Tag: nevin manimala

JMIR Form Res. 2025 Apr 14;9:e66301. doi: 10.2196/66301.

ABSTRACT

BACKGROUND: Approximately 20% of US adults identify as having a mental illness. Structural and other barriers prevent many people from receiving mental health services. Digital mental health apps that provide 24-hour, real-time access to human support may improve access to mental health services. However, information is needed regarding how and why people engage with licensed counselors through a digital, real-time, text-based mental health support app in nonexperimental settings.

OBJECTIVE: This study aimed to evaluate how people engage with Counslr, a 24-hour, digital, mental health support app where users communicate in real time with human counselors through text messaging. Specifically, access patterns (eg, day of the week and time of session) and reasons for accessing the platform were examined. Furthermore, whether differences existed between session types (on-demand or scheduled) and membership types (education or noneducation) in regard to access patterns and why people accessed the platform were evaluated.

METHODS: The study population (users) consisted of students whose schools, universities, or colleges partnered with Counslr and employees whose organizations also partnered with Counslr. Users participated in text-based mental health support sessions. In these sessions, users engaged with licensed counselors through digital, text-based messaging in real time. Users could initiate an on-demand session or schedule a session 24 hours a day. User engagement patterns were evaluated through session length, session day, session time, and self-reported reasons for initiating the session. The data were stratified by membership type (education [students] or noneducation [employees]) and session type (on-demand or scheduled) to evaluate whether differences existed in usage patterns and self-reported reasons for initiating sessions by membership and session types.

RESULTS: Most students (178/283, 62.9%) and employees (28/44, 63.6%) accessed Counslr through on-demand sessions. The average and median session times were 40 (SD 15.3) and 45 minutes. On-demand sessions (37.9 minutes) were shorter (P=.001) than scheduled sessions (43.5 minutes). Most users (262/327, 80.1%) accessed Counslr between 7 PM and 5 AM. The hours that users accessed Counslr did not statistically differ by membership type (P=.19) or session type (P=.10). Primary self-reported reasons for accessing Counslr were relationship reasons, depression, and anxiety; however, users initiated sessions for a variety of reasons. Statistically significant differences existed between membership and session types (P<.05) for some of the reasons why people initiated sessions.

CONCLUSIONS: The novel findings of this study illustrate that real-time, digital mental health support apps, which offer people the opportunity to engage with licensed counselors outside of standard office hours for a variety of mental health conditions, may help address structural barriers to accessing mental health support services. Additional research is needed to evaluate the effectiveness of human-based apps such as Counslr and whether such apps can also address disparities in access to mental health support services among different demographic groups.

PMID:40228290 | DOI:10.2196/66301

Medicine (Baltimore). 2025 Apr 11;104(15):e41839. doi: 10.1097/MD.0000000000041839.

ABSTRACT

This study aimed to evaluate return to work (RTW) across different job groups, identify predictors of successful RTW, and investigate reasons for RTW failure. This case-control study, conducted in 2022, included 164 male patients who had ST elevation myocardial infarction (STEMI) in 2016 to 2017 and were registered in the 5-year ST Elevation Myocardial Infarction Cohort in Isfahan, Iran. Patients were divided into RTW (n = 82) and RTW failure (n = 82) groups, frequency-matched for education, marital status, and comorbidities. Baseline data were extracted from the cohort database, and occupational factors were gathered via telephone contact. Statistical analysis was performed using chi-square tests, t tests, and multivariate logistic regression to identify significant predictors of RTW, with P < .05 considered statistically significant. Data from 164 patients aged 18 to 65 with STEMI showed that those who returned to work had a mean age of 49.05 years, compared to 53.04 years for those who did not (P = .001). Factors associated with increased RTW included younger age (odds ratios [OR]: 0.86; 95% confidence intervals: 0.77-0.95), shorter hospitalization (OR: 0.63; 0.44-0.91), and lower first systolic blood pressure (OR: 0.97; 0.94-0.99). Most patients (49.39%, n = 59) returned within 1 month. Common RTW failure reasons were personal decisions (36.58%, n = 30), retirement (25.61%, n = 21), and choosing lighter jobs (25.61%, n = 21). No significant relationship was found between job groups of the International Standard Classification of Occupations and RTW (P = .581). Our study identifies key factors influencing RTW after STEMI, including age, history of myocardial infarction, hospitalization duration, treatment methods, and initial systolic blood pressure. The most common barrier to RTW was patient unwillingness. A comprehensive approach that integrates primary prevention, personalized rehabilitation, and financial and social support is recommended to improve RTW outcomes.

