Tag: statistics

JMIR Form Res. 2025 Jul 24;9:e71393. doi: 10.2196/71393.

ABSTRACT

BACKGROUND: Social frailty poses a potential risk even for relatively healthy older adults, necessitating development of early detection and prevention strategies. Recently, consumer-grade wearable devices have attracted attention due to their ability to continuously collect physiological and activity-related data. These data can potentially be used to calculate digital biomarkers for screening social frailty in older adults.

OBJECTIVE: The objective of this study was to explore digital biomarkers associated with social frailty using sensor data recorded via Fitbit devices and evaluate their relationship with health outcomes in older adults.

METHODS: This cross-sectional study was conducted in 102 community-dwelling older adults. Participants attending frailty prevention programs wore devices from the Fitbit Inspire series on their nondominant wrist for at least 7 consecutive days, during which step count and heart rate data were collected. Standardized questionnaires were used to assess physical functions, cognitive functions, and social frailty, and based on the scores, the participants were categorized into 3 groups: robust, social prefrailty, and social frailty. The sensor data were analyzed to calculate nonparametric and extended cosinor rhythm metrics, along with heart rate-related metrics.

RESULTS: The final sample included 86 participants who were categorized as robust (n=28, 33%), social prefrailty (n=39, 45%), and social frailty (n=19, 22%). The mean age of the participants was 77.14 (SD 5.70) years, and 91% (78/86) were women. Multinomial logistic regression analysis revealed that a step-based rhythm metric (intradaily coefficient of variation) was significantly associated with social frailty (odds ratio 1.05, 95% CI 1.01-1.11; P=.01). The heart rate metrics, including the delta resting heart rate and time of transition from rest to activity, showed significant associations with both social prefrailty (odds ratio 0.82, 95% CI 0.68-0.99; P=.04) and social frailty (odds ratio 0.69, 95% CI 0.50-0.95; P=.01). Specifically, delta resting heart rate, defined as the difference between the overall average heart rate and resting heart rate, exhibited significant negative associations with social prefrailty (odds ratio 0.82, 95% CI 0.68-0.97; P=.02) and social frailty (odds ratio 0.74, 95% CI 0.58-0.94; P=.02). Furthermore, analysis using a linear regression model revealed a significant association between the intradaily coefficient of variation and the word list memory score, a measure of cognitive decline (β=-0.04; P=.02).

CONCLUSIONS: This study identified associations between novel rhythm and heart rate metrics calculated from the step count and heart rate recorded by Fitbit devices and social frailty. These findings suggest that consumer-grade wearable devices, which are low cost and accessible, hold promise as tools for evaluating social frailty and its risk factors through enabling the calculation of digital biomarkers. Future research should include larger sample sizes and focus on the clinical applications of these findings.

PMID:40706025 | DOI:10.2196/71393

JMIR Form Res. 2025 Jul 24;9:e50504. doi: 10.2196/50504.

ABSTRACT

BACKGROUND: The accurate diagnosis of mental disorders, such as depression, requires comprehensive, valid, and reliable tools to ensure evidence-based treatments and effective outcome monitoring. Existing diagnostic practices often lack standardization, leading to missed comorbidities and variable diagnostic accuracy. The Klenico system is an innovative, web-based diagnostic tool that integrates patient self-reports with clinical validations by mental health professionals. This system covers a broad spectrum of mental disorders, including depression.

OBJECTIVE: This research aimed to evaluate the psychometric properties of the Klenico Depression Domain (KDD), the component of the Klenico system that measures depressive symptomatology, in a real-world clinical setting. Specifically, the evaluation focused on the assessment of its construct validity, internal consistency, and sensitivity to change in symptom severity.

METHODS: Anonymized data from 496 inpatients with mental disorders collected between 2019 and 2022 were analyzed. Patients completed the KDD alongside parts of the Patient Health Questionnaire (PHQ), Beck Depression Inventory (BDI-II), and Satisfaction With Life Scale (SWLS) at both admission and discharge. Internal consistency was measured using Cronbach α. Exploratory factor analysis was conducted to examine the factor structure. Construct validity was assessed via Pearson correlations with PHQ-9 and BDI-II, while divergent validity was tested against the PHQ Somatic Symptoms Scale (PHQ-15), PHQ-Generalized Anxiety Disorder-7, and SWLS. Sensitivity to change was evaluated using paired 1-tailed t tests, effect sizes, and repeated measures correlations.

