Tag: nevin manimala

Soc Sci Med. 2024 Aug 5;364:117166. doi: 10.1016/j.socscimed.2024.117166. Online ahead of print.

ABSTRACT

BACKGROUND: Improving older people’s health-promoting lifestyle (HPL) may slow the progression of health conditions and improve quality of life. Electronic health (eHealth) literacy is increasingly important for individuals managing health in the digital age. Previous cross-sectional studies have shown a positive association between eHealth literacy and HPL among older adults. However, no longitudinal studies have examined the association over time, their temporal relationship, and the potential underlying mechanisms.

OBJECTIVES: To examine the longitudinal association and temporal relationship between eHealth literacy and HPL among older adults, and to explore their underlying mechanisms based on the Integrated Model of eHealth Use (iMeHU).

METHODS: This longitudinal study was conducted among older adults in Jiangxi Province, China, from February to November 2022. Data were collected at baseline (T1) and 3-month (T2) and 6-month follow-up (T3), using online self-reported questionnaires. Older people’s eHealth literacy and HPL were measured using the Digital Health Literacy Instrument and Health-Promoting Lifestyle Profile-II. Statistical analyses included Linear mixed model (LMM), cross-lagged panel model (CLPM), longitudinal mediation analysis, and multi-group analysis.

RESULTS: 611 participants were included at T1; 464 (75.9%) completed the follow-ups at T2 and T3. The LMM results suggested that older individuals with higher eHealth literacy levels showed better HPL over time (adjusted β = 0.31, 95%CI: 0.27-0.35, p < 0.001), after adjusting for covariates. CLPMs supported that eHealth literacy could predict older people’s improved HPL subsequently, but not the reverse. Attitude towards eHealth mediated the relationship from eHealth literacy to improved HPL, with a mediated proportion of 17.2%. In addition, the prospective relationships were stronger and only significant in older patients.

CONCLUSIONS: From a longitudinal perspective, this study highlighted the important roles of eHealth literacy and attitude towards eHealth in improving older people’s HPL, especially for the patients. The findings provide robust evidence and practical implications to develop targeted interventions.

PMID:39586136 | DOI:10.1016/j.socscimed.2024.117166

Int J Med Educ. 2024 Nov 22;15:139-149. doi: 10.5116/ijme.6736.4367.

ABSTRACT

OBJECTIVES: The aim of this study was to confirm and evaluate the learning effect of a physician-facing e-learning course on genetic medicine for improving genomic literacy.

METHODS: We employed qualitative and quantitative methodology to survey 103 physicians who took the course at a national university in Japan. Evaluations were conducted at the levels of participant feedback, learning, and behaviour. Participants completed a questionnaire and test (full score = 100) before and after the course. Pre- and post-test scores were compared using paired-samples t-tests and Mann-Whitney U test was used to compare the difference their clinical experience. The effect size was estimated using Cohen’s d.

RESULTS: Responses were obtained from 96 physicians. Approximately 80% (n = 75-93) of participants responded positively to the course, a result supported by the qualitative data. The mean scores for the pre- and post-test showed an increase from 71.25 to 74.58 (p=0.008). In particular, mean test scores increased significantly from 68.94 to 75.53 (p<0.001) in physicians with no clinical experience in genetic medicine, while no significance was observed scores for physicians with clinical experience in genetics from 73.47 to 73.67 (p=0.903). Behavioural assessment was carried out for 28 participants; however, no statistically significant differences were identified.

CONCLUSIONS: Our findings indicate that our e-learning course was useful for physicians with no experience of genetic medicine. For those with experience, it may be necessary to provide more practice-based education and educational methodologies. Behavioural assessment needs to be examined further.

PMID:39586107 | DOI:10.5116/ijme.6736.4367

J Med Internet Res. 2024 Nov 25;26:e63661. doi: 10.2196/63661.

