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The Effect of the Virtual Reality-Based Biofeedback Intervention DEEP on Stress, Emotional Tension, and Anger in Forensic Psychiatric Inpatients: Mixed Methods Single-Case Experimental Design

JMIR Form Res. 2025 Feb 12;9:e65206. doi: 10.2196/65206.

ABSTRACT

BACKGROUND: Decreasing aggression through stress reduction is an important part of forensic psychiatric treatment. DEEP is an experience-based virtual reality intervention that uses biofeedback to train diaphragmatic breathing and increase relaxation. Although DEEP has shown promising results in reducing stress and anxiety in students and adolescents in special education, it has not been examined in forensic psychiatric populations.

OBJECTIVE: This study aimed to evaluate DEEP’s potential to reduce stress, emotional tension, and anger in forensic psychiatric inpatients.

METHODS: A mixed methods, alternating treatment, single-case experimental design was conducted with 6 Dutch forensic inpatients. For 20 days, participants engaged in 4 DEEP sessions. Experience sampling was used for continuous monitoring of stress, emotional tension, and anger twice daily. A repeated linear mixed model was used as a primary statistical approach for analyzing the experience sampling data as well as visual analyses. Finally, semistructured interviews were conducted with participants and health care professionals to compare quantitative with qualitative results.

RESULTS: Of the 6 participants, 3 (50%) completed all 4 DEEP sessions, while the other 3 (50%) missed one session due to technical difficulties or absence from the inpatient clinic. P1 showed a significant reduction of stress after session 2 (β=-.865; P=.005). No significant changes over time were found, although an experienced effect was reported during the interviews. P2 showed no significant results. They reported the sessions as being repetitive, with no experienced effect. P3 showed a momentary increase of emotional tension after the first session (β=-.053; P=.002), but no changes were observed over time. No experienced effects were reported in the interview. P4 did not show significant results over time, and was hesitant to report clear experienced effects. P5 showed a significant decline of emotional tension (β=-.012; P=.006), stress (β=-.014; P=.007), and anger (β=-.007; P=.02) over time. They also reported short-term experienced effects in the interview. P6 showed a significant decline of stress over time (β=-.029; P<.001) and reported experiencing substantial effects. Finally, health care professionals reported a relaxing effect of DEEP in their patients but did not expect many long-term effects because no clear behavioral changes were observed.

CONCLUSIONS: DEEP shows promise in teaching deep breathing techniques to forensic psychiatric inpatients, potentially decreasing stress, emotional tension, and anger in some patients. However, DEEP is not a one-size-fits-all intervention that supports every patient because the effectiveness on the outcome measures varied among participants. To increase effectiveness, emphasis should be put on supporting patients to transfer deep breathing skills into their daily lives. This highlights the importance for the structural integration of DEEP into current treatment protocols.

PMID:39938081 | DOI:10.2196/65206

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Childbirth Experiences and Challenges for Women with Sensory Disabilities: A Systematic Review of Delivery Methods and Healthcare Barriers

J Mother Child. 2025 Feb 11;28(1):113-128. doi: 10.34763/jmotherandchild.20242801.d-24-00038. eCollection 2024 Feb 1.

ABSTRACT

BACKGROUND: Women with sensory disabilities, including deafness and blindness, face significant barriers to equitable healthcare in pregnancy, childbirth, and postnatal care. Representing over 5% of the global population-a number expected to rise-these women often encounter discrimination, limited information access, and inadequate childbirth support, increasing pregnancy-related risks.

MATERIALS AND METHODS: This systematic review examines childbirth methods for women with sensory disabilities and the healthcare barriers they face during prenatal, perinatal, and postnatal periods. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 methodology, searches were performed in PubMed, Scopus, BioMed Central, and Cochrane Library databases. From 270 relevant studies, 10 met the inclusion criteria, comprising 8 quantitative and 2 qualitative studies. All studies were critically appraised using the Caldwell framework.

RESULTS: The review identified that women with sensory disabilities, particularly those who are deaf or blind, experience higher rates of caesarean sections compared to women without disabilities. However, a significant proportion of women in this demographic group successfully deliver vaginally. The review also highlighted substantial healthcare barriers, including inadequate communication between patients and healthcare providers, limited information regarding childbirth options, and insufficient postnatal care. Discrimination and obstetric violence were reported in several studies, further exacerbating the healthcare experiences of these women.

CONCLUSIONS: This study highlights the urgent need for healthcare systems to enhance communication, accessibility, and support for women with sensory disabilities. An equity and inclusion framework in maternal care should ensure that these women receive adequate and respectful healthcare. Addressing these gaps will improve outcomes for mothers and newborns and reduce discrimination and inequitable treatment.