PMID:40228286 | DOI:10.1097/MD.0000000000041839

Medicine (Baltimore). 2025 Apr 11;104(15):e41918. doi: 10.1097/MD.0000000000041918.

ABSTRACT

BACKGROUND: There is a close relationship between asthma and obstructive sleep apnea (OSA), and the mechanisms of these 2 diseases are overlapped. However, the relationship between OSA and allergic asthma remains to be analyzed through systematic review and meta-analysis.

METHODS: A systematic search was conducted using Scopus, PubMed, ISI, Google Scholar, and Cochrane Library by utilizing the keywords Allergic asthma, Obstructive sleep apnea, and OSA. Hazard ratio, odds ratio (OR), and risk ratio with 95% confidence interval, fixed and Mantel-Haenszel methods were calculated. Statistical software Stata was used for the evaluation of this meta-analysis.

RESULTS: Finally, 19 articles were included in this study. The prevalence of OSA in allergic asthma patients was 35.25% (19.92%, 50.57%), which was statistically significant, and pooled analysis of ORs observed in individual studies showed that the odds of OSA prevalence were 2.24 (1.32, 3.12) (P < 0.001). Also, the prevalence of OSA risk in allergic asthma patients was 30.08% (19.73%, 40.43%), which was statistically significant, and pooled analysis of ORs observed in individual studies showed that the odds of OSA risk were 3.46 (2.96, 4.94) (P < 0.001).

CONCLUSION: The present meta-analysis showed that the prevalence of OSA as well as the OSA risk in patients with asthma were significantly higher compared with healthy people.

PMID:40228283 | DOI:10.1097/MD.0000000000041918

Medicine (Baltimore). 2025 Apr 11;104(15):e42135. doi: 10.1097/MD.0000000000042135.

ABSTRACT

Artificial intelligence (AI) and the introduction of Large Language Model (LLM) chatbots have become a common source of patient inquiry in healthcare. The quality and readability of AI-generated patient education materials (PEM) is the subject of many studies across multiple medical topics. Most demonstrate poor readability and acceptable quality. However, an area yet to be investigated is chemotherapy-induced cardiotoxicity. This study seeks to assess the quality and readability of chatbot created PEM relative to chemotherapy-induced cardiotoxicity. We conducted an observational cross-sectional study in August 2024 by asking 10 questions to 4 chatbots: ChatGPT, Microsoft Copilot (Copilot), Google Gemini (Gemini), and Meta AI (Meta). The generated material was assessed for readability using 7 tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index (ARI), and FORCAST Grade Level. Quality was assessed using modified versions of 2 validated tools: the Patient Education Materials Assessment Tool (PEMAT), which outputs a 0% to 100% score, and DISCERN, a 1 (unsatisfactory) to 5 (highly satisfactory) scoring system. Descriptive statistics were used to evaluate performance and compare chatbots amongst each other. Mean reading grade level (RGL) across all chatbots was 13.7. Calculated RGLs for ChatGPT, Copilot, Gemini and Meta were 14.2, 14.0, 12.5, 14.2, respectively. Mean DISCERN scores across the chatbots was 4.2. DISCERN scores for ChatGPT, Copilot, Gemini, and Meta were 4.2, 4.3, 4.2, and 3.9, respectively. Median PEMAT scores for understandability and actionability were 91.7% and 75%, respectively. Understandability and actionability scores for ChatGPT, Copilot, Gemini, and Meta were 100% and 75%, 91.7% and 75%, 90.9% and 75%, and 91.7% and 50%, respectively. AI chatbots produce high quality PEM with poor readability. We do not discourage using chatbots to create PEM but recommend cautioning patients about their readability concerns. AI chatbots are not an alternative to a healthcare provider. Furthermore, there is no consensus on which chatbots create the highest quality PEM. Future studies are needed to assess the effectiveness of AI chatbots in providing PEM to patients and how the capabilities of AI chatbots are changing over time.

