Tag: nevin manimala

BMJ Open. 2025 Mar 18;15(3):e086150. doi: 10.1136/bmjopen-2024-086150.

ABSTRACT

OBJECTIVES: The aim of this study was to compare the cost-effectiveness of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) and explore variation by age and gender.

DESIGN: Cost-effectiveness analysis using a lifetime cohort Markov model.

SETTING: National population registry data.

PARTICIPANTS: Model parameters were informed by propensity score-matched comparisons of TSA and HA in patients with osteoarthritis and an intact rotator cuff using data from the National Joint Registry.

INTERVENTIONS: TSA and HA.

PRIMARY OUTCOME MEASURES: Quality-adjusted life years (QALYs) and healthcare costs for age and gender subgroups. A probabilistic sensitivity analysis was performed.

RESULTS: In all subgroups, TSA was more cost-effective, with the probability of being cost-effective about 70% for TSA versus 30% for HA at any willingness-to-pay threshold above £1100 per QALY. TSA was dominant in young patients (≤60 years) with a mean cost saving of £463 in men and £658 in women, and a mean QALY gain of 2 in both men and women. In patients aged 61-75 years, there was a mean cost saving following HA of £395 in men and £181 in women, while QALYs remained superior following TSA with a 1.3 gain in men and 1.4 in women. In the older cohort (> 75 years), the cost difference was highest and the QALY difference was lowest; there was a cost-saving following HA of £905 in men and £966 in women. The mean QALY gain remained larger after TSA: 0.7 in men and 0.9 in women.

CONCLUSION: TSA was more cost-effective than HA in patients with osteoarthritis. QALYs were superior following TSA in all patient groups. Cost differences varied by age and TSA was dominant in young patients.

PMID:40107707 | DOI:10.1136/bmjopen-2024-086150

BMJ Open. 2025 Mar 18;15(3):e082952. doi: 10.1136/bmjopen-2023-082952.

ABSTRACT

OBJECTIVE: This study examines the risk factors associated with non-communicable diseases (NCDs), specifically diabetes mellitus (DM) and hypertension (HTN), among adults in Bangladesh, a lower-middle-income country. Given the rising prevalence of DM and HTN and their significant public health burden, this research aims to identify key socioeconomic, demographic and lifestyle-related determinants to inform targeted interventions.

DESIGN: The study used nationally representative cross-sectional data extracted from the Bangladesh Demographic and Health Survey conducted in 2017-2018.

SETTING: Bangladesh.

PARTICIPANTS: The study included 8013 women and 6691 men aged 18 and older who were eligible for blood pressure and blood glucose measurements.

PRIMARY OUTCOMES: Type 2 DM, HTN.

RESULTS: HTN was significantly associated with higher odds of diabetes (adjusted OR (AOR)=1.28, 95% CI: 1.14 to 1.43), while diabetes was associated with increased odds of HTN (AOR=1.24, 95% CI: 1.11 to 1.39). Individuals aged 40 years and older had 74.8% higher odds of diabetes (AOR=1.748, 95% CI: 1.58 to 1.993) and were 3.21 times more likely to have HTN (AOR=4.208, 95% CI: 3.781 to 4.685). Overweight individuals had 2.15 times higher odds of HTN compared with those with normal weight (AOR=2.154, 95% CI: 1.98 to 2.34). Wealthier individuals also showed significantly higher odds of both DM and HTN.

CONCLUSIONS: This study highlights the strong association between DM and HTN and identifies age, overweight status and higher socioeconomic class as key risk factors. These findings underscore the need for integrated public health strategies targeting NCD prevention and management in Bangladesh. Further research should explore longitudinal trends and the impact of targeted interventions on reducing the burden of NCDs.

PMID:40107706 | DOI:10.1136/bmjopen-2023-082952

JMIR Cancer. 2025 Mar 19;11:e64809. doi: 10.2196/64809.

