Tag: pubmed

J Med Internet Res. 2024 Dec 3;26:e53685. doi: 10.2196/53685.

ABSTRACT

BACKGROUND: In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity.

OBJECTIVE: This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants.

METHODS: We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ≥50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study’s potential to facilitate insights into the impact of a TBI for members of specific URM groups.

RESULTS: Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups.

CONCLUSIONS: While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity.

PMID:39626234 | DOI:10.2196/53685

JMIR Diabetes. 2024 Dec 3;9:e62831. doi: 10.2196/62831.

ABSTRACT

BACKGROUND: Wearable devices can simultaneously collect data on multiple items in real time and are used for disease detection, prediction, diagnosis, and treatment decision-making. Several factors, such as diet and exercise, influence blood glucose levels; however, the relationship between blood glucose and these factors has yet to be evaluated in real practice.

OBJECTIVE: This study aims to investigate the association of blood glucose data with various physiological index and nutritional values using wearable devices and dietary survey data from PhysioNet, a public database.

METHODS: Three analytical methods were used. First, the correlation of each physiological index was calculated and examined to determine whether their mean values or SDs affected the mean value or SD of blood glucose. To investigate the impact of each physiological indicator on blood glucose before and after the time of collection of blood glucose data, lag data were collected, and the correlation coefficient between blood glucose and each physiological indicator was calculated for each physiological index. Second, to examine the relationship between postprandial blood glucose rise and fall and physiological and dietary nutritional assessment indices, multiple regression analysis was performed on the relationship between the slope before and after the peak in postprandial glucose over time and physiological and dietary nutritional indices. Finally, as a supplementary analysis to the multiple regression analysis, a 1-way ANOVA was performed to compare the relationship between the upward and downward slopes of blood glucose and the groups above and below the median for each indicator.

RESULTS: The analysis revealed several indicators of interest: First, the correlation analysis of blood glucose and physiological indices indicated meaningful relationships: acceleration SD (r=-0.190 for lag data at -15-minute values), heart rate SD (r=-0.121 for lag data at -15-minute values), skin temperature SD (r=-0.121), and electrodermal activity SD (r=-0.237) for lag data at -15-minute values. Second, in multiple regression analysis, physiological indices (temperature mean: t=2.52, P=.01; acceleration SD: t=-2.06, P=.04; heart rate_30 SD: t=-2.12, P=.04; electrodermal activity_90 SD: t=1.97, P=.049) and nutritional indices (mean carbohydrate: t=6.53, P<.001; mean dietary fiber: t=-2.51, P=.01; mean sugar: t=-3.72, P<.001) were significant predictors. Finally, the results of the 1-way ANOVA corroborated the findings from the multiple regression analysis.

CONCLUSIONS: Similar results were obtained from the 3 analyses, consistent with previous findings, and the relationship between blood glucose, diet, and physiological indices in the real world was examined. Data sharing facilitates the accessibility of wearable data and enables statistical analyses from various angles. This type of research is expected to be more common in the future.

PMID:39626230 | DOI:10.2196/62831

JMIR Res Protoc. 2024 Dec 3;13:e63276. doi: 10.2196/63276.

ABSTRACT

BACKGROUND: Men who have sex with men (MSM) experience a disproportionate burden of HIV infection globally, including in Ghana. The use of condoms with lubricants correctly and consistently plays a vital role in reducing the number of new HIV infections among MSM. However, there are concerns about the consistent and correct use of condoms and lubricants among MSM in Ghana. In this regard, there is a need to understand context-specific factors associated with consistent and correct condom use with lubricants.

OBJECTIVE: This study aims to determine the current scope of consistent and correct use of condoms with lubricants, associated factors, interventions, and user- and service-related challenges on correct condom and lubricant use among the MSM population in Ghana.