PMID:40228277 | DOI:10.1097/MD.0000000000042135

Medicine (Baltimore). 2025 Apr 11;104(15):e42134. doi: 10.1097/MD.0000000000042134.

ABSTRACT

The high readmission rate of patients with chronic heart failure (HF) can cause waste of medical resources and economic losses. Establishing an effective HF readmission model can effectively alleviate medical pressure and improve the quality of treatment. In this study, we conducted a comprehensive analysis of clinical and laboratory data from 248 patients with chronic HF who received treatment at our medical center between January 2021 to January 2022. We also measured soluble CD40 ligand (sCD40L) levels to determine their association with readmission due to HF during follow-up. To analyze the data, we employed various statistical methods including one-way ANOVA, correlation analysis, univariate COX regression, and Least Absolute Shrinkage and Selection Operator COX regression. Using these techniques, we organized the data and constructed a predictive model that was both trained and validated. We developed a nomogram to assess the likelihood of readmission within 180 days for patients with chronic HF. Our findings revealed that monocytes, creatinine, sCD40L, and hypertension history were all independent risk factors for 180-day HF readmissions. Additionally, our model’s AUC was 0.731 in the training dataset and 0.704 in the validation dataset. This study provides new insights for predicting readmission within 180 days for patients with chronic HF. And sCD40L is an important predictive indicator for readmission of HF patients within 180 days, and clinical doctors can develop appropriate treatment plans based on sCD40L.

PMID:40228270 | DOI:10.1097/MD.0000000000042134

Medicine (Baltimore). 2025 Apr 11;104(15):e42060. doi: 10.1097/MD.0000000000042060.

ABSTRACT

BACKGROUND: Open reduction and percutaneous pinning (ORPP) is commonly regarded as the primary treatment option for serious displaced lateral condyle fractures of the humerus (LCFs) in children. However, some authors have suggested that closed reduction and percutaneous pinning (CRPP) may be an appropriate method for treating LCFs. This meta-analysis aims to compare the outcomes of these 2 fixation techniques.

METHODS: Our study conducted a search of the Pubmed, Embase, and Cochrane Library databases for published research up to October 1, 2022. Our analysis comprehensively compared the operation failure rate, elbow function, and complication rate between CRPP and ORPP. This study was registered with PROSPERO (CRD42022379655).

RESULTS: Our analysis included 6 non-randomized controlled trials and 532 patients. We used the Newcastle Ottawa Scale to assess the bias risk of these studies, with scores ranging from 6 to 9. The results indicate that both CRPP and ORPP yielded satisfactory elbow function outcomes (OR = 0.35, 95% CI = 0.07-1.88, P = .22). However, CRPP had a significant rate of operative failure (17.65%, OR = 21.77, 95% CI = 3.98-119.08, P = .0004) but a lower likelihood of unsightly scars (OR = 0.06, 95% CI = 0.01-0.31, P = .008). The failure rate of surgery is 0% in ORPP. There were no significant differences found in total infection (OR = 0.46, 95% CI = 0.21-1.01, P = .05), avascular necrosis (OR = 0.84, 95% CI = 0.09-7.79, P = .88), delayed union (OR = 1.49, 95% CI = 0.06-37.35, P = .81), or surgical time (MD = 4.46, 95% CI = -25.92 to 34.84, P = .77).

CONCLUSIONS: In comparison to ORPP, CRPP may result in a higher rate of operative failure but has been found to significantly reduce the occurrence of unsightly scars. Both CRPP and ORPP showed similar levels of postoperative functional satisfaction, with no statistical difference in other complications. Our research suggests that qualified closed reduction is a viable option for doctors to treat LCF.

LEVELS OF EVIDENCE: IV.

