Tag: nevin manimala

PLoS One. 2025 Jan 13;20(1):e0304293. doi: 10.1371/journal.pone.0304293. eCollection 2025.

ABSTRACT

BACKGROUND: It is unclear what impact iron deficiency has on fatigue in people with inflammatory bowel disease (IBD). This systematic review examined the evidence of whether iron deficiency, with or without anaemia, was associated with fatigue in IBD. Fatigue is a common symptom in patients with IBD that can be difficult to manage and treat. A greater understanding of the role and contribution of iron deficiency to fatigue may help improve the management of this condition.

METHODS: The databases searched were MEDLINE, OVID, CINAHL and Web of Science. Inclusion criteria were studies measuring iron status for iron deficiency (ID) and patient-reported outcome measures (PROMs) for fatigue in patients with IBD of any level of disease activity. Assessment of bias was conducted using the Newcastle Ottawa Scale. Studies were grouped for syntheses according to whether exposure was iron deficiency without anaemia (IDWA) or ID regardless of haemoglobin level.

RESULTS: Two hundred and eighty-five individual database results were identified and screened; 32 complete records were reviewed, from which seven studies with 1425 individuals were deemed eligible for inclusion in the results synthesis. Considerable variation in the methods and statistical analysis used to investigate the relationship between ID and fatigue prevented any quantitative synthesis. Studies varied by population disease activity levels, approaches used to define ID and PROMs used to measure fatigue. Three studies directly compared fatigue scores in IDWA to those not iron deficient, two of which showed patients with IDWA had significantly lower fatigue scores. Four studies used ID irrespective of anaemia as the exposure and reported mixed results on fatigue, with only one study reporting a higher prevalence of fatigue in the ID group.

CONCLUSIONS: There was marked heterogeneity between studies in this review. Two studies found evidence of a slight increase in fatigue levels in patients with IDWA. Though this does not explain all fatigue in patients with IBD, iron replacement should be considered to improve fatigue in iron-deficient patients.

PMID:39804874 | DOI:10.1371/journal.pone.0304293

PLoS One. 2025 Jan 13;20(1):e0317406. doi: 10.1371/journal.pone.0317406. eCollection 2025.

ABSTRACT

INTRODUCTION: Sedation ensures a child remains motionless during a procedure and decreases anxiety. Several pharmacologic regimes exist for paediatric sedation. However, often, intravenous cannulation is required, causing distress for the child. Creating a low-stress environment for children during medical procedures is crucial. Intranasal dexmedetomidine offers a promising alternative by either removing the need for intravenous cannulation or significantly reducing stress and anxiety when cannulation is necessary. We aim to investigate the safety and efficiency of sedating children with intranasal dexmedetomidine.

METHODS AND ANALYSIS: We will systematically search MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), CENTRAL, Clinicaltrials.gov, and the WHO ICTRP portal. We will include all randomized controlled trials (RCT) that investigate the use of intranasal dexmedetomidine compared to alternative sedatives for premedication or sedation of children. Two researchers will independently screen title/abstract and full-text articles for eligibility using Covidence. Our primary outcome is sedation success rate. RCTs that meet the inclusion criteria will form the unit of analysis. Data extracted from each study will be presented in table format (S2 Table). Information on parameters that describe safety and efficiency outcomes will be extracted and analysed. Outcome data will be reported as risk ratios and 95% confidence intervals (CI) for dichotomous outcomes or mean and standardized mean differences with 95% CI for continuous outcomes. The assessment of statistical heterogeneity will be examined using Chi2- and I2-statistics. PROSPERO registration number CRD42024532993.

DISCUSSION: Sedation with intranasal dexmedetomidine is not common practice in all countries, though the medicament has the potential to provide a child-friendly approach to sedation and premedication. Reviews on the area are conflicting, and new RCT studies have been published. Our systematic review aims to comprehensively assess intranasal paediatric sedation, focusing on dexmedetomidine and guiding clinicians in daily decision-making for optimal paediatric sedation.

PMID:39804873 | DOI:10.1371/journal.pone.0317406

PLoS One. 2025 Jan 13;20(1):e0316800. doi: 10.1371/journal.pone.0316800. eCollection 2025.

