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JMIR Preprints
A preprint server for pre-publication/pre-peer-review preprints intended for community review as well as ahead-of-print (accepted) manuscripts
Background: Regular physical activity is a crucial and an important modifiable lifestyle factor reducing the risk of recurrent incidents after stroke or transient ischemic attack (TIA). Mobile Health (mHealth) has emerged as a promising approach for providing long-term support for physical activity. However, little is known about how individuals post-stroke or TIA adhere to and engage with mHealth interventions. Objective: This study aimed to: (1) describe adherence to supervised sessions in an mHealth intervention targeting physical activity, (2) describe engagement with self-managed mHealth support for physical activity during and after the intervention, (3) compare characteristics of participants with high and low adherence and engagement, and (4) examine whether high adherence and engagement were associated with maintained physical activity after having completed the intervention and at a 12-month follow-up. Methods: In this study, a secondary analysis of data from the experimental arm of a feasibility randomized controlled trial was conducted. The experimental group received a 6-month mHealth version of the i-REBOUND program, which included supervised mHealth support for physical activity and behavior change, followed by a 6-month post-intervention period with access to self-managed mHealth support. Adherence outcomes included attendance at supervised exercise and counseling sessions, while engagement outcomes measured weekly interactions with self-managed mHealth support during and after the intervention. Participants’ level of physical activity (steps per day) was measured using accelerometers at baseline, and at 6- and 12 months post-baseline. Logistic regression analysis examined the associations between high adherence and engagement during the intervention and post-intervention period and maintained physical activity (i.e. >7000 steps/day) across the 12-month study period. Results: Of the 57 participants enrolled (67% female, average age 71), 96% had mild stroke symptoms, and 51 (89%) completed the intervention. Adherence to supervised mHealth support was high (supervised exercise sessions: 79%, counseling: 98%), while engagement with self-managed mHealth support was high during the intervention (83%) but declined post-intervention (38%). A larger proportion of females (77%) demonstrated high adherence to the intervention compared to males (23%, P = .043). High adherence (≥80%) during the intervention was associated with maintained physical activity between baseline and the 6-months follow-up (odds ratio: 5.50, P = .015), while high engagement (≥80%) during post-intervention was associated with maintained physical activity between the 6- and 12 month follow-up (odds ratio: 4.12, P = .043). Conclusions: Supervised mHealth support was well received with high adherence, while modules for self-management of physical activity faced challenges in engaging the participants. Future research should focus on co-creating self-managed mHealth support with individuals post-stroke or TIA to better understand and address their needs of support for long-term engagement in physical activity. Clinical Trial: ClinicalTrials: NCT0511195
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Background: Regular physical activity is a crucial and an important modifiable lifestyle factor reducing the risk of recurrent incidents after stroke or transient ischemic attack (TIA). Mobile Health...
Background: Regular physical activity is a crucial and an important modifiable lifestyle factor reducing the risk of recurrent incidents after stroke or transient ischemic attack (TIA). Mobile Health (mHealth) has emerged as a promising approach for providing long-term support for physical activity. However, little is known about how individuals post-stroke or TIA adhere to and engage with mHealth interventions. Objective: This study aimed to: (1) describe adherence to supervised sessions in an mHealth intervention targeting physical activity, (2) describe engagement with self-managed mHealth support for physical activity during and after the intervention, (3) compare characteristics of participants with high and low adherence and engagement, and (4) examine whether high adherence and engagement were associated with maintained physical activity after having completed the intervention and at a 12-month follow-up. Methods: In this study, a secondary analysis of data from the experimental arm of a feasibility randomized controlled trial was conducted. The experimental group received a 6-month mHealth version of the i-REBOUND program, which included supervised mHealth support for physical activity and behavior change, followed by a 6-month post-intervention period with access to self-managed mHealth support. Adherence outcomes included attendance at supervised exercise and counseling sessions, while engagement outcomes measured weekly interactions with self-managed mHealth support during and after the intervention. Participants’ level of physical activity (steps per day) was measured using accelerometers at baseline, and at 6- and 12 months post-baseline. Logistic regression analysis examined the associations between high adherence and engagement during the intervention and post-intervention period and maintained physical activity (i.e. >7000 steps/day) across the 12-month study period. Results: Of the 57 participants enrolled (67% female, average age 71), 96% had mild stroke symptoms, and 51 (89%) completed the intervention. Adherence to supervised mHealth support was high (supervised exercise sessions: 79%, counseling: 98%), while engagement with self-managed mHealth support was high during the intervention (83%) but declined post-intervention (38%). A larger proportion of females (77%) demonstrated high adherence to the intervention compared to males (23%, P = .043). High adherence (≥80%) during the intervention was associated with maintained physical activity between baseline and the 6-months follow-up (odds ratio: 5.50, P = .015), while high engagement (≥80%) during post-intervention was associated with maintained physical activity between the 6- and 12 month follow-up (odds ratio: 4.12, P = .043). Conclusions: Supervised mHealth support was well received with high adherence, while modules for self-management of physical activity faced challenges in engaging the participants. Future research should focus on co-creating self-managed mHealth support with individuals post-stroke or TIA to better understand and address their needs of support for long-term engagement in physical activity. Clinical Trial: ClinicalTrials: NCT0511195
Background: Transgender and gender diverse (TGD) individuals often turn to online platforms for information about gender-affirming healthcare. YouTube, a widely used video-sharing platform, hosts cont...
Background: Transgender and gender diverse (TGD) individuals often turn to online platforms for information about gender-affirming healthcare. YouTube, a widely used video-sharing platform, hosts content from popular TGD creators that may serve as an educational resource. Objective: This study aims to describe the health-related content posted by popular TGD content creators on YouTube. Methods: A qualitative content analysis was performed on 2,485 videos produced by 42 self-identified TGD YouTube content creators from January 2023 to February 2024. Videos were systematically evaluated for mentions of gender-affirming care and other health-related topics. We also examined how creators framed medical information and characterized their medical experiences. Results: Most videos (n = 1,724) created by TGD content creators did not include discussions related to gender identity or transitioning. However, among the videos that did address gender identity (n = 761), mentions of medical topics were prevalent (n = 554). Hormone replacement therapy (n = 356) and surgeries (n = 307) were the most frequently discussed topics. Videos covering medical topics primarily centered on personal experiences (n = 411), with content creators often characterizing these experiences positively (n = 224). Conclusions: This study provides insights into the medical information shared by TGD content creators on YouTube, highlighting the types of content that TGD individuals may encounter on the platform. These findings can help clinicians better understand the sources of information their TGD clients are likely to be using, fostering more informed and supportive conversations about gender-affirming care.
Background: Background: Given the necessity of effective communication of healthcare providers, especially doctors, and nurses, with patients and the existence of many challenges in providing effectiv...
Background: Background: Given the necessity of effective communication of healthcare providers, especially doctors, and nurses, with patients and the existence of many challenges in providing effective healthcare services, the present study aimed to identify healthcare provider-patient communication challenges and the facilitating and inhibiting factors underlying such communication using a scoping review protocol. Objective: Objectives: This scoping review protocol aims to systematically map existing evidence on HCP-patient communication challenges, with particular focus on identifying: (1) key barriers to effective communication, (2) facilitating factors that enhance interactions, and (3) critical gaps in current research. Methods: Materials & Methods: This study was conducted following the JBI method for scoping reviews, which focuses on studies that have addressed the relationship between healthcare providers (doctors, nurses, clinical specialists) and patients. The search strategy was applied in two PubMed and Embase databases including studies published since 2000 in English and Persian, without restrictions on the type of publication or study design. The participants in the studies were patients as well as healthcare providers and health professionals who had direct contact with patients. Results: Significance: The findings will provide valuable insights for healthcare policymakers, educators, and practitioners seeking to improve communication practices and enhance the quality of patient care. Conclusions: Ethics of data publication: As a scoping review seeks to merge information from publicly available publications, this study does not require ethical approval. The findings from this study may be relevant to health policymakers who are interested in planning to improve the quality of healthcare services.
The European Health Data Space (EHDS) aspires to enable secure, interoperable, and decentralized health data usage across Europe. This paper explores legal and technical challenges in implementing EHD...
The European Health Data Space (EHDS) aspires to enable secure, interoperable, and decentralized health data usage across Europe. This paper explores legal and technical challenges in implementing EHDS goals, particularly for secondary data use. It highlights federated and swarm learning as promising yet complex solutions, requiring robust infrastructure, standardization, and regulatory clarity. We emphasize the need for coordinated legislative and technological advances to realize EHDS ambitions.
Background: Mobile apps that implement disorder-specific psychotherapy for panic disorder with and without agoraphobia (PD/A) can be used in real-life situations that trigger symptoms and, therefore,...
Background: Mobile apps that implement disorder-specific psychotherapy for panic disorder with and without agoraphobia (PD/A) can be used in real-life situations that trigger symptoms and, therefore, are a promising novel therapeutic tool. Objective: This RCT aims to expand the currently limited evidence base for the efficacy of mobile interventions for PD/A by evaluating a mobile app focusing on interoceptive and in-vivo exposure therapy. Methods: After establishing the diagnosis of PD/A using a secure video communication platform, we randomized 111 adults to three equally sized groups: PD/A-specific exposure therapy app; mindfulness meditation app unrelated to the disorder (active control condition); and waiting list (passive control condition). Participants used the apps self-guided. Additional psychotherapy was not allowed during the study. Self-reported PD/A symptom severity was our primary outcome parameter and measured by the Panic and Agoraphobia Scale (PAS) and symptom subset scales. Secondary outcome parameters included depressive symptoms and quality of life (QoL). We conducted assessments at baseline, after the intervention (allocation + 5 weeks), and at follow-up (allocation + 13 weeks). Results: We observed significantly lower overall PD/A symptom severity in the exposure app group compared to waiting list post-treatment (P = .04, Cohen's d = 0.55) and at follow-up (P = .04, d = 0.60). At follow-up, the exposure app group demonstrated significantly stronger improvements than the waiting list group in depressive symptoms (P =.007, d = 0.75) and psychological QoL (P = .01, d = 0.63). We observed no significant differences between the exposure and the meditation apps. In the exposure app group, 35 % of participants showed reliable improvement in overall PD/A symptom severity at post-treatment (meditation app: 6 %, waiting list 7 %). The dropout rate after five weeks was 14 % in the exposure app group (meditation app: 8 %, waiting list 16 %). No adverse outcomes were reported in the exposure app group. Conclusions: Our findings suggest that app-guided exposure therapy can be a useful further treatment option in addition to established psychological and pharmacological strategies. However, superiority compared to the disorder-unspecific meditation app remains unclear. Clinical Trial: German Clinical Trials Register (DRKS00022204)
Background: Older adults with sarcopenia often engage in therapeutic exercises to improve muscle thickness, balance confidence, activities of daily living (ADL), and quality of life (QOL). However, co...
Background: Older adults with sarcopenia often engage in therapeutic exercises to improve muscle thickness, balance confidence, activities of daily living (ADL), and quality of life (QOL). However, conventional face-to-face group exercise programs are typically standardizThis study aimed to evaluate the effects of a Mixed Reality–based Physical Therapy platform (Mr.PT) compared with Conventional Physical Activity (CPA) programs on quadriceps muscle thickness, balance confidence, independence in ADLs, and quality of life in older adults with sarcopenia.ed and may not adequately address individual needs, limiting their effectiveness. Objective: This study aimed to evaluate the effects of a Mixed Reality–based Physical Therapy platform (Mr.PT) compared with Conventional Physical Activity (CPA) programs on quadriceps muscle thickness, balance confidence, independence in ADLs, and quality of life in older adults with sarcopenia. Methods: In this preliminary randomized controlled trial, 30 older adults with sarcopenia were randomly assigned to either the Mr.PT group or the CPA group. Both groups participated in 30-minute sessions, five times per week, for four weeks. Primary outcomes included quadriceps muscle thickness. Secondary outcomes included the Activities-specific Balance Confidence (ABC) Scale, Katz Index of Independence in Activities of Daily Living (KIADL), and the 12-Item Short-Form Survey (SF-12). Outcomes were assessed at baseline and after the intervention. Analysis of variance (ANOVA) was used to assess time and group differences. Results: ANOVA demonstrated significant time effects on muscle thickness, ABC scores, KIADL scores, and SF-12 scores (p < 0.05). Post hoc analyses revealed that participants in the Mr.PT group achieved greater improvements in quadriceps This preliminary study suggests that a Mixed Reality–based physical therapy platform may offer enhanced benefits for improving muscle thickness and quality of life among older adults with sarcopenia. Further large-scale trials are warranted to confirm these findings and to optimize intervention protocols.muscle thickness and SF-12 scores compared to the CPA group. Conclusions: This preliminary study suggests that a Mixed Reality–based physical therapy platform may offer enhanced benefits for improving muscle thickness and quality of life among older adults with sarcopenia. Further large-scale trials are warranted to confirm these findings and to optimize intervention protocols. Clinical Trial: KCT0010241
Background: Growing evidence indicates that around half of all adolescents and young adults living with Human Immunodeficiency Virus (AYALWHIV) experience mental health difficulties in Africa. Despite...
Background: Growing evidence indicates that around half of all adolescents and young adults living with Human Immunodeficiency Virus (AYALWHIV) experience mental health difficulties in Africa. Despite this, less than 1% of AYALWHIV receive mental health screening as part of routine care in resource-limited settings. Little is known about the determinants of mental health in this population. Objective: The overall objective of this study is to address this mental health gap in this vulnerable population by investigating the feasibility, acceptability and adoptability of a self-administered m-health-based mental health screening tool among Kenyan AYALWHIV. We will also investigate the psycho-social determinants of mental illnesses and resulting virological outcomes. Methods: This study proposes to use a mixed methods design. We will enroll AYALWHIV aged 15-24 years from eight urban HIV clinics in Nairobi Kenya. We will collect socio-demographic, psycho-social, and viral suppression data from chart abstraction and semi-structured interviews at enrollment. We will use a ready-for-use m-health Open Data Kit (ODK) based self-administered tool that consists of four mental health and substance use screening tools to measure the prevalence and severity of General Anxiety Disorder, Depressive illness, Post-Traumatic Stress Disorder, and substance use. We will assess acceptance of the m-health tool using a brief questionnaire. In-depth interviews will be used to investigate individual-level factors that influence acceptance by AYALWHIV of the self-administered m-health tool and its integration within routine HIV care, and to identify health system barriers and facilitators towards the integration of a digital mental health screening approach as perceived by health care workers. Results: We hypothesize a high level of acceptability of the m-health mental health screening intervention and a high prevalence of mental health difficulties linked to psycho-social factors in this population. Conclusions: We anticipate this study will generate evidence on the rapid, scale-up and sustainable implementation of the tool and illuminate organizational, health care provider, policy maker and intervention-related barriers and facilitators to adoptability. If the intervention is found to be acceptable and feasible, the clinical implication would be to increase the use of the m-health screening tool in routine HIV care among AYALWHIV in Kenya. Clinical Trial: n/a for a cross-sectional study
Background: Helicobacter pylori commonly colonizes the mucus in the stomach and can lead to peptic ulcer disease and chronic gastritis. Toxins, such as cytotoxin-associated genes, are the primary viru...
Background: Helicobacter pylori commonly colonizes the mucus in the stomach and can lead to peptic ulcer disease and chronic gastritis. Toxins, such as cytotoxin-associated genes, are the primary virulence factors of this bacteria., Artemisia annua extract has shown a variety of biological activity on Gram-negative bacteria. Objective: Helicobacter pylori is a gram-negative, spiral-shaped microaerophilic bacterium. About half of the world's population is infected with it , which is a major source of illness and mortality and a burden on health care systems throughout the globe. A variety of antibiotics and stomach acid inhibitors are needed for the complex treatment of H. pylori eradication, which frequently results in side effects such as nausea, drug resistance, and recurrence. Because of their wide range of applications and little toxicity, natural chemicals are becoming more and more popular Methods: The in vitro effectiveness of Artemisia annua against H. pylori was examined using the broth microdilution and agar diffusion techniques. Results: The different concentrations of A. annua used in this study inhibited the growth of H. pylori more effectively than control positive ampicillin. Conclusions: These results indicate that the use of different concentrations of A. annua extract was significantly more efficient against H. pylori. Molecular technique was used to detect the nucleic acid cagA gene, which is responsible for peptic ulcers.
Background: Transition to adult healthcare for young people and young adults (YP/YA) with Type 1 Diabetes Mellitus (T1DM) starts around 11 years-of-age, but transition services may not always meet the...
Background: Transition to adult healthcare for young people and young adults (YP/YA) with Type 1 Diabetes Mellitus (T1DM) starts around 11 years-of-age, but transition services may not always meet their needs. Post-transition many YAs are reluctant to request diabetes self-management support, this can lead to increased anxiety and deterioration in diabetes control and quality of life. Chatbots increasingly offer social support in daily life so could also provide diabetes self-management support, but there is a lack of co-developed, evidence-based, developmentally appropriate chatbots. Therefore, the DigiBete Chatbot, the first user-led, clinically approved transition chatbot for YP/YA with T1DM was recently developed Objective: Study objectives were to (1) evaluate the DigiBete Chatbot in four English diabetes services for YP/YA, and (2) assess the feasibility of a future full trial of the chatbot Methods: YP/YA received password-protected access to the chatbot and were encouraged to use it ad libitum. YP/YA completed web-based questionnaires (the Mobile App. Rating Scale (MARS), the Hospital Anxiety and Depression Scale (HADS), the Short-Form 36 (SF36), and the System Usability Scale (SUS) at baseline, 2-weeks and 6-weeks to evaluate quality of life, anxiety and depression and chatbot usability and acceptability. After 6-weeks, YP/YA and parents participated in individual qualitative interviews to ascertain their views on the chatbot’s design, content and usability. Parents also discussed the chatbot’s potential to enable their child to become autonomous in T1DM self-management. Healthcare professionals (HCPs) participated in focus groups to determine their views on the chatbot and their perceived role in supporting its use if it became standard practice. Data were analyzed using descriptive statistics and Framework Analysis Results: Eighteen YP/YA enrolled. YP/YAs' SUS and uMARS scores demonstrated improvement from baseline to the second timepoint in perceived ease of use, functionality and confidence, and most viewed the chatbot as highly usable with over 50 percent finding it easy to navigate. Some modifications were recommended to increase accessibility. HADS anxiety scores were higher than the depression scores and overall, there was no significant change across the 3 time points for all SF36 domains. Four parents, 24 HCPs and 12/18 YP/YA completed qualitative interviews. Questionnaire uptake/outputs and the emergent qualitative themes: Living with T1DM, Using the Chatbot and Refining the Chatbot, indicated that the study measures are feasible to use, the chatbot is acceptable and functional, and with refinements incorporating our results, could beneficially support YP/YA during transition. Users scored the chatbot as ‘good’ to ‘excellent’ for being engaging, informative and aesthetically pleasing, and would use it again. Conclusions: Study results specify minor refinement of the chatbot and further investigation in a full cohort study prior to it's wider clinical use. Our research design and methodology could also be transferred to the development, evaluation and use of chatbots for other chronic conditions. Clinical Trial: Not relevant
Background: Electronic Health Records (EHRs), including datasets like MIMIC-IV, often lack explicit links between medications and diagnoses, complicating clinical decision-making and research efforts....
Background: Electronic Health Records (EHRs), including datasets like MIMIC-IV, often lack explicit links between medications and diagnoses, complicating clinical decision-making and research efforts. Even when such links are present, diagnosis lists can be incomplete or inaccurate, particularly during early patient visits when diagnostic uncertainty is high. Discharged summaries, documented at the end of patient care, may offer more detailed explanations of patient visits, potentially aiding in inferring the most likely accurate diagnoses for prescribed medications, especially if we can exploit Large Language Models (LLMs). LLMs have shown promise in processing unstructured medical text, but systematic evaluations are necessary to determine their effectiveness in extracting meaningful medication-diagnosis relationships. Objective: This study explores the use of LLMs to predict implicitly mentioned diagnoses from clinical notes and link them to corresponding medications. We evaluate their effectiveness and investigate strategies to improve prediction performance. Specifically, we examine two research questions: (1) Does majority voting across diverse LLM configurations enhance diagnostic prediction accuracy compared to the best single-model configuration? (2) How sensitive is the diagnostic prediction accuracy of majority voting to the LLM's hyperparameters, including temperature, top-p, and clinical note summary length? Methods: A new dataset of 240 expert-annotated medication-diagnosis pairs from 20 MIMIC-IV clinical notes was created to evaluate predictive accuracy, as no such dataset previously existed. We hypothesized that combining deterministic, balanced, and exploratory configurations could enhance prediction performance. Key hyperparameters—temperature, top-p, and summary length—were systematically varied. Two levels of summarization, short and long, were tested to assess context length impact. Using GPT-3.5 Turbo, 18 configurations were generated, and random subsets of five were selected, resulting in 8,568 test cases. Majority voting was applied to select the most frequent diagnosis. Performance was evaluated using accuracy scores, comparing majority voting with the best single-model configuration and analyzing hyperparameters contributing to the highest accuracy. Results: The majority voting achieved 75% accuracy, outperforming the best single configuration (66%). No single parameter setting consistently excelled; instead, combining diverse configurations aligned with deterministic, balanced, and exploratory strategies yielded better performance. Shorter summaries (2000 tokens) generally improved accuracy. Longer summaries (4000 tokens) were effective only with deterministic settings. Conclusions: Majority voting across LLM configurations enhances diagnostic prediction accuracy in EHRs, demonstrating the potential of ensemble methods for improving medication-diagnosis associations. By leveraging diverse configurations, this approach mitigates model biases and improves robustness in predictive analytics. Future work should explore scalability with larger datasets, additional LLM architectures, and broader clinical applications to refine its effectiveness in real-world settings.
Background: Across populations, risky drinking has been demonstrated to increase HIV risk behaviors. This is of special concern for sexually minoritized cisgender men and transgender (SMMT) young adul...
Background: Across populations, risky drinking has been demonstrated to increase HIV risk behaviors. This is of special concern for sexually minoritized cisgender men and transgender (SMMT) young adults (aged 18-34), who report greater incidence of hazardous drinking (as defined by AUDIT-C criteria) and HIV compared to their heterosexual and/or cisgender peers. Objective: This study examined alcohol perceptions, patterns of use, and the role that anti-LGBTQ+ (lesbian, gay, bisexual, transgender, queer) policies and discrimination played in alcohol risk behaviors for SMMT individuals. Results were used to inform development of an alcohol reduction intervention for this population. Methods: A qualitative study was conducted with data collected via four focus groups and one in-depth interview among young adult SMMT individuals in the United States from April-June 2023 (n=22). Participants were grouped according to SMMT identity: cisgender men, transgender men, transgender women, and nonbinary individuals. Transcripts were analyzed using codebook thematic analysis. Results: Alcohol use was described as a way to navigate belonging, social connection, and identity expression within LGBTQ+ contexts. Alcohol was viewed as a mainstay of LGBTQ+ spaces, with many using it as a social lubricant and coping mechanism for LGBTQ+ related stress, as well as for relaxation and having fun. Drinking intensity was often tied to an individual’s comfort with their evolving SMMT identity, with drinking being higher in earlier stages of exploration. The consequences of drinking discussed by participants included impaired decision-making and negative effects on mental and physical health. Anti-LGBTQ+ laws and policies were seen as contributing to the further stigmatization of SMMT individuals and hazardous use of alcohol was used as a means of escape and coping. Conclusions: Alcohol use among SMMT is an important aspect of negotiating identity within different social settings and coping with stigma. Findings have valuable implications for tailoring alcohol reduction interventions for SMMT young adults as they encounter stressors in real-time.
Background: Health information exchange (HIE) supports clinical decision-making in emergency medicine settings. Despite evidence and policies that encourage adoption of HIE, usage by clinicians is lim...
