Nevin Manimala

JMIR Aging. 2025 Nov 25;8:e80700. doi: 10.2196/80700.

ABSTRACT

BACKGROUND: Digital inclusion has become increasingly important in promoting healthy aging, yet its association with mental health among older adults appears complex and heterogeneous. The role of cognitive function as a moderator and the underlying mechanisms remain understudied.

OBJECTIVE: This study aims to examine cognitive function’s moderating role in the relationship between digital inclusion and depression risk among older adults, and to investigate multiple pathways of association.

METHODS: Using data from the 2020 wave of the China Health and Retirement Longitudinal Study, we analyzed 18,673 adults aged 60 years and above (mean age 68.4 y, SD 6.5; 50.8% male participants [n=9486], 49.2% female participants [n=9187]). We constructed interaction effect models to test the moderation hypothesis and employed path analysis with bootstrapped 95% confidence intervals (2000 iterations) to investigate multiple pathways through which digital inclusion is associated with depression.

RESULTS: Cognitive function significantly moderated the digital inclusion-depression relationship (β=-.002, P=.03). The association was not statistically significant at low cognitive function (β=-.137, P=.33) but strongly protective at high cognitive function (β=-.517, P<.001), revealing a “cognitive threshold effect.” Path analysis identified 3 significant pathways: direct effects (66.7% of total effect), cognitive enhancement (8.3%), and social participation (8%). Importantly, higher digital inclusion was not found to be associated with increased depression risk at any cognitive function level.

CONCLUSIONS: Our findings suggest that older adults require adequate cognitive resources to derive mental health benefits from digital participation, though no harmful effects were observed at lower cognitive levels. This asymmetric pattern has important implications for designing cognitive-informed digital inclusion programs that integrate digital skills training with cognitive enhancement strategies for promoting mental health in aging populations.

PMID:41289574 | DOI:10.2196/80700

JMIR Ment Health. 2025 Nov 25;12:e77796. doi: 10.2196/77796.

ABSTRACT

BACKGROUND: The impact of smartphone use on sleep remains intensely debated. Most existing studies have used self-reported smartphone use data. Moreover, few studies have simultaneously examined associations between both smartphone addiction and objectively measured smartphone use and sleep, and the dose-response relationship between smartphone use and risk of poor sleep has been consistently overlooked, requiring systematic and further research on this topic.

OBJECTIVE: This study aimed to examine the associations between smartphone addiction and objectively measured smartphone use and sleep quality and duration.

METHODS: This cross-sectional study enrolled 17,713 participants from a university in China. We assessed objective smartphone screen time and unlocks by collecting screenshots of use records and measured smartphone addiction using a validated questionnaire. Sleep quality and duration were estimated via the Pittsburgh Sleep Quality Index. Binary logistic regression, linear regression, and restricted cubic spline regression models were used for the analyses.

RESULTS: A total of 14.3% (2533/17,713) of the participants met the criterion for poor sleep, with a mean sleep duration of 507.1 (SD 103.2) minutes per night. Notably, university students with smartphone addiction exhibited 184% higher risk of poor sleep (odds ratio [OR] 2.84, 95% CI 2.59-3.11) and a 15.47-minute-shorter nighttime sleep duration (β=-15.47, 95% CI -18.53 to -12.42) compared to those without smartphone addiction. Regarding objectively measured smartphone use, participants with ≥63 hours per week of smartphone screen time had 22% higher odds of poor sleep (OR 1.22, 95% CI 1.08-1.37) and a 6.66-minute-shorter nighttime sleep duration (β=-6.66, 95% CI -10.19 to -3.13) compared to those with 0 to 21 hours of screen time per week, whereas those with approximately 21 to 42 hours per week of smartphone screen time had a 5.47-minute-longer nighttime sleep duration (β=5.47, 95% CI 1.28-9.65). Similarly, compared to those with 0 to 50 smartphone unlocks per week, participants with ≥400 smartphone unlocks per week showed 61% higher odds of poor sleep (OR 1.61, 95% CI 1.41-1.85) accompanied by a 4.09-minute-shorter nighttime sleep duration (β=-4.09, 95% CI -8.08 to -0.09), whereas those with approximately 50 to 150 smartphone unlocks per week had a 5.84-minute-longer sleep duration (β=5.84, 95% CI 2.32-9.36). An inverted U-shaped association between smartphone screen time and sleep duration was observed (P<.001 for nonlinearity).

