Tag: statistics

J Speech Lang Hear Res. 2025 Jun 13:1-35. doi: 10.1044/2025_JSLHR-24-00856. Online ahead of print.

ABSTRACT

PURPOSE: Auditory acclimatization refers to changes in auditory performance over time due to hearing aid modifications, extending beyond task-specific or training effects. This preregistered systematic review expands on previous ones by examining a broader range of outcomes, including auditory (e.g., speech recognition, electrophysiological responses) and selected nonauditory (e.g., self-reported outcomes) measures. It aimed to assess acclimatization’s presence, magnitude, and influencing factors, focusing on controlled trials comparing postfitting aided outcomes with a control group. This is the first review to comprehensively report self-reported outcomes, advancing the field.

METHOD: A systematic literature search was conducted in CINAHL, PubMed, and Web of Science in March 2024. Eligible studies followed the Population, Intervention, Comparison, Outcome, Study Design, and Timeline framework, including new adult hearing aid users with sensorineural hearing loss using air-conduction hearing aids. Studies were required to report outcomes, with a comparator and at least two data points in the same condition. Exclusions applied to studies involving children, advanced feature devices, surgical implants, non-peer-reviewed work, or uncontrolled studies. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. A planned meta-analysis was excluded due to missing data.

RESULTS: The review included 25 controlled studies on auditory acclimatization. Of these, 18 examined speech recognition, with 10 reporting acclimatization, one mixed, and seven no acclimatization. Among eight studies with self-reported outcomes, three supported acclimatization, three showed mixed results, and two found no evidence. For electrophysiological outcomes, four of seven studies reported acclimatization, and three did not. Consistent hearing aid use and hearing loss severity influenced acclimatization, while cognitive abilities and age had no significant impact. Of the 25 studies, 16% were rated good quality, 80% were rated fair, and 4% were rated poor, with common issues including lack of randomization, blinding, and insufficient sample size reporting.

CONCLUSIONS: This review highlighted the complexity of auditory acclimatization, influenced by various factors. Evidence suggested acclimatization occurred in some users and outcomes, though improvements were modest and variable. The most consistent gains were in speech recognition in noise and self-reported measures (e.g., Abbreviated Profile of Hearing Aid Benefit, Hearing Handicap Inventory for the Elderly, Glasgow Hearing Aid Benefit Profile), though changes were generally modest. Future studies should include essential statistical data, prioritize randomized controlled trials, and ensure early baseline and key interval measurements to better isolate and quantify acclimatization effects.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.29242493.

PMID:40513036 | DOI:10.1044/2025_JSLHR-24-00856

J Med Internet Res. 2025 Jun 13;27:e72276. doi: 10.2196/72276.

ABSTRACT

BACKGROUND: The onset of the COVID-19 pandemic led US health systems to rapidly implement telehealth services to connect patients and clinicians. This rapid expansion of telehealth allowed us to explore how a telehealth experience may be best delivered across populations and contexts.

OBJECTIVE: We aimed to identify telehealth modality preferences (voice vs video) among clinicians and the populations they serve and explore the barriers to telehealth use from clinician and public perspectives.

METHODS: We conducted 2 independent, cross-sectional, web-based surveys. US physicians specializing in internal medicine, psychiatry, urology, orthopedic surgery, or obstetrics and gynecology completed a 23-item survey through Sermo’s research panel. Quotas ensured equal representation across the selected clinical specialties. Adult members of the US general public completed a 26-item survey through Qualtrics’ research panel. Quotas ensured the general public sample approximated the US population on educational attainment, gender, and rural residence.

RESULTS: We recruited 253 clinician participants and 418 general public participants in September 2020, with survey completion rates of 22% (253/1139) and 93% (418/451), respectively. For the initial encounter, 85% (216/253; 95% CI 80%-89%) of clinicians and 51% (215/418; 95% CI 47%-56%) of public participants preferred video over voice only. In multiple logistic regression analyses, members of the public with broadband internet at home were more likely than those without broadband to prefer video over voice only for a first visit with a new clinician (57% vs 40%; odds ratio 2.09, 95% CI 1.25-3.49). In an established clinical relationship, 63% (160/253; 95% CI 57%-69%) of clinicians and 33% (137/418; 95% CI 28%-38%) of the general public preferred video over voice only when discussing a new clinical problem. For a follow-up visit, only 26% (65/253; 95% CI 20%-32%) of clinicians and 28% (117/418; 95% CI 24%-33%) of the general public preferred video over voice only. Clinicians and the general public agree that technology not working properly is their main source of telehealth frustration (86/249, 35% of clinicians; 62/220, 28% of public with telehealth experience). Other major frustrations include limitations on what content can be included in the visit (main frustration for 83/249, 33% of clinicians; 54/220, 25% of the public) and downloading new technology (52/220, 24% of the public).