Background: Health information exchange (HIE) supports clinical decision-making in emergency medicine settings. Despite evidence and policies that encourage adoption of HIE, usage by clinicians is limited. Moreover, few studies examine usage of HIE years after adoption by hospitals or clinics. Objective: To examine perceptions and usage of a mature, operational HIE system by emergency department (ED) clinicians years after its implementation. Methods: We interviewed 21 clinicians in various roles (e.g., attending physician, nurse practitioner) across multiple health systems that participate in a statewide HIE network. We asked questions about their use of the HIE system and the factors that facilitate or inhibit use. Analysis of interview transcripts was guided by a theoretical framework derived from information systems theories describing individual perception of and usage behavior towards HIE systems. Results: A total of 26 factors across 6 domains were identified by respondents. All respondents recognized the value of HIE for medical decision-making in the ED, and access to information via the HIE was preferred over traditional methods of calling other facilities or waiting for faxed records. Ease of use, particularly single sign on (SSO) functionality, was recognized as a key facilitator to routine use, enabling clinician access via a single click from their EHR directly into the patient’s HIE record. Access to integrated data and advanced search features supported clinical decision-making. Limited training and poor system usability were identified as barriers to use. Conclusions: Achieving widespread adoption and use of HIE systems globally will require a focused effort to address multiple individual perception and behavioral factors. Researchers, HIE organizational leaders, and policymakers alike should leverage these factors to achieve the goals of HIE and interoperability. Clinical Trial: N/A
Background: Vaccine hesitancy hinders the management of preventable illnesses. Currently, there are gaps in public health research on vaccine hesitancy among Muslim-Americans. Objective: We aimed to u...
Background: Vaccine hesitancy hinders the management of preventable illnesses. Currently, there are gaps in public health research on vaccine hesitancy among Muslim-Americans. Objective: We aimed to understand the extent of vaccine hesitancy among American-Muslims, and the factors for health care decision making regarding vaccination. Methods: Participants were recruited through Facebook group posts. Seventy-three participants completed the online Qualtrics survey. Sixty-three participants met the inclusion criteria. Participants’ responses were collapsed into the following belief scores: political leaning, religiosity, trust in public institutions, and vaccine hesitancy. Results: Participants who were older in age, had attained higher levels of education, employed, unmarried, and identified with the Sunni sect were less vaccine hesitant. Most participants (36.5%) were more likely to accept a vaccine if it had no reported safety issues. Participants were more likely to be hesitant about vaccines with safety concerns or poor efficacy. Conclusions: Results both align with and contradict previous studies conducted in Muslim majority and religiously heterogenous countries. This study found an association between Islamic sect and attitudes towards vaccines. Follow up studies are necessary to gauge a larger, more diverse population of Muslim-Americans. Based on this study’s findings, healthcare professionals can better promote vaccines by addressing their patient’s trust in public institutions.
Background: Heterogeneity in outcome selection and measurement methods has been noted in previous studies examining physical restraint minimization in adult intensive care units (ICUs). This variabili...
Background: Heterogeneity in outcome selection and measurement methods has been noted in previous studies examining physical restraint minimization in adult intensive care units (ICUs). This variability undermines meaningful evidence synthesis, including systematic reviews and meta-analyses, thereby limiting the development of evidence-based clinical approaches in minimizing physical restraint use and improve patient outcomes. Objective: This protocol outlines the methods for developing an international consensus on priority core outcomes, along with standardized measurement approaches for these outcomes in studies focused on minimizing physical restraint use in adult ICUs. Methods: We will follow the guidelines outlined in the Core Outcome Measures in Effectiveness Trials Handbook. At the outset, representatives from key stakeholder groups—including former ICU survivors/ family members, ICU clinicians, and researchers—are involved in designing this protocol to enhance its relevance and applicability. Drawing on our previous work, including a scoping review of studies on physical restraint minimization that we will update, and interviews with family members about restraint use and minimization in the ICU, we will compile a comprehensive list of potential outcomes for stakeholders to use in the two-round Delphi process. In the first round, stakeholders will rank the identified outcomes using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) scale. In the second round, they will be provided with a summary of the results from Round 1 for rescoring and further refinement. A series of consensus meetings using the modified nominal group technique will be held with representatives from our stakeholder groups to finalize the core outcome set, followed by another meeting to establish standardized measurement methods for the agreed-upon outcomes. Results: We are in the process of finalizing the REB application for this protocol, which will be submitted shortly. The anticipated project start date is June/July 2025, with completion expected by October 2026. Conclusions: This study will be the first to establish both a core outcome set, and a core measurement set for minimizing physical restraint use in adult ICUs. By standardizing outcomes and measurement methods, it will enhance comparability across future research and contribute to improved patient care in ICUs Clinical Trial: This protocol is registered in the Core Outcome Measurement in Effectiveness Trials (COMET) Initiative database registration: https://cometinitiative.org/Studies/Details/3368
Background: The burden of paralytic ileus (PI) in the intensive care unit (ICU) remains high, and the Charlson Comorbidity Index (CCI) is strongly associated with the prognosis of several acute and ch...
Background: The burden of paralytic ileus (PI) in the intensive care unit (ICU) remains high, and the Charlson Comorbidity Index (CCI) is strongly associated with the prognosis of several acute and chronic diseases. However, there is no literature on the clinical value of CCI as a prognostic assessment tool for critically ill patients with PI in the ICU. Objective: The aim of this study was to investigate the relationship between CCI and clinical prognosis in critically ill patients with PI. Methods: In this study, data from the Critical Care Medical Information Marketplace IV 2.2 database were used to determine the optimal cutoff value of CCI for predicting mortality in patients with PI using receiver operating characteristic (ROC) curves, and the relationship between CCI and mortality was evaluated using Cox regression and restricted cubic spline analysis. A machine learning (ML) prediction model was then constructed to predict hospital mortality by combining CCI and other clinical characteristics. Results: The study included 863 patients with PI (median age 65.4 years [interquartile range 54.6-75.5 years], 66.6% male). The ROC curve identified an optimal cut-off value of 4.5 for CCI. Multivariate Cox regression analysis showed that compared to the lowest CCI quartile, patients with elevated CCI levels were more likely to have elevated hospital (Q4: HR 2.447, 95% CI 1.210-4.951), 28-day (Q4: HR 3. 891, 95% CI 1.956-7.740) and 90-day (Q4: HR 3.994, 95% CI 2.224-7.173) all-cause mortality were significantly associated with elevated CCI levels; however, the association with ICU mortality (Q4: HR 1.892, 95% CI 0.653-5.480) was weak. Among the 11 ML models, the LightGBM model performed best, with internal validation results showing an area under the curve of 0.811, a G-mean of 0.670, and an F1 score of 0.895. Conclusions: The CCI is an important predictor of hospital, 28-day, and 90-day all-cause mortality in critically ill patients with PI, and the optimal threshold is 4.5. ML models including the CCI show high accuracy in predicting hospital mortality, and the CCI occupies an important position in the model. This suggests that the CCI helps to identify high-risk patients, supports clinical decision making, and improves prognosis. Clinical Trial: NO
Background: Feature selection is essential in machine learning (ML) for identifying relevant variables. The Boruta algorithm and the least absolute shrinkage and selection operator (LASSO) are two wid...
Background: Feature selection is essential in machine learning (ML) for identifying relevant variables. The Boruta algorithm and the least absolute shrinkage and selection operator (LASSO) are two widely used methods. Objective: This study aimed to (1) compare feature selection methods (Boruta, LASSO, their combination, principal component analysis (PCA), and non-feature selection), and (2) develop ML tools to predict cancer information seeking among U.S. adults. Methods: Data from 5505 individuals (2630 cancer information seekers and 2975 non-seekers) were selected from the 2022 Health Information National Trends Survey (HINTS 6). Four feature selection approaches and five ML tools (the support vector machines (SVMs) algorithms, logistic regression (LR), random forest (RF), k-nearest neighbor (KNN), and extreme gradient boosting (XGBoost)) were applied to develop ML models to predict cancer information seeking. Results: The cancer information seeking prevalence was 47.2% (42.8% for males and 49.7% for females). The Boruta and LASSO selected 45 and 55 variables, respectively, with 36 in common. The PCA identified 21 uncorrelated factors. RF performed best, with similar AUCs for Boruta, LASSO, and no feature selection (≈0.950) and accuracy (≈0.860). Using PCA-selected variables yielded a slightly lower AUC (0.931) but comparable accuracy (0.853). Stepwise regression confirmed 21 of 36 selected key predictors, including personal/family cancer history, health information access, education, income, social media use, smoking, alcohol beliefs, and healthcare visits. Conclusions: Feature selection effectively reduce dimensionality while retaining the predictive power. Boruta and LASSO performed comparably in terms of the selected variables. PCA-based selection uncorrelated s also proved useful. The key identified factors associated with cancer information seeking can guide future cancer intervention and prevention strategies.
With the rapid development of artificial intelligence (AI), particularly the emergence of generative AI technologies such as ChatGPT and DeepSeek-R1, their potential applications in medical education...
With the rapid development of artificial intelligence (AI), particularly the emergence of generative AI technologies such as ChatGPT and DeepSeek-R1, their potential applications in medical education are becoming increasingly evident. This paper explores the role of ChatGPT in standardized training for radiation oncology residents, examining its advantages and limitations while providing a brief comparison with the emerging AI model, DeepSeek-R1. ChatGPT serves as an auxiliary tool for licensing exam preparation, real-time knowledge retrieval, virtual clinical training, and research support. However, its application in medical education presents both opportunities and challenges, such as potential “hallucinations,” data privacy concerns, and the risk of learning dependency which necessitate careful supervision and critical evaluation. Radiation oncology residents must develop critical thinking skills to effectively utilize AI-generated content. ChatGPT and DeepSeek-R1 offer different advantages in radiation oncology training. DeepSeek-R1 excels in real-time knowledge retrieval, medical image analysis, and computational tasks, making it particularly suitable for data-driven applications such as dose calculation and imaging interpretation. In contrast, ChatGPT, with its strong theoretical foundation and natural language processing capabilities, is well-suited for theoretical education, case discussions, and communication training. This suggests that integrating different AI models, such as ChatGPT and DeepSeek-R1, can create a more balanced and effective learning system. The synergy between AI and medical education may drive transformative advancements, ultimately optimizing training programs and improving clinical competency in radiation oncology.
Background: Mobile health (mHealth) technologies, including smartphone health apps and wearable trackers, are increasingly used to promote health behaviors. However, their impact on physical and menta...
Background: Mobile health (mHealth) technologies, including smartphone health apps and wearable trackers, are increasingly used to promote health behaviors. However, their impact on physical and mental well-being remains complex, with both benefits and potential unintended negative consequences. Objective: This study aimed to examine the relationship between mHealth use (i.e., health app, wearable tracker) and two health outcomes (body mass index (BMI) and emotional distress), as well as the mediating roles of healthy eating, sleep, and physical activity based on a representative sample. Methods: We analyzed data from a nationally representative sample of U.S. adults aged 33–43 (N = 1,931). Chi-square tests and one-way ANOVA were used to compare demographic differences between mHealth users and non-users. A path model examined the relationship between mHealth use (i.e., smartphone health apps, wearable trackers) and health outcomes (i.e., BMI, emotional distress), with lifestyle factors (i.e., healthy eating, physical activity, sleep) as mediators. Mediation analyses tested indirect effects through these lifestyle factors. Results: mHealth users are more likely to be female, married, have higher levels of education and income, and have health insurance. The primary use of mHealth is the management of physical activity. The use of health apps positively correlates with the use of wearable trackers (β = .408, p < .001). Surprisingly, health app use predicts greater BMI (β = .058, p = .019). However, the use of health apps, as well as wearable trackers, predicts more healthy eating (βhealth_app = .097, p < .001; βwearable = .081, p < .001) and physical activity (βhealth_app = .125, p < .001; βwearable = .105, p < .001), both of which link to lower BMI (βhealthy_eating = -.075, p =.001; βphysical_activity = -.147, p < .001). For emotional distress, wearable tracker use directly predicts lower emotional distress (β = -.089, p < .001); a path also mediated by healthy eating (β = -.120, p <.001) and physical activity (β = -.077, p = .001). Although health app use does not predict emotional distress directly, the mediated path via healthy eating and physical activity remains significant. Notably, the use of wearable trackers, not that of health apps, connects with reduced sleep hours (β = -.077, p = .001), which in turn correlates with higher BMI (β = -.109, p < .001) and greater emotional distress (β = -.137, p < .001). Conclusions: mHealth technologies can promote healthier behaviors, but their impact depends on users taking the initiative toward sustained lifestyle changes. While wearable trackers may aid in mental well-being, their association with reduced sleep warrants further investigation.
Background: Social media platforms are increasingly used for both sharing and seeking of health-related information online. Especially TikTok has become one of the most widely used social networking p...
Background: Social media platforms are increasingly used for both sharing and seeking of health-related information online. Especially TikTok has become one of the most widely used social networking platforms over the last few years. One health-related topic trending on TikTok recently is Attention Deficit/Hyperactivity Disorder (ADHD). However, the accuracy of health-related information on TikTok remains a significant concern. Misleading information on ADHD on TikTok can increase stigmatization and lead to false “self-diagnosis”, pathologizing normal behavior and overuse of care. Objective: This study aims at investigating the occurrence of misleading information in TikTok videos about ADHD and at exploring the amount of potential self-diagnosis among viewers based on an in-depths analysis of the video comments. Methods: We scraped data from the 124 most liked ADHD-related TikTok videos uploaded between March 2022 and November 2023 using a commercial scraping software. We categorised videos based on the usefulness of their content as "misleading", "personal experience" or "useful" and used the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) to evaluate the video quality regarding understandability and actionability.
By purposive sampling we selected six videos and analyzed the content of 100 randomly selected user comments per video to understand the extent of self-identification with ADHD-behaviour among the viewers.
All qualitative analyses were carried out independently by at least two authors, disagreement was resolved by discussion. Using SPSS 27, we calculated the interrater reliability between the raters and descriptive statistics for video and creator characteristics. We used one-way ANOVA to compare the usefulness of the videos. Results: We assessed 51% of the videos as misleading, 30% as personal experience, and 19% as useful. The PEMAT-A/V scores for understandability and actionability are 79.5% and 5.1%, respectively, with the highest scores observed for useful videos (92.3% for understandability, 8.3% for actionability).
Viewers resonated with ADHD-related behaviours depicted in the videos in 36.7% and with ADHD in 5.3% of the comments. The self-attribution of behavioural patterns varied significantly, depending on the usefulness of the videos, with personal experience videos showing the most comments on self-attribution of behavioural patterns (102/600, 17% of comments, P<.001). For the self-attribution of ADHD, we found no significant difference depending on the usefulness of the videos (P=.359). Conclusions: A high proportion of ADHD-related TikTok videos are misleading and a high percentage of viewers seem to self-identify with the symptoms and behaviours presented. Self-identification is most common in videos on personal experiences, but also occurs in misleading videos, potentially increasing misdiagnosis. This highlights the need to critically evaluate health information on social media and for healthcare professionals to address misconceptions arising from these platforms.
Background: Pre-operative anxiety and the desire for information are prevalent conditions among patients undergoing surgery. Understanding the prevalence and associated factors of these psychological...
Background: Pre-operative anxiety and the desire for information are prevalent conditions among patients undergoing surgery. Understanding the prevalence and associated factors of these psychological states is essential for improving patient care and surgical outcomes. Objective: This study aimed to assess the prevalence of preoperative anxiety and the desire for information, as well as associated socio-demographic, medical, and surgical factors among elective surgery patients, in Northern state, Sudan Methods: A hospital-based, multi-center cross-sectional study was conducted over four months in Northern State, Sudan, involving patients undergoing elective surgery. Socio-demographic characteristics, medical and surgical history, pre-operative anxiety, and the desire for information were collected through face-to-face interviews using a structured questionnaire and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The data were analyzed using SPSS (version 27), where Chi-square tests, univariate logistic regression, and multivariate logistic regression were used to identify risk factors, with statistical significance set at p<.05. Results: Among the 305 participants (Response rate = 80.3%), 56.9% were male, with a median age of 43 years (IQR: 30–64 years). Most were married (67.9%), educated (81.3%), and had family support (83.0%). The majority underwent intermediate (44.6%) or major (46.6%) surgeries under general anesthesia (52.2%), and primarily in public hospitals (55.4%). Most participants lacked insurance (86.6%) and reported good sleep quality the night before surgery (72.5%). The prevalence of pre-operative anxiety was 24.6%, while 23.9% expressed an average desire for information, and 6.2% reported a high desire. Factors significantly associated with pre-operative anxiety included family support (aOR = 7.12, 95% CI: 2.64–19.23, p<.001), surgery in public hospitals (aOR = 4.31, 95% CI: 2.30–8.07, p<.001), poor sleep quality the night before surgery (aOR = 2.85, 95% CI: 1.51–5.38, p=.001), and ASA classification III and IV (aOR = 2.36, 95% CI: 1.00–5.54, p=.049). For the desire for information, significant factors included being educated (aOR = 2.48, 95% CI: 1.00–6.11, p=.049), family support (aOR = 4.10, 95% CI: 1.81–9.30, p=.001), surgery in public hospitals (aOR = 3.57, 95% CI: 1.93–6.61, p<.001), and ASA classification III and IV (aOR = 3.26, 95% CI: 1.39–7.64, p=.007). Conclusions: Pre-operative anxiety and the desire for information are prevalent among patients undergoing elective surgery. Family support, poor sleep quality, and higher ASA classification were significant predictors of pre-operative anxiety, while education, family support, and chronic diseases were associated with a higher desire for information. We recommend developing strategies and targeted interventions to address psychological and informational needs in the pre-operative period.
Background: Virtual reality (VR) is increasingly applied in rehabilitation training. Flow experience, a critical factor for enhancing user engagement and training efficacy, exhibits age-related differ...
Background: Virtual reality (VR) is increasingly applied in rehabilitation training. Flow experience, a critical factor for enhancing user engagement and training efficacy, exhibits age-related differences that are essential for designing elderly-friendly rehabilitation tasks. However, current VR rehabilitation systems often overlook age-related subjective experience disparities, leading to insufficient engagement among older adults. Objective: This study aims to explore differences in flow experience between younger and older adults during identical VR rehabilitation tasks and provide empirical evidence for designing personalized elderly rehabilitation programs. Methods: We recruited 21 older adults (mean age: 63.00 ± 6.64 years, 10 males) and 19 younger adults (mean age: 24.68 ± 1.16 years, 9 males). Participants performed the "Space Pop" task in Kinect Adventures (simulating limb coordination training) using VR. Flow experience was measured using the Chinese version of the Flow State Scale-2 (CFSS-2). Group differences were analyzed via Wilcoxon rank-sum tests. Results: Older adults exhibited significantly lower overall flow experience than younger adults (p < 0.001, d = 1.45), with significant differences in the dimensions of "challenge-skill balance" (p < 0.001), "clear goals" (p = 0.044), "sense of control" (p < 0.001), and "loss of self-consciousness" (p = 0.048). Other dimensions (e.g., concentration, time transformation) showed no statistical differences. Conclusions: Age significantly impacts flow experience in VR rehabilitation tasks. Tailoring designs through dynamic difficulty adjustment, intuitive goal cues, and reduced motor demands can enhance older adults’ control, immersion, and active participation, thereby improving health outcomes.
Background: Telehealth training is increasingly incorporated into educational programs for health professions students and practicing clinicians. However, many health care professionals remain uncerta...
Background: Telehealth training is increasingly incorporated into educational programs for health professions students and practicing clinicians. However, many health care professionals remain uncertain about how to foster empathetic connections during video conferencing visits (VV). Existing competencies and standards primarily address VV logistics, diagnostic modifications, and etiquette, often lacking comprehensive guidance on adapting interpersonal skills to convey empathy, cultural humility, and trust in virtual settings. Building rapport in VV requires specific knowledge, skills, and attitudes, supported by teaching strategies that promote relationship-based care. Objective: This study aimed to establish consensus on the knowledge, skills, and attitudes required for health professions students and clinicians to build rapport with patients in telehealth VV, and to identify teaching strategies that best support these educational goals. Methods: An e-Delphi study was conducted using a panel of 12 interprofessional experts in telehealth and telehealth education. Round 1 involved interviews, followed by anonymous surveys in Rounds 2-4 to build consensus. Results: All 12 experts participated in Rounds 1-3. In Round 1, 19 themes related to rapport-building (e.g., empathy, virtual communication) and 75 specific curriculum items were identified. Two additional items emerged in Round 2, resulting in 77 items, all achieving the established level of consensus. Conclusions: Using a competency-based education framework, this study offers a practical resource for health professions educators. Organizing the findings by cognitive (knowledge), psychomotor (skills), and affective (attitudes) domains enhances their applicability for integration into existing telehealth curricula. Future research is needed to test the feasibility, acceptability, and effectiveness of curricula based on these competencies. Additionally, evaluating the effectiveness of the recommended teaching strategies, particularly in relation to the three learning domains, is essential. Clinical Trial: Registration in Open Science Framework (OSF) completed on January 22, 2025.
Background: Patient safety remains a global priority, with preventable adverse events—often caused by communication failures among healthcare professionals—posing serious risks. Interprofessional...
Background: Patient safety remains a global priority, with preventable adverse events—often caused by communication failures among healthcare professionals—posing serious risks. Interprofessional education (IPE) is a promising strategy to improve collaboration and communication, thereby enhancing care quality and patient outcomes. While IPE has been widely studied in student populations, limited evidence exists regarding its implementation and effectiveness for licensed rehabilitation professionals such as physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). Objective: This scoping review aimed to comprehensively map the implementation, content, and effects of interprofessional education (IPE) targeting groups including licensed physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). Methods: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines. Searches were performed using PubMed, Web of Science, CINAHL, MEDLINE, and ERIC databases, targeting studies published up to March 2024. The study population consisted of licensed PTs, OTs, and SLPs. Regarding concept, we targeted studies in which IPE was provided to groups with at least one licensed PT, OT, or SLP. Regarding context, we included studies reporting the effects of IPE in clinical settings. Controlled vocabulary (e.g., MeSH) for terms such as IPE, PT, OT, and SLP was used to develop the search strategy. Eight reviewers extracted data and identified eligible studies. Results: Of the 3,389 records identified, eight were included. Mapping revealed that IPE implementation primarily involved lectures, discussions, and team-based practices. The content covered theories and concepts, treatment, and workplace problem-solving. Regarding effects, the results demonstrated that IPE improved role understanding, collaboration skills, knowledge, and confidence in the long term. However, simulation training did not improve interprofessional attitudes or network expansion. Conclusions: IPE targeting licensed PTs, OTs, and SLPs was structured in a way that combined multiple implementation methods to enable comprehensive learning, with the content adjusted to meet participant needs. Future studies should consider systematic reviews and meta-analyses to identify recommended combinations of IPE implementation and content. Clinical Trial: Not applicable.
Background: Short video platforms have become important channels for psoriasis-related health information dissemination, yet their content quality remains understudied. Objective: This study aimed to...
Background: Short video platforms have become important channels for psoriasis-related health information dissemination, yet their content quality remains understudied. Objective: This study aimed to assess the quality and content of psoriasis-related videos on Bilibili and TikTok. Methods: The top 100 relevant videos on each of the two platforms were retrieved in February 2025, and the video features were recorded after screening, and the content and quality were assessed using modified DISCERN (mDISCERN), Video Information and Quality Index (VIQI), Global Quality Score (GQS), and Journal of the American Medical Association (JAMA). Results: A total of 173 psoriasis-related videos from Bilibili (n=85) and TikTok (n=88) were included in this study. The median video length was 447 seconds (Bilibili) and 55 seconds (TikTok). In both platforms, Treatment was the most popular video topic, doctor monologue was the most common presentation format, and Bilibili demonstrated a broader range of topics and more diverse presentation formats. Video uploaders were mainly self-media (Bilibili) and doctors (TikTok), with TikTok authors exhibiting the highest certification rate (89.47%). Videos from professional and certified uploaders showed superior quality according to video quality assessed by mDISCERN, GQS, VIQI, and JAMA tools. Spearman correlation analysis showed no significant correlation between video quality and viewer interaction. Conclusions: The number of psoriasis-related videos on both platforms is large, but the quality of both needs to be improved. It is recommended that cross-platform collaborative optimization be implemented to enhance the content output of professional and certified creators and to strengthen the scientific rigor and accessibility of the psoriasis information ecosystem.
