Tag: nevin manimala

JMIR Rehabil Assist Technol. 2025 Oct 8;12:e71379. doi: 10.2196/71379.

ABSTRACT

BACKGROUND: Digitalization is seen as a way to reduce the negative environmental impacts of health care production, but research is still limited.

OBJECTIVE: This study focuses on the assessment of the sustainability aspects of digital services in home care and health care. It demonstrates the approach to identify the climate impacts and social impacts-both positive and negative-on a selection of digital home care and health care services, such as medicine robot services for older home care clients, through 2 Finnish case studies.

METHODS: Impacts are identified from interviews and statistical data collected from public service providers and technology suppliers using both quantitative and qualitative assessments.

RESULTS: While a well-planned and well-implemented digital service is likely to be a climate-friendly option, every digitalization action carries at least some negative impacts. The design, architecture, and practical implementation of these services greatly affect their climate and social impacts.

CONCLUSIONS: This study uses a novel combination of impact assessment methods, highlighting the importance of qualitative understanding alongside quantitative approaches for interpreting results, especially when numerical data are limited. Advocating for multimethod impact assessments is crucial to properly capturing the service context and promoting holistic sustainability thinking.

PMID:41061252 | DOI:10.2196/71379

JMIR Res Protoc. 2025 Oct 8;14:e74988. doi: 10.2196/74988.

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) is a chronic neurological disease of the central nervous system, primarily affecting young adults. Common challenges in MS include fatigue, physical impairments, and cognitive impairments, associated with low levels of physical activity, unemployment, reduced health-related quality of life (HRQoL), and substantial personal and societal costs. Many leave the workforce or reduce hours even when disability is low and despite a desire to increase work hours if the job is adjusted to their needs. Existing services aiming to optimize physical functions and work participation only initiate retrospectively, and there is a lack of knowledge regarding the possible effect of more proactive services.

OBJECTIVE: The objective of this study is to investigate the effects of a comprehensive multidisciplinary intervention, CoreDISTparticipation, delivered across health care levels (hospitals and municipalities) and sectors (health and employment/welfare), on barriers to work, physical activity, and physical functions; fatigue; and HRQoL for employed people with multiple sclerosis (pwMS) and to perform a health economic evaluation.

METHODS: This prospective, single-blinded randomized controlled trial (RCT) will include 115 pwMS with Expanded Disability Status Scale (EDSS) scores of 0-4 randomly allocated to either a CoreDISTparticipation intervention group or usual care (control group). The CoreDISTparticipation intervention includes (1) information videos, hospital outpatient physiotherapist assessments, and meetings with employment consultants; (2) group-based physiotherapy in municipalities for 60 minutes over 6 weeks, one indoor CoreDIST balance session, one outdoor CoreDIST balance and high-intensity interval session, and tailored work follow-up; and (3) 6 weeks of digitally supported independent training, twice weekly. Assessments will be conducted at baseline, week 9, and week 16. Primary outcomes include Multiple Sclerosis Work Difficulties Questionnaire-23 – Norwegian version (MSWDQ-23NV) and ActiGraph wGT3x-BT monitor scores. Secondary outcomes include Trunk Impairment Scale – modified Norwegian Version (TIS-modNV), Mini Balance Evaluation Systems Test (MiniBESTest), AccuGait Optimized force platform, 6-minute walk test (6MWT), Multiple Sclerosis Walking Scale-12, Multiple Sclerosis Impact Scale-29 – Norwegian version, EQ-5D-5L, and Fatigue Severity Scale – Norwegian version scores. The study will identify effects of CoreDISTparticipation versus usual care on work barriers, physical activity, balance, walking, fatigue, and quality of life, along with a health economic evaluation. Descriptive statistics and repeated measures mixed models will be performed using IBM SPSS version29.

RESULTS: We completed the enrolment phase and enrolled and randomized 115 participants in two phases by August 1, 2024. The 15-week retests were completed in December 2024, and data collection is estimated to be completed by September 2025. Results are expected to be published in the first quarter of 2026.