CONCLUSIONS: Smartphone addiction, excessive objectively measured smartphone screen time, and unlocks are positively associated with both sleep quality and duration. Restricted cubic spline analyses revealed different nuanced dose-response relationships, with an inverted U-shaped association observed between smartphone screen time and sleep duration.

PMID:41289567 | DOI:10.2196/77796

JMIR Form Res. 2025 Nov 25;9:e76896. doi: 10.2196/76896.

ABSTRACT

BACKGROUND: Large language models (LLMs) have great potential to improve and make the work of clinicians more efficient. Previous studies have mainly focused on web-based services, such as ChatGPT, often with simulated cases. For the processing of personalized patient data, web-based services have major data protection concerns. Ensuring compliance with data protection and medical device regulations therefore remains a critical challenge for adopting LLMs in clinical settings.

OBJECTIVE: This retrospective single-center study aimed to evaluate locally run LLMs (Gemma 2, Mistral Nemo, and Llama 3) in providing diagnosis and treatment recommendation for real-world outpatient cases in otorhinolaryngology (ORL).

METHODS: Outpatient cases (n=30) from regular consultation hours and the emergency service at a university hospital ORL outpatient department were randomly selected. Documentation by ORL doctors, including anamnesis and examination results, was passed to the locally run LLMs (Gemma 2, Mistral Nemo, and Llama 3), which were asked to provide diagnostic and treatment strategies. Recommendations of the LLMs and the treating ORL doctors were rated by 3 experienced ORL consultants on a 6-point Likert scale for medical adequacy, conciseness, coherence, and comprehensibility. Moreover, consultants were asked whether the answers pose a risk to the patient’s safety. A modified Turing test was performed to distinguish responses generated by LLMs from those of doctors. Finally, the potential influence of the information generated by the LLMs on the raters’ own diagnosis and treatment opinions was evaluated.

RESULTS: Over all categories, ORL doctors achieved superior (P<.0005) ratings compared to locally run LLMs (Llama 3, Mistral Nemo, and Gemma 2). ORL doctors’ responses were considered hazardous for patients in only 1% of the ratings, whereas recommendations by Llama 3, Gemma 2, and Mistral Nemo were considered hazardous in 54%, 47%, and 32% of cases, respectively. According to the raters, the LLM’s information rarely influenced their judgment, with Mistral Nemo, Gemma 2, and Llama 3 achieving 1%, 3%, and 4% of the ratings, respectively.

CONCLUSIONS: Although locally run LLM models still underperform compared with their web-based counterparts, they achieved respectable results on outpatient treatment in this study. Nevertheless, the retrospective and single-center nature of the study, along with the clinicians’ documentation style, may have introduced bias in favor of human recommendations. In the future, locally run LLMs will help address data protection concerns; however, further refinement and prospective validation are still needed to meet strict medical device requirements. As locally run LLMs continue to evolve, they are likely to become comparably powerful to web-based LLMs and become established as useful tools to support doctors in clinical practice.

PMID:41289564 | DOI:10.2196/76896

JCO Oncol Pract. 2025 Nov 25:OP2500584. doi: 10.1200/OP-25-00584. Online ahead of print.

ABSTRACT

PURPOSE: Demand for integrative medicine (IM) in cancer care is increasing, yet limited data exist regarding which hospitals offer IM services and what those services include. This exploratory cross-sectional study aimed to (1) examine organizational characteristics and market factors of cancer hospitals that offered IM services and those that did not; and (2) identify the types of services included in IM programs within cancer hospitals and their funding sources.

METHODS: Bivariate analysis evaluated the relationship between the dependent variable (cancer hospitals offering IM services) and the independent categorical variables. χ² tests were performed for categorical variables, and t tests were used to compare means for continuous variables. An electronic survey was developed and distributed to 150 IM program leaders. The survey assessed service offerings, delivery settings, referrals, funding, barriers, and facilitators. Descriptive statistics were used to summarize and describe survey results.