CONCLUSIONS: Although telehealth connections with video are increasingly common, important factors are associated with a preference for voice-only telehealth connections. Clinicians prefer video over voice-only connections more than patients do for new clinical relationships and new clinical problems. For follow-up care, both clinicians and the public prefer voice-only telephone visits over video. Barriers to video-enabled telehealth experiences include technology failures, varied technology platforms across providers, and a need for more reliable high-speed internet connection. Voice-only telephone-mediated services can potentially improve health care access and experiences in light of these barriers to video-based care.

PMID:40513030 | DOI:10.2196/72276

JMIR Form Res. 2025 Jun 13;9:e54630. doi: 10.2196/54630.

ABSTRACT

BACKGROUND: Recent advancements in sports medicine have been fueled by innovative technologies, particularly consumer-grade wearable devices like Fitbit, Apple Watch, and Garmin. These devices offer physiological and biomechanical data and hold promise for personalized, real-time, and remote assessment of athlete recovery. However, few studies have been conducted with these devices in adolescent student athletes.

OBJECTIVE: The primary objective of this study was to assess the feasibility of integrating consumer-grade wearable technology into injury recovery monitoring of adolescent student athletes.

METHODS: The study included 34 high school student athletes aged 14-18 diagnosed with either concussion or orthopedic injury, enrolled within 10 days of injury. Participants were equipped with a Fitbit Sense for continuous monitoring of physiological markers, including cardiovascular metrics, physical activity levels, and sleep patterns. Data collection extended 4-6 weeks beyond injury clearance, during which adherence rates were assessed at both hourly and daily intervals. Hourly adherence was defined as the proportion of participants with at least 1 recorded heart rate data point per hour, while daily adherence was defined as the proportion of participants with at least 1 recorded heart rate data point per 24-hour period.

RESULTS: The study demonstrated high participant adherence to wearing the device. The orthopedic injury cohort exhibited a median adherence rate of 95%, with individual rates ranging from 82% to 100%. Similarly, the concussion cohort demonstrated a median adherence rate of 93%, with adherence rates spanning from 37% to 100%. Notably, the study encountered minimal issues related to device functionality, with only 1 participant necessitating a device replacement.

CONCLUSIONS: These findings demonstrate successful integration of wearable technology in data collection for adolescent student athletes recovering from sports-related injuries. However, it is important to consider current limitations, including factors that may influence data accuracy and precision. In conclusion, this feasibility study demonstrates the practicality of using consumer-grade wearable technology for the collection of physiological and biomechanical parameters in adolescent student athletes recovering from sport-related injuries. The high level of adherence highlights the potential applicability of consumer-grade wearable devices in this population. Study findings lay the foundation for future investigations with larger and more diverse cohorts to identify the utility of device metrics in identifying unique patterns of injury-specific recovery (ie, sport-related concussion). Consumer-grade wearable devices offer promise for optimizing assessment and management of injured athletes through wearable technology integration into standard clinical protocols.

PMID:40513029 | DOI:10.2196/54630

Anal Chem. 2025 Jun 13. doi: 10.1021/acs.analchem.5c01279. Online ahead of print.

ABSTRACT

Recombinant proteins are critical for modern therapeutics and diagnostics, with Chinese hamster ovary (CHO) cells serving as the primary production platform. However, environmental and chemical stressors in bioreactors often trigger cell death, particularly apoptosis, posing a significant challenge to recombinant protein manufacturing. Rapid, label-free methods to monitor cell death are essential for ensuring better production quality. Stimulated Raman scattering (SRS) microscopy offers a powerful, label-free approach to measure lipid and protein compositions in live cells. We demonstrate that SRS microscopy enables rapid and reagent-free analysis of apoptotic and necrotic transitions. Our results show that apoptotic cells exhibit higher protein concentrations, while necrotic cells show an opposite trend. To enhance analysis, we developed a quantitative single-cell analysis pipeline that extracts chemotypic and phenotypic signatures of apoptosis and necrosis, enabling the identification of subpopulations with varied responses to stressors or treatments. Furthermore, the cell death analysis was successfully generalized to other stressors and cell types. This study highlights SRS microscopy as a robust and noninvasive tool for rapid monitoring of live cell apoptotic and necrotic transitions. Our method and findings hold potential for improving quality control in CHO cell-based biopharmaceutical production and for evaluating cell death in diverse biological contexts.

