Tag: statistics

JMIR Mhealth Uhealth. 2022 Jan 4;10(1):e25586. doi: 10.2196/25586.

ABSTRACT

BACKGROUND: The dose-response relationship between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed.

OBJECTIVE: This study aims to examine dose-response relationships between patient engagement and 3 psychosocial outcomes in an mHealth intervention, Run4Love, using repeated measurements of outcomes at baseline and 3, 6, and 9 months.

METHODS: This study is a secondary analysis using longitudinal data from the Run4Love trial, a randomized controlled trial with 300 people living with HIV and elevated depressive symptoms to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (N=150) using 4-time-point outcome measurements. Patient engagement was assessed using the completion rate of course assignments and frequency of items completed. Cluster analysis was used to categorize patients into high- and low-engagement groups. Generalized linear mixed effects models were conducted to investigate the dose-response relationships between patient engagement and outcomes.

RESULTS: The cluster analysis identified 2 clusters that were distinctively different from each other. The first cluster comprised 72 participants with good compliance to the intervention, completing an average of 74% (53/72) of intervention items (IQR 0.22). The second cluster comprised 78 participants with low compliance to the intervention, completing an average of 15% (11/72) of intervention items (IQR 0.23). Results of the generalized linear mixed effects models showed that, compared with the low-engagement group, the high-engagement group had a significant reduction in more depressive symptoms (β=-1.93; P=.008) and perceived stress (β=-1.72; P<.001) and an improved QOL (β=2.41; P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the 2 engagement groups were 0.8, 1.6, 2.3, and 3.7 points, respectively, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points, respectively; group differences in the Perceived Stress Scale: 0.9, 1.4, 2.3, and 3.0 points, respectively).

CONCLUSIONS: This study revealed a positive long-term dose-response relationship between patient engagement and 3 psychosocial outcomes among people living with HIV and elevated depressive symptoms in an mHealth intervention over 9 months using 4 time-point repeat measurement data. The high- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at the 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019.

PMID:34982724 | DOI:10.2196/25586

JMIR Med Educ. 2022 Jan 4;8(1):e31634. doi: 10.2196/31634.

ABSTRACT

BACKGROUND: The Do-Live-Well (DLW) framework is an occupation-focused health promotion approach. Occupational therapists (OTs) have been interested in training opportunities regarding this framework. Traditionally, in-person continuing educational interventions are the main way that OTs obtain knowledge, but web-based learning has become popular among health care professionals. However, its effectiveness and learners’ experience in web-based learning have not been well-studied in occupational therapy education.

OBJECTIVE: This study aims to evaluate the effectiveness of the web-based and in-person educational DLW workshops for Canadian OTs and to understand their experiences in both workshop types.

METHODS: An explanatory sequential mixed methods study design was used, where quantitative data were collected first, then qualitative data were used to explain the quantitative findings. A quasi-experimental design and interpretative description methodology were used in the quantitative and qualitative phases, respectively.

RESULTS: Quantitative results were as follows: a total of 43 OTs completed pre-, post-, and follow-up evaluations (in-person group: 21/43, 49%; web-based group: 22/43, 51%). Practice settings of the participants varied, including geriatric, hospital, long-term, mental health, pediatric, and primary settings. The primary outcome was as follows: there were no statistically significant differences in knowledge changes at the 3 time points (P=.57 to P=.99) between the groups. In the web-based group, the knowledge scores at follow-up were lower compared with the posttest results, meaning that knowledge gain was reduced over time (P=.001). The secondary outcomes were as follows: there were statistically significant differences between the groups in factors influencing DLW adoption at posttest (P=.001) and in satisfaction with the workshop (P<.001) at posttest in favor of the in-person group. Qualitative results were as follows: a total of 18 OTs (9/18, 50% from each group) participated in an individual interview. Five themes were identified regarding learners’ workshop experiences: relevance to their practices and interests may improve learning, a familiar learning environment may facilitate learning, synchronous in-person interaction is valuable in the learning process, ease of access to learning should be considered, and flexibility in web-based learning can be both beneficial and challenging.

CONCLUSIONS: The quantitative results of this study reported no difference in knowledge acquisition between the in-person and web-based groups, indicating that web-based education is as effective as in-person workshops. However, participants’ satisfaction with the workshop was statistically significantly higher for the in-person workshop. The qualitative findings described the participants’ perceived benefits and challenges of each educational format. The participants in both the web-based and in-person workshop groups valued in-person interactions in learning, but the participants in the web-based workshop group expressed web-based learning lacked in-person-like interactions. Thus, adding synchronous in-person interactions to web-based learning may improve learners’ educational experiences in web-based occupational therapy and continuing education.

