Tag: nevin manimala

J Med Internet Res. 2025 Mar 28;27:e65269. doi: 10.2196/65269.

ABSTRACT

BACKGROUND: The technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) are widely used to examine health care technology acceptance among older adults. However, existing literature exhibits considerable heterogeneity, making it difficult to determine consistent predictors of acceptance and behavior.

OBJECTIVE: We aimed to (1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use health care technology among older adults and (2) assess the moderating effects of age, gender, geographic region, type of health care technology, and presence of visual demonstrations.

METHODS: A systematic search was conducted across Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest databases on March 15, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1167 initially identified studies, 41 studies (11,574 participants; mean age 67.58, SD 4.76 years; and female:male ratio=2.00) met the inclusion criteria. The studies comprised 12 mobile health, 12 online or telemedicine, 9 wearable, and 8 home or institution hardware investigations, with 23 studies from Asia, 7 from Europe, 7 from African-Islamic regions, and 4 from the United States. Studies were eligible if they used the TAM or UTAUT, examined health care technology adoption among older adults, and reported zero-order correlations. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, evaluating selection, comparability, and outcome assessment with 34% (14/41) of studies rated as good quality and 66% (27/41) as satisfactory.

RESULTS: Random-effects meta-analysis revealed significant positive correlations for PU-BI (r=0.607, 95% CI 0.543-0.665; P<.001), PEOU-BI (r=0.525, 95% CI 0.462-0.583; P<.001), and SI-BI (r=0.551, 95% CI 0.468-0.624; P<.001). High heterogeneity was observed across studies (I²=95.9%, 93.6%, and 95.3% for PU-BI, PEOU-BI, and SI-BI, respectively). Moderator analyses revealed significant differences based on geographic region for PEOU-BI (Q=8.27; P=.04), with strongest effects in Europe (r=0.628) and weakest in African-Islamic regions (r=0.480). Technology type significantly moderated PU-BI (Q=8.08; P=.04) and SI-BI (Q=14.75; P=.002), with home or institutional hardware showing the strongest effects (PU-BI: r=0.736; SI-BI: r=0.690). Visual demonstrations significantly enhanced PU-BI (r=0.706 vs r=0.554; Q=4.24; P=.04) and SI-BI relationships (r=0.670 vs r=0.492; Q=4.38; P=.04). Age and gender showed no significant moderating effects.

CONCLUSIONS: The findings indicate that PU, PEOU, and SI significantly impact the acceptance of health care technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. This suggests that tailored strategies for different types of technology and the use of visual demonstrations are important for enhancing adoption rates. Limitations include varying definitions of older adults across studies and the use of correlation coefficients rather than controlled effect sizes. Results should therefore be interpreted within specific contexts and populations.

PMID:40153796 | DOI:10.2196/65269

J Med Internet Res. 2025 Mar 28;27:e63278. doi: 10.2196/63278.

ABSTRACT

BACKGROUND: Carbohydrate counting (CC) can be burdensome and difficulty with adherence has been reported. Automated CC through mobile apps offers innovative solutions to ease this burden.

OBJECTIVE: This cross-sectional web-based survey aims to identify (1) perceived barriers to CC by Canadians living with type 1 diabetes (T1D) and (2) app features that would help reduce these barriers. The secondary objective aims to compare apps used by participants with the suggested app features.

METHODS: People with T1D aged 14 years and older, living in Canada, were recruited through the BETTER Canadian registry, diabetes organizations, and social media. Participants completed a 39-question web-based survey (closed- and open-ended) to identify barriers in CC, preferred CC app features, and current app use. Respondents rated barriers and app features using a 5-point Likert scale. The features were cross-referenced in each app reported being used by participants. Descriptive statistics summarized barriers and app feature preferences, and statistical analyses identified differences by age, app use, and insulin modality. Mean scores (out of 5) were compared using 2-tailed t tests or nonparametric tests. Open-ended questions were analyzed using inductive thematic analysis.