ABSTRACT

BACKGROUND: Geographic, demographic, and socioeconomic differences in health outcomes persist despite the global focus on these issues by health organizations. Barriers to accessing care contribute significantly to these health disparities. Among these barriers, those related to travel time-the time required for patients to travel from their residences to health facilities-remain understudied compared with others.

OBJECTIVE: This study aimed to explore the impact of telehealth in addressing health disparities associated with travel time to hospitals for patients with recurrent hospital admissions. It specifically examined the role of telehealth in reducing in-hospital length of stay (LOS) for patients living farther from the hospital.

METHODS: We sourced the data from 4 datasets, and our final effective sample consisted of 1,600,699 admissions from 536,182 patients from 63 hospitals in New York and Florida in the United States from 2012 to 2015. We applied fixed-effect models to examine the direct effects and the interaction between telehealth and patients’ travel time to hospitals on LOS. We further conducted a series of robustness checks to validate our main models and performed post hoc analyses to explore the different effects of telehealth across various patient groups.

RESULTS: Our summary statistics show that, on average, 22.08% (353,396/1,600,699) of patients were admitted to a hospital with telehealth adopted, with an average LOS of 5.57 (SD 5.06) days and an average travel time of about 16.89 (SD 13.32) minutes. We found that telehealth adoption is associated with a reduced LOS (P<.001) and this effect is especially pronounced as the patients’ drive time to the hospital increases. Specifically, the coefficient for drive time is -0.0079 (P<.001), indicating that for every additional minute of driving time, there is a decrease of 0.0079 days (approximately 11 minutes) in the expected LOS. We also found that telehealth adoption has a larger impact on patients frequently needing health services, patients living in high internet coverage areas, and patients who have high virtualization potential diseases.

CONCLUSIONS: Our findings suggest that telehealth adoption can mitigate certain health disparities for patients living farther from hospitals. This study provides key insights for health care practitioners and policy makers on telehealth’s role in addressing distance-related disparities and planning health care resources. It also has practical implications for hospitals in resource-limited countries that are in the early stages of implementing telehealth.

PMID:39586091 | DOI:10.2196/63661

J Med Internet Res. 2024 Nov 25;26:e51978. doi: 10.2196/51978.

ABSTRACT

BACKGROUND: Mobile cognitive testing is growing in popularity, with numerous advantages over traditional cognitive testing; however, the field lacks studies that deeply examine mobile cognitive test data from general adult samples.

OBJECTIVE: This study characterized performance for a suite of 8 mobile cognitive tests from the NeuroUX platform in a sample of US adults across the adult lifespan.

METHODS: Overall, 393 participants completed 8 NeuroUX cognitive tests and a brief ecological momentary assessment survey once per day on their smartphones for 10 consecutive days; each test was administered 5 times over the testing period. The tests tapped the domains of executive function, processing speed, reaction time, recognition memory, and working memory. Participants also completed a poststudy usability feedback survey. We examined alternate form test-retest reliability; practice effects; and associations between scores (averages and intraindividual variability) and demographics as well as test-taking context (ie, smartphone type, being at home vs not at home, and being alone vs not alone).

RESULTS: Our final sample consisted of 393 English-speaking US residents (aged 20-79 y; female: n=198, 50.4%). Of the 367 participants who provided responses about their race and ethnicity, 258 (70.3%) were White. Of the 393 participants, 181 (46.1%) were iOS users, and 212 (53.9%) were Android users. Of 12 test scores derived from the 8 tests, 9 (75%) showed good to excellent test-retest reliability (intraclass correlation coefficients >0.76). Practice effects (ie, improvements in performance) were observed for 4 (33%) of the 12 scores. Older age was associated with worse performance on most of the test scores (9/12, 75%) and greater within-person variability for nearly all reaction time scores (3/4, 75%). Relationships with smartphone type showed better performance among iOS users and those with newer Android software versions compared to those with older software. Being at home (vs not at home) was associated with better performance on tests of processing speed. Being alone (vs not alone) was associated with better performance on tests of recognition and working memory. Poststudy feedback indicated that participants found NeuroUX easy to learn and use, an enjoyable experience, and an app that would be helpful in understanding their thinking skills. Only 4.2% (16/379) endorsed privacy concerns, and 77.3% (293/379) reported that they would be willing to share their results with their health care provider. Older age-but not other demographics-was associated with finding the tests more challenging.

