Tag: pubmed

J Int Med Res. 2025 Apr;53(4):3000605251328245. doi: 10.1177/03000605251328245. Epub 2025 Apr 11.

ABSTRACT

ObjectivesThis study aimed to identify risk factors for postoperative recurrence in patients with perianal fistulizing Crohn’s disease and assess the predictive value of fecal calprotectin and serum miRNA6086.MethodsFrom 105 patients with perianal fistulizing Crohn’s disease, blood and fecal samples as well as clinical data were collected. Analysis of blood tests, C-reactive protein, miRNA6086, and fecal calprotectin revealed postoperative recurrence risk factors. Receiver operating characteristic curve analysis assessed the predictive accuracy of miRNA6086 and fecal calprotectin for perianal fistulizing Crohn’s disease recurrence and determined their optimal cutoff values, sensitivity, and specificity.ResultsOf the 105 patients with perianal fistulizing Crohn’s disease, 33 (31.4%) experienced recurrence. Anal fistula type, preoperative miRNA6086, and fecal calprotectin levels were identified as independent risk factors for postoperative recurrence. Receiver operating characteristic curve analysis revealed that miRNA6086 had a cutoff value of 0.3195, sensitivity of 65.28%, specificity of 66.67%, and area under curve value of 0.6589 (95% confidence interval, 0.5503-0.7674). Fecal calprotectin had a cutoff value of 0.6073, sensitivity of 81.94%, specificity of 78.79%, and area under curve value of 0.8224 (95% confidence interval, 0.5503-0.7674). Combined miRNA6086 and fecal calprotectin detection had a cutoff value of 0.7121, sensitivity of 83.33%, specificity of 87.88%, and area under curve value of 0.9146 (95% confidence interval, 0.8547-0.9744).ConclusionAnal fistula type, preoperative miRNA6086, and fecal calprotectin levels are independent risk factors for perianal fistulizing Crohn’s disease recurrence. Combined detection of miRNA6086 and fecal calprotectin levels enhances predictive accuracy for postoperative recurrence.

PMID:40215410 | DOI:10.1177/03000605251328245

JMIR Form Res. 2025 Apr 11;9:e65188. doi: 10.2196/65188.

ABSTRACT

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients.

OBJECTIVE: We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT.

METHODS: eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the “think aloud” method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months.

RESULTS: During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection.

CONCLUSIONS: The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation.

PMID:40215402 | DOI:10.2196/65188

JMIR Form Res. 2025 Apr 11;9:e67275. doi: 10.2196/67275.

ABSTRACT

BACKGROUND: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions.

OBJECTIVE: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions.

METHODS: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from “strongly agree” to “strongly disagree”.

RESULTS: Twenty-six participants consented and were enrolled in the study, with 23 participants (82%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100% positive responses, with no single question scoring below 83% positive responses. In the “ease of use and satisfaction” category, 100% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83%-96% (19-22) of users responded positively to the remaining four questions. In the “system information arrangement” category, 100% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87%-96% of users approving action acknowledgment, error recovery, and expected functions. Under the “usefulness” category, 96% (n=22) of users found the app beneficial for health and well-being, and 91% (n=21) users felt it effectively managed their health. For the five custom questions, 100% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations.

CONCLUSIONS: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app’s potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience.

PMID:40215401 | DOI:10.2196/67275

J Clin Psychiatry. 2025 Apr 2;86(2):24m15516. doi: 10.4088/JCP.24m15516.

ABSTRACT

Objectives: To describe the characteristics, clinical trajectories, and disposition of older adults consulting in the emergency department (ED) for mental health issues. The secondary objective was to explore the impact of age, sex, and living environment on those patients’ clinical care and disposition.

Methods: This registry study included data from 5 Canadian EDs. Patients were included if they were aged ≥65 years and consulting in the ED between March 1, 2020, and March 31, 2021, for mental health issues. Relative risks (RRs) were obtained using a modified Poisson regression model, and 95% confidence intervals (CIs) were estimated with a robust variance estimator.

