Nevin Manimala

PLoS One. 2025 Jan 13;20(1):e0313732. doi: 10.1371/journal.pone.0313732. eCollection 2025.

ABSTRACT

BACKGROUND: Rigorous population-based assessments of the use of specialty palliative care (SPC) in the US are rare.

SETTINGS/SUBJECTS: This study examined SPC use among cancer patients in a mid-sized metropolitan area in Southeast US.

MEASUREMENTS: In this cancer decedent cohort study, data were acquired and linked from the state-wide cancer registry; state-wide hospital discharge dataset; and local SPC providers.

RESULTS: 12,030 individuals with cancer were included in this study; only 2,958 (24.6%) used SPC. Of the 9,072 persons who did not use SPC, 3,877 (42.7%) went only to hospitals that did not offer SPC; and 3,517 (38.8%) went to hospitals that offered SPC but did not use it. About half of SPC recipients (1493; 50.5%) first received SPC in the final 30 days of life, including 768 (26.0%) in the final week of life. Characteristics associated with using SPC use included being in an socio-economic status quintile other than the lowest; being younger; being Black; having a solid (versus hematological) cancer; having a shorter survival with cancer; dying in the latter two years of the study; being from an area of low or complete rurality; having a hospital admission in the final 60 days prior to initiation of PC or death; having more days in hospital; and living within 15 miles of a hospital offering SPC.

CONCLUSIONS: In this population-based study, only one-quarter of cancer patients used SPC, and for half who did so, it came in the final 30 days of life.

PMID:39804856 | DOI:10.1371/journal.pone.0313732

PLoS One. 2025 Jan 13;20(1):e0317374. doi: 10.1371/journal.pone.0317374. eCollection 2025.

ABSTRACT

BACKGROUND: The warm chain of support is the continuous enabling environment from the mother’s first contact with healthcare professionals during early pregnancy, birth and immediate post-partum period, her transition from healthcare facility to home, through to work and the community at large. A breastfeeding-friendly city should be able to support a breastfeeding journey across the warm chain.

OBJECTIVE: To determine breastfeeding women’s perspective of an ideal breastfeeding-friendly city.

METHODS: Between September 2021 and January 2022, twenty-two women who were breastfeeding or had ever breastfed in the last 5 years from Ireland and Malaysia were interviewed. A set of selection criteria was applied to ensure representation of a range of the characteristics known to be associated with breastfeeding success: diverse age groups, birth and breastfeeding experiences, culture and socioeconomical background. One-on-one semi-structured online interviews were conducted by the first author. Data were analysed using Braun and Clarke’s Thematic Analysis framework.

RESULTS: One overarching theme of breastfeeding at the front and centre of the city, and three major themes were developed: 1. mothers feel supported when breastfeeding is prioritised; 2. when breastfeeding is visible in the environment, it becomes normalized; 3. there is a need to have seamless breastfeeding support across the continuum of the warm chain, and at all levels of society.

CONCLUSIONS: The findings demonstrated the importance of prioritized, and continuous support throughout the breastfeeding journey. The hopes and aspirations of a breastfeeding-friendly city expressed here would be useful for cities to consider when developing or implementing breastfeeding support programmes as well as guide development of indicators of a breastfeeding-friendly city.

PMID:39804854 | DOI:10.1371/journal.pone.0317374

J Med Internet Res. 2025 Jan 13;27:e59027. doi: 10.2196/59027.

ABSTRACT

BACKGROUND: Digital health interventions have emerged as promising tools to promote health behavior change and improve health outcomes. However, a comprehensive synthesis of strategies contributing to these interventions is lacking.

OBJECTIVE: This study aims to (1) identify and categorize the strategies used in digital health interventions over the past 25 years; (2) explore the differences and changes in these strategies across time periods, countries, populations, delivery methods, and senders; and (3) serve as a valuable reference for future researchers and practitioners to improve the effectiveness of digital health interventions.

METHODS: This study followed a systematic review approach, complemented by close reading and text coding. A comprehensive search for published English academic papers from PubMed, Web of Science, and Scopus was conducted. The search employed a combination of digital health and intervention-related terms, along with database-specific subject headings and filters. The time span covered 25 years, from January 1, 1999, to March 10, 2024. Sample papers were selected based on study design, intervention details, and strategies. The strategies were identified and categorized based on the principles of Behavior Change Techniques and Behavior Strategies.