ABSTRACT

OBJECTIVES: Clinical breast examination (CBE) open the pathway to early detection and diagnosis of breast cancer. This study examined barriers to CBE uptake in seven sub-Saharan African (SSA) countries.

METHODS: Data from the most current Demographic and Health Surveys of Burkina Faso, Cote d’Ivoire, Ghana, and Kenya Mozambique, Senegal and Tanzania was used. A weighted sample size of 65,486 women aged 25-49 years was used to estimate the pooled prevalence of CBE. We employed a multilevel logistic regression modelling technique, with results presented in adjusted odds ratios (aOR) along with a 95% confidence interval (CI).

RESULTS: The pooled prevalence of CBE uptake in the studied SSA countries is low at 19.2% [95%CI: 18.5-19.8]. Screening uptake was significantly low among women reporting difficulty in getting permission (aOR = 0.88, 95% CI: 0.82-0.95), and distance (aOR = 0.95, 95% CI: 0.89-0.99), as well as those who reported financial constraints (aOR = 0.92, 95% CI: 0.88-0.97), as barriers to access healthcare facilities. However, surprisingly, women who faced travel-alone barriers were 1.19 times (95%CI: 1.10-1.28) more likely to utilise CBE than those who did not face this barrier.

CONCLUSIONS: We conclude that barriers such as difficulties in obtaining permission, long distances to healthcare facilities, and financial constraints significantly reduce the likelihood of women undergoing CBE. The study underscores a need to improve access to healthcare facilities. Practically, this can be achieved by expanding mobile health services and integrating CBE into primary healthcare will help overcome distance-related challenges. Additionally, targeted outreach and transportation initiatives are necessary to support women facing travel barriers.

PMID:39804868 | DOI:10.1371/journal.pone.0316800

PLoS One. 2025 Jan 13;20(1):e0317417. doi: 10.1371/journal.pone.0317417. eCollection 2025.

ABSTRACT

INTRODUCTION: Heart failure (HF) is a chronic condition with an unpredictable trajectory, making effective communication between patients and healthcare providers crucial for optimizing outcomes. This study aims to investigate and compare the communication needs regarding HF trajectory and palliative care between patients and healthcare providers and to identify factors associated with the communication needs of patients with HF.

METHODS: A cross-sectional study design was employed, involving 100 patients with HF and 35 healthcare providers. Data were collected using structured questionnaires assessing communication needs, health literacy, self-care behavior, and social support. Statistical analyses were performed, including Spearman’s rank correlation, Pearson’s correlation, and multiple regression analyses.

RESULTS: Patients prioritized communication related to device-related questions, whereas healthcare providers focused more on aspects of HF in daily life. Both groups ranked end-of-life communication as the lowest priority. The communication needs of patients were positively correlated with health literacy (r = 0.27, p = .007), self-care behavior (r = 0.32, p = .001), and social support (r = 0.24, p = .016). Multiple regression analyses indicated that self-care behavior was a significant factor influencing the communication needs of patients (β = 0.27, p = .011).

CONCLUSIONS: Enhanced patient-centered communication strategies are required to address the communication priority gaps between patients and healthcare providers. Improving health literacy, supporting self-care behaviors, and leveraging social support are critical in meeting patients’ communication needs. Tailored communication training for healthcare providers can bridge this gap and improve overall HF management.

PMID:39804863 | DOI:10.1371/journal.pone.0317417

PLoS One. 2025 Jan 13;20(1):e0316833. doi: 10.1371/journal.pone.0316833. eCollection 2025.

ABSTRACT

BACKGROUND: Youth soccer players in the UK transition into the professional game at 16 years of age. Understanding the differences between youth and professional standards can help coaches and clubs to support player development during this transition.

OBJECTIVES: To (i) assess the differences in technical and possession statistics between different age groups (U16, U18, U23) and outfield positions (central defender [CD], wide defender [WD], central midfielder [CM], attacking midfielder [AM], wide midfielder [WM], striker [ST]), within an English academy soccer programme, during match-play.

