Tag: nevin manimala

JMIR Mhealth Uhealth. 2026 Mar 12;14:e88054. doi: 10.2196/88054.

ABSTRACT

BACKGROUND: Behavior change interventions delivered through mobile phones often have low engagement among end users.

OBJECTIVE: This study aimed to explore factors influencing engagement among Swedish high school students with access to LIFE4YOUth, a mobile-based multiple behavior change intervention targeting physical activity, diet, alcohol consumption, and cigarette smoking. Special emphasis was placed on understanding low engagement.

METHODS: A sequential explanatory mixed methods design was used. Quantitative usage data from 377 students were analyzed to describe engagement patterns. This was followed by qualitative data collection through 3 focus groups and 2 individual interviews (n=20), analyzed using inductive content analysis. Finally, qualitative comparative analysis (QCA) was used to integrate findings and identify configurations of psychosocial and behavioral conditions associated with low engagement. The results from all phases were interpreted and discussed as a whole.

RESULTS: A majority (253/377, 67%) of participants showed low engagement, with 62% (158/253) never interacting with the intervention beyond receiving weekly SMS text messaging. Focus group discussions revealed 3 overarching categories influencing engagement: perceived importance of behavior change, user experiences, and environment of use. In total, 48% (121/253) of the low-engaged participants were represented by 1 of 3 configurations, which described participants’ characteristics as unmotivated high-needers, motivated low-needers, and dissatisfied needers. Robustness tests confirmed the stability of the unmotivated high-needers configuration.

CONCLUSIONS: LIFE4YOUth (Linköping University) did not engage high school students with multiple risk behaviors who were content with their lives and did not consider healthy behaviors as very important. However, positive experiences of being both confirmed and encouraged may explain engagement among students engaged in a combination of health-risk and health-promoting behaviors. Future research could explore how tailoring the number of behaviors targeted by mHealth interventions for adolescents might increase engagement and, in turn, behavioral outcomes.

PMID:41818749 | DOI:10.2196/88054

J Med Internet Res. 2026 Mar 12;28:e79563. doi: 10.2196/79563.

ABSTRACT

BACKGROUND: Hip fractures in older adults increasingly challenge public health, making traditional rehabilitation very challenging. Digital health interventions (DHIs) have emerged as a promising solution for postoperative rehabilitation. However, evidence on DHIs’ effects on functional and psychological outcomes remains insufficient.

OBJECTIVE: This systematic review aimed to comprehensively examine the effects of DHIs on functional and psychological outcomes in older adults with hip fractures.

METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 9 databases (PubMed, Embase, CENTRAL, APA PsycINFO, Web of Science, PEDro, CNKI, WANFANG, and SinoMed) from inception to November 13, 2025. Included studies enrolled adults aged 60 years and older with hip fractures, delivered DHIs, assessed functional and psychological outcomes, set usual care or no intervention as the control, and had a randomized controlled trial design. Studies were excluded if they enrolled nonhospitalized patients in the emergency department, patients discharged to nonhome settings, or had inaccessible full text or insufficient data. Study quality was evaluated using the Cochrane Risk of Bias tool 2.0 (Cochrane Collaboration), and evidence certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). The literature screening, data extraction, and quality assessment were independently conducted by 2 researchers, and any disputes were resolved by the third researcher. We performed analysis using R version 4.0.3 (R Foundation for Statistical Computing) with a random-effects model.

RESULTS: Of 17,723 studies screened, 13 met the inclusion criteria. DHIs, compared to the control, significantly improved hip function (standardized mean difference [SMD] 0.80, 95% CI 0.33-1.26; 95% prediction interval [PI] -0.24 to 1.83; P=.007) and functional independence (SMD 1.23, 95% CI 0.34-2.11; 95% PI -0.98 to 3.34; P=.02). Despite favorable pooled effects, a wide 95% PI spanning positive or negative values signals substantial heterogeneity. No significant difference was observed in balance function, risk of falling, and quality of life. Only a single available study reported a 70% adherence rate in the DHIs group. Subgroup analyses stratified by intervention duration revealed no significant intersubgroup differences for hip function (χ₁²=0.1; P=.75) or functional independence (χ₁²=2.93; P=.09). For hip function, the point estimate favored the 3 months subgroup (SMD 0.89, 95% CI 0.36-1.41; I²=7%; P=.41) over the <3 months subgroup. Conversely, for functional independence, the point estimate favored shorter intervention duration (SMD 0.67, 95% CI 0.12-1.23; I²=0%; P=.72).

