Nevin Manimala

J Med Internet Res. 2024 Oct 25;26:e53298. doi: 10.2196/53298.

ABSTRACT

BACKGROUND: Telehealth (care delivered by phone or video) comprises a substantial proportion of cardiology care delivered in the Veterans Health Administration (VHA). Little is known about how factors specific to patients, clinicians, and facilities contribute to variation in cardiology telehealth use.

OBJECTIVE: The aim of this study is to estimate the relative extent to which patient-, clinician-, and facility-level factors affect cardiology telehealth use in VHA.

METHODS: This was a retrospective, nation-wide cohort study of veterans’ use of VHA cardiology telehealth care during the first 2 years of the COVID-19 pandemic (March 11, 2020, to March 10, 2022). We constructed multilevel, multivariable, logistic regression models of patient-level cardiology telehealth use (telephone or video-based care). Models included random effects for the patient, the patient’s main cardiology provider, and the patient’s primary facility (ie, VHA medical center) for specialty care and fixed effects for patient sociodemographic and clinical characteristics.

RESULTS: Our analytic cohort comprised 223,809 veterans with 989,271 encounters among 2235 unique clinicians. The veterans’ average age was 70.2 years, and 3.4% (n=7616) were women. Of the 989,271 encounters, 4.2% (n=41,480) were video based and 34.3% (n=338,834) were phone based. Adjusted odds of telehealth use were slightly higher for women versus men (adjusted odds ratio [AOR] 1.08, 95% CI 1.05-1.10), individuals identifying as Hispanic or Latino versus not Hispanic or Latino (AOR 1.46, 95% CI 1.43-1.49), and those with medium and long drive times versus short drive time (AOR 1.11, 95% CI 1.10-1.12 and AOR 1.09, 95% CI 1.07-1.10, respectively). Further, 40.5% of the variation in a veteran’s likelihood of using cardiology telehealth care was found at the patient level, 30.8% at the clinician level, and 7% at the facility level.

CONCLUSIONS: The largest share of the attributable variability in VHA cardiology telehealth use in this cohort was explained by the patient, followed closely by the clinician. Little variability was attributed to the primary facility through which the veteran received their cardiology care. These results suggest that policy solutions intended to improve equity of cardiology telehealth care use in VHA may be most impactful when directed at patients and clinicians.

PMID:39454198 | DOI:10.2196/53298

JMIR Hum Factors. 2024 Oct 25;11:e54673. doi: 10.2196/54673.

ABSTRACT

BACKGROUND: Health care providers can make health guidance more effective by using mobile health technologies such as health apps. Although health care providers need to know who uses health apps, existing studies have yielded inconsistent results.

OBJECTIVE: The aim of the study was (1) to clarify the prevalence and patterns of health app use to improve health behaviors for preventing lifestyle-related diseases among Japanese workers and (2) to identify the associations among demographic characteristics, health behavior, and internet use and health app use by gender.

METHODS: Data were collected from a cross-sectional internet survey in 2023. In total, 2200 participants were included, with an even distribution of men and women in each age group aged 20 to 60 years. The participants were workers with smartphones and reported their gender, age, residence area, marital status, education, employment status, occupation, work pattern, diseases under treatment, health checkups, health guidance, health behaviors, internet use duration, and number of devices used. We asked about current and previous health app use for 1 month. A multivariate logistic regression analysis was conducted by gender.