CONCLUSIONS: In a sample of adults across a wide age range, this study characterized features that are particularly important for the interpretation of remote, repeated mobile cognitive testing performance, including test-retest reliability, practice effects, smartphone type, and test-taking context. These data enhance the understanding and application of mobile cognitive testing, paving the way for improved clinical decision-making, personalized interventions, and advancements in cognitive research.

PMID:39586088 | DOI:10.2196/51978

J Med Internet Res. 2024 Nov 25;26:e54597. doi: 10.2196/54597.

ABSTRACT

BACKGROUND: Adverse events (AEs) associated with vaccination have traditionally been evaluated by epidemiological studies. More recently, they have gained attention due to the emergency use authorization of several COVID-19 vaccines. As part of its responsibility to conduct postmarket surveillance, the US Food and Drug Administration continues to monitor several AEs of interest to ensure the safety of vaccines, including those for COVID-19.

OBJECTIVE: This study is part of the Biologics Effectiveness and Safety Initiative, which aims to improve the US Food and Drug Administration’s postmarket surveillance capabilities while minimizing the burden of collecting clinical data on suspected postvaccination AEs. The objective of this study was to enhance active surveillance efforts through a pilot platform that can receive automatically reported AE cases through a health care data exchange.

METHODS: We detected cases by sharing and applying computable phenotype algorithms to real-world data in health care providers’ electronic health records databases. Using the fast healthcare interoperability resources standard for secure data transmission, we implemented a computable phenotype algorithm on a new health care system. The study focused on the algorithm’s positive predictive value, validated through clinical records, assessing both the time required for implementation and the accuracy of AE detection.

RESULTS: The algorithm required 200-250 hours to implement and optimize. Of the 6,574,420 clinical encounters across 694,151 patients, 30 cases were identified as potential myocarditis/pericarditis. Of these, 26 cases were retrievable, and 24 underwent clinical validation. In total, 14 cases were confirmed as definite or probable myocarditis/pericarditis, yielding a positive predictive value of 58.3% (95% CI 37.3%-76.9%). These findings underscore the algorithm’s capability for real-time detection of AEs, though they also highlight variability in performance across different health care systems.

CONCLUSIONS: The study advocates for the ongoing refinement and application of distributed computable phenotype algorithms to enhance AE detection capabilities. These tools are crucial for comprehensive postmarket surveillance and improved vaccine safety monitoring. The outcomes suggest the need for further optimization to achieve more consistent results across diverse health care settings.

PMID:39586081 | DOI:10.2196/54597

J Med Internet Res. 2024 Nov 25;26:e50476. doi: 10.2196/50476.

ABSTRACT

BACKGROUND: Patient-centered communication refers to interaction between patients and health professionals that considers patients’ preferences and empowers patients to contribute to their own care. Research suggests that patient-centered communication promotes patients’ satisfaction with care, trust in physicians, and competence in their abilities to manage their health.

OBJECTIVE: The study aims to explore the role of patients’ use of electronic health records (EHRs) in promoting patient-centered communication. Specifically, we investigated how health information efficacy mediates the association of EHR use with patient-centered communication and whether and how the relationship between EHR use and health information efficacy varies according to patients’ perceived social support levels.

METHODS: We conducted mediation and multigroup analyses using nationally representative data from the Health Information National Trends Survey 5 cycle 1 conducted in the United States (N=3285). Among respondents, we analyzed those who received care from health professionals over the previous year (2823/3285, 85.94%).