Background: Wearable sensor technologies, such as inertial measurement units (IMUs), smartwatches, and multi-sensor systems, have emerged as valuable tools in clinical and real-world health monitoring...
Background: Wearable sensor technologies, such as inertial measurement units (IMUs), smartwatches, and multi-sensor systems, have emerged as valuable tools in clinical and real-world health monitoring. These devices allow continuous, non-invasive tracking of gait, mobility, and functional health across a variety of populations. However, significant challenges remain, including variability in sensor placement, data processing methodologies, and insufficient validation in real-world settings. Objective: This systematic review aims to evaluate recent literature on the clinical and research applications of wearable sensors. Specifically, it investigates how these technologies are used to assess mobility, predict disease risk, and support rehabilitation. It also identifies limitations and proposes future research directions. Methods: The review was conducted according to PRISMA guidelines. A comprehensive search of PubMed, Scopus, and Web of Science databases was performed for studies published in the past ten years. Inclusion criteria focused on studies using wearable sensors in clinical or real-world environments. A total of 30 eligible studies were identified for qualitative synthesis. Data extracted included study design, population characteristics, sensor type and placement, machine learning algorithms, and clinical outcomes. Results: Among the reviewed studies, observational designs were the most common (43.3%), followed by experimental studies (26.7%) and randomized controlled trials (10%). IMU-based sensors were used in 66.7% of studies, with wrist-worn devices being the most common placement (43.3%). Machine learning techniques were frequently applied, with random forest (20%) and deep learning (16.7%) models predominating. Clinical applications spanned Parkinson’s disease, stroke, multiple sclerosis, and frailty, with several studies reporting high predictive accuracy for fall risk and mobility decline (AUROC up to 0.919, p < 0.05). Conclusions: Wearable sensors demonstrate strong potential for enhancing mobility monitoring, disease risk assessment, and rehabilitation tracking in both clinical and real-world settings. However, challenges remain in standardizing sensor protocols and data analysis. Future research should focus on large-scale, longitudinal studies, harmonized machine learning pipelines, and integration with cloud-based health systems to improve scalability and clinical translation.
Background: Implementing new technologies in healthcare settings is often a complex and challenging process. Virtual reality (VR) has demonstrated promising results in terms of feasibility, acceptabil...
Background: Implementing new technologies in healthcare settings is often a complex and challenging process. Virtual reality (VR) has demonstrated promising results in terms of feasibility, acceptability, and effectiveness across various health conditions. However, little research has been done on patients’ acceptance of VR technology in psychiatric care. Objective: This study aimed to explore patients’ experiences of being offered the use of a virtual calm room when feeling anxious or worried in a psychiatric inpatient setting. Methods: A mixed-methods design was employed, with a qualitative → quantitative (QUAL → QUAN) approach. Data were gathered through individual interviews (n = 10) and a three-item rating scale (n = 59). The qualitative findings were then validated within a larger population using the quantitative data. Results: The majority of participants reported being satisfied with the option of using VR. Their initial impressions of the virtual calm room were that it seemed like a creative and stimulating environment that could potentially have a positive impact on them. They expected the VR experience to enhance their feelings of relaxation and concentration. The participants highlighted human interaction as a particularly valuable aspect to consider when implementing VR, emphasizing its role in enhancing the overall experience and ensuring a sense of connection and support throughout the process. Participants reported no significant difficulties in using the VR technology. They expressed high willingness to use the virtual calm room again in future and viewed the method as modern and innovative. Conclusions: The qualitative findings highlighted patients’ openness to innovative methods for enhancing their engagement in the psychiatric inpatient setting. Patients expressed a desire for increased availability of the virtual calm room. However, maintaining a balance between innovative technologies and human support is crucial for the successful implementation of such methods. Quantitative results demonstrated high acceptance of the option of using the virtual calm room, with no significant difficulties reported.
Through a co-design and community-based participatory approach with Latino and NHPI communities, we identified key themes for an initial beta version of a mHealth app, including priorities around ment...
Through a co-design and community-based participatory approach with Latino and NHPI communities, we identified key themes for an initial beta version of a mHealth app, including priorities around mental health, access to resources, and chronic disease prevention. Social and cultural connectedness and generational approaches emerged as important strategies for successful intervention design and long-term adoption.
Background: Mental health conditions account for significant distress, burden, and societal costs. Despite efforts to implement evidence-based practices, access to high quality mental health treatment...
Background: Mental health conditions account for significant distress, burden, and societal costs. Despite efforts to implement evidence-based practices, access to high quality mental health treatment in general practice remains limited, and clinical outcomes sub-optimal. Measurement-based care (MBC) is a transtheoretical and transdiagnostic strategy that has the potential, when implemented effectively, to improve the quality of care. Digital tools can also support clinicians by alleviating administrative tasks and providing in-the-moment performance data and clinical decision support. In this study, we examine the clinical outcomes of a technology-enabled psychotherapy practice, where clinicians are supported by a suite of innovations including an MBC platform, clinical decision support tools, and tools designed to alleviate administrative burden. Objective: The current study examines client retention and depression and anxiety outcomes within a technology enabled psychotherapy practice. Methods: This retrospective cohort study examines 2,984 adults who initiated mental health treatment with Two Chairs, a hybrid technology enabled behavioral health provider, between January 1 to June 30, 2024. Rates of reliable change, recovery, remission, and magnitude and trajectory of symptom change in depression and anxiety symptoms were assessed using the PHQ-9 and GAD-7. Results: The population demonstrated high rates of retention in care (89.9%), as well as high rates of MBC survey completion (96.3%). From baseline to the 12th session, patients showed significant symptom improvements in depression and anxiety, achieving high rates of reliable improvement (65.8%) and recovery (53.2%). Aggregate clinical outcomes continued to improve up to the point of termination. Pre to post-treatment effect sizes were large (all Cohen’s d’s > 0.9). Conclusions: This study demonstrates how technology-enabled measurement-based care and clinical decision support systems may drive high quality patient outcomes in mental health. Implications for healthcare costs and value-based payment models are discussed.
Objectives: Community health screening programs frequently report inconsistent follow-up rates and barriers to sustained lifestyle changes. This study evaluated the HealthStart program, a layperson-le...
Objectives: Community health screening programs frequently report inconsistent follow-up rates and barriers to sustained lifestyle changes. This study evaluated the HealthStart program, a layperson-led intergenerational health coaching program that aims to improve health screening follow-up, chronic disease understanding and ownership, digital health application adoption and sustained lifestyle changes.
Methods: HealthStart is a self-determination theory-based intervention that aims to increase the autonomy and competence of participants via volunteer engagement, health coaching, and post-health screening follow-up. Lay volunteers (LVs) were taught principles of motivational interviewing, health coaching and social determinants of health via a training model anchored on principles of intergenerational and service learning. LVs act as health advocates through the participants’ journeys under the guidance of healthcare volunteers.
Convergent parallel mixed-methods analysis was employed. A total of 192 participants’ quantitative data were collected through pre- and post-program surveys. Qualitative data were obtained from 36 semi-structured interviews analyzed through thematic analysis.
Results: The follow-up rate among primary care providers increased significantly from 42.7% to 84.5% (χ2=43, p<0.001). A total of 66.2% (92/139) of the participants achieved their health goals, and 81.3% (113/139) reported satisfaction with the program. There was a statistically significant correlation (Z=2.44, p=0.015) between participant health goal attainment and the number of follow-up visits and between post-cycle participant eHealth literacy scale (eHEALS) scores and the number of follow-up visits (F(2,130)=6.06, p=0.003).
The qualitative findings highlighted LVs’ crucial role in facilitating health conversations, promoting lifestyle changes, and building meaningful connections in catalyzing lifestyle changes in the participants. While the training adequately prepared LVs for these tasks, some encountered challenges with participants resistant to change or with complex needs.
Conclusion: HealthStart demonstrated the feasibility and impact of using laypersons in the community to increase follow-up rates and promote healthier lifestyles among older adults.
Background: Telehealth is a potential tool to alleviate geographic cardiology specialist shortages, but there is limited data regarding current telehealth use for common cardiology conditions, includi...
Background: Telehealth is a potential tool to alleviate geographic cardiology specialist shortages, but there is limited data regarding current telehealth use for common cardiology conditions, including atrial fibrillation (AF). Objective: We evaluated variation in telehealth use in primary care and cardiology clinics for patients with incident AF in the Veterans Health Administration (VA). Methods: We constructed a cohort of patients with AF diagnoses made in the outpatient setting 1/2022-9/2023. We included facility-specialty groups with at least 20 visits for these patients between 1/2022-12/2023. We assessed the association of any video visit and any telehealth use (including phone) for primary care or cardiology visits within 90 days of AF diagnosis with selected patient and facility characteristics using Bayesian logistic regression, including facility random intercepts. We evaluated facility variation in video visit and telehealth use via the median odds ratio (MOR). Results: Our cohort included 36,929 patients with new AF, with 80,596 visits across 125 facilities. Of these, 2,088 of 63,835 primary care visits (3.3%) and 323 of 16,761 cardiology visits (1.9%) were delivered by video and 13,403 primary care visits (21.0%) and 3,288 cardiology visits (19.6%) by telehealth. Average age was 74, 2.9% were female, 78% were White, and average CHA2DS2-VASc was 2.8. In adjusted analyses, older age was associated with lower use of video care for both primary care and cardiology and any telehealth for cardiology (e.g., adjusted odds ratio [AOR] of 0.61 [95% credible interval, CrI, 0.42-0.85] for use of video cardiology for patients older than 77). Living >40 miles from care was associated with increased use of both video and any telehealth care for primary care and cardiology (e.g., AOR 1.91 [95% CrI 1.21-3.00] for video cardiology care); rural location was associated with lower odds of using video or any telehealth for primary care (video AOR 0.73 [95% CrI 0.64-0.84]; telehealth AOR 0.89 [95% CrI 0.83-0.96]). There was marked variability across facilities in use of video care (range 0%-17.4% for cardiology, 0%-12.5% for primary care) and telehealth (range 0%-82.6% for cardiology, 3.8%-61.6% for primary care) for this patient population. The facility-level adjusted MOR for video care was 1.97 (95% CrI: 1.77-2.24) for primary care and 4.95 (95% CrI 3.39-7.98) for cardiology. Similarly, the adjusted MOR for any telehealth use was 1.79 for primary care (95% CrI: 1.65-1.96) and 2.61 for cardiology (95% CrI 2.25-3.13). Conclusions: Following incident AF diagnosis, telehealth may increase access to primary and cardiology care for Veterans living at a distance, but its use remains lower for older patients and those in rural geographies. There was significant variation in telehealth use across facilities not explained by differences in patient and facility characteristics. Standardizing telehealth use across VA facilities may improve access to AF care.
Background: Functional cognitive disorder (FCD) is a common and disabling condition for which accessible and evidence-based treatments are urgently needed. Objective: We describe the planning and deve...
Background: Functional cognitive disorder (FCD) is a common and disabling condition for which accessible and evidence-based treatments are urgently needed. Objective: We describe the planning and development stages of a new self-help mobile app intervention for FCD. Methods: The UK Medical Research Council's Complex Interventions framework was followed. Theory- and user-centered approaches were adopted to develop Mementum – a 6-week programme rooted on cognitive behavioural techniques and complementary principles (mindfulness, education, cognitive rehabilitation). Results: A scoping review is presented. Thematic analysis of patient interviews identified 6 themes and 13 subthemes, including user needs, management strategies, opportunity and motivation. The treatment model places attentional dysregulation as the core symptom generator, around which treatment content was developed. Provisional insights from a focus group suggested the intervention is acceptable and credible. Facilitators and barriers were uncovered and addressed. The programme includes 7 modules, videos, patient stories, FAQs, and signposting to existing resources. Interactive features include a weekly memory diary and symptom checklist, tailoring of contents to symptoms, and homework tasks. Conclusions: We used a systematic approach to develop a novel digital health intervention for FCD. Collaborations with key stakeholders enabled intervention development and optimisation. Feasibility, acceptability, and efficacy testing of this intervention are underway. Clinical Trial: N/A
Background: Successful Research and MedTech collaborations depend on six key components: talent and workforce development, innovative solutions, robust research infrastructure, regulatory compliance,...
Background: Successful Research and MedTech collaborations depend on six key components: talent and workforce development, innovative solutions, robust research infrastructure, regulatory compliance, patient-centered care, and rigorous evaluation.
Institutional leaders frequently navigate multiple professional identities; simultaneously serving as educators, researchers, clinicians, and innovators; creating bridges between academic rigor and practical application that accelerate the translation of research into meaningful solutions. Institutions and organizations may also need to broaden their identities.
The contemporary landscape presents significant challenges as institutions balance the pursuit of academic excellence with the need for rapid responsiveness to technological and commercial innovation. Traditional research processes, while ensuring quality, often impede the pace of advancement necessary in today's rapidly evolving environment. This tension necessitates structural reforms across multiple dimensions of institutional operation.
To cultivate a thriving research and innovation ecosystem, several essential components must be established:First, institutions require agile research infrastructure with cutting-edge laboratories and collaboration spaces, specialized equipment, and certified research professionals specifically trained in device development and regulatory compliance. Robust clinical management platforms can expedite trials and streamline data extraction for publication and dissemination. Objective: The Orange County (OC) Impact Conference, held in November 2024, convened 180 key stakeholders from the life sciences, technology, medical device, and healthcare sectors. CHOC Research in collaboration with University Lab Partners (ULP) and the University of California, Irvine, provided this platform for leaders, decision-makers, and experts to discuss the intersection of innovation in research, healthcare, biotechnology, and data science. Methods: We convened a multidisciplinary symposium (180 participants) to examine advancements in life sciences and medical device research development. The structured forum incorporated moderated panel discussions and a keynote speaker. Participants represented diverse stakeholder categories including research scientists, clinicians, investors and financiers, and executive research and healthcare leadership. The event design facilitated both structured knowledge exchange and strategic networking opportunities aimed at identifying implementation pathways to enhance clinical impact. Results: The 2024 OC Impact Conference Proceedings outline a strategy for healthcare innovation, demonstrating how targeted collaboration between patients, families, researchers, clinicians, engineers, data scientists, and industry is reshaping the healthcare innovation ecosystem. This integrated approach ensures every stakeholder's voice contributes to meaningful advancement, guiding resource allocation and partnership development across the life science and medical device sectors. Our findings demonstrate that success requires moving beyond traditional approaches to patient-driven research priorities, augmented design principles for medical device development, and direct engagement between innovators, research participants, industry and healthcare centers throughout the research development cycle. Conclusions: The insights gained through participation in the OC Impact Conference contribute to the ongoing discourse in these fields, emphasizing collaborative efforts to enhance pediatric and adult healthcare outcomes. Clinical Trial: N/A
Background: This study aims to detect self-harm and/or suicidal ideation (SH/S) language used by youth (ages 13–21) in their private Instagram conversations. While automated mental health tools have...
Background: This study aims to detect self-harm and/or suicidal ideation (SH/S) language used by youth (ages 13–21) in their private Instagram conversations. While automated mental health tools have shown promise, there remains a gap in understanding how nuanced youth language around SH/S can be effectively identified. Our work focuses on developing interpretable models that go beyond binary classification to recognize the spectrum of SH/S expressions. Objective: Our work focuses on developing interpretable models that go beyond binary classification to recognize the spectrum of SH/S expressions. Methods: We analyzed a dataset of Instagram private conversations donated by youth. A range of traditional machine learning models (SVM, Random Forest, Naive Bayes, XGBoost) and transformer-based architectures (BERT, DistilBERT) were trained and evaluated. In addition to raw text, we incorporated contextual, psycholinguistic (LIWC), sentiment (VADER), and lexical (TF-IDF) features to improve detection accuracy. We further explored how increasing conversational context—from message-level to sub-conversation level—affected model performance. Results: DistilBERT demonstrated a good performance in identifying the presence of SH/S behaviors within individual messages, achieving an accuracy of 99%. However, when tasked with a more fine-grained classification—differentiating among “Self” (personal accounts of self-harm or suicide), “Other” (references to SH/S experiences involving others), and “Hyperbole” (sarcastic, humorous, or exaggerated mentions not indicative of genuine risk)—the model's accuracy declined to 89%. Notably, by expanding the input window to include a broader conversational context, the model's performance on these granular categories improved to 91%, highlighting the importance of contextual understanding when distinguishing between subtle variations in SH/S discourse. Conclusions: Our findings underscore the importance of designing SH/S automatic detection systems sensitive to the dynamic language of youth and social media. Contextual and sentiment-aware models improve detection and provide a nuanced understanding of SH/S risk expression. This research lays the foundation for developing inclusive and ethically grounded interventions, while also calling for future work to validate these models across platforms and populations.
Background: Psoriasis, a chronic inflammatory skin disease, is increasingly linked to metabolic disorders, particularly obesity. Traditional anthropometric measures like body mass index (BMI) and wais...
Background: Psoriasis, a chronic inflammatory skin disease, is increasingly linked to metabolic disorders, particularly obesity. Traditional anthropometric measures like body mass index (BMI) and waist circumference (WC) have limitations in assessing fat distribution and metabolic risk. The Body Roundness Index (BRI), which integrates height and waist circumference, may offer superior predictive value for psoriasis risk, but its clinical utility remains underexplored. Objective: This study aimed to evaluate BRI as a potential digital biomarker for psoriasis risk prediction, comparing its performance with BMI and WC across diverse demographic subgroups using large-scale national health data. Methods: We analyzed cross-sectional data from 13,798 adults aged 20–59 years in the National Health and Nutrition Examination Survey (NHANES, 2003–2014). Psoriasis status was self-reported. BRI, BMI, and WC were calculated from standardized measurements. Weighted multivariable logistic regression and restricted cubic spline (RCS) models assessed associations, adjusting for sociodemographic, metabolic, and lifestyle factors. A nomogram model quantified predictive contributions. Results: BRI showed a robust linear association with psoriasis risk (OR=1.11 per unit increase, 95% CI=1.05–1.17, p<0.001), outperforming BMI (OR=1.03) and WC (OR=1.01). Tertile analyses revealed a 1.73-fold higher psoriasis risk in the highest BRI group (p=0.003). Subgroup analyses confirmed consistency across age, sex, and metabolic status (p for interaction >0.05). The nomogram highlighted BRI’s dominant predictive contribution (largest score-axis span). Conclusions: BRI demonstrates stronger and more consistent associations with psoriasis risk than traditional measures, supporting its role as a digital biomarker for early risk stratification. Integration of BRI into clinical informatics tools could enhance personalized psoriasis prevention and management.
Background: Telehealth is a promising approach to managing chronic conditions like type 2 diabetes mellitus (T2DM), providing more access and convenience. Asian Americans, who are 40% more likely to b...
Background: Telehealth is a promising approach to managing chronic conditions like type 2 diabetes mellitus (T2DM), providing more access and convenience. Asian Americans, who are 40% more likely to be diagnosed with diabetes than non-Hispanic Whites, remain underrepresented in telehealth utilization.
While general barriers such as digital literacy and provider engagement have been documented, few studies focus on the cultural and technological challenges specific to Asian American communities. Language barriers, limited access to technology, and a preference for in-person care may also impact adoption.
This study addresses these gaps by examining the barriers to telehealth use among Asian Americans with T2DM, using the Unified Theory of Acceptance and Use of Technology (UTAUT) to explore how social, cultural, and technological factors influence adoption. Objective: This study examines cultural and technological barriers affecting telehealth adoption among Asian Americans with type 2 diabetes mellitus (T2DM). Methods: A qualitative case study approach was employed, utilizing semi-structured interviews with Asian American individuals in Missouri. Thematic analysis was used to identify key barriers. Results: Four major barriers emerged: (1) Language and cultural barriers—limited availability of translated materials and interpreters; (2) Digital literacy and access—older adults and individuals with low technological exposure struggled with telehealth platforms; (3) Limited provider recommendations—healthcare providers did not actively endorse telehealth, reducing patient awareness; and (4) Technology and infrastructure disparities—low-income participants faced challenges with access to broadband and telehealth-compatible devices. Conclusions: Addressing cultural and technological barriers is crucial to increasing telehealth adoption among Asian Americans with T2DM. Culturally tailored interventions, provider engagement, and digital literacy programs should be prioritized. Policy efforts must focus on expanding broadband access and providing multilingual telehealth resources.
Background: Background/Objectives: Excessive infant crying affects approximately 20% of families, often resulting in parental distress, anxiety, and strained relationships. Despite its prevalence, man...
Background: Background/Objectives: Excessive infant crying affects approximately 20% of families, often resulting in parental distress, anxiety, and strained relationships. Despite its prevalence, many parents, particularly mothers, report feeling misunderstood and unsupported. Objective: This study aimed to examine mothers’ perceptions of understanding and support from partners, their social environment, and healthcare professionals. Methods: Methods: A mixed-methods design was employed, integrating both quantitative and qualitative data. A total of 432 mothers participated in the study. Quantitative assessments compared perceived levels of understanding and support from three groups: partners, the social environment, and healthcare professionals. Qualitative data explored specific forms of support mothers found meaningful. Results: Results: Quantitative findings indicated that healthcare professionals were rated lowest in both understanding and support, with 50.6% of mothers reporting little or no understanding, and 47.1% reporting little or no support. In contrast, partners were perceived as the most supportive and understanding group. Qualitative analysis highlighted essential support forms, including emotional reassurance, avoiding maternal blame, practical assistance, and open communication. Conclusions: Conclusions: The study reveals a gap in perceived support from healthcare professionals and emphasizes the vital role of partners and the social environment. Based on qualitative insights, a Maternal Support Framework is proposed to guide holistic, family-centered interventions, with the goal of enhancing parental and infant well-being.
Background: Isolated premature thelarche (IPT) is characterized by early breast development in girls under 8 years old without other signs of puberty. Zhibai Dihuang Ointment Prescription, a tradition...
Background: Isolated premature thelarche (IPT) is characterized by early breast development in girls under 8 years old without other signs of puberty. Zhibai Dihuang Ointment Prescription, a traditional Chinese medicine (TCM) formulation, has been proposed as an alternative. Objective: This study aims to explore parents' perceptions of using this intervention for treating IPT in their children. Methods: Semi-structured individual interviews were conducted online with 14 parents of children diagnosed with IPT who had been treated with Zhibai Dihuang Ointment Prescription for over six months. Participants were recruited through purposive sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using template analysis. NVivo 12 software was used to facilitate data. Results: Three main themes emerged: (1) facilitators of Zhibai Dihuang Ointment Prescription for IPT, (2) barriers of Zhibai Dihuang Ointment Prescription for IPT, and (3) parental demands on Zhibai Dihuang Ointment Prescription for IPT. Facilitators included: (a) positive impacts on children and parents and (b) good acceptance among children and parents. Barriers included (a) limitations of the use of Zhibai Dihuang Ointment Prescription and (b) limitations in medical resources. Parental demands focused on (a) improvements in medication experience and (b) improvements in hospitals’ medical services. Conclusions: Zhibai Dihuang Ointment Prescription positively impacts children's development and family well-being. However, challenges like bitter taste, long treatment periods, and occasional side effects affect adherence. Improved healthcare access and patient-centered approaches are needed. Future quantitative and qualitative research are needed to evaluate its effects and understand patient experiences.
The lifestyle pattern has changed drastically in recent decades. There is a huge change from few decades ago to the present day. This review study is done to know the change of lifestyle pattern manif...