METHODS: All matches were monitored using foot-mounted inertial measurements units (F-IMU; Playermaker™) to quantify the technical (touches and releases from the feet) and individual possession statistics (Time on the ball, Time on the ball per possession) from each match. Teams were instructed to play a 1-4-3-3 formation as part of their clubs playing philosophy, with positions defined per this formation. Data were analysed using a multi-variate ANOVA Two-tailed statistical significance was accepted as p ≤ 0.05 and measures of effect size were calculated using partial eta-squared (η2). Magnitude of the effect sizes were small (0.2<ES<0.6), moderate (0.6<ES<1.2), large (1.2<ES<2) and very large (≥2).

RESULTS: Trivial to small effect sizes were observed across age groups for both technical and possession-based statistics during match-play. Across all age groups and positions, CD`s had the highest number of technical actions (touches and releases), whereas ST`s & AM`s, had the highest amount of time in possession of the ball. Further, positional analysis showed ST`s and AM`s had moderate to large decreases in time on the ball per possession at the U23’s age group in comparison to the U16 and U18’s, with no technical differences observed within the same positional analysis.

CONCLUSION: Attacking players (AM & ST) are required to move the ball quicker as they progress from U16 to U23’s within the current English football academy. Further exploration is required to assess if these changes are context specific given requirements of those age groups.

PMID:39804859 | DOI:10.1371/journal.pone.0316833

PLoS One. 2025 Jan 13;20(1):e0313732. doi: 10.1371/journal.pone.0313732. eCollection 2025.

ABSTRACT

BACKGROUND: Rigorous population-based assessments of the use of specialty palliative care (SPC) in the US are rare.

SETTINGS/SUBJECTS: This study examined SPC use among cancer patients in a mid-sized metropolitan area in Southeast US.

MEASUREMENTS: In this cancer decedent cohort study, data were acquired and linked from the state-wide cancer registry; state-wide hospital discharge dataset; and local SPC providers.

RESULTS: 12,030 individuals with cancer were included in this study; only 2,958 (24.6%) used SPC. Of the 9,072 persons who did not use SPC, 3,877 (42.7%) went only to hospitals that did not offer SPC; and 3,517 (38.8%) went to hospitals that offered SPC but did not use it. About half of SPC recipients (1493; 50.5%) first received SPC in the final 30 days of life, including 768 (26.0%) in the final week of life. Characteristics associated with using SPC use included being in an socio-economic status quintile other than the lowest; being younger; being Black; having a solid (versus hematological) cancer; having a shorter survival with cancer; dying in the latter two years of the study; being from an area of low or complete rurality; having a hospital admission in the final 60 days prior to initiation of PC or death; having more days in hospital; and living within 15 miles of a hospital offering SPC.

CONCLUSIONS: In this population-based study, only one-quarter of cancer patients used SPC, and for half who did so, it came in the final 30 days of life.

PMID:39804856 | DOI:10.1371/journal.pone.0313732

PLoS One. 2025 Jan 13;20(1):e0317374. doi: 10.1371/journal.pone.0317374. eCollection 2025.

ABSTRACT

BACKGROUND: The warm chain of support is the continuous enabling environment from the mother’s first contact with healthcare professionals during early pregnancy, birth and immediate post-partum period, her transition from healthcare facility to home, through to work and the community at large. A breastfeeding-friendly city should be able to support a breastfeeding journey across the warm chain.

OBJECTIVE: To determine breastfeeding women’s perspective of an ideal breastfeeding-friendly city.

METHODS: Between September 2021 and January 2022, twenty-two women who were breastfeeding or had ever breastfed in the last 5 years from Ireland and Malaysia were interviewed. A set of selection criteria was applied to ensure representation of a range of the characteristics known to be associated with breastfeeding success: diverse age groups, birth and breastfeeding experiences, culture and socioeconomical background. One-on-one semi-structured online interviews were conducted by the first author. Data were analysed using Braun and Clarke’s Thematic Analysis framework.

RESULTS: One overarching theme of breastfeeding at the front and centre of the city, and three major themes were developed: 1. mothers feel supported when breastfeeding is prioritised; 2. when breastfeeding is visible in the environment, it becomes normalized; 3. there is a need to have seamless breastfeeding support across the continuum of the warm chain, and at all levels of society.

