Tag: statistics

JMIR Aging. 2025 Apr 17;8:e64254. doi: 10.2196/64254.

ABSTRACT

BACKGROUND: Frailty syndrome increases the vulnerability of older adults. The growing proportion of older adults highlights the need to better understand the factors contributing to the prevalence of frailty. Current evidence suggests that geomatic tools integrating geolocation can provide valuable information for implementing preventive measures by enhancing the urban physical environment.

OBJECTIVE: The aim of this study was to analyze the relationship between various elements of the urban physical environment and the level of frailty syndrome in older Chilean people.

METHODS: A cohort of 251 adults aged 65 years or older from Talca City, Chile, underwent comprehensive medical assessments and were geographically mapped within a Geographic Information Systems database. Frailty was determined using the Fried frailty criteria. The spatial analysis of the frailty was conducted in conjunction with layers depicting urban physical facilities within the city, including vegetables and fruit shops, senior centers or communities, pharmacies, emergency health centers, main squares and parks, family or community health centers, and sports facilities such as stadiums.

RESULTS: The studied cohort was composed of 187 women and 64 men, with no significant differences in age and BMI between genders. Frailty prevalence varied significantly across clusters, with Cluster 3 showing the highest prevalence (14/47, P=.01). Frail individuals resided significantly closer to emergency health centers (960 [SE 904] m vs 1352 [SE 936] m, P=.04), main squares/parks (1550 [SE 130] m vs. 2048 [SE 105] m, P=.03), and sports fields (3040 [SE 236] m vs 4457 [SE 322]m, P=.04) compared with nonfrail individuals. There were no significant differences in urban quality index across frailty groups, but frail individuals lived in areas with higher population density (0.013 [SE 0.001] vs 0.01 [SE 0.0007], P=.03).

CONCLUSIONS: Frail individuals exhibit geospatial patterns suggesting intentional proximity to health facilities, sports venues, and urban facilities, revealing associations with adaptive responses to frailty and socioeconomic factors. This highlights the crucial intersection of urban environments and frailty, which is important for geriatric medicine and public health initiatives.

PMID:40245404 | DOI:10.2196/64254

J Med Internet Res. 2025 Apr 17;27:e67646. doi: 10.2196/67646.

ABSTRACT

BACKGROUND: The global COVID-19 pandemic’s mental health impact was primarily studied in the initial year of lockdowns but remained underexplored in subsequent years despite evolving conditions. This study aimed to address this gap by investigating how COVID-19-related factors, including nationwide COVID-19 deaths and incidence rates, influenced mental health indicators over time.

OBJECTIVE: This study aimed to examine the interplay among national COVID-19 pandemic deaths, incidence rates, stay-at-home behaviors, and mental health indicators across different income-level countries. Specifically, we assessed the mediating role of stay-at-home behaviors in the relationship between the COVID-19 pandemic deaths and mental health indicators.

METHODS: We analyzed data from 45 countries spanning March 2020 to October 2022. COVID-19-related factors included national COVID-19 pandemic deaths and incidence rates, obtained from publicly available datasets. Stay-at-home behaviors were assessed using Google Location History data, which captured residence-based cell phone activity as a proxy for mobility patterns. Mental health indicators were evaluated through Google Trends data, measuring changes in search volumes for “insomnia” and “suicide.” The interplay among these variables was assessed using mediation analysis to quantify the proportion mediated by stay-at-home behaviors in the association between COVID-19 deaths and mental health indicators.

