Tag: statistics

J Infus Nurs. 2026 Jan-Feb 01;49(1):22-28. doi: 10.1097/NAN.0000000000000629. Epub 2025 Dec 23.

ABSTRACT

OBJECTIVES: The United States opioid crisis has led to significant health care challenges. Patients who inject drugs (PWID) may self-inject illicit substances into vascular access devices (SIVAD). This behavior can lead to complications, including overdose and death. Given lack of data on SIVAD, this study aims to survey hospital staff on experiences with PWID and SIVAD, assess effectiveness of current protocols, and highlight the underreporting of incidents and their impact on care.

METHODS: A cross-sectional survey study was conducted among hospital staff. The survey assessed experiences with SIVAD, perceptions, and suggestions for improvement. Analyses with descriptive statistics for quantitative data and thematic analysis for qualitative responses were performed.

RESULTS: Overall, 254 surveys were obtained. Of these, 31.7% (72/227) reported confirmed SIVAD during their care, and 48.6% (110/226) believed their patient did not complete care due to the stigma of SIVAD. Furthermore, 72.3% (68/94) reported altering care plans due to concern of SIVAD. Finally, 93.8% (212/226) of respondents stated that they would use a device to mitigate SIVAD, if available.

CONCLUSION: By surveying hospital staff about their experience with SIVAD, this study highlights the impact and underreporting of this issue. This study also underscores the need for enhanced patient safety in cases of SIVAD and desire for new protocols and devices to improve care quality.

PMID:41494173 | DOI:10.1097/NAN.0000000000000629

J Infus Nurs. 2026 Jan-Feb 01;49(1):13-21. doi: 10.1097/NAN.0000000000000626. Epub 2025 Dec 23.

ABSTRACT

BACKGROUND: Peripheral intravenous catheter (PIVC) vasopressor administration is increasingly used to expedite the treatment of septic shock when central venous access is not immediately available. This shift in practice reflects growing support from national guidelines, which permit short-term peripheral administration of vasopressors in adults. On March 9, 2023, hospitals within 1 health care system implemented guidelines for PIVC vasopressor administration in adult critical care settings, specifically emergency departments and intensive care units.

OBJECTIVE: This study examined adherence to these guidelines for PIVC vasopressor use and to identify associated complications.

METHODS: This retrospective descriptive study included 106 adult patients (68 emergency department and 38 intensive care unit patients) diagnosed with sepsis and receiving peripheral vasopressors.

RESULTS: The majority of patients received norepinephrine through a short PIVC. Overall, 5 patients (4.7%) experienced complications, 4 with thrombophlebitis and 1 with an extravasation. All 5 patients received norepinephrine at the organization’s policy-specified concentration via short PIVCs. However, only 1 of these patients met the system’s guidelines for minimum PIVC size, quantity, and maximum infusion duration. Overall, only 58% of patients were managed in full compliance with the system’s guidelines.

CONCLUSION: These results support the use of standardized protocols to reduce complications associated with short-term peripheral vasopressor administration.

PMID:41494172 | DOI:10.1097/NAN.0000000000000626

J Med Internet Res. 2026 Jan 6;28:e73757. doi: 10.2196/73757.

ABSTRACT

BACKGROUND: Although video consultations (VCs) are permitted in German outpatient care and have seen a notable rise during the COVID-19 pandemic, their use still does not seem to have become established in Germany.

OBJECTIVE: This survey aims to evaluate the attitudes of physicians and psychotherapists with regard to the use of VC after the COVID-19 pandemic, in particular in the context of types of treatment and suitable medical fields.

METHODS: A standardized questionnaire was sent out to all 34,095 physicians and psychotherapists in 4 German regions. The analysis consisted of both descriptive and inferential statistics. Subgroup analysis included gender, age groups, community size of practice location, VC experience, type and ownership of practice, and area of medical care. Binary logistic regression was conducted to determine whether physicians’ and psychotherapists’ individual factors, organizational factors, or area of medical care were associated with at least monthly VC provision or interest in VC provision.