RESULTS: A total of 885 papers involving 954,847 participants met the eligibility criteria. We identified 173 unique strategies used in digital health interventions, categorized into 19 themes. The 3 most frequently used strategies in the sample papers were “guide” (n=492, 55.6%), “monitor” (n=490, 55.4%), and “communication” (n=392, 44.3%). The number of strategies employed in each paper ranged from 1 to 32. Most interventions targeted clients (n=844, 95.4%) and were carried out in hospitals (n=268, 30.3%). High-income countries demonstrated a substantially higher number and diversity of identified strategies than low- and middle-income countries, and the number of studies targeting the public (n=647, 73.1%) far exceeded those focusing on vulnerable groups (n=238, 26.9%).

CONCLUSIONS: Digital health interventions and strategies have undergone considerable development over the past 25 years. They have evolved from simple approaches to sophisticated, personalized techniques and are trending toward multifaceted interventions, leveraging advanced technologies for real-time monitoring and feedback. Future studies should focus on rigorous evaluations, long-term effectiveness, and tailored approaches for diverse populations, and more attention should be given to vulnerable groups.

PMID:39804697 | DOI:10.2196/59027

J Med Internet Res. 2025 Jan 13;27:e57619. doi: 10.2196/57619.

ABSTRACT

BACKGROUND: Improving adherence to pre-exposure prophylaxis (PrEP) via digital health interventions (DHIs) for young sexual and gender minority men who have sex with men (YSGMMSM) is promising for reducing the HIV burden. Measuring and achieving effective engagement (sufficient to solicit PrEP adherence) in YSGMMSM is challenging.

OBJECTIVE: This study is a secondary analysis of the primary efficacy randomized controlled trial (RCT) of Prepared, Protected, Empowered (P3), a digital PrEP adherence intervention that used causal mediation to quantify whether and to what extent intrapersonal behavioral, mental health, and sociodemographic measures were related to effective engagement for PrEP adherence in YSGMMSM.

METHODS: In May 2019, 264 YSGMMSM were recruited for the primary RCT via social media, community sites, and clinics from 9 study sites across the United States. For this secondary analysis, 140 participants were eligible (retained at follow-up, received DHI condition in primary RCT, and completed trial data). Participants earned US currency for daily use of P3 and lost US currency for nonuse. Dollars accrued at the 3-month follow-up were used to measure engagement. PrEP nonadherence was defined as blood serum concentrations of tenofovir-diphosphate and emtricitabine-triphosphate that correlated with ≤4 doses weekly at the 3-month follow-up. Logistic regression was used to estimate the total effect of baseline intrapersonal measures on PrEP nonadherence, represented as odds ratios (ORs) with a null value of 1. The total OR for each intrapersonal measure was decomposed into direct and indirect effects.

RESULTS: For every US $1 earned above the mean (US $96, SD US $35.1), participants had 2% (OR 0.98, 95% CI 0.97-0.99) lower odds of PrEP nonadherence. Frequently using phone apps to track health information was associated with a 71% (OR 0.29, 95% CI 0.06-0.96) lower odds of PrEP nonadherence. This was overwhelmingly a direct effect, not mediated by engagement, with a percentage mediated (PM) of 1%. Non-Hispanic White participants had 83% lower odds of PrEP nonadherence (OR 0.17, 95% CI 0.05-0.48) and had a direct effect (PM=4%). Participants with depressive symptoms and anxiety symptoms had 3.4 (OR 3.42, 95% CI 0.95-12) and 3.5 (OR 3.51, 95% CI 1.06-11.55) times higher odds of PrEP nonadherence, respectively. Anxious symptoms largely operated through P3 engagement (PM=51%).

CONCLUSIONS: P3 engagement (dollars accrued) was strongly related to lower odds of PrEP nonadherence. Intrapersonal measures operating through P3 engagement (indirect effect, eg, anxious symptoms) suggest possible pathways to improve PrEP adherence DHI efficacy in YSGMMSM via effective engagement. Conversely, the direct effects observed in this study may reflect existing structural disparity (eg, race and ethnicity) or behavioral dispositions toward technology (eg, tracking health via phone apps). Evaluating effective engagement in DHIs with causal mediation approaches provides a clarifying and mechanistic view of how DHIs impact health behavior.

TRIAL REGISTRATION: ClinicalTrials.gov; NCT03320512; https://clinicaltrials.gov/study/NCT03320512.

PMID:39804696 | DOI:10.2196/57619

J Med Internet Res. 2025 Jan 13;27:e63004. doi: 10.2196/63004.