PMID:40228269 | DOI:10.1097/MD.0000000000042060

Medicine (Baltimore). 2025 Apr 11;104(15):e42105. doi: 10.1097/MD.0000000000042105.

ABSTRACT

In our study, we aimed to investigate the relationship between anti-müllerian hormone (AMH) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score, which are known to be increased in patients with polycystic ovary syndrome (PCOS), and morning blood pressure surge (MBPS), and whether these measurements are a marker for early cardiovascular disease risk in patients with PCOS. Forty patients aged between 18 and 65 years with hypertension (HT) and PCOS, 40 patients with HT but without PCOS, and 40 people representing the healthy control group were included in our prospective, cross-sectional study. All patients underwent ambulatory blood pressure measurement for 24 hours and MBPS was calculated. The study groups were divided into 3 groups as healthy control group (group 1), patient group with HT without PCOS (group 2), and patient group with HT and PCOS (group 3). MBPS was found to be statistically significantly higher in group 3. In linear regression analysis, AMH and HOMA-IR levels were found to be independently associated with MBPS. In patients with PCOS, AMH, and HOMA-IR levels were significantly higher in the group with MBPS > 25 mm Hg. Early diagnosis and treatment of PCOS and accompanying comorbidities can halt the progression of cardiac disorders and reduce cardiovascular mortality and morbidity. AMH level, HOMA-IR score, and MBPS measurement can be used in early detection and prediction of cardiovascular disease in PCOS patients.

PMID:40228266 | DOI:10.1097/MD.0000000000042105

Medicine (Baltimore). 2025 Apr 11;104(15):e41692. doi: 10.1097/MD.0000000000041692.

ABSTRACT

BACKGROUND: To evaluate the effect of laparoscopic procedures integrated with traditional Chinese medicine (TCM), specifically aimed at enhancing blood flow and alleviating blood stasis, on oxidative stress levels in individuals with endometriosis-induced infertility.

METHODS: We performed a systematic quantitative review to evaluate the effects of laparoscopic surgery combined with TCM on oxidative stress in endometriosis-related infertility by enhancing blood circulation and resolving stasis. A literature search of 9 major databases was performed. Meta-analysis was performed using Review Manager version 5.4 (R Foundation for Statistical Computing, Vienna, Austria) and Stata Release 16.0 (StataCorp LLC, College Station, TX). This systematic review was registered with the International Prospective Register of Systematic Reviews (i.e., “PROSPERO”) (registration number: CRD42024526800).

RESULTS: Thirteen trials comprising 1084 participants were included. Laparoscopy combined with TCM for promoting blood circulation and removing blood stasis significantly reduced the levels of 8-isoprostane prostaglandin F2α (mean difference [MD] -29.57 [95% confidence interval (CI) -32.65 to -26.49]; P < .001), regulated on activation, normal T cell expressed and secreted (MD -231.83 [95% CI -341.33 to -122.32]; P < .001), reactive oxygen species (MD -0.92; [95% CI -1.12 to -0.73]; P < .001), monocyte chemoattractant protein-1 (MD -31.23 [95% CI -42.70 to -19.77]; P < .001), and increased glutathione peroxidase (MD 31.45 [95% CI 26.04 to 36.87]; P < .001), vitamin E (MD 4.86 [95% CI 3.77 to 5.94]; P < .001), superoxide dismutase (standardized MD 0.92 [95% CI 0.41 to 1.42]; P < .001).

CONCLUSION: Compared with laparoscopic surgery alone, the combination of TCM for promoting blood circulation and removing blood stasis demonstrated the potential to ameliorate oxidative stress in patients with endometriosis-induced infertility. However, further large-scale clinical trials are required to confirm these findings.

PMID:40228263 | DOI:10.1097/MD.0000000000041692

Medicine (Baltimore). 2025 Apr 11;104(15):e42073. doi: 10.1097/MD.0000000000042073.