RESULTS: The KDD demonstrated excellent internal consistency (Cronbach α=0.91 at admission and 0.93 at discharge). Factor analysis revealed a 7-factor structure encompassing dimensions like “inadequacy,” “anhedonia,” and “self-hatred,” aligning with core depressive symptoms outlined in the International Statistical Classification of Diseases, Tenth Revision. The correlations with the convergent questionnaires PHQ-9 (r=0.68; P<.001) and BDI-II (r=0.70; P<.001) were high. While the KDD showed a moderate correlation with the divergent PHQ-15 (r=0.35; P<.001), it was more strongly associated with the divergent SWLS (r=-0.51; P<.001) and Generalized Anxiety Disorder-7 (r=0.51; P<.001). Sensitivity to change was high, with significant reductions in KDD scores for patients with improved symptoms (t₂₇=5.36, P<.001; Cohen d=0.79) and high repeated measures correlation with both the BDI-II (r=0.61; P<.001) and the PHQ-9 (r=0.59; P<.001).

CONCLUSIONS: The KDD shows promise as a reliable and valid instrument for diagnosing depression and monitoring treatment outcomes in psychotherapeutic settings. Its alignment with International Statistical Classification of Diseases, Tenth Revision diagnostic criteria and sensitivity to symptom change underlines its potential utility. These findings highlight the Klenico system’s potential to enhance clinical diagnostics by addressing current gaps in mental health care, thus improving diagnostic accuracy and consistency. Further research is recommended to validate its performance across different populations and settings.

PMID:40706024 | DOI:10.2196/50504

JMIR Form Res. 2025 Jul 24;9:e67550. doi: 10.2196/67550.

ABSTRACT

BACKGROUND: Adverse childhood experiences such as violence, substance use, and family disruption disproportionately affect youth in urban communities, increasing the risk of emotional and behavioral challenges. Social-emotional learning (SEL) and trauma-informed programming are effective strategies for mitigating these effects, fostering resilience, and promoting mental well-being. Game-based learning is a promising, engaging method for delivering SEL content. STRYV365 developed Brain Agents, a trauma-informed, game-based SEL intervention aimed at improving emotional regulation, coping strategies, and interpersonal skills among students in grades 5 through 9.

OBJECTIVE: This study explored students’ experiences with and perceptions of Brain Agents, evaluating its effectiveness in fostering SEL skills and resilience across 4 diverse urban schools in Milwaukee, Wisconsin.

METHODS: A cluster-randomized, incomplete block factorial crossover design was implemented from 2022-2024. Of 1626 eligible students, 329 (20%) had caregiver consent and student assent. Among these, 180 students in grades 5-9 played Brain Agents at school over 4-5 weeks, for an average of 10 sessions and 23 minutes per session. SEL-related outcomes were assessed using surveys, focus groups, and interviews. Qualitative data were analyzed using Dedoose software, with thematic coding conducted by multiple coders to ensure reliability.

RESULTS: Student demographics included 189/321 (58.9%) Black, 112/321 (34.9%) White, and 221/321 (68.8%) from economically disadvantaged backgrounds. Baseline surveys of 277 children revealed that 202 (72.9%) of students had experienced the death of someone close, 147 (53.1%) had a close contact incarcerated, and 39 (14.1%) reported feeling nervous or anxious daily. Strengths included 230 (83.0%) students reporting life satisfaction and 183 (66.1%) able to calm down when upset. Game performance data from 328 students indicated varying levels of achievement, with a median of 3 (IQR 1.5-4) missions completed, 4 (IQR 2-6) stars earned, 8 positive energies collected, and 2 (IQR 1-2.5) crew members rescued. Grades 7-8 had the highest engagement, while grade 9 students had the lowest participation. Qualitative analysis from 62 participants identified 8 core themes: qualities of most pride, neighborhood relationships, challenges in life, emotions associated with loss of control, coping strategies, future goals, experiences with Brain Agents, and suggestions to improve the game. Students most frequently cited anger as a cause of emotional dysregulation and named coping strategies such as self-calming, asking for help, and perseverance. Feedback on Brain Agents highlighted improved focus, emotional control, and critical thinking, with younger students more positively engaged. Suggested improvements included better graphics, more customization, and cooperative play.