CONCLUSIONS: CoreDISTparticipation is an innovative approach proactively addressing physical functions, physical activity, and work participation. If effective, it can offer a low-cost approach that potentially may enhance the quality of life and workforce sustainability and reduce societal costs.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06110468; https://www.clinicaltrials.gov/study/NCT06110468.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/74988.

PMID:41061251 | DOI:10.2196/74988

JMIR Aging. 2025 Oct 8;8:e76981. doi: 10.2196/76981.

ABSTRACT

BACKGROUND: Neuroimaging is crucial in the diagnosis of Alzheimer disease (AD). In recent years, artificial intelligence (AI)-based neuroimaging technology has rapidly developed, providing new methods for accurate diagnosis of AD, but its performance differences still need to be systematically evaluated.

OBJECTIVE: This study aims to conduct a systematic review and meta-analysis comparing the diagnostic performance of AI-assisted fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) and structural magnetic resonance imaging (sMRI) for AD.

METHODS: Databases including Web of Science, PubMed, and Embase were searched from inception to January 2025 to identify original studies that developed or validated AI models for AD diagnosis using 18F-FDG PET or sMRI. Methodological quality was assessed using the TRIPOD-AI (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis-Artificial Intelligence) checklist. A bivariate mixed-effects model was employed to calculate pooled sensitivity, specificity, and summary receiver operating characteristic curve area (SROC-AUC).

RESULTS: A total of 38 studies were included, with 28 moderate-to-high-quality studies analyzed. Pooled SROC-AUC values were 0.94 (95% CI 0.92-0.96) for sMRI and 0.96 (95% CI 0.94-0.98) for 18F-FDG PET, demonstrating statistically significant intermodal differences (P=.02). Subgroup analyses revealed that for machine learning, pooled SROC-AUCs were 0.89 (95% CI 0.86-0.92) for sMRI and 0.95 (95% CI 0.92-0.96) for 18F-FDG PET, while for deep learning, these values were 0.96 (95% CI 0.94-0.97) and 0.97 (95% CI 0.96-0.99), respectively. Meta-regression identified heterogeneity arising from study quality stratification, algorithm types, and validation strategies.

CONCLUSIONS: Both AI-assisted 18F-FDG PET and sMRI exhibit high diagnostic accuracy in AD, with 18F-FDG PET demonstrating superior overall diagnostic performance compared to sMRI.

PMID:41061249 | DOI:10.2196/76981

J Speech Lang Hear Res. 2025 Oct 8:1-16. doi: 10.1044/2025_JSLHR-25-00162. Online ahead of print.

ABSTRACT

PURPOSE: This study is the first step in a project aimed at developing an intervention program for new hearing aid (HA) users and their relatives in the Province of Quebec, Canada. The objectives were to describe the experience of a first HA fitting from the perspective of adults with hearing loss and their relatives, to identify facilitators and barriers to the fitting process, and to identify elements that should be included in an intervention program to support HA adoption and use. Satisfaction regarding HAs and fitting services was also assessed after fitting.

METHOD: A mixed-methods design combining qualitative and quantitative data sources was used. Interviews were conducted with 10 new HA users, seven relatives, and 10 hearing care professionals. HA users also completed a questionnaire to assess their satisfaction with HAs and services after fitting. A qualitative content analysis was done on the data obtained from the interviews, and descriptive statistics were used to analyze data on satisfaction.

RESULTS: Identified facilitators and barriers to HA fitting for new users were related to professional services, HAs, relatives, and personal factors. Elements for inclusion in the intervention program were categorized into two groups: information to provide and support to offer. Participants reported a high satisfaction level with HAs (M = 87.6 ± 7.5%).

CONCLUSIONS: Several factors can influence the success of a first HA fitting, including aspects related to technology, professional services, and psychosocial elements. Participants suggested important components to include in the intervention for first-time fittings. These results will be used to develop an intervention program for new HA users and their relatives.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.30235315.

PMID:41061248 | DOI:10.1044/2025_JSLHR-25-00162

Neurology. 2025 Nov 11;105(9):e214270. doi: 10.1212/WNL.0000000000214270. Epub 2025 Oct 8.