RESULTS: Participants (N=196; woman: n=145, 74%; mean age 40 [SD 17] years; mean diabetes duration 22 (14) years; relied on CC to determine insulin doses at mealtimes: n=178, 90.8%) reported barriers related to carbohydrate identification, nutrient interaction, and insulin dose calculation, as well as psychosocial factors. Preferred app features included nutrient analysis (165/196, 84.2%), personalization (151/196, 77.1%), insulin bolus calculation (145/196, 74%), and health care professional support (135/196, 68.8%). Among the 16 apps used by participants, most (12/16, 75%) supported nutrient analysis but only one offered bolus calculations or health care professional support, and none offered personalization. Users on injections reported greater barriers to blood glucose monitoring for insulin adjustments compared to exclusive pump users (mean score of 3.87, SD 1.22 vs mean 3.30, SD 1.28; P=.001). They also expressed higher needs for meal logs in an electronic food journal (mean 4.06, SD 1.18 vs mean 3.69, SD 1.17; P=.01), bolus dose suggestions (mean 4.37, SD 0.98 vs mean 3.84, SD 1.26; P=.001), and app personalization (mean 4.47, SD 0.86 vs mean 3.93, SD 1.21; P<.001). No significant differences were observed based on age or app use. The thematic analysis revealed participants’ perceptions of suggested barriers and features, as well as new barriers such as calculation errors from unreliable food data and nutrition labels, fear of eating disorders, limited app reliability, and insufficient health care support, with suggestions for technology-based solutions.

CONCLUSIONS: CC mobile apps currently used do not meet the needs of people with T1D. A novel CC app with app features such as photo recognition, reliable nutrient values, and personalized bolus calculations could reduce the CC burden.

PMID:40153793 | DOI:10.2196/63278

J Med Internet Res. 2025 Mar 28;27:e62957. doi: 10.2196/62957.

ABSTRACT

BACKGROUND: Interest in integrating robotics within intensive care units (ICUs) has been propelled by technological advancements, workforce challenges, and heightened clinical demands, including during the COVID-19 pandemic. The integration of robotics in ICUs could potentially enhance patient care and operational efficiency amid existing challenges faced by health care professionals, including high workload and decision-making complexities.

OBJECTIVE: This qualitative study aimed to explore ICU clinicians’ perceptions of robotic technology and to identify the types of tasks that might benefit from robotic assistance. We focused on the degree of acceptance, perceived challenges, and potential applications for improving patient care in 5 Southeastern US hospitals between January and August 2023.

METHODS: A qualitative study through semistructured interviews and questionnaires was conducted with 15 ICU clinicians (7 nurses, 6 physicians, and 2 advanced practice providers) from 5 hospitals in the Southeast United States. Directed content analysis was used to categorize and interpret participants’ statements, with statistical tests used to examine any role-based differences in how they viewed robotic integration.

RESULTS: Among the 15 participants, 73% (11/15) were female, with an average of 6.4 (SD 6.3) years of ICU experience. We identified 78 distinct tasks potentially suitable for robotic assistance, of which 50 (64%) involved direct patient care (eg, repositioning patients and assisting with simple procedures), 19 (24%) concerned indirect patient care (eg, delivering supplies and cleaning), 6 (8%) addressed administrative tasks (eg, answering call lights), and 3 (4%) were classified as mixed direct and indirect (eg, sitting with a patient to keep them calm). Most participants supported the automation of routine, noncritical tasks (eg, responding to nurse calls and measuring glucose levels), viewing this strategy as a way to alleviate workload and enhance efficiency. Conversely, high-complexity tasks requiring nuanced clinical judgment (eg, ventilator settings) were deemed unsuitable for full automation. Statistical analysis revealed no significant difference in how nurses, physicians, and advanced practice providers perceived these tasks (P=.22).

CONCLUSIONS: Our findings indicate a significant opportunity to use robotic systems to perform noncomplex tasks in ICUs, thereby potentially improving efficiency and reducing staff burden. Clinicians largely view robots as supportive tools rather than substitutes for human expertise. However, concerns persist regarding privacy, patient safety, and the loss of human touch, particularly for tasks requiring high-level clinical decision-making. Future research should involve broader, more diverse clinician samples and investigate the long-term impact of robotic assistance on patient outcomes while also incorporating patient perspectives to ensure ethical, patient-centered adoption of robotic technology.

PMID:40153785 | DOI:10.2196/62957

JMIR Form Res. 2025 Mar 28;9:e69001. doi: 10.2196/69001.