ABSTRACT

BACKGROUND: Cancer is the second leading cause of death in the United States. Compelling evidence shows screening detects colorectal cancer (CRC) at earlier stages and prevents the development of CRC through the removal of precancerous polyps. The Healthy People 2030 goal for CRC screening is 68.3%, but only 36.5% of Missouri federally qualified health center patients aged 50-75 years are up-to-date on CRC screening. For average risk patients, there are three commonly used screening tests in the United States-two types of stool tests collected at home (fecal immunochemical test [FIT]-immunochemical fecal occult blood test [FOBT] and FIT-DNA, such as Cologuard) and colonoscopies completed at procedural centers.

OBJECTIVE: This study aims to examine variation by month for the three types of CRC testing to evaluate consistent patient care by clinical staff.

METHODS: Data from 31 federally qualified health center clinics in Missouri from 2011 to 2023 were analyzed. A sample of 34,124 unique eligible “average risk” patients defined as persons not having a personal history of CRC or certain types of polyps, family history of CRC, personal history of inflammatory bowel disease, and personal history of receiving radiation to the abdomen or pelvic to treat a previous cancer or confirmed or suspected hereditary CRC syndrome. Another eligibility criterion is that patients need to be seen at least once at the clinic to be included in the denominator for the screening rate calculation. Descriptive statistics characterize the sample, while bivariate analyses assess differences in screening types by month.

RESULTS: Completion of CRC screening yielded statistically significant differences for patients completing the different types of CRC screening by month. October-January had the highest proportions of patients (644-680 per month, 8.5%-10.2%) receiving a colonoscopy, while February-April had the lowest (509-578 per month, 6.9%-7.8%), with 614 being the average monthly number of colonoscopies. For FIT-FOBT, June-August had the higher proportions of patients receiving this test (563-613 per month, 8.9%-9.6%), whereas December-February had the lowest (453-495 per month, 7.1%-8%), with 541 being the average monthly number of FIT-FOBT kits used. For FIT-DNA, March was the most popular month with 11.3% (n=261 per month) of patients using the Cologuard test, followed by April, May, and November (207-220 per month, 8.7%-9.4%), and January and June (168-171 per month, 7.2%-7.3%) had the lowest proportion of patients using Cologuard, with 193 being the average monthly number of FIT-DNA kits used. Combining all tests, February had the fewest CRC tests completed (1153/16,173, 7.1%).

CONCLUSIONS: Home-based tests are becoming popular, replacing the gold standard colonoscopy, but need to be repeated more frequently. Monthly variation of screening over the course of a year suggests that CRC screening efforts and patient care may be less than ideal. Months with lower rates of screening for each type of CRC test represent opportunities for improving CRC screening.

PMID:40106833 | DOI:10.2196/64809

Oral Dis. 2025 Mar 19. doi: 10.1111/odi.15316. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate the status of periodontitis patients and changes in their quality of life (QoL) after non-surgical and surgical periodontal treatment using OHIP-14, OHRQoL-UK questionnaires, and VAS.

METHODS: Of the 50 periodontitis patients included in the study, 27 received only non-surgical treatment. The remaining 23 individuals received additional surgical treatment because full recovery was not achieved with non-surgical periodontal treatment. OHIP-14, OHRQoL-UK questionnaires, and VAS were administered to these patients before periodontal treatment and after (4th and 12th weeks) to assess QoL measurements.

RESULTS: OHRQoL-UK results found that there was a statistically significant increase in the 3rd month (T2) values after the flap operation compared to the initial session (T0) (p < 0.05). Compared to non-surgical periodontal treatment (T1) with T2, the difference was not statistically significant except in the pain/discomfort category (p > 0.05). Although the results of the OHIP-14 questionnaire at T1 and T2 showed a significant difference compared to T0 values (p < 0.05), no significant difference was found between T1 and T2 (p > 0.05). An increase in some values was observed in VAS results compared to T0, but it was not significant (p > 0.05).

CONCLUSIONS: VAS, OHIP-14, and OHRQoL-UK questionnaires have shown that periodontal treatment improves the QoL of patients with periodontitis.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06539364.

PMID:40106822 | DOI:10.1111/odi.15316

JMIR Aging. 2025 Mar 19;8:e69107. doi: 10.2196/69107.

ABSTRACT

BACKGROUND: Researchers in Nova Scotia and Ontario, Canada, implemented a passive remote monitoring (PRM) model of home care unique to their health system contexts. Each PRM model integrated tailored PRM devices (eg, motion sensors, cameras, and door alarms) into home care patients’ residences with the aim of linking patients, family and friend caregivers, and health care providers to support older adults’ aging in place.