RESULTS: EHR use by patients was associated with high levels of health information efficacy (unstandardized coefficient=0.050, SE 0.024; P=.04). In turn, health information efficacy was positively related to patient-centered communication (unstandardized coefficient=0.154, SE 0.024; P<.001). The indirect pathway from EHR use to patient-centered communication, mediated by health information efficacy, was statistically significant (unstandardized coefficient=0.008, SE 0.004; P=.04). Among patients with high social support (2349/2823, 83.21%), EHR use was not significantly associated with health information efficacy (unstandardized coefficient=0.038, SE 0.026; P=.15), although health information efficacy was linked to high levels of patient-centered communication (unstandardized coefficient=0.151, SE 0.030; P<.001). The indirect relationship in this group was not significant (unstandardized coefficient=0.006, SE 0.004; P=.11). However, among those with low social support (474/2823, 16.79%), EHR use was positively associated with health information efficacy (unstandardized coefficient=0.155, SE 0.048; P=.001), which in turn relates to high levels of patient-centered communication (unstandardized coefficient=0.137, SE 0.050; P=.01). The indirect pathway was also significant (unstandardized coefficient=0.021, SE 0.010; P=.03).

CONCLUSIONS: Patients who use EHRs may build health information efficacy, which seems to promote communication between patients and health care providers. This indirect pathway was not detected among patients with high social support. However, among those with low social support, EHR use seems to enhance health information efficacy, which may in turn facilitate patient-centered communication. Given the nature of the dataset used, the findings of this study are more relevant to the United States than other contexts.

PMID:39586071 | DOI:10.2196/50476

J Insur Med. 2024 Nov 1;51(3):171-174. doi: 10.1029/AAIMEDICINE-D-24-00028.1.

ABSTRACT

Little evidence based information exists in the medical literature on the mortality of abusers of anabolic androgenic steroids. These individuals range from competitive athletes and body builders to those whose who use physician prescribed mega-doses. Life insurance medical directors have little guidance on how to underwrite these individuals when presented with their applications. A recent article presented a Kaplan-Meir mortality curve accompanied with a control population demonstrating the mortality of these individuals over a 13-year period. Users of non-physiologic doses of anabolic androgenic steroids experience a mortality about two times the expected mortality of the control population. They should be underwritten with ratings commensurate with their anabolic androgenic steroid abuse and demonstrated mortality.

PMID:39586065 | DOI:10.1029/AAIMEDICINE-D-24-00028.1

J Insur Med. 2024 Nov 1;51(3):138-142. doi: 10.1029/AAIMEDICINE-D-24-00014.1.

ABSTRACT

Universal Health Insurance does not exist in the United States for two reasons: (1) there is a general unwillingness to dismantle the historically grown framework of the world’s most complex mix of public and private sector health coverage and (2) mere cost considerations. The first concern can be abated by establishing a Universal Health Insurance system which retains many or most of the historically grown infrastructure. Cost containment of such a reform is addressed herein in that the two proposed pathways comprise either (1) a leveled solution through Medicare-expansion for the uninsured only or (2) a more complex solution through a national, 2-tier healthcare system for all Americans. Both pathways are based on solid financing without major tax increases by using existing and/or yet untapped funding sources. The insurance consequences for both options are assessable. They are minor for the Medicare-expansion and more wide-ranging, yet also achievable, for a national, 2-tier healthcare system. Universal Health Insurance must no longer be an illusion that continues to haunt our society in the 21st century.

PMID:39586063 | DOI:10.1029/AAIMEDICINE-D-24-00014.1

Neurology. 2024 Dec 24;103(12):e210102. doi: 10.1212/WNL.0000000000210102. Epub 2024 Nov 25.

ABSTRACT

BACKGROUND AND OBJECTIVES: Multiple studies found a higher ischemic stroke incidence in rural areas compared with urbanized areas, often explained by a low socioeconomic status (SES). However, this has rarely been investigated specifically in younger adults. We aimed to investigate the age-specific (15-49 years vs 50+ years) incidence of ischemic stroke in rural and urbanized municipalities within the Netherlands.