Results: 1,673 patients were included. The mean ±SD age was 75.2±8.1 years; 58.8% were female, and 87.4% had a prior history of mental health issues. Suicidal ideations (40.8%) and neurocognitive disorders (31.8%) were the most frequent diagnostic impressions. 52.0% were assessed by a psychiatrist, and 49.9% were discharged from the ED. Males were at higher risk of neurocognitive (RR: 1.16 [95% CI, 1.01-1.32]) and substance use disorders (RR: 1.54 [95% CI, 1.19-1.99]). Patients aged ≥85 were more likely to be physically/chemically restrained and less likely to be assessed by psychiatry and hospitalized (RR: 1.69 [95% CI, 1.14-2.50], RR: 0.62 [95% CI, 0.52-0.74], RR: 0.73 [95% CI, 0.57-0.95]).

Conclusion: This study highlights that most older ED patients consulting for mental health issues had a prior history of such issues. A psychiatrist assessed most patients, but those aged ≥85 were less likely to be assessed or hospitalized, yet more likely to be restrained. These results should be considered when designing targeted investigations to meet the complex needs of this population.

PMID:40215386 | DOI:10.4088/JCP.24m15516

J Clin Psychiatry. 2025 Mar 31;86(2):24m15476. doi: 10.4088/JCP.24m15476.

ABSTRACT

Background: Major depressive disorder (MDD) has been associated with both all cause and suicide mortality in young adults. However, the effects of parental severe mental disorders (SMDs), such as schizophrenia, bipolar disorder, MDD, alcohol use disorder (AUD), and substance use disorder, on the risks of all-cause and suicide mortality in adolescents and young adults with MDD remain unclear.

Methods: We retrospectively evaluated the incidence of all-cause and suicide mortality (2001-2011) in 196,000 adolescents (age: 10-17 years) and young adults (age: 18-29 years) with MDD. We investigated associations between parental SMDs and all-cause and suicide mortality among patients with MDD using Cox regression analyses. In addition, we assessed the additive effects of paternal and maternal SMDs on the mortality risk of depressed offspring.

Results: Our findings revealed that all cause mortality in offspring was associated with paternal AUD (hazard ratio [HR]: 1.66) as well as maternal schizophrenia (HR: 2.77), bipolar disorder (HR: 1.99), and MDD (HR: 1.25). Furthermore, suicide mortality in offspring was associated with maternal schizophrenia (HR: 4.36) and bipolar disorder (HR: 4.01). Notably, the risk of suicide mortality was the highest in offspring with paternal bipolar disorder and maternal MDD (HR: 7.31).

Conclusion: Parental SMDs such as schizophrenia, bipolar disorder, MDD, and AUD are associated with all-cause and suicide mortality in adolescents and young adults with MDD. Optimizing support systems and prioritizing early interventions for parental mental health problems may help reduce the risks of suicide and premature death in young patients with MDD.

PMID:40215383 | DOI:10.4088/JCP.24m15476

JMIR Form Res. 2025 Apr 11;9:e63700. doi: 10.2196/63700.

ABSTRACT

BACKGROUND: Dependent older people or those losing their autonomy are at risk of emergency hospitalization. Digital systems that monitor health remotely could be useful in reducing these visits by detecting worsening health conditions earlier. However, few studies have assessed the medico-economic impact of these systems, particularly for older people.

OBJECTIVE: The objective of this study was to compare the clinical and economic impacts of an eHealth device in real life compared with the usual monitoring of older people living at home.

METHODS: This study was a comparative, retrospective, and controlled trial on data collected between May 31, 2021, and May 31, 2022, in one health care and home nursing center located in Brittany, France. Participants had to be aged >75 years, living at home, and receiving assistance from the home care service for at least 1 month. We implemented among the intervention group an eHealth system that produces an alert for a high risk of emergency department visits or hospitalizations. After each home visit, the home care aides completed a questionnaire on participants’ functional status using a smartphone app, and the information was processed in real time by a previously developed machine learning algorithm that identifies patients at risk of an emergency visit within 7 to 14 days. In the case of predicted risk, the eHealth system alerted a coordinating nurse who could then inform the family carer and the patient’s nurses or general practitioner.