ABSTRACT

BACKGROUND: Digital biomarkers are increasingly used in clinical decision support for various health conditions. Speech features as digital biomarkers can offer insights into underlying physiological processes due to the complexity of speech production. This process involves respiration, phonation, articulation, and resonance, all of which rely on specific motor systems for the preparation and execution of speech. Deficits in any of these systems can cause changes in speech signal patterns. Increasing efforts are being made to develop speech-based clinical decision support systems.

OBJECTIVE: This systematic scoping review investigated the technological revolution and recent digital clinical speech signal analysis trends to understand the key concepts and research processes from clinical and technical perspectives.

METHODS: A systematic scoping review was undertaken in 6 databases guided by a set of research questions. Articles that focused on speech signal analysis for clinical decision-making were identified, and the included studies were analyzed quantitatively. A narrower scope of studies investigating neurological diseases were analyzed using qualitative content analysis.

RESULTS: A total of 389 articles met the initial eligibility criteria, of which 72 (18.5%) that focused on neurological diseases were included in the qualitative analysis. In the included studies, Parkinson disease, Alzheimer disease, and cognitive disorders were the most frequently investigated conditions. The literature explored the potential of speech feature analysis in diagnosis, differentiating between, assessing the severity and monitoring the treatment of neurological conditions. The common speech tasks used were sustained phonations, diadochokinetic tasks, reading tasks, activity-based tasks, picture descriptions, and prompted speech tasks. From these tasks, conventional speech features (such as fundamental frequency, jitter, and shimmer), advanced digital signal processing-based speech features (such as wavelet transformation-based features), and spectrograms in the form of audio images were analyzed. Traditional machine learning and deep learning approaches were used to build predictive models, whereas statistical analysis assessed variable relationships and reliability of speech features. Model evaluations primarily focused on analytical validations. A significant research gap was identified: the need for a structured research process to guide studies toward potential technological intervention in clinical settings. To address this, a research framework was proposed that adapts a design science research methodology to guide research studies systematically.

CONCLUSIONS: The findings highlight how data science techniques can enhance speech signal analysis to support clinical decision-making. By combining knowledge from clinical practice, speech science, and data science within a structured research framework, future research may achieve greater clinical relevance.

PMID:39804693 | DOI:10.2196/63004

JMIR Public Health Surveill. 2025 Jan 13;11:e64564. doi: 10.2196/64564.

ABSTRACT

BACKGROUND: The effects of physical activity (PA) across different domains and intensities on depressive symptoms remain inconclusive. Incorporating the community-built environment (CBE) into longitudinal analyses of PA’s impact on depressive symptoms is crucial.

OBJECTIVE: This study aims to examine the effects of PA at different intensities-low-intensity PA (eg, walking activities) and moderate-to-vigorous-intensity PA (eg, activities requiring substantial effort and causing faster breathing or shortness of breath)-across leisure-time and occupational domains on depressive symptom trajectories among middle-aged and older adults. Additionally, it investigated how CBEs influence depressive symptoms and PA trajectories.

METHODS: This longitudinal study included 6865 middle-aged and older adults from the China Health and Retirement Longitudinal Survey. A CBE variable system was developed using a community questionnaire to assess attributes of the physical built environment. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Latent growth curve modeling was applied to analyze 3 waves of the cohort data (2015, 2018, and 2020) to explore the differential effects of PA on depressive symptoms and the role of the CBE.

RESULTS: In the 2015 and 2018 waves, higher low-intensity leisure-time physical activity (LTPA) was associated with lower depressive symptoms (β=-.025, P=.01 and β=-.027, P=.005, respectively). Across all waves, moderate-to-vigorous-intensity LTPA showed no significant predictive effects (P=.21 in 2015, P=.57 in 2018, and P=.85 in 2020, respectively). However, higher occupational physical activity (OPA), particularly at moderate-to-vigorous intensities, was consistently associated with higher depressive symptoms. Parallel process latent growth curve modeling revealed that the initial level of total LTPA negatively predicted the initial level of depressive symptoms (β=-.076, P=.01). OPA exhibited dual effects, positively predicting the initial level of depressive symptoms (β=.108, P<.001) but negatively predicting their upward trajectory (β=-.136, P=.009). Among CBE variables, better infrastructure conditions (β=-.082, P<.001) and greater accessibility to public facilities (β=-.036, P=.045) negatively predicted the initial level of depressive symptoms. However, greater accessibility to public facilities positively predicted the upward trajectory of depressive symptoms (β=.083, P=.04). Better infrastructure conditions (β=.100, P=.002) and greater accessibility to public transport (β=.060, P=.01) positively predicted the initial level of total LTPA. Meanwhile, better infrastructure conditions (β=-.281, P<.001) and greater accessibility to public facilities (β=-.073, P<.001) negatively predicted the initial level of total OPA. Better infrastructure conditions positively predicted the declining trajectory of total OPA (β=.100, P=.004).