PMID:39938073 | DOI:10.34763/jmotherandchild.20242801.d-24-00038

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Nevin Manimala Statistics

THE EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION ADJUNCT TO LUMBAR STABILIZATION EXERCISES ON MULTIFIDUS MUSCLE THICKNESS, PAIN, DISABILITY, AND PSYCHOSOCIAL STATUS IN PATIENTS WITH CHRONIC LOW BACK PAIN

Am J Phys Med Rehabil. 2025 Feb 12. doi: 10.1097/PHM.0000000000002715. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effects of neuromuscular electrical stimulation combined with lumbar stabilization exercises on lumbar multifidus muscle thickness, disability, pain, depression, anxiety, and fear-avoidance beliefs in patients with chronic low back pain; and to examine the correlation between ultrasound and magnetic resonance imaging of the lumbar multifidus.

DESIGN: Forty patients aged 18-65 years were randomized into two groups: Group 1: exercise and Group 2: exercise + neuromuscular electrical stimulation. The participants underwent 15-session electrical stimulation and/or exercise (3 days/week). All outcome measures assessed at baseline, post-treatment, and 3 months after. Multifidus cross-sectional area on magnetic resonance imaging was measured only at baseline.

RESULTS: Multifidus thickness increased, and pain decreased significantly in both groups, more prominent in Group 2. Disability, depression, and fear-avoidance beliefs scores significantly decreased in both groups, while anxiety decreased only in Group 1. Both magnetic resonance and ultrasound measurements demonstrated excellent inter-rater reliability and statistically significant correlations.

CONCLUSION: Both groups improved in terms of pain, disability, psychological status and muscle thickness. Neuromuscular electrical stimulation adjunct to lumbar stabilization exercises demonstrated enhanced effectiveness in increasing lumbar multifidus thickness.

PMID:39938065 | DOI:10.1097/PHM.0000000000002715

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Vitamin B6 catabolism and psoriasis risk: A cross-sectional study

Clin Exp Dermatol. 2025 Feb 12:llaf065. doi: 10.1093/ced/llaf065. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a common autoimmune inflammatory disease. Vitamin B6 is crucial for the body’s inflammatory response, yet the relationship between pyridoxal 5′-phosphate (PLP), 4-pyridoxic acid (4-PA), and vitamin B6 turnover (4-PA/PLP) in psoriasis remains unexplored.

OBJECTIVE: To investigate the relationship of PLP, 4-PA and vitamin B6 catabolism with the risk of psoriasis.

METHODS: This cross-sectional study analyzed 7,540 participants from the National Health and Nutrition Examination Survey. Vitamin B6 catabolism was assessed via the serum 4-PA to PLP ratio (4-PA/PLP). The primary outcome was psoriasis, evaluated using weighted univariate and multivariate logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses were performed by age, gender, body mass index (BMI), hypertension, dyslipidemia, and cardiovascular disease (CVD).

RESULTS: Out of the participants, 208 had psoriasis. After adjusting for confounders, 4-PA levels in cutoff above group were positively associated with psoriasis (OR=1.51, 95% CI: 1.03-2.20). Additionally, 4-PA/PLP correlated with increased psoriasis risk (OR=1.82, 95% CI: 1.02-3.26). However, PLP levels did not show a significant association. The positive link between 4-PA/PLP and psoriasis was consistent in individuals with BMI ≥25 kg/m², hypertension, and those without dyslipidemia.

CONCLUSION: The results revealed significant association of 4-PA and 4-PA/PLP level with the presence of psoriasis. However, further extensive prospective studies are necessary to establish causality.

PMID:39938060 | DOI:10.1093/ced/llaf065

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Predictors of Persistent COVID-19 Vaccine Refusal Among Previously Infected Patients in Nebraska

Am J Public Health. 2025 Mar;115(3):414-424. doi: 10.2105/AJPH.2024.307921.

