Tag: pubmed

JMIR Hum Factors. 2025 Jun 13;12:e60628. doi: 10.2196/60628.

ABSTRACT

BACKGROUND: Anxiety and depression symptoms have been rising among college students, with many increasingly meeting the criteria for 1 or more mental health problems. Due to a rise in internet access and lockdown restrictions associated with the COVID-19 pandemic, online mediums, such as teletherapy, repositories for mental health information, discussion forums, self-help programs, and online screening tools, have become more popular and used by college students to support their mental health. However, there is limited information about individual-level factors that lead college students to use these online tools to support their mental health.

OBJECTIVE: This mixed methods study aimed to examine the associations between demographics, symptom severity, mental health literacy, stigma, attitudes, and self-efficacy and the use of online tools to seek psychological information and services among racially and ethnically diverse college students. This study also aimed to qualitatively characterize types of online tools used, reasons for using tools or lack thereof, and perceived helpfulness of tools.

METHODS: Undergraduate students (N=123) completed validated measures and provided open-ended descriptions of the types of online tools they used to seek psychological information and services and their reasons for using those tools. Logistic regression analyses were used to test associations of online tool use to seek mental health information and hypothesized predictors. Descriptive statistics were conducted to examine online tool types, reasons for using online tools, and helpfulness explanations.

RESULTS: In total, 49.6% (61/123) of the participants used online tools (eg, search engines) to seek mental health information, while 30.1% (37/123) used online tools (eg, medical websites) to seek mental health services. Mental health literacy (P=.002; odds ratio 1.14, 95% CI 1.05-1.24) was associated with greater use of online tools to seek mental health information. None of the hypothesized variables predicted online tool use to seek mental health services. In total, 82% (50/61) of participants who sought information found online tools somewhat helpful, while 49% (18/37) of participants who sought services found online tools very helpful. Of the students who did not use online tools to seek information, 19% (12/62) reported it was because they did not know which online tools to use and 31% (19/62) stated they would be encouraged to use online tools if it was recommended by professionals, therapists, family, or friends. Of the students who did not use online tools to seek services, 33% (28/86) reported it was because they did not think mental health help was necessary.

CONCLUSIONS: These findings highlight the use of online tools to provide mental health information and connect to professional services, suggesting that online tools are widely used to access mental health support.

PMID:40513094 | DOI:10.2196/60628

Nano Lett. 2025 Jun 13. doi: 10.1021/acs.nanolett.5c02087. Online ahead of print.

ABSTRACT

Single-particle electrochemistry (SPE) is essential for uncovering the electrochemical behavior and underlying mechanisms of individual nanomaterials. However, conventional approaches often overlook dynamic interactions between nanocrystals and the conductive substrate, leading to significant interference from substrate-induced concentration gradients and electron-transfer perturbations. Here, we address this challenge by developing transient electrogenerated chemiluminescence microscopy (ECLM) to visualize the diffusion dynamics and electrocatalytic behavior of single PtAu-loaded carbon nanoparticles. ECL imaging quantitatively analyzes reaction kinetics at single nanocatalysts and reveals the diffusion dynamics significantly influenced by conductive substrate. To mitigate substrate-induced interference and improve measurement accuracy, we introduce the pulse-clean cycle technique (PCCT). By applying millisecond-level potential pulses, PCCT achieves high temporal resolution and captures rapid catalytic events with statistical reliability. This work bridges the gap between single-particle imaging and precise kinetic quantification, offering a robust platform for probing nanoscale electrocatalytic transients, understanding nanostructure-activity relationships, and guiding the rational design of advanced nanocatalysts.

PMID:40513079 | DOI:10.1021/acs.nanolett.5c02087

Neurology. 2025 Jul;105(1):e213795. doi: 10.1212/WNL.0000000000213795. Epub 2025 Jun 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: The aim of this study was to gain rare insight into prolonged cluster headache (CH) remission by (1) identifying patterns and factors associated with and (2) phenotypical changes before prolonged remission. The results can help patients better understand their disease course and uncover mechanisms behind spontaneous remission.