CONCLUSIONS: This review incorporates the latest randomized controlled trials and comprehensively assesses functional and psychological outcomes of DHIs in older patients with hip fractures, distinct from prior studies focusing solely on functional outcomes. While the 95% CI supports the potential of DHIs to improve hip function and functional independence, the wide 95% PI indicating substantial real-world response variability, which calls for cautious interpretation, informs the design of targeted DHI-based rehabilitation regimens, warranting further research into optimal techniques and dosages in clinical practice.

TRIAL REGISTRATION: PROSPERO CRD42024626186; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024626186.

PMID:41818747 | DOI:10.2196/79563

J Craniofac Surg. 2025 Nov 24. doi: 10.1097/SCS.0000000000012224. Online ahead of print.

ABSTRACT

PURPOSE: This study compares postoperative outcomes of resorbable versus nonresorbable implants in pediatric orbital fracture repair.

METHODS: The authors conducted a retrospective cohort study of 132 pediatric patients who underwent surgical repair of orbital fractures at Texas Children’s Hospital between 2011 and 2023. Patients were grouped by implant type: nonresorbable (n=100), resorbable (n=15), mixed (n=3), and no implant (n=14). The authors analyzed patient demographics, fracture characteristics, surgical approach, and postoperative outcome measures, including persistent diplopia, enophthalmos, extraocular motility deficit, infraorbital hypoesthesia, signs of infection, and necessity of revision surgery.

RESULTS: There were no statistically significant differences between implant types for any outcome measures, including persistence of diplopia, enophthalmos, extraocular motility deficit, infraorbital hypoesthesia, and the necessity of revision surgery. Nonresorbable implants were used in the majority of cases (75.8%) with a slight trend toward higher frequencies of negative postoperative outcomes, including persistence of diplopia and extraocular motility restriction. No signs of infection were reported in any group.

CONCLUSIONS: The results of our study indicate comparable safety and functionality of resorbable and nonresorbable implants in the repair of pediatric orbital fractures. While the use of nonresorbable implants is more common, resorbable implants may offer advantages, particularly in the pediatric population.

PMID:41818745 | DOI:10.1097/SCS.0000000000012224

JMIR Form Res. 2026 Mar 12;10:e84130. doi: 10.2196/84130.

ABSTRACT

BACKGROUND: Visual patient avatars are an innovative patient monitoring technology that can be used to translate numerical and waveform data into intuitive, avatar-based representations of patient conditions. Previous research indicates that this technology improves health care providers’ situational awareness compared to conventional monitoring methods. As patient-worn continuous vital sign monitoring continues to evolve, we introduce the Visual Patient Wearable device to provide avatar-based visualization tailored to this application.

OBJECTIVE: This study aimed to evaluate whether a wearable-based animated patient avatar can improve patients’ perception and recall of simulated vital sign deviations compared to conventional monitoring methods, and to assess the usability and acceptance of this avatar-based visualization.

METHODS: This computer-based study included 67 patients from 3 academic hospitals in Central Europe. Participants were randomly assigned to a Visual Patient Wearable group or a conventional monitoring group and viewed a standardized instructional video for their allocated method. They then completed 4 randomized clinical scenarios, each displayed for 6 seconds to simulate glance-based assessment. Accuracy in recalling vital sign deviations was measured, and Visual Patient Wearable participants additionally gave user feedback on Likert scales.

RESULTS: The Visual Patient Wearable system was associated with higher detection accuracy of vital sign deviations compared with standard monitoring layouts, increasing from a median correctness of 46% (IQR 33%-63%) with conventional monitoring to a median of 67% (IQR 49%-79%) with the Visual Patient Wearable system (P<.001). This corresponded to a risk ratio of 1.34 (95% CI 1.23%-1.47%). The magnitude of this association varied across signals, with the largest relative improvement observed for heart rhythm (137% improvement, 95% CI 85%-209%), followed by oxygen saturation (SpO₂; 64% improvement, 95% CI 30%-108%) and temperature (30% improvement, 95% CI 5%-60%). No statistically significant reductions in risk were observed for heart rate, respiratory rate, or blood pressure. User experience ratings based on Likert scale assessments indicated high levels of satisfaction across all 6 vital sign categories (median score 4, IQR 4-5 on a 5-point scale).