CONCLUSIONS: This study underscores the importance of considering the differential effects of PA across domains and intensities on depressive symptoms in public policies and guidelines. Given the influence of the environment on PA and depressive symptoms, targeted community measures should be implemented.

PMID:39804686 | DOI:10.2196/64564

Games Health J. 2025 Jan 13. doi: 10.1089/g4h.2024.0192. Online ahead of print.

ABSTRACT

Due to the exponential growth in technology, exergames emerged as a potential tool to foster physical activity (PA) levels. This study provides an overall view of the literature on the effects of exergaming on physical fitness components among overweight and obese children and adolescents. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in the PubMed, Web of Science, and Scopus databases. Among the 618 articles identified at the first screening stage, 17 were retained for analysis. The results indicate positive effects of exergaming interventions in body composition outcomes, cardiorespiratory fitness, muscular strength, and skills performance. Results from the randomized studies with the control group revealed significant effects of exergames in decreasing body mass index (mean difference = 0.24; 95% confidence interval [CI]: 0.06 to 0.43, P = 0.01) and increasing cardiorespiratory fitness (Hedges’s g = 0.28; 95% CI: 0.09 to 0.46, P = 0.00). Although not statistically significant, participants submitted to exergames interventions also showed decreased body weight compared to their control peers. The results emphasize the ability of exergames to enhance PA levels and physical fitness components, which might influence the health status of overweight and obese youth. However, due to the limited number of studies included in the meta-analysis (n = 4), future randomized controlled experiments are still needed to improve the understanding of the impact of exergames interventions on physical fitness.

PMID:39804680 | DOI:10.1089/g4h.2024.0192

Diabetes. 2025 Jan 13:db240841. doi: 10.2337/db24-0841. Online ahead of print.

ABSTRACT

Clonal haematopoiesis of indeterminate potential (CHIP) is associated with macrovascular diseases, including coronary artery disease and stroke. However, the effects of CHIP on microvascular complication have not been evaluated in individuals with type 2 diabetes (T2D). This study included 20,712 T2D participants without prevalent diabetic microvascular complication (DMCs) and hematologic malignancy at baseline. CHIP and related phenotypes were identified using whole exome sequencing derived from peripheral blood samples. The incidence of DMCs defined as a composite of diabetic kidney disease, diabetic retinopathy, or diabetic neuropathy. Associations of any CHIP with incident DMCs and subtypes were assessed using Cox regression. Gene-specific analyses also conducted to determine the effect of mutated driver genes with DMCs. During a median follow-up of 13.0 years, 5,673 participants developed DMCs. Any CHIP was associated with high risk of DMCs (HR, 1.23; 95% CI, 1.10-1.38; P<0.001), specifically, diabetic retinopathy (HR, 1.34; 95% CI, 1.13-1.57; P=0.001) and diabetic kidney disease (HR, 1.26; 95% CI, 1.10-1.45; P=0.001), but not diabetic neuropathy. Gene-specific analyses suggested that DNMT3A, TET2, NF1, and Spliceosome genes were associated with risk of developing DMCs. CHIP increases the risk of developing DMCs in individuals with T2D, independently of other risk factors. These findings offered potential implications for the prevention and management of DMCs.

PMID:39804667 | DOI:10.2337/db24-0841

Transl Vis Sci Technol. 2025 Jan 2;14(1):12. doi: 10.1167/tvst.14.1.12.

ABSTRACT

PURPOSE: To compare a novel high-resolution optical coherence tomography (OCT) with improved axial resolution (High-Res OCT) with conventional spectral-domain OCT (SD-OCT) with regard to their capacity to characterize the disorganization of the retinal inner layers (DRIL) in diabetic maculopathy.

METHODS: Diabetic patients underwent multimodal retinal imaging (SD-OCT, High-Res OCT, and color fundus photography). Best-corrected visual acuity and diabetes characteristics were recorded. DR was graded using the international clinical diabetic retinopathy severity scale (DRSS). In each OCT B-scan, retinal layers were segmented and the loss of discernibility was annotated. DRIL areas were analyzed in en face projection using FIJI plugins. The Wilcoxon test and regression models were used for statistical analysis.