RESULTS: In high-income countries, during the first pandemic year (March 2020 to February 2021), a higher monthly COVID-19 death count was associated with increased searches for “insomnia,” with a total effect estimate of 2.1×10^-4 (95% CI 4.3×10^-5 to 3.9×10^-4; P=.01). Stay-at-home behaviors mediated 31.9% of this effect (95% CI 9.8% to 127.5%, P=.02). This association weakened and became nonsignificant in the second and third years (P=.25 and P=.54, respectively). For middle-income countries, a different pattern emerged regarding “suicide” searches. Higher COVID-19 death counts were linked to a decline in “suicide” searches in the first (estimate: -3.5×10^-4, 95% CI -6.1×10^-4 to -9.8×10^-5; P=.006) and second years (P=.01). Mediation analysis indicated that this effect was not significantly explained by stay-at-home behaviors, suggesting the influence of other societal factors. In high-income countries, no significant association between COVID-19 deaths and “suicide” searches was observed in the first year (P=.86). However, a positive association emerged in the second year, approaching statistical significance (estimate: 2.2×10^-4, 95% CI -9.5×10^-7 to 4.2×10^-4; P=.05), and became significant in the third year (estimate: 5.0×10^-4, 95% CI 5.0×10^-5 to 1.0×10^-3; P=.03,), independent of stay-at-home behaviors.

CONCLUSIONS: Our findings highlight how the mental health impact of the pandemic varied across income groups and evolved over time. The mediating effect of stay-at-home behaviors was significant in the early phases but diminished in later stages, particularly in high-income countries. Meanwhile, middle-income countries exhibited unique patterns that suggest alternative protective factors. These insights can inform tailored mental health interventions and policy strategies in future public health crises.

PMID:40245400 | DOI:10.2196/67646

JMIR Form Res. 2025 Apr 17;9:e62754. doi: 10.2196/62754.

ABSTRACT

BACKGROUND: Nowadays, the internet has become the primary source of information for physicians seeking answers to medical questions about their patients before consulting colleagues. However, many websites provide low-quality, unreliable information that lacks scientific validation. Therefore, physicians must develop strong information search skills to locate relevant, accurate, and evidence-based content. However, previous studies have shown that physicians often have poor search skills and struggle to find information on the web, which may have detrimental consequences for patient care.

OBJECTIVE: This study aims to determine how medical students and residents searched for medical information on the internet, the quality of the web resources they used (including their nature and credibility), and how they evaluated the reliability of these resources and the answers they provided. Given the importance of domain knowledge (in this case, medicine) and information search skills in the search process, we compared the search behaviors of medical students and residents with those of computer science students. While medical students and residents possess greater medical-related knowledge, computer science students have stronger information search skills.

METHODS: A total of 20 students participated in this study: 10 medical students and residents, and 10 computer science students. Data were extracted from a freely accessible data set in accordance with FAIR (Findable, Accessible, Interoperable, and Reusable) principles. All participants searched for medical information online to make a diagnosis, select a treatment, and enhance their knowledge of a medical condition-3 primary activities they commonly perform. We analyzed search performance metrics, including search time, the use of medical-related keywords, and the accuracy of the information found, as well as the nature and credibility of web resources used by medical students and residents compared with computer science students.

RESULTS: Medical students and residents provided more accurate answers than computer science students without requiring additional time. Their medical expertise also enabled them to better assess the reliability of resources and select high-quality web sources, primarily from hospital websites. However, it is noteworthy that they made limited use of evidence-based tools such as PubMed.

CONCLUSIONS: Although medical students and residents generally outperformed computer science students, they did not frequently use evidence-based tools. As previously observed, they may avoid databases due to the risk of encountering too many irrelevant articles and difficulties in applying appropriate filters to locate relevant information. Nevertheless, clinical and practical evidence-based medicine plays a crucial role in updating physicians’ knowledge, improving patient care, and enhancing physician-patient relationships. Therefore, information search skills should be an integral part of medical education and continuing professional development for physicians.

PMID:40245399 | DOI:10.2196/62754

J Med Internet Res. 2025 Apr 17;27:e63786. doi: 10.2196/63786.

ABSTRACT

BACKGROUND: Effective physician-patient communication is essential in clinical practice, especially in oncology, where radiology reports play a crucial role. These reports are often filled with technical jargon, making them challenging for patients to understand and affecting their engagement and decision-making. Large language models, such as GPT-4, offer a novel approach to simplifying these reports and potentially enhancing communication and patient outcomes.