ABSTRACT

Objectives. To identify factors associated with persistent COVID-19 vaccine refusal among Nebraska residents 6 months after an initial COVID-19 diagnosis. Methods. Using case investigation surveillance data and vaccination records from the Nebraska Department of Health and Human Services, a cohort of 16 344 unvaccinated, COVID-19‒confirmed individuals (May 2021‒February 2023) were asked for their reason for nonvaccination (RNV), then followed for 6 months to assess subsequent vaccination status. We used a modified Poisson regression to estimate risk of unvaccinated status at follow-up against predictors, including RNV, demographic characteristics, adherence to mitigation measures, hospitalization, and rurality. Results. Compared with those whose RNV was missed opportunity/lack of convenience, individuals who cited religious exemption (adjusted incidence risk ratio [AIRR = 1.36; 95% confidence interval [CI] = 1.31, 1.41), philosophical objection (AIRR = 1.28; 95% CI = 1.24, 1.34), or institutional confidence/complacency concerns (AIRR = 1.26; 95% CI = 1.19, 1.33) showed greatest risk of nonvaccination. Older age, nonadherence to mitigation measures, and higher rurality are positively associated with nonvaccination. Minority status and hospitalization were correlated with vaccination. Conclusions. Ideology-centered objections held significant weight among previously infected individuals who displayed sustained reluctance toward COVID-19 vaccination. Distinguishing sources of misinformation among ideologically similar communities could instigate reconsideration for vaccination. (Am J Public Health. 2025;115(3):414-424. https://doi.org/10.2105/AJPH.2024.307921).

PMID:39938043 | DOI:10.2105/AJPH.2024.307921

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Nevin Manimala Statistics

Changes to Parental Consent Requirements for Abortion in Massachusetts and Impact on Timeliness of Care for Adolescents Aged 16 to 17 Years

Am J Public Health. 2025 Mar;115(3):397-402. doi: 10.2105/AJPH.2024.307918.

ABSTRACT

Objectives. To measure the effect of the ROE Act on abortion timing for adolescents aged 16 to 17 years in Massachusetts. Methods. The primary outcome was gestational duration at abortion for individuals aged 16 to 19 years at Planned Parenthood League of Massachusetts from 2017 to 2022. Our control group included individuals aged 18 to 19 years undergoing abortions. In our primary analysis, we used a comparative interrupted time series with a linear model to capture temporal trends, seasonality, whether an abortion was undergone during the acute phase of the COVID-19 pandemic, previous abortion, and race/ethnicity categories. Results. Minors aged 16 to 17 years underwent 749 abortions during the study. Individuals aged 18 to 19 years underwent 2773 abortions. The ROE Act resulted in a 5.46-day decrease in gestational duration at abortion among minors (95% confidence interval = -11.82, 0.91). Conclusions. Removal of the parental involvement requirement for adolescents aged 16 to 17 years in Massachusetts led to minors undergoing abortions at earlier gestational durations, highlighting the importance of potential impacts of similar legislation to decrease barriers to abortion access for minors. (Am J Public Health. 2025;115(3):397-402. https://doi.org/10.2105/AJPH.2024.307918).

PMID:39938038 | DOI:10.2105/AJPH.2024.307918

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Nevin Manimala Statistics

Changes in Contraceptive Services During Utah’s Family Planning Elevated Contraceptive Access Initiative: A Prospective Assessment of Intervention and Control Sites

Am J Public Health. 2025 Mar;115(3):387-396. doi: 10.2105/AJPH.2024.307917.

ABSTRACT

Objectives. To assess contraceptive service changes during the Family Planning Elevated (FPE) Contraceptive Access Program in Utah clinics from 2018 to 2023. Methods. We assessed de-identified electronic health record data on female clients aged 18 to 50 years from intervention and matched control sites. We used comparative interrupted time series analyses comparing total number of contraceptive services and their proportion relative to visits between intervention and control sites before, during, and after FPE. Results. Intervention sites provided on average 1.76 (95% confidence interval [CI] = 1.17, 2.66) times as many contraceptive services per month as controls during the 24-month intervention period, with no significant decreases in services noted in the postintervention period. The proportions of total visits related to family planning decreased by a factor of 0.70 (95% CI = 0.52, 0.94) during the intervention period. However, this effect was mitigated at intervention sites where proportions of contraceptive services were 1.44 (95% CI = 0.97, 2.14) times greater than control sites and did not significantly decrease after the intervention. Conclusions. Contraceptive access initiatives have capacity to make meaningful change in communities where they are employed, even after they end. (Am J Public Health. 2025;115(3):387-396. https://doi.org/10.2105/AJPH.2024.307917).

PMID:39938037 | DOI:10.2105/AJPH.2024.307917

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Prevalence and Clinical Association of CD276 (B7-H3) Expression in Pleural Mesothelioma: Results From the European Thoracic Platform Mesoscape Project

JCO Precis Oncol. 2025 Feb;9:e2400675. doi: 10.1200/PO-24-00675. Epub 2025 Feb 12.

ABSTRACT

PURPOSE: CD276 (B7-H3) is an immunoregulatory protein that plays an important role in the inhibition of T-cell function. CD276 is overexpressed on a variety of human solid cancer cells with limited expression in normal tissues, making it an appealing target for innovative cancer immunotherapy approaches. Pleural mesothelioma (PM) is a highly aggressive disease with a need for new treatment options. Our objective was to investigate the expression of CD276 in the multicenter PM cohort of the European Thoracic Oncology Platform Mesoscape project and correlate the results with annotated clinical data.