ABSTRACT

BACKGROUND: Subsequent to the COVID-19 pandemic in 2020, a different approach to health care utilization was required to improve safety and efficiency. In the postpandemic era, virtual care and remote assessment of musculoskeletal conditions has become more common, and examining the accuracy of these remote encounters remains vital. In 2023, an innovative, video-based tool-the Virtual Performance Measure (VPM)-was introduced to assess the functional difficulties of patients with osteoarthritis of the knee joint. Further validation of this tool is warranted to expand its application longitudinally and in more diverse populations.

OBJECTIVE: This study examined the longitudinal validity of the VPM, a digitally based outcome tool, in patients with osteoarthritis of the hip and knee joints who had undergone arthroplasty.

METHODS: Patients completed a web-based survey after watching 40 videos that demonstrated 10 functional tasks with increasing difficulty, prior to and at approximately 3-5 months following surgery. The Lower Extremity Functional Scale (LEFS) was used as the reference measure. Longitudinal convergent and known-groups validity as well as sensitivity to change were assessed.

RESULTS: The data of 120 patients (n=80, 67% female; mean age 67, SD 9 years; n=58, 48% with hip osteoarthritis and n=62, 52% with knee osteoarthritis) were examined. There was a statistically significant improvement in both LEFS (t₁₁₉=16.04, P<.001) and VPM total scores (t₁₁₉=13.92, P<.001) over time. The correlation between the postoperative LEFS and VPM scores was higher (r=0.66; P<.001) than the correlation between the change scores of these measures (r=0.51; P<.001). The area under the curve value for the VPM’s ability to differentiate between urgent and nonurgent candidates for surgery was 0.71 (95% CI 0.57-0.84). Sensitivity to change as measured by the standardized response mean was 1.27 (95% CI 1.09-1.45), indicating good ability to detect change over time.

CONCLUSIONS: The VPM demonstrated sufficient longitudinal convergent and known-groups validity as well as sensitivity to change in patients with hip and knee osteoarthritis following arthroplasty. This tool has a potential to improve the delivery of care by increasing access, reducing the frequency of in-person visits, and improving the overall efficiency of the health care system following a major surgery.

PMID:40153784 | DOI:10.2196/69001

J Med Internet Res. 2025 Mar 28;27:e55072. doi: 10.2196/55072.

ABSTRACT

BACKGROUND: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health.

OBJECTIVE: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health.

METHODS: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis.

RESULTS: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use.

CONCLUSIONS: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology.

PMID:40153777 | DOI:10.2196/55072

JMIR Mhealth Uhealth. 2025 Mar 28;13:e56666. doi: 10.2196/56666.

ABSTRACT

BACKGROUND: Mobile health (mHealth) apps provide innovative solutions for improving treatment adherence, facilitating lifestyle modifications, and optimizing blood pressure control in patients with hypertension. Despite their potential benefits, the adoption and recommendation of mHealth apps by physicians in Germany remain limited. This reluctance may be due to a lack of understanding of the factors influencing physicians’ willingness to incorporate these digital tools into routine clinical practice. Understanding these factors is crucial for fostering greater integration of mHealth apps in hypertension care.

OBJECTIVE: The aim of this study was to explore the relationship between physicians’ information needs and acceptance factors, and how these elements can support the effective integration of mHealth apps into daily medical routines.

METHODS: We conducted a qualitative study involving 24 semistructured telephone interviews with physicians, including 14 cardiologists and 10 general practitioners, who are involved in the treatment of hypertensive patients. Participants were selected through purposive sampling to ensure a diverse range of perspectives. Thematic analysis was conducted using MAXQDA software (Verbi GmbH) to identify key themes and subthemes related to the acceptance and use of mHealth apps.

RESULTS: The analysis revealed significant variability in physicians’ information needs regarding mHealth apps, particularly concerning their functionalities, clinical benefits, and potential impact on patient outcomes. These informational gaps play a critical role in determining whether physicians are willing to recommend mHealth apps to their patients. Key determinants influencing acceptance were identified, including the availability of robust knowledge about the apps, high-quality and reliable data, generational shifts within the medical profession, solid evidence supporting the effectiveness of the mHealth apps, and clearly defined areas of application and responsibilities within the physician-patient relationship. The study found that acceptance of mHealth apps could be significantly increased through targeted educational initiatives, enhanced data quality, and better integration of these tools into existing clinical workflows. Furthermore, younger physicians, more familiar with digital technologies, demonstrated greater openness to using mHealth apps, suggesting that generational changes may drive future increases in adoption.