METHODS: The study will use a mixed methods study approach. First, a retrospective analysis of the Ghana Men’s Study II data set involving 4095 MSM will be conducted to determine the scope of consistency and correct use of condoms with lubricants as well as associated factors. The data will be imported into STATA (version 17; StataCorp LLC) to treat missing data and outliers before the analysis. Bivariate and multivariate logistic regression analyses will be conducted to determine the associated factors of consistent condom use with lubricants. All statistical analyses will be done at a 95% CI, with significant differences at P<.05. Second, in-depth interviews with a purposive sample of about 15-20 stakeholders will also be conducted to understand contextual issues regarding the factors identified, identify existing interventions for correct condom and lubricant use, user and service-related challenges, and how best to address those challenges from the stakeholders’ perspectives. For qualitative data, thematic analysis will be conducted using Atlas.ti version 23.1.1.

RESULTS: Qualitative and quantitative results will be triangulated together with systematic review results, and key findings will be highlighted and used to guide the development of a predictive model for improving correct and consistent condom use with lubrication among MSM. This protocol paper, part of a doctoral study by the first author (RA), received approval from the Research and Ethics Committee of the University of Johannesburg on May 10, 2024. Data collection commenced on August 20, 2024, and the expected results will be published by October 2025.

CONCLUSIONS: Results from qualitative interviews and secondary data analysis will be triangulated to develop a predictive model to strengthen the correct and consistent use of condoms with condom-compatible lubricants among MSM and other key population groups in Ghana and other parts of sub-Saharan Africa for future pandemic preparedness, policy making, and targeted budget allocation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63276.

PMID:39626229 | DOI:10.2196/63276

J Med Internet Res. 2024 Dec 3;26:e60353. doi: 10.2196/60353.

ABSTRACT

BACKGROUND: Digital health interventions are a promising method for delivering timely support to underresourced family caregivers. The uptake of digital health interventions among caregivers may be improved by engaging caregivers in participatory design (PD). In recent years, there has been a shift toward conducting PD remotely, which may enable participation by previously hard-to-reach groups. However, little is known regarding how best to facilitate engagement in remote PD among family caregivers.

OBJECTIVE: This study aims to (1) understand the context, quality, and outcomes of family caregivers’ engagement experiences in remote PD and (2) learn which aspects of the observed PD approach facilitated engagement or need to be improved.

METHODS: We analyzed qualitative and quantitative data from evaluation and reflection surveys and interviews completed by research and community partners (family caregivers) across 4 remote PD studies. Studies focused on building digital health interventions for family caregivers. For each study, community partners met with research partners for 4 to 5 design sessions across 6 months. After each session, partners completed an evaluation survey. In 1 of the 4 studies, research and community partners completed a reflection survey and interview. Descriptive statistics were used to summarize quantitative evaluation and reflection survey data, while reflexive thematic analysis was used to understand qualitative data.

RESULTS: In 62.9% (83/132) of evaluations across projects 1-3, participants described the session as “very effective.” In 74% (28/38) of evaluations for project 4, participants described feeling “extremely satisfied” with the session. Qualitative data relating to the engagement context identified that the identities of partners, the technological context of remote PD, and partners’ understanding of the project and their role all influenced engagement. Within the domain of engagement quality, relationship-building and co-learning; satisfaction with prework, design activities, time allotted, and the final prototype; and inclusivity and the distribution of influence contributed to partners’ experience of engagement. Outcomes of engagement included partners feeling an ongoing interest in the project after its conclusion, gratitude for participation, and a sense of meaning and self-esteem.

CONCLUSIONS: These results indicate high satisfaction with remote PD processes and few losses specific to remote PD. The results also demonstrate specific ways in which processes can be changed to improve partner engagement and outcomes. Community partners should be involved from study inception in defining the problem to be solved, the approach used, and their roles within the project. Throughout the design process, online tools may be used to check partners’ satisfaction with design processes and perceptions of inclusivity and power-sharing. Emphasis should be placed on increasing the psychosocial benefits of engagement (eg, sense of community and purpose) and increasing opportunities to participate in disseminating findings and in future studies.

PMID:39626228 | DOI:10.2196/60353

J Med Internet Res. 2024 Dec 3;26:e53834. doi: 10.2196/53834.