The lifestyle pattern has changed drastically in recent decades. There is a huge change from few decades ago to the present day. This review study is done to know the change of lifestyle pattern manifested in the form of malnutrition and obesity/overweight (Double Burden of Malnutrition, DBM) and its link with the parasitic infection, both culminating into a Triple Burden of Malnutrition in the Low-Middle Income Countries (LMICs). DBM, a challenging issue, in today’s context is one of the major problem in south Asia. This review aims at showing the real picture of today’s scenario of DBM accompanied with high prevalence of parasitic infections. Data used in this review are taken from the research articles through google search engine, different journals, websites, national surveys and other sources. References to the original source are strictly given to be safe from plagiarism and academic dishonesty. Gender differences in the prevalence of Overweight and Obesity (OWOB) and underweight is not considerable in this review but rural-urban differences is notable in this review, urban areas based people with higher prevalence of OWOB and rural areas people with higher prevalence of underweight. This study finds no significant difference in parasitic infections among OWOB and underweight population. Entamoeba coli and adenovirus -36 infection may contribute to fat deposition but still further studies required. This review study finds that DBM along with parasitic infections result into a Triple Burden of Malnutrition which is currently a disastrous condition for low-middle income countries. Simple concept of search, compile, analyze and interpret is used in this study. This can be a limitation in this study. The findings of this review cannot be neglected as it is very important in present context for low-middle income countries in south Asia.
Background: Cyber victimization exposes teens to numerous risks. Their developmental stage often leaves them unaware of potential dangers, making them susceptible to psychological distress. Despite th...
Background: Cyber victimization exposes teens to numerous risks. Their developmental stage often leaves them unaware of potential dangers, making them susceptible to psychological distress. Despite this vulnerability, methods for identifying teens at risk of cyber victimization within healthcare settings are limited, as is research that explores their experiences of cyber victimization. The purpose of this study was to analyze how teens describe experiences of cyber victimization on the social media platform Reddit using data mining. Objective: This study aimed to analyze and describe how teens on Reddit describe and discuss their experience of cyber victimization using data mining and computational analysis of unsolicited data. Methods: This computational qualitative study used data mining, Word Adjacency Graph (WAG) Modeling, and thematic analysis to analyze discussions of Reddit users surrounding cyber victimization. Inclusion criteria included posts from 2012-2023 from subreddits r/cyberbullying and r/bullying. GPT-4, an advanced artificial intelligence language model, summarized posts and assisted in cluster labeling. Posts were reviewed to remove irrelevant content and duplicates. User anonymity was maintained throughout the study. Results: 13,381 posts from 3,283 Reddit were analyzed, with 5.07% originating between 2012 and 2018 and 94.93% from 2019 to 2023. The WAG modeling approach identified 38 clusters, with 35 deemed to be relevant to cyber victimization experiences. Two clusters containing irrelevant material were excluded. Six overarching themes emerged: (1) psychological impact, (2) coping and healing, (3) protecting yourself online, (4) protecting yourself offline, (5) victimization across various settings, and (6) seeking meaning and understanding. Conclusions: The study highlights the effectiveness of data mining and AI in analyzing large public data sets for qualitative research. These methods can inform future studies on risky internet behavior, victimization, and assessment strategies in healthcare settings.
Background: Mobile health (mHealth) technologies show promise in addressing suboptimal anticoagulation adherence among venous thromboembolism (VTE) patients Objective: To evaluate the impact of a mobi...
Background: Mobile health (mHealth) technologies show promise in addressing suboptimal anticoagulation adherence among venous thromboembolism (VTE) patients Objective: To evaluate the impact of a mobile VTE application (mVTEA) on thromboprophylaxis adherence in VTE or moderate-to-high-risk patients. Methods: This single-center pilot study enrolled 88 patients at the Chinese PLA General Hospital (August–December 2023). Participants used mVTEA for automated medication reminders and self-management. Adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8) and Beliefs about Medicines Questionnaire-Specific (BMQ-Specific). Real-time adherence data were analyzed at 1 month (Trial registration: ChiCTR2200063206). Results: Among 45 completers (age 60.8±15.2 years; 35.6% female), baseline adherence was suboptimal (good: 28.9%; moderate/poor: 71.1%). Primary non-adherence drivers included forgetfulness (Q2: 0.69±0.47) and premature discontinuation (Q6: 0.78±0.42). BMQ-Specific revealed higher necessity than concern scores (17.58±3.12 vs. 14.58±3.34, p<0.001). At 1-month follow-up, 100% achieved perfect adherence, with 80% completing mVTEA check-ins. Patients utilizing check-in features demonstrated superior necessity-concern differentials (NCD>0: 80.6% vs. 0%, p<0.001). No adverse events occurred. Conclusions: mVTEA significantly improved short-term anticoagulation adherence through behavioral nudges and real-time monitoring. Individualized patient education may further optimize outcomes. Clinical Trial: ChiCTR2200063206
Background: Accurate staging of esophageal cancer is crucial for determining prognosis and guiding treatment strategies, but manual interpretation of radiology reports by clinicians is prone to variab...
Background: Accurate staging of esophageal cancer is crucial for determining prognosis and guiding treatment strategies, but manual interpretation of radiology reports by clinicians is prone to variability and limited accuracy, resulting in reduced staging accuracy. Recent advances in large language models (LLMs) have shown promise in medical applications, but their utility in esophageal cancer staging remains underexplored. Objective: To compare the performance of three publicly available LLMs (INF, Qwen2.5-72B, and LLaMA3.1-70B) and clinicians in automated esophageal cancer staging using free-text radiology reports. Methods: This retrospective study included 161 patients from Shanghai Chest Hospital who underwent esophageal cancer surgery from May to September 2024. The dataset consisted of 916 Chinese free-text radiology reports. The reference standard was derived from postoperative pathological staging. Three LLMs
determined T classification (T1-T4), N classification (N0-N3), and overall staging (I-IV) using three prompting strategies (Zero-shot, Chain-of-thought, and a proposed Interpretable Reasoning method). The McNemar test and Pearson chi-square test were used for comparisons. Results: INF combined with Interpretable Reasoning demonstrated superior performance, achieving an accuracy of 58% in overall staging, which significantly outperformed clinicians (37%, P < .001). For T classification, it achieved an F1 score of 0.67, markedly surpassing clinicians (0.43, P < .001). For N classification, it achieved an F1 score of 0.54, significantly exceeding the performance of clinicians (0.42, P < .001). For overall staging, it attained an F1 score of 0.60, significantly outperforming clinicians (0.39, P < .001). Conclusions: The findings demonstrate the potential of LLMs to improve the accuracy and reliability of esophageal cancer staging based on radiology reports. LLMs can serve as valuable tools to support clinicians in complex diagnostic tasks when properly adapted.
Background: Febrile seizures, although typically benign, can cause significant emotional distress for parents. Their diverse etiological risk factors underscore the need for further research. Ecologic...
Background: Febrile seizures, although typically benign, can cause significant emotional distress for parents. Their diverse etiological risk factors underscore the need for further research. Ecological Momentary Assessment (EMA) offers a cost-effective and timely method for real-time data collection. The FeverApp, an EMA-based registry for fever management, enables parents to document febrile seizures as they occur. Objective: This study systematically evaluates febrile seizure records from the FeverApp registry to assess their characteristics and explore the clinical implications of the findings. By providing real-world data on seizure management, this research demonstrates the potential of app-based EMA in pediatric care. Additionally, it offers insights for targeted interventions and improved febrile seizure management. Methods: Parents descriptions of 226 seizures belonging to 161 children were qualitatively analysed. Group differences in quantitative data were assessed through matched-pair sampling, comparing 114 children. Statistical methods were tailored to the nature of the respective variables, which included prevalence, age, gender, health and febrile history, fever management, temperature, well-being, and parental confidence. Results: Qualitative analyses provided detailed descriptions of seizure symptoms, seizure duration, and seizure management practices. Additionally, the data revealed a high rate of emergency consultations related to febrile seizures. However, there was underreporting of febrile seizures within the FeverApp, with a reported incidence of only 0.4% among febrile children. In a matched sample controlled for gender and age, significant differences were observed between febrile children with and without febrile seizures in several parameters, including maximum recorded temperature (P < .001), prevalence of chronic diseases (P = 0.004), parental confidence (P = 0.014), and frequency of emergency consultations (P < .001). Conclusions: This study offers valuable insights into the characteristics, temporal dynamics, management strategies, and parental responses to febrile seizures in children. Despite the limitation of potential underreporting in an EMA-based registry, the findings highlight the critical importance of parental education and support in managing febrile seizures. Enhancing these areas has the potential to reduce unnecessary medical consultations and improve the overall care of affected children. Furthermore, integrating improvements in the FeverApp's education and documentation system regarding febrile seizures could facilitate better management and support future research efforts. Clinical Trial: DRKS00016591
Background: The impact of Pass/Fail or Tiered Grade assessment for exams in undergraduate medical education causes much debate while there is little data to inform decision making. The increasing numb...
Background: The impact of Pass/Fail or Tiered Grade assessment for exams in undergraduate medical education causes much debate while there is little data to inform decision making. The increasing number of medical schools transitioned to Pass/Fail assessment has raised a concern about medical students’ academic performance. In 2018, the undergraduate medical curriculum reform at the Faculty of Medicine, Aalborg University changed some exams from Pass/Fail to Tiered Grade and vice versa for other exams. These changes provide an opportunity to evaluate the different assessment forms. Objective: To evaluate medical students’ academic performance at the final licensing exam in relation to exam grading principle. Methods: This single-centre cohort-study at the Aalborg University Medical School, North Denmark Region assess the change from 2-digit Tiered Grade to Pass/Fail evaluation and vice versa of undergrade medical students’ exams after the 4th and 5th year clinical training modules from Autumn 2015 through Spring 2023. The primary outcome was the number of students failing clinical training exams, and the final licensing exam grades. Results: Among the total of 7,634 exams, 7,164 4th and 5th year clinical training exams were included in the comparisons of which 3,047 (42.5%) were Pass/Fail exams and 4,117 (57.5%) were Tiered Grade exams. The frequency of students failing exams was 3,3% (n=101/3,047) at Pass/Fail and 1.97% (81/4,117) with Tiered Grade exams (p<0.001). This difference was levelled out when counting the near failure tiered grade as fail. Tiered Grade exams did not differ between semesters (p=0.99) nor show a time trend at the 4th year (p=0.66). The final licensing exam grades were unaltered (p=0.47). Conclusions: Despite our expectation, Pass/Fail exams exhibit a higher fail rate compared to Tiered Grade exams without lowering the final academic performance. These results suggest that a shift from tiered grading to Pass/Fail assessment redirects the focus from rewarding high performance to ensuring standards are maintained among underperforming students.
Background: Parents of premature infants often face challenges in transitioning from hospital to home, requiring reliable and accessible information to support their caregiving. In the Netherlands, a...
Background: Parents of premature infants often face challenges in transitioning from hospital to home, requiring reliable and accessible information to support their caregiving. In the Netherlands, a post-discharge, responsive parenting intervention (TOP program) is standard care for very preterm born infants and their parents. However, parents still indicate unmet information needs. Mobile health (mHealth) interventions have the potential to supplement post-discharge education and empower parents by providing tailored, evidence-based information. Objective: The primary objectives of this study were: (1) to develop an information app (e-TOP) for parents of preterm infants and (2) to evaluate its usability. Methods: An exploratory two-phase mixed-method design was employed. In Phase 1, the app was developed through iterative focus group discussions with parents of premature infants and TOP interventionists (pediatric physiotherapists). The content of the app was developed through co-creation by professionals and was subsequently refined and adapted to improve its practical use. In Phase 2, parents with a preterm born infant who participated in the TOP-program received access to the e-TOP app for six months. During and after six months, usability was assessed with a range of quantitative and qualitative measurements, including thinking aloud sessions, online analytics, questionnaires including the System Usability Scale (SUS) and semi-structured interviews. Results: The collaborative approach with end-users and experts for the development led to a fully functional e-TOP app. Expert review and content validation ensured that information was accurate, accessible, and relevant for parents. For the usability testing, 58 families (116 participants) were recruited, and 69 participants actively used the app. The cumulative e-TOP median (IQR) usage per participant for 26 weeks was 39 minutes (IQR: Q1 8.8 - Q3 53.0). The median number of actions was 64.0 (IQR: 33.5-88.0). The eTOP app received a median SUS score of 75 (IQR: 67.5–80.0), indicating good usability. Participants rated their overall satisfaction with the app with a median of 7.0 (IQR: 7.0–8.0) out of 10. While the app was perceived as useful for finding information on prematurity-specific topics, engagement declined over time. The interviews highlighted a need for improved navigation (e.g., search function), expanded content (e.g. practical exercises, sensory processing), and more interactive features (e.g., chat support, parental community forums). Conclusions: The e-TOP app is a valuable, digital resource that can supplement post-discharge care by providing tailored, evidence-based, and accessible information for parents of premature infants. While usability scores were high, engagement trends and retrieved feedback suggested the need for enhanced retention strategies, such as push notifications, time-line based navigation structure, interactive tools, and adding (practical) content. Clinical Trial: ISRCTN65709138
Background: Total knee arthroplasty (TKA) is a widely performed procedure for knee osteoarthritis, yet patient satisfaction remains suboptimal, with preoperative anxiety and depression contributing to...
Background: Total knee arthroplasty (TKA) is a widely performed procedure for knee osteoarthritis, yet patient satisfaction remains suboptimal, with preoperative anxiety and depression contributing to poor postoperative outcomes. Large-scale language models (LLMs), such as ChatGPT, have shown potential in healthcare applications but remain underexplored in the context of TKA. This study evaluates the impact of an AI-driven dialogue system on perioperative anxiety and depression in TKA patients. Objective: This study aimed to evaluate the effect of LLMs dialogue system on improving anxiety and depression, as well as overall psychological well-being, in patients undergoing TKA. The primary objective was to assess the system’s impact on reducing perioperative anxiety and depression levels before and after surgery. Secondary objectives included evaluating patient satisfaction, the feasibility and scalability of the AI system compared to traditional methods, and its potential for broader clinical application in surgical settings. Methods: We expect to conduct a parallel randomized and controlled trial in Tianjin Hospital. This trial content needs to gather 210 participants between the ages of 50-80 and randomly divide them into two groups, namely, the LLM intervention group or the usual care group. ChatGPT 4.0 software was used to conduct a personalized psychological education activity for about 20-30 minutes for the LLM intervention group every day, and the routine nursing group was used as the control group, receiving standard preoperative education. The test results were evaluated by the hospital anxiety and Depression Scale (HADS) at baseline, 48 hours, 24 hours before surgery, and 24 hours, 48 hours, 72 hours after surgery to determine whether artificial intelligence is effective in anti anxiety and depression, and improve patients' surgical mood and health. Results: Statistical analyses showed that compared with the usual care group, the reduction of anxiety and depression in the LLM group was significantly greater. We found that both groups of patients experienced significant anxiety and depression before surgery. With the intervention and guidance of artificial intelligence, these symptoms in the LLM group continued to alleviate after surgery. The effect was particularly significant at 48 and 72 hours after surgery (P<.001), while the conventional nursing group showed a slower decline. Conclusions: Experimental data shows that an intelligent psychological support system driven by artificial intelligence can effectively reduce anxiety and depression in TKA patients before and after surgery. Compared with traditional psychological intervention measures, this method breaks through the limitations of high labor costs, high economy, and difficulties in implementing personalized plans, achieving efficient and innovative breakthroughs. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2500099927; https://www.chictr.org.cn/bin/project/edit?pid=256631ChatGPT；Total Knee Arthroplasty；Perioperative；Anxiety；Depression.
Background: The fistula plays a crucial role in hemodialysis for patients, ensuring blood circulation between the patient's body and the dialysis machine, thereby enabling effective dialysis treatment...
Background: The fistula plays a crucial role in hemodialysis for patients, ensuring blood circulation between the patient's body and the dialysis machine, thereby enabling effective dialysis treatment. If the fistula loses its functionality without the knowledge of the hospital and medical staff, it poses significant risks to the patient, potentially even fatal. Objective: This study designs a home care device based on AIoT technology that allows patients to easily operate it at home while facilitating the exchange of care information with medical institutions, addressing the aforementioned problem. Methods: The designed detection device collects fistula blood flow sound signals using a microphone. These signals are then analyzed by a trained neural network model, which alerts the patient to the current status of their fistula through sound and light indicators. Additionally, the results are transmitted to the hospital's medical information system via low-power wireless modulation signals, enabling medical staff to record the patient's condition. The neural network model of the home care device was trained using 245 audio samples, each 30 seconds in length, of vascular sounds. Results: The device achieved a 100% accuracy rate in identifying blockages (support=16, f1-score=1.00), a 100% accuracy rate in identifying slight blockages (support=19, f1-score=0.93), and a 91% accuracy rate in identifying no blockages (support=14, f1-score=1.00). The wireless signal transmission capability was effective over distances ranging from 8.68 km to 6.17 km, with RSSI (Received Signal Strength Indication) values between -107.2 dBm and -97.2 dBm, ensuring accurate and efficient data transmission. Additionally, a qualitative assessment using the Technology Acceptance Model was conducted to evaluate users' attitudes towards the system. Patients reported that the device is easy to use and expressed willingness to recommend it to others. Conclusions: In conclusion, the proposed AIoT-based home care device demonstrates high detection accuracy, reliable wireless communication, and strong user acceptance. It not only enhances patient safety by enabling early detection of fistula issues at home but also facilitates proactive care coordination with medical institutions. This system shows great potential for widespread adoption in chronic dialysis care, improving both patient outcomes and healthcare efficiency.
Background: Nursing is a stressful and threatening occupation, and nurses face different stressors and risks during their professional practice, such as the coronavirus disease 2019 (COVID-19) pandemi...
Background: Nursing is a stressful and threatening occupation, and nurses face different stressors and risks during their professional practice, such as the coronavirus disease 2019 (COVID-19) pandemic. Therefore, they need great self-care ability to improve and protect their health. Spiritual self-care (SSC) is one of the main aspects of self-care. However, there is limited scientific evidence about the process of SSC formation among nurses. The present study will be conducted to develop the theory of Nurses’ SSC in Biological Events and strategies to improve nurses’ SSC in biological events. Objective: The present study will be conducted to develop the theory of Nurses’ SSC in Biological Events and strategies to improve nurses’ SSC in biological events. Methods: This multi-methods study will be conducted using the grounded theory method, Systematic Scoping Review, and the Delphi technique. Participants will be hospital nurses with experience in patient care provision during the COVID-19 pandemic and will be selected through purposeful and theoretical sampling. Data will be collected through semi-structured interviews and will be analyzed through Corbin and Strauss’s method. Then, a Systematic Scoping Review will be conducted to determine the experiences of nurses in other countries. The findings of the grounded theory study and Systematic Scoping Review will be provided to a panel of experts, and their comments will be gathered to develop the best strategies to improve nurses' SSC in the form of a policy brief. Results: The findings of this study will be the theory of Nurses’ SSC in Biological Events and a policy brief containing strategies to improve nurses’ SSC in biological events. Conclusions: The findings of this study can be used in nursing practice, education, and research to improve nurses’ SSC in biological events.
Background: Adults who smoke cigarettes may reduce their exposure to cigarette smoke by switching completely or partially to an electronic nicotine delivery system (ENDS). Objective: This study aimed...
Background: Adults who smoke cigarettes may reduce their exposure to cigarette smoke by switching completely or partially to an electronic nicotine delivery system (ENDS). Objective: This study aimed to investigate the use patterns of a novel ENDS, over 8 weeks, among U.S. adults who smoke cigarettes daily. The objectives were to assess the proportion of participants who switched completely and any changes in cigarette consumption. Methods: This actual use study assessed the use of a novel ENDS with two variants (tobacco and menthol) among exclusive cigarette smokers (n = 353) and dual users of cigarettes/ENDS (n = 367). Use of ENDS and cigarettes was reported daily during a 1-week baseline and during an 8-week observational period, during which participants could also use the novel ENDS. Use of, complete switching to, and sensory experience of both novel ENDS variants and cigarette consumption use patterns were assessed at the end of the observational period and compared to baseline. Results: At the end of the observational period, over 85% of both study groups used the novel ENDS and 4% switched completely. Additionally, 25% of both study groups reduced their cigarette consumption by 50% or more. A higher proportion of participants used the menthol variant, which was also more positively evaluated in terms of taste, smell, and aftertaste than the tobacco variant. Conclusions: This study indicates that adults who smoke cigarettes daily can switch to the novel ENDS, using it exclusively or substantially reducing their cigarette consumption. These results complement the scientific evidence suggesting that ENDS are an acceptable alternative to cigarette smoking among adults who would otherwise continue to smoke.
Background: Untreated dental caries is the most common health condition globally. Because of this, new strategies need to be developed to reduce the manifestations of dental caries. Objective: The aim...
Background: Untreated dental caries is the most common health condition globally. Because of this, new strategies need to be developed to reduce the manifestations of dental caries. Objective: The aim of this study was to develop and test a machine learning (ML) algorithm for detecting present and predicting future carious lesions in the adolescent population, utilizing a set of easy- to-collect predictive variables. In addition, another aim was to deal with an imbalanced and small dataset with an oversampling method. Methods: This population-based study was conducted among secondary schoolchildren, between 13–17 years of age, from northern parts of Finland in 2022. After the inclusion criteria was met, a total of n=218 participants were included in this study. The inclusion criteria consisted of participants having completed a web-based risk assessment questionnaire and undergone a clinical examination at Public Healthcare Services. Dental caries (ICDAS4-6) and active initial caries (ICDAS2+,3+) were considered as outcomes. Several predictors, such as behavioral and dietary habits, were included. An eXtreme Gradient Boosting (XGBoost) model was developed, tested and assessed for its predictive performance. A 4-fold cross-validation (CV) was performed using the nested resampling technique. The random over-sampling examples (ROSE) method and the k-nearest neighbors (KNN) classifiers were utilized for all four folds. The mean (SD) performance of all folds was computed. Results: The prevalence of dental caries was 65.56% (ICDAS2+,3+,4-6). The mean (SD) area under the curve (AUC) was 0.769 (0.042) and the mean (SD) F1-score was 0.816 (0.055) for the XGBoost model. Similarly, the mean (SD) AUC and mean (SD) F1-scores after oversampling were 0.744 (0.045) and 0.787 (0.035), respectively. The SHapley Additive exPlanations (SHAP) values were calculated for all four folds to assess feature importance, revealing that previous dental fillings were the feature most strongly associated with the need for restorative treatment. Conclusions: Based on performance metrics, the ML algorithm developed and tested in this study can be considered good. The ML algorithm could serve as a cost-effective screening tool for dental professionals in identifying the risk the future restorative treatment needs. However, future studies with longitudinal cohorts and longitudinal data, along with external validation for generalizability, are needed to validate our model.
Background: The proliferation of social media has reshaped healthcare decision-making, enabling patients to access diverse information sources beyond traditional referrals. In maxillofacial surgery, w...
Background: The proliferation of social media has reshaped healthcare decision-making, enabling patients to access diverse information sources beyond traditional referrals. In maxillofacial surgery, where trust and expertise are critical, the interplay between digital platforms and conventional networks remains underexplored, particularly in non-Western settings like Iran. Understanding how patients navigate these channels offers insights into evolving healthcare behaviors and informs strategies to enhance patient-centered care. Objective: This study aimed to evaluate the influence of social media platforms (Google and Instagram) compared to personal recommendations on maxillofacial surgeon selection among Iranian patients, assessing decision-making factors, trust perceptions, and concerns about information accuracy. Methods: A cross-sectional survey was conducted with 384 patients at maxillofacial surgery clinics in Isfahan, Iran, in autumn 2023. Data on demographics, pathways to surgeon selection, social media use (Google and Instagram), decision-making factors, trust perceptions and concerns about information accuracy were collected via structured questionnaires. Descriptive statistics and one-sample t-tests assessed the impact and reliability of digital platforms. Results: Personal recommendations dominated surgeon selection (62.2%), far surpassing Google (19.5%) and Instagram (2.9%). While 41.7% and 31.0% of patients used Google and Instagram, respectively, their impact on decision-making was significantly below average (p < 0.001). Patient-generated content (e.g., reviews: 37.5% for Google, 40.9% for Instagram) and professional credentials (30.2% for Google) were pivotal in decision-making and trust, yet moderate concerns about accuracy underscored skepticism toward digital sources. The majority of participants were female (60.7%), aged 21–30 (30.5%), employed (41.4%), and without prior surgery (53.4%). Conclusions: Social media plays a supplementary rather than primary role in maxillofacial surgeon selection in Iran, with traditional networks retaining primacy. The reliance on credible patient feedback and credentials highlights the need for verified online content to enhance trust. These findings, contrasting with higher digital reliance in aesthetic surgery contexts, suggest cultural and procedural influences on platform use, advocating for strategies to bridge digital credibility gaps in healthcare decision-making.
