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Nevin Manimala Statistics

Determining Cluster-Specific Differences in the Number of Days Required to Reliably Predict Habitual Physical Activity: Intraclass Correlation Resampling Analysis

JMIR Mhealth Uhealth. 2026 Feb 10;14:e64323. doi: 10.2196/64323.

ABSTRACT

BACKGROUND: Previous research has attempted to determine the minimum number of days of accelerometry required to reliably reflect an individual’s physical activity. However, human behaviors on a day-to-day basis can be highly variable. As a consequence, the number of days required to reliably predict habitual physical activity is dependent on the variability that exists within an individual. There is a concern that adopting generic recommendations from previous research could provide unreliable estimates by failing to represent individuals with specific physical activity patterns.

OBJECTIVE: The main aim of this study was to identify clusters of individuals with distinct physical activity patterns and to determine if the number of days of accelerometry data required to reliably estimate short- (7 days) and medium-term (28 days) physical activity differed between each unique cluster.

METHODS: Accelerometry data were retrieved from 2 independent research studies. Participants during each study had their physical activity recorded using a Withings Scanwatch (Withings Health Solutions). Following a data eligibility process, agglomerative hierarchical clustering was used to identify clusters of individuals based on their physical activity. The clusters were determined using 4 dimensions; mean, SD, skewness, and kurtosis of the step count data. Intraclass correlation coefficients (ICCs) of step count were then calculated within each physical activity cluster. A series of ICCs were computed by separately comparing the average step count across the full periods (7 and 28, for the short- and medium-term analysis, respectively) to a series of averaged subsamples (ranging from 1-6 days and 1-27 days, for the short- and medium-term analysis, respectively). For each subsample, 500 random combinations were generated and compared, providing a distribution of ICCs for each subsample. An ICC of ≥0.80 identified when the subsample of days was sufficient to achieve appropriate reliability.

RESULTS: Of 258 participant datasets, 149 were eligible for the short-term analysis and 64 were eligible for the medium-term analysis. Following agglomerative hierarchical clustering, 4 and 3 clusters of sufficient size (n≥12) were identified in the short-term and medium-term analyses, respectively. When considering the short-term analysis, to achieve a mean ICC score greater than or equal to 0.80, using all randomized combinations, the number of days ranged from 2 to 6 days depending on the physical activity cluster. For the medium-term analysis, the number of days required to achieve a mean ICC score greater than or equal to 0.80 ranged from 6 to 11 days. The short-term analysis clusters displayed more diversity in physical activity patterns than the medium-term analysis.

CONCLUSIONS: Physical activity patterns influence the number of days required to estimate habitual physical activity. Thus, to avoid unreliable estimates of physical activity, which could significantly impact the interpretation of results, researchers should be mindful of the physical activity patterns of their sample before adopting generic recommendations.

PMID:41666367 | DOI:10.2196/64323

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Nevin Manimala Statistics

Exploring Self-Management-Based Mobile Health User Typologies and Associations Between User Types and Satisfaction With Key Mobile Health Functions: Comparative Study of Various Fitness and Weight Management App User Types

JMIR Med Inform. 2026 Feb 10;14:e64860. doi: 10.2196/64860.

ABSTRACT

BACKGROUND: Exploring user satisfaction is crucial for enhancing and ensuring the sustainable development of mobile health (mHealth) apps, particularly in the fitness and weight management sectors. Analyzing user types and developing user profiles are valuable for understanding differences in satisfaction. However, prior research lacks a classification of user types based on self-management characteristics and an analysis of satisfaction disparities among these types.

OBJECTIVE: This study analyzes user heterogeneity from a self-management perspective among fitness and weight management app users by identifying user types and constructing profiles. It further explores differences in satisfaction with the functional design of these mHealth apps across user types.

METHODS: First, 8 feature indicators were selected based on the Health Belief Model and the Behavior Change Wheel to evaluate users’ levels of health knowledge and beliefs, as well as self-regulation related to self-management. Existing research was integrated to categorize mHealth app functional design into 5 categories: health guidance, health education, health monitoring, social features, and gamification. Second, a questionnaire survey was used to collect data on users’ 8 health management characteristics and their satisfaction with the 5 functional design categories. A total of 2518 responses were collected, of which 1025 were included in the analysis. Cluster analysis was conducted to classify users into distinct types based on the 8 health management characteristics, and user profiles were constructed according to the distribution of these characteristics within each type. Finally, the Kruskal-Wallis test was used to analyze differences in satisfaction across user types with respect to the 5 functional design categories of mHealth apps.