CONCLUSIONS: This computer-based study suggests that Visual Patient Wearable visualizations enhance patients’ ability to detect and recall simulated vital sign deviations. Participants found the system intuitive, easy to learn, and reassuring. The Visual Patient Wearable system provides an at-a-glance interface that may support patients’ understanding of their vital signs and could facilitate communication of relevant information to clinical staff, thereby potentially contributing to informed patient engagement. The next step is to develop a software prototype for wearable devices and test it in a clinical study.

PMID:41818743 | DOI:10.2196/84130

Jpn J Clin Oncol. 2026 Mar 12:hyag039. doi: 10.1093/jjco/hyag039. Online ahead of print.

ABSTRACT

INTRODUCTION: Comprehensive genomic profiling (CGP) has expanded treatment options for metastatic castration-resistant prostate cancer (mCRPC); however, real-world data on its clinical utility in Japanese patients remain limited. To address this gap, we conducted a multicenter real-world analysis to evaluate the implementation and clinical relevance of CGP in Japanese patients with mCRPC.

METHODS: We retrospectively analyzed 128 patients with mCRPC who underwent CGP at four Japanese institutions using FoundationOne® CDx, FoundationOne® Liquid CDx, or OncoGuide™ NCC Oncopanel. We assessed the prevalence of druggable genomic signatures, including BRCA pathogenic variants (PVs), microsatellite instability-high (MSI-high), and tumor mutational burden-high (TMB-high), and described subsequent use of genomically matched therapies.

RESULTS: The median age at CGP testing was 73 years, and patients had received a median of three prior systemic treatment lines. BRCA PVs were identified in 18 patients (14%), MSI-high in 4 (3%), and TMB-high in 11 (9%); all MSI-high cases were also TMB-high. Overall, 26 patients (20%) harbored either BRCA PVs or TMB-high status. Among these, 14 patients (54%) received matched targeted therapies, including poly(ADP-ribose) polymerase inhibitors or pembrolizumab. BRCA PVs were detected in 17% of tissue-based (F1 CDx) assays and 9% of liquid-based assays, without a statistically significant difference.

CONCLUSIONS: CGP identified BRCA PVs, MSI-high, or TMB-high in 20% of patients with metastatic CRPC, supporting its value in guiding precision oncology. However, only some patients received matched therapy, supporting earlier CGP testing. Routine integration of CGP may facilitate precision oncology-guided treatment decision-making in this population.

PMID:41818716 | DOI:10.1093/jjco/hyag039

Bioinformatics. 2026 Mar 12:btag065. doi: 10.1093/bioinformatics/btag065. Online ahead of print.

ABSTRACT

MOTIVATION: Comparing mathematical models offers a means to evaluate competing scientific theories. However, exact methods of model calibration are not applicable to many probabilistic models which simulate high-dimensional spatio-temporal data. Approximate Bayesian Computation is a widely-used method for parameter inference and model selection in such scenarios, and it may be combined with Topological Data Analysis to study models which simulate data with fine spatial structure.

RESULTS: We develop a flexible pipeline for parameter inference and model selection in spatio-temporal models. Our pipeline identifies topological summary statistics which quantify spatio-temporal data and uses them to approximate parameter and model posterior distributions. We validate our pipeline on models of tumour-induced angiogenesis, inferring four parameters in three established models and identifying the correct model in synthetic test-cases.

AVAILABILITY AND IMPLEMENTATION: Simulation code for all models, data analyses, parameter inference and model selection is available online at https://github.com/rmcdomaths/tms/ and archived at https://doi.org/10.5281/zenodo.17392787.

SUPPLEMENTARY INFORMATION: Supplementary Information will be available online.