OBJECTIVE: The purpose of this study was to examine the use of PRM technologies in the home to support older adults’ safe aging in place and avoidance or delay of higher levels of care.

METHODS: This multiprovincial pragmatic randomized controlled trial examined how PRM technologies support older adults to safely remain in their home and avoid or delay admission to higher levels of care. Pairs of home care patients and their family and friend caregivers were recruited in Ontario and Nova Scotia. Participant pairs were randomly assigned to one of two conditions: (1) standard home care (ie, control) or (2) standard home care plus study-provided PRM (ie, intervention). Participants provided their provincial health insurance numbers to link with provincial health administrative databases and identify if patients were admitted to higher levels of care after 1 year. Cox proportional hazards models were used to evaluate the primary outcome in each province.

RESULTS: In total, 313 patient-caregiver pairs were recruited: 174 pairs in Ontario (intervention: n=60; control: n=114) and 139 pairs in Nova Scotia (intervention: n=45; control: n=94). Results indicate PRM was associated with a nonsignificant 30% reduction in risk of patients being admitted to higher levels of care in Ontario (hazard ratio 0.7, 95% CI 0.3-1.4) and no reduction in risk in Nova Scotia (hazard ratio 1.1, 95% CI 0.3-3.7). Adjusting for patient sex had no impact on model estimates for either province.

CONCLUSIONS: Limitations related, in part, to the impact of the COVID-19 pandemic may have contributed to the effectiveness of the intervention. While our study did not yield statistically significant results (P=.30 and P=.90) regarding the effectiveness of the PRM model in prolonging home stays, the observed trends suggest that technology-assisted aging in place may be a valuable goal for older adults. Further study is required to understand if longer follow-up time allows more effects of PRM on patients’ avoidance of higher levels of care to be detected.

TRIAL REGISTRATION: ISRCTN ISRCTN79884651; https://www.isrctn.com/ISRCTN79884651.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/15027.

PMID:40106817 | DOI:10.2196/69107

J Med Internet Res. 2025 Mar 19;27:e51524. doi: 10.2196/51524.

ABSTRACT

BACKGROUND: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention.

OBJECTIVE: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania.

METHODS: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data.

RESULTS: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers.

CONCLUSIONS: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624.

PMID:40106816 | DOI:10.2196/51524

J Med Internet Res. 2025 Mar 19;27:e64193. doi: 10.2196/64193.

ABSTRACT

BACKGROUND: The integration of digital technology into older adult health and care has enhanced the intelligence of health and older adult care products and services while also transforming how seniors acquire and share health information. Assessing older adults’ digital health literacy (DHL) is crucial for developing targeted interventions.

OBJECTIVE: This study aims to develop and validate a DHL assessment questionnaire for older adults. It also seeks to evaluate the questionnaire’s scientific validity and feasibility among community-dwelling older adults in China, providing a reliable tool for assessing their level of DHL.

METHODS: A literature review, focus group discussions, and the Delphi method were used to construct the questionnaire item pool and perform item screening. Item analysis was conducted for comprehensive evaluation, and questionnaire validity was assessed through construct validity (exploratory factor analysis, confirmatory factor analysis, convergent validity, and discriminant validity), content validity, and criterion-related validity. Reliability was analyzed using Cronbach alpha coefficient, split-half reliability, and test-retest reliability.

RESULTS: The study included 710 participants. Item analysis indicated that the questionnaire had strong discriminant validity. Correlation coefficient analysis showed that the item-total correlation coefficients ranged from 0.497 to 0.920 (P<.01). After multiple exploratory factor analyses, 6 common factors were extracted, with a cumulative variance contribution rate of 73.745%. Confirmatory factor analysis demonstrated a good model fit (χ²/df=2.803, root-mean-square error of approximation=0.071, comparative fit index=0.907, goodness-of-fit index=0.773, incremental fit index=0.908, Tucker-Lewis index=0.901, normed fit index=0.863). The questionnaire demonstrated favorable convergent validity, content validity, and criterion-related validity. The total Cronbach α coefficient was 0.976, with dimension-specific Cronbach α coefficients ranging from 0.819 to 0.952, indicating satisfactory internal consistency. Additionally, the test-retest reliability coefficient for the total questionnaire was 0.925, demonstrating good stability over time.