PMID:40513011 | DOI:10.1021/acs.analchem.5c01279

JMIR Ment Health. 2025 Jun 13;12:e70925. doi: 10.2196/70925.

ABSTRACT

BACKGROUND: Telemental health services effectively address major challenges in mental health care delivery. To maximize the potential of the services, it is essential to facilitate patient use and reduce use disparities. Nevertheless, determinants of patient use of telemental health services have been scarcely investigated thus far.

OBJECTIVE: We aimed to identify determinants of patient use of telemental health services since the onset of the COVID-19 pandemic and in the last 4 weeks.

METHODS: In December 2023, we conducted a cross-sectional, quota-based (gender and age group) online survey. The sample comprised individuals aged 18 to 74 years, who had been using mental health services since March 2020 (n=2082). Telemental health service use was assessed using items that inquired whether individuals had used the services since March 2020 or currently (in the last 4 weeks). Logistic regressions were computed to test the associations of socioeconomic, access, health, COVID-19-related, psychosocial, and service factors, as well as personality and provider characteristics with patient use.

RESULTS: Younger age, a more positive patient attitude toward telemental health services, a more positive provider attitude toward using the services, and higher provider skills for using the services were positively associated with patient use of telemental health services since the onset of the COVID-19 pandemic. When exclusively looking at current use, positive associations with full-time employment, lower neuroticism, a more positive provider attitude toward the services, and use of the services to avoid stigmatization, long waiting times, or inconvenient scheduling were observed. Access, health, and COVID-19-related factors were not associated with patient use (since the onset of the COVID-19 pandemic and currently).

CONCLUSIONS: Beyond socioeconomic factors, personality, and a positive patient attitude toward the services, patient use of telemental health services was associated with a positive provider attitude toward using the services and higher provider skills for using the services, which underscores the need for provider support and training in telemental health care. Furthermore, avoiding stigmatization and higher convenience of the services were associated with patient use, which highlights the substantial potential of the services to address current mental health care challenges.

PMID:40513010 | DOI:10.2196/70925

J Med Internet Res. 2025 Jun 13;27:e72260. doi: 10.2196/72260.

ABSTRACT

BACKGROUND: The exponential growth of digital technologies and the ubiquity of social media platforms have led to unprecedented mental health challenges among college students, highlighting the critical need for effective intervention approaches.

OBJECTIVE: This study aimed to explore the relationship between meeting the 24-hour movement guidelines (24-HMG) health behavior combinations and the risk of social network addiction (SNA) as well as mental health issues among university students. It further sought to compare differences in mental health indicators and SNA levels across various risk groups and adherence patterns, and to identify the optimal 24-HMG health behavior intervention strategies for students at high risk of SNA.

METHODS: This cross-sectional study recruited a total of 12,541 university students from the university town of Guizhou Province as participants. Data were collected through standardized questionnaires, including the Chinese version of Social Network Addiction Scale for College Students (SNAS-C), the adult attention-deficit/hyperactivity disorder (ADHD) self-report scale (ASRS), and the Chinese version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Self-Report Level 1 Cross-Cutting Symptom Measure for Adults (DSM-5 CCSM), among others. The primary analytical method used was the random forest model, which was used to explore the relationship between different 24-HMG behavior combinations and mental health variables among student at high-risk of SNA. In addition, the study aimed to identify the optimal 24-HMG health behavior intervention strategies for this high-risk group.

RESULTS: Participants in the meeting none group exhibited the highest SNA scores (57.98), which declined progressively with greater adherence. Among single-guideline groups, meeting physical activity (PA; 53.07) and meeting sedentary time (ST; 52.72) showed similar scores. Further reductions were seen in meeting PA+ST (49.68), meeting sleep (48.44), and meeting ST+sleep (44.75), with the lowest in meeting PA+ST+sleep. Approximately 6% of the variance in SNA was attributable to differences in adherence patterns (η²=0.06). Students meeting all three 24-HMG components-PA, sleep, and ST-demonstrated the strongest protection against attention deficit, depression, and anxiety. All 24-HMG behaviors were inversely associated with mental health symptoms, except academic satisfaction, which was positively correlated. Random forest modeling identified meeting sleep+ST as the most impactful for mania (0.4491), sleep disturbance (0.4032), personality (0.3924), and dissociation (0.3832). Meeting ST alone showed the strongest effects on substance (0.6176) and alcohol use (0.6597). Depression was influenced by meeting sleep+ST (0.2053), meeting PA+ST+sleep (0.1650), and meeting PA+ST (0.1634). The model achieved high accuracy for ASRS (0.912; F1-score=0.927), with robust predictions for substance use (F1-score=0.873) and mania (F1-score=0.836).