RESULTS: The response rate was 17.9%, including a total of 5930 participants in the analysis. About 40% (2216/5863) of the physicians and psychotherapists surveyed stated that they offer VC at least once a month. In the area of medical care, the odds ratio (OR) of at least monthly VC provision in psychotherapeutic care was about 8.2 (95% CI 7.4-1.64; P<.001) compared to primary care, whereas in specialist care, the odds for monthly VC provision were approximately 50% lower than in primary care (OR 0.5, 95% CI 0.43-0.59; P<.001). Further, female participants have higher odds to provide VC at least once a month (OR 1.163, 95% CI 1.01-1.34; P=.03). The odds for monthly VC provision in older age groups are approximately 60% higher than in the <40 years old age group (OR 0.41, 95% CI 0.32-0.52; P<.001). Around 80% (4347/5442) of the participants expressed interest in VC use. The most common occasions for which treatment by VC was reported to be suitable were discussing test results (1422/1896, 75.0%), taking the patient’s medical history (1195/2147, 55.7%), issuing prescriptions for drugs and remedies (793/1204, 65.9%), and the issuing of incapacity certificates for work (677/1042, 65.0%).

CONCLUSIONS: There has been an increase in the self-reported uptake of VC among physicians and psychotherapists compared to prepandemic levels, although this remains at a relatively low level in primary and specialist care. A significant proportion of doctors and psychotherapists have expressed an interest in using VC after the pandemic period. However, this self-reported use is not yet reflected in actual usage data, suggesting the need for further investigation into the underlying factors influencing the gap and identifying potential enablers. Further, these self-assessments by service providers on suitable types of treatment and suitable medical fields can inform political decision-making.

PMID:41494170 | DOI:10.2196/73757

JMIR Res Protoc. 2026 Jan 6;15:e74186. doi: 10.2196/74186.

ABSTRACT

BACKGROUND: The prevalence of diabetes mellitus is increasing in sub-Saharan Africa. Data on the prevalence of diabetes in Zimbabwe are scarce, and the etiologic types of diabetes are not well characterized. Classification of diabetes in Zimbabwe relies on clinical criteria at the time of diagnosis, and more detailed phenotype data are lacking. Furthermore, the prevalence of complications at diagnosis of diabetes and the incidence of complications during follow-up are not well documented in Zimbabwe.

OBJECTIVE: The primary aim of this study is to characterize the etiological types of diabetes in adult and adolescent patients with newly diagnosed diabetes in Bulawayo, Zimbabwe. The secondary objectives are to determine the prevalence of chronic complications of diabetes among adult and adolescent patients with newly diagnosed diabetes and to determine the incidence and risk factors for the development of diabetes complications after a 2-year follow-up in patients with type 2 diabetes who are free of complications at baseline.

METHODS: This is a cross-sectional and prospective observational study. The cross-sectional (phase 1) study was conducted in patients presenting for the first time to the diabetes service at 2 referral hospitals and 2 diabetes clinics in Bulawayo, Zimbabwe. Data collected from consenting participants included demographic data, social and medical history, and clinical examination. Laboratory tests included serum urea, creatinine and electrolytes, liver function tests, lipids, plasma glucose, glycated hemoglobin, serum C-peptide, spot urine (dipstick, albumin, and creatinine), and β-cell antibodies (antiglutamic acid decarboxylase, anti-islet antigen, anti-insulin antibodies, anti-islet cell antibodies, and antizinc transporter 8 antibodies). All patients had retinal photography, a 12-lead electrocardiograph, and measurement of carotid intima-media thickness and arterial stiffness. Determination of the incidence of diabetes complications will be conducted through a 2-year follow-up (encompassing 6-mo review) of a subgroup of patients with type 2 diabetes and no diabetes complications at the time of enrollment. At each 6-month visit, in addition to all variables collected at baseline, data on diabetes management and drug therapy compliance will be obtained.