CONCLUSIONS: Brain Agents was positively received by students, particularly those in earlier grades, and demonstrated potential as an effective trauma-informed SEL tool. The findings support the role of game-based interventions in enhancing resilience and emotional intelligence among youth exposed to adversity. Broader implementation may extend benefits to diverse student populations and settings.

PMID:40706022 | DOI:10.2196/67550

J Cogn Neurosci. 2025 Jul 18:1-18. doi: 10.1162/jocn.a.81. Online ahead of print.

ABSTRACT

Graphical representations of quantitative data abound in our culture, and yet the brain mechanisms of graphicacy, by which viewers quickly extract statistical information from a data graphic, are unknown. Here, using scatterplots as stimuli, we tested two hypotheses about the brain areas underlying graphicacy. First, at the perceptual level, we hypothesized that the visual processing of scatterplots and their main trend recycles cortical regions devoted to the perception of the principal axis of objects. Second, at a higher level, we speculated that the math-responsive network active during arithmetic and mathematical truth judgments should also be involved in graphical perception. Using fMRI, we indeed found that the judgment of the trend in a scatterplot recruits a right lateral occipital area involved in detecting the orientation of objects, as well as a right anterior intraparietal region also recruited during mathematical tasks. Both behavior and brain activity were driven by the t value that indexes the statistical correlation in the data, and right intraparietal activation covaried with participants’ graphicacy level. On the basis of this first approach to the neural bases of graphical perception, we suggest that, like literacy and numeracy, graphicacy relies on the recycling of brain areas previously attuned to a similar problem, here the perception of object orientation.

PMID:40706015 | DOI:10.1162/jocn.a.81

Prehosp Emerg Care. 2025 Jul 24:1-16. doi: 10.1080/10903127.2025.2538741. Online ahead of print.

ABSTRACT

OBJECTIVES: Whether clinical outcomes differ for hemorrhaging patients receiving prehospital whole blood versus blood component transfusion is unclear. Furthermore, most prehospital transfusion studies are limited to injured patients and commingle interfacility transfers with 9-1-1 scene responses. This study assessed outcomes exclusively among 9-1-1 scene response patients receiving prehospital transfusion with either whole blood or blood components for traumatic and non-traumatic hemorrhage.

METHODS: Using the ESO Data Collaborative for 2019- 2023, patients 8 to 100 years old who received whole blood or blood components were identified. Interfacility transports, patients receiving blood products prior to EMS arrival, and those with pre-arrival cardiac arrest were excluded. The primary prehospital outcome was change in shock index, along with changes in individual vital signs (Glasgow coma score (GCS), heart rate, systolic blood pressure). The primary hospital outcome was mortality at emergency department (ED) or hospital disposition. We also analyzed adverse events.

RESULTS: Of 1,990 eligible patients, 1,515 received whole blood and 475 received blood components. There were significant baseline differences between the two groups, with whole blood more frequently used by ground ambulance services, in urban areas and for penetrating trauma. Patients receiving blood components had statistically greater decreases in shock index (median change, -0.3 vs. -0.2, p = 0.040) and heart rate (median change, -7 bpm vs. – 4 bpm, p = 0.007), but there was no significant difference in mortality for patients receiving whole blood vs. blood components after multivariable analysis adjusting for baseline differences (adjusted odds ratio: 1.7, CI: 0.6-4.9). No patients in either group received prehospital epinephrine, and there were no ED diagnoses of transfusion reaction. Three whole blood patients had diagnoses related to thromboembolic events, but these were unlikely to be related to the transfusion.

CONCLUSIONS: In this retrospective observational study of 9-1-1 scene response patients with traumatic or non-traumatic hemorrhage, differences between shock index and heart rate for patients receiving whole blood or blood components were of questionable clinical significance, and adjusted mortality did not significantly differ for the two groups. There were no instances of prehospital anaphylaxis or ED transfusion reactions. Both transfusion strategies appear equally effective and safe.

PMID:40705958 | DOI:10.1080/10903127.2025.2538741

J Eval Clin Pract. 2025 Aug;31(5):e70203. doi: 10.1111/jep.70203.

ABSTRACT

BACKGROUND: Nursing education encompasses both theoretical knowledge and clinical practice. Nursing students can find the opportunity to increase their competences by applying the knowledge they have learnt in theoretical education in clinical practice. A multitude of factors influence the efficacy of clinical practice. It is expected that students will develop professional competencies before graduation and cultivate a positive attitude towards the nursing profession and clinical practice.

OBJECTIVE: The objective of this study is to examine the influence of nursing students’ competencies and their attitudes toward the profession on their attitudes toward clinical practice.

METHODS: The study employed a correlational design. This study was conducted in a hospital between February 27 and August 25, 2023, and included 585 nursing students who agreed to participate in the study. The study used the Nursing Students’ Attitudes towards Clinical Practices Scale, the Attitude Scale for Nursing Profession, and the Competency Inventory of Nursing Students as data collection tools together with the Descriptive Information Form. Structural equation modelling was used to analyse the research data.

RESULTS: The study revealed that nursing students’ competencies and attitudes toward the profession influence their attitudes toward clinical practices.

CONCLUSION: Nursing students’ attitudes and competencies towards the profession should be taken into consideration throughout their education to enhance the efficacy and quality of clinical practice.

PMID:40705950 | DOI:10.1111/jep.70203

J Eval Clin Pract. 2025 Aug;31(5):e70215. doi: 10.1111/jep.70215.

ABSTRACT

AIM: To conduct the cross-cultural and psychometric validation of the ‘Ageism in the Organizational Context Scale’ with Peruvian nursing students.

METHODS: This is a methodological quantitative study conducted with 882 nursing students between February and August 2023. For the adaptation process, the forward-backward method of the original version from Portuguese to Spanish was used. The content analysis was performed with the participation of specialist judges, while for the internal structure of the construct, confirmatory factor analysis and measurement invariance with multigroup confirmatory factor analysis were used.

RESULTS: Content validity was 0.93. The best internal structure of the construct is represented by the bi-factor model for the 14-item scale (CFI and TLI > 0.97, RMSEA = 0.057 and SRMR = 0.028). The measurement invariance by sex for the four levels (configural, metric, strong and strict) is also satisfactorily fulfilled. The internal consistency of the bifactor model according to the hierarchical omega (> 0.85) and the H coefficient for the latent construct (> 0.90) presented high reliability. In addition, the ordinal alpha coefficient and McDonald omega presented high precision (≥ 0.85).

CONCLUSION: The Ageism in the Organizational Context Scale adapted to the Peruvian version with 14 items showed excellent validity evidence based on the internal structure of the construct for a bifactor model and high reliability for the general score and for the two dimensions in nursing students. Identifying ageism towards the older population among nursing students is important in the training of future nurses, eliminating prejudice and improving the quality of care in this population.

PMID:40705949 | DOI:10.1111/jep.70215

J Eval Clin Pract. 2025 Aug;31(5):e70146. doi: 10.1111/jep.70146.

ABSTRACT

RATIONALE: Many service users with neurological conditions do not meet the recommended physical activity requirements. Cultivating early and ongoing access to physical activity and exercise opportunities is vital to improve or maintain function and general health in this vulnerable group.

AIM: To evaluate the impact of a pathway that aimed to facilitate access and adherence to physical activity and exercise for service users with neurological conditions.

METHODS: A London-based NHS healthcare team providing community neurorehabilitation developed a pathway in co-production with public health, local authority, third sector parties and service users to facilitate physical activity and exercise opportunities. First, NHS neurophysiotherapists offered a bespoke programme on exercise, physical activity and education to service users for up to 12 weeks. The pathway continued in local gyms, supported by a fitness instructor, for at least a further 12 weeks. Using a pre-post design, outcomes relating to function, strength and physical activity were recorded at baseline, 6-12 weeks (health care) and 6 weeks later (telephone survey after transition to local gyms). Data analysis was descriptive.

RESULTS: Thirty-five service users (20 men), mean (SD) age 60 (15), with a range of neurological conditions, were eligible and included. Ten participants dropped out: eight (23%) for medical reasons, two (6%) for other reasons. Due to the COVID-19 pandemic, four (11%) service users could not transition when facilities closed in March 2020. Analysis showed potential beneficial effects on function, strength and physical activity for service users as well as reduced waiting times to access the NHS and local gyms.

CONCLUSION: Outcomes suggested the pathway enabled service users to access and adhere to physical activity and exercise following neurorehabilitation. This evaluation included small numbers but could inform service development and future studies.

PMID:40705945 | DOI:10.1111/jep.70146

Braz J Cardiovasc Surg. 2025 Jul 24;40(4):e20240216. doi: 10.21470/1678-9741-2024-0216.

ABSTRACT

INTRODUCTION: Delirium is one of the most serious and common neuropsychological complications in the immediate postoperative period of cardiac surgery, always resulting in negative consequences, prolonged hospitalization, and increased early and late morbidity and mortality.

METHODS: An active search for acute cognitive dysfunction was performed in the electronic medical records written by the multidisciplinary team about the immediate postoperative period of 262 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass operated on in 2019 at the Instituto do Coração of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. To maintain randomness, data were collected from 25 patients per month for a total of 10 months.

RESULTS: Seventy-three patients (27.9%) presented symptoms of delirium or perioperative neurocognitive disorder in the postoperative period, with a median time of four days. The most frequent symptoms were changes in cognition (25.6%), attention (25.2%), and agitation (24.8%). Patients with delirium had a longer intensive care unit stay (median seven days vs. three days, P < 0.001), longer mechanical ventilation (median 977 vs. 535, P < 0.001), longer hospital stay (median 20 days vs. 13 days, P < 0.001), and higher incidence of hospital death (22.2% vs. 3.2%, P < 0.001).

CONCLUSION: The incidence of delirium immediately after cardiac surgery was high, around 27.9%, which is consistent with values found in the literature. The occurrence of delirium was highly associated with worse outcomes, such as longer hospital stays and mortality.

PMID:40705941 | DOI:10.21470/1678-9741-2024-0216

J Eval Clin Pract. 2025 Aug;31(5):e70213. doi: 10.1111/jep.70213.

ABSTRACT

RATIONALE: In Portugal, living wills-legal documents allowing individuals to express healthcare preferences in case of future incapacity-have been recognized since 2012. Despite this, public engagement remains limited, and previous studies have highlighted both public unawareness and knowledge gaps among healthcare professionals.

AIMS AND OBJECTIVES: This study aimed to assess the perspectives, knowledge, and clinical use of living will among Portuguese General Practitioners (GPs), given their pivotal role in promoting health literacy and patient autonomy.

METHODS: A cross-sectional, quantitative survey was conducted among Portuguese GPs, using a 30-item online questionnaire that covered demographics, knowledge, attitudes, and clinical practices. Non-parametric statistical analyses, including Spearman correlation and the Mann-Whitney test, were used to assess associations.

RESULTS: A total of 392 GPs answered the questionnaire, with a median age of 35 years. In their clinical practice, almost half of healthcare professionals have had conversations with their patients about Advance Directives (ADs), although 22.3% were unable to locate a living will in the Portuguese Public Healthcare Service Electronic System. The median number of correct answers to the 14 questions that require knowledge about the Portuguese law of ADs was 10, with a minimum of 5 and a maximum of 14. Most doctors reported that fewer than 1% of their patients have inquired about ADs.

CONCLUSIONS: Despite recognizing the importance of living wills, GPs seldom address them in consultations, often due to limited knowledge and practical barriers. Findings underscore the need for targeted training and public awareness initiatives to promote advanced care planning in primary care settings.

PMID:40705937 | DOI:10.1111/jep.70213