Background: Personal Health Records (PHRs) are increasingly promoted as tools to enhance patient engagement and healthcare efficiency. Despite their growing prevalence, limited evidence exists from na...
Background: Personal Health Records (PHRs) are increasingly promoted as tools to enhance patient engagement and healthcare efficiency. Despite their growing prevalence, limited evidence exists from nationally representative samples assessing PHR satisfaction—especially when comparing individuals with and without prior PHR experience. Objective: To examine determinants of PHR user satisfaction in a nationally representative UK sample by comparing individuals with experience using PHRs to those without, including perceptions of utility, functionality, and cost-related benefits. Methods: We surveyed a nationally representative sample of UK adults (N = [insert N here]) through an online panel. Participants were divided into two groups: (1) those with PHR experience, who answered perception-based questions about actual use, and (2) those without PHR experience, who responded to analogous questions framed hypothetically. Descriptive statistics and t-tests were used to compare satisfaction levels, perceived utility, and feature valuation across the two groups. Results were also benchmarked against data from Canadian users for broader context. Results: Respondents with PHR experience rated their systems positively on ease of use, scheduling efficiency, and provider communication. UK users scored PHRs slightly lower than Canadian counterparts, though systems differed in design. Both groups highly valued access to health information, lab results, and appointment scheduling. Participants reported avoiding some clinic and emergency visits due to PHR use, resulting in savings on transportation, parking, and time off work. Those without experience tended to overestimate their ability to manage family members’ health and had high expectations for PHR functionality—expectations that were not implausible but reflected current implementation gaps. Experienced users also expressed interest in broader data access and greater system convenience. Conclusions: PHR usage in the UK is associated with high user satisfaction and tangible material and non-material benefits. However, there is a gap between expected and actual functionality, particularly among non-users. Policymakers and developers should consider these findings when expanding access to PHRs and improving their usability and feature set. This study adds value by using a nationally representative sample and by comparing both user and non-user perspectives.
Background: Social media has become a primary source of infant feeding guidance, but content accuracy remains unverified. While the World Health Organization (WHO) and American Academy of Pediatrics (...
Background: Social media has become a primary source of infant feeding guidance, but content accuracy remains unverified. While the World Health Organization (WHO) and American Academy of Pediatrics (AAP) endorse breastfeeding for its health benefits, formula feeding is frequently promoted as an alternative. Objective: This study evaluates the quality, engagement patterns, and feeding recommendations of infant-feeding videos on YouTube, Bilibili, and TikTok to inform platform content policies and viewer decision-making. Methods: On November 1, 2024, searches were conducted with the terms “Breastfeeding” and “Formula Feeding” on YouTube, along with “母乳喂养” (breastfeeding) and “奶粉喂养” (formula feeding) on Bilibili and TikTok. The first 100 videos from each platform were collected based on the default sorting, with promotional and unrelated material excluded. Video details were documented, and their quality was measured using the Global Quality Score (GQS), the Video Information and Quality Index (VIQI), and a modified DISCERN (mDISCERN) tool. Results: A total of 88 YouTube videos, 83 Bilibili videos, and 84 TikTok videos posted between September 2019 and November 2024 qualified for this study. TikTok clips drew the most audience interaction, while YouTube clips showed higher reliability based on mDISCERN ratings. No major differences emerged regarding feeding advice or the proportion of professional creators across platforms. However, professional content was of markedly higher quality and tended to favor breastfeeding, whereas non-professionals more often highlighted formula feeding. Additionally, formula-related videos generally attracted stronger engagement. Correlation tests revealed a clear positive association between engagement metrics and video quality on Bilibili, but this pattern was less pronounced on YouTube and TikTok. Conclusions: Short-form platforms amplify formula-feeding narratives driven by algorithmic biases and unregulated commercial interests, often conflicting with WHO guidelines. Professional health entities predominantly share evidence-based breastfeeding guidance through less engaging long-form content. Systemic interventions are needed: Algorithmic prioritization of certified health content;WHO Code-compliant digital marketing regulations;AI-driven misinformation filters;Micro-influencer partnerships for breastfeeding advocacy. This multi-platform analysis highlights critical tensions between engagement-driven content ecosystems and public health priorities in infant nutrition.
Background: Osteoarthritis (OA) is a chronic degenerative joint condition and is the 15th major cause of disability worldwide. Family physicians play a significant role in managing these patients; the...
Background: Osteoarthritis (OA) is a chronic degenerative joint condition and is the 15th major cause of disability worldwide. Family physicians play a significant role in managing these patients; their up-to-date knowledge is essential for evidence-based management. Objective: This study assesses family physicians’ knowledge, attitude, and practice toward OA management. Furthermore, it explores knowledge gaps and discrepancies in practice and compares them with similar studies in the Arabian Peninsula. Methods: We conducted a cross-sectional online survey at Primary Healthcare Corporation (PHCC), Qatar. We sent a targeted online survey link via PHCC intranet email to 724 family physicians working across twenty-eight health centers in Qatar. Results: About 100 family physicians responded to the survey. Out of 100, 75 (75%) were male, 59 out of 100 (59%) were consultants, and the average age of respondents was 48 (SD 7.1). Overall knowledge of family physicians was 76.7%, exhibiting a positive attitude and good practice. A substantial majority of family physicians, 78 out of 100 (78%), acknowledged that OA adversely affects patients’ mental well-being, leading to anxiety and concern. 75 out of 100 (75%) of the participants believed they had adequate training to manage OA. 88 out of 100 (88%) family physicians frequently recommended non-pharmacological management approaches, particularly weight loss. Oral non-steroidal anti-inflammatory drugs (NSAIDs) were offered (75%) most of the time by general practitioners compared to specialists (16.7%) (P=.019). Notably, female physicians exhibited significantly higher utilization rates of pharmacological treatments, which include topical capsicum (P=.013), topical NSAIDs (P=.048), and oral NSAIDs (P=.049), and non-pharmacological treatment like thermotherapy (P=.011). Conclusions: Overall, this study found that PHCC family physicians’ knowledge, attitude, and practice in managing OA were good. However, targeted educational interventions are required, along with professional development programs, to promote evidence-based practices and address gender disparities in prescribing. Future research is necessary to delve deeper into the factors that contribute to the existing gaps in prescribing behavior between male and female physicians. Enhancing OA management further can lead to better patient outcomes and improved quality of care.
Background: Effective management of cardiometabolic conditions requires sustained positive nutrition habits, often hindered by complex and individualized barriers. Direct human management is simply no...
Background: Effective management of cardiometabolic conditions requires sustained positive nutrition habits, often hindered by complex and individualized barriers. Direct human management is simply not scalable, while deterministic automated approaches to nutrition coaching may lack the personalization needed to address these diverse challenges. Objective: We report the development and validation of a novel large language model (LLM)-powered agentic workflow designed to provide personalized nutrition coaching by directly identifying and mitigating patient-specific barriers. Methods: We used behavioral science principles to create a comprehensive workflow that can map nutrition-related barriers to corresponding evidence-based strategies. First, a specialized LLM agent intentionally probes for and identifies root causes of a patient’s dietary struggles. Subsequently, a separate LLM agent delivers tailored tactics designed to overcome those specific barriers. We conducted a user study with individuals with cardiometabolic conditions (N=16) to inform our workflow design and then validated our approach through an additional user study (n=6). We also conducted a large-scale simulation study, grounding on real patient vignettes and expert-validated metrics, where human experts evaluated the system’s performance across multiple scenarios and domains. Results: In our user study, the system accurately identified barriers and provided personalized guidance. Five out of 6 participants agreed that the LLM agent helped them recognize obstacles preventing them from being healthier, and all participants strongly agreed that the advice felt personalized to their situation. In our simulation study, experts agreed that the LLM agent accurately identified primary barriers in more than 90% of cases. Additionally, experts determined that the workflow delivered personalized and actionable tactics empathetically, with average ratings of 4.17-4.79 on a 5-point Likert scale. Conclusions: Our findings demonstrate the potential of this LLM-powered agentic workflow to improve nutrition coaching by providing personalized, scalable, and behaviorally-informed interventions. Clinical Trial: NA
Background: The global incidence of spinal cord injury (SCI) is between 10 and 80 new cases per million people each year, with more traumatic injuries occurring than non-traumatic. This equates to bet...
Background: The global incidence of spinal cord injury (SCI) is between 10 and 80 new cases per million people each year, with more traumatic injuries occurring than non-traumatic. This equates to between 250,000 and 500,000 injuries worldwide, per year. In the UK it is estimated that 4400 people per year sustain a SCI. People with tetraplegia report upper limb function as their highest priority for improvement after SCI. Using immersive virtual reality (VR) headsets, physical rehabilitation exercises can be completed in engaging digital environments. Immersive VR therefore has the potential to increase the amount of therapy undertaken, leading to improvements in arm and hand function. There is little evidence supporting immersive VR as exercise in SCI, especially while SCI patients are undergoing acute rehabilitation. This study recruited people with tetraplegia and therapists to establish the design direction for a VR-based upper limb exercise platform. In spinal cord injury research, co-design of new interventions is not a widely adopted approach, yet people with SCI want to contribute with their expert knowledge on their experiences of SCI. Objective: To explore the lived experiences of people with tetraplegia and specialist SCI therapists related to acute upper limb rehabilitation and to co-design immersive virtual reality-based upper limb activities. Methods: Seven focus groups were conducted online using Microsoft Teams: four with people with tetraplegia (n = 15, age range 36-65 years) and three with occupational therapists and physiotherapists specialising in spinal cord injury rehabilitation (n = 11). Participants were asked to discuss their experiences and expertise about acute SCI upper limb rehabilitation and their opinions on the use of VR for upper limb rehabilitation. The transcripts were analysed using content analysis enabling the proposition of design characteristics of a VR-based intervention for upper limb exercise. Results: The study identified five major themes describing the clinical features, treatment, and recovery of spinal cord injured people during the acute stage of SCI, and suggestions for the design of a VR intervention in treating the upper limbs following SCI. The results highlighted what motivates people with SCI to participate in therapy and how these motivators could be encouraged and maintained using VR. These findings can be used to design accessible VR applications for use by people with SCI and their therapists. They can also contribute to the better understanding of the advantages of using VR as an adjunct to upper limb rehabilitation, as well as features of VR-based interventions to avoid. Conclusions: The themes identified in this study allow the elicitation of software requirements for a bespoke immersive VR platform for upper limb rehabilitation following spinal cord injury. Additionally, participants used their expertise to suggest factors that would enable the development of a usable and effective intervention as well as identifying potential pitfalls and software features to avoid during the intervention development.
Background: Type 2 Diabetes Mellitus (T2DM) is a chronic disease that requires long-term management, including behavioral changes in self-care to prevent complications. Health education is an essentia...
Background: Type 2 Diabetes Mellitus (T2DM) is a chronic disease that requires long-term management, including behavioral changes in self-care to prevent complications. Health education is an essential strategy for improving self-care among T2DM patients. However, there remains variability in the educational approaches used and their effectiveness in enhancing patient adherence to self-care practices. Objective: This study aims to explore and analyze various forms of health education that influence improving self-care behaviors in T2DM patients. Methods: This study employs a scoping review approach with five main stages: (1) formulating research questions, (2) searching for relevant studies, (3) screening and selecting suitable research, (4) mapping the data, and (5) thematic analysis and summarizing the findings. The process follows the PRISMA-P protocol and evaluation using the PRISMA checklist. The literature analyzed comes from international journals in the PubMed, ProQuest, and Scopus databases. The criteria include full-text articles, English language, and publication dates between 2015 and 2024, focusing on diabetes-related subjects. Inclusion and exclusion criteria follow the PCC model. A total of 26 articles were analyzed in this study. Results: This scoping review identifies various forms of health education that influence improving self-care behaviors in T2DM patients. From the 26 studies analyzed, it was found that digital technology-based interventions, such as mobile applications, telehealth, and video-based education, demonstrated significant improvements in self-care behaviors. Additionally, personalized, face-to-face education enhances patient understanding and adherence in the short term but requires reinforcement through follow-up interventions to sustain its benefits. Although these interventions were adequate, the main challenges identified were the heterogeneity of study designs, the relatively short duration of interventions, and sample size limitations, which may affect the generalizability of the research findings. Overall, technology-based health education shows excellent potential for supporting long-term disease management. Conclusions: Technology-based health education approaches effectively improve self-care behaviors in T2DM patients. These findings can serve as a foundation for developing more optimal health education strategies.
Background: As restrictive abortion laws continue to emerge in various states of the United States, pregnant individuals are turning to alternative channels to seek abortion medication, one of which i...
Background: As restrictive abortion laws continue to emerge in various states of the United States, pregnant individuals are turning to alternative channels to seek abortion medication, one of which is engaging in self-managed medication abortion, outsourcing the medicines from online websites without any medical prescriptions. Objective: This study explores the phenomenon of self-managed abortion outsourcing medication online by
focusing mainly on the motivational factors and concerns behind such a decision and the abortion seekers' journey throughout this process. Methods: Through the qualitative analysis of 20 semi-structured interviews with abortion seekers living in the U.S., we have examined the motivations, experiences, and challenges encountered by individuals seeking abortion medication online. Results: Our research provides evidence that, although using illicit e-pharmacies can lead to counterfeit medication and health consequences, these platforms create the perception of complete anonymity for pregnant individuals. Hence, they offer a way to find abortion medication detached from pregnant individuals' physical communities, circumventing the stigma associated with seeking an abortion and the socio-cultural consequences of it, leading pregnant individuals to prefer these systems compared to legal options. Conclusions: This research uncovers the motivational factors and concerns behind the growing reliance on online tools to outsource the medication necessary for engaging in self-managed abortion.
Background: Nigeria faces severe economic losses ($14 billion annually) and high youth unemployment (33.3%) due to persistent skills gaps, exacerbated by sectoral disparities (e.g., 68% ICT shortages...
Background: Nigeria faces severe economic losses ($14 billion annually) and high youth unemployment (33.3%) due to persistent skills gaps, exacerbated by sectoral disparities (e.g., 68% ICT shortages vs. 63% agricultural deficits) and systemic inequities in education and vocational access. Despite growing HRM interventions, empirical evidence on their efficacy remains limited, necessitating a comprehensive review to guide policy. Objective: This study analyzes Nigeria’s sector-specific skills gaps, evaluates the effectiveness of HRM interventions (apprenticeships, digital upskilling, PPPs), and proposes actionable frameworks to align workforce development with labor market demands. Methods: A narrative review of peer-reviewed literature (2015–2023), institutional reports (World Bank, PwC, NBS), and case studies (e.g., Andela’s model) was conducted. Data were synthesized to compare regional benchmarks (Kenya’s TVET, South Africa’s HRM reforms) and Nigeria’s performance (talent readiness score: 42/100). Results: Key findings include: (1) Vocational training (60% readiness) outperforms tertiary education (40%); (2) Apprenticeships and PPPs show high impact (30% job placement increase); (3) Urban-rural and gender disparities persist (women 30% less likely to access training). Private-sector models demonstrate scalability but require policy support. Conclusions: Nigeria’s skills crisis demands urgent, context-sensitive interventions. Blended strategies (e.g., industry-aligned curricula, gender-inclusive vocational programs) could unlock 5% annual GDP growth. Prioritize: (1) National skills councils to standardize certifications; (2) Tax incentives for employer-led training; (3) Digital infrastructure for rural upskilling. Closing Nigeria’s skills gaps would mitigate economic losses, reduce inequality, and enhance global competitiveness, transforming its youth bulge into a sustainable demographic dividend.
Background: The usability of medical device software (SW) significantly influences the clinical utility and effectiveness of treatment. Importantly, user experience (UX) with cognitive rehabilitation...
Background: The usability of medical device software (SW) significantly influences the clinical utility and effectiveness of treatment. Importantly, user experience (UX) with cognitive rehabilitation SW can directly affect treatment adherence and outcomes. Objective: To evaluate the usability of tablet-based cognitive rehabilitation SW and identify areas for improvement of the user-centered UX/user interface (UI). Methods: A formative evaluation utilizing cognitive walkthrough and the system usability scale (SUS) was conducted with occupational therapists, the primary users of the SW. User errors that may potentially occur during system navigation and interface issues were analyzed, whereas the usability level was quantitatively evaluated based on the SUS. Results: We identified the following key areas for improvement: adjustment of keypad size and position, addition of information before cognitive development evaluation, enhancement of the evaluation completion method, improvement of user manual accessibility, and refinement of the hint button and difficulty level adjustment interface. The mean SUS score was 73.5 points (B- grade), indicating an overall “Acceptable” usability level. Furthermore, the need for improvement was also identified in some UX/UI elements (e.g., utility, complexity, integration, unity, and satisfaction). To address these issues, this study proposed measures for enhancing UX/UI, including improving UI intuitiveness, optimizing the evaluation process, and improving user manual accessibility. Conclusions: The measures proposed for identifying the usability tasks of digital rehabilitation SW and improving the UX may contribute to optimizing the UX of medical device SW and increase the prospect of clinical adoption.
Background: The polymorphisms of protein or protein family are the divergences of amino acid and nucleotide sequences which provided much useful information on the divergent evolution of proteins.RNA...
Background: The polymorphisms of protein or protein family are the divergences of amino acid and nucleotide sequences which provided much useful information on the divergent evolution of proteins.RNA viruses, such as hepatitis C virus (HCV), influenza virus, and SARS-CoV-2, are notorious for their ability to evolve rapidly under selection in novel environments. It is known that the high mutation rate of RNA viruses can generate huge genetic diversity to facilitate viral adaptation. For hepatitis C virus (HCV), The vast diversity of HCV sequences is mainly due to the error-prone RNA polymerase. RNA viruses offer a unique opportunity for the experimental study of molecular evolution. Objective: In this paper, I analyzed the polymorphisms of enzyme NS5B of HCV for which sequence variation amongst most isolates have been characterized and protein structures of the catalytic domain form of this enzyme are also known. Protein structure acts as a general constraint on the evolution of viral proteins. One widely recognized structural constraint explaining evolutionary variation among sites is the relative solvent accessibility (RSA) of residues in the folded protein. The relative solvent accessibility, which measures the extent to which amino acid side chains are exposed on the surface of the protein or buried within the protein structure, has been shown to predict site-wise evolution in eukaryotes, bacteria and some viral proteins. However, to what extent RSA in the protein can be used more generally to explain protein adaptation in other viruses and in different proteins of any given virus remains an open question. Methods: Multiple protein and nucleotide sequences were collected from databank. Statistical analysis were used to analyse polymorphisms with structural characterics.Structure function relationship were studied for this protein. Results: I found that protein sequence polymorphisms are correlated with residue solvent accessibility. Apart from polymorphism, I found conservatism at every level among site is universal for this protein.I also found that purifying selection at different levels was strong in the forming of the polymorphism and conservatism of this protein. Conclusions: Despite the high mutation rate owning to its error-prone RNA polymerase, there is still considerable conservation of virus encoded NS5B protein (and its other encoded proteins, data not shown) among all genotypes found all over the world and there is strong conservative within every genotype and subtype, showing that the selection against deleterious mutations is strong and these purifying selection is the predominant form of selection at the molecular level. Simmonds P proposed that there were constraints on RNA virus evolution at the virus RNA secondary structure level, my study of the nature of factors determining levels its ‘ecological niche’ in the human liver which include the variation of virus proteins also show that there are strong constraints on sequence change of this virus (encoded proteins) both on protein structural and functional and protein stability levels.
Background: Artificial intelligence (AI) and telemedicine have great potential to transform dermatology care delivery, but patient perspectives on these technologies have not been systematically compa...
Background: Artificial intelligence (AI) and telemedicine have great potential to transform dermatology care delivery, but patient perspectives on these technologies have not been systematically compared. Objective: To examine patient perspectives on AI and telemedicine in dermatology to inform implementation strategies as these technologies increasingly converge in clinical practice. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Embase databases between August 2024 and October 2024. We identified 48 articles addressing patient perspectives on AI and telemedicine in dermatology, with none directly comparing views on both technologies. Results: Several distinct themes emerged regarding patient perspectives on these technologies: willingness to use, perceived benefits and risks, barriers to implementation, and conditions necessary for successful integration. Findings revealed that patients express hesitancy towards AI-based diagnoses that lack dermatologist involvement, while preferences for teledermatology varied by appointment reason, age, and prior technology exposure. Patients' motivations for AI implementation are connected to AI's potential for quicker diagnoses and improved triage efficiency, while telemedicine addresses logistical challenges such as reduced travel time and improved appointment availability. Both technologies were perceived to improve accessibility and diagnostic efficiency, though patients expressed concerns about AI's limited communication abilities and teledermatology's limits in performing physical examinations. Primary adoption barriers for these modalities included technological limitations and trust concerns, with patients emphasizing the need for dermatologist oversight, transparency, and adequate educational resources for successful integration. Conclusions: The complementary strengths of AI and teledermatology suggest they could mitigate each other's limitations when integrated—AI potentially enhancing teledermatology's diagnostic accuracy while teledermatology addresses AI's lack of human connection. By thoroughly examining these perspectives, this review may serve as a guide for patient-centered technological integration in the future landscape of accessible dermatologic care.
Background: Students pursuing health professional education, are preparing for professions where they will interact with people in vulnerable life situations. Therefore, it is crucial that these stude...
Background: Students pursuing health professional education, are preparing for professions where they will interact with people in vulnerable life situations. Therefore, it is crucial that these students develop knowledge and skills in interaction, communication, and guidance during their education. In the context of health professions, this can be described as developing therapeutic competencies. Utilizing virtual learning environments, 360-degree video, and VR technology, the resource allows students to explore, observe, and practice therapeutic conversations in a safe setting. Objective: This study explores the use of a virtual learning resource in the development of therapeutic competence among students training to become health care professionals. Methods: The study was set up using an approach inspired by action research, in the sense that researchers have been closely involved in the development and testing process. An important prerequisite was to facilitate systematic development and improvement based on students' experiences with using the learning resource.
The testing of the learning resource was conducted with two different test groups, recruited from study program leaders at a faculty of health science. A total of twelve students participated. The students were interviewed in focus groups. Results: The results indicated that students experienced increased engagement and learning outcomes compared to traditional teaching methods. They reported that the interactive approach provided a deeper understanding of complex topics, such as legislative frameworks and therapeutic practice, and that the resource promoted the development of practical skills. Conclusions: The study concludes that VR technology can be valuable in healthcare education, helping to prepare students for challenges in professional practice.
Background: Digital phenotyping refers to the objective measurement of human behavior via devices such as smartphones or watches and constitutes a promising advancement in personalized medicine. Digit...
Background: Digital phenotyping refers to the objective measurement of human behavior via devices such as smartphones or watches and constitutes a promising advancement in personalized medicine. Digital phenotypes derived from heart rate, mobility, or sleep schedule data utilized in psychiatry to either diagnose individuals with psychotic disorders, or to predict relapse as a binary outcome. Machine learning models so far have achieved predictive accuracies that are significant but have not large enough for clinical applications. This could hinge on broad clinical definitions, which encompass heterogenous symptom and sign ensembles, thus hindering accurate classification. The five-factor model for the Positive and Negative Symptom Scale (PANNS), which entails five independently varying dimensions, is thought to better capture symptom variability. Utilizing the specific definitions of this refined clinical taxonomy in combination with digital phenotypes could yield more precise results. Objective: The present study aims to investigate potential links between digital phenotypes and each dimension of the five-factor PANNS model. We also assess whether clinical, demographic and medication variables confound said relations. Methods: In the E-prevention study, heart rate, accelerometer, gyroscope and sleep schedule data were continuously collected via smartwatch for a maximum of 24 months, in 38 patients with psychotic spectrum disorders. Obtaining the mean and standard deviation for each patient-month, resulted in a database consisting of more than 740 monthly data points. A linear mixed model analysis was used to ascertain connections between monthly aggregated heart rate and mobility features and the 5 symptom dimension scores of PANNS, obtained during monthly clinical interviews. Results: The positive symptom dimension was associated with increased sympathetic and decreased parasympathetic tone, while the negative dimension was mainly connected to decreased mobility during wakefulness. For the excitement/hostility and the depression/anxiety dimension we report an increase in motor activity during sleep while only excitement/hostility was related to increase in sympathetic heart activation and decreased sleep. The cognitive/disorganization dimension was related to decreased variability in sympathetic activation during wakefulness. Conclusions: This study provides evidence that biological changes assessed by continuous measurement of digital phenotypes could be characteristic of specific symptom clusters rather than entire diagnostic categories of psychotic disorders. These results support the use of digital phenotypes not only as means for remote patient monitoring, but as concrete targets for biomarker research in psychotic disorders.