RESULTS: Data collection commenced in October 2021, with 323 participants recruited. Data analysis for phase 1 is ongoing. The study will be completed in October 2026. The results will describe the spectrum of diabetes and complications found at diagnosis (phase 1) and the incidence and risk factors associated with the development of complications of diabetes (phase 2).

CONCLUSIONS: The study will provide data on etiologic types of diabetes in patients presenting to health facilities in urban centers in Bulawayo, Zimbabwe. In addition, data on diabetes complications at the time of diagnosis as well as incident complications over 2 years of follow-up will be compared with data from other studies. The data will be used to inform management strategies for patients diagnosed with diabetes in Zimbabwe.

PMID:41494166 | DOI:10.2196/74186

JMIR Public Health Surveill. 2026 Jan 6;12:e71701. doi: 10.2196/71701.

ABSTRACT

BACKGROUND: Scales for measuring health literacy and numeracy have been broadly classified into performance-based (objective) and self-reported (subjective) scales. Both types of scales have been widely used in research and practice; however, they are not always consistent and may assess different latent constructs. Furthermore, an increasing number of objective measures have been developed, and it is unclear how many latent factors should be assumed.

OBJECTIVE: This study aimed to examine the psychometric properties and factor structure of items assessing objective health literacy across multiple scales and to clarify which aspects of objective health literacy would be correlated with subjective measures, as well as health behaviors and lifestyles.

METHODS: A total of 5 objective scales (72 items in total) were administered to Japanese-speaking adults (N=16,097; women: 7722/16,097, 48%; mean age 54.89, SD 16.46 years). The analyzed scales included items assessing the numeracy, comprehension, and application of health information, some of which were contextualized for specific diseases, such as diabetes and cancer. Participants’ responses were submitted to exploratory factor analysis, and individual factor scores were calculated to test correlations with subjective health literacy, health behavior, and lifestyle.

RESULTS: Exploratory factor analysis identified 3 factors, which were interpreted as conceptual knowledge, numeracy, and synthesis. The conceptual knowledge factor consisted of items about medical word comprehension. All numeracy items loaded onto the same factor, even when contextualized for different diseases. The synthesis factor was characterized by items assessing the ability to read and understand health-related information and make judgments on it using one’s own knowledge. The identified factors showed high interfactor correlations (r values 0.53-0.64) and small-to-moderate correlations with subjective health literacy (r values 0.14-0.45). Additionally, each factor indicated small positive correlations with healthy diet and nutrition and lower substance use (r values 0.17-0.26).

CONCLUSIONS: Our findings suggest that scales of objective health literacy have at least three latent constructs (ie, conceptual knowledge, numeracy, and synthesis) and that disease specificity is not psychometrically prominent. Each factor has some overlap with subjective health literacy, but overall, subjective and objective health literacy should be interpreted as independent constructs, given the small-to-modest correlations.

PMID:41494165 | DOI:10.2196/71701

JMIR Cancer. 2026 Jan 6;12:e68101. doi: 10.2196/68101.

ABSTRACT

BACKGROUND: Patients with cancer often face significant financial challenges, known as financial toxicity (FT), which is associated with reduced quality of life. Patients with hematologic malignancies (HMs) are especially vulnerable due to intensive and prolonged treatments, frequent hospital visits, and a high risk of complications. While FT affects many in the general population, it is particularly severe among racial and ethnic minorities, especially those below the poverty line. To our knowledge, no studies have specifically examined FT in this vulnerable group in the United States.

OBJECTIVE: This study aimed to evaluate the severity of FT in patients receiving treatment for HMs in a socioeconomically underserved population, explore sociodemographic factors that may predict the severity of FT, and evaluate the subjective experiences of these patients as they relate to FT.