PMID:34982719 | DOI:10.2196/31634

JMIR Public Health Surveill. 2022 Jan 4;8(1):e33311. doi: 10.2196/33311.

ABSTRACT

BACKGROUND: Tramadol is known to cause fewer adverse events (AEs) than other opioids. However, recent research has raised concerns about various safety issues.

OBJECTIVE: We aimed to explore these new AEs related to tramadol using social media and conventional pharmacovigilance data.

METHODS: This study used 2 data sets, 1 from patients’ drug reviews on WebMD (January 2007 to January 2021) and 1 from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS; January 2016 to December 2020). We analyzed 2062 and 29,350 patient reports from WebMD and FAERS, respectively. Patient posts on WebMD were manually assigned the preferred terms of the Medical Dictionary for Regulatory Activities. To analyze AEs from FAERS, a disproportionality analysis was performed with 3 measures: proportional reporting ratio, reporting odds ratio, and information component.

RESULTS: From the 869 AEs reported, we identified 125 new signals related to tramadol use not listed on the drug label that satisfied all 3 signal detection criteria. In addition, 20 serious AEs were selected from new signals. Among new serious AEs, vascular disorders had the largest signal detection criteria value. Based on the disproportionality analysis and patients’ symptom descriptions, tramadol-induced pain might also be an unexpected AE.

CONCLUSIONS: This study detected several novel signals related to tramadol use, suggesting newly identified possible AEs. Additionally, this study indicates that unexpected AEs can be detected using social media analysis alongside traditional pharmacovigilance data.

PMID:34982723 | DOI:10.2196/33311

Interact J Med Res. 2022 Jan 4;11(1):e25589. doi: 10.2196/25589.

ABSTRACT

BACKGROUND: Outdoor swimming in lakes, lidos (outdoor pools), rivers, and the sea has grown in popularity in many countries, including the United Kingdom. Many anecdotal accounts indicate improvements in medical conditions, which are considered a consequence of outdoor swimming.

OBJECTIVE: The aim of this study is to better understand outdoor swimmers’ perceptions of their health and the extent to which participation impacted their existing self-reported symptoms.

METHODS: A survey was conducted to investigate outdoor swimming behaviors and reports of any diagnosed medical conditions. Medical conditions were coded into categories, and descriptive statistics were generated regarding the outdoor swimmers’ behaviors and the effect that outdoor swimming had on their medical symptoms if any. The medical categories were clustered into five larger categories based on their prevalence in the current sample: mental health; musculoskeletal and injury; neurological; cardiovascular and blood disease; and other, which comprises inflammatory, immune, endocrine, and respiratory conditions.

RESULTS: In total, 722 outdoor swimmers responded, of whom 498 (68.9%) were female. The probability of outdoor swimming having some positive impact on health across all medical categories was 3.57 times higher compared with no impact (B=1.28, 95% CI 0.63-1.91; P<.001), 44.32 times higher for the mental health category (B=3.79, 95% CI 2.28-5.30; P<.001), 5.25 times higher for musculoskeletal and injury category (B=1.66, 95% CI 0.52-2.79; P=.004), and 4.02 times higher for the other category (B=1.39, 95% CI 0.27-2.51; P=.02). Overall, outdoor swimming was associated with perceived reductions in symptoms of poor mental health (χ²₂=25.1; P<.001), musculoskeletal and injury (χ²₂=8.2; P=.04), cardiovascular and blood (χ²₂=14.7; P=.006), and other conditions (χ²₂=18.2; P<.001).

CONCLUSIONS: Physical activity in the form of outdoor swimming is perceived to have positive impacts on health and is associated with perceived symptom reductions in mental health, musculoskeletal and injury, and cardiovascular and blood conditions. This study cannot provide causal relationships or provide mechanistic insights. However, it does provide a starting point for more targeted prospective intervention research into individual conditions or categories of conditions to establish the impact in those who choose to start outdoor swimming.

PMID:34982711 | DOI:10.2196/25589

J Med Internet Res. 2022 Jan 4;24(1):e26779. doi: 10.2196/26779.

ABSTRACT

BACKGROUND: Gamification refers to the use of game elements in nongame contexts. The use of gamification to change behaviors and promote physical activity (PA) is a promising avenue for tackling the global physical inactivity pandemic and the current prevalence of chronic diseases. However, there is no evidence of the effectiveness of gamified interventions with the existence of mixed results in the literature.

OBJECTIVE: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of gamified interventions and their health care potential by testing the generalizability and sustainability of their influence on PA and sedentary behavior.

METHODS: A total of 5 electronic databases (PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials published in English from 2010 to 2020. Eligibility criteria were based on the components of the participants, interventions, comparators, and outcomes framework. Studies were included when they used gamified interventions in daily life with an active or inactive control group and when they assessed a PA or sedentary behavior outcome. We conducted meta-analyses using a random-effects model approach. Sensitivity analyses, influence analyses, and publication bias analyses were performed to examine the robustness of our results.

RESULTS: The main meta-analysis performed on 16 studies and 2407 participants revealed a small to medium summary effect of gamified interventions on PA behavior (Hedges g=0.42, 95% CI 0.14-0.69). No statistical difference among different subgroups (adults vs adolescents and healthy participants vs adults with chronic diseases) and no interaction effects with moderators such as age, gender, or BMI were found, suggesting good generalizability of gamified interventions to different user populations. The effect was statistically significant when gamified interventions were compared with inactive control groups, such as waiting lists (Hedges g=0.58, 95% CI 0.08-1.07), and active control groups that included a nongamified PA intervention (Hedges g=0.23, 95% CI 0.05-0.41). This suggests that gamified interventions are not only efficient in changing behavior but also more effective compared with other behavioral interventions. The long-term effect (measured with follow-up averaging 14 weeks after the end of the intervention) was weaker, with a very small to small effect (Hedges g=0.15, 95% CI 0.07-0.23).

CONCLUSIONS: This meta-analysis confirms that gamified interventions are promising for promoting PA in various populations. Additional analyses revealed that this effect persists after the follow-up period, suggesting that it is not just a novelty effect caused by the playful nature of gamification, and that gamified products appear effective compared with equivalent nongamified PA interventions. Future rigorous trials are required to confirm these findings.

PMID:34982715 | DOI:10.2196/26779

Turk J Haematol. 2022 Jan 4. doi: 10.4274/tjh.galenos.2021.2021.0607. Online ahead of print.

ABSTRACT

Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) have a high propensity for thrombosis, which has been attributed to the increased blood counts, endothelial cell (EC) dysfunction, and inflammation. The presence of the JAK2V617F mutation in the ECs of MPN patients has been confirmed, but the consequences of EC involvement by JAK2V617F in the pathogenesis of thrombosis are unclear. Endothelial microparticles (EMPs) released from EC play an important role in endothelial dysfunction and also for the intercellular exchange of biological signals and information. Several studies have revealed that the patients with JAK2V617F and a thrombosis history have an increased number of microparticles in their circulation. The current study utilized a lentiviral transduction model of JAK2 wild type (JAK2wt) or JAK2V617F encoding green fluorescent protein (GFP) into the human umbilical vein EC to determine the effect of the JAK2V617F on EC. The proteins of ECs that potentially play a role in the development of thrombosis, including endothelial protein C receptor, thrombomodulin, and tissue factor, were detected between JAK2617F, JAK2wt, and GFP-only ECs with no statistical significance after two days infection with flow cytometry analysis. Increased annexin- V uptake of JAK2617F and JAK2wt ECs compared to GFP-alone EC were detected. The EMP production in the supernatants of the EC culture was investigated. Genotyping of EMP revealed the presence of genomic DNA and RNA fragments in the EMP cargos from the cell of origin in which JAK2V617F EC released EMPs with JAK2V617F DNA fragments-a result that reveals that EMPs might regulate distant and neighboring cells via their cargo materials. This novel finding provides the first evidence for the direct effect of JAK2V617F on the ECs and their functions and suggests the role of other mechanisms in the pathogenesis of thrombosis in MPNs.

PMID:34981912 | DOI:10.4274/tjh.galenos.2021.2021.0607

Microsc Res Tech. 2022 Jan 4. doi: 10.1002/jemt.24052. Online ahead of print.

ABSTRACT

The aim of this study was to assess the ability of self-assembling peptide (P11-4) diffusion, assembly, and remineralization to effect artificial secondary caries-like lesions in human primary teeth in vitro. Enamel-dentin blocks obtained from extracted human primary molars were embedded into epoxy resin blocks. Cavities (approximately 1 × 1 × 2 mm) were prepared on the surface using a high-speed diamond bur under constant water cooling and filled with composite restorative material (Filtek Z250; 3 M ESPE). The samples were immersed in demineralizing solution (20 ml) for 96 h to produce secondary caries lesions and divided into two groups according to the testing materials: fluoride varnish (Duraphat; Colgate, UK) and P11-4 (Curodont Repair; Credentis, Switzerland). Except for the control areas, all samples were remineralized for 3-5 min using the remineralizing agents, and then all the sections were placed in a pH-cycling system for 5 days at 35°C. The pH cycling procedure was followed by micro-CT analysis for the qualitative evaluation of surface changes. The Mann-Whitney U test was used to compare two independent groups. In the comparison of more than two dependent groups, Bonferroni smoothed pairwise analyses were used to determine the source of the Kruskal-Wallis H test difference. The results of the study revealed that the remineralization depths of the peptide group were higher than those of the fluoride group (p < .01). There was a statistically significant difference in remineralization effects between the fluoride and peptide groups. P11-4 can be considered as an effective remineralizing agent for secondary caries lesions.

PMID:34981866 | DOI:10.1002/jemt.24052

J Mother Child. 2021 Jan 29;22(2):128-134. doi: 10.34763/devperiodmed.20182202.128134.

ABSTRACT

INTRODUCTION: Fatty acids are some of the most important components of human milk. Polyunsaturated fatty acids (PUFAs) are essential nutrients required for the optimal growth and development of infants, especially the central nervous system, brain and retina.

AIM: To determine the conjugated linolenic acid (CLA) and vaccenic acid (VA) content of human breast milk from mothers consuming different diets, and to compare the results with CLA and VA levels in infant formulas (IF) and follow-up formulas (FF).

MATERIAL AND METHODS: Fifty healthy mothers were classified according to their diet status into one of two groups: diet low in dairy products and conventional diet without limiting the intake of dairy products. Dietary intake of dairy fat was determined based on 3-day food diaries. Fatty acid (FA) composition in samples were analyzed by High Resolution Gas Chromatography (HR-GC).

RESULTS: In the group of 20 mothers whose diets were deficient in dairy products, the average CLA content of breast milk fat was determined to be 0.27% of total FA, the VA 0.36%. In the group of 30 women consuming dairy products, the average content of CLA and VA in breast milk fat was statistically significantly higher: 0.49% and 0.69% of total FAs, respectively. In the fat of the IF and FF tested (n=11) only trace amounts of both FA were found.

CONCLUSION: The results of the study indicate that CLA and VA concentrations of human milk can be influenced by diet. It is recommended that the source of these FAs in the diet of breastfeeding women are natural products and not dietary supplements. The majority of commercially available IF and FF do not contain sufficient amounts of CLA and VA, and that their FA composition is deficient in comparison with breast milk fat.

PMID:34981910 | DOI:10.34763/devperiodmed.20182202.128134

Proteins. 2022 Jan 4. doi: 10.1002/prot.26296. Online ahead of print.

ABSTRACT

We compare the sequences of folded and intrinsically disordered proteins, using bioinformatic methods recently developed to study protein dynamic properties. We demonstrate that the two classes of sequences are organized in diametrically opposite ways with respect to long-length-scale dynamic properties. We further demonstrate a statistically significant difference between the amino acid compositions of folded and disordered proteins which is expressed in dynamic properties. Our results indicate that the long-length-scale properties of sequences are critical in determining whether proteins are able to fold, and, more generally, that they are central to an understanding of protein physics. They further provide a physical basis for the empirically observed differences in amino acid composition between folded and intrinsically disordered proteins. This article is protected by copyright. All rights reserved.

PMID:34981860 | DOI:10.1002/prot.26296

J Card Surg. 2022 Jan 3. doi: 10.1111/jocs.16192. Online ahead of print.

ABSTRACT

One-year outcomes of Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis (TARGET), a randomized double-blinded clinical trial comparing post-coronary artery bypass surgery antiplatelet therapy with ticagrelor versus aspirin are published in this issue of the Journal. Although the authors did not detect statistically significant differences in their primary outcome (saphenous vein graft patency at 1 year) and major adverse cardiovascular events, their findings must be interpreted with caution given important limitations in the design and execution of the trial.

PMID:34981862 | DOI:10.1111/jocs.16192