RESULTS: Cluster analysis revealed that users could be categorized into 6 types based on the 8 self-management characteristics: positively proactive energizers, proactive intenders, negatively proactive energizers, low health management demanders, potential health management demanders, and passive attitude holders. Significant differences were observed across all 8 health management characteristics among the 6 user types (all P<.001). The Kruskal-Wallis test indicated significant variations in user satisfaction with the 5 functional designs of mHealth apps: H(4)=445.388, (P<.001). Overall, users reported the highest satisfaction with health guidance and health monitoring (median 4.00, IQR 1.00) and the lowest satisfaction with gamification (median 3.00, IQR 1.00). Positively proactive energizers, proactive intenders, and negatively proactive energizers demonstrated the highest satisfaction with health education and health guidance (median 4.00). Potential health management demanders, proactive intenders, positively proactive energizers, and negatively proactive energizers reported the highest satisfaction with health monitoring (median 4.00). Proactive intenders reported the highest satisfaction with social features and gamification (median 4.00).

CONCLUSIONS: Users of mHealth apps exhibit diverse types, with significant differences in health management characteristics and satisfaction with the 5 functional designs of fitness and weight management apps. This study clarifies individual-level differences in user satisfaction with mHealth apps.

PMID:41666365 | DOI:10.2196/64860

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Factors associated with penicillin and sulfonamide allergy and Stevens-Johnson syndrome/toxic epidermal necrolysis

AIDS. 2026 Feb 9. doi: 10.1097/QAD.0000000000004457. Online ahead of print.

ABSTRACT

BACKGROUND: People with HIV (PWH) are more susceptible to drug reactions than the general population. This study aimed to investigate the prevalence of, and demographic characteristics associated with a history of penicillin and sulfonamide allergy and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and to assess whether HLA-B∗57:01 is associated with these drug reactions among PWH followed in a large French multicenter cohort.

METHODS: All PWH followed from January 2000 to December 2023 with available results for HLA-B∗57:01 were included. Logistic regression models were used to identify associations between each drug allergy (outcome variable) and explanatory variables.

RESULTS: Among 35,924 PWH, the prevalence of penicillin and sulfonamide allergy and SJS/TEN were 1.05% (95%CI 0.94-1.16), 1.01% (95%CI 0.91-1.11) and 0.15% (95%CI 0.11-0.19), respectively. AIDS status was significantly associated with a higher risk of penicillin and sulfonamide allergy and SJS/TEN; while female sex was associated with sulfonamide allergy and SJS/TEN. Being born in mainland France, other European countries, and North Africa was associated with a higher risk of penicillin allergy (OR 1.88 [95%CI, 1.13-3.42], p = 0.02), while being born in Sub-Saharan Africa was associated with a lower risk of penicillin allergy (OR 0.39 [95% CI, 0.19-0.81], p = 0.009) and sulfonamide allergy (OR 0.57 [95%CI, 0.34-0.95], p = 0.03). The association between HLA-B∗57:01 and penicillin allergy was positive but statistically non-significant (OR 1.34 [95%CI, 0.87-1.97], p = 0.16).

CONCLUSION: In the combined antiretroviral therapy era, the prevalence of both penicillin and sulfonamide allergy is low. Our study confirms ethnic differences in penicillin and sulfonamide allergy.

PMID:41666357 | DOI:10.1097/QAD.0000000000004457

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Nevin Manimala Statistics

The Effect of Mindfulness-Based Art Therapy in Nursing Students: A Randomized Controlled Trial

J Nurs Educ. 2026 Feb 11:1-10. doi: 10.3928/01484834-20251119-01. Online ahead of print.

ABSTRACT

BACKGROUND: Critical thinking and self-confidence are important concepts for nursing students. This study aimed to investigate the effects of mindfulness-based art therapy (MBAT) on the critical thinking dispositions and self-confidence levels of nursing students.

METHOD: A randomized controlled trial was conducted using a parallel-group design with pretest and posttest measurements. A total of 53 nursing students completed the study. The intervention group participated in an 8-week MBAT program, whereas the control group received no intervention during this period.

RESULTS: During the pretest phase, the intervention and control groups showed no statistically significant differences in their mean scores on the Critical Thinking Disposition and Self-Confidence scales (p > .05). However, following the MBAT program, the intervention group showed notably higher mean scores than the control group in both the posttest and follow-up assessments (p < .001).

CONCLUSION: The findings indicate that MBAT effectively enhances critical thinking disposition and self-confidence levels in nursing students.