OBJECTIVE: We aimed to assess the feasibility and effectiveness of using GPT-4 to simplify oncological radiology reports to improve physician-patient communication.

METHODS: In a retrospective study approved by the ethics review committees of multiple hospitals, 698 radiology reports for malignant tumors produced between October 2023 and December 2023 were analyzed. In total, 70 (10%) reports were selected to develop templates and scoring scales for GPT-4 to create simplified interpretative radiology reports (IRRs). Radiologists checked the consistency between the original radiology reports and the IRRs, while volunteer family members of patients, all of whom had at least a junior high school education and no medical background, assessed readability. Doctors evaluated communication efficiency through simulated consultations.

RESULTS: Transforming original radiology reports into IRRs resulted in clearer reports, with word count increasing from 818.74 to 1025.82 (P<.001), volunteers’ reading time decreasing from 674.86 seconds to 589.92 seconds (P<.001), and reading rate increasing from 72.15 words per minute to 104.70 words per minute (P<.001). Physician-patient communication time significantly decreased, from 1116.11 seconds to 745.30 seconds (P<.001), and patient comprehension scores improved from 5.51 to 7.83 (P<.001).

CONCLUSIONS: This study demonstrates the significant potential of large language models, specifically GPT-4, to facilitate medical communication by simplifying oncological radiology reports. Simplified reports enhance patient understanding and the efficiency of doctor-patient interactions, suggesting a valuable application of artificial intelligence in clinical practice to improve patient outcomes and health care communication.

PMID:40245397 | DOI:10.2196/63786

J Med Internet Res. 2025 Apr 17;27:e64882. doi: 10.2196/64882.

ABSTRACT

BACKGROUND: Mobile app-based interventions are viable methods of delivering perinatal care support to parents. A mobile app-based intervention entitled Parentbot-a Digital Healthcare Assistant (PDA) was developed and evaluated via a randomized controlled trial. PDA aimed to provide informational, socioemotional, and psychological support to parents across the perinatal period. As developing such interventions is resource intensive, it is important to evaluate participants’ use and the components that are appreciated by them.

OBJECTIVE: This study aims to examine the (1) relationship between participants’ characteristics and PDA use, (2) relationship between PDA use and parenting outcomes, and (3) relationship between participants’ characteristics and the time taken to respond to the surveys (survey response timing).

METHODS: This study is the secondary analysis of a randomized controlled trial. A convenient sample of 118 heterosexual couples (236 participants: n=118, 50% mothers and n=118, 50% fathers) from a public tertiary hospital in Singapore were recruited. Data were collected from November 2022 to August 2023. Descriptive statistics were used to summarize the parents’ characteristics and study variables. Linear mixed models were used to examine the effect of (1) participants’ sociodemographic characteristics on PDA use metrics, (2) use metrics on parenting outcomes, and (3) participants’ sociodemographic characteristics on the survey response timing. The Pearson correlation was also used to examine the linear relationships between the PDA use metrics and parenting outcomes.

RESULTS: The following parental characteristics were found to be associated with PDA use: antenatal course attendance, gender, religion, ethnicity, and the number of children. After adjusting for baseline values and sociodemographic covariates, only the viewing of educational materials was statistically significantly associated with improvements in parents’ anxiety (β=-0.48, 95% CI -0.94 to -0.009; P=.046), parent-child bonding (β=-0.10, 95% CI -0.19 to -0.01; P=.03), social support (β=0.31, 95% CI 0.08-0.54; P=.01), and parenting satisfaction (β=0.57, 95% CI 0.07-1.07; P=.03) at 1 month post partum. Moreover, parents’ age, ethnicity, grouping, and number of children were found to be related to the survey response timing.

