Nevin Manimala

JMIR Form Res. 2025 Dec 10;9:e77319. doi: 10.2196/77319.

ABSTRACT

BACKGROUND: While digital health solutions are becoming increasingly sophisticated, simple forms of everyday digital support may offer underexplored opportunities to promote health among older adults. However, evidence remains scarce on whether such teleassistance-based approaches can effectively enhance health literacy and daily self-care, particularly among populations facing socioeconomic and educational disparities.

OBJECTIVE: This study examined whether a 14-week mobile teleassistance intervention could support daily health promotion and improve health literacy and quality of life among older adults, and whether different levels of user engagement were associated with differences in outcomes.

METHODS: This randomized digital pilot study involved 21 older adults (aged ≥60 years) from Ribeirão Preto, Brazil. All participants were assigned to the intervention arm and subsequently categorized into high-engagement (n=11) and low-engagement (n=10) subgroups according to platform-use metrics. The intervention combined weekly teleconsultations, gamified educational quizzes, and guided health-related activities delivered through a mobile app. Outcomes included health literacy (Health Literacy Questionnaire), quality of life (36-Item Short-Form Health Survey), physical activity, and sedentary behavior, assessed at baseline and postintervention. Analyses appropriate for small samples were applied, including frequentist and Bayesian models.

RESULTS: Participants in the high-engagement subgroup showed greater improvements in health literacy compared with those in the low-engagement subgroup (mean change +9.5 vs +9.1 points; time × group: P<.001; Bayes Factors [BF₁₀]=15). Significant interactions also favored higher engagement for selected quality-of-life domains: vitality (P≤.001), functional capacity (P=.02), and general health (P=.02). A group effect was observed for the mental component (P<.001). Physical activity (F2,38=0.95; P=.39; BF_incl=0.68) and sedentary behavior (F1,19=1.12; P=.32; BF_incl=0.53) did not differ significantly between subgroups. Engagement analytics confirmed higher overall platform use in the high-engagement subgroup (mean 6483.8, SD 807.0 vs mean 3345.3, SD 742.7; t19=6.238; P<.001; d=2.73) and more weekly health-activity minutes (mean 5124.3, SD 757.9 vs mean 3120.7, SD 704.3; t19=6.256; P<.001; d=2.73).

CONCLUSIONS: This 14-week randomized digital pilot trial suggests that everyday digital teleassistance may enhance health literacy and specific quality-of-life domains among older adults when engagement is high. However, such support alone appears insufficient to modify physical activity or sedentary behavior in the short term. Larger and longer trials are needed to assess sustainability, scalability, and strategies to address structural inequalities in digital health adoption.

PMID:41370788 | DOI:10.2196/77319

JMIR Ment Health. 2025 Dec 10;12:e79838. doi: 10.2196/79838.

ABSTRACT

BACKGROUND: Many youth rely on direct-to-consumer generative artificial intelligence (GenAI) chatbots for mental health support, yet the quality of the psychotherapeutic capabilities of these chatbots is understudied.

OBJECTIVE: This study aimed to comprehensively evaluate and compare the quality of widely used GenAI chatbots with psychotherapeutic capabilities using the Conversational Agent for Psychotherapy Evaluation II (CAPE-II) framework.

METHODS: In this cross-sectional study, trained raters used the CAPE-II framework to rate the quality of 5 chatbots from GenAI platforms widely used by youth. Trained raters role-played as youth using personas of youth with mental health challenges to prompt chatbots, facilitating conversations. Chatbot responses were generated from August to October 2024. The primary outcomes were rated scores in 9 sections. The proportion of high-quality ratings (binary rating of 1) across each section was compared between chatbots using Bonferroni-corrected chi-square tests.

RESULTS: While GenAI chatbots were found to be accessible (104/120 high-quality ratings, 86.7%) and avoid harmful statements and misinformation (71/80, 89%), they performed poorly in their therapeutic approach (14/45, 31%) and their ability to monitor and assess risk (31/80, 39%). Privacy policies were difficult to understand, and information on chatbot model training and knowledge was unavailable, resulting in low scores. Bonferroni-corrected chi-square tests showed statistically significant differences in chatbot quality in the background, therapeutic approach, and monitoring and risk evaluation sections. Qualitatively, raters perceived most chatbots as having strong conversational abilities but found them plagued by various issues, including fabricated content and poor handling of crisis situations.

CONCLUSIONS: Direct-to-consumer GenAI chatbots are unsafe for the millions of youth who use them. While they demonstrate strengths in accessibility and conversational capabilities, they pose unacceptable risks through improper crisis handling and a lack of transparency regarding privacy and model training. Immediate reforms, including the use of standardized audits of quality, such as the CAPE-II framework, are needed. These findings provide actionable targets for platforms, regulators, and policymakers to protect youth seeking mental health support.