Background: In recent years, digital biomarkers have become increasingly popular in research and clinical investigations for therapeutic interventions. Traditionally, biomarkers are classified as phys...
Background: In recent years, digital biomarkers have become increasingly popular in research and clinical investigations for therapeutic interventions. Traditionally, biomarkers are classified as physiological, pathological, and anatomical agents with specific features or characteristics for biological processes, including monitoring mechanisms and assays. As new generation of biomarkers, wearable technologies, or mobile health (mHealth) are rapidly expanding as outpatient tools for early disease screening and diagnosis. Digital biomarkers are non-imaging (non-invasive) sensors that are used to collect real-time data, perform measurements and/or enter metrics value in portable devices such as smartphones, and immersive technologies for alternatives to conventional biomarkers. When pairing with other advanced technologies including machine learning, and algorithm, multimodal biomarkers are proven efficient for biological monitoring including cognitive and behavioural changes. However, the socio-technological aspects are not well studied, and no specific policy exists for data collection, management and governance. Recent research raised several concerns relating to digital biomarkers including ethical issues, data privacy and security and data governance. This paper presents a short review highlighting the critical issues with digital biomarkers, considering their proliferation in healthcare. Objective: This research presents an in-depth analysis with critical issues surrounding non-imaging biomarkers. Drawing from empirical data, the literature is scoped systematically to present an in-depth analysis where the issues surrounded non-digital biomarkers are highlighted and examined Methods: Comprehensive electronic searches were conducted in the literature as a first steps, following a five-stages approach for scoping method in social science described by Arksey and O’Malley, (2005). Data from six public databases were analysed searched. Key words: “non imaging biomarker” “safety”, “privacy”, “security” narrow the search to focus relevant issues addressing the problem questions that retrieve and synthesise existing data; in addition to “ethics”, and “social” concerns. Our selection purpose was meant to explore the literature and summarise findings and identifying gaps. Results: Emerging App-based devices exploit behaviour patterns to predict or response to the user’s cognitive states or cognitive manipulation. Data collected can potentially be used to trigger mental health interventions. Table 2 highlighted the four types of risks identified (1) ethical concerns, (2) privacy, (3) security/cyber breach, (4) data safeguarding/data governance, and (5) policy/regulation/governance (Table 1). The risk of data hacking through data storage sites increased significantly with open platforms available to users, including those who are inexperienced and vulnerable users. Conclusions: Digital biomarkers enable individuals to remotely personalized and self-assessed their condition for better health management. Between 2014 and 2023, the digital market has seen a boom in digital health devices ranging Portable smartphone App connected wearable devices to neuromodulating devices. However, the socio-technological aspects are not well studied, and no specific policy exists for data collection, management and governance. Recent research raised several concerns relating to digital biomarkers including ethical issues, data privacy and security and data governance. Clinical Trial: N/A
Background: Central venous catheterization (CVC) is a very common procedure performed across medical and surgical wards as well as intensive care units. It provides relatively extended vascular access...
Background: Central venous catheterization (CVC) is a very common procedure performed across medical and surgical wards as well as intensive care units. It provides relatively extended vascular access for critically ill patients, in order to the administer intricate life-saving medications, blood products and parenteral nutrition.
Major vascular catheterization provides a risk of easy accessibility and dissemination of catheter related infections as well as venous thromboembolism. Therefore, its crucial to ensure following standardized practices while insertion and management of CVC in order to minimize the infection risks and procedural complications. The aim of these central line insertion guidelines is to address the primary concerns related to predisposition of Central line associated blood stream infections (CLABSI). These guidelines are evidence based and gathered from pre-existing data associated with CVC insertion.
The most common used sites for central venous catheterization are internal jugular and subclavian veins as compared to femoral veins. Catheterization of these vessels enables healthcare professionals to monitor hemodynamic parameters while ensuring lower risks of CLABSI and thromboembolism. Femoral vein is less preferred due to advantage of invasive hemodynamic monitoring and low risk of local infection and thromboembolic phenomena.
CVC can be inserted using Landmark guided technique and ultrasound guided techniques. Following informed consent, the aseptic technique for CVC insertion includes performing appropriate hand hygiene and ensuring personal protective measures, establishing and maintaining sterile field, preparation of the site using chlorhexidine, and draping the patient in a sterile manner from head to toe. Additionally, the catheter is prepared by pre-flushing and clamping all unused lumens, and the patient is placed in the Trendelenburg position. Throughout the procedure, maintaining a firm grasp on the guide wire is essential, which is subsequently removed post-procedure. It is followed by flushing and aspirating blood from all lumens, applying sterile caps, and confirming venous placement. Procedure is ended with cleaning the catheter site with chlorhexidine, and application of a sterile dressing.
Hence, formal training and knowledge of standardized practices of CVC insertion is essential for health care professionals in order to prevent CLABSI. Our audit assesses the current practices of doctors working at a tertiary care hospital to analyze their background knowledge of standard practices to prevent CLABSI during insertion of CVC. Objective: This study was aimed to audit and re-audit residents’ practices of central venous line insertion in medical and nephrology units of A Tertiary Care Hospital of Rawalpindi, Pakistan and to assess the adherence of residents to checklist and practice guidelines of CVC insertion implemented by John Hopkins Hospital and American Society of Anesthesiologists. Methods: This audit was conducted as a cross sectional direct observational study and two-phase quality improvement project in the Medical and Nephrology Units of a Tertiary Care Hospital of Rawalpindi from December 2023 to February 2024.
After taking informed consent from patients and residents, CVC insertion in 34 patients by 34 individual residents was observed. Observers were given a purposely designed observational tool made from John Hopkins Medicine checklist and ASA practice guidelines for central line insertion, for assessment of residents’ practices.
First part contained questions regarding the demographic details of residents such as age, gender, year of post graduate training, and parent department, and data related to the procedure such as date and time of procedure, need of CVC discussion during rounds, site of CVC insertion, catheter type and type of procedure (Landmark guided CVC or Ultrasound guided CVC insertion). Second part included direct observational checklist based on checklist provided for prevention of intravascular catheter-associated bloodstream infections to audit the practices of residents during CVC insertion that included: adequate hand hygiene before insertion, adherence to aseptic techniques, using sterile personal protective equipment and sterile full body drape of patient, choosing the best insertion site to minimize infections based on patient characteristics.
The parameters observed to be done completely were scored "1" and the items not done were scored "0". The cumulative percentage of performed practices according to checklist, was satisfactory if it was 80% or more and unsatisfactory if it was less than 80%.
After initial audit, participants were given pamphlets with checklist incorporating John Hopkins Medicine checklist and ASA practice guidelines for CVC insertion. Re audit was performed one month after the audit, including same participants who participated in initial audit. The results of audit and re-audit were analyzed using SPSS version 25. Mean +/- SD was calculated for quantitative variables and Number (N) percentage was calculated for qualitative variables. Z- Test was applied on proportions of parameters and test scores to calculate Z –score and P value (<0.05 was significant). Results: Among the 34 participants, 44% of the participants belonged to Nephrology Department and 56% of participants belonged to Department of Internal Medicine.
32.3% residents were in their first year, 14.7% in second, 14.7 in third year, 17.6% in fourth year and 17.6% in 5th/Final year of training.
47% of the participants were male and 53% were female. Participants were aged between 27 and 34 years old, the median age at the time of audit was 29 years.
Landmark guided CVC insertion was performed in Subclavian Vein (73.5%) and Internal Jugular Vein (26.5%).
Post audit practices were improved from 73.5% to 94%. Conclusions: Our audit found that many of the residents adopted inadequate practices because of lack of proper training and institutional guidelines for CVC insertion. Our re-audit elaborated an improvement in the practices of residents following intervention with educational material. Our study underscores the importance of structured quality improvement initiatives in enhancing clinical practices and patient outcomes.
Background: Mental health concerns among adolescents and young adults have increased post-pandemic. Mental health literacy remains insufficient in this population despite its importance for health out...
Background: Mental health concerns among adolescents and young adults have increased post-pandemic. Mental health literacy remains insufficient in this population despite its importance for health outcomes. Gaming platforms, central to youth culture, offer potential for innovative health interventions. Objective: To co-design with Minecraft players and Twitch streamers, implement, and evaluate a gaming-based intervention delivered through Minecraft and broadcasted on Twitch to promote mental health literacy among adolescents and young adults (aged 15-25 years). Methods: Using a co-design approach with four streamers and a clinical psychologist, "#walkyourtherapist" was developed as a streaming event where a psychologist-streamer pair combined gameplay with mental health literacy education. A quasi-experimental comparative study evaluated the intervention through MHLq questionnaire (pre/post), observations, chat analysis, and interviews. A different streaming community served as the control group. Results: Three "#walkyourtherapist" sessions reached over 600 unique viewers. The intervention group was measured at baseline (n=97) and follow-up (n=43). Though these measurements cannot ensure the same individuals participated at both times, the community showed significant improvement in mental health literacy scores (from 94 to 104, p<0.01), particularly in knowledge of mental health problems, first aid skills, and self-help strategies. Streamers reported high satisfaction and increased personal mental health awareness. Conclusions: This innovative approach shows promising results for youth mental health promotion through gaming platforms. The successful engagement and improved literacy scores demonstrate the potential of virtually co-constructed interventions leveraging streamers within existing communities. Future research should focus on improving control group participation and maintaining long-term engagement to enable stronger evidence generation. Clinical Trial: ClinicalTrials.gov NCT06473857
Background: With rapid digitalisation, technologies are increasingly integrated as part of our everyday lives, and are becoming increasingly essential for individuals to participate in society. Techno...
Background: With rapid digitalisation, technologies are increasingly integrated as part of our everyday lives, and are becoming increasingly essential for individuals to participate in society. Technology presents opportunities to support healthy ageing, however the processes in which older adults select and integrate technologies into their daily live has not been well examined. Objective: This study uses the Selection, Optimisation and Compensation (SOC) Model to understand how older adults integrate technology into their everyday lives to live well. The two key research questions are as follows: 1.How do older adults describe their technology use and their choices, analysed with respect to SOC processes? 2. How do older adults perceive that technology is a part of living well? Methods: A descriptive qualitative study was conducted. Purposive sampling was used to recruit older adults who were aged 55 and above, living in the community, who speak and understand English, and resided in Australia. Five focus groups comprising 20 older adults were conducted. Data were analysed using hybrid inductive and deductive reflexive thematic analysis, based on the SOC Model Results: Older adults selected technology intentionally to enhance different aspects of their daily lives. Perceived ‘involuntary’ selection of technology could lead to feelings of resentment or frustration. Optimisation strategies included self-monitoring, integrating technology into daily routines, digital literacy and proficiency, and problem-solving skills. Compensatory strategies included choosing alternative technology that suited participants’ abilities or skills, and seeking support through informal or formal avenues. Conclusions: These findings provide important considerations for technology developers to design technology in collaboration with older adults to ensure that they align with needs and preferences. Digital literacy is not sufficient to empower older adults to use technology; when empowering older adults to use technology, service providers should also consider facilitating other intrinsic and extrinsic resources and skills. Clinical Trial: Not applicable.
Background: Labor shortages in healthcare pose significant challenges to sustaining high-quality care for people with intellectual disabilities (PwID). Social robots show promise in supporting both Pw...
Background: Labor shortages in healthcare pose significant challenges to sustaining high-quality care for people with intellectual disabilities (PwID). Social robots show promise in supporting both PwID and their healthcare professionals, yet few are fully developed and embedded in productive care environments. Implementation of such technologies is inherently complex, requiring careful examination of facilitators and barriers influencing sustained use. Objective: This research aims to evaluate the value creation and implementation of social robot Ivy for PwID and healthcare professionals, examining facilitators and barriers to sustained use across six care organizations. Methods: A qualitative field study was conducted involving 19 cases of robot implementation across six care organizations in the Netherlands; each case consisted of PwID (client) and the involved healthcare professionals. The study examined actual robot deployment in daily care practice between April-October 2023. Semi-structured interviews were conducted with healthcare professionals after two months of implementation. Analysis followed a thematic approach guided by the NASSS framework and a model for tracing facilitators of and barriers to the adaptive implementation of the robot. Facilitators were classified as key drivers (complex), enablers (complicated), minor benefits (simple), while barriers were categorized as deal-breakers (complex), obstacles (complicated), or minor hurdles (simple). Robot’s sustained use (i.e., robot use continuance at two months post-implementation) served as a key indicator of success. Results: After two months, robot use was sustained in 12 of 19 cases (63%). For successful cases, key value emerged for both clients (enhanced daily structure, improved emotional well-being through non-judgmental interactions, increased independence) and healthcare professionals (reduced workload through automation, improved quality of client interactions, reduced emotional burden). Sustained use was determined by client characteristics (cognitive capabilities, care predictability), healthcare professional factors (available time, digital competency), contextual conditions (timing, connectivity), and organizational support (training, resources). Main implementation barriers included complex/unpredictable care needs, insufficient programming time, and contextual factors influencing care environments. Conclusions: The findings inform long-term care organizations on the implementation and value of sustained use of social robot Ivy for both PwID and their caregivers. Social robot Ivy demonstrates potential for supporting care delivery to PwID when implemented under appropriate conditions. Success requires careful matching of robot capabilities with client needs, sufficient time and support for healthcare professionals, and stable care environments. Future research should examine longer-term sustainability and integrate direct client feedback.
Background: The synthesis of evidence in healthcare is essential for informed decision-making and policy development. This study aims to validate The Umbrella Collaboration® (TU®), an innovative, se...
Background: The synthesis of evidence in healthcare is essential for informed decision-making and policy development. This study aims to validate The Umbrella Collaboration® (TU®), an innovative, semi-automatic tertiary evidence synthesis methodology, by comparing it with Traditional Umbrella Reviews (TUR), which are currently the gold standard. Objective: The primary objective of this study is to evaluate whether TU®, an AI-assisted, software-driven system for tertiary evidence synthesis, can achieve comparable effectiveness to TURs, while offering a more timely, efficient, and comprehensive approach. Methods: This comparative study evaluated TU® against TURs across eight matched projects in geriatrics. For each selected TUR, a parallel TU® project was conducted using the same research question. Outcomes of interest (OoIs), effect sizes, certainty ratings, and execution times were systematically compared. Effect sizes were assessed both quantitatively, by transforming TUR metrics to Cohen’s d and correlating them with TU®’s RTU metric, and qualitatively, through categorical classifications (trivial, small, moderate, large). Certainty levels were compared by mapping GRADE ratings and TU®’s sentiment analysis scores onto a common 0–1 scale. Execution time was measured precisely in TU®, while TUR durations were estimated from literature benchmarks. Statistical analyses included chi-squared tests and Spearman correlations. Results: Eight TURs in geriatrics were matched with parallel projects using TU®. TU® replicated 84.9% (73/86) of the OoIs identified by TURs and reported an additional 337 OoIs, representing a 4.77-fold increase in outcome identification. In the comparison of effect size classifications, full concordance was observed in 50.0% of cases and consistent concordance (full plus one-level deviation) in 93.8%, with a moderate strength of association (Cramér’s V = 0.339). The correlation of transformed certainty values between TU® and GRADE yielded a statistically significant Spearman coefficient (ρ = 0.446; P = .025). The average execution time per TU® project was 4 hours and 46 minutes, compared to estimated durations of 6–12 months for TURs. Conclusions: The Umbrella Collaboration® demonstrated high concordance with TURs, replicating 84.9% of the outcomes identified by TURs and identifying nearly five times as many additional outcomes. The experimental effect size metric (RTU) showed moderate agreement with conventional measures, and the certainty ratings derived from sentiment analysis correlated acceptably with GRADE-based assessments. While further validation is needed, TU® appears to be a valid and efficient approach for tertiary evidence synthesis, offering a scalable and time-efficient alternative when rapid results are required.
The article is devoted to the use of garden therapy and swimming in the framework of the social and psychological rehabilitation of children affected by the war on the territory of Ukraine. The articl...
The article is devoted to the use of garden therapy and swimming in the framework of the social and psychological rehabilitation of children affected by the war on the territory of Ukraine. The article actualizes the problem of socialization disruption and psychological trauma experienced by children during the Russian-Ukrainian war in the period of 2022-2023 in the territories of the Eastern and Southern Ukraine. The article examines the mechanisms of the emergence of socialization problems among children who left the territory of active hostilities in Zaporizhzhia, which is located 30 kilometers from active hostilities. The article discusses the psychological problems faced by children who witnessed active hostilities during the Russian-Ukrainian military conflict. The paper analyzes the results of the experiment, which revealed a positive trend in the use of art therapy, garden therapy and swimming in the framework of the program of social adaptation and psychological rehabilitation of children who were subjected to social and psychological disorders during the Russian-Ukrainian military conflict. The article proposes the author's method of social and psychological rehabilitation of children affected by military conflicts and technological and natural disasters.
Background: To validate the application of the Human Activity Profile (HAP) questionnaire via telephone call in patients with cardiovascular disease (CVD). Objective: Objective of this study is to inv...
Background: To validate the application of the Human Activity Profile (HAP) questionnaire via telephone call in patients with cardiovascular disease (CVD). Objective: Objective of this study is to investigate the validity of applying the HAP questionnaire via telephone call to patients with cardiovascular disease participating in a cardiovascular rehabilitation program. Methods: Two scores were calculated based upon HAP scores: the maximum activity score (MAS), the number of the most difficult task the respondent is “still doing”; and the adjusted activity score (AAS), the number of items that the individual “stopped doing”, prior to the last one that he “still does”. Patients with CVD answered the HAP questionnaire on 2 random occasions, face-to-face and by telephone call. Results: Fifty-six patients with CVD (64.30% men) with a mean age of 75.14±10.28 years participated in this study. The MAS was similar in both applied modes (Face-to-face: 79.11±11.48; Telephone call: 82.71±7.48; p=0.101). Similarly, The AAS did not differ in both applied modes (Face-to-face: 69.11±14.18; Phone call: 71.21±13.43; p=052). There was high agreement between the two modes of administration (ICC - 0.999; 95%CI, 0.879-0.948; p<0.05). The mean bias and 95% limits of agreement evaluated by Bland-Altman plot for average applied face-to-face and the telephone call versus the mean difference in the MAS and AAS applied face-to-face and the telephone call were, respectively, -4.0 (95%CI 12.1 to -19.3) and -2.1 (95%CI 13.4 to -17.6). Conclusions: The MAS and AAS from HAP can be applied over the telephone call in patients with CVD. Clinical Trial: CAAE 58283422.0.0000.5134 (number: 5.646.387)
Background: Growing evidence indicates an association between cognitive impairments and sleep disorders, two highly prevalent public health conditions. However, the causality and direction of this ass...
Background: Growing evidence indicates an association between cognitive impairments and sleep disorders, two highly prevalent public health conditions. However, the causality and direction of this association are not clear. Objective: we conducted a two-sample MR analysis with the use of publicly available GWAS data, in order to assess the potential causal association between sleep disorder and cognitive performance. Methods: Genome-wide association study summary data of cognitive performance in 260354 participants from the Social Science Genetic Association Consortium Publication were used to identify general cognitive performance. Data for 386533 individuals taken from the Complex Trait Genetics Lab were used to identify insomnia disorder. Data for 345552 individuals taken from the Complex Trait Genetics Lab were used to identify morningness. The weighted median, inverse-variance weighting, and Mendelian randomization-Egger methods were used for the mendelian randomization analysis to estimate a causal effect and detect directional pleiotropy. Results: GWAS summary data were obtained from three combined samples, containing 260354, 386533, 345552 individuals of European ancestry. Mendelian randomization evidence suggested that cognitive performance decreased the onset of insomnia disorder (P<0.001), and cognitive performance could also be decreased by the morningness (P<0.05). In contrast, there were no reliable results to describe the relationship of insomnia disorder on cognitive performance and cognitive performance on morningness (P>0.05). Conclusions: Using large-scale GWAS data, robust evidence supports causal relationships of cognitive performance on insomnia disorder and morningness on cognitive performance, but no relationship of insomnia disorder on cognitive performance and cognitive performance on morningness was observed. This study indicates a potential marker for the early identification of sleep disorder, while also offering possible explanations for previously conflicting results.
Our study demonstrated the ability of ChatGPT-4 to answer 77.5% of all sampled text-based board review type questions correctly. Questions requiring recall of factual information were answered correct...
Our study demonstrated the ability of ChatGPT-4 to answer 77.5% of all sampled text-based board review type questions correctly. Questions requiring recall of factual information were answered correctly most often, with slight decreases in correctness as higher-order thinking requirements increased. Improvements to ChatGPT’s visual diagnostics capabilities will be required before it can be used reliably for clinical decision-making and visual diagnostics
Background: Colorectal cancer (CRC) incidence and mortality rates continue to be elevated even though effective screening methods are widely available. To increase CRC screening in primary care pract...
Background: Colorectal cancer (CRC) incidence and mortality rates continue to be elevated even though effective screening methods are widely available. To increase CRC screening in primary care practices, our team developed a tablet-based digital health program (mPATH®) designed to identify patients needing CRC screening, provide education, and empower patients to request a screening test via the program. Based on recommendations from clinical staff and providers in previous formative research to determine the best strategy to implement the program in primary care, we divided mPATH into two separate tablet programs: mPATH-CheckIn and mPATH-CRC. Objective: Our objectives were to qualitatively assess facilitators and barriers to implementing and maintaining mPATH in primary care clinics. Methods: After the practices implemented mPATH, we conducted telephone interviews with providers, clinic managers, front desk and nursing staff recruited from a subset of eight of the participating primary care clinics with varying size and degrees of adoption of mPATH. The interview was designed to collect perceived facilitators and barriers to using mPATH. All interviews were administered by a single project staff member with no prior contact with participants. Interviews were audio recorded and reviewed and respondents were offered a $50 gift card. Two study team members independently coded each interview transcript and developed a codebook to identify meaningful categories in the database. The coders met periodically to resolve discrepancies. Data within each category were abstracted and synthesized into themes. Themes were determined inductively by prevalence and salience in the data per the principles of thematic analysis. Results: A total of 33 interviews were completed between September 2021 and April 2023 with providers (n=8), clinic managers (n=9), nursing staff (n=8), and front desk staff (n=8). Interviews averaged 25 minutes. Barriers and facilitators identified varied among clinic sites, and by clinic role. Overall, the primary factors driving continued use of mPATH beyond 12 months were staff buy-in, potential time savings and workflow improvement. The primary barriers identified in discontinuing use were perceived lack of need for the program and technical issues. There was no significant indication that clinic size or randomization to low or high intensity bundling of intervention strategies played a role in the decision. Conclusions: Implementation of a tablet-based CRC screening tool in primary care practices is feasible with staff buy-in and validation of potential time savings and workflow improvements but may be limited by perceived lack of need and technical issues. Clinical Trial: NCT03843957
Background: Urban environments influence frailty through factors related to infrastructure for physical activity, social and medical support, and access to quality nutrition. Given the increasing agin...