RESULTS: Of the participants, 472 (21.5%) and 189 (8.6%) were current and previous health app users, respectively. Most current and previous health app users used features that record and track their physical activity and other health behaviors. Health app users-both men and women-were more likely to have health checkups (odds ratio [OR] 1.53, 95% CI 1.12-2.11 and OR 1.51, 95% CI 1.10-2.07, respectively), receive health guidance (OR 2.01, 95% CI 1.47-2.74 and OR 1.86, 95% CI 1.32-2.62, respectively), engage in regular physical activity (OR 2.57, 95% CI 1.91-3.47 and OR 1.94, 95% CI 1.41-2.67, respectively), use the internet for 120-179 minutes per day (OR 1.76, 95% CI 1.13-2.75 and OR 1.70, 95% CI 1.12-2.57, respectively), and were less likely to be older (50-59 years: OR 0.54, 95% CI 0.33-0.88 and OR 0.40, 95% CI 0.25-0.6, respectively, and 60-69 years: OR 0.37, 95% CI 0.22-0.62 and OR 0.47, 95% CI 0.28-0.77, respectively). According to gender, male health app users were more likely to be married (OR 1.69, 95% CI 1.23-2.33) and less likely to work in the security, agriculture, forestry, fishing, manufacturing, or transportation industries (OR 0.62, 95% CI 0.41-0.95). Female health app users were more likely to have a university education or higher (OR 1.55, 95% CI 1.061-2.26), maintain an appropriate body weight (OR 1.52, 95% CI 1.10-2.11), and use 3 or more devices (OR 2.13, 95% CI 1.41-3.23).

CONCLUSIONS: Physical activity and health guidance are strong predictors of app use. Health care providers should assess the target populations’ preferences for app use based on their characteristics, support their app use, and enhance the effectiveness of health guidance.

PMID:39454195 | DOI:10.2196/54673

J Med Internet Res. 2024 Oct 25;26:e52129. doi: 10.2196/52129.

ABSTRACT

BACKGROUND: Despite the prevalence of vaping nicotine, most nicotine cessation research remains focused on smoking cigarettes. However, the lived experience of quitting smoking is different from quitting vaping. As a result, research examining the unique experiences of those quitting vaping can better inform quitting resources and cessation programs specific to e-cigarette use. Examining Reddit forums (ie, subreddits) dedicated to the topics of quitting vaping nicotine can provide insight into the discussion around experiences on quitting vaping. Prior literature examining limited discussions around quitting vaping on Reddit has identified the sharing of barriers and facilitators for quitting, but more research is needed to investigate the content comprehensively across all subreddits.

OBJECTIVE: The objective of this study is to examine content across quit vaping subreddits since their inception to better understand quitting vaping within the context of the expanding nicotine market.

METHODS: All posts from January 2015 to October 2021 were scraped from all quit vaping subreddits: r/QuittingJuul, r/QuitVaping, r/quit_vaping, and r/stopvaping (N=7110). Rolling weekly average post volume was calculated. A codebook informed by a latent Dirichlet allocation topic model was developed to characterize themes in a subsample of 695 randomly selected posts. Frequencies and percentages of posts containing each coded theme were assessed along with the number of upvotes and comments.

RESULTS: Post volume increased across all subreddits over time, spiking from August – September of 2019 when vaping lung injury emerged. Just over 52% of posts discussed seeking social support and 16.83% discussed providing social support. Posts providing support received the most positive engagements (i.e. upvotes) of all coded categories. Posts also discussed physical and psychological symptoms of withdrawal (30.65% and 18.85%, respectively), strategies for quitting including: quitting cold turkey (38.33%), using alternative nicotine products (17%), and tapering down nicotine content (10.50%). Most posts shared a personal narrative (92.37%) and some discussed quit motivation (28.20%) and relapse (14.99%).

CONCLUSIONS: This work identifies a desire for peer-to-peer support for quitting vaping, which reinforces existing literature and highlights characteristics of quitting vaping specific to a changing nicotine product environment. Given that posts providing social support were the most upvoted, this suggests that subreddit contributors are seeking support from their peers when discussing quitting vaping. Additionally, this analysis shows the sharing of barriers and facilitators for quitting, supporting findings from prior exploration of quit vaping subreddits. Finally, quitting vaping in an ever-growing nicotine market has led to the evolution of vaping-specific quit methods such as tapering down nicotine content. These findings have direct implications for quit vaping product implementation and development.

PMID:39454194 | DOI:10.2196/52129

J Strength Cond Res. 2024 Nov 1;38(11):1941-1950. doi: 10.1519/JSC.0000000000004884. Epub 2024 Sep 17.