ABSTRACT

BACKGROUND AND OBJECTIVES: Concomitant use of tramadol and antidepressants with potent inhibition of the cytochrome P450 2D6 (CYP2D6) enzyme is postulated to increase risk of seizures in older adults; yet, such an association has not been empirically tested in populations. We aimed to examine the association of concomitant tramadol and CYP2D6-inhibiting vs CYP2D6-neutral antidepressant use and the risk of seizures among older nursing home (NH) residents.

METHODS: This population-based cohort study was conducted using a 100% Medicare NH sample from January 2010 to December 2021. We included long-term residents aged 65 years or older who initiated antidepressants on existing tramadol use (tramadol-antidepressant users) or initiated tramadol on existing antidepressant use (antidepressant-tramadol users). Patients were followed up until the end of 1 year, NH discharge, death, or study end. The key exposure was concomitant use of tramadol with CYP2D6-inhibiting vs CYP2D6-neutral antidepressants. The key outcome was incident rates of medical encounters with a diagnosis of seizure and analyzed using negative binomial or Poisson regression models adjusted for baseline covariates (e.g., pain status and depressive, physical, and cognitive function) through the inverse probability of treatment weighting.

RESULTS: We identified 11,162 concomitant tramadol-antidepressant users (mean [SD] age, 86.2 [8.5] years; 9,077 [81.3%] female) and 58,994 concomitant antidepressant-tramadol users (mean [SD] age, 85.3 [8.4] years; 47,053 [79.8%] female). The incidence rate of seizures was 16.10 and 20.17 per 100 patient-years, respectively, for the tramadol-antidepressant and antidepressant-tramadol group. In both subgroups, co-use of tramadol with CYP2D6-inhibiting (vs with CYP2D6-neutral) antidepressants was associated with higher adjusted incidence rate ratios of seizures (1.09 [95% CI 1.02-1.18] and 1.06 [95% CI 1.03-1.10]). Findings were corroborated by a negative control exposure analysis in which co-use of hydrocodone with CYPD2D6-inhibiting (vs CYP2D6-neutral) antidepressants was not associated with risk of seizures.

DISCUSSION: Concomitant use of tramadol with CYP2D6-inhibiting vs CYP2D6-neutral antidepressants was associated with increased risk of seizures. Findings are only generalizable to long-term NH populations and are subject to residual confounding. Clinicians should be mindful of seizure risk in older patients who use tramadol concomitantly with antidepressants, particularly CYP2D6-inhibiting antidepressants.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that the combination of tramadol and CYP2D6-inhibiting antidepressants is associated with a higher risk of seizures compared with the combination of tramadol and CYP2D6-neutral antidepressants.

PMID:41061201 | DOI:10.1212/WNL.0000000000214270

Int J Oral Maxillofac Implants. 2025 Oct 8;0(0):1-21. doi: 10.11607/jomi.11375. Online ahead of print.

ABSTRACT

Titanium ions and particles (TiP) are associated with localized inflammatory response and may play a role in further peri-implant tissue breakdown.

OBJECTIVE: The purpose of this study was to evaluate presence of TiP after instrumentation of implant surfaces using different debridement methods.

METHODS: Six debridement methods, stainless steel (SS), titanium (T)-curette, ultrasonic tip (CV), an ultrasonic tip with plastic sleeve (CS), a CO2- and an Er,Cr:YSGG-laser were evaluated. A simulated defect was created around an implant in type II-bone block and irrigation was performed with water. A CO2-laser (non-contact, defocused beam, continuous wave, 2 W power) and an Er,Cr:YSGG-laser tip was used in contact with the implant (power of 2 W, 75 Hz, 40% water: 2% air). Twenty samples (per method) were collected using paper points after 30 seconds of instrumentation. Chemical composition analysis of the bone block, water irrigation and instruments (baseline) were evaluated for presence of TiP and liquid samples after instrumentation with an x-ray fluorescent spectrometer. Statistical analysis using simple t-test was performed for each debridement method.