CONCLUSIONS: This study developed a questionnaire specifically designed to assess DHL in older adults through a scientifically rigorous and systematic process. The questionnaire demonstrates strong psychometric properties and can serve as an empirical tool for health professionals to design personalized intervention policies and enhance health service delivery.

PMID:40106815 | DOI:10.2196/64193

J Med Internet Res. 2025 Mar 19;27:e67228. doi: 10.2196/67228.

ABSTRACT

BACKGROUND: Heart failure (HF) is a complex, life-threatening condition marked by high morbidity, mortality, reduced functional capacity, poor quality of life, and substantial health care costs. HF with reduced ejection fraction (HFrEF) represents the subgroup of HF with the highest risks of mortality and hospitalization, necessitating the prioritization of care and management models to optimize treatment outcomes in these patients. Currently, data on the effectiveness of telemedicine models in resource-limited settings, such as low- and middle-income countries, are scarce.

OBJECTIVE: This study aimed to evaluate the impact of telemedicine on improving prognosis in patients with HFrEF in Vietnam.

METHODS: In this prospective cohort study, we recruited patients who received either remote monitoring and management (telemedicine) or standard monitoring and management (usual care) in the outpatient department of the Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam. Eligible patients were ≥18 years old, had a diagnosis of HFrEF defined as left ventricular ejection fraction (LVEF) ≤40%, had a history of HF hospitalization within the past 12 months, and presented with clinical symptoms classified as New York Heart Association (NYHA) II or III. The primary composite outcome was defined as the time to the first unplanned HF hospitalization or all-cause mortality. The follow-up period for all outcomes extended to 12 months.

RESULTS: In total, 426 patients (298/426, 70% male; 128/426, 30% female) with a mean age of 61.3 (SD 14.6) years and a mean LVEF of 32.1% (SD 6.0%) were included in our study. Of these patients, 121 received telemedicine care, while 305 received usual care. The primary outcome occurred in 23 (23/121, 19%) patients in the telemedicine group and 82 (82/305, 26.9%) patients in the usual care group during the follow-up period, indicating a significant reduction in risk (adjusted hazard ratio [aHR] 0.57, 95% CI 0.35-0.94; P=.03). However, this effect was primarily driven by a significant reduction in unplanned HF hospital admissions (aHR 0.57, 95% CI 0.33-0.98; P=.04) rather than in all-cause mortality (aHR 0.77, 95% CI 0.36-1.63; P=.49).

CONCLUSIONS: This study demonstrates that a simplified telemedicine model, even in resource-limited settings such as Vietnam, can effectively facilitate the remote monitoring and management of patients with HFrEF, resulting in significant reductions in HF-related hospitalizations and all-cause mortality.

TRIAL REGISTRATION: National Agency for Science and Technology Information (NASATI), Vietnam CT07/01-2022-3; https://nsti.vista.gov.vn/projects/dth/xay-dung-mo-hinh-theo-doi-va-tu-van-suc-khoe-tim-mach-tu-xa-tai-thanh-pho-ha-noi-109276.html.

PMID:40106810 | DOI:10.2196/67228

J Med Internet Res. 2025 Mar 19;27:e63137. doi: 10.2196/63137.

ABSTRACT

BACKGROUND: Enhancing the effectiveness of current pain relief strategies is a persistent clinical challenge. Although transcutaneous electrical nerve stimulation (TENS) is used in various painful conditions, its effectiveness may decline over time, requiring additional pain management strategies. Immersive virtual reality (VR) with personalized visuo-tactile stimulation has demonstrated analgesic properties. Nevertheless, whether visuo-tactile stimulation can enhance the pain-relieving outcomes of TENS and its underlying neurophysiological mechanisms remains largely unknown.

OBJECTIVE: The study aims to investigate whether the integration of visuo-tactile stimulation with TENS can enhance the pain-relieving outcomes of TENS alone, and we also aim to explore the brain mechanisms underlying the analgesic effect of this integrated intervention.