MATERIALS AND METHODS: Using tissue microarrays (TMAs), the expression of CD276, assessed using a semiquantitative aggregate H-score method on the membrane (and secondarily in the cytoplasm), was correlated with clinicopathologic characteristics and survival outcome.

RESULTS: CD276 immunohistochemistry results were available for 353 patients, with mostly epithelioid histology (71%). Membranous CD276 expression was present in 86%. High membranous CD276 expression (H-score ≥the median H-score of 120) was significantly more common in females (P = .0029; 71% v 47%) and in epithelioid histology (P < .001; 59% v 29%), whereas no significant association in clinical outcome (overall survival [OS]/progression-free survival) was found. Cross-validation of the TMA method using whole sections revealed a moderate agreement for membranous assessment (Cohen’s kappa = 0.47) and a lower agreement for cytoplasm assessment (Cohen’s kappa = 0.37). In an exploratory analysis, high cytoplasmic CD276 expression was associated with worse prognosis (OS, log-rank P = .043), but was not significant when adjusting for other clinical variables.

CONCLUSION: Although no prognostic value of CD276 expression was found, its high membranous expression (86%) in the PM samples of the study supports further research of its potential as a therapeutic target for this disease.

PMID:39938010 | DOI:10.1200/PO-24-00675

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The Clery Act’s transparency purpose & campus sexual misconduct: A longitudinal analysis

J Am Coll Health. 2025 Feb 12:1-13. doi: 10.1080/07448481.2025.2461606. Online ahead of print.

ABSTRACT

Objective: Campus sexual misconduct causes adverse physical, mental, behavioral, reproductive, and financial consequences. Informing prevention efforts at federal, state, and institution levels requires valid data. We assessed the appropriateness of Clery Act Campus Crime Statistics data for evaluating campus sexual misconduct. Participants: We sampled 40 institutions within the American Association of Universities (AAU) from 2014 to 2020. Methods: We determined annual differences between rates of sexual misconduct reported in public Clery Act data and those reported by institutional Title IX coordinator offices (which are not required to be public). Results: Clery Act data offer a considerable undercount relative to Title IX Office sexual misconduct data. The magnitude of the differences was similar in both the institutions that published Title IX data and those that did not. Conclusions: Clery Act data are not appropriate for evaluating campus sexual misconduct, necessitating policy steps that require standardization and publication of Title IX Office data.

PMID:39937991 | DOI:10.1080/07448481.2025.2461606

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Nevin Manimala Statistics

Ordered Pt3Mn Intermetallic Setting the Maximum Threshold Activity of Disordered Variants for Glycerol Electrolysis

ACS Nano. 2025 Feb 12. doi: 10.1021/acsnano.4c16468. Online ahead of print.

ABSTRACT

Glycerol electrolysis is a promising strategy for generating hydrogen at the cathode and value-added products at the anode. However, the effect of the atomic distribution within catalysts on their catalytic performance remains largely unexplored, primarily because of the inherent complexity of the glycerol oxidation reaction (GOR). Herein, an ordered Pt3Mn (O-Pt3Mn) intermetallic compound and a disordered Pt3Mn (D-Pt3Mn) alloy are used as model catalysts, and their performance in the GOR and hydrogen evolution reaction (HER) is studied. O-Pt3Mn consistently outperforms D-Pt3Mn and commercial Pt/C catalysts. It can generate high-value glycerate at a notable production rate of 17 mM h-1 while achieving an impressively low cell voltage of 0.76 V for glycerol electrolysis, which is ∼0.98 V lower than that required for water electrolysis. Statistical analysis using theoretical calculations reveals that Pt-Pt-Pt hollow sites are crucial for the catalytic GOR and HER. The averaged adsorption energies of key intermediates (simplified as C*, O*, and H*) on diverse catalysts closely correlate with their experimentally observed activity. Our proposed linear models accurately predict these adsorption energies, exhibiting high correlation coefficients ranging from 0.97 to 0.99 and highlighting the significance of the distribution of the topmost and subsurface-corner Mn atoms in determining these adsorption energies. By sampling all possible Mn configurations within the fitted linear models, we confirm that O-Pt3Mn establishes the maximum activity threshold for the GOR and HER compared with any disordered variant. This study presents an innovative framework for exploring the effect of the atomic distribution within catalysts on their catalytic performance and designing high-performance catalysts for complex reactions.

PMID:39937986 | DOI:10.1021/acsnano.4c16468