METHODS: We conducted a prospective, observational, longitudinal study at the Montefiore Cancer Center’s outpatient department in the Bronx, New York, from October 1, 2022, to October 30, 2023. Participants included either adult patients newly diagnosed (ND) with HMs or those already diagnosed, undergoing cellular therapy (CT). The severity of FT was assessed using the validated Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) questionnaire. Additionally, an investigator-designed questionnaire was developed to gather sociodemographic data and evaluate the subjective effects of financial burden on patient care. Patients in both the ND and CT groups were followed for 90 days. Data collection occurred at their initial presentation, as well as on days 30 and 90.

RESULTS: Ninety patients participated in the study (ND=52 and CT=38). The median age was 59 (IQR 44-66) years, with 27% (n=24) African American and 55% (n=48) Hispanic. Overall, 75% (n=67) of participants experienced some degree of FT, most with mild FT at baseline (day 0, median COST-FACIT score=19.4). In the CT group, FT worsened significantly over time, with a decline in median COST-FACIT scores from 19.9 at day 0 to 15.5 on day 90 (P=.02). In a multivariable linear regression model, race and ethnicity were a significant predictor of FT burden: identifying as African American or Hispanic was associated with a significantly lower COST-FACIT score (ie, higher FT) compared to non-Hispanic White participants (B=-3.08, P=.04, 95% CI -6.05 to -0.12). Additionally, over half of ND and CT participants reported difficulty affording basic necessities (ND: 28/52, 54%; CT: 23/38, 61%) and concerns regarding transportation access and costs (ND: 26/50, 52%; CT: n=18/38, 47%).

CONCLUSIONS: FT is prevalent among patients with HMs receiving care in underserved populations, and the burden is significantly higher among African American and Hispanic populations.

PMID:41494164 | DOI:10.2196/68101

JMIR Infodemiology. 2026 Jan 6;6:e74221. doi: 10.2196/74221.

ABSTRACT

BACKGROUND: Alcohol consumption in China poses significant public health challenges. Alcohol marketing has been shown to increase public alcohol consumption, with social media platforms such as Douyin (TikTok in Mainland China) being among the main channels for alcohol marketing.

OBJECTIVE: This study aimed to analyze the thematic content of alcohol advertising on the Douyin platform and to explore the factors influencing the popularity of these types of advertising.

METHODS: Using data from the JINGDONG platform and alcohol industry reports, we identified 40 popular alcohol brands. For each brand, we located their official Douyin accounts and selected the top 20 most-liked videos posted between November 1, 2020, and November 1, 2021. In total, 659 videos from 37 brands were collected for analysis. Two trained researchers independently coded each video using a predefined codebook, which consisted of 7 sections and 20 items. Binary logistic regression was conducted with the grouping of the number of likes as the dependent variable, and the marketing strategies and warning elements of each video as independent variables.

RESULTS: Among the 659 videos analyzed, 320 (48.6%) garnered more than 1000 likes. A significant portion of the videos was direct advertisements (281/659, 42.6%) and short skits (255/659, 38.7%), with 56.0% (369/659) featuring characters engaging in drinking-related behaviors or directly consuming alcohol. Additionally, many videos highlighted brand elements (510/659, 77.4%) and extended features (161/659, 24.4%). Cultural themes were also common, with 23.2% (153/659) of the videos promoting the enjoyment of life and 6.8% (45/659) emphasizing balance in life. However, age restrictions were missing for 26.9% (177/659) of the videos, and only 1.2% (8/659) included a health warning stating that “Drinking is harmful to health.” Certain marketing strategies were significantly associated with greater video popularity, including the use of short skits (odds ratio [OR] 2.77, 95% CI 1.42-5.41), highlighting brand elements (OR 2.96, 95% CI 1.59-5.51), and emphasizing life balance (OR 3.44, 95% CI 1.11-10.66). In contrast, the presence of age restrictions (OR 0.32, 95% CI 0.15-0.67) and explicit health warnings (OR 0.06, 95% CI 0.01-0.84) were associated with lower popularity. The period from July to September and November was the peak release period for alcohol advertisements on Douyin.