CONCLUSIONS: Adherence to the health behaviors recommended by the 24-HMG can significantly improve the mental health outcomes of university students at high risk for SNA. The findings of this study support the development of mental health intervention strategies for students at high-risk of SNA based on the 24-HMG framework.

PMID:40512996 | DOI:10.2196/72260

JMIR Med Inform. 2025 Jun 13;13:e72238. doi: 10.2196/72238.

ABSTRACT

BACKGROUND: Insulin resistance (IR), a precursor to type 2 diabetes and a major risk factor for various chronic diseases, is becoming increasingly prevalent in China due to population aging and unhealthy lifestyles. Current methods like the gold-standard hyperinsulinemic-euglycemic clamp has limitations in practical application. The development of more convenient and efficient methods to predict and manage IR in nondiabetic populations will have prevention and control value.

OBJECTIVE: This study aimed to develop and validate a machine learning prediction model for IR in a nondiabetic population, using low-cost diagnostic indicators and questionnaire surveys.

METHODS: A cross-sectional study was conducted for model development, and a retrospective cohort study was used for validation. Data from 17,287 adults with normal fasting blood glucose who underwent physical exams and completed surveys at the Health Management Center of Xiangya Third Hospital, Central South University, from January 2018 to August 2022, were analyzed. IR was assessed using the Homeostasis Model Assessment (HOMA-IR) method. The dataset was split into 80% (13,128/16,411) training and 20% (32,83/16,411) testing. A total of 5 machine learning algorithms, namely random forest, Light Gradient Boosting Machine (LightGBM), Extreme Gradient Boosting, Gradient Boosting Machine, and CatBoost were used. Model optimization included resampling, feature selection, and hyperparameter tuning. Performance was evaluated using F1-score, accuracy, sensitivity, specificity, area under the curve (AUC), and Kappa value. Shapley Additive Explanations analysis was used to assess feature importance. For clinical implication investigation, a different retrospective cohort of 20,369 nondiabetic participants (from the Xiangya Third Hospital database between January 2017 and January 2019) was used for time-to-event analysis with Kaplan-Meier survival curves.

RESULTS: Data from 16,411 nondiabetic individuals were analyzed. We randomly selected 13,128 participants for the training group, and 3283 participants for the validation group. The final model included 34 lifestyle-related questionnaire features and 17 biochemical markers. In the validation group, their AUC were all greater than 0.90. In the test group, all AUC were also greater than 0.80. The LightGBM model showed the best IR prediction performance with an accuracy of 0.7542, sensitivity of 0.6639, specificity of 0.7642, F1-score of 0.6748, Kappa value of 0.3741, and AUC of 0.8456. Top 10 features included BMI, fasting blood glucose, high-density lipoprotein cholesterol, triglycerides, creatinine, alanine aminotransferase, sex, total bilirubin, age, and albumin/globulin ratio. In the validation queue, all participants were separated into the high-risk IR group and the low-risk IR group according to the LightGBM algorithm. Out of 5101 high-risk IR participants, 235 (4.6%) developed diabetes, while 137 (0.9%) of 15,268 low-risk IR participants did. This resulted in a hazard ratio of 5.1, indicating a significantly higher risk for the high-risk IR group.

CONCLUSIONS: By leveraging low-cost laboratory indicators and questionnaire data, the LightGBM model effectively predicts IR status in nondiabetic individuals, aiding in large-scale IR screening and diabetes prevention, and it may potentially become an efficient and practical tool for insulin sensitivity assessment in these settings.

PMID:40512995 | DOI:10.2196/72238

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251340818. doi: 10.1177/21501319251340818. Epub 2025 Jun 13.

ABSTRACT

INTRODUCTION/OBJECTIVES: Stable housing is a well-recognized health-related social need (HRSN) with little attention in medical training. This study examined the efficacy of a resident housing curriculum on referrals to a Community Health Worker (CHW) intervention to assist patients with unmet housing needs.

METHODS: This was a retrospective cohort study conducted on Internal Medicine residents at a large urban residency program in Bronx, NY. We utilized multivariate mixed-effects logistic regression to determine whether clinician curriculum exposure increased CHW referrals among patients who self-reported housing needs in a HRSN screening tool between July 2021 and August 2024.