PMID:41666347 | DOI:10.3928/01484834-20251119-01

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Use of a Specialist Telephone Consultation Line for Long COVID in Primary Care in British Columbia: Retrospective Descriptive Quality Improvement Study

JMIRx Med. 2026 Feb 10;7:e57021. doi: 10.2196/57021.

ABSTRACT

BACKGROUND: Long COVID (post-COVID-19 condition) continues to challenge primary care. To support family physicians in British Columbia, the general internal medicine (GIM) COVID-19 Rapid Access to Consultative Expertise (RACE) line was launched in August 2020 to provide real-time specialist advice.

OBJECTIVE: This quality improvement study aimed to evaluate the implementation and utilization of the GIM-COVID-19 Long-Term Sequelae RACE line in British Columbia. Specifically, it sought to characterize the demographics of patients involved in RACE consultations, identify the most common themes and clinical queries presented by primary care providers, and assess how usage patterns evolved over time during the COVID-19 pandemic.

METHODS: We conducted a retrospective descriptive analysis of 149 RACE line call summaries between August 2020 and June 2021. Six calls were excluded due to insufficient information, such as incomplete documentation or absence of a clear COVID-19-related question. Because the original extraction notes are no longer available, further details about these calls cannot be provided, leaving 143 eligible calls. Data extracted included patient age, sex, geographical location, symptom type, and timing of symptom onset post-COVID-19 infection. Calls were categorized by symptom duration (acute: <2 wk, subacute: 2-12 wk, chronic: >12 wk), thematic content (respiratory, fatigue, neurological, etc), and query type (symptom management, return-to-work, vaccination, etc). Data were coded independently by two reviewers using a standardized spreadsheet and predefined codebook. Discrepancies were resolved through discussion. Descriptive statistics summarized the findings.

RESULTS: Many calls involved female patients (91/143, 64%), with the most common age group being 40-49 years (32/113, 28%). Most calls came from Greater Vancouver (35/83, 42%) and the Fraser Valley (29/83, 35%). Subacute symptoms (52/149, 35%) and vaccination-related concerns (29/149, 19%) were the most common inquiry types. Symptom-related inquiries accounted for 92 of 143 calls (64%), with 253 symptoms documented overall. Respiratory symptoms were most common (100/253, 40%), especially shortness of breath (35 calls), cough (26), and fatigue (23). Call volumes peaked from January to June 2021, coinciding with the provincial vaccine rollout.

CONCLUSIONS: The GIM-COVID-19 Long-Term Sequelae RACE line served as a critical early support system for primary care providers as the long COVID landscape evolved. This quality improvement study emphasizes the value of rapid access and specialist-informed consultation tools during emerging public health challenges. The trends ascertained may inform future health system responses, particularly when designing more scalable, interdisciplinary models to support primary care in managing complex chronic conditions.

PMID:41666312 | DOI:10.2196/57021

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Nevin Manimala Statistics

Acceptance of Men Living With HIV Toward Treatment-Supportive Mobile Apps Using the Unified Theory of Acceptance and Use of Technology: Cross-Sectional Study

JMIR Form Res. 2026 Feb 10;10:e83065. doi: 10.2196/83065.

ABSTRACT

BACKGROUND: Despite a 40-year prevalence of HIV, the AIDS epidemic prevails. Effective AIDS treatment requires specialist care and high adherence often hindered by structural issues in care access. Innovative eHealth solutions like treatment-supportive mobile apps can help address these issues. Successful implementation depends on user acceptance. Acceptance can be operationalized as behavioral intention and measured through the Unified Theory of Acceptance and Use of Technology (UTAUT).

OBJECTIVE: This study examines the acceptance and its influencing factors of treatment-supportive mobile apps among men living with HIV.

METHODS: A cross-sectional study was conducted among 172 men living with HIV between September 2021 and April 2024. In addition to the collection of sociodemographic, medical, and eHealth-related data, acceptance and its influencing factors were assessed by applying the UTAUT model. A multiple hierarchical regression analysis was conducted.

RESULTS: High acceptance of treatment-supportive mobile apps in men living with HIV was reported by 45.3% (n=78) of the participants. Significant predictors of acceptance were age (β=-0.27; P<.001); health literacy regarding disease (β=0.11; P<.001); eHealth literacy (β=0.10; P=.001); internet anxiety (β=-0.18; P=.04); and the UTAUT predictors: effort expectancy (β=0.38; P<.001), performance expectancy (β=0.24; P<.001), and social influence (β=0.40; P<.001). The UTAUT model explained 72% of the variance in acceptance.