METHODS: In this study, 75 healthy participants were enrolled and randomly assigned to 1 of 3 groups: congruent TENS-VR (TENS-ConVR) and 2 control groups (incongruent TENS-VR [TENS-InVR] and TENS alone). In the context of TENS-ConVR, we combined TENS and VR by connecting TENS-induced paresthesia with personalized visual bodily feedback. The visual feedback was designed to align with the spatiotemporal patterns of the paresthesia induced by TENS. A pain rating task and a 32-channel electroencephalography were applied.

RESULTS: Two-way ANOVAs showed that TENS-ConVR exhibited a statistically greater reduction in pain rating (F_1,48=6.84; P=.01) and N2 amplitude (F_1,48=5.69; P=.02) to high-intensity pain stimuli before and after stimulation than TENS alone. The reduction of brain activity was stronger in participants who reported stronger pain-relieving outcomes. TENS-ConVR reduced the brain oscillation in the gamma band, whereas this result was not found in TENS alone.

CONCLUSIONS: This study observed that combining TENS and visual stimulation in a single solution could enhance the pain-relieving effect of TENS, which has the potential to improve the effectiveness of current pain management treatments.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2500098834; https://www.chictr.org.cn/showprojEN.html?proj=254171.

PMID:40106805 | DOI:10.2196/63137

JMIR Mhealth Uhealth. 2025 Mar 19;13:e55379. doi: 10.2196/55379.

ABSTRACT

BACKGROUND: Tobacco use remains the leading preventable cause of morbidity and mortality in the United States. Novel interventions are needed to improve smoking cessation rates. Mindfulness-based interventions (MBIs) for cessation address tobacco use by increasing awareness of the automatic nature of smoking and related behaviors (eg, reactivity to triggers for smoking) from a nonjudgmental stance. Delivering MBIs for smoking cessation via innovative technologies allows for flexibility in the timing of intervention delivery, which has the potential to improve the efficacy of cessation interventions. Research shows MBIs target key mechanisms in the smoking cessation process and can be used to minimize drivers of smoking lapse.

OBJECTIVE: This single-arm study investigated the impact of mindfulness-based strategies and motivational messages on proximal outcomes, collected via ecological momentary assessment (EMA), relevant to tobacco abstinence via a microrandomized trial. This approach allows for the evaluation of intervention content on proximal outcomes (eg, reduced negative affect) that are thought to impact positive distal outcomes (eg, smoking abstinence).

METHODS: All participants were motivated to quit smoking, and the intervention they received included nicotine replacement therapy, brief individual counseling, and a 2-week Just-in-Time Adaptive Intervention (JITAI) with wearable sensors. Throughout the JITAI period, a single strategy was randomly pushed (vs not) multiple times per day through the smartphone application. An EMA next assessed negative affect, positive affect, mindfulness, abstinence self-efficacy, motivation to quit, craving, and smoking motives. The primary analyses evaluated differences in EMA outcomes (proximal) for when a strategy was pushed versus not pushed. Additional analyses evaluated changes in similar outcomes collected from surveys at the baseline and end-of-treatment visits.

RESULTS: Participants (N=38) were 63% (24/38) female, 18% (7/38) Hispanic or Latino, and 29% (11/38) African American. They had an average age of 49 years and smoked an average of 15 (SD 7.9) cigarettes per day. Results indicated that receiving the JITAI significantly reduced proximal negative affect in the second (and final) week of the intervention. Self-reports provided at baseline and end of treatment showed significant decreases in perceived stress, automaticity of smoking and craving, and a significant increase in abstinence self-efficacy. Increases in abstinence self-efficacy significantly predicted abstinence.

CONCLUSIONS: To our knowledge, this is the first study to test the proximal impact of a mindfulness-based JITAI on key variables associated with smoking cessation. Our primary finding was that negative affect was lower following the completion of a strategy (vs when no strategy was delivered) in the final week of the JITAI. Among a larger sample size, future research should extend the length of the intervention to further evaluate the impact of the JITAI, as well as include a comparison condition to further evaluate how each component of the intervention uniquely impacts outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03404596; https://clinicaltrials.gov/study/NCT03404596.

PMID:40106803 | DOI:10.2196/55379