Background: Urban environments influence frailty through factors related to infrastructure for physical activity, social and medical support, and access to quality nutrition. Given the increasing aging population, understanding the link between urban quality, frailty, and metabolic health is crucial for effective public health and urban planning interventions. Objective: To investigate the impact of urban quality on frailty and its correlation with nutritional status and hematological/biochemical parameters using geospatial analysis. Methods: A cohort of 251 older adults (aged 65+) was studied. Frailty was assessed using the Frailty Trait Scale 5 (FTS-5), and nutritional status was determined using the Controlling Nutritional Status (CONUT) score. Hematological and biochemical parameters were evaluated in a subset of 70 participants by MINDRAY automatic equipment. A spatial analysis of frailty was conducted by incorporating GIS layers that mapped the distribution of urban facilities, including fruit and vegetable shops, senior centers, pharmacies, emergency health centers, parks and squares, community centers, and sports fields. Statistical analyses included t-tests, Mann-Whitney, ANOVA, and correlation analyses. Results: The prevalence of frailty was 17.5%. Frail individuals exhibited significantly higher BMI (31.5 ± 4.4 vs. 28.5 ± 4.5 kg/m²; p=0.0001). When comparing the upper (Q4) and lower (Q1) quartiles of urban quality, Q4 participants had higher FTS-5 scores (15.2 ± 7.4 vs. 11.8 ± 6.4; p=0.0334) and lower handgrip strength (19.1 ± 4.4 vs. 22.8 ± 7.3 kg; p=0.0059). Frail individuals resided significantly closer to emergency health centers (p<0.0001), family health centers (p<0.05), and sports fields (p<0.05). Additionally, bilirubin (Spearman R=0.3325, p=0.0049), serum iron (Spearman R=0.272, p=0.0272), transferrin saturation (Spearman R=0.2478, p=0.0386), RBC (Spearman R=0.2629, p=0.0303), and RDW (Spearman R=0.2391, p=0.0462) were positively correlated with urban quality. Frail participants also had higher CONUT scores (p=0.0323), which were positive correlated with urban quality (Spearman R=0.2513, p=0.0359). Conclusions: Urban quality significantly influences hematological parameters, nutritional status, and frailty. Frail individuals in areas with better urban quality exhibit lower handgrip strength, higher frailty scores, and greater proximity to emergency rooms, community health centers, and sports fields. This suggests compensatory behaviour to address increased healthcare needs. Urban planning and public health strategies should focus on creating age-friendly environments to prevent frailty and improve health outcomes.
Background: Biotinidase deficiency is a metabolic disorder that is included in newborn screening programmes. This condition prevents individuals from performing biotin metabolism properly and can lead...
Background: Biotinidase deficiency is a metabolic disorder that is included in newborn screening programmes. This condition prevents individuals from performing biotin metabolism properly and can lead to serious health problems when left untreated. It is important that health resources are understandable and accessible for families to be informed about the disease and to be directed to the right treatment. Objective: This study evaluates the readability and understandability of online resources on biotinidase deficiency, a metabolic disorder included in newborn screening programs. The aim is to determine whether these materials meet health literacy standards. Methods: Fifty online documents were initially identified via Google searches using “biotinidase deficiency.” After excluding academic articles, duplicates, and inaccessible resources, 21 documents were analyzed. They were categorized as nonprofit (13) or private (8) based on domain extensions. Readability was assessed using Readable.io, providing Flesch Reading Ease scores. The Patient Education Materials Assessment Tool (PEMAT) was used to evaluate understandability and actionability, with scores averaged by four reviewers. Statistical analyses compared group differences. Results: Private articles had significantly higher Flesch Reading Ease scores, indicating more difficult readability (mean ± SD: 13.9 ± 2.2 vs. 10.7 ± 2.0; p = 0.002). PEMAT understanding (U) scores showed no significant difference between private and nonprofit articles (mean ± SD: 52.0 ± 10.5 vs. 42.3 ± 11.4; p = 0.060). Similarly, actionability (A) scores were not significantly different (mean ± SD: 29.1 ± 20.0 vs. 13.4 ± 18.0; p = 0.063). Articles with lower readability (levels D and E) had significantly lower actionability scores compared to higher readability articles (levels A to C). Conclusions: Most online biotinidase deficiency resources fail to meet health literacy standards, particularly in readability and actionability. Improving clarity and usability is essential to better support families managing this condition. The study emphasizes patient-centered approaches for creating effective health education materials.
Background: Patients with multimorbidity have complex healthcare needs and are at high-risk for adverse health outcomes. Primary care teams need tools to effectively and proactively plan care for thes...
Background: Patients with multimorbidity have complex healthcare needs and are at high-risk for adverse health outcomes. Primary care teams need tools to effectively and proactively plan care for these patients. We developed VET-PATHS (VETeran PAnel management Tool for High-risk Subgroups), a novel care planning informatics tool for complex primary care patients. VET-PATHS a) groups patients by chronic condition profile via latent class analysis of electronic health record (EHR) data, then b) jumpstarts care planning by suggesting ‘care steps’ based on data-driven high-priority care for the group, indicated as not receive by EHR. Objective: Iteratively adapt VET-PATHS with user input, then test feasibility and acceptability of tool use by frontline primary care teams for their empaneled high-risk patients. Methods: Three rounds of user-centered design sessions with 17 primary care providers and registered nurses were held at 5 sites from 2019-2021, for feedback on VET-PATHS layout, content, and user-interface. Feedback was summarized into 4 user experience domains (useful, desirable, credible, and usable), leading to progressively updated prototypes. After national tool release, we conducted a pilot intervention study in 2023-2024 with 6 primary care teams at 4 sites. Teams used VET-PATHS during asynchronous regular meetings. Tool use and resulting care plans were assessed by templated observation during meetings and post-pilot chart review. Individual qualitative interviews were analyzed by rapid template analysis for themes of feasibility, acceptability, and utility. Results: User-centered feedback led to updates in tool content, context (e.g., use in proactive panel management), targeting of users (e.g., focusing on primary care providers as the principal users), and layout of informational displays. Pilot intervention teams used VET-PATHS over 4-8 weekly team meetings (mean length, 24 min (range 16-49m)), in which they actively reviewed 80% (280/351) of empaneled high-risk patients visible in the tool. Tool use prompted teams to plan 127 new actions for 91 unique patients (33% of patients reviewed), and document >1 new care plans for 19% of patients reviewed. Common actions included requests to return to clinic (27%), referrals (20%), or vaccinations (19%). Of actions planned, 53 (42%) were received by patients. Four teams with general patient panels (n=11 interviews) described higher acceptability. Two ‘focused’ teams with smaller more homogenous patient panels, e.g. substance use disorder, (n=3 interviews) found care steps less useful. Teams described how VET-PATHS improved efficiency of care planning through automated patient grouping and identification of care gaps, and increased multidisciplinary role involvement. Conclusions: User-centered improvements to VET-PATHS were designed to help clinicians process and use complex information about patient multimorbidity to efficiently create new care plans. In subsequent production, VET-PATHS was acceptable and feasible to use by frontline primary care teams, particularly with larger, more heterogenous patient panels, and led to concrete changes to clinical care delivery. Clinical Trial: N/A
Background: Surgical Site Infection (SSI) is one of the most common healthcare-associated infections, comprising nearly 20% of all Healthcare-Associated Infections (HAI) in hospitalized patients. SSIs...
Background: Surgical Site Infection (SSI) is one of the most common healthcare-associated infections, comprising nearly 20% of all Healthcare-Associated Infections (HAI) in hospitalized patients. SSIs contribute to increased hospital length of stay, readmission, and healthcare costs, with an associated mortality rate twice that of non-infected patients. Objective: To develop machine learning models to predict potential SSI cases following colon surgeries, thereby improving the efficiency of SSI surveillance and enabling healthcare professionals to better prioritize patient care. Methods: Data was extracted from the EPIC Electronic Health Record system at a single academic center focusing on colon surgery patients between 2018 and 2023. The dataset included structured features such as demographics, medications, and vital signs, as well as unstructured clinical notes processed using natural language processing techniques. Logistic Regression, Random Forest, and XGBoost models were developed and trained to predict SSI risk. Cost-sensitive learning and Synthetic Minority Over-sampling Technique (SMOTE) were applied to handle the imbalanced dataset. Model evaluation was conducted using performance metrics including accuracy, precision, recall, and Area Under the Receiver Operating Characteristic curve (AUC-ROC). Results: From a cohort of 1508 patients, 66 (4.4%) developed SSIs. The XGBoost model demonstrated the best overall performance with precision of 50%, recall of 38%, and an AUC-ROC score of 0.788. The Random Forest model achieved the highest precision (100%) but with lower recall (23%), while Logistic Regression showed higher recall (46%) but lower precision (10%). Patients who developed SSIs were significantly older (mean age 61.1 vs. 58.5 years), had higher ASA scores (78.8% vs. 45.3% with ASA score 3), more frequently had contaminated wounds (40.9% vs. 27.5%), and more commonly received steroids (83.3% vs. 58.7%). Conclusions: Machine learning has shown promising results in enhancing the efficiency of SSI surveillance by enabling healthcare professionals to prioritize high-risk patients. While the models demonstrated strong overall accuracy, challenges related to imbalanced datasets remain. The XGBoost model provided the best balance between precision and recall, making it potentially the most clinically useful approach for SSI surveillance augmentation.
Background: The rise of short-video platforms, such as TikTok (Douyin in China) and Bilibili, has significantly influenced how health information is disseminated to the public. However, the quality, r...
Background: The rise of short-video platforms, such as TikTok (Douyin in China) and Bilibili, has significantly influenced how health information is disseminated to the public. However, the quality, reliability, and effectiveness of health-related content on these platforms, particularly regarding uterine fibroids, remain underexplored. Uterine fibroids are a common medical condition that affects a substantial proportion of women worldwide. While these platforms have become vital sources of health education, misinformation and incomplete content may undermine their efficacy. Objective: This study aims to address these gaps by evaluating the quality and dissemination effectiveness of uterine fibroid-related health information on TikTok and Bilibili. Methods: A total of 200 uterine fibroid-related videos (100 from TikTok and 100 from Bilibili) were selected through a keyword search. The videos were evaluated by two trained gynecological experts using the Global Quality Score (GQS) and a modified version of the DISCERN tool (mDISCERN). Additionally, the Patient Education Materials Assessment Tool for Audio/Visual Materials (PEMAT-A/V) was employed to assess the understandability and actionability of the videos. Statistical analyses, including the Mann-Whitney U test, Spearman rank correlation, and stepwise regression analysis, were used to assess differences between platforms and identify predictors of video quality. Results: The results indicated that TikTok outperformed Bilibili in terms of user engagement metrics such as likes, comments, shares, and followers (all P < .001). However, Bilibili videos were generally longer than those on TikTok (P < .001). The overall quality and reliability of the videos on both platforms were suboptimal, with median GQS scores of 3 (range: 1-5) for TikTok and Bilibili. The median modified DISCERN scores were also low: 2 (range: 1-4) for TikTok and 2 (range: 1-3) for Bilibili, with no significant differences between the two platforms (P = 0.62 for GQS, P = 0.18 for mDISCERN). Both platforms scored similarly on understandability (median PEMAT-U = 77%) and actionability (median PEMAT-A = 67%). Videos uploaded by medical professionals on TikTok had significantly higher quality scores compared to those uploaded by non-professionals. A moderate positive correlation was observed between the GQS and mDISCERN scores (r = 0.41, P < .01), indicating an interrelationship between quality and reliability. Stepwise regression analysis identified "completeness score," "source," and "PEMAT scores" as significant predictors of video quality. Conclusions: This study highlights the generally low quality of uterine fibroid-related health information on short-video platforms, although TikTok showed better performance in terms of engagement and quality. The involvement of medical professionals was found to enhance video quality. These findings underscore the need for improved oversight of health content on social media platforms and greater involvement of healthcare professionals to ensure the dissemination of accurate and reliable health information.
Background: Chronic pain management in older adults can be challenging for primary care clinicians because of comorbidities, side effects, and complicated guideline recommendations. Clinical decision...
Background: Chronic pain management in older adults can be challenging for primary care clinicians because of comorbidities, side effects, and complicated guideline recommendations. Clinical decision support systems (CDSS) can enhance guideline adherence in chronic pain management by collecting and organizing patient information and aiding clinician decision-making. This study examined clinicians’ views on challenges in managing chronic pain and their opinions on a CDSS that gathered patient preferences and provided clinicians with decision support for chronic pain management. Objective: The objective of this study was to explore primary care clinicians’ perspectives on the challenges of managing chronic pain in older adults and evaluate their opinions on a clinical decision support system (CDSS) designed to gather patient preferences and facilitate guideline-based, multimodal pain management. Methods: We conducted semi-structured interviews with 18 clinicians from two University of Chicago Medicine primary care clinics piloting the CDSS. The interview guide was informed by the Consolidated Framework for Implementation Research. Results: Participants included 89% physicians and 11% advanced practice nurses. Participants stressed the importance of a comprehensive, patient-centered approach to chronic pain management and favored multimodal and non-pharmacological treatments. Challenges included complex medical histories, competing priorities, insurance limitations, and opioid misuse concerns. Clinicians found the CDSS beneficial for promoting multimodal care discussions and enhancing visit efficiency. However, there were concerns regarding its complexity, workflow compatibility, and older patients' technology navigation difficulties. While tools, such as the pre-visit questionnaire and conversation tool, were valued, clinicians emphasized the need for adaptability and streamlined usability. Conclusions: The primary care clinicians in this study were aligned with clinical practice guidelines to provide patient-centered pain management using multimodal treatments. However, they had several concerns regarding how complex chronic pain management can be for older adult patients. They expressed interest in using the CDSS but were concerned about its complexity. I-COPE offers a promising approach to support guideline-based chronic pain and opioid management in primary care. By addressing usability and workflow compatibility, CDSS tools like I-COPE can better equip clinicians to provide comprehensive, patient-centered care, ultimately enhancing treatment outcomes for older adults with chronic pain.
Background: In Bangladesh as well as throughout the world, children's screen time has significantly increased. Children spent a lot of time on the internet and digital screens for entertainment, educa...
Background: In Bangladesh as well as throughout the world, children's screen time has significantly increased. Children spent a lot of time on the internet and digital screens for entertainment, education, and communication which have increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children's mental, physical, and social health have drawn attention. Objective: This study aimed to explore the effect of high exposure to screen on health and mental well-being of school-going children in Dhaka, Bangladesh. Methods: From July 2022 to June 2024, this cross-sectional descriptive study was carried out. 420 kids between the ages of 6 and 14 were enrolled in three English-medium and three Bangla-medium schools in Dhaka city using a stratified random sample technique. Anthropometric measurements, a semi-structured questionnaire, the Pittsburgh Sleep Quality Index Scale (PSQI), the Development and Wellbeing Assessment Scale (DAWBA), and the Strength and Difficulties Questionnaire (SDQ), which was validated in Bangla, were used to gather data. We considered the students who were exposed to screen for less than 2 hours as the low-exposed group and those who were exposed for more than 2 hours as high-exposed group. Results: We found 83% of the students were high exposed group and their average screen time was 4.6 ± 2.3 hours. Compared to the low exposed group, the high exposed group had a significantly higher rate of eye problems (96% vs 4%, P< 0.001). Headache was also common in high exposed group (83%). Moreover, students of high exposed group had a short duration and poor quality of sleep which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (p < 0.001). Our study revealed overall 40% of children suffered from mental health problems by using DAWBA scale which was increased in high exposed group compared to low exposed group. Behavioral problems, such as conduct issues (28.3%) and peer difficulties (28.8%), were observed among the participants. However, there was no statistically significant difference was found between two groups. Conclusions: A collaborative and coordinated multistage approach will be required to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on larger scales can be conducted to determine the impacts on health aspects meticulously.
Background: Dementia is a global health challenge, particularly in Nigeria, where limited healthcare infrastructure, cultural stigmas, and poor awareness hinder its care. Telemedicine can improve pati...
Background: Dementia is a global health challenge, particularly in Nigeria, where limited healthcare infrastructure, cultural stigmas, and poor awareness hinder its care. Telemedicine can improve patient outcomes, increase healthcare access, and support caregivers. However, challenges like poor internet connectivity, digital literacy, and lack of integrated strategies hinder its adoption, particularly in rural areas Objective: This study evaluates the adoption of telemedicine for dementia care in Nigeria, examining effectiveness in improving patient outcomes, reducing caregiver burden, and enhancing accessibility. It also identifies infrastructural and cultural barriers, proposing strategies for a sustainable telemedicine framework tailored to Nigeria’s sociocultural context. Methods: A scoping review guided by the (PRISMA) framework used databases like PubMed, Scopus, CINAHL, PsycINFO, and Google Scholar. Search terms included “telemedicine”, "dementia care," “Nigeria”, “digital health”, “telehealth interventions”, “video consultations”, and “remote monitoring tools”. Out of 640 results, 23 articles were selected. Issues like poor digital literacy, internet access, and lack of a cohesive policy were identified. Results: Out of 23 studies, 10 (43.5%) focused on m(Health) applications, 8 (34.8%) on video consultations, and 5 (21.7%) on remote monitoring tools. These interventions improved caregiver support, medication adherence, and access to specialist care but faced challenges in rural settings. Conclusions: There is an urgent need for an all-inclusive policy in Nigeria that integrates technological solutions into existing dementia care frameworks. mHealth apps, video consultations, and remote monitoring tools show potential for enhancing healthcare access, improving outcomes, and reducing caregiver burden.
Background: Generation Scotland (GS) is a genetic family health cohort study established in 2006 (N~24,000). A new wave of recruitment was initiated in 2022 aimed at adding a further 20,000 new partic...
Background: Generation Scotland (GS) is a genetic family health cohort study established in 2006 (N~24,000). A new wave of recruitment was initiated in 2022 aimed at adding a further 20,000 new participants to the cohort using online data collection and remote saliva sampling (for genotyping and DNA methylation profiling). Eligible individuals included anyone living in Scotland aged over 12 years. New participants give consent for linkage to their medical and administrative records, and to provide a saliva sample for DNA. The current study evaluates the different strategies employed to recruit new participants to the GS cohort for those aged 16+ (recruitment of ages 12-15 will be presented separately due to additional strategies). Objective: This study aimed to evaluate recruitment strategies employed to recruit new participants to the GS cohort. Recruitment strategies were compared in terms of overall numbers as well as sociodemographic characteristics of the recruits, sample return rates and cost-effectiveness. Methods: From May 2022 to the end of December 2023 recruitment was undertaken by the following methods: snowball recruitment (through friends and family of existing volunteers), invitations to those who participated in a previous survey during the pandemic (CovidLife: the GS COVID-19 impact survey) and Scotland-wide recruitment through social media (including sponsored Meta advertisements), news media and TV advertisement. Method of recruitment was self-reported by participants in the baseline questionnaire. Results: Over the above period, 7,889 new participants were recruited to the cohort. According to the different strategies, this included, in order: social media (N=2,436, 30.9%), CovidLife survey responder invitations (N=2,049, 26.0%), TV advertising (N=1,367, 17.3%), snowball (N=891, 11.3%), news media (N=747, 9.5%) and other methods/unknown (N=399, 5.0%). More females signed up than males (70.5% female participants). To date, 83.5% of participants have returned their postal saliva sample. Sample return varied between demographic factors (>60 years 90.5% vs 16-34 years 71.1%). The average cost per participant across all recruitment strategies was £13.52. Past survey invitations (CovidLife) were most cost-effective at £0.37 per recruit, social media cost £14.78 per recruit, whilst TV advertisement recruitment was the most expensive at £33.67. Conclusions: We present the challenges and successes of recruitment of new participants to a large ongoing cohort using remote assessment. Besides targeting existing survey responders, social media advertising has been the most cost-effective and easily sustained strategy for recruitment. We note different strategies resulted in successful recruitment over varying timescales (e.g. consistent sustained recruitment for social media, and large spikes for news media and TV advertising) which may be informative for future studies with different requirements of recruitment periods. Limitations include self-reported methods of recruitment, and difficulties in capturing multi-layered recruitment. Overall, these data demonstrate the potential cost requirements and effectiveness of different strategies that could be applied to future research studies. Future work will report success and challenges of recruitment activities aimed at younger individuals, under 16 years.
Background: Lassa fever, an acute viral hemorrhagic illness endemic in West Africa, remains a significant public health concern in Nigeria, particularly in Edo, Ondo, and Kwara States. Despite recurre...
Background: Lassa fever, an acute viral hemorrhagic illness endemic in West Africa, remains a significant public health concern in Nigeria, particularly in Edo, Ondo, and Kwara States. Despite recurrent outbreaks, limited data exist on the knowledge, attitudes, and practices (KAP) of residents and healthcare personnel across these states, creating a critical research gap. Effective prevention and control require a thorough understanding of these factors to inform targeted interventions and policy decisions. Objective: This study aimed to assess the KAP of residents and primary healthcare (PHC) personnel regarding Lassa fever across Edo, Ondo, and Kwara States. Specifically, it examined awareness levels, preventive behaviors, misconceptions about transmission, and compliance with infection control measures, including the use of personal protective equipment (PPE). The findings provide insights for evidence-based interventions to reduce the burden of Lassa fever in these endemic regions. Methods: A cross-sectional survey was conducted among 3,582 residents and 540 PHC personnel across Edo, Ondo, and Kwara States. Data were collected through structured questionnaires assessing knowledge, attitudes, and practices related to Lassa fever. Statistical analyses, including cross-tabulations and the Relative Importance Index (RII), were employed to identify patterns and disparities across different residential and professional groups. Results: Among residents, 80.1% recognized Lassa fever as a severe illness, yet only 6.9% had participated in awareness campaigns. Preventive behaviors were inadequate, with only 12.1% storing food in rodent-proof containers and 25.4% engaging in frequent environmental sanitation. Knowledge gaps persisted, as only 3% were aware of the disease’s 1–21-day incubation period, and 0.3% acknowledged sexual transmission. Socioeconomic disparities significantly influenced compliance with sanitation measures (p < 0.001), with higher-income households demonstrating better adherence. Furthermore, preventive practices such as using traps (14.5%) and participating in sanitation campaigns (6.8%) varied significantly by residence type (p < 0.001). PHC personnel demonstrated strong theoretical knowledge, with an RII of 0.960 for key facts, including the classification of Lassa fever as a viral hemorrhagic illness and the identification of rats as primary reservoirs. However, only 84% recognized alternative reservoirs such as bats and mosquitoes. PPE adherence was poor, particularly for facemasks and eye protection (RII = 0.217), highlighting significant gaps in infection control practices. Conclusions: The study reveals critical gaps in awareness, preventive behaviors, and infection control measures across Edo, Ondo, and Kwara States. While healthcare workers displayed strong theoretical knowledge, practical compliance with PPE use was insufficient, posing a risk of disease transmission. Addressing these gaps is essential for effective Lassa fever control. Targeted health education campaigns should be implemented to enhance public awareness and dispel misconceptions about Lassa fever transmission. Strengthened training programs for PHC personnel, stricter PPE compliance policies, and improved access to sanitation resources should be prioritized. Additionally, community-based interventions, including regular environmental sanitation and rodent control, should be encouraged to reduce exposure risks. Bridging the knowledge and practice gaps in Lassa fever prevention is essential to mitigating outbreaks, reducing fatalities, and strengthening public health resilience in Edo, Ondo, Kwara States, and other endemic regions.
Coronaviruses, including SARS-CoV-2, are responsible for COVID-19, a highly transmissible disease that emerged in December 2019 in Wuhan, China. During the past five years, significant advancements ha...
Coronaviruses, including SARS-CoV-2, are responsible for COVID-19, a highly transmissible disease that emerged in December 2019 in Wuhan, China. During the past five years, significant advancements have been made in understanding and
mitigating the virus. Although the initial outbreak led to global health crises, improved vaccination strategies, antiviral treatments, and AI-driven diagnostic tools have contributed to better disease management. However, COVID-19 continues to pose risks, particularly for immuno-compromised individuals and those with pre-existing conditions. This study explores the use of deep learning for a rapid and accurate diagnosis of COVID-19, addressing ongoing challenges in healthcare infrastructure and testing accessibility. We propose an enhanced automated detection system leveraging state-of-the-art convolutional neural networks (CNNs), including updated versions of VGG16, VGG19, and ResNet50, to classify COVID-19 infections from chest radiographs and computerized tomography (CT) scans. Our results, based on an expanded dataset of over 6000 medical images, demonstrate that the optimized ResNet50 model achieves the highest classification performance, with 97.77% accuracy, 100%
sensitivity, 93.33% specificity, and a 98.0% F1-score. These findings reinforce the potential of AI-assisted diagnostic tools in improving early detection and pandemic preparedness.