RESULTS: Key findings showed statistically significant associations between cancer hospitals providing IM services and those that did not. A higher proportion of cancer hospitals with IM programs offered palliative care services, were not-for-profit, larger (bed size 400+), teaching entities located in metropolitan areas with larger populations and higher per capita income. Most frequently offered IM services were nutrition counseling, acupuncture, and massage therapy. Additionally, philanthropy was essential in providing financial support for IM services.

CONCLUSION: This study emphasizes the need for a better understanding of the factors influencing the availability and accessibility of IM services in cancer care. IM programs are increasingly embedded within cancer centers, offering diverse services to support patients’ symptom management and quality of life. However, funding, staffing, and integration variations reflect a need for standardized models and best practices.

PMID:41289555 | DOI:10.1200/OP-25-00584

Neurology. 2025 Dec 23;105(12):e214433. doi: 10.1212/WNL.0000000000214433. Epub 2025 Nov 25.

ABSTRACT

BACKGROUND AND OBJECTIVES: Kappa-free light chain (κ-FLC) is a quantitative biomarker of intrathecal immunoglobulin synthesis, with diagnostic accuracy comparable to oligoclonal bands in patients with multiple sclerosis (pwMS). However, their association with longitudinal brain MRI parameters remains unclear. We investigated associations between κ-FLC and MRI metrics in pwMS.

METHODS: In this retrospective cohort study, serum and CSF samples were collected from pwMS with brain MRI performed ≥1 year after lumbar puncture at the Medical University of Graz between 2005 and 2020. κ-FLC concentrations were quantified in paired serum and CSF samples using the Optilite turbidimeter; κ-FLC index was calculated as ratio of the quotient of κ-FLC to albumin. MS lesions were segmented on FLAIR images using the lesion prediction algorithm of SPM’s LST toolbox, categorized into periventricular lesions (PVLs) and non-PVLs. We assessed association of κ-FLC with lesion types, hypothesizing their contribution to damage in CSF-proximal regions. Brain volumes (gray, subcortical gray and white matter) and mean cortical thickness were estimated with FreeSurfer v.6.0.

RESULTS: A total of 109 participants were included (66% female, mean age 33.0 ± 9.5 years). Those with κ-FLC index ≥ median showed significantly higher PVL load (median: 3.2 cm³ [interquartile range (IQR) 1.5-8.4]) than those with values below median (median: 1.9 cm³ [IQR 0.9-3.3], p = 0.007). In regression models adjusted for age, sex, follow-up time, baseline corticosteroid use, and disease-modifying therapy, both baseline κ-FLC index and CSF κ-FLC were independently associated with greater total lesion load (κ-FLC index: B = 0.283, 95% CI 0.130-0.436, p < 0.001; CSF κ-FLC: B = 0.255, 95% CI 0.105-0.405, p = 0.001) and PVL load (κ-FLC index: B = 0.286, 95% CI 0.123-0.449, p = 0.001; CSF κ-FLC: B = 0.274, 95% CI 0.115-0.433, p = 0.001) at follow-up. They were also linked to lower mean cortical thickness (κ-FLC index: B = -0.001, 95% CI -0.001-0.0001, p = 0.011; CSF κ-FLC: B = -0.001, 95% CI -0.001-0.0001, p = 0.010).

DISCUSSION: Higher κ-FLC levels were associated with both PVL burden and cortical pathology, regions adjacent to the CSF. Although this study was limited by a relative small sample size, our findings underscore the potential of κ-FLC as a diagnostic and prognostic MS biomarker.

PMID:41289552 | DOI:10.1212/WNL.0000000000214433

Invest Educ Enferm. 2025 Sep;43(3). doi: 10.17533/udea.iee.v43n3e13.

ABSTRACT

OBJECTIVE: To assess the effectiveness of nurse-led or nurse-integrated interventions in improving maternal health outcomes, particularly antenatal care (ANC) attendance, in resource-constrained settings.

METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases including PubMed, Scopus, CINAHL and Web of Science were searched for studies evaluating the impact of nursing interventions on maternal health outcomes. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle-Ottawa Scale. A random-effects meta-analysis was performed for studies reporting ANC attendance (4 and more visits). (PROSPERO CRD420251067253).