CONCLUSIONS: The findings demonstrated the importance of prioritized, and continuous support throughout the breastfeeding journey. The hopes and aspirations of a breastfeeding-friendly city expressed here would be useful for cities to consider when developing or implementing breastfeeding support programmes as well as guide development of indicators of a breastfeeding-friendly city.

PMID:39804854 | DOI:10.1371/journal.pone.0317374

J Med Internet Res. 2025 Jan 13;27:e59027. doi: 10.2196/59027.

ABSTRACT

BACKGROUND: Digital health interventions have emerged as promising tools to promote health behavior change and improve health outcomes. However, a comprehensive synthesis of strategies contributing to these interventions is lacking.

OBJECTIVE: This study aims to (1) identify and categorize the strategies used in digital health interventions over the past 25 years; (2) explore the differences and changes in these strategies across time periods, countries, populations, delivery methods, and senders; and (3) serve as a valuable reference for future researchers and practitioners to improve the effectiveness of digital health interventions.

METHODS: This study followed a systematic review approach, complemented by close reading and text coding. A comprehensive search for published English academic papers from PubMed, Web of Science, and Scopus was conducted. The search employed a combination of digital health and intervention-related terms, along with database-specific subject headings and filters. The time span covered 25 years, from January 1, 1999, to March 10, 2024. Sample papers were selected based on study design, intervention details, and strategies. The strategies were identified and categorized based on the principles of Behavior Change Techniques and Behavior Strategies.

RESULTS: A total of 885 papers involving 954,847 participants met the eligibility criteria. We identified 173 unique strategies used in digital health interventions, categorized into 19 themes. The 3 most frequently used strategies in the sample papers were “guide” (n=492, 55.6%), “monitor” (n=490, 55.4%), and “communication” (n=392, 44.3%). The number of strategies employed in each paper ranged from 1 to 32. Most interventions targeted clients (n=844, 95.4%) and were carried out in hospitals (n=268, 30.3%). High-income countries demonstrated a substantially higher number and diversity of identified strategies than low- and middle-income countries, and the number of studies targeting the public (n=647, 73.1%) far exceeded those focusing on vulnerable groups (n=238, 26.9%).

CONCLUSIONS: Digital health interventions and strategies have undergone considerable development over the past 25 years. They have evolved from simple approaches to sophisticated, personalized techniques and are trending toward multifaceted interventions, leveraging advanced technologies for real-time monitoring and feedback. Future studies should focus on rigorous evaluations, long-term effectiveness, and tailored approaches for diverse populations, and more attention should be given to vulnerable groups.

PMID:39804697 | DOI:10.2196/59027

J Med Internet Res. 2025 Jan 13;27:e57619. doi: 10.2196/57619.

ABSTRACT

BACKGROUND: Improving adherence to pre-exposure prophylaxis (PrEP) via digital health interventions (DHIs) for young sexual and gender minority men who have sex with men (YSGMMSM) is promising for reducing the HIV burden. Measuring and achieving effective engagement (sufficient to solicit PrEP adherence) in YSGMMSM is challenging.

OBJECTIVE: This study is a secondary analysis of the primary efficacy randomized controlled trial (RCT) of Prepared, Protected, Empowered (P3), a digital PrEP adherence intervention that used causal mediation to quantify whether and to what extent intrapersonal behavioral, mental health, and sociodemographic measures were related to effective engagement for PrEP adherence in YSGMMSM.

METHODS: In May 2019, 264 YSGMMSM were recruited for the primary RCT via social media, community sites, and clinics from 9 study sites across the United States. For this secondary analysis, 140 participants were eligible (retained at follow-up, received DHI condition in primary RCT, and completed trial data). Participants earned US currency for daily use of P3 and lost US currency for nonuse. Dollars accrued at the 3-month follow-up were used to measure engagement. PrEP nonadherence was defined as blood serum concentrations of tenofovir-diphosphate and emtricitabine-triphosphate that correlated with ≤4 doses weekly at the 3-month follow-up. Logistic regression was used to estimate the total effect of baseline intrapersonal measures on PrEP nonadherence, represented as odds ratios (ORs) with a null value of 1. The total OR for each intrapersonal measure was decomposed into direct and indirect effects.