METHODS: In this cross-sectional cohort study, all participants with a history of (probable) CH from the Leiden University Medical Center cohort were invited to complete a screening survey. Participants in prolonged remission were invited for a telephone interview. Prolonged remission was defined as (1) no current prophylactic treatment and (2) an attack-free period of ≥5 years and/or twice the mean between-episode time. Main outcomes are average age at prolonged remission onset and disease duration. Data were collected between April 10 and August 9, 2024, and analyzed using descriptive and survival statistics.

RESULTS: Of those invited, 43.2% (778/1,801) responded; 625 were included in the survey analysis, and 125 (20%) met prolonged remission criteria during interview. The median age at inclusion was 58 years (interquartile range [IQR] 48-67) with 32% female. Remission occurred on average at age 55 (IQR 48-63) after a disease duration of 23 (15-33) years. In 62% (N = 78), remission occurred abruptly. Of those with gradual remission (38%, N = 47), attack frequency (65%) and intensity (59%) decreased and between-episode intervals increased (52%) before remission. Probability of prolonged remission was higher in those with episodic CH (hazard ratio [HR] 6.60, 95% CI 3.55-12.31), who had quit smoking (HR 2.53, 95% CI 1.66-3.86), who had a higher attack intensity (HR 1.28, 95% CI 1.08-1.52), and who had a higher age at disease onset (HR 1.05, 95% CI 1.03-1.06).

DISCUSSION: This cohort offers rare insight into prolonged CH remission, typically starting around the mid-50s after 25 years of active disease. Prolonged remission is not tied to a single factor such as disease duration. Remission onset does not peak at a specific age, and disease duration varies widely between patients with remission. Remission probability is higher in the episodic form despite a longer disease duration compared with the chronic form. The association between quitting smoking and prolonged remission supports a causal link with smoking and disease activity. These preliminary retrospective results require confirmation in future studies.

PMID:40513059 | DOI:10.1212/WNL.0000000000213795

Neurology. 2025 Jul;105(1):e213589. doi: 10.1212/WNL.0000000000213589. Epub 2025 Jun 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: N-acetyl-l-leucine (NALL) has been established to improve the neurologic manifestations of Niemann-Pick disease type C (NPC) after 12 weeks in a placebo-controlled trial. In the open-label extension phase (EP) follow-up, data were obtained after 12 and 18 months to evaluate the long-term effects of NALL for NPC.

METHODS: This is an ongoing, multinational, multicenter EP. Patients with a genetic diagnosis of NPC aged 4 years or older who completed the placebo-controlled trial were eligible to continue in the EP and receive orally administered NALL 2-3 times per day in 3 tiers of weight-based dosing. The primary end point is the modified 5-domain NPC Clinical Severity Scale (NPC-CSS) (range 0-25 points; lower score representing better neurologic status); data from the EP cohort are compared with the expected annual trajectory of decline (i.e., disease progression) established in natural history studies. Analyses are also performed on exploratory end points, including the 15-domain and 4-domain NPC-CSSs and the Scale for Assessment and Rating of Ataxia (SARA).

RESULTS: Fifty-three patients aged 5-67 years (45.3% female, 54.7% male) were enrolled in the EP. After 12 months, the mean (±SD) change from baseline on the 5-domain NPC-CSS was -0.27 (±2.42) with NALL vs +1.5 (±3.16) in the historical cohort (95% CI -3.05 to -0.48; p = 0.009), corresponding to a 118% reduction in annual disease progression. After 18 months, the mean (±SD) change was +0.05 (±2.95) with NALL vs +2.25 (±4.74) in the historical cohort (95% CI -4.06 to -0.35; p = 0.023). The 15-domain and 4-domain NPC-CSSs were consistent with the 5-domain NPC-CSS. The improvements in neurologic manifestations demonstrated in the placebo-controlled trial on the primary SARA end point were sustained over the long-term follow-up. NALL was well tolerated, and no treatment-related adverse events or serious reactions occurred.

DISCUSSION: Treatment with NALL was associated with a significant reduction in NPC disease progression after 12 and 18 months, demonstrating a disease-modifying, neuroprotective effect.

TRIAL REGISTRATION INFORMATION: The trial is registered with ClinicalTrials.gov (NCT05163288; registered December 6, 2021), EudraCT (2021-005356-10). The first patient was enrolled into the EP on March 8, 2023. The trial was funded by IntraBio Inc.

CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that NALL reduces disease progression in NPC.

PMID:40513057 | DOI:10.1212/WNL.0000000000213589

Neurology. 2025 Jul;105(1):e213615. doi: 10.1212/WNL.0000000000213615. Epub 2025 Jun 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Socioeconomically deprived neighborhoods are known to have higher incidence rates of stroke and less access to high-quality stroke care. We aimed to examine whether there is an association between neighborhood socioeconomic status (nSES) and functional outcome after endovascular thrombectomy (EVT) for ischemic stroke in a high-income country.

METHODS: Data from 2 randomized trials, which included patients treated with EVT within 6 hours after stroke onset: MR CLEAN-MED and MR CLEAN-NO IV were studied. A per postcode composite score of education, employment, and household income (scores ranging from -1 to 1) created by Statistics Netherlands, represented nSES. The association with functional outcome after 90 days (modified Rankin Scale [mRS]), functional independence (mRS 0-2), neurologic deficit at 24 hours (NIH Stroke Scale [NIHSS]), and radiologic outcomes (expanded treatment in cerebral infarction score and follow-up infarct volume [FIV]) were analyzed using regression analyses adjusted for patient characteristics, including baseline NIHSS.

RESULTS: We included 910 patients (median age 71.5 years, 404 (44.4%) women, median baseline NIHSS 15) in the analyses. Patients with a higher nSES had a higher likelihood of a more favorable functional outcome (a shift toward improved outcome on the mRS) (adjusted common odds ratio [OR] 1.90, 95% CI 1.21-3.01) and were more likely to have regained functional independence (adjusted OR 3.21, 95% CI 1.82-5.70) at 90 days. There was no significant association between the nSES and the degree of neurologic deficit at 24 hours (adjusted β -0.24, 95% CI -0.50 to 0.01, p = 0.06) or radiologic outcomes (reperfusion status [adjusted OR 0.89, 95% CI 0.45-1.78], FIV [adjusted β 0.01, 95% CI -0.17 to 0.20, p = 0.89]).

DISCUSSION: Living in a more socioeconomically affluent neighborhood was associated with a more favorable functional outcome at 90 days, but not with degree of neurologic deficit at 24 hours or radiologic outcomes. This suggests that nSES-based inequalities exist in the postacute phase of stroke care, and highlights the importance of continuing to work toward health equity for patients with stroke.

PMID:40513055 | DOI:10.1212/WNL.0000000000213615

Epidemiology. 2025 Jun 13. doi: 10.1097/EDE.0000000000001884. Online ahead of print.

ABSTRACT

Unmeasured confounding is a major concern in obtaining credible inferences about causal effects from observational data. Proximal causal inference is an emerging methodological framework to detect and potentially account for confounding bias by carefully leveraging a pair of negative control exposure and outcome variables, also known as treatment and outcome confounding proxies. Although regression-based proximal causal inference is well-developed for binary and continuous outcomes, analogous proximal causal inference regression methods for right-censored time-to-event outcomes are currently lacking. In this paper, we propose a novel two-stage regression proximal causal inference approach for right-censored survival data under an additive hazard structural model. We provide theoretical justification for the proposed approach tailored to different types of negative control outcomes, including continuous, count, and right-censored time-to-event variables. We illustrate the approach with an evaluation of the effectiveness of right heart catheterization among critically ill patients using data from the SUPPORT study. Our method is implemented in the open-access R package “pci2s.”

PMID:40513053 | DOI:10.1097/EDE.0000000000001884

Epidemiology. 2025 Jun 13. doi: 10.1097/EDE.0000000000001873. Online ahead of print.