RESULTS: Baseline measurements showed no TiP. TiP were found in SS-, T- and CV-groups with values of 0.02340.0181, 0.0072±0.0037, 0.0051±0.0041 ppm, respectively. TiP were not observed in CS-, and laser groups. The semiquantitative data showed higher presence of TiP in the SS-, T- and CV-groups in comparison to the baseline (P < .0001).

CONCLUSION: TiP were found after instrumentation using SS, T, CV, which may affect the disease etiology and outcomes of peri-implantitis therapy, compared to CS, CO2- or Er,Cr:YSGG-laser irradiation.

PMID:41061196 | DOI:10.11607/jomi.11375

Int J Oral Maxillofac Implants. 2025 Oct 8;0(0):1-29. doi: 10.11607/jomi.11589. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the influence of osseodensification (OD) and conventional drilling (CD) techniques on primary and secondary implant stability. The study also compares the effect of these techniques on peri-implant bone density, crestal bone level, alveolar ridge width, and concentration of TNF-α and IL-1β.

MATERIALS & METHODS: A total of 24 single or multiple edentulous sites were randomly and evenly allocated into two groups of 12, such that osteotomy preparation for implant placement was carried out using the OD technique in Group A and the CD technique in Group B. Follow-up evaluations were performed at 1, 4, and 6 months after implant placement. Intergroup and intragroup comparisons were performed with independent t-tests and paired t-tests respectively. Repeated measures ANOVA was applied to compare bone density across different time points. A p-value ≤ 0.05 was set as statistically significant.

RESULTS: Of 24 sites, only 20 (6 males, 5 females) were evaluated in the final analysis, as 3 subjects (1 male, 2 females) missed their follow-up visits. Group A showed significantly higher ISQ values immediately after implant placement (p ≤ 0.001), but not after 4 months (p = 0.053). No significant intergroup differences were found for bone density, crestal bone levels, ridge width, or TNF-α/IL-1β levels at all time points. Nevertheless, Group A exhibited significant postoperative increases in bone density (p = 0.003) and ridge width (p ≤ 0.001) relative to preoperative measurements.

CONCLUSION: OD offers a conservative and biologically favorable approach to implant osteotomy preparation, particularly beneficial in sites with compromised bone conditions by simultaneously enhancing primary stability, bone density, and ridge width without inducing adverse peri-implant tissue responses.

PMID:41061195 | DOI:10.11607/jomi.11589

J Am Acad Orthop Surg Glob Res Rev. 2025 Oct 7;9(10). doi: 10.5435/JAAOSGlobal-D-25-00295. eCollection 2025 Oct 1.

ABSTRACT

BACKGROUND: Bioinductive collagen implants (BCIs) have been growing in popularity for use in rotator cuff repair (RCR) over the past several years, but recent literature has raised concerns about the implants contributing to postoperative stiffness. The purpose of this study was to investigate the incidence of stiffness over a decade of experience with the BCI.

METHODS: A retrospective review was conducted of all cases of RCR using a BCI performed between September 2014 and December 2023. The primary outcome measure was postoperative range of motion, with significant stiffness defined by parameters in the existing literature. The secondary outcome measure was any revision procedure for stiffness.

RESULTS: After application of inclusion and exclusion criteria to 522 cases of RCR, there were 432 cases (390 individual patients) available for outcome analysis with an average follow-up of 34.9 months (range, 6 months to 9.25 years). There were only 12 cases (2.8%) of significant postoperative stiffness. All of them required additional operative intervention for stiffness, and all but two patients had at least one risk factor for stiffness. Stiffness rates were 4 of 291 (1.4%) for full-thickness tears and 8 of 141 (5.7%) for partial-thickness tears (P = 0.0149).

CONCLUSION: This study, the largest single cohort to date analyzing BCIs in RCR, found a low incidence of significant postoperative stiffness in cases associated with the use of the implant. Stiffness rates were markedly higher for repairs of partial-thickness tears. To further improve understanding of postoperative stiffness after RCR with BCI, better definitions and prospective comparative studies across larger groups are needed.

LEVEL OF EVIDENCE: Level IV, retrospective cohort with no comparison group.