PMID:41370787 | DOI:10.2196/79838

JCO Clin Cancer Inform. 2025 Dec;9:e2500178. doi: 10.1200/CCI-25-00178. Epub 2025 Dec 10.

ABSTRACT

PURPOSE: Electronic patient portals can promote patient-centered care, but determinants of engagement remain underexplored in oncology. This study examines sociodemographic and clinical factors associated with engagement with four portal features, including invitations to complete patient-reported outcome (PRO) measures before appointments.

METHODS: Secondary analysis of the Northwestern University IMproving the Management of symPtoms during and following Cancer Treatment study, a stepped-wedge cluster randomized trial to promote symptom management using PROs in adult oncology care was performed. For each enrolled participant, we examined portal usage across 1 year.

RESULTS: A total of 3,457 patients were enrolled between April 2020 and April 2023 from 30 Northwestern Medicine ambulatory oncology clinics. Patients were 65% female, 85% White, and 85% non-Hispanic/Latino, with a mean age of 60.8 years. Cancer diagnoses were 30% breast, 12% lymphoma, and all other types accounted for <10% of the sample. Patients accessed laboratory results most frequently (median 23 days in the year), followed by messaging (median 11 days) and physician notes (median 2 days). A total of 62.6% of patients completed at least one invited PRO. Controlling for sociodemographic factors, patient characteristics that were associated with greater engagement across three or more features included more oncology appointments, high health literacy, high anxiety, one or more severe physical symptoms, and high shared decision making with their health care team. Black race, Hispanic/Latino ethnicity, and Medicaid insurance were associated with lower portal engagement. Patients who used any other portal features were more likely to complete PROs. In contrast to other portal features, patients with at least one severe physical symptom were less likely to complete PROs (incidence rate ratio, 0.87 [95% CI, 0.81 to 0.93]; P < .001).

CONCLUSION: Portal use among patients with cancer varies by sociodemographic and clinical characteristics. Findings suggest a need for targeted interventions to promote equitable use among under-represented groups and promote portal-based PRO completion for patients with higher symptom burden.

PMID:41370780 | DOI:10.1200/CCI-25-00178

Clin Neuropsychol. 2025 Dec 10:1-26. doi: 10.1080/13854046.2025.2592660. Online ahead of print.

ABSTRACT

Objective: Ecological momentary assessment (EMA) is a popular method for analyzing intra-individual variability (IIV) of psychological constructs, including cognition. Multilevel modeling (MLM) is a widely used method for analyzing EMA data in intensive longitudinal designs. This systematic review examines how psychologists use and report MLM in EMA studies. It evaluates (1) adherence to the Checklist for Reporting EMA Studies (CREMAS) guidelines, (2) common factors reported in addition to the CREMAS guidelines, and (3) consistency in reporting MLM to analyze EMA data, aiming to improve research design and reporting consistency in the field. Method: Phase 1 searched research databases to explore the commonly used statistical analyses for EMA data. Subsequently, a systematic review was conducted of psychological research articles published between January 2021 and February 2023 which used MLM as the primary method to analyze EMA data. Phase 2 comprised an updated systematic review of articles published from November 2024 to April 2025 to examine whether reporting patterns improved across time. Results: Phase 1 confirmed MLM is the most often statistical procedure used to analyze EMA. 43 articles were reviewed and found (1) generally strong adherence to the CREMAS guidelines, (2) additional components commonly reported, and (3) varied reporting of MLM data preparation and analysis. Phase 2 reviewed 14 articles and found similar results as Phase 1. Conclusions: To further increase transparency and standardize reporting, we recommend several additions to the CREMAS guidelines and a set of Reporting MLM in EMA studies (REMMES) guidelines for future research.

PMID:41370712 | DOI:10.1080/13854046.2025.2592660

Georgian Med News. 2025 Oct;(367):176-180.

ABSTRACT

BACKGROUND: Tracheoesophageal fistula with esophageal atresia (TEF/EA) is a rare congenital disease which has high morbidity and complications. However, there are various factors which can increase the risk of mortality among TEF/EA patients.

AIM: The study’s objective was to assess the features and results of treatment for patients with tracheoesophageal fistula (TEF) and esophageal atresia. Another goal of the study was to evaluate and determine how related anomalies and syndromes affected the course of treatment.

SETTING & DESIGN: a retrospectively designed study was conducted at the Maternity and Children’s Hospital in Qassim, Saudi Arabia.

METHOD & MATERIALS: Patients underwent surgical treatment for TEF/EA were included in the study. Electronic records were used to extract the data. Hence, all the data for all required variables were extracted on excel sheet.