RESULTS: For every US $1 earned above the mean (US $96, SD US $35.1), participants had 2% (OR 0.98, 95% CI 0.97-0.99) lower odds of PrEP nonadherence. Frequently using phone apps to track health information was associated with a 71% (OR 0.29, 95% CI 0.06-0.96) lower odds of PrEP nonadherence. This was overwhelmingly a direct effect, not mediated by engagement, with a percentage mediated (PM) of 1%. Non-Hispanic White participants had 83% lower odds of PrEP nonadherence (OR 0.17, 95% CI 0.05-0.48) and had a direct effect (PM=4%). Participants with depressive symptoms and anxiety symptoms had 3.4 (OR 3.42, 95% CI 0.95-12) and 3.5 (OR 3.51, 95% CI 1.06-11.55) times higher odds of PrEP nonadherence, respectively. Anxious symptoms largely operated through P3 engagement (PM=51%).

CONCLUSIONS: P3 engagement (dollars accrued) was strongly related to lower odds of PrEP nonadherence. Intrapersonal measures operating through P3 engagement (indirect effect, eg, anxious symptoms) suggest possible pathways to improve PrEP adherence DHI efficacy in YSGMMSM via effective engagement. Conversely, the direct effects observed in this study may reflect existing structural disparity (eg, race and ethnicity) or behavioral dispositions toward technology (eg, tracking health via phone apps). Evaluating effective engagement in DHIs with causal mediation approaches provides a clarifying and mechanistic view of how DHIs impact health behavior.

TRIAL REGISTRATION: ClinicalTrials.gov; NCT03320512; https://clinicaltrials.gov/study/NCT03320512.

PMID:39804696 | DOI:10.2196/57619

J Med Internet Res. 2025 Jan 13;27:e63004. doi: 10.2196/63004.

ABSTRACT

BACKGROUND: Digital biomarkers are increasingly used in clinical decision support for various health conditions. Speech features as digital biomarkers can offer insights into underlying physiological processes due to the complexity of speech production. This process involves respiration, phonation, articulation, and resonance, all of which rely on specific motor systems for the preparation and execution of speech. Deficits in any of these systems can cause changes in speech signal patterns. Increasing efforts are being made to develop speech-based clinical decision support systems.

OBJECTIVE: This systematic scoping review investigated the technological revolution and recent digital clinical speech signal analysis trends to understand the key concepts and research processes from clinical and technical perspectives.

METHODS: A systematic scoping review was undertaken in 6 databases guided by a set of research questions. Articles that focused on speech signal analysis for clinical decision-making were identified, and the included studies were analyzed quantitatively. A narrower scope of studies investigating neurological diseases were analyzed using qualitative content analysis.

RESULTS: A total of 389 articles met the initial eligibility criteria, of which 72 (18.5%) that focused on neurological diseases were included in the qualitative analysis. In the included studies, Parkinson disease, Alzheimer disease, and cognitive disorders were the most frequently investigated conditions. The literature explored the potential of speech feature analysis in diagnosis, differentiating between, assessing the severity and monitoring the treatment of neurological conditions. The common speech tasks used were sustained phonations, diadochokinetic tasks, reading tasks, activity-based tasks, picture descriptions, and prompted speech tasks. From these tasks, conventional speech features (such as fundamental frequency, jitter, and shimmer), advanced digital signal processing-based speech features (such as wavelet transformation-based features), and spectrograms in the form of audio images were analyzed. Traditional machine learning and deep learning approaches were used to build predictive models, whereas statistical analysis assessed variable relationships and reliability of speech features. Model evaluations primarily focused on analytical validations. A significant research gap was identified: the need for a structured research process to guide studies toward potential technological intervention in clinical settings. To address this, a research framework was proposed that adapts a design science research methodology to guide research studies systematically.

CONCLUSIONS: The findings highlight how data science techniques can enhance speech signal analysis to support clinical decision-making. By combining knowledge from clinical practice, speech science, and data science within a structured research framework, future research may achieve greater clinical relevance.

PMID:39804693 | DOI:10.2196/63004