ABSTRACT

Anxiety is common in emergency department (ED) patients, affecting physiological stability, treatment adherence, and clinical outcomes. Standardized quality care models may alleviate these effects, but further validation is needed. This study evaluates the impact of a standardized quality care model on anxiety, physiological parameters, and quality of life in ED patients. This retrospective cohort study included 205 ED patients treated between January 2021 and December 2023, selected using consecutive sampling. Patients were categorized into the standardized quality care group (n = 95) or the routine care group (n = 110) based on prior nursing care. Anxiety and depression were assessed using SAS, HAMA, GAD-7, and self-depression scale (SDS), and psychological distress with SCL-90. Quality of life was measured using social functioning (SF)-36v2, while physiological indicators (heart rate, blood pressure, oxygen saturation), patient satisfaction, and medical compliance were recorded. Statistical analyses were conducted using SPSS 26.0, with independent sample t-tests or Mann-Whitney U tests for continuous variables and chi-square (χ²) tests for categorical variables (P < .05 considered significant). The standardized care group had significantly lower anxiety (SAS, HAMA, GAD-7) and depression (SDS) scores than the routine care group (P < .05). Moderate to severe psychological distress (SCL-90) was also lower (P = .015). Physiological indicators, including heart rate (P = .012), systolic blood pressure (P = .03), diastolic blood pressure (P = .03), and oxygen saturation (P = .03), improved significantly. At the 1-month follow-up, SF-36v2 scores, including physical component summary and mental component summary, were significantly higher in the standardized care group (P < .05). Patient satisfaction (χ² = 13.28, P = .004) and medical compliance (χ² = 6.01, P = .049) were also improved. The standardized quality care model effectively reduces anxiety and depression, enhances physiological stability, and improves quality of life, patient satisfaction, and treatment adherence in ED patients. These findings support integrating structured nursing interventions into ED care. Larger prospective studies are needed to validate long-term benefits and explore technology-driven enhancements.

PMID:40228261 | DOI:10.1097/MD.0000000000042073

Medicine (Baltimore). 2025 Apr 11;104(15):e42163. doi: 10.1097/MD.0000000000042163.

ABSTRACT

Pneumonia and other lower respiratory tract diseases rank as the fourth leading cause of death worldwide. The objective of this study was to examine pneumonia hospitalization patterns, and trends in total pneumonia hospitalization stratified by age group, by type of hospitalization, and by age group in Australia, England, Wales. This study utilized 3 databases to obtain hospital admissions data: the National Hospital Morbidity Database for Australian hospital admissions data, the Hospital Episode Statistics database (HES) for England hospital admissions data, and the Patient Episode Database for Wales. Pneumonia hospitalization data were extracted utilizing J12 to J18 codes. From 2013 to 2020, there were 4,514,444 cases of pneumonia hospitalizations reported in Australia (646,515 [14.32%]), England (3,668,106 [81.25%]), and Wales (199,823 [4.43%]). The most common type of pneumonia hospitalization in Australia, England, and Wales was “pneumonia, organism unspecified,” accounting for 77.12%, 95.49%, and 95.75% of the total number of pneumonia hospitalizations in each country, respectively. The most common subtype of pneumonia hospitalization in Australia was “pneumonia, unspecified,” accounting for 72.98% of the total number of pneumonia hospitalizations in the country. The most common type of pneumonia hospitalization in England and Wales was “lobar pneumonia, unspecified,” accounting for 59.00% and 56.73% of the total number of pneumonia hospitalizations in each country, respectively. Most pneumonia hospitalizations in Australia, England, and Wales were non-same-day hospitalizations, accounting for 90.78%, 99.91%, and 99.95%, respectively. Pneumonia hospitalizations in Australia, England, and Wales were directly related to age. Males accounted for most pneumonia hospitalizations in Australia, England, and Wales. This study highlighted that hospitalization rate for pneumonia increased during the past decade in Australia, England, and Wales. The age and male gender were clearly contributing factors that affected pneumonia hospitalizations rate. Educational campaign aiming to increase public knowledge of pneumonia, its risk factors, and lifestyle modification should be prioritized to decrease pneumonia episodes.

PMID:40228257 | DOI:10.1097/MD.0000000000042163