CONCLUSIONS: Since the acceptance of eHealth services is a reliable indicator of the actual usage behavior, the results of this study are a promising basis for the successful implementation of eHealth offerings in the group of men living with HIV.

PMID:41666306 | DOI:10.2196/83065

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Nevin Manimala Statistics

Over 40 Years of Experience With Aortic Valve Surgery in the Paediatric Population-What Is the Current Best Strategy?

Eur J Cardiothorac Surg. 2026 Feb 5;68(2):ezag063. doi: 10.1093/ejcts/ezag063.

ABSTRACT

OBJECTIVES: Congenital aortic valve (AoV) disease has limited treatment options in growing children. Different initial strategies, AoV repair/surgical valvuloplasty (SAV), AoV replacement (AVR), and Ross procedure were compared to elucidate the current best strategy.

METHODS: All paediatric patients undergoing different initial AoV surgeries from 1976 to 2024 were included. Factors including prior balloon dilation (balloon valvuloplasty [BAV]), valve morphology, and initial disease (stenosis/regurgitation/mixed) were analysed. Survival and incidence of AoV reoperation/≥moderate AoV insufficiency/stenosis were evaluated.

RESULTS: A total of 323 patients underwent 142 SAV/33 AVR/137 Ross at median age/weight of 5.7 years [interquartile range, 0.5-12.6]/19.9 kg [6.9-48.8]. Surgical valvuloplasty group was the youngest (P < .01). Thirty-day mortality was 2.5% (8/323) without group differences (P = .15). Median follow-up was 9.6 years [2.7-17.8] with 10-/20-year survival rates of 90.4% [86.1-93.4]/87.1% [81.4-91.1] without group differences. Twenty-year cumulative incidences of AoV reoperations were higher after SAV: 78.4% [70.8-86.9] vs 24.6% [11.7-51.7] after AVR and 15% [6.8-33.1] after Ross, P < .01. Survivors with their native AoV at 20 years (n = 48, 14.8%) were younger at initial surgery (P < .01), had predominantly AoV stenosis (91.7%), and had fewer BAVs (P < .01). Cox regression demonstrated 7.8-fold higher mortality hazard after AVR (P < .01) and a lower reoperation hazard after AVR and Ross (HR 0.1 [95% CI, 0.1-0.5], P < .01 and HR 0.1 [95% CI, 0.1-0.3], P < .01) compared to SAV.

CONCLUSIONS: All initial AoV surgeries brought excellent early/long-term survival. Aortic valve reoperations occur most frequently after SAV. In case of favourable AoV anatomy, early SAV can preserve the native valve. Ross procedure identified as safe and durable.

PMID:41666304 | DOI:10.1093/ejcts/ezag063

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Nevin Manimala Statistics

Role of Self-Sampling Devices for HPV Detection in Cervical Cancer Screening: A Systematic Review

J Low Genit Tract Dis. 2026 Feb 10. doi: 10.1097/LGT.0000000000000935. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study is to evaluate self-sampling devices as an innovative resource with high performance, acceptability, and implementation for improving Human Papillomavirus detection in cervical cancer screening.

METHODS: This systematic review followed PRISMA 2020 guidelines and counts with the PROPERO register. A comprehensive literature search was conducted following the PRISMA guidelines using PubMed, EBSCO, and Scielo databases, including articles published between 2014 and 2025 in English and Spanish. MeSH terms related to “Uterine Cervical Neoplasms,” “Papillomaviridae,” “Molecular Diagnostic Techniques,” and “Self-Testing” were used. Inclusion criteria included clinical trials and comparative studies evaluating self-sampling test performance in terms of sensitivity and specificity values. Exclusion criteria included studies without statistical analysis, duplicates, and test usage with no cervical cancer objective.

RESULTS: Seven eligible studies were included. Self-sampling devices, such as a brush-based device, swab-type device, and sponge-type swabs, demonstrated high acceptability and usability among women, especially in underserved populations. Sensitivity and specificity range oscillated between 75%-91% and 34%-74% respectively, depending on the device and reference method. Compared with clinician-collected samples, most self-collected tests showed comparable diagnostic accuracy, making them a viable option for early detection. Limitations included small sample sizes, heterogeneity in test platforms, and a lack of long-term outcomes.

CONCLUSIONS: Self-sampling devices offer an important potential to reduce cervical cancer morbidity and mortality globally, particularly in limited-access health care services. Their implementation in routine women’s care and health screening contributes to reducing morbidity and mortality from cervical cancer. Further studies are needed to confirm long-term effectiveness and standardized implementation protocols.