ABSTRACT

Simulation studies are used to evaluate and compare the properties of statistical methods in controlled experimental settings. In most cases, performing a simulation study requires knowledge of the true value of the parameter, or estimand, of interest. However, in many simulation designs, the true value of the estimand is difficult to compute analytically. Here, we illustrate the use of Monte Carlo integration to compute true estimand values in simple and more complex simulation designs. We provide general pseudocode that can be replicated in any software program of choice to demonstrate key principles in using Monte Carlo integration in two scenarios: a simple three-variable simulation where interest lies in the marginally adjusted odds ratio and a more complex causal mediation analysis where interest lies in the controlled direct effect in the presence of mediator-outcome confounders affected by the exposure. We discuss general strategies that can be used to minimize Monte Carlo error and to serve as checks on the simulation program to avoid coding errors. R programming code is provided illustrating the application of our pseudocode in these settings.

PMID:40513048 | DOI:10.1097/EDE.0000000000001873

J Speech Lang Hear Res. 2025 Jun 13:1-35. doi: 10.1044/2025_JSLHR-24-00856. Online ahead of print.

ABSTRACT

PURPOSE: Auditory acclimatization refers to changes in auditory performance over time due to hearing aid modifications, extending beyond task-specific or training effects. This preregistered systematic review expands on previous ones by examining a broader range of outcomes, including auditory (e.g., speech recognition, electrophysiological responses) and selected nonauditory (e.g., self-reported outcomes) measures. It aimed to assess acclimatization’s presence, magnitude, and influencing factors, focusing on controlled trials comparing postfitting aided outcomes with a control group. This is the first review to comprehensively report self-reported outcomes, advancing the field.

METHOD: A systematic literature search was conducted in CINAHL, PubMed, and Web of Science in March 2024. Eligible studies followed the Population, Intervention, Comparison, Outcome, Study Design, and Timeline framework, including new adult hearing aid users with sensorineural hearing loss using air-conduction hearing aids. Studies were required to report outcomes, with a comparator and at least two data points in the same condition. Exclusions applied to studies involving children, advanced feature devices, surgical implants, non-peer-reviewed work, or uncontrolled studies. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. A planned meta-analysis was excluded due to missing data.

RESULTS: The review included 25 controlled studies on auditory acclimatization. Of these, 18 examined speech recognition, with 10 reporting acclimatization, one mixed, and seven no acclimatization. Among eight studies with self-reported outcomes, three supported acclimatization, three showed mixed results, and two found no evidence. For electrophysiological outcomes, four of seven studies reported acclimatization, and three did not. Consistent hearing aid use and hearing loss severity influenced acclimatization, while cognitive abilities and age had no significant impact. Of the 25 studies, 16% were rated good quality, 80% were rated fair, and 4% were rated poor, with common issues including lack of randomization, blinding, and insufficient sample size reporting.

CONCLUSIONS: This review highlighted the complexity of auditory acclimatization, influenced by various factors. Evidence suggested acclimatization occurred in some users and outcomes, though improvements were modest and variable. The most consistent gains were in speech recognition in noise and self-reported measures (e.g., Abbreviated Profile of Hearing Aid Benefit, Hearing Handicap Inventory for the Elderly, Glasgow Hearing Aid Benefit Profile), though changes were generally modest. Future studies should include essential statistical data, prioritize randomized controlled trials, and ensure early baseline and key interval measurements to better isolate and quantify acclimatization effects.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.29242493.

PMID:40513036 | DOI:10.1044/2025_JSLHR-24-00856

J Med Internet Res. 2025 Jun 13;27:e72276. doi: 10.2196/72276.

ABSTRACT

BACKGROUND: The onset of the COVID-19 pandemic led US health systems to rapidly implement telehealth services to connect patients and clinicians. This rapid expansion of telehealth allowed us to explore how a telehealth experience may be best delivered across populations and contexts.

OBJECTIVE: We aimed to identify telehealth modality preferences (voice vs video) among clinicians and the populations they serve and explore the barriers to telehealth use from clinician and public perspectives.

METHODS: We conducted 2 independent, cross-sectional, web-based surveys. US physicians specializing in internal medicine, psychiatry, urology, orthopedic surgery, or obstetrics and gynecology completed a 23-item survey through Sermo’s research panel. Quotas ensured equal representation across the selected clinical specialties. Adult members of the US general public completed a 26-item survey through Qualtrics’ research panel. Quotas ensured the general public sample approximated the US population on educational attainment, gender, and rural residence.