METHODS: Patients with a first-ever ischemic stroke (15 years or older) between 1998 and 2018 were included in this registry-based study through linkage of Dutch national hospital administrative registries. Ischemic stroke was defined through ICD-9 and ICD-10 codes. The urbanization grade of the municipality was defined by the address density in 5 subgroups (from most urban ≥2,500 addresses per km² to rural <500 addresses per km²). The urbanization grade-specific incidence rate per 100,000 person-years, standardized for age and sex, and incidence rate ratios (IRRs) were calculated. In addition, we performed stratified analyses for young age groups (15-39 and 40-49 years) and neighborhood SES (nSES), which was calculated using welfare, level of education, and recent labor participation.

RESULTS: In total, 23,720 patients aged 15-49 years (median age 44.7 years [interquartile range (IQR) 40.6-48.8], 51.6% women) and 369,107 patients aged older than 50 years (median age 76.7 years [IQR 68.8-84.7], 50.8% women) were included. Patients aged 15-49 years living in rural areas showed a 5% higher risk of ischemic stroke (IRR 1.05 [99% CI 0.98-1.13]) compared with patients in urbanized areas, whereas for persons aged 50 years and older, this risk was decreased by 3% (IRR 0.97 [99% CI 0.95-0.98]). For patients aged 15-39 years, this risk was 20% higher (IRR 1.20 [99% CI 1.05-1.37]), and for patients aged 40-49 years, the risk did not differ (IRR 1.01 [99% CI 0.93-1.09]). The rural-urban disparities in all age groups remained similar when stratified for nSES.

DISCUSSION: The incidence of ischemic stroke is higher among persons aged 15-49 years living in rural areas compared with urban areas, which was driven by a risk-increase in patients 15-39 years. This was reversed among persons aged 50 years and older. Our findings were not fully explained by differences in nSES. This suggests that different age-specific predictors might play a role in rural-urban disparities in ischemic stroke incidence.

PMID:39586044 | DOI:10.1212/WNL.0000000000210102

J Occup Environ Hyg. 2024 Nov 25:1-15. doi: 10.1080/15459624.2024.2420994. Online ahead of print.

ABSTRACT

Several recent studies have examined the role of intermediate/semi-volatile organic compound emissions from paving and roofing asphalts in the formation of secondary organic aerosols (SOAs), which constitute a portion of fine atmospheric particulate matter. These studies have yielded divergent results. Building upon this research, this study aims to develop more representative emission factors for estimating the contribution of roofing materials to SOA formation. This was accomplished by investigating the impact on SOA formation of variables such as rooftop temperatures, solar insolation values, study durations, and the physical and chemical properties of the roofing materials tested. To quantify the influence of these variables, data from existing literature were drawn, and limited experimental lab work was conducted. Monte Carlo-based quantitative uncertainty and sensitivity analyses were completed to estimate more representative emission factors, generate accompanying uncertainty ranges, and rank critical parameters driving emissions that should be considered in any follow-up research. The emission factors developed in this study resulted in a central tendency estimate of 1.7 × 10^-4 Gg/yr SOA for the 720 hottest hours in Southern California, with a 90% confidence interval of 6.0 × 10^-5 to 3.4 × 10^-4 Gg/yr. For the 4,320 annual daylight hours, the central tendency estimate is 2.1 × 10^-5 Gg/yr, with a 90% confidence interval of 4.7 × 10^-6 to 5.1 × 10^-5 Gg/yr. To provide perspective, the results of this study indicate that the SOA contribution to in-service emissions from asphalt roofing surfaces is four to five orders of magnitude lower than that reported for mobile diesel and gasoline sources.

PMID:39586037 | DOI:10.1080/15459624.2024.2420994