ABSTRACT

BACKGROUND: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention-Advanced Symptom Management System (ASyMS)-after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries.

OBJECTIVE: In this qualitative study, both patients’ and clinicians’ experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients’ experiences, clinical practice, and supportive care delivery.

METHODS: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients’ and clinicians’ experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways.

RESULTS: Thematic analysis identified several themes that describe patients’ and clinicians’ experiences using ASyMS. One central orienting theme-ASyMS as a facilitator of change-was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is “normal” and what is to be expected, enhancing cancer care experiences, and informing future cancer care.

CONCLUSIONS: This study is the first to evaluate both patients’ and clinicians’ experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients’ and clinicians’ perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2016-015016.

PMID:39626227 | DOI:10.2196/53834

JMIR Diabetes. 2024 Dec 3;9:e55677. doi: 10.2196/55677.

ABSTRACT

BACKGROUND: Diabetes is a significant health concern in sub-Saharan Africa, emphasizing the importance of assessing the health literacy and eHealth skills of hospitalized patients with diabetes. This study evaluated the health literacy and eHealth literacy of patients with diabetes at Donka Hospital in Guinea and Sanou Sourou Hospital in Burkina Faso, providing insights for targeted interventions and mobile health (mHealth) solutions to improve self-management and treatment outcomes.

OBJECTIVE: The aim of this study is to evaluate the levels of health literacy and eHealth literacy among patients at Sanou Sourou Hospital in Burkina Faso and Donka Hospital in Guinea.

METHODS: The study included 45 participants from Donka Hospital and 47 from Sanou Sourou Hospital. Data collection took place in May 2022, focusing on variables such as gender, age, education, income, and technology access. Health literacy and eHealth literacy were measured using the Brief Health Literacy Screen (BHLS) and the eHealth Literacy Scale (eHEALS), respectively. Statistical analysis was performed using SPSS 28.

RESULTS: The results indicated that 64% (64/99) of participants at Donka Hospital and 57% (57/99) at Sanou Sourou Hospital were female. The majority of participants (48/98, 49% in both hospitals) fell within the age range of 25-50 years. High rates of illiteracy were observed (62/100, 62% in Donka Hospital and 59/100, 59% in Sanou Sourou Hospital). Smartphone ownership was prevalent (62/99, 62% at Donka Hospital and 64/100, 64% at Sanou Sourou Hospital). Participants reported occasional use of technology for basic purposes and frequent internet usage for accessing health information. However, a significant proportion of participants demonstrated low health literacy (73/99, 73% at Donka Hospital; 79/101, 78% at Sanou Sourou Hospital) and inadequate eHealth literacy (57/100, 57% at Donka Hospital; 62/100, 62% at Sanou Sourou Hospital). Education was observed to positively correlate with health literacy, while age displayed a moderate negative correlation. Weak correlations were observed between gender, income, and health literacy, but these were not statistically significant. No significant correlation was found between the scores of the BHLS and the eHEALS in either hospital.

CONCLUSIONS: This study highlights the importance of targeted educational interventions and mHealth solutions aimed at enhancing health and eHealth literacy among hospitalized patients with diabetes. Addressing both health literacy and eHealth literacy is paramount for improving diabetes management and treatment outcomes in Guinea and Burkina Faso. Targeted interventions and mHealth solutions have the potential to empower patients, enabling their active involvement in health care decisions and ultimately improving overall health outcomes.

PMID:39626226 | DOI:10.2196/55677

JMIR Mhealth Uhealth. 2024 Dec 3;12:e53430. doi: 10.2196/53430.

ABSTRACT

BACKGROUND: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic.

OBJECTIVE: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable.

METHODS: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire.

RESULTS: Of the 389 participants who enrolled in and completed the study, 380 (98%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1%) of the 239 participants entered full BP routines into the digital app 80% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as “excellent” for domains of perspicuity, efficiency, and dependability and “above average” for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period.

CONCLUSIONS: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension.

PMID:39626222 | DOI:10.2196/53430

Pancreas. 2024 Dec 2. doi: 10.1097/MPA.0000000000002444. Online ahead of print.