PMID:41666300 | DOI:10.1097/LGT.0000000000000935

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Nevin Manimala Statistics

Matched Analysis of the Risk Assessment and Prediction Tool for Post-Operative Disposition Needs in a Spinal Oncology Population

Global Spine J. 2026 Feb 10:21925682251414112. doi: 10.1177/21925682251414112. Online ahead of print.

ABSTRACT

Study DesignRetrospective cohort study.ObjectivesAs cancer survival improves, metastatic spinal cancer has become increasingly common worldwide. Given the high resource demands of spinal oncology care, tools to optimize perioperative planning are essential. The objective of the study was to assess the effectiveness of the Risk Assessment and Prediction Tool (RAPT) in predicting post-operative needs in patients undergoing surgery for spinal tumors.MethodsConsecutive patients (n = 384) undergoing spinal oncology surgery were enrolled and prospectively assessed with RAPT. Coarsened exact matching (CEM) was used to retrospectively isolate risk factors associated with outcomes. Enrolled patients with a low RAPT score (≤9, n = 44) were exact matched against high-scoring patients (10-12, n = 44). The primary outcome of interest was post-acute care disposition; secondary outcomes were 30- and 90- day ED visits, readmissions, and reoperations. McNemar’s test was utilized for matched comparisons.ResultsA low RAPT score was significantly associated with non-home discharge (OR = 4.33 [1.23, 15.20], P = 0.02) and 30-day readmission (OR = 3.66 [1.02, 13.14], 0.03). Among low-scoring patients, 31.8% required post-acute care (while only 11.3% of high-scoring patients required post-acute care). A low RAPT score was not associated with ER visits, reoperation, or mortality. Isolation of the RAPT walk score alone significantly predicted non-home discharge (OR = 2.8 [1.01, 7.78], P = 0.04).ConclusionsWhen applied prospectively before spinal cancer surgery, the RAPT tool and its subcomponents effectively predict post-acute care needs. Pre-operative prediction of non-home discharge may help guide in-hospital resource allocation and post-acute care of spinal oncology patients.

PMID:41666294 | DOI:10.1177/21925682251414112

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Peripheral manifestations in spondyloarthritis: a systematic literature review on their assessment and the effect of biological/targeted synthetic DMARDs

Rheumatology (Oxford). 2026 Feb 4;65(2):keag042. doi: 10.1093/rheumatology/keag042.

ABSTRACT

OBJECTIVES: Peripheral manifestations (peripheral arthritis/enthesitis/dactylitis) are frequent in axial spondyloarthritis (axSpA) yet, understudied. We (i) evaluated the assessment/reporting of peripheral manifestations in trials of biological or targeted synthetic DMARDs (b/tsDMARDs) for axSpA and peripheral SpA (pSpA), and (ii) synthesized the efficacy of b/tsDMARDs on these manifestations.

METHODS: Systematic literature review (SLR) of controlled trials evaluating b/tsDMARDs in axSpA/pSpA (excluding psoriatic arthritis). Records were identified through previous SLRs informing ASAS-EULAR recommendations and updated searches. Outcomes included (i) frequency of assessment/reporting of peripheral arthritis/enthesitis/dactylitis and (ii) treatment efficacy of b/tsDMARDs on these peripheral manifestations [standardized mean differences (SMDs) or relative risk].

RESULTS: We included 100 axSpA and four pSpA trials. In axSpA, peripheral arthritis was assessed in 54%, enthesitis in 64% and dactylitis in only 10% of studies. When assessed, results were reported in 69%, 72% and 10% of studies, respectively, and often in all patients (instead of those affected at baseline). Most frequently used instruments were 44-joint count for peripheral arthritis (48%), Maastricht Ankylosing Spondylitis Enthesitis Score for enthesitis (88%) and digit count for dactylitis (40%). Composite indices like DAS were not used. SMDs (range 0.26 to -1.18) indicated mainly small-to-moderate b/tsDMARD effects, typically higher in patients with baseline peripheral involvement. In pSpA, peripheral manifestations were always assessed/reported, with generally moderate effects (SMD range -0.10 to -1.22).

CONCLUSION: Peripheral manifestations are inconsistently assessed and reported in axSpA trials. While b/tsDMARDs have small-to-moderate effects on peripheral manifestations, these may be underestimated due to not being assessed in the population affected at baseline.

PMID:41666292 | DOI:10.1093/rheumatology/keag042