RESULTS: In 93 eyes of 93 patients (mean age, 61.8 ± 12.9 years) DRIL was identified in 48 eyes. DRIL was most frequent in the central subfield (27%). In DRIL eyes, DRSS was significantly higher (4.43 ± 1.01 vs. 2.12 ± 1.66; P < 0.001), BCVA was significantly worse (0.34 ± 0.38 vs. 0.13 ± 0.22; P < 0.001), and the loss of discernibility of the individual inner retinal layers was significantly smaller in High-Res OCT compared with SD-OCT (0.21 ± 0.29 vs. 1.21 ± 1.21 mm2; P < 0.001). The discernibility loss was greatest in the retinal nerve fiber layer and ganglion cell layer.

CONCLUSIONS: DRIL occurs in eyes with advanced diabetic retinopathy, with a characteristic spread: from the inner toward the outer retina. High-Res OCT shows significantly smaller DRIL areas compared with SD-OCT, because of a more precise delineation of the inner retinal layers.

TRANSLATIONAL RELEVANCE: Using OCT with increased axial resolution could enhance our understanding of DRIL development and progression, providing deeper insights into pathophysiological aspects, including malperfusion in the inner capillary plexus.

PMID:39804658 | DOI:10.1167/tvst.14.1.12

JAMA Pediatr. 2025 Jan 13. doi: 10.1001/jamapediatrics.2024.5466. Online ahead of print.

ABSTRACT

IMPORTANCE: Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening complication of COVID-19 infection. Data on midterm outcomes are limited.

OBJECTIVE: To characterize the frequency and time course of cardiac dysfunction (left ventricular ejection fraction [LVEF] <55%), coronary artery aneurysms (z score ≥2.5), and noncardiac involvement through 6 months after MIS-C.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study enrolled participants between March 2020 and January 2022 with a follow-up period of 2 years. Participants were recruited from 32 North American pediatric hospitals, and all participants met the 2020 Centers for Disease Control and Prevention case definition of MIS-C.

EXPOSURE: MIS-C after COVID-19 infection.

MAIN OUTCOMES AND MEASURES: Outcomes included echocardiography core laboratory (ECL) assessments of LVEF and maximum coronary artery z scores (zMax); data collection on cardiac and noncardiac sequelae during hospitalization and at 2 weeks, 6 weeks, and 6 months after discharge; and age-appropriate Patient-Reported Outcomes Measurement Information Systems (PROMIS) Global Health Instruments at follow-up. Descriptive statistics, linear regression models, and Kaplan-Meier analysis were used.

RESULTS: Of 1204 participants (median [IQR] age, 9.1 [5.6-12.7] years; 724 male [60.1%]), 325 self-identified with non-Hispanic Black race (27.0%) and 324 with Hispanic ethnicity (26.9%). A total of 548 of 1195 participants (45.9%) required vasoactive support, 17 of 1195 (1.4%) required extracorporeal membrane oxygenation, and 3 (0.3%) died during hospitalization. Of participants with echocardiograms reviewed by the ECL (n = 349 due to budget constraints), 131 of 322 (42.3%) had LVEF less than 55% during hospitalization; of those with follow-up, all but 1 normalized by 6 months. Black race (vs other/unknown race), higher C-reactive protein level, and abnormal troponin level were associated with lowest LVEF (estimate [SE], -3.09 [0.98]; R2 = 0.14; P =.002). Fifteen participants had coronary artery z scores of 2.5 or greater at any time point; 1 participant had a large/giant aneurysm. Of the 13 participants with z scores of 2.5 or greater during hospitalization, 12 (92.3%) had normalized by 6 months. Return to greater than 90% of pre-MIS-C health status (energy, sleep, appetite, cognition, and mood) was reported by 711 of 824 participants (86.3%) at 2 weeks, increasing to 548 of 576 (95.1%) at 6 months. Fatigue was the most common symptom reported at 2 weeks (141 of 889 [15.9%]), falling to 3.4% (22 of 638) by 6 months. PROMIS Global Health parent/guardian proxy median T scores for fatigue, global health, and pain interference improved significantly from 2 weeks to 6 months (fatigue, 56.1 vs 48.9; global health, 48.8 vs 51.3; pain interference, 53.0 vs 43.3; P < .001) and by the 6-week visit were at least equivalent to prepandemic population norms.

CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that although children and young adults with MIS-C can have severe disease during the acute phase, most recovered quickly and had a reassuring midterm prognosis.

PMID:39804656 | DOI:10.1001/jamapediatrics.2024.5466