CONCLUSIONS: As the viewing of PDA’s educational materials was linked to improvements in parents’ perinatal well-being, the provision of educational resources should be prioritized in future app-based parenting interventions. Because the use of other PDA features, such as poster activities, forum posts, and reflection and gratitude exercises, had a limited effect in improving parents’ well-being, future interventions could explore alternative activities to better engage parents. Future mobile app-based parenting interventions could conduct similar evaluations on app use and the effectiveness of specific features to validate the findings of this study.

PMID:40245395 | DOI:10.2196/64882

JMIR Res Protoc. 2025 Apr 17;14:e60417. doi: 10.2196/60417.

ABSTRACT

BACKGROUND: Long-chain omega-3 polyunsaturated fatty acids (LCPUFAs) are essential fatty acids that protect cellular structures and provide energy, particularly for fetal growth and development. The maternal supplementations of omega-3 LCPUFA may affect the rate of intelligence in early childhood development.

OBJECTIVE: This systematic review aims to synthesize available evidence on the impact of omega-3 LCPUFA supplementation during pregnancy toward intelligence in early childhood development by analyzing the outcomes specifying the aspects of intelligence such as neurodevelopment, social-emotional, language, attention, behavior, cognition, vision, hearing, and motor skills.

METHODS: We will only include randomized controlled trials on pregnant women supplemented with omega-3 LCPUFA interventions and the outcome measured is the children’s intelligence. Based on the World Health Organization’s definition of early childhood, we will include children aged 8 years or younger. Children’s intelligence can be indicated using several tools measuring their intelligence index, such as neurodevelopment, social-emotional, language, attention, behavior, cognition, vision, hearing, and motor skills. Irrelevant and unavailable studies will be excluded. A systematic search will be conducted in 3 electronic databases, namely PubMed, Scopus, and Cochrane using relevant and synonymous terms. Study screening and selection will be conducted by the authors based on eligibility criteria. Upon encountering conflicting decisions, a discussion will be held to reach a consensus. The screening and selection process will be recorded using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The included studies will be subjected to bias and quality assessment in accordance with the Critical Appraisal Skills Programme (CASP) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment tool for randomized controlled trials.

RESULTS: An initial search was conducted on November 1, 2023, which returned 1998 studies for screening. The extracted data will be classified into groups and subgroups according to the indicator of intelligence measured in the study. Next, the extracted data will be summarized using tables of evidence. Whenever possible, a meta-analysis of homogeneous groups of studies will be conducted using statistical software such as RevMan (version 5.4; Cochrane Collaboration). Studies with significant heterogeneity will be discussed narratively. The systematic review is estimated to be published in November 2025.

CONCLUSIONS: This systematic review will systematically pool the evidence on the potential use of omega-3 LCPUFA supplementation to improve children’s intelligence status. This review is also important in addressing any existing knowledge gaps on this topic. Finally, a deeper understanding of the association between the consumption of omega-3 LCPUFA supplementation during pregnancy and children’s intelligence will aid policy makers, health care practitioners, and mothers with more informed evidence-based decisions.

TRIAL REGISTRATION: PROSPERO CRD42023463910; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023463910.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60417.

PMID:40245394 | DOI:10.2196/60417

J Med Internet Res. 2025 Apr 17;27:e67484. doi: 10.2196/67484.

ABSTRACT

BACKGROUND: The need for health care underpins health care service provision and serves as the foundation for enhancing service capacity and allocating resources. Health care needs are influenced by health, social, and economic conditions and may exhibit different characteristics over time. However, previous studies have primarily focused on specific populations or types of needs, overlooking the diversity and complexity of residents’ health care requirements. Furthermore, as informatization becomes a defining aspect of modern social development, the impact of internet utilization on the co-occurrence of health care needs remains unclear.

OBJECTIVE: This study aims to determine the co-occurrence of health care needs among residents in China, explore the relationship between internet use frequency and co-occurring health care needs, and analyze the potential pathways of influence.