STATISTICAL ANALYSIS USED: a statistical package of social sciences (SPSS) was used. Median, Interquartile range (IQR) and frequency distributions were tabulated as a part of descriptive analysis of the data. For the inferential analysis, chi-square test and odds ratios were computed. All P-values less than .05 were considered statistically significant.

RESULTS: Findings of the study revealed that the presence of associated anomalies (p=.003) and associated syndromes (p=.016) was significantly correlated with non-survival. In addition, associated anomalies were present in all non-survivors (P=.003), and associated syndrome was detected in 3 out of 4 non-survivors (P=.016).

CONCLUSION: The mortality rate was found to be strongly correlated with certain demographic variables, such as birth weight and gender. Furthermore, compared to their counterparts, patients with multiple anomalies and related syndromes had a higher death rate.

PMID:41370701

Georgian Med News. 2025 Oct;(367):169-175.

ABSTRACT

RESEARCH OBJECTIVE: This research aims to examine the association between labor participation and mental health of older adults, particularly depressive symptoms, and to investigate the extent to which this relationship varies across gender and socioeconomic backgrounds. Based on data from the China Longitudinal Aging Social Survey (CLASS), the research examined the mechanisms through which labor participation influenced the mental health of older adults and provided theoretical support and practical guidance for policymakers.

MATERIALS AND METHODS: This research utilized data from the 2023 China Longitudinal Aging Social Survey (CLASS), involving 10,366 older adults aged 60 and above. Employing a cross-sectional design, the research assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Labor participation was measured through the questionnaire item, “whether engaged in paid work.” Descriptive statistics, univariable analysis, and multiple linear regression analysis explored the relationship between labor participation and mental health of older adults. Gender-stratified analyses were conducted to examine potential heterogeneity, and further heterogeneity analysis based on job types was performed to examine employment quality.

RESULTS: Labor participation showed a significant association with depressive symptoms among older adults, with those engaged in labor exhibiting lower levels of depressive symptoms than their non-working counterparts. Gender analysis revealed that labor participation exerted a significantly greater association with depressive symptom among women than men. Heterogeneity analysis further revealed that a significant negative association with depressive symptoms was strongest only for work characterized by high autonomy and low physical demands. Additionally, factors such as educational attainment, health status, and marital status significantly influenced depressive symptoms. Labor participation interacted with these factors, jointly influencing the mental health of older adults.

CONCLUSION: A significant association was found between labor participation and reduced depressive symptoms, particularly among women. Furthermore, this relationship varied by job type, showing the strongest association in high-autonomy, low-physical-demand positions. Policy interventions should not only encourage labor participation-particularly among women-but also prioritize job quality by creating positions with greater autonomy and manageable physical demands. Enhancing these job characteristics can strengthen social participation and self-efficacy, thereby maximizing the mental health benefits of working in later life.

PMID:41370700

Georgian Med News. 2025 Oct;(367):160-165.

ABSTRACT

BACKGROUND: Neck pain is a common musculoskeletal condition which is becoming more common in undergraduate students due to the modification in modern lifestyle, learning methods, and the use of electronic devices.

AIM: To assess the prevalence of neck pain and its associated factors among Baghdad undergraduate students.

MATERIALS AND METHODS: A descriptive cross-sectional study was performed by means of a self-administered online questionnaire distributed among the undergraduate students in December 2023. GraphPad Prism was used to analyse data from 520 students.

RESULTS: The study involved 520 college students (198 males and 322 females). The overall prevalence of neck pain was 74.23% (95% CI: 70.30-77.80%), and it was higher in females (81.37%) than in males (62.63%). Statistically significant associations were found between neck pain and gender (p<0.0001), duration of electronic device use (p<0.0001), family history of neck pain (p<0.0001), age (p=0.0036), and study position (p=0.0127).

CONCLUSION: Neck pain prevalence was 74.23% among undergraduate students in Baghdad, with female gender, age, prolonged electronic device use, poor study posture, and family history found as significant associated factors. Despite the methodological limitations, the findings highlight the necessity for preventive strategies that focus on ergonomic education and performing future multi-institutional studies with multivariate analysis.

PMID:41370698

Georgian Med News. 2025 Oct;(367):131-136.

ABSTRACT

BACKGROUND AND OBJECTIVES: Paraproctitis is a common proctological condition that can present in acute or chronic forms, each requiring distinct diagnostic and therapeutic approaches. However, there is limited comparative data on the clinical and organizational characteristics of these forms. The purpose of this study is to conduct a retrospective analysis of medical care for patients with paraproctitis in the Abay region.