Background: Large Language Models (LLMs) continue to enjoy enterprise-wide adoption in healthcare while evolving in number, size, complexity, cost, and more importantly performance. Performance benchm...
Background: Large Language Models (LLMs) continue to enjoy enterprise-wide adoption in healthcare while evolving in number, size, complexity, cost, and more importantly performance. Performance benchmarks play a critical role in their ranking across community leaderboards and subsequent adoption. Objective: Given the small operating margins of healthcare organizations and growing interest in LLMs and conversational AI, there is an urgent need for objective approaches that can assist in identifying viable LLMs without compromising their performance. The objective of the present study is to generate a taxonomy portrait of medical LLMs (N = 33) whose domain-specific and domain non-specific multivariate performance benchmarks were available from Open-Medical LLM and Open LLM leaderboards on Hugging Face. Methods: Hierarchical clustering of multivariate performance benchmarks is used to generate taxonomy portraits revealing inherent partitioning of the medical LLMs across diverse tasks. While domain-specific taxonomy is generated using nine performance benchmarks related to medicine from the Hugging Face Open-Medical LLM initiative, domain non-specific taxonomy is presented in tandem to assess their performance on a set of six benchmarks on generic tasks from the Hugging Face Open LLM initiative. Subsequently, non-parametric Wilcoxon Ranksum test and linear correlation is used to assess differential changes in the performance benchmarks between two broad groups of LLMs and potential redundancies between the benchmarks. Results: Two broad families of LLMs with statistically significant differences (\alpha = 0.05) in performance benchmarks are identified for each of the taxonomies. Consensus in their performance on the domain-specific, and domain non-specific tasks revealed inherent robustness of these LLMs across diverse tasks. Subsequently, statistically significant correlations between performance benchmarks revealed inherent redundancies, indicating a subset of these benchmarks may be sufficient in assessing the domain-specific performance of medical LLMs. Conclusions: Understanding the medical LLM taxonomies is an important step in identifying LLMs with similar performance while aligning with the needs, economics, and other demands of healthcare organizations. While the focus of the present study is on a subset of medical LLMs from the Hugging Face, enhanced transparency of performance benchmarks and economics across a larger family of medical LLMs is needed to generate more comprehensive taxonomy portraits accelerating their strategic and equitable adoption in healthcare. Clinical Trial: Not applicable
Background: The utility of online engagement in enhancing quality of life and mitigating social isolation among older adults is well-documented. However, its effects on cognitive functions, mainly thr...
Background: The utility of online engagement in enhancing quality of life and mitigating social isolation among older adults is well-documented. However, its effects on cognitive functions, mainly through online social engagement, require further exploration. Objective: This study investigates the potential of active online engagement via a Virtual Senior Center (VSC) to enhance subjective memory capability among older adults, thereby potentially improving their psychological well-being and loneliness. Methods: Utilizing a cohort of 53 homebound older adults participating in the VSC program, which offers diverse online classes to promote social interaction, using path analysis to investigate the relationship between online engagement, subjective memory capabilities, the quality of social relationships, and overall well-being. Results: The findings reveal that increased participation in VSC activities is significantly associated with improved subjective memory capability. Conclusions: This enhanced self-assessment of memory capability is linked to a better quality of life and reduced loneliness. Although online engagement has no direct association, these indirect effects suggest the critical role of positive subjective memory capability, fostered through online engagement, in enriching social interactions. It posits the potential of digital platforms to augment traditional methods of socialization, especially for those contending with physical or geographical barriers to interaction.
Background: Marine ecosystems face increasing threats from overfishing, pollution, and climate change, leading to biodiversity loss and habitat degradation. Marine Protected Areas (MPAs) serve as a st...
Background: Marine ecosystems face increasing threats from overfishing, pollution, and climate change, leading to biodiversity loss and habitat degradation. Marine Protected Areas (MPAs) serve as a strategic conservation tool to mitigate these impacts while supporting economic sustainability. However, their effectiveness varies based on governance structures, enforcement mechanisms, and financial sustainability. This study evaluates the role of MPAs in enhancing biodiversity conservation and fostering sustainable economic growth within the blue economy. Objective: This study aims to assess the impact of MPAs on biodiversity, fisheries, and eco-tourism, identify governance and enforcement challenges, and propose actionable policy recommendations to enhance their ecological and economic effectiveness. By analyzing global case studies, the study provides data-driven insights to strengthen participatory governance, financial sustainability, and adaptive management strategies. Methods: A systematic review methodology was employed, following PRISMA guidelines. Data was collected from peer-reviewed journals, book chapters, and reputable databases, focusing on empirical studies evaluating MPAs' ecological and economic impacts. The analysis was structured around three core components: ecological outcomes, economic benefits, and governance frameworks. Selected case studies, including the Great Barrier Reef, Tanzania’s Coastal MPAs, Mediterranean MPAs, Lekki Conservation Centre, and Niger Delta MPAs, were examined to illustrate the diversity of MPA impacts and governance challenges. Results: Findings indicate that well-managed MPAs enhance biodiversity by increasing species richness, apex predator recovery, and habitat restoration. Economically, MPAs contribute significantly to fisheries sustainability and eco-tourism revenues, fostering job creation and local economic resilience. However, governance challenges such as weak enforcement, inadequate funding, and limited community engagement hinder MPA effectiveness. Participatory governance models and revenue-sharing mechanisms improve conservation outcomes and stakeholder compliance. Conclusions: MPAs play a vital role in maintaining marine biodiversity and supporting sustainable economic development. Effective governance, stringent enforcement, and stable financial mechanisms are crucial to maximizing their benefits. Scaling up MPA coverage, integrating adaptive management strategies, and fostering multi-stakeholder collaborations are essential for long-term success. Future MPA development should prioritize participatory governance, innovative financing strategies, and science-based conservation planning. Strengthening enforcement through technology, investing in local capacity-building, and aligning MPAs with broader economic policies will enhance their impact. International collaborations and policy integration should be leveraged to improve MPA management worldwide. This study underscores the importance of MPAs as a conservation and economic sustainability tool. By protecting critical marine habitats, MPAs contribute to climate resilience, biodiversity preservation, and global food security. Strengthening their governance and financial sustainability will ensure their effectiveness in mitigating environmental threats while promoting sustainable blue economy initiatives.
Background: Harmful suicide content on the internet poses significant risks, as it can induce suicidal thoughts and behaviors, particularly among vulnerable populations. Despite global efforts, existi...
Background: Harmful suicide content on the internet poses significant risks, as it can induce suicidal thoughts and behaviors, particularly among vulnerable populations. Despite global efforts, existing moderation approaches remain insufficient, especially in high-risk regions like South Korea, which has the highest suicide rate among OECD countries. Previous research has primarily focused on assessing the suicide risk of individuals rather than the harmfulness of content itself, highlighting a gap in automated detection systems for harmful suicide content. Objective: In this study, we aimed to develop an AI-driven system for classifying online suicide-related content into five levels: illegal, harmful, potentially harmful, harmless, and non-suicide-related. Additionally, the researchers construct a multi-modal bench- mark dataset with expert annotations to improve content moderation and assist AI models in detecting and regulating harmful content more effectively. Methods: We collected 43,244 user-generated posts from various online sources, including social media, Q&A platforms, and online communities. To reduce the workload on human annotators, GPT-4 was used for pre-annotation, filtering and categorizing content before manual review by medical professionals. A task description document ensured consistency in classification. Ultimately, a benchmark dataset of 452 manually labeled entries was developed, including both Korean and English versions, to support AI-based moderation. The study also evaluated zero-shot and few-shot learning to determine the best AI approach for detecting harmful content. Results: The multi-modal benchmark dataset showed that GPT-4 achieved the highest F1 scores (66.46 for illegal and 77.09 for harmful content detection). Image descriptions improved classification accuracy, while directly using raw images slightly decreased performance. Few-shot learning significantly enhanced detection, demonstrating that small but high-quality datasets could improve AI-driven moderation. However, translation challenges were observed, particularly in suicide-related slang and abbreviations, which were sometimes inaccurately conveyed in the English benchmark. Conclusions: This study provides a high-quality benchmark for AI-based suicide content detection, proving that LLMs can effectively assist in content moderation while reducing the burden on human moderators. Future work will focus on enhancing real-time detection and improving the handling of subtle or disguised harmful content.
Background: Low birth weight (LBW) is linked to higher risks of neonatal morbidity, developmental delays, and long-term health issues. Although baby massage has been proven to enhance growth and neuro...
Background: Low birth weight (LBW) is linked to higher risks of neonatal morbidity, developmental delays, and long-term health issues. Although baby massage has been proven to enhance growth and neuro-developmental outcomes in LBW infants, access to suitable training and compliance with massage regimes continue to be challenges, especially in low-resource settings. Mobile health (mHealth) interventions represent a novel solution for addressing these challenges through the provision of scalable and standardized education in Baby Massage. Objective: This study aimed to design and test a human-centered baby massage mobile application (app) to promote the growth and development of LBW infants in Indonesia. Methods: We used a human-centered iterative design framework to create the mobile application. System Usability Scale (SUS) was used to assess the usability of the application among 42 caregivers of LBW infants. Feedback was collected qualitatively through semi-structured interviews, and thematic analysis was applied to understand user experience. A pilot study assessed the impact of the application on caregiver knowledge, confidence, adherence to baby massage practices, and infant growth outcomes. Weight pre- and post-intervention assessments were compared using paired t-tests. Results: The mobile application was found to have high usability, evidenced by an average SUS score of 78.6 (SD = 8.2). The majority of participants (85%) rated the app as "excellent" or "good" with respect to ease of use and navigation. Qualitative feedback emphasized its effectiveness at increasing caregiver confidence and its cultural relevance. Statistical analyses from the pilot study showed significant gains in caregiver knowledge (+20.5 points, p < 0.01), confidence (+21.6 points, p < 0.01), and adherence to baby massage practices (+20.3 points, p < 0.05). Statistically significant weight (+330 grams, p < 0.01) and head circumference (+1.3 cm, p < 0.01) improvement was observed in infants in the intervention group. Conclusions: The human-centered baby massage mobile application showed promising evidence of feasibility and effectiveness in increasing knowledge, confidence, and adherence to baby massage practices by caregivers. The application features a culturally tailored and user-friendly design, which makes it accessible, especially in low-resource settings. This was a small-scale study and future work should involve scaling the intervention as well as evaluating the long-term effects on infant health outcomes.
Overdoses of medications, including over-the-counter (OTC) and prescription drugs, have increased in Japan, with digital platforms contributing to inappropriate use patterns. This study analyzed overd...
Overdoses of medications, including over-the-counter (OTC) and prescription drugs, have increased in Japan, with digital platforms contributing to inappropriate use patterns. This study analyzed overdose-related online search trends by using data from Yahoo! JAPAN between 2020 and 2024. Search volume for “overdose” increased approximately fivefold, from 89,800 in 2020 to 240,000 in 2024. Female individuals accounted for 52.67%-72.11% of the users who conducted overdose-related searches. The most frequently searched medication class (36.6%) in the context of overdose was benzodiazepines. Furthermore, compounds contained in OTC drugs accounted for approximately 11.8% of all medication-related searches. These findings reveal a concerning trend in medication overdose risk in Japan and underscore the importance of developing targeted prevention strategies based on the digital surveillance of online search patterns.
Background: Hypertension is a prevalent concern among older adults, and when left uncontrolled, it can lead to complex cardiovascular complications. Tele-nursing technology facilitates self-management...
Background: Hypertension is a prevalent concern among older adults, and when left uncontrolled, it can lead to complex cardiovascular complications. Tele-nursing technology facilitates self-management, empowering older adults with uncontrolled hypertension to regulate their behaviors and achieve sustainable disease control. Objective: This study aimed to study the effects of self-health monitoring using smart devices and ontology technology on disease-controlling behavior and mean arterial pressure of older adults with uncontrolled hypertension. Methods: The design was quasi-experimental research. The sample was older adults with uncontrolled hypertension who lived in Bangkok, Thailand, which was divided into 46 experimental people and 45 control people. The implementation tools were a program of self-health monitoring using smart devices and ontology technology. It featured the "HT GeriCare@STOU" application on smartphones that was linked to detecting blood pressure from smartwatches, and telenursing could be provided through the application and video calls. The data-collecting questionnaires had a Cronbach's alpha coefficient of 0.83 and a content validity index of 0.98 for disease-controlling behavior. Descriptive and t-test statistics analyzed the data. Results: The results revealed that after joining the program, the disease-controlling behavior of older adults with uncontrolled hypertension was better than before joining the program, but was not better than the comparison group at P<.05. However, the mean arterial pressure of older adults with uncontrolled hypertension was lower than before joining the program and lower than the comparison group at P<.05. Conclusions: A program of self-health monitoring using smart devices and ontology technology was effective for older adults with uncontrolled hypertension. The technological and cost problems are potential obstacles to eHealth programs. More experimental and longitudinal studies with larger sample sizes are needed to properly evaluate this program. Clinical Trial: Trial Registry Number: Thai Clinical Trials Registry (TCTR20250110003)
Background: Unsupervised cognitive assessments are becoming commonly used in studies of aging and neurodegenerative diseases. Because assessments are completed in everyday environments and without a p...
Background: Unsupervised cognitive assessments are becoming commonly used in studies of aging and neurodegenerative diseases. Because assessments are completed in everyday environments and without a proctor, there are concerns about how common distractions may impact performance and whether these distractions may differentially impact those experiencing the earliest symptoms of dementia. Objective: We examined the impact of location and social context, and self-reported interruptions on remote cognitive assessments in older adults. Methods: Participants from the Ambulatory Research in Cognition (ARC) smartphone study were classified as cognitively normal (N = 380) or as having very mild dementia (N = 37). Participants completed daily tests of processing speed, working memory, and associate memory. At each assessment, participants were asked to report on their current location and social surroundings, which was used to quantify if participants were either at home (or not) and by themselves (or not). After each assessment session, participants were asked if they experienced any interruptions. Mixed effect modeling was used to test the interactions between location, social context, and clinical status. Additional analyses were conducted by removing sessions where participants reported that they were interrupted at any point during the testing period. Results: Across all participants, momentary effects of environmental distractions were minimal. Specifically, when tests were completed in the presence of others, participants exhibited slightly increased variability in processing speed. However, these momentary effects of environmental distractions were dependent upon cognitive status. Cognitively normal older adults had better visuospatial working memory performance when they completed tests at home compared to when they completed tests away from home. However, older adults with very mild dementia showed no effect of testing location on the same task. Conversely, cognitively normal older adults did not differ in their processing speed at either testing location. Older adults with very mild dementia were slightly faster when not at home. Social context only impacted variability in processing speed for participants with very mild dementia. When considering tests completed in the most distracting environments (away from home and in the presence of others) those with very mild dementia showed larger differences only on the visuospatial working memory measure. Additional analyses demonstrated that after removing sessions in which participants self-reported experiencing an interruption (~12% of assessments), these small effects of environmental distractions on cognition remained, but were more apparent in those with very mild dementia. Conclusions: Social context and location of unsupervised remote cognitive testing has small impacts on performance, but these impacts were not consistent across cognitive domains and were mostly limited to participants demonstrating the earliest symptoms of dementia. Remote cognitive testing provides valid and reliable data in older adults, but care should be taken to allow participants to report distractions that may occur during testing.
Background: We co-designed a novel multicomponent Care Assistant and support Program for people after Stroke or transient ischaemic attack (CAPS) to augment secondary prevention of stroke. Objective:...
Background: We co-designed a novel multicomponent Care Assistant and support Program for people after Stroke or transient ischaemic attack (CAPS) to augment secondary prevention of stroke. Objective: Following completion of a feasibility study, we sought feedback from Australian clinicians and service provider representatives (the potential deliverers of CAPS) regarding their perceptions of CAPS for secondary prevention, and pathways to real-world adoption. Methods: Qualitative descriptive study of clinicians and service provider representatives involved in delivery of stroke care around Australia. A pragmatic convenience sample was obtained from previous CAPS co-design study participants, leveraging professional networks (e.g., LinkedIn), and distributing study flyers and newsletters via Primary Healthcare Networks, General Practitioner (GP) networks, and social media posts (CSIRO LinkedIn pages). Semi-structured interviews and focus groups were conducted virtually with clinicians and representatives of the Stroke Foundation (Australia). Data were thematically analysed using an integrated approach. Results: Three Stroke Foundation representatives and eighteen clinicians participated, from five Australian states, including medical specialists, GPs, nurses, and allied health professionals. We collected their perceptions of CAPS, including potential benefits of the program for secondary prevention, and considerations for facilitators and challenges to real-world program implementation. Discussion regarding the perceived benefits focussed more on the benefits to patients than to clinicians. Program implementation sub-themes included program initiation and duration, patient support considerations; and workflow alignment, which included consideration of barriers and enablers to uptake within primary care practice and Stroke Foundation outreach support programs. Conclusions: There was support from participants for the potential of CAPS to improve secondary prevention of stroke. However, addressing the challenges raised by participants including further implementation and integration considerations, such as sustainability of the model of care, are likely required for CAPS to be successfully embedded within clinical settings.
Background: Digital therapeutics (DTx) have attracted attention as the substitutes or add-ons to conventional pharmacotherapy. The number of clinical trials for DTx has increased recently and one of t...
Background: Digital therapeutics (DTx) have attracted attention as the substitutes or add-ons to conventional pharmacotherapy. The number of clinical trials for DTx has increased recently and one of the main targets for DTx is psychiatric disorders. Generalized Anxiety Disorders (GAD) is one of the most common and notable psychiatric disorders and it’s known that the magnitude of placebo effect in the pharmacotherapy is quite large. The randomized clinical trials (RCTs) with digital shams are the most reliable clinical trials to evaluate the safety and efficacy of DTx. However, the effect size and the associated factors of digital shams on GAD have not been investigated although they are critical to assess the true treatment effect of DTx. Objective: The objectives of this study were to identify RCTs with digital shams as comparators which evaluated GAD assessment scores, to review the characteristics of the RCTs and of the digital shams in the systematic review, and to investigate the effect size and the associated factors in the meta-analysis. Methods: The RCTs evaluating the GAD assessment scores by setting digital shams as comparators were identified by searching the database of PubMed, Web of Science and Scopus in July 2024. The characteristics of the RCTs and of the digital shams were reviewed systematically. The meta-analysis including sub-group analyses and meta-regressions were conducted to investigate the effect size and the associated factors of the digital shams. Results: 54 RCTs were included in the systematic review and 32 RCTs with 3 GAD assessment scores were included in the meta-analysis with a total of 5311 participants. The pooled effect size of digital sham for all the included studies was large (Hedge’s g=0.28, 95% CI 0.18 to 0.38). The sub-group analyses showed the significant difference in the effect size among target population (p=.03), sham approach (p=.02) and baseline values (p=.02). The meta-regressions also indicated that the primary psychiatric patients in the target population (p=.01), removed type in sham approach (p=.04) and high baseline values (p=.02) were associated with the effect size of digital shams. Conclusions: This study showed the large effect size of digital shams on GAD assessment scores, which is consistent with the large placebo effect in pharmacotherapy. Target population, sham approach and baseline values were also identified as the associated factors of the effect size. It would be effective to create the study protocols for the DTx trials with digital shams by considering the factors identified in this study.
Background: Atrial fibrillation (AF), a common arrhythmia, is a major stroke risk factor, making patient education critical. Artificial intelligence (AI) platforms like Google Gemini and ChatGPT are e...
Background: Atrial fibrillation (AF), a common arrhythmia, is a major stroke risk factor, making patient education critical. Artificial intelligence (AI) platforms like Google Gemini and ChatGPT are emerging tools for medical education. Objective: This study aimed to (1) assess the quality of ChatGPT and Google Gemini’s explanations of AF and its treatment, (2) compare responses from both platforms and (3) analyze differences in interpretation between cardiologists and non-medical professionals. Methods: On September 6, 2024, the prompt “Explain atrial fibrillation and how to treat it to a patient” was entered into ChatGPT and Google Gemini. A survey based on PEMAT-P and DISCERN criteria was completed by 11 cardiologists and 17 non-medical professionals. Averages and standard deviations were calculated and compared using the Wilcoxon signed-rank test. Results: No significant quality difference was observed between ChatGPT and Google Gemini. Cardiologists rated bias lower (3.82 vs. 4.33, p=0.04) and explanations of consequences of no treatment higher (2.85 vs. 1.86, p=0.005) compared to non-medical professionals. Visual cues, informative headers, concise sections, actionable advice, and direct addressing of the reader received significantly higher ratings from cardiologists. Conclusions: The comparable quality of ChatGPT and Google Gemini suggests that both are viable for AF education. Cardiologists’ higher ratings for critical aspects of explanation highlight a gap in patient understanding, underscoring the need for clearer AI-driven educational tools. Clinical Trial: n/a
Background: Approximately one third of epilepsy patients are resistant to anti-seizure medication (ASM). There are currently no mobile devices that allow early detection of seizures. Hypothesized that...
Background: Approximately one third of epilepsy patients are resistant to anti-seizure medication (ASM). There are currently no mobile devices that allow early detection of seizures. Hypothesized that the use of an intra-aural EEG device (mjn-SERAS) will allow the activity recording and the subsequent processing by the AI algorithm of MJN to anticipate the event of suffering an epileptic seizure in those patients already diagnosed previously, generating an alert to prevent accidents. Objective: To assess the epilepsy-related quality of life in patients with drug-resistant epilepsy using the mjn-SERAS solution compared to the control group
To assess the seizure-related safety in patients with drug-resistant epilepsy using the mjn-SERAS solution compared to the control group in terms of the number of accidents caused by seizure episodes Methods: A prospective, multicentre, pilot clinical trial, with a controlled and randomized design, is proposed to validate a medical device (mjn-SERAS), CE certificated. This new validation will be in the participant's normalized environment, in individuals over 2 years of age, with a diagnosis of refractory epilepsy, which will make it possible to determine the impact of the mjn-SERAS device on the early detection of epileptic seizures and the generation of a pre-seizure alert with a time window of a minimum of 1 minute. The sample size determined is an n=150 exposed individuals who meet the inclusion criteria. The sensitivity, specificity, positive predictive value, PPV and F-Score of the device will be analysed. Also, the degree of satisfaction of patients and their caregivers, including the impact on quality of life and the degree of health perceived by the caregiver when alarms are generated to assess the possibility of a new epileptic seizure. Finally, to describe possible improvements in indicators of social relationships in different areas of personal development. Results: This study is funded in 2022 by the EIT Health and European Union, under the programme EIT Health Amplifier n. 220445-230126.
As of February 2025, we enrolled 76 patients in 6 clinical sites in Spain, UK and Germany. Data analysis is currently underway, and the first results are expected for June 2025. Conclusions: The mjn-SERAS device, an intra-aural EEG, aims to record brain activity and use artificial intelligence (AI) algorithms to anticipate seizures in previously diagnosed patients. By generating early alerts, it allows individuals to take preventive measures and enhance safety. Although participants may not experience direct benefits, validating or improving this technology could enhance future epilepsy management and treatment.
Unlike previous research efforts, mjn-SERAS is the first device to systematically provide seizure alerts using an AI-based algorithm to detect early warning signs. Its real-world application could significantly improve the quality of life for epilepsy patients and advance medical understanding of seizure prediction.
This study evaluates the device’s accuracy in predicting seizures in everyday settings and assesses its psychological, mental, and social impact on people with refractory epilepsy. Clinical Trial: ClinicalTrials.gov NCT05845255; https://clinicaltrials.gov/study/NCT05845255
Background: Background: Dermatology, as a frontier medical discipline integrating clinical practice and cross-disciplinary innovation, has undergone dynamic evolution driven by technological advanceme...
Background: Background: Dermatology, as a frontier medical discipline integrating clinical practice and cross-disciplinary innovation, has undergone dynamic evolution driven by technological advancements in recent years. However, persistent challenges in workforce development and educational frