Tag: statistics

JMIR Diabetes. 2026 May 7;11:e80177. doi: 10.2196/80177.

ABSTRACT

BACKGROUND: Participating in a Diabetes Self-Management Education and Support (DSMES) program improves self-care behaviors, quality of life, and health outcomes. However, language barriers and cultural differences can hinder participation, leaving many Vietnamese Americans with limited access to DSMES services.

OBJECTIVE: This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of a 3-month Blended Automated Links Augmented by Nurse Call and Engagement (BALANCE) intervention designed to deliver culturally tailored DSMES in the Vietnamese language, with participants monitored for 12 months afterward to assess sustained effects on key outcomes.

METHODS: An explanatory sequential mixed methods design was used, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework. Feasibility and acceptability were measured by the participation rate of eligible clinics and patients, patient message response rate, and retention rate. Focus groups were conducted to assess adoption and sustainability. A pilot single-arm, prospective interventional trial was conducted with a sample of 88 Vietnamese American adults with type 2 diabetes from 10 primary care clinics. Surveys were administered at baseline and every 3 months over 12 months. Repeated measures ANOVA assessed changes in clinical outcomes at 3, 6, 9, and 12 months. Qualitative data from in-depth interviews and focus groups were thematically analyzed to validate and expand on quantitative findings. Integrated analysis using joint display enabled meta-inferences across data sources.

RESULTS: Among 88 participants (mean age 68, SD 9.8; range 35-86 years), the intervention did not significantly affect glycated hemoglobin A1c (P=.63) but led to a statistically and clinically significant reduction in low-density lipoprotein (P=.001) and improvement in exercise performance (P=.04). Qualitative data from 45 patient interviews reached data saturation, with 80% (n=36) describing the intervention as “convenient” and “helpful.” Clinic staff (n=18) participated in 3 focus groups and endorsed the intervention as acceptable and feasible. Mixed methods analysis confirmed high feasibility (83% clinic participation and 100% clinic retention) and acceptability (90.9% patient retention). Key barriers to sustainability included limited staffing and supply infrastructure.

CONCLUSIONS: Intervention feasibility and acceptability were demonstrated but require further refinement to achieve long-term, consistent glycemic control. Findings indicated that clinic staff workload and clinic workflow were key determinants of the study’s feasibility and acceptability. Future research should test BALANCE in a fully powered randomized controlled trial to evaluate intervention effectiveness.

PMID:42096691 | DOI:10.2196/80177

JMIR Form Res. 2026 May 7;10:e87453. doi: 10.2196/87453.

ABSTRACT

BACKGROUND: Substance use disorders (SUDs) are a major public health concern, contributing to significant individual and societal costs. Despite this, the uptake of evidence-based pharmacologic and behavioral interventions remains limited. The digital delivery of SUD treatment has emerged as a potentially scalable way to reduce access barriers and increase treatment use. Existing digital therapeutic interventions are often created without clinician involvement, evidence-based materials, interdisciplinary input, or content review. The implementation of a structured and methodologically rigorous development process is needed across digital health interventions to help ensure patient-facing materials are validated, understandable, and actionable for the end user.

OBJECTIVE: This early report seeks to describe and evaluate an iterative, interdisciplinary, platform-agnostic process for adapting and refining existing print materials for digital therapeutic modules in SUD treatment. The a priori goal was to evaluate if a structured, human-centered approach would generate digital modules that were rated as understandable and actionable based on a validated assessment for written materials.

METHODS: Fourteen therapeutic modules were adapted from existing Mayo Clinic-written, patient-facing education materials originally developed by a board-certified addiction psychiatrist and a doctoral-level education specialist for clinical use. A team of 4 purposively recruited licensed alcohol and drug counselors with lived experience with a SUD, all in recovery, and a doctoral-level therapeutic specialist met weekly for one hour over a 6-month period to iteratively adapt this existing content for smartphone delivery (2-3 hours per module). The process flow included selecting source material, restructuring content for viewing on a phone screen, simplifying language, improving organization and flow to promote understanding, and including specific actions users could take based on the content. The counselors then independently evaluated the modules using the Patient Education Materials Assessment Tool for printable materials (PEMAT-P). PEMAT-P scores for understandability and actionability were calculated as percentages, and descriptive statistics were used to summarize scores in aggregate and across modules. A target of >70% was set for each PEMAT-P domain, consistent with accepted benchmarking standards.

RESULTS: Mean understandability and actionability for all modules were 87.2% (SD 4.8%; range 81.4%-96.9%) and 75.1% (SD 12.3%; range 57.1%-95.0%), respectively, exceeding the recommended threshold. While all modules were adequately understandable, 35.7% (5/14) scored below the actionability threshold.

CONCLUSIONS: This early report highlights the value of a human-centered, iterative process for adapting therapeutic materials for digital delivery in SUD treatment. Although the modules performed well overall on PEMAT-P benchmarks, actionability was less consistent than understandability, and aggregate scores masked weaknesses in several individual modules. This indicates that a standardized process does not guarantee actionable material across all content types. Involving current patients in this process may improve the end product by incorporating a perspective that was previously missed.

PMID:42096690 | DOI:10.2196/87453

JMIR Form Res. 2026 May 7;10:e82061. doi: 10.2196/82061.

ABSTRACT

BACKGROUND: Society faces multiple challenges, including lifestyle diseases and global climate change. Framing health education within sustainable development may enhance motivation for behavior change because proenvironmental behaviors, as well as healthy behaviors, often rely on the same behavior change principles. Combining these perspectives may therefore reinforce health behaviors and climate-friendly choices.

OBJECTIVE: This pilot study aims to explore changes in dietary intake, diet-related carbon footprint, and physical activity among office workers receiving sustainable plus healthy lifestyle (sustainable lifestyle arm) or healthy lifestyle education (healthy lifestyle arm) alone. It also aims to assess the feasibility of the intervention functions, including workshop attendance rate, participants’ dietary goals, social support, and facilitators and barriers to behavior change.

METHODS: A 2-armed participant-blinded cluster randomized study, including an experimental intervention arm (sustainable lifestyle; n=19) and a control intervention arm (healthy lifestyle; n=14), was conducted in Sweden. The study lasted 8 weeks and included 6 workplace-based workshops and was framed by the behavioral change wheel and the socioecological model. Diet, carbon footprint, and physical activity were assessed using the web-based questionnaires Meal-Q and Active-Q. Attendance rate, individual goals, social support, and facilitators and barriers were assessed using printed questionnaires.

RESULTS: The reduction of total diet-related carbon dioxide equivalents (CO2e) was 0.8 kg and 0.4 kg per day for the sustainable and healthy lifestyle arm, respectively. Also, there was a statistically significant interaction between time and lifestyle when the carbon footprint was expressed as a qualitative aspect of diet, that is, CO2e kg per 1000 kcal per day (P=.05). Moreover, the intake of vitamin C, a marker for fruits and vegetables, increased to 8.0 and 12.5 mg per 1000 kcal per day for the sustainable and healthy lifestyle arms, respectively. In addition, total sedentary time decreased by 0.4 hours per day in the sustainable lifestyle arm, but not in the healthy lifestyle arm. This indicates that the educational workshops in respective arms had different impacts on health behavior over time. Minor differences were found in dietary goals, with the sustainable lifestyle arm setting more goals related to ecological and vegetarian foods. No differences were seen between arms regarding barriers or facilitators.

CONCLUSIONS: This study suggests that embedding healthy lifestyle recommendations within a sustainable development context may be an efficient way to reduce carbon footprint and increase healthy behavior among office workers. Given the ongoing global epidemic of metabolic diseases, climate change, and environmental degradation, promoting a sustainable lifestyle in a workplace context has the potential to counteract these trends.

PMID:42096679 | DOI:10.2196/82061

Neurology. 2026 Jun 9;106(11):e218031. doi: 10.1212/WNL.0000000000218031. Epub 2026 May 7.

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic kidney disease is a recognized risk factor for adverse neurocognitive outcomes, but the effect of acute kidney injury (AKI) on brain health remains less well defined. We conducted a systematic review and meta-analysis to evaluate associations between AKI and subsequent risk of stroke, delirium, and dementia.

METHODS: Eligible studies were identified by searching Ovid MEDLINE and Embase from inception (Ovid: January 1946; Embase: January 1970) until April 2025. Studies were included if they reported quantitative estimates with measures of precision for the association between AKI and delirium, stroke, or dementia in adult populations. Two reviewers independently screened and extracted data, and study quality was assessed using standardized criteria. Study characteristics, participant demographics, and adjusted effect estimates (hazard ratios [HRs] or odds ratios [ORs]) with 95% CIs were extracted. Pooled HRs and ORs with 95% CIs were calculated using random-effects models. Heterogeneity was evaluated with the χ² test and I² statistic, and sources of heterogeneity were explored through prespecified subgroup analyses and meta-regression.

RESULTS: We identified 49 studies comprising 11,253,825 participants with 1,279,145 events. Individuals with AKI were at increased risk of stroke (pooled adjusted HR 1.35, 95% CI 1.20-1.52), delirium (pooled adjusted OR 1.76; 1.42-2.17), and dementia (pooled adjusted HR 1.64, 1.41-1.89). A gradient of risk across increasing AKI stages was demonstrated for stroke (stage 1: HR 1.11; 1.00-1.23; combined stages 2 and 3: HR 1.57; 1.35-1.81). AKI was also associated with higher in-hospital and 90-day mortality poststroke (pooled HR 2.13, 1.56-2.90, and 4.81, 2.55-9.08, respectively) and with 90-day disability (pooled adjusted OR 1.47, 1.22-1.76). Associations between AKI and all outcomes were directionally consistent across sensitivity analyses and pooled propensity score-matched studies.

DISCUSSION: In this systematic review and meta-analysis, AKI was consistently associated with increased short-term and long-term neurocognitive risk, including stroke, delirium, and dementia. These findings suggest that AKI may identify individuals vulnerable to both acute and chronic brain injury. Further studies are needed to clarify mechanisms linking AKI to brain injury and to identify strategies to mitigate neurocognitive risk in this high-risk population.

PMID:42096677 | DOI:10.1212/WNL.0000000000218031

Neurology. 2026 Jun 9;106(11):e214862. doi: 10.1212/WNL.0000000000214862. Epub 2026 May 7.

ABSTRACT

BACKGROUND AND OBJECTIVES: Data on time trends in cluster headache epidemiology are sparse. The aim of this study was to report trends in prevalence and incidence of cluster headache in Norway over a 14-year period.

METHODS: We conducted a registry-based study using linked data from the Norwegian Registry for Primary Health Care, the Norwegian Control and Payment of Health Reimbursements Database, the Norwegian Patient Registry, the Norwegian Prescribed Drug Registry, and Statistics Norway from 2009 to 2022. Data included diagnostic codes, prescriptions, and education. Adults (age ≥18 years) were included. Cluster headache prevalence was defined as ≥2 contacts (clinical consults or prescriptions) for cluster headache in a 365-day period. Age-standardized trends in prevalence and incidence by sex and year, and interactions between education and year, were analyzed with negative binomial regression. We estimated prevalence rate ratio (PRR) and incidence rate ratio per calendar year with 95% CIs.

RESULTS: The number of patients with cluster headache increased from 1,029 in 2009 (median age 44 years; 39.7% women) to 1,833 patients in 2022 (median age 47 years; 50.1% women). The annual age-standardized prevalence rate increased from 27.0 to 42.5 per 100,000 in the same period. Women had a 3-fold higher annual increase of 6% (PRR 1.06, 95% CI 1.05-1.07) compared with 2% (PRR 1.02, 95% CI 1.02-1.03) in men. The prevalence rate was higher in women than in men by 2022 (43.4 vs 41.7 per 100,000). The annual prevalence of chronic cluster headache and refractory chronic cluster headache varied between 6%-7% and 1%-2% of all cluster headache cases, respectively. The annual age-standardized incidence rate of cluster headache increased in women, from 10.1 to 14.6 per 100,000 from 2012 to 2022 and decreased in men, from 13.5 to 11.0 per 100,000. Incidence and prevalence rates were higher among individuals with lower education.

DISCUSSION: Prevalence increased over 14 years, possibly reflecting improved diagnostic practices and awareness. These findings challenge previous reports of cluster headache predominantly affecting men, illustrating distinct shifts and trends in disease epidemiology. A limitation was the lack of clinical validation of cluster headache diagnostic codes in primary health care.

PMID:42096674 | DOI:10.1212/WNL.0000000000214862

Neurology. 2026 Jun 9;106(11):e214948. doi: 10.1212/WNL.0000000000214948. Epub 2026 May 7.

ABSTRACT

BACKGROUND AND OBJECTIVES: Adults older than age 55 years have the highest incidence rate and are the fastest-growing population among people with epilepsy. The aim of this study was to characterize the etiologies of new-onset seizures in older adults and to examine how seizure etiology varies across demographic groups. We used data from 7 US epilepsy centers from 2021 to 2025 and compared findings with those of previous population-based studies, providing an updated view and highlighting opportunities for prevention and improved risk stratification.

METHODS: We retrospectively reviewed medical charts of 2,052 patients aged ≥55 years at the time of a first seizure, who were evaluated at 7 epilepsy centers between 2021 and 2025. We categorized seizures by etiology as follows: ischemic stroke, hemorrhagic stroke, tumor, neurodegeneration, provoked seizures, traumatic brain injury, and unknown. We examined differences in etiology by demographic strata (age, sex, race, and primary language) using chi-square tests, Kruskal-Wallis tests, analysis of variance, and Cuzick tests.

RESULTS: The most frequent seizure etiologies among older adults were unknown (29.9%), ischemic stroke (15.4%), and provoked seizures (14.9%). Neurodegenerative disease was the etiology for 5.3% of cases overall but increased in prevalence with age, accounting for 18.5% among patients aged 85-89 years. Seizure etiologies also differed by sex and race. Men more commonly had seizures caused by cerebrovascular disease and traumatic brain injury, while women more commonly had seizures due to neurodegenerative disease. Black patients had higher proportions of ischemic stroke and neurodegenerative disease, while unexplained epilepsy was more common among White patients.

DISCUSSION: The causes of late-onset seizures vary based on age, sex, and race. Nearly one-third of cases of epilepsy in older adults remain unexplained despite advances in imaging techniques, underscoring the need for further research on the mechanisms and health implications of late-onset unexplained epilepsy. Improved prevention of cerebrovascular disease and optimized management of provoked seizures may reduce the growing burden of epilepsy in older adults.

PMID:42096671 | DOI:10.1212/WNL.0000000000214948

J Med Internet Res. 2026 May 7;28:e98435. doi: 10.2196/98435.

ABSTRACT

This commentary argues that for low-intensity postdischarge interventions, emergency department use may be a more sensitive and appropriate indicator of transitional care quality than readmission. It also positions nurse-led telephone follow-up as interpretive, equity-sensitive transitional care work that helps patients make discharge plans actionable in the home context while highlighting the value of accessible, scalable digital modalities such as telephone outreach.

PMID:42096670 | DOI:10.2196/98435

Phlebology. 2026 May 7:2683555261451569. doi: 10.1177/02683555261451569. Online ahead of print.

ABSTRACT

BackgroundUltrasound-guided foam sclerotherapy (UGFS) is a minimally invasive procedure recommended for the management of chronic venous disease, particularly for varicose veins and saphenous trunk insufficiency, although rare, systemic effects may occur. The study aims to evaluate the impact of UGFS on pulmonary artery pressure and right ventricular function through indirect echocardiographic measurements.Material and MethodsA total of 50 patients with incompetent great saphenous veins underwent UGFS. Preoperative assessments and echocardiographic monitoring of right heart function were conducted at baseline (T0), 5 min (T5), 10 min (T10), and 15 min (T15) after FS injection. Primary endpoint included changes in systolic pulmonary artery pressure (PAPs), while secondary endpoints focused on tricuspid annular plane systolic excursion (TAPSE) and right ventricular diameter (RVD1). Statistical analyses were performed using paired t-tests and linear mixed models.ResultsThe results indicated a significant increase in PAPs from T0 to T10 (mean increase of 8.13 mmHg, p < .01) and T5, with a reduction at T15 that remained above baseline (mean difference of 3.01 mmHg, p < .01). TAPSE showed a significant increase at T15 compared to T0 (mean increase of 1.6 mm, p = .04). No significant changes were observed in RVD1. Importantly, no local or systemic complications occurred, and all patients remained asymptomatic.ConclusionUGFS is a safe and effective treatment for chronic venous disease, with transient and benign alterations in right heart hemodynamic likely attributable to foam degradation products. Further studies with larger cohorts and longer follow-up are warranted to enhance understanding of the long-term effects of UGFS on pulmonary hemodynamic and right ventricular function.

PMID:42096649 | DOI:10.1177/02683555261451569

JMIR Cardio. 2026 May 7;10:e81777. doi: 10.2196/81777.

ABSTRACT

BACKGROUND: Telehealth has shown promise in enhancing care transitions and physical health outcomes in patients with cardiovascular disease. However, limited studies have explored its effect on functional status, psychological health, and rehospitalization, specifically in older patients undergoing coronary artery bypass grafting (CABG).

OBJECTIVE: This study aimed to evaluate the effectiveness of a telehealth intervention in improving functional status, reducing anxiety and depression, and decreasing rehospitalization rates compared with usual care among older patients undergoing CABG.

METHODS: The study was a 2-arm parallel randomized controlled trial. This was conducted in 2 phases. Phase 1 was conducted in the cardiac surgical units at a university hospital in Bangkok, Thailand. Phase 2 involved following up with the participant at home 30 and 90 days after discharge. A total of 84 older adults undergoing CABG were randomly assigned to either the control group (n=42), which received usual care (discharge planning), or the intervention group (n=42), which received a telehealth intervention based on the transitional care model in addition to usual care. The telehealth intervention included home monitoring via the “Zip Heart” app and scheduled video consultations. The primary outcome was functional status, measured using the Thai version of the Enforced Social Dependency Scale. Secondary outcomes included anxiety and depression, assessed using the Thai Hospital Anxiety and Depression Scale, and rates of rehospitalization. Data were collected at baseline, 30, and 90 days after discharge. Analyses were conducted using an intention-to-treat approach, with missing outcome data handled using multiple imputation. Two-way repeated-measures ANOVA was used to evaluate group, time, and group-by-time interaction effects.

RESULTS: A total of 84 participants were randomized and included in the intention-to-treat analysis (intervention group, n=42; control group, n=42). At baseline, there were no statistically significant differences between the two groups. Significant group-by-time interactions were observed for functional status scores (F2,164=32.09, ηp²=.28; P<.001), anxiety (F2, 164=20.22, ηp²=.2; P<.001), and depression (F2,164=16.81, ηp²=.17; P<.001). The intervention group demonstrated significantly greater improvements in functional status and greater reductions in anxiety and depression at both 30 and 90 days after discharge compared to the control group (all P<.001). Additionally, rehospitalization rates were significantly lower in the intervention group at 30 days (Z=2.77; P=.006) and between 31 and 90 days post discharge (Z=2.31; P=.02).

CONCLUSIONS: The Telehealth intervention is effective in improving functional and psychological outcomes and reducing rehospitalization rates among older patients undergoing CABG. Integrating telehealth into usual care can support recovery and enhance continuity of care.

PMID:42096646 | DOI:10.2196/81777

Prev Chronic Dis. 2026 May 7;23:E11. doi: 10.5888/pcd23.250407.

ABSTRACT

INTRODUCTION: Mobility is a critical determinant of healthy aging. Agility, gait, balance, and fall risk, when left unassessed and unaddressed, may diminish older adults’ ability to age in place, often leading to more restrictive, supervised care environments. This study examined racial and ethnic disparities in a composite mobility/functional measure in Hawai’i and the associations of selected social determinants of health (SDOH) with limitation status.

METHODS: We analyzed data from the Hawai’i Behavioral Risk Factor Surveillance System collected from 2019 through 2021. The study population included community-dwelling adults aged 55 years or older from the 4 largest racial and ethnic groups in Hawai’i: White, Filipino, Japanese, and Native Hawaiian (unweighted n = 10,039; weighted population estimate = 350,922). We used weighted logistic regression to assess associations between mobility limitations and SDOH.

RESULTS: Mobility limitations were reported by 28% of Native Hawaiian people aged 55 years or older, compared with 17% to 19% among other groups. Native Hawaiian adults aged 55 to 64 years also had substantially higher prevalence of mobility limitations than adults of the same age in other racial and ethnic groups. Higher income was protective against mobility limitations for both Native Hawaiian and White adults. In contrast, the associations of education and health insurance with mobility limitations varied across groups, with weaker protective associations of education among Native Hawaiian adults.

CONCLUSION: Findings suggest the importance of considering mobility-focused prevention and assessment for Native Hawaiian adults before the Medicare eligibility age of 65 years. To be effective, these interventions must be culturally grounded and tailored to the unique needs and lived experiences of Native Hawaiian communities.

PMID:42096639 | DOI:10.5888/pcd23.250407