CONCLUSIONS: The successful integration of mHealth apps into hypertension management requires a multifaceted approach that addresses both the informational and practical concerns of physicians. By disseminating comprehensive knowledge about the variety, functionality, and proven efficacy of hypertension-related mHealth apps, health care providers can be better equipped to use these tools effectively. This approach necessitates the implementation of various knowledge transfer strategies, such as targeted training programs, peer learning opportunities, and active engagement with digital health technologies. As physicians become more informed and confident in the use of mHealth apps, their acceptance and recommendation of these tools are likely to increase, leading to more widespread adoption. Overcoming current barriers related to information deficits and data quality is essential for ensuring that mHealth apps are optimally used in routine hypertension care, ultimately improving patient outcomes and enhancing the overall quality of care.

TRIAL REGISTRATION: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3389/fcvm.2022.1089968.

PMID:40153776 | DOI:10.2196/56666

Medicine (Baltimore). 2025 Mar 28;104(13):e41969. doi: 10.1097/MD.0000000000041969.

ABSTRACT

Inflammatory bowel disease (IBD) is a chronic recurrent IBD, whose cause involves the interaction between genetic and environmental factors. Although there is a recognized link between immune response and IBD, the causal relationship between circulating immune cell counts and IBD remains controversial. This study aimed to elucidate the causal relationship between genetically predicted circulating immune cell counts and IBD. We conducted a bidirectional 2-sample Mendelian randomization (MR) study using aggregated statistics from genome-wide association studies. The causal relationship between 5 circulating leukocytes cells (monocytes, lymphocytes, eosinophils, basophils and neutrophils) counts and IBD, including ulcerative colitis (UC) and Crohn disease (CD) was analyzed. Horizontal pleiotropy test and heterogeneity test were used to ensure the stability of the results. Our findings indicated that monocytes, lymphocytes, eosinophils, and basophils count were not significantly associated with IBD, however, elevated circulating neutrophils count was significantly associated with higher risk of IBD [odds ratio (OR) = 1.0017; 95% confidence interval (CI) = 1.0004-1.003; P = .009] and UC [OR = 2.465; 95% CI = 1.236-4.916; P = .01]. In addition, we also found that IBD [OR: 12.07; 95% CI = 1.909-76.316; P = .008] and CD [OR = 1.014; 95% CI = 1.004-1.023; P = .005] were significantly associated with higher circulating neutrophils count in reverse MR. This MR study provides genetic evidence for the causal relationship between the genetically predicted increase in circulating neutrophils count and the risk of IBD (UC and CD). This finding stresses the need for further exploring physiological functions of neutrophils in order to develop effective strategies against IBD.

PMID:40153772 | DOI:10.1097/MD.0000000000041969

Medicine (Baltimore). 2025 Mar 28;104(13):e41948. doi: 10.1097/MD.0000000000041948.

ABSTRACT

After hospitalization caused by COVID-19, a high prevalence of physical deterioration has been observed, hence the importance of having tests to evaluate the functional status of patients and to be able to perform a partition and subsequent referral to the physiotherapy service. This cross-sectional observational study describes the physical status according to the short physical performance battery (SPPB) of patients admitted to the hospital setting for COVID-19 and to identify variables potentially related to this outcome. Thirty-six patients admitted to the hospital setting for COVID-19 in the first wave living in the community. Patients were evaluated with the SPPB, strength test, the International Physical Activity Questionnaire, the 1-minute sit-to stand, spirometry, the Barthel index, the Hospital Anxiety and Depression Scale, and other patient-related data were collected. We performed bivariate and regression analyses. A linear regression was fitted, having SPPB as a dependent variable to ascertain the impact of intensive care unit (ICU) admission on physical performance. Five variables were related to SPPB. There was a significant relationship between admission to the ICU and having a heart disease (P = .015), the level of physical activity (P = .049), number of years smoking (P = .029) and days of hospitalization (P = .005). A total of 22.22% of analyzed patients suffered frailty. SPPB is related to altered respiratory pattern, quadriceps strength, 1-minute sit-to-stand and FEV1, Barthel score, days of hospitalization and FEV/FVC ratio. Lack of association between ICU stay, age or sex with SPPB results differs from the results of other studies.