RESULTS: Of the 1038 records identified, 11 studies met the inclusion criteria, and 3 were eligible for meta-analysis. The pooled Odds Ratio for ANC attendance was 1.48 (95% CI = 1.06-2.08), indicating a statistically significant improvement. For facility use at birth, results also showed positive effects (OR=1.49, 95% CI = 1.21-1.77). Mortality-related outcomes showed a midwife-delivered postpartum hemorrhage bundle reduced a composite outcome including severe hemorrhage and death (RR = 0.40, 95% CI = 0.32-0.50) Narrative synthesis of other outcomes such as skilled birth attendance and maternal mortality also suggested a positive impact of nurse-led interventions.

CONCLUSION: Nurse-led and nurse-integrated maternal health interventions significantly improve ANC utilization in low-resource settings. Policymakers should consider scaling these models as part of broader maternal health strategies.

PMID:41289537 | DOI:10.17533/udea.iee.v43n3e13

Invest Educ Enferm. 2025 Sep;43(3). doi: 10.17533/udea.iee.v43n3e12.

ABSTRACT

OBJECTIVE: To test the effectiveness of nursing intervention to control fluid volume on improving laboratory test results and dialysis adequacy in patients with Excess fluid volume.

METHODS: This is a randomized, double-blind, parallel-group controlled trial involving 34 patients with chronic kidney disease and a nursing diagnosis of Excess Fluid Volume undergoing chronic hemodialysis equally randomized into two groups (control n=17 and intervention n=17). Data were collected on sociodemographic and clinical factors, the presence of Excess Fluid Volume, and water balance. Laboratory parameters, including serum electrolytes, urea, creatinine, and dialysis adequacy markers, were assessed before and after the intervention. The intervention consisted of 13 nursing activities, including educational, follow-up, and reminder components, such as fluid balance monitoring, daily weight control, edema assessment, laboratory follow-up, and health education on diet and self-care. The control group received only the usual care provided at the dialysis clinic.

RESULTS: There were significant improvements in laboratory test results and dialysis adequacy. The statistical difference between the groups was significant in the mean values of calcium (p<0.001), post-hemodialysis urea (p=0.002), and creatinine (p=0.006), demonstrating the direct effect of the intervention. In addition, there were improvements in overall dialysis quality and adequacy measures.

CONCLUSION: The nursing intervention significantly improved laboratory test results and dialysis adequacy in patients with chronic renal failure and Excess Fluid Volume, highlighting its potential for enhancing patient management and nursing care.

PMID:41289536 | DOI:10.17533/udea.iee.v43n3e12

Invest Educ Enferm. 2025 Sep;43(3). doi: 10.17533/udea.iee.v43n3e11.

ABSTRACT

OBJECTIVE: To verify evidence of validity of the instrument “Knowledge, Attitude, and Practice of Nurses in Prenatal Care for Visually Impaired Pregnant Women”.

METHODS: Methodological study to assess content validity with the participation of 22 expert nurses (11 from the area of Sexual and Reproductive Health and 11 from the area of People with Disabilities). The instrument was adapted into a Google Forms questionnaire and assessed Objectivity, Clarity, and Relevance. The data were analyzed using the Content Validity Coefficient and Content Validity Ratio, in addition to calculating Cronbach’s Alpha for internal consistency. Ten generalist nurses from Primary Care participated in the semantic validation, evaluating comprehension, relevance, and possible adjustments to the instrument, with calculation of the Semantic Concordance Index.

RESULTS: The instrument obtained an overall Content Validity Coefficient above 0.90 for objectivity, clarity, and relevance, with internal consistency (Cronbach’s Alpha = 0.89). The experts’ suggestions improved the wording and structure. In semantic validation, the Semantic Concordance Index was 0.97, reinforcing clarity and applicability.

CONCLUSION: The instrument showed evidence of content validity, being objective, clear, and relevant for assessing the Knowledge, Attitude, and Practice of nurses in the prenatal care of pregnant women with visual impairment.

PMID:41289535 | DOI:10.17533/udea.iee.v43n3e11

J Orthop Sports Phys Ther. 2025 Dec;55(12):1-9. doi: 10.2519/jospt.2025.13558.