METHODS: Data were obtained from the “Survey on Chinese Residents’ Health Services Needs in the New Era,” conducted from July to August 2018, yielding a sample of 12,513 individuals. An association rule learning algorithm was used to analyze the characteristics of co-occurring health care needs among Chinese residents, while a generalized linear model was used to examine the relationship between internet use frequency and co-occurring health care needs. Additionally, physical exercise and health status were selected as mediating variables, and their mediating effects were assessed using a path analysis model.

RESULTS: A substantial proportion of the surveyed population (8601/12,513, 68.74%) had 2 or more co-occurring health care needs, with a lower percentage among rural residents (4045/6053, 66.83%) compared with urban residents (4556/6460, 70.53%). Frequent internet users tended to have more co-occurring health care needs (β=.895, SE 0.019, P<.001). The results indicated a positive relationship between internet use frequency and both improved physical exercise (β=.121, P<.001) and health status (β=.026, P<.001). Notably, a high level of physical exercise was associated with an increase in co-occurring health care needs (β=.087, P<.001). By contrast, a significant negative correlation was observed between health status and co-occurring health care needs (β=-.787, P<.001), indicating that these needs decreased as health status improved.

CONCLUSIONS: The findings highlight the need for health policy makers and health care providers to address evolving health care needs and the impact of information technology on these needs. Furthermore, health care providers must adapt their services and delivery methods to meet residents’ co-occurring health care needs. Meanwhile, policy makers and service managers should ensure that service delivery keeps pace with residents’ changing needs through resource allocation, health insurance payment reforms, and performance incentives.

PMID:40245390 | DOI:10.2196/67484

J Med Internet Res. 2025 Apr 17;27:e72321. doi: 10.2196/72321.

ABSTRACT

BACKGROUND: Canadian public safety personnel (PSP) report high rates of mental health concerns and barriers to treatment. PSPNET is a clinical research unit that offers internet-delivered cognitive behavioral therapy (ICBT) that is free, confidential, and developed with and for PSP. Treatment outcomes are promising with clinically significant symptom improvement (eg, anxiety, depression, and posttraumatic stress) and favorable treatment satisfaction. While these results are promising, research has yet to explore ways to optimize therapist-guided ICBT for leaders within public safety. Optimizing ICBT for leaders is particularly important given their widespread organizational impact.

OBJECTIVE: This study aims to investigate (1) the perceived mental health stressors of Canadian leaders within public safety, (2) the degree to which leaders perceived existing therapist-guided ICBT courses tailored for PSP (ie, PSP Wellbeing Course and PSP PTSD Course) as suitable for their needs, and (3) ways to further optimize therapist-guided ICBT for public safety leaders.

METHODS: This study included 10 clients who self-identified as being in a supervisory or leadership position within their public safety organization and completed either the therapist-guided PSP Wellbeing Course or PSP PTSD Course. We used descriptive statistics to analyze demographics, mental health symptoms, treatment engagement, and treatment satisfaction. We also used a reflexive thematic analysis of semistructured interview transcripts to assess leaders’ course perceptions and feedback.

RESULTS: Canadian leaders within public safety reported occupational and nonoccupational stressors and enrolled in ICBT to support their own or colleagues’ mental health. Most clients enrolled in the PSP Wellbeing Course, accessed 4 of 5 lessons (n=7, 70%), engaged with therapist support (n=7, 70%), and identified as employed (n=8, 80%), White (n=8, 80%), and men (n=7, 70%) with an average age of 45 years. At pretreatment, 80% of clients endorsed clinically significant symptoms of one or more disorders; most often depression (n=7, 70%) and anger (n=6, 60%). Clients reported favorable attitudes toward the ICBT courses with most reporting that they were satisfied with the course (n=9, 90%). Feedback to further optimize ICBT content for leaders included the development of a leader case story (n=6, 60%) and new resources to help leaders apply skills learned in ICBT within the context of their leadership roles (n=4, 40%). Leaders also recommended optimizing ICBT delivery by improving the platform technology and incorporating more multimedia.