ABSTRACT

OBJECTIVES: Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may reduce AP severity and improve outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients.

METHOD: Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until mid-May 2024 for RCTs comparing EA with other pain management strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed a random-effects model and the Mantel-Haenszel method. Study heterogeneity was assessed using the I2 statistic.

RESULTS: Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR = 0.69, 95% CI [0.29, 1.65], p = 0.40), mechanical ventilation (RR = 0.82, 95% CI [0.61, 1.10], p = 0.19), sepsis events (RR = 0.88, 95% CI [0.42, 1.86], p = 0.74), hospital/ICU stay (WMD = 0.49 days, 95% CI [-1.13, 2.10], p = 0.55), and pain score (WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13). However, opioid requirements were significantly lower, as reported by one study with morphine milligram equivalent of 15 mg/day compared to 52 mg/day in the control group (p = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was very low due to the small number of studies, risk of bias, and limited sample size.

CONCLUSIONS: EA did not significantly improve in-hospital outcomes in AP patients. However, findings indicated reduced opioid consumption in the EA group, suggesting potential benefits in pain management. Further high-quality, large-scale randomized trials are needed to understand the potential benefits of EA in this population.

PMID:39626190 | DOI:10.1097/MPA.0000000000002444

Environ Technol. 2024 Dec 3:1-16. doi: 10.1080/09593330.2024.2423907. Online ahead of print.

ABSTRACT

Soil erosion is a world-wide issue driven by land management and climate change. Research has focussed on soil loss rates from agricultural land. However, the loss of trace elements essential for soil and plant health, or potentially toxic elements that occur as impurities in fertilisers and manures, is poorly understood. This study reports on the loads and forms of copper, cadmium, manganese, nickel, selenium and zinc lost from three types of agricultural systems at Rothamsted Research’s North Wyke Farm Platform over five individual storm events. Loads reflected a combination of concentrations in the soil, annual additions from fertilisers, the ability to leach from the soil and rainfall intensity. Arable fields demonstrated an order of magnitude greater loss of soil compared to pasture. Consequently, particulate-bound losses were higher, and the proportion of losses in solution were 29% lower on average, compared with pasture. Overall losses for each element were statistically similar for pastures. In comparison, arable fields showed greater average losses for five essential elements (15.3%) compared to pasture (9.7%). Nickel exhibited the greatest average loss (27% overall; 39% for arable) and zinc the lowest (2% overall; 3% for arable). The predominant loss of cadmium was in the dissolved phase (96% overall; 92% arable), followed by selenium (81%/63%), nickel (64%/35%) and copper (61%/34%). Conversely, dissolved losses of manganese (38%/21%) and zinc (28%/8%) were lower than particulate losses. We conclude that overall loss, and form of the loss, varies significantly between arable and pastoral systems, and the physico-chemical properties of the element itself.

PMID:39626187 | DOI:10.1080/09593330.2024.2423907

J Addict Med. 2024 Dec 3. doi: 10.1097/ADM.0000000000001429. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study is to determine the difference, if any, in prevalence of wounds in individuals who were exposed to xylazine and fentanyl compared to individuals who were exposed to fentanyl and not xylazine.

METHODS: A large inpatient substance use disorder specialty hospital provided medical records over an 8-month period from July 2023 to February 2024. Individuals were admitted to an American Society of Addiction Medicine 3.7 level of care where a urine drug screen and skin assessment was conducted on admission. If the urine screen noted a presence of fentanyl, the sample was then tested for xylazine exposure. Patients were considered positive for wounds on admission to treatment if any wound was noted during the skin assessment during the admission process.

RESULTS: A total of 282 medical records were identified. A chi square test of association was completed and revealed a statistically significant association between xylazine exposure and wounds (P = 0.002, odds ratio = 2.420, 95% confidence interval = 1.376-4.254).

CONCLUSIONS: This study provides early support for the previously theorized connection between xylazine exposure and wounds.

PMID:39626182 | DOI:10.1097/ADM.0000000000001429