RESULTS: A total of 120 patients were included in the study, with 60 in the control group and 60 in the intervention group. Among the 726 visits from the intervention group that were not followed by an alert, only 4 (0.6%) resulted in hospitalizations (P<.001), confirming the relevance of the system’s alerts. Over the course of the study, 37 hospitalizations were recorded for 25 (20.8%) of the 120 patients. Additionally, of the 120 patients, 9 (7.5%) were admitted to a nursing home, and 7 (5.8%) died. Patients in the intervention group (56/60, 93%) remained at home significantly more often than those in the control group (48/60, 80%; P=.03). The total cost of primary care and hospitalization during the study was €167,000 (€1=US $1.09), with €108,000 (64.81%) attributed to the intervention group (P=.20).

CONCLUSIONS: This study presents encouraging results on the impact of a remote medical monitoring system for older adults, demonstrating a reduction in both emergency department visits and hospitalization costs.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697.

PMID:40215100 | DOI:10.2196/63700

Anal Chem. 2025 Apr 11. doi: 10.1021/acs.analchem.4c06815. Online ahead of print.

ABSTRACT

The target neutrophil-activating peptide-2, NAP2, is a potential biomarker for early lung cancer diagnosis, whereas there are currently no precise techniques for differentiating NAP2 from its precursors. To overcome this difficulty, we created an electrochemical aptamer-based sensor (E-AB) consisting of the 33-mer aptamer domain, a 2-bp three-junction region, and two conductive signal reporter stems. Whereas E-AB-AT and E-AB-RAN sensors with two (AT)₆ or N₁₂ stems, respectively, were unable to distinguish between platelet basic protein (PBP) (94 aa) and NAP2 (70 aa). However, in contrast, the E-AB-GC sensor with two (GC)₆ stems could selectively detect NAP2 but hardly recorded PBP. Here, we developed an E-AB-GC point-of-care test (POCT) technique to detect NAP2 away from its precursors in 10 μL of human serum and provide concentration data in 5 min. Interestingly, serum NAP2 levels in human samples, as determined by the E-AB-GC sensor, were roughly 30-50% lower than those obtained by ELISA. Results also showed that E-AB-GC analysis of serum NAP2 in patients in stages I through IV revealed statistical significance and an excellent guiding function in the early diagnosis of lung cancer, particularly for patients in stage I cancer (p = 0.0054, area under the curve, 0.95). Importantly, this E-AB-GC POCT platform has shown potential as an on-site quick diagnostic tool, which can also be used to detect other lung cancer markers. Our research on the impacts of stem sequencing on sensing capabilities might assist in the future development of E-AB biomarker sensors.

PMID:40215095 | DOI:10.1021/acs.analchem.4c06815

Musculoskeletal Care. 2025 Jun;23(2):e70099. doi: 10.1002/msc.70099.

ABSTRACT

BACKGROUND: General practitioners (GPs) use of imaging for acute low back pain (LBP) is above guideline recommendations, and the reasons for this remain under-researched. We examined the perspectives, expectations and information needs of Australian GPs requesting lumbar spine diagnostic imaging for patients presenting with acute LBP.

METHODS: We completed semi-structured interviews with 12 GPs practising in Victoria, Australia. Transcripts were thematically analysed, and themes compared according to whether or not GPs reported they regularly requested imaging for LBP.

RESULTS: We identified four themes. (1) Besides responding to ‘red flags’, GPs’ experiences of uncovering unexpected but serious findings on imaging for LBP as well as perceived external pressures motivated their defensive imaging practices. (2) While most were reluctant to request imaging for LBP, once requested, GPs escalated through imaging modalities and focused on the diagnostic benefit of their findings. (3) GPs supported the inclusion of epidemiological data on imaging reports, but (4) largely opposed imaging reports being written in plain language, believing reports to be clinician-to-clinician communications that patients would misunderstand. All GPs were aware of the limited utility of imaging for diagnosing LBP, and themes were similar between GPs who regularly requested imaging and those who did not. Factors other than knowledge of imaging efficacy for LBP seemed to play an important role in imaging requests.