CONCLUSIONS: Alcohol marketing strategies on Douyin leverage experiential, brand-driven, collaborative, and cultural marketing techniques to enhance video attractiveness and create alcogenic environments. Moreover, effective age restrictions and health warnings are largely absent. It is essential to legislate and enforce stricter alcohol marketing regulations to reduce the health risks associated with alcohol marketing.

PMID:41494163 | DOI:10.2196/74221

J Am Acad Orthop Surg. 2026 Jan 6. doi: 10.5435/JAAOS-D-24-00718. Online ahead of print.

ABSTRACT

BACKGROUND: Press-fit femoral osseointegrated limb replacement (FOLR) allows for a direct transcutaneous skeletal connection between an artificial leg and the residual femur in a single-stage procedure that can be performed open or percutaneously. A skeletally anchored prosthesis can offer enhanced mobility, balance, and proprioception to amputees, as well as eliminate problems associated with socket mounted prostheses, such as skin problems, ulcers, and pain. The purpose of this research is to describe the safety, functional, and patient-reported outcomes for this technique.

METHODS: We retrospectively reviewed all patients at our institution who underwent press-fit FOLR between January 2017 to May 2023 (at least 1 year postsurgery). The primary outcome was adverse events prompting additional surgery. Secondary outcomes were changes in mobility (timed up and go), 2-minute walk test (2MWT), 6-minute walk test (6MWT), prosthetic use, walking aids, and patient-reported quality of life surveys (Limb Deformity-Scoliosis Research Society, QTFA, and patient-reported outcomes measurement information system).

RESULTS: Sixty-seven FOLR procedures in 65 patients were included in this cohort. The total revision surgery rate was 40.3%, including 12 débridements (17.9%), six fracture repairs (9.0%), 14 soft-tissue revisions (20.9%), and two implant removals (3.0%). Thirty limbs (44.8%) developed drainage or inflammation around their aperture and were successfully treated with antibiotics alone. Implant survival was 98.4% at 1 year, 98.4% at 2 years, and 93.0% at 5 years. Large statistically significant improvements were found in mobility (2MWT, 6MWT), walking aids, and patient-reported outcomes scores (Limb Deformity-Scoliosis Research Society, patient-reported outcomes measurement information system) in patients who underwent FOLR, as well as improvements in prosthetic use in patients who initially presented with a prosthesis.

CONCLUSION: Osseointegration of the femur reliably improves function and quality of life for transfemoral amputees. There is a high rate of complications and revision surgery, but the problems encountered are manageable in most instances.

PMID:41494162 | DOI:10.5435/JAAOS-D-24-00718

Pain. 2026 Jan 6. doi: 10.1097/j.pain.0000000000003901. Online ahead of print.

ABSTRACT

Chronic pain is linked to accelerated brain aging, often measured through the brain-age gap (BAG), the difference between chronological age and neuroimaging-derived brain age. Whether endogenous pain modulation declines with brain aging remains unknown. We tested this in participants with temporomandibular disorder (TMD) in a cross-sectional study with 84 TMD participants and 84 age- and sex-matched healthy controls (HCs) from the Cambridge Centre for Ageing and Neuroscience database. Temporomandibular disorder participants completed the Graded Chronic Pain Scale and a placebo procedure combining verbal suggestion and classical conditioning. We estimated brain age using machine-learning and deep-learning approaches: a previously published Gaussian process regression (GPR) model trained on cortical thickness features, and a convolutional neural network (CNN) trained end-to-end on T1-weighted volumes. The brain-age gap was calculated as the difference between the estimated brain age and chronological age. Using both GPR and CNN models, we found that TMD participants exhibited an older estimated brain age compared with HCs. Higher estimated brain age was associated with greater pain severity and statistically mediated the link between chronological age and pain severity. In addition, the CNN model suggested that older brain age was associated with greater pain interference and a higher likelihood of experiencing high-impact pain, controlling for sex and race. However, neither estimated brain age nor BAG influenced the magnitude of placebo effects. These findings suggest that while older brain age is associated with greater chronic pain severity and interference, placebo effects remain robust despite age-related changes in the brain, highlighting the therapeutic potential of placebo effects for older adults living with chronic pain.