ABSTRACT

Willingham, BD, Daou, M, VanArsdale, J, Thomas, M, and Saracino, PG. Energy availability in female collegiate beach volleyball athletes. J Strength Cond Res 38(11): 1941-1950, 2024-Low energy availability (LEA) is a present risk for many female athletes. Yet, the literature on LEA is often reliant on single, short-term, snapshots, which may not be reflective of the chronic energy balance surrounding female athletes in sport. Therefore, the purpose of this study was to establish the current prevalence of LEA in female collegiate beach volleyball athletes during the preseason and across the competitive season. One-way repeated measures analysis of variance was used to compare measures of EA (i.e., dietary intake, activity energy expenditure [EE], body composition) and EE (i.e., resting metabolic rate and thermic effect of feeding) at 4 timepoints-once in the preseason (i.e., Fall), and 3 times across the 10-week competitive season in Spring (i.e., week 1, week 5, and week 9). Significance was set at p ≤ 0.05. Although mean EA was in the subclinical zone (i.e., 30-45 kcal·kg FFM-1·d-1) at each timepoint, the prevalence of LEA for individuals was 30.8% in the preseason, 37.5% at week 1, 25.0% at week 5, and 62.5% at week 9. Further, carbohydrate intake was below the recommended range for power athletes at each timepoint, suggesting that female beach volleyball athletes with LEA may benefit from increasing carbohydrate intake. Despite no statistical differences in body mass across the season (p = 0.577), there was a trend for increasing fat-free mass (p = 0.062) as the season progressed. Importantly, LEA is not a team-wide condition but an individual one. Therefore, approaches to mitigate LEA should be individualized.

PMID:39454190 | DOI:10.1519/JSC.0000000000004884

J Med Internet Res. 2024 Oct 25;26:e58257. doi: 10.2196/58257.

ABSTRACT

BACKGROUND: Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person’s social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions.

OBJECTIVE: We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union.

METHODS: We conducted 83 face-to-face interviews with participants from a living lab in Lerești, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents’ preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category.

RESULTS: In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95% CI 1.79-7.85; P<.001).

CONCLUSIONS: Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals’ vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes.

PMID:39454189 | DOI:10.2196/58257

JMIR Res Protoc. 2024 Oct 25;13:e59894. doi: 10.2196/59894.

ABSTRACT

BACKGROUND: With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation.

OBJECTIVE: This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs.

METHODS: We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories-Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority.

RESULTS: This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year.

CONCLUSIONS: Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/59894.

PMID:39454188 | DOI:10.2196/59894

Mol Pharm. 2024 Oct 25. doi: 10.1021/acs.molpharmaceut.4c00686. Online ahead of print.

ABSTRACT

Spray drying is one of the leading manufacturing methods for active pharmaceutical ingredients (APIs) owing to its rapid, single-step, and cost-effective nature. It also has the capacity to generate microspheres capable of controlled release of APIs including biomolecules and vaccines. However, one of the key challenges of spray-dried formulations especially with poly(lactic-co-glycolic acid) (PLGA)-based controlled-release injectables is burst release, where a significant fraction of the API is released prematurely within a short period of time following administration, leading to detrimental impact on the performance and quality of end products. This study uses a model API, bovine serum albumin (BSA) protein, to identify the sources of burst release that may affect the kinetics and performance of long-acting injectable microsphere formulations. Spray-dried microspheres with various formulations (i.e., variable BSA/PLGA ratios) were characterized in terms of their morphology, particle size, surface area, thermal properties, moisture content, as well as chemical compositions and their distributions to investigate the impact of spray drying on the burst release phenomenon. The results suggest that a relatively high initial release (85%) observed is mainly attributed to the protein distribution close to the particle surface. Morphology analysis provided evidence that the microspheres retained their spherical structure during the burst release phase. X-ray photoelectron spectroscopy, hard X-ray photoelectron spectroscopy, and argon cluster sputtering-assisted time-of-flight secondary ion mass spectrometry analysis suggest an enrichment of PLGA on particle surfaces with buried BSA protein. The statistically significant difference in particle size and surface area between three different formulations may be responsible for an initial variation in release but did not seem to alter the overall burst release profile. Considering the suggested source of burst release, the two-fluid spray-drying method, characterized by a single liquid feed delivering a preprepared emulsion, generated matrix-type microspheres with a surface layer of PLGA, as evidenced by surface analysis. The PLGA surface layer proved to be prone to degradation and pore formation, allowing for faster diffusion of BSA out of the microspheres, resulting in a burst release. Increasing the polymer concentration did not seem to halt this process.