RESULTS: Nine hundred six unique patients screened positive for unmet housing needs, and 303 (33.4%) patients were referred to CHWs by eligible clinicians (n = 118). Clinician exposure to the curriculum was not a significant predictor of CHW referrals (aOR = 1.03, 95% CI = 0.69-1.54), adjusting for covariates. Patient age (aOR = 0.98, 95% CI = 0.97-0.99), Spanish language (aOR = 1.65, 95% CI = 1.09-2.51), and Medicaid coverage (aOR = 1.61, 95% CI = 1.03-2.51) were associated with likelihood of referral.

CONCLUSIONS: Our findings demonstrate that the curriculum did not increase CHW referrals. Multimodal educational and systemic interventions that support the use of existing workflows may be needed to increase uptake of interventions to address HRSNs.

PMID:40512994 | DOI:10.1177/21501319251340818

Womens Health (Lond). 2025 Jan-Dec;21:17455057251347079. doi: 10.1177/17455057251347079. Epub 2025 Jun 13.

ABSTRACT

BACKGROUND: Overactive bladder and urinary incontinence are strongly associated with falling in older adults. Despite this established link, research on how women experience these coexisting conditions is lacking.

OBJECTIVE: This study aimed to better understand how older women with both urgency urinary incontinence and an increased risk of falls perceive their urinary symptoms in relation to fall risk.

DESIGN: Mixed-methods study using concurrent triangulation design with qualitative interviews and quantitative patient-reported outcome measures.

METHODS: English-speaking women aged 60 and older with urgency or mixed urinary incontinence who screened positive for fall risk were recruited through online advertising. Fall risk was assessed using the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries “3 Key Questions.” Semistructured interviews explored participants’ perspectives on urinary symptoms, fall risk, and quality of life. Standardized measures included the Falls Efficacy Scale International, PROMIS Physical Function, The International Consultation on Incontinence Modular Questionnaire – Overactive Bladder symptom severity scale, The International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract Symptoms Quality of Life Module, and Functional Comorbidity Index. Thematic analysis of interview transcripts was conducted using constant comparison. Multiple regression models examined associations between fear of falling, symptom severity, physical function, and urinary incontinence-related quality of life.

RESULTS: Sixty women responded to the online advertising for the study and completed the initial screening questionnaire. Twenty-five were enrolled and interviewed. Mean age was 68 ± 4.7. None were aware of linkages between urinary incontinence and falls. Their concerns about falling were unique to the experience of living with a urinary condition and often interacted with social stigma such as embarrassment from incontinence after a fall. Fear of falling was more strongly associated with urinary incontinence-related quality of life than symptom severity, physical functioning, or comorbid burden after adjusting for age (p < 0.01). Fear of falling and symptom severity were the only factors significantly associated with urinary incontinence-related quality of life in regression models.

CONCLUSION: There is a need to better communicate to older women with urinary incontinence the known risk of falling associated with their urinary condition.

PMID:40512992 | DOI:10.1177/17455057251347079

Transl Behav Med. 2025 Jan 16;15(1):ibaf026. doi: 10.1093/tbm/ibaf026.

ABSTRACT

Physical activity and nutrition programs improve children’s health. However, cost and competition for resources between programs are common implementation challenges. Currently, no guidance exists for practitioners about how to spend money within various programs. This study examines spending patterns of schools that concurrently delivered multiple programs to help provide spending guidance. Middle schools (n = 8; 75% rural) that participated in the Healthy School Recognized Campus (HSRC) initiative were provided $3500. To achieve HSRC recognition, schools complete a school-wide walking program, a physical activity or nutrition program for students, and a physical activity or nutrition program for adults (teachers and parents). We tracked purchases, grouped receipts by categories and program, and analyzed spending using descriptive statistics. On average, schools spent $3383.26 ± $159.27. For both adult and teacher incentives, over half of the schools spent $0. Program equipment ($1145.14 ± $1139.10; e.g. cooking equipment and hydroponics kit) was the largest category of spending, followed by student incentives ($945.04 ± $946.62). Schools purchased 5031 items (628.88 ± 926.50 items/school) categorized as small student incentives (e.g. water bottles and gift cards), averaging $1.04 each, and 12 items (1.5 ± 2.78 items/school) on large student incentives (e.g. bike) averaging $124.72 each. On average schools completed 2.88 ± 0.83 (range 2-4) youth programs and 1.50 ± 0.93 (range 0-2) adult programs, which cost around $300-$1500 and $0-$700 per program, respectively. Schools spent almost all the money allocated for HSRC and made strategic spending decisions to maximize student engagement, specifically prioritizing student programs over adult ones. This information about how schools spend their money offers insights for decision-making in future programs.

PMID:40512531 | DOI:10.1093/tbm/ibaf026