PMID:41061192 | DOI:10.5435/JAAOSGlobal-D-25-00295

Blood Adv. 2025 Oct 8:bloodadvances.2025017035. doi: 10.1182/bloodadvances.2025017035. Online ahead of print.

ABSTRACT

Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only potential curative therapy for myelodysplastic syndrome (MDS), recommended in higher-risk according to IPSS. We conducted a phase II multicenter trial (MDS-ALLO-RISK, CNT: NCT02757989) investigating whether allogeneic hematopoietic stem cell transplantation (HSCT) improves overall survival (OS) in patients with lower-risk myelodysplastic syndromes (MDS) who exhibit additional high-risk features (intermediate or higher IPSS-R risk, thrombocytopenia < 20 G/L, neutropenia < 0.5 G/L or failure to 2 lines of therapy). A total of 77 patients (median age 62.5) with low or intermediate-1 IPSS scores were enrolled and stratified based on the presence of a matched HLA donor: 62 patients in the donor arm and 15 without a donor . Despite high remission rates in transplanted patients (67.8% vs. 21.4%), the 3-year OS did not significantly differ between arms (57.6% in donor arm vs. 64.3% in non-donor arm, HR 0.75, p=0.53). The adjusted analysis using inverse probability of treatment weighting (IPTW) confirmed the lack of survival benefit with HSCT. Transplantation was associated with higher rates of chronic graft-versus-host disease (GVHD), severe infections, and non-relapse mortality (24.7%). Although quality of life improved slightly over time in transplanted patients, the difference was not statistically significant. The trial was stopped early due to slow enrollment and futility. The findings highlight the need for improving post-transplant outcomes to justify HSCT in lower-risk MDS patients with poor prognostic features.

PMID:41061188 | DOI:10.1182/bloodadvances.2025017035

JCO Glob Oncol. 2025 Oct;11:e2500012. doi: 10.1200/GO-25-00012. Epub 2025 Oct 8.

ABSTRACT

PURPOSE: In 2013, Brazil implemented a federal law (Law 12.732/2012) mandating cancer treatment to begin within 60 days of diagnosis. Among women with newly diagnosed estrogen receptor-positive (ER+) nonmetastatic breast cancer, we describe the diagnosis-to-treatment interval, patient and tumor characteristics, and the type of treatment received, and we assess these metrics by public versus private health care setting.

METHODS: The study included patients with early-stage ER+ breast cancer from 14 centers in Brazil who had completed locoregional care and received >6 months of adjuvant endocrine therapy (ET). Patient, tumor, and treatment characteristics were abstracted from clinical documentation and collected in REDCap. Qualitative variables were compared between groups using the chi-square or Fisher exact tests. For quantitative variables, the nonparametric Mann-Whitney test was used. P < .05 was considered significant.

RESULTS: From June 2021 to March 2024, 774 women enrolled in the study. The mean age at diagnosis was 56.5 years, and 55.2% received public health care. Women who received care at public institutions were more likely to be premenopausal at diagnosis (45.3% public v 29.2% private, P < .0001), living with no partner (45.6% public v 34.7% private, P = .002), and have lower educational levels (43.6% public v 6.8% private, P < .0001). Women treated in the public sector had more advanced disease with stage III tumors (29.3% public v 13.5% private, P < .0001) and were more likely to receive mastectomies (36.8% public v 29.8% private, P = .0003), axillary dissections (43.1% public v 18.1% private, P < .0001), chemotherapy (73.8% public v 58.5% private, P < .0001), and radiotherapy (87.0% public v 78.7% private, P = .002). Regarding adjuvant ET, women treated in the public sector had lower ovarian function suppression (6.8% public v 18.8% private, P < .0001) and higher tamoxifen use (52.4% public v 29.4% private, P < .0001). The diagnosis-to-treatment interval was longer in the public versus private system (93 v 41 days, P < .0001).

CONCLUSION: Our study revealed significant disparities in cancer care between patients with stage I to III ER+ breast cancer treated in public versus private health care systems in Brazil. Law 12.732/2012 has proven ineffective for patients treated in the public sector and is not being adequately observed or enforced by Brazilian authorities.

PMID:41061177 | DOI:10.1200/GO-25-00012