CONCLUSIONS: Our study identified key drivers of imaging use for LBP in primary care. The findings underscore that interventions targeting GPs addressing the overuse of imaging for LBP should transcend knowledge deficit models.

PMID:40215089 | DOI:10.1002/msc.70099

Psychooncology. 2025 Apr;34(4):e70149. doi: 10.1002/pon.70149.

ABSTRACT

PURPOSE: Death preparedness plays a crucial role in improving the quality of death for advanced cancer patients. However, existing tools only assess certain aspects of death preparedness in advanced cancer patients, and there is limited evidence regarding their reliability and validity. To develop and validate a specific and comprehensive measurement tool for death preparedness in advanced cancer patients.

METHODS: The scale was developed using an exploratory mixed-methods approach, which included both qualitative and quantitative stages. Grounded theory and existing literature were used to construct a death preparedness scale for advanced cancer patients. Content validity was assessed using the Delphi method. A convenience sampling approach was employed to recruit 753 advanced cancer patients from the oncology wards of six tertiary grade-A general hospitals in Hubei and Anhui provinces, China, for psychometric testing of the scale. Item selection was based on item analysis, exploratory factor analysis was conducted to extract factors, and confirmatory factor analysis was used to assess structural validity.

RESULTS: The final scale consists of 4 dimensions and 22 items. These four dimensions are named “Death awareness,” “Emotional response,” “Hospice program,” and “Reflexive care.” They explain 64.010% of the total variance. The confirmatory factor analysis (CFA) model showed that the 4-factor model fit the data well. The overall Cronbach’s alpha coefficient for the scale was 0.991.

CONCLUSION: The death preparedness scale for advanced cancer patients that we developed demonstrates good reliability and validity, and can be used to comprehensively assess the death preparedness level of advanced cancer patients. Additionally, with the subscale scoring system, healthcare professionals can provide targeted interventions in specific areas of death preparedness for patients, thereby improving both the quality of life and quality of death for advanced cancer patients.

PMID:40215084 | DOI:10.1002/pon.70149

Ann Indian Acad Neurol. 2025 Apr 11. doi: 10.4103/aian.aian_773_24. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Persons with epilepsy (PWE) have poor dental hygiene, contributed by the severity of epilepsy, ignoring oral health, and the medications used. A continuing need exists for a better understanding of the effects of antiseizure medications (ASMs) on oral health. Several studies have shown the effects of older ASMs on oral health, but there is a lack of those exploring oral side effects of newer ASMs.

METHODS: A cross-sectional study was conducted in which 69 PWE on ASMs were compared with 33 controls. A structured questionnaire was used to collect data on demographics, oral hygiene practices, and medication history including use of older and newer ASMs. Dental examination along with plaque, gingival, Decayed, Missing, and Filled Teeth (DMFT), and Decayed, Missing, and Filled teeth Surface (DMFS) indices were assessed. PWE were divided into three groups based on whether they were on older ASMs, newer ASMs, or a combination of both. Data was statistically analyzed.

RESULTS: PWE have poor dental health with significantly higher gingival index, plaque index, calculus, DMFS, and DMFT scores compared to controls (P < 0.001). Concerning ASMs, patients on older ASMs had poor dental health with higher gingival index, gingivitis, and periodontitis compared to those on newer ASMs (P < 0.005). Patients on polytherapy tended to have worse periodontal parameters. Gingival hyperplasia was common in patients taking phenytoin alone compared to those taking folic acid along with phenytoin (P < 0.05).

CONCLUSION: Older ASMs, especially phenytoin, can be associated with significant oral side effects. Newer ASMs are relatively safe, but further research is needed to fully understand their long-term effects.

PMID:40215081 | DOI:10.4103/aian.aian_773_24