ABSTRACT

OBJECTIVES: To (a) estimate the association between socioeconomic position (SEP) and the use and frequency of physical therapy visits in the year preceding hip arthroscopic surgery for femoroacetabular impingement (FAI) syndrome in Denmark and (b) compare these associations before and after 2019, following international recommendations. STUDY DESIGN: Retrospective cohort study. METHODS: A cohort of 5739 patients with FAI syndrome and hip arthroscopy (2012-2024) was identified from the Danish Hip Arthroscopy Registry. Physical therapy use (yes/no) and visit frequency in the year preceding surgery were identified from national registries. SEP was categorized as low, medium, or high based on a composite score of educational attainment, income, and labor market affiliation. Binomial and negative binomial regressions were used to estimate relative risk ratios (RRs) and incidence rate ratios (IRRs). RESULTS: Overall, 35.1% of patients used physical therapy before hip arthroscopy, with lower use among those in the low-SEP group (29.3%) compared to the high-SEP group (36.0%) (directed acyclic graph [DAG]-adjusted RR = 0.83 [95% CI: 0.70, 0.98]) and no significant difference in visit frequency (DAG-adjusted IRR = 0.79 [95% CI: 0.59, 1.07]). Use declined from 38.9% before 2019 to 30.1% after (DAG-adjusted RR = 0.77 [95% CI: 0.72, 0.83]), with visits decreasing from 3.95 to 2.59 (DAG-adjusted IRR = 0.64 [95% CI: 0.56, 0.74]). CONCLUSION: One third of patients used physical therapy in the year before hip arthroscopy in Denmark, with one fifth having 6 or more visits. Patients in the lowest SEP group were less likely to use physical therapy, while differences in visit frequency were not statistically significant. Use of physical therapy declined from 39% before 2019 to 30% after. J Orthop Sports Phys Ther 2025;55(12):1-9. Epub 30 October 2025. doi:10.2519/jospt.2025.13558.

PMID:41288047 | DOI:10.2519/jospt.2025.13558

J Genet Couns. 2025 Dec;34(6):e70129. doi: 10.1002/jgc4.70129.

ABSTRACT

Current reproductive guidelines call for offering expanded carrier screening (ECS) for genetic conditions. Currently available panels can include screening for carrier status of tens to hundreds of autosomal recessive and/or X-linked conditions. Clinical utility is based on alterations to reproductive decision-making, but study cohorts supporting the utility of ECS largely consist of individuals of European ancestry who are highly educated, of high income, and who often receive preconception counseling. There is a lack of research on the views of patients from diverse backgrounds. Therefore, we aimed to assess and compare perceptions of the utility of ECS and targeted carrier screening (TCS) in an ethnically, economically, and educationally diverse population. We administered a survey to obstetrics and gynecology patients in Houston, Texas in the fall of 2022. Questions regarding genetic testing, reproductive management, and demographics were asked. Of the respondents who wanted children in the future, expressed interest in knowing reproductive genetic risks, and would consider using this information to change reproductive plans (114/186, 61%), 100 indicated their test preference, with 70 (70%) preferring ECS and 30 (30%) preferring TCS. There was no statistical difference in test preference by race and ethnicity, education, income, or insurance. Eighty-one of the 114 participants provided feedback on the utility of CS, and 74/81 (91%) of them found it useful. Only 30/81 (37%) of them, however, stated that they would change their reproductive plans if identified as at-risk. Participants were more likely to change their reproductive plans if they were not pregnant (OR = 3.63; 95 CI = 1.26-10.47), had not had prior genetic testing (OR = 3.03; 95 CI = 1.02-8.95), or had higher income (OR = 1.25; 95 CI = 1.00-1.55). This heterogeneous cohort expands upon data from previous homogeneous cohorts assessing CS utility. While attitudes toward CS were favorable, its perceived utility was lower. Information on reproductive management options should be provided to patients in the preconception period, and access to reproductive services must be improved for those with lower incomes. Further insight on the perspectives of diverse populations is imperative to defining the utility of carrier screening most accurately and equitably.

PMID:41288026 | DOI:10.1002/jgc4.70129