PMID:39454183 | DOI:10.1021/acs.molpharmaceut.4c00686

Phys Rev Lett. 2024 Oct 11;133(15):158302. doi: 10.1103/PhysRevLett.133.158302.

ABSTRACT

We discover an instability mechanism in suspensions of self-propelled particles that does not involve active stress. Instead, it is driven by a subtle interplay of inertia, swimmer motility, and concentration fluctuations, through a crucial time lag between the velocity and the concentration field. The resulting time-persistent state seen in our high-resolution numerical simulations consists of self-sustained waves of concentration and orientation, transiting from regular oscillations to wave turbulence. We analyze the statistical features of this active turbulence, including an intriguing connection to the Batchelor spectrum of passive scalars.

PMID:39454139 | DOI:10.1103/PhysRevLett.133.158302

J Clin Oncol. 2024 Oct 25:JCO2400965. doi: 10.1200/JCO.24.00965. Online ahead of print.

ABSTRACT

PURPOSE: Fatigue is a highly prevalent and disabling symptom for patients with metastatic breast cancer (MBC). Evidence-based interventions for managing fatigue in advanced cancer populations are lacking. This phase II randomized controlled trial tested the effect of acceptance and commitment therapy (ACT) on fatigue interference with functioning in patients with MBC.

METHODS: Eligible patients were women with stage IV breast cancer who had moderate to severe fatigue interference. Patients completed a baseline assessment that included self-report measures of fatigue interference with activities, mood, and cognition (primary outcome) and sleep interference with functioning, engagement in daily activities, and quality of life (QOL; secondary outcomes). Then patients were randomly assigned to six weekly telephone-delivered sessions of either ACT (n = 116) or education/support (n = 120). Follow-up assessments occurred at 2 weeks, 3 months, and 6 months postintervention (means, 9.69, 20.51, and 33.59 weeks postbaseline, respectively).

RESULTS: Linear mixed model analyses showed that compared with patients in the education/support condition, patients in the ACT condition reported significantly less fatigue interference (P = .018). These results were significant at 2 weeks and 6 months postintervention. ACT’s effect on sleep interference was not statistically significant after the Sidak adjustment for multiple comparisons (P = .037). ACT patients showed a steady decline in sleep interference, a trend that was not found for education/support patients. Engagement in daily activities and QOL did not significantly differ between study groups, except for functional QOL (P = .006). Compared with education/support patients, ACT patients showed significantly better functional QOL at 2 weeks and 6 months postintervention.

CONCLUSION: Results suggest that a brief, telephone-delivered ACT intervention can reduce fatigue interference with functioning in patients with MBC.

PMID:39454125 | DOI:10.1200/JCO.24.00965

PLoS One. 2024 Oct 25;19(10):e0306180. doi: 10.1371/journal.pone.0306180. eCollection 2024.

ABSTRACT

This study examines the effects of relative household income on individual well-being, mental health, and physical health in Germany. Consistent with previous studies, we document a dip in the distribution of households in which the wife out-earns the husband. Using a regression discontinuity design, we show that husbands in couples in which the wife earns just more exhibit lower satisfaction with life, work, and health, and report worse physical health. Women in these couples report lower satisfaction with life and health, and worse mental health. Results on life, work, and health satisfaction among women are more pronounced in West Germany, consistent with previous evidence of gender norm differences between East and West Germany.

PMID:39454115 | DOI:10.1371/journal.pone.0306180