PMID:41494156 | DOI:10.1097/j.pain.0000000000003901

JMIR Hum Factors. 2026 Jan 6;13:e75465. doi: 10.2196/75465.

ABSTRACT

BACKGROUND: Entrapment of sickled red blood cells in the microvasculature leads to sudden painful vaso-occlusive crises (VOCs) in sickle cell disease (SCD). This is potentially triggered by autonomic nervous system-mediated vasoconstriction in the microvasculature. Indeed, vasoconstriction biomarkers derived from a single night of laboratory-based fingertip photoplethysmography (PPG) recording were predictive of a higher frequency of future VOC in SCD. Noninvasive, remote, and longitudinal monitoring of autonomic vasoreactivity will facilitate the development of predictive biomarkers of imminent VOC.

OBJECTIVE: This study aimed to assess the feasibility and performance of a wearable wristband device to longitudinally monitor nocturnal peripheral autonomic vasoreactivity and to cross-validate the vasoconstriction parameters across the “gold-standard” finger sensor.

METHODS: A total of 12 patients with SCD and 6 healthy controls were recruited to wear a wristband device (Biostrap) with a PPG sensor on a nightly basis. For cross-validation studies, 50% (3/6) controls wore both the wristband and a sleep monitoring device (AliceNightOne) with a finger PPG sensor. We quantified autonomic vasoreactivity by processing PPG signals and deriving vasoconstriction parameters-magnitude of vasoconstriction (Mvasoc) and photoplethysmography amplitude coefficient of variation (PPGampCV). We performed a correlation analysis of the vasoconstriction parameters within each device to investigate whether Mvasoc and PPGampCV can be used as surrogate markers of vasoconstriction, and then cross-validated the PPGampCV across the wristband and finger PPG devices.

RESULTS: A total of 131 nocturnal PPG recordings were made with a wristband device (1-19 nights per participant; patients with SCD: n=79, 60%; controls: n=52, 40%). A total of 9 nocturnal recordings (3 nights per participant) were made with both wristband and finger sensor devices. Longitudinal continuous PPG recordings were feasible with the wearable device, with significant within-night and night-to-night variability in vasoconstriction parameters, suggesting dynamic changes in autonomic vasoreactivity. Mvasoc and PPGampCV significantly correlated within devices-the maximum overnight correlation was 0.82 (P<.001) for the finger sensor and 0.69 (P<.001) for the wristband sensor, suggesting that PPGampCV can serve as a surrogate for Mvasoc. Cross-validation analysis of PPGampCV across wristband and fingertip sensors showed statistically significant correlations on all 9 nights (overnight correlation coefficient ranging from 0.24-0.7), with some nightly segments of PPGampCV showing very strong correlation across devices.

CONCLUSIONS: Wearable wristband devices are feasible tools for the collection of continuous PPG measurements and vasoconstriction parameters, which serve as objective markers of autonomic vasoreactivity in users with and without SCD. We have optimized the methods of quantifying vasoconstriction from wearable device PPG signals, and cross-validated them with standardized sensors. These findings enable large-scale, real-time monitoring of autonomic vasoreactivity along with pain outcomes for the development of vasoconstriction parameters as biomarkers imminent VOC in patients with SCD. This biomarker also has the potential to impact other diseases involving autonomic vascular dysregulation.

PMID:41494152 | DOI:10.2196/75465