PMID:40153771 | DOI:10.1097/MD.0000000000041948

Medicine (Baltimore). 2025 Mar 28;104(13):e41941. doi: 10.1097/MD.0000000000041941.

ABSTRACT

Vaccination against human papilloma virus (HPV) play a major role in preventing infection with HPV among heterosexual couples. The aim of this study was to assess public knowledge and attitude towards HPV vaccine in Saudi Arabia. This is an online cross-sectional survey study that was conducted between May and June 2023. This study utilized the convenience sampling technique to recruit the study participants. The study participants were invited to participate in this study through social media platforms (X, Facebook, and WhatsApp). Multiple logistic regression was performed to assess the factors associated with better knowledge level and the findings were presented as odds ratios (OR) with 95% confidence intervals (CI) and corresponding p-values. A total of 819 participants were included in the analysis. A total of 355 participants (43.3%) had a good knowledge score and 464 participants (56.7%) had poor knowledge. The total mean of knowledge score was (3.22 ± 2.44). As the table shown, single participants reported a significant higher knowledge score mean (3.59 ± 2.52) compared to married (2.84 ± 2.32) (P = .0001). Participants aged between 18 to 29 years reported a significant higher knowledge score mean (3.57 ± 2.52) compared to participants aged between 40 and 49 years (2.60 ± 2.21) (P = .0001). Participants who lived in Eastern area had significantly higher odds of knowledge compared to other areas (OR = 2.19, 95% CI = 1.45 – 3.33, P = .001). Participants who worked in medical field had significantly higher odds of having good knowledge compared to other jobs (OR = 3.65, 95% CI = 2.39-5.57, P = .0001). Participants who had 2 sexual partners have you had in the past 2 years had a significant higher odd of having good knowledge (OR = 2.05, 95% CI = 1.02-4.12, P = .04). This study identified that a considerable proportion of the study participants demonstrated poor level of knowledge of HPV vaccine. Participants who lived in Eastern area, those who worked in medical field, and those who had 2 sexual partners have you had in the past 2 years had a significant higher odd of having good knowledge. Future studies should be directed towards developing educational campaign to improve public awareness of HPV.

PMID:40153766 | DOI:10.1097/MD.0000000000041941

Medicine (Baltimore). 2025 Mar 28;104(13):e41950. doi: 10.1097/MD.0000000000041950.

ABSTRACT

Mandibular fractures are one of the most common maxillofacial bone fractures that can occur during many activities in daily life. The aim of this study was to provide data for practitioners and researchers about the variables and outcomes associated with mandibular fractures by examining the relationships between gender, age groups, trauma causes, side, type, and anatomic location of mandibular fractures and concomitant injuries. The demographic and clinical data of the patients were obtained from the hospital information management system of a university hospital. The hospital records for the 10-year period between 2014 and 2023 were examined retrospectively. The mandible fractures were classified according to type, side, and location and compared against gender, age group, and trauma cause. Evaluation was made of 142 patients with traumatic mandibular fracture, comprising 76.8% males and 23.2% females. Of these cases with mandible fracture, 82.4% were aged < 35 years, and 45.1% of the fractures occurred in road traffic accidents. The majority of mandibular fractures were caused by road traffic accidents in males and adults over the age of 18, whereas home, environmental, and leisure accidents were the major cause of mandibular fractures in females and persons under the age of 18. Compound fractures were determined in 59.2% of the cases, single fractures in 80.3%, and parasymphysis and symphysis fractures in 46.2%. The compound and parasymphysis/symphysis region fractures were more common in males, patients aged < 35 years, and those who had undergone any type of trauma. We consider the information obtained through this study could make significant contributions to the data bank for multicenter prospective in-depth epidemiological research in clinical and forensic sciences in the future.

PMID:40153762 | DOI:10.1097/MD.0000000000041950