience. Finally, phase 3 will engage Black women and birthing persons (n=30) in a codesign session using the concept mapping method to identify priority areas for action to inform policy and programming. We will use SPSS version 26 (IBM Corp) to analyze the survey data, drawing on both descriptive and inferential statistics. NVivo (Lumivero), a qualitative data analysis software, will be used to organize the data from phase 2 into meaningful themes informed by Braun and Clarke’s thematic analysis approach.

RESULTS: Ethics approval was granted in July 2024. Data collection for phase 1 started in December 2024 and will be completed in April 2025. Findings from phase 1 will inform phases 2 and 3 of this study, which will be conducted in the third quarter of 2025. We will disseminate the results of this study in the second and third quarters of 2025.

CONCLUSIONS: The findings will generate the much-needed knowledge to shift policy, practice, and research and support capacity building among Black mothers and birthing persons. In addition, the proposed study will contribute to informing policy initiatives and interventions at the health system and community level to advance mental health equity and build capacity among service providers to provide culturally safe and equitable mental health care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/70076.

PMID:40523275 | DOI:10.2196/70076

JMIR Infodemiology. 2025 Jun 16;5:e69945. doi: 10.2196/69945.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been accompanied by an unprecedented infodemic characterized by the widespread dissemination of misinformation. Globally, misinformation about COVID-19 has led to polarized beliefs and behaviors, including vaccine hesitancy, rejection of governmental authorities’ recommendations, and distrust in health institutions. Thus, understanding the prevalence and drivers of misinformation is critical for designing effective and contextualized public health strategies.

OBJECTIVE: On the basis of a tailored survey on health misinformation, this study aims to assess the prevalence and distribution of COVID-19-related misinformation in Spain; identify population groups based on their beliefs; and explore the social, economic, ideological, and media use factors associated with susceptibility to misinformation.

METHODS: A cross-sectional telephone survey was conducted with a nationally representative sample of 2200 individuals in Spain. The study developed the COVID-19 Misinformation Scale to measure beliefs in misinformation. Exploratory factor analysis identified key misinformation topics, and k-means clustering classified participants into 3 groups: convinced, hesitant, and skeptical. Multinomial logistic regression was used to explore associations between misinformation beliefs and demographic, social, and health-related variables.

RESULTS: Three population groups were identified: convinced (1078/2200, 49%), hesitant (666/2200, 30.27%), and skeptical (456/2200, 20.73%). Conspiracy theories, doubts about vaccines, and stories about sudden death emerged as the most endorsed current misinformation topics. Higher susceptibility to misinformation was associated with the female sex, lower socioeconomic status, use of low-quality information sources, higher levels of media sharing, greater religiosity, distrust of institutions, and extreme and unstated political ideologies. Frequent sharing of health information on social networks was also associated with membership in the skeptical group, regardless of whether the information was verified. Interestingly, women were prone to COVID-19 skepticism, a finding that warranted further research to understand the gender-specific factors driving vulnerability to health misinformation. In addition, a geographic distribution of hesitant and skeptical groups was observed that coincides with the so-called empty Spain, areas where political disaffection with the main political parties is greater.

CONCLUSIONS: This study highlights the important role of determinants of susceptibility to COVID-19 misinformation that go beyond purely socioeconomic and ideological factors. Although these factors are relevant in explaining the social reproduction of this phenomenon, some determinants are linked to the use of social media (ie, searching and sharing of alternative health information) and probably the political disaffection of citizens who have stopped believing in both the ideologically centrist mainstream parties and the institutions that represent them. Furthermore, by establishing the profile and geographic distribution of the convinced, hesitant, and skeptical groups, our results provide useful insights for public health interventions. Specific strategies should focus on restoring institutional trust, promoting reliable sources of information, and addressing structural drivers of health misinformation linked to gender inequalities.

PMID:40523274 | DOI:10.2196/69945

J Med Internet Res. 2025 Jun 16;27:e65304. doi: 10.2196/65304.

ABSTRACT

BACKGROUND: The COVID-19 pandemic accelerated global telehealth adoption, prompting the South Korean government to temporarily legalize telemedicine in 2020 and subsequently launch a pilot program in 2023. As South Korea transitions to a postpandemic digital health environment, understanding the factors associated with willingness to use (WTU) and willingness to pay (WTP) for telemedicine and teleconsultation is essential for informing effective policy and service design. However, few studies have explored how preferences vary across clinical domains or user groups.

OBJECTIVE: This study examined the factors that influence WTU and WTP for telemedicine and teleconsultation across 5 clinical domains: dermatological, psychiatric, musculoskeletal, internal medicine, and cancer disorders.

METHODS: A cross-sectional survey was conducted among 552 participants aged 19-69 years in South Korea, selected through stratified sampling. Multiple logistic regression analysis was used to examine WTU and WTP, considering sociodemographic factors and previous telemedicine experience.

RESULTS: Participants’ age, residence, and previous telemedicine experience significantly influenced their WTU and WTP for telemedicine services. WTP increased with age for both telemedicine (P-for-trend=.02) and teleconsultation (P-for-trend=.001). Noncapital residents showed significantly higher WTU for teleconsultation than capital area residents (odds ratio [OR] 1.48, 90% CI 1.03-2.12; P=.07). Participants with previous telemedicine experience showed higher WTU for telemedicine (OR 4.07, 90% CI 1.84-9.04; P=.004) and teleconsultation (OR 2.21, 90% CI 1.21-4.06; P=.03), and higher WTP for telemedicine (OR 2.89, 90% CI 1.84-4.54; P<.001) and teleconsultation (OR 2.76, 90% CI 1.77-4.30; P<.001). WTU and WTP varied by clinical domain: psychiatric care showed the highest WTU (64.5%) and WTP (27.0%) for telemedicine, while cancer disorders showed higher WTU (48.6%) and WTP (24.8%) for teleconsultation than for telemedicine.

CONCLUSIONS: WTU and WTP for telemedicine and teleconsultation differ substantially depending on service type, clinical domain, and user characteristics. These findings highlight the importance of considering prior telemedicine experience, regional access disparities, and condition-specific care needs when designing digital health strategies. Accordingly, flexible, user-centered telehealth policies are needed to support service accessibility and equitable implementation in the post-COVID-19 era. The insights from this study can serve as a practical foundation for developing inclusive digital health systems in countries undergoing similar transitions.

PMID:40523273 | DOI:10.2196/65304

JMIR Mhealth Uhealth. 2025 Jun 16;13:e51707. doi: 10.2196/51707.

ABSTRACT

BACKGROUND: College students are vulnerable to setting long-term trajectories of low physical activity (PA) but are reachable via mobile health fitness tracking (eg, mobile health step counting) and interpersonal support tailored to the college community. However, no studies have statistically isolated the appeal and influence of these intra- and interpersonal components in college-based PA interventions.

OBJECTIVE: This study retrospectively examined a college-based PA promotion program at a northeast US public university during the COVID-19 pandemic to (1) test the impact of student status on the use of intervention components and (2) determine whether such use was associated with successful retention and goal achievement in the program.

METHODS: The university used a commercial platform for a 30-day PA promotion program during April 2021 with intrapersonal (step-tracker syncing, education, self-monitoring, and motivational messaging) and interpersonal (friend interactions and team games) components. App use was operationalized as intrapersonal (frequency of opening app, education, and self-monitoring) and interpersonal (friends made in-app and team affiliation and size).

RESULTS: Campus-wide emails elicited sign-up by 156 undergraduate students, 57 graduate students, and 126 faculty and staff members. Objective 1 yielded the following results: undergraduates used the app less frequently (median 0.8, IQR 0.4-1.7 times per day) than other groups (graduate students: median 1.4, IQR 0.7-2.7 times per day; P=.01; faculty: median 1.3, IQR 0.7-2.7 times per day, H₂=14.5; P=.001) but made the same number of friends (median 1-2) and teammates (median 8-9; P=.77 for friends and P=.93 for teammates). Objective 2 yielded the following results: most participants (313/335, 93.4%; 95% CI 90%-96%) were retained for the first 7 days, but by 30 days, retention dropped, most notably for undergraduate students (82/154, 53.2%; 95% CI 45%-61%), followed by graduate students (39/56, 70%; 95% CI 56%-81%) and faculty and staff (93/125, 74.4%; 95% CI 66%-82%; χ²₂=12.6; P<.001). Retention was associated with app engagement frequency (model hazard ratio 0.56, 95% CI 0.43-0.72; P<.001) and affiliation with a team having high median app engagement and a large size (intracluster correlation coefficient 0.064, 95% CI 0.001-0.164, P=.05). Meeting a daily step goal was associated with app engagement frequency (β=.72, SE=0.21; P=.001), number of friends (β=.40, SE 0.20; P=.04), and an initial motive of maintaining or increasing (rather than starting) PA (β=.99, SE=0.21; P<.001).

CONCLUSIONS: College students, compared with faculty and staff, used the app less frequently, used the app for a shorter duration before abandonment, and met the step goal on fewer days. Engagement with the program was associated with longer retention and better PA outcomes, which were critically modified by the interpersonal engagement. These findings suggest that college students using virtual PA support during times of physical isolation could benefit from more tailored implementation strategies (eg, timed prompts and team reassignments).

PMID:40523272 | DOI:10.2196/51707

J Biomater Sci Polym Ed. 2025 Jun 16:1-18. doi: 10.1080/09205063.2025.2504022. Online ahead of print.

ABSTRACT

Polyglycolic acid (PGA) suture is a synthetic, absorbable, and biocompatible material. However, it lacks bioactivity and cannot bond with osseous tissue. Bioactive glasses have the ability to form surface apatite and bond with bone, but they are brittle and therefore difficult to shape in the operating room. PGA sutures were coated with chloride-silicate glass (CSG) using the slurry dipping technique. The CSG-coated sutures were characterized before and after immersion in simulated body fluid (SBF) by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). The adhesion of the glass coating to the PGA suture was assessed by the knot performance test. The bioactivity of the coated sutures was investigated in SBF) after 7, 14, 21, and 28 days of immersion. The pH variation of the SBF was measured using a pH meter. Tensile strength of the bare and coated sutures was quantified using a universal testing machine before and after immersion in SBF, and the cytotoxicity was assessed using osteoblast-like cells after 24, 48, 72, and 168h. The results revealed that the coating covered and adhered to the surgical suture. The coated suture had the ability to form a small size or low amount of apatite after 7 days of immersion. The CSG coating exhibited a tendency to increase the tensile strength of the suture, but this increase was not statistically significant. The glass coating was not cytotoxic to osteoblast-like cells. It is suggested that PGA sutures coated with CSG could be used as a potential material to promote bone regeneration.

PMID:40523270 | DOI:10.1080/09205063.2025.2504022

JMIR Serious Games. 2025 Jun 16;13:e63424. doi: 10.2196/63424.

ABSTRACT

BACKGROUND: Nature engagement, including affective and physical interactions with nature, is linked to a multitude of health and well-being benefits. Unfortunately, opportunities for engaging with nature are decreasing worldwide. University students, especially, are a demographic group that tends to engage little with nature. Immersive virtual nature (IVN; ie, digital nature content delivered through immersive devices, such as head-mounted displays) has been proposed as a medium to facilitate nature experiences and engagement. In recent years, 360° nature videos have emerged as an accessible way to create IVN content, although it is still unclear whether they can elicit presence and increase nature engagement to a greater extent than nature videos delivered through nonimmersive media.

OBJECTIVE: We aimed to investigate the effectiveness of nature videos as a medium to promote nature engagement among university students, comparing devices with different levels of immersion. Specifically, 2 experimental conditions were tested: a 360° nature video delivered through a head-mounted display (IVN) and a matching video displayed on a tablet screen (nonimmersive virtual nature).

METHODS: In total, 38 students were recruited at the library of a university campus and invited to participate in an organized hiking tour at the location displayed during the virtual nature experience. They were then randomized, using a random number generator, to either the IVN (n=20, 53%) or the nonimmersive virtual nature condition (n=18, 47%). Pre- and postexposure assessments of nature connectedness, intention to perform green exercise, intention to visit the hiking location, and intention to participate in the organized hiking tour were collected. Presence, cybersickness, and actual attendance on the tour were also assessed.

RESULTS: A mixed ANOVA showed statistically significant pre- to postexposure assessment increases in nature connectedness (F_1,36=33.49; P<.001; η_p²=0.48); intention to perform green exercise (F_1,36=5.55; P=.02); intention to visit the hiking location (F_1,36=15.34; P<.001; η_p²=0.26); and intention to participate in the hiking tour (F_1,36=12.45; P=.001; η_p²=0.30). Both conditions were associated with medium to high ratings of “being there” and “sense of reality” but low ratings of “realism.” The cybersickness levels were generally low. Of the 38 students, 6 (16%) participated in the organized tour. The mixed ANOVA found no statistical differences between the two conditions for any of the outcomes. The participants’ changes in nature connectedness (ρ=0.35; P=.03) and attendance on the hiking tour (ρ=.37; P=.02) correlated with the presence item “being there.”

CONCLUSIONS: This study provides novel evidence on the potential of virtual nature as a medium to improve nature engagement among university students, adding to the current debate on the effectiveness of 360° videos. These findings can inform future research as well as initiatives seeking to promote nature engagement.

PMID:40523269 | DOI:10.2196/63424

Ann Am Thorac Soc. 2025 Jun 16. doi: 10.1513/AnnalsATS.202501-129OC. Online ahead of print.

ABSTRACT

RATIONALE: The effects of long-term ambient air pollution exposure on survival in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) remain unclear.

OBJECTIVES: Evaluate the association between exposure to PM2.5, NO2, and O3, and mortality or lung transplantation in the Pulmonary Hypertension Association Registry (PHAR).

METHODS: 2,196 adult patients enrolled in the PHAR provided data between 2015 and 2024. Annual average concentrations of air pollutants, including PM2.5, NO2, and O3, estimated from validated spatiotemporal models in 2015 were linked to each participant’s residential address. Cox proportional hazards models evaluated the associations between air pollutant exposures and risk of death or lung transplantation, adjusting for baseline demographics, individual and neighborhood socioeconomic factors (SES), disease severity, and spatial confounders. Additional analyses were adjusted for and stratified by nine U.S. census divisions.

RESULTS: Study participants were broadly distributed across U.S. regions, with 72.0% female and a mean age of 55.7. 35.6% had idiopathic PAH, 26.5% had connective tissue disease-associated PAH, and 14.5% had CTEPH. In models adjusted for demographics, individual and neighborhood SES, each IQR increase of PM2.5 was associated with a mortality or lung transplant hazard ratio (HR) of 1.16 (95% confidence interval [CI]: 1.01-1.33). This association was marginally attenuated and not statistically significant after adjusting for spatial covariates, with an HR of 1.12 (95% CI: 0.95-1.31) per IQR increase in PM2.5. We noted regional variation in the observed associations. No significant associations were found with NO2 or O3.

CONCLUSIONS: Long-term ambient air pollution exposure was not significantly associated with survival in PHAR patients with PAH or CTEPH. Future research should investigate potential modifying effects of regional social determinants and healthcare-related factors on the relationship between air pollution exposure and mortality in these conditions.

PMID:40523262 | DOI:10.1513/AnnalsATS.202501-129OC