PMID:41818692 | DOI:10.1093/bioinformatics/btag065

Neurology. 2026 Apr 14;106(7):e214704. doi: 10.1212/WNL.0000000000214704. Epub 2026 Mar 12.

ABSTRACT

BACKGROUND AND OBJECTIVES: There are limited population-based data on the incidence and risk factors for childhood stroke, including associations with recent infection and vaccination. Therefore, we aimed to determine (1) the incidence of childhood ischemic and hemorrhagic stroke and (2) associations between a recent infection or vaccination and the risk of childhood stroke.

METHODS: A population-based case-control study was undertaken using linked administrative data from 2017 to 2023 in Victoria, Australia. All residents, aged 28 days to <18 years, were included. Infections in the 60 days immediately before admission were ascertained using state-wide notifiable infections and hospital admissions data sets. Vaccinations in the 42 days immediately before admission were ascertained using the Australian Immunisation Register. Strokes were identified in state-wide hospital admissions and death registry databases. Each case of childhood stroke was matched with up to 5 nonstroke controls on age (1-year bands), sex, socioeconomic position, comorbidities, and year. Conditional logistic regression was used to examine associations between infection and vaccination with childhood stroke.

RESULTS: Over the 7 years, 571 childhood strokes (60% ischemic; median age 8.2 years; 44% female patients) occurred among 9,881,934 person-years (5.8 events [95% CI 5.3-6.3] per 100,000 person-years). Two in 5 patients had evidence of an infection in the preceding 60 days, with lower respiratory infections (n = 74), sepsis (n = 67), upper respiratory tract infections (n = 63), meningitis/encephalitis (n = 40), gastrointestinal tract infections (n = 28), and urinary tract infections (n = 22) being the most common. Children with stroke (vs matched controls) were more likely to have had a recent infection (cases 41.9% vs controls 18.6%; adjusted odds ratio [aOR] 2.54, 95% CI 1.97-3.27). The magnitude of this association was greater for ischemic stroke (aOR 3.39, 95% CI 2.45-4.69) than hemorrhagic stroke (aOR 1.90, 95% CI 1.24-2.90). No significant association was detected between recent vaccination and childhood stroke (cases 4.2% vs controls 2.5%; aOR 1.69, 95% CI 0.92-3.09).

DISCUSSION: We provide contemporary data on new cases of childhood stroke in Australia, using population-wide linked data. Having a recent infection doubled the risk of childhood stroke. We found no significant evidence of an association between vaccination and childhood stroke.

PMID:41818652 | DOI:10.1212/WNL.0000000000214704

JCO Precis Oncol. 2026 Mar;10(3):e2500635. doi: 10.1200/PO-25-00635. Epub 2026 Mar 12.

ABSTRACT

PURPOSE: MYCN amplification (MYCN-A) is an important prognostic marker in neuroblastoma. However, the impact of MYCN-A in patients with metastasized high-risk neuroblastoma during the course of disease remains unclear. The aim of this study was to investigate response and relapse patterns of stage IV patients with and without amplification of MYCN.

MATERIALS AND METHODS: Amplification of the MYCN oncogene was assessed by fluorescence in situ hybridization, whole exome sequencing, or single nucleotide polymorphism analysis. Complete remission (according to the revised International Neuroblastoma Response Criteria) and survival outcomes were estimated.

RESULTS: Among the 164 patients older than 12 months with metastatic high-risk neuroblastoma, 50 (30%) had MYCN-A. MYCN-A was a significant prognostic marker for overall survival (P = .04). Patients with MYCN-amplified tumors reached complete remission faster compared with those without MYCN amplification (HR, 1.8 [95% CI, 1.2 to 2.8]; P < .01). MYCN-A was associated with recurrence when evaluated from diagnosis and after induction treatment (HR, 1.6 [95% CI, 1.0 to 2.4]; and HR, 1.8 [95% CI, 1.1 to 2.8], respectively), as well as to the cumulative incidence of recurrence (P = .04 and P = .03, respectively). SIOPEN scores detected on meta-[¹²³I]iodobenzylguanidine (MIBG) scintigraphy were significantly lower in patients with MYCN-amplified tumors than in patients with MYCN nonamplified tumors at diagnosis and after induction treatment (P < .01 and P = .01, respectively). From end of induction, MYCN-A stratified by SIOPEN score was associated with the cumulative incidence of recurrence (P < .01).