RESULTS: We recruited 253 clinician participants and 418 general public participants in September 2020, with survey completion rates of 22% (253/1139) and 93% (418/451), respectively. For the initial encounter, 85% (216/253; 95% CI 80%-89%) of clinicians and 51% (215/418; 95% CI 47%-56%) of public participants preferred video over voice only. In multiple logistic regression analyses, members of the public with broadband internet at home were more likely than those without broadband to prefer video over voice only for a first visit with a new clinician (57% vs 40%; odds ratio 2.09, 95% CI 1.25-3.49). In an established clinical relationship, 63% (160/253; 95% CI 57%-69%) of clinicians and 33% (137/418; 95% CI 28%-38%) of the general public preferred video over voice only when discussing a new clinical problem. For a follow-up visit, only 26% (65/253; 95% CI 20%-32%) of clinicians and 28% (117/418; 95% CI 24%-33%) of the general public preferred video over voice only. Clinicians and the general public agree that technology not working properly is their main source of telehealth frustration (86/249, 35% of clinicians; 62/220, 28% of public with telehealth experience). Other major frustrations include limitations on what content can be included in the visit (main frustration for 83/249, 33% of clinicians; 54/220, 25% of the public) and downloading new technology (52/220, 24% of the public).

CONCLUSIONS: Although telehealth connections with video are increasingly common, important factors are associated with a preference for voice-only telehealth connections. Clinicians prefer video over voice-only connections more than patients do for new clinical relationships and new clinical problems. For follow-up care, both clinicians and the public prefer voice-only telephone visits over video. Barriers to video-enabled telehealth experiences include technology failures, varied technology platforms across providers, and a need for more reliable high-speed internet connection. Voice-only telephone-mediated services can potentially improve health care access and experiences in light of these barriers to video-based care.

PMID:40513030 | DOI:10.2196/72276

JMIR Form Res. 2025 Jun 13;9:e54630. doi: 10.2196/54630.

ABSTRACT

BACKGROUND: Recent advancements in sports medicine have been fueled by innovative technologies, particularly consumer-grade wearable devices like Fitbit, Apple Watch, and Garmin. These devices offer physiological and biomechanical data and hold promise for personalized, real-time, and remote assessment of athlete recovery. However, few studies have been conducted with these devices in adolescent student athletes.

OBJECTIVE: The primary objective of this study was to assess the feasibility of integrating consumer-grade wearable technology into injury recovery monitoring of adolescent student athletes.

METHODS: The study included 34 high school student athletes aged 14-18 diagnosed with either concussion or orthopedic injury, enrolled within 10 days of injury. Participants were equipped with a Fitbit Sense for continuous monitoring of physiological markers, including cardiovascular metrics, physical activity levels, and sleep patterns. Data collection extended 4-6 weeks beyond injury clearance, during which adherence rates were assessed at both hourly and daily intervals. Hourly adherence was defined as the proportion of participants with at least 1 recorded heart rate data point per hour, while daily adherence was defined as the proportion of participants with at least 1 recorded heart rate data point per 24-hour period.

RESULTS: The study demonstrated high participant adherence to wearing the device. The orthopedic injury cohort exhibited a median adherence rate of 95%, with individual rates ranging from 82% to 100%. Similarly, the concussion cohort demonstrated a median adherence rate of 93%, with adherence rates spanning from 37% to 100%. Notably, the study encountered minimal issues related to device functionality, with only 1 participant necessitating a device replacement.

CONCLUSIONS: These findings demonstrate successful integration of wearable technology in data collection for adolescent student athletes recovering from sports-related injuries. However, it is important to consider current limitations, including factors that may influence data accuracy and precision. In conclusion, this feasibility study demonstrates the practicality of using consumer-grade wearable technology for the collection of physiological and biomechanical parameters in adolescent student athletes recovering from sport-related injuries. The high level of adherence highlights the potential applicability of consumer-grade wearable devices in this population. Study findings lay the foundation for future investigations with larger and more diverse cohorts to identify the utility of device metrics in identifying unique patterns of injury-specific recovery (ie, sport-related concussion). Consumer-grade wearable devices offer promise for optimizing assessment and management of injured athletes through wearable technology integration into standard clinical protocols.

PMID:40513029 | DOI:10.2196/54630