CONCLUSIONS: Canadian leaders within public safety perceived therapist-guided ICBT developed with and for PSP as a suitable treatment option for their needs and identified ways to further optimize its content and delivery. Future research should investigate the impacts of these efforts and explore optimizing ICBT for other groups of clients.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04127032, https://www.clinicaltrials.gov/study/NCT04127032; ClinicalTrials.gov NCT04335487, https://clinicaltrials.gov/study/NCT04335487.

PMID:40245389 | DOI:10.2196/72321

Expert Rev Hematol. 2025 Apr 17. doi: 10.1080/17474086.2025.2492886. Online ahead of print.

ABSTRACT

BACKGROUND: Glasdegib (GLAS) and venetoclax (VEN) are approved in the US for treating AML in patients aged 75+ or with comorbidities precluding intensive induction chemotherapy. Community oncology outcomes for these therapies are limited.

RESEARCH DESIGN AND METHODS: This retrospective chart review summarized characteristics, treatment patterns, and outcomes of US patients treated with first-line (1 L) GLAS or VEN for AML using descriptive statistics. The study was not designed or powered to compare GLAS and VEN cohorts.

RESULTS: Among 50 patients receiving 1 L GLAS (82.0% with low-dose cytarabine), 50.0% achieved complete remission (CR), morphological leukemia-free state (MLFS), or partial response (PR). Median overall survival (OS) was 6.9 months (95% CI: 5.4-8.9). A trial-matched GLAS cohort represented 80.0% of all GLAS-treated patients in the study. Among 83 patients receiving 1 L VEN (94.0% with a hypomethylating agent), 51.8% achieved CR, MLFS, or PR, median OS was 8.4 months (95% CI: 5.7-16.2), and 31.3% met pivotal trial eligibility criteria.

CONCLUSIONS: This observational study supports the clinical benefit of GLAS and VEN in treating AML patients in the real-world setting.

PMID:40245377 | DOI:10.1080/17474086.2025.2492886

PLoS One. 2025 Apr 17;20(4):e0321988. doi: 10.1371/journal.pone.0321988. eCollection 2025.

ABSTRACT

BACKGROUND: Among acute stroke patients (ASPs), diabetes mellitus (DM) is associated with a higher risk of death, functional dependency, and recurrence. This study aimed to determine the impact of DM on the 30-day mortality among admitted ASPs in northern Tanzania.

MATERIALS AND METHODS: This was a hospital-based prospective cohort study performed among ASPs with and without DM who were admitted to Kilimanjaro Christian Medical Centre from November 2022 to May2023. ASPs were followed for 30 days after the onset of an acute stroke to identify the primary outcome, which was all-cause mortality. Descriptive statistics, logistic regression, and survival analysis were conducted.

RESULTS: Out of 213 ASP, 82 (38.5%) had DM. The overall crude mortality rate was 46.9%. ASPs with DM had a higher mortality rate of 53.7% compared with those without DM (42.7%). A higher proportion of acute stroke patients with DM (84.1%) had a poor outcome (mRS 3-6) (p = 0.038). DM was statistically non-significant for 30-day mortality (aHR 1.56; 95% CI: 0.73-3.32; p = 0.252). However, fever (p = 0.005), severe admission Glasgow coma scale (p = 0.005), severe stroke (p = 0.008), elevated serum creatinine (p = 0.008), and an abnormal respiratory pattern (p = 0.042), were predictors of 30-day mortality.

CONCLUSION: This study demonstrated a high mortality in ASPs. Although DM did not have a significant impact on 30-day mortality, other factors, such as altered mental state, stroke severity, fever, elevated creatinine, and abnormal respiration, need to be accounted for that may have a significant impact on the mortality in ASPs. These findings highlight the significant burden of DM in stroke patients and underscore the importance of early diagnosis and treatment of ASPs, in the hopes of improving clinical practice and guidelines and reducing morbidity and mortality in Tanzania.

PMID:40245372 | DOI:10.1371/journal.pone.0321988