CONCLUSION: Despite achieving complete remission faster, patients with MYCN-A have a higher probability of recurrence compared with those without MYCN-A.

PMID:41818646 | DOI:10.1200/PO-25-00635

JCO Precis Oncol. 2026 Mar;10(3):e2500725. doi: 10.1200/PO-25-00725. Epub 2026 Mar 12.

ABSTRACT

PURPOSE: A multicancer early detection (MCED) test was developed and validated in the case-control Circulating Cell-free Genome Atlas (CCGA) study (ClinicalTrials.gov identifier: NCT02889978). Previous analysis of the second (cross-validation) CCGA substudy identified prognostic value of cancer signal detection by the MCED test with 3-year follow-up. Here, we evaluated the prognostic value of a cancer signal detected (CSD) result in the third (validation) CCGA substudy (CCGA3) using an updated statistical methodology with 5-year follow-up.

METHODS: CCGA3 participants with confirmed cancer were followed for up to 5 years; overall survival was stratified by MCED test result (CSD or no CSD [NCSD]). Observed survival was compared with the expected survival of a reference population calculated from Surveillance, Epidemiology, and End Results data matched to clinical characteristics (age, sex, cancer type, and stage) in each signal detection group.

RESULTS: Of 2,513 participants with stageable, invasive cancer, 792 (31.5%) died and 1,683 (67.0%) were confirmed alive at follow-up, with 38 (1.5%) lost to follow-up. CSD rates were higher in participants who died during follow-up compared with those alive (85% v 34%). Overall observed survival versus expected survival was similar for CSD (43% observed v 40% expected) and NCSD (88% observed v 81% expected) groups. For NCSD, hazard ratios (HRs) were more favorable (<1) relative to the matched reference population at all stages (P < .0001); for CSD, HRs were <1 at stages III to IV (P < .0001) and ≅1 at stages I to II (P > .4).

CONCLUSION: CSD cancers had long-term survival similar to expectations, even in early stages, indicating that CSD early-stage cancers are unlikely to be more micrometastatic and lethal than cancers detected by conventional means. The MCED test was likely to find clinically significant cancers without contributing to overdiagnosis.

PMID:41818645 | DOI:10.1200/PO-25-00725

PLoS Med. 2026 Mar 12;23(3):e1004923. doi: 10.1371/journal.pmed.1004923. eCollection 2026 Mar.

ABSTRACT

BACKGROUND: In the United States, already-prevalent power outages are increasing in frequency and duration with climate change. Studies from New York State show that power outages may increase hospitalizations for cardiovascular disease (CVD) and respiratory disease in vulnerable populations such as older adults, but exposure data limitations have constrained nationwide studies of power outages and health. Here, we tested if power outages were associated with emergency CVD and respiratory disease-related hospitalizations among older adults in the United States.

METHODS AND FINDINGS: We developed a national dataset of power outage exposure and identified county-days with ≥1% of customers exposed to 8+ hour power outages in 2018. We leveraged data on 23 million Medicare Fee-For-Service beneficiaries aged 65+ to estimate daily county-level rates of emergency CVD- and respiratory-related hospitalizations. We applied a case-crossover design with a conditional Poisson model to estimate the lagged association (up to 1 week) between daily county-level power outage exposure and cause-specific hospitalization rates. Models controlled for daily temperature, precipitation, and wind speed.

RESULTS: Power outages were associated with increased emergency CVD and respiratory hospitalizations. The association between power outage and CVD hospitalizations was strongest the day after power outage exposure (rate ratio [RR]=1.02, 95% CI: 1.01, 1.03), while the association between outage and respiratory disease was strongest the day of power outage exposure (RR = 1.03, 95% CI: 1.01, 1.04). We estimated this association using county-level power outage data; future studies could use higher spatial resolution data.

CONCLUSIONS: Power outages may increase the risk of CVD and respiratory hospitalizations among US older adults. Improving electricity reliability could support community health and protect older adults from CVD and respiratory disease exacerbations.

PMID:41818642 | DOI:10.1371/journal.pmed.1004923