MATERIALS AND METHODS: A retrospective cross-sectional study was conducted using data from 453 patients treated for paraproctitis at the University Hospital of NAO “MUS” from 2019 to 2024. Patients aged 18 years and older were included, with diagnosis confirmed by clinical, laboratory, and instrumental methods. Exclusion criteria were age under 18, presence of other diseases. Statistical analysis was performed using SPSS 24.0, with p<0.05 considered significant.

RESULTS: A total of 453 patients were included in the study, of whom 68% had acute paraproctitis and 32% had chronic forms. Males predominated in both groups (83.8%), and most patients were aged 18-44 years. Urban residents accounted for the majority of hospitalizations (77.9%). All patients underwent surgical treatment; abscess drainage prevailed in acute cases (91.2%), while reconstructive procedures were more frequent in chronic cases. Conservative therapies such as physiotherapy, strengthening treatment, and diet No. 3 were significantly more common in chronic cases (p<0.0001). Complications occurred more frequently in acute cases, especially wound infections (74.9%) and bleeding (42.3%), while fecal incontinence and rectovaginal fistulas were more common in chronic disease. The mean hospital stay did not differ significantly between groups; however, mortality was observed only in the acute group (1.6%, p<0.0001). Full recovery was more frequent in chronic cases (53.1%), whereas clinical improvement prevailed in acute cases (83.8%).

CONCLUSION: Acute and chronic paraproctitis differ significantly in clinical presentation, treatment approaches, complication rates, and outcomes. These findings emphasize the importance of tailored treatment strategies and early intervention to reduce complications and mortality.

PMID:41370694

Georgian Med News. 2025 Oct;(367):121-125.

ABSTRACT

Despite the widespread use of dental implants and the increasing number of procedures, complications remain prevalent and, according to some authors, are rising. The aim of the study was to investigate the effect of hyaluronic acid on improving the quality of life of patients with peri-implant mucositis. The patients were divided into three groups: Control group (20 patients): mechanical tartar removal using Master Piezon EMS. Conditional control group (20 patients) – plaque removal using the device (Master Piezon EMS) and the patient’s application of an antiseptic agent containing a 0.05% solution of chlorhexidine bigluconate; Main group (20 patients) – Plaque removal using the device (Master Piezon EMS) and the patient using a preparation containing hyaluronic acid (Hy+Al Gel). Comparative methods of clinical examination (indexes PI, PD) studied the indicators of the state of the oral cavity in all three groups of patients before treatment and after treatment (after 1, 3 months). After the application of Hy+Al Gel in the main group, the improvements in indices were more pronounced and statistically significant compared to the other groups (p<0.0001). In addition, after the course of therapy conducted in the control group and in the comparison group, the clinical picture and indicators of the PI and PD indices after 3 months also changed in the positive direction, only less pronounced than in the main group.

PMID:41370692

Georgian Med News. 2025 Oct;(367):73-80.

ABSTRACT

INTRODUCTION: Despite the inclusion of dental examination in the screening package of the guaranteed volume of free medical care (GVFMC), the coverage of pregnant women with dental care in Kazakhstan remains extremely low. Untimely treatment, lack of awareness and financial barriers contribute to the deterioration of the oral cavity and the increased risk of pregnancy complications.

MATERIALS AND METHODS: As part of the doctoral thesis, a survey of 455 pregnant women was conducted from September to December 2024 on the basis of voluntary informed consent. The author’s questionnaire was used with questions about seeking dental care. The analysis included descriptive characteristics, medians and interquartile range, and comparison of index of caries according to the Kruskal-Wallis test. Additionally, a retrospective analysis of CSHI tariffs for 2020-2024 for key types of dental services was conducted, taking into account their importance for pregnant women and comparing them with clinical results.

RESULTS: Only 17.6% of women went to the dentist during pregnancy, only 4.8% of them – for preventive purposes. The median index of caries was 6.0 (IQR: 5.0-7.0) for those who did not apply, and 2.0 (IQR: 2.0-3.0) – for those referred by an obstetrician-gynecologist, p<0.001. Despite the fact that 81.3% were registered before the 10th week, few people received preventive care, which indicates routing problems. Only 14% patients were fully informed, and 65% patients paid extra for treatment. Complaints were related to inattentive attitude (28%), insufficient qualifications (22%) and inconvenient schedule. The analysis of CSHI tariffs showed a slowdown in growth in 2024 after a jump in 2021-2023, which worsens the gap between real costs and service coverage.

CONCLUSION: The study revealed low coverage, insufficient information and economic barriers. Interdisciplinary collaboration needs to be strengthened, routing needs to be improved, and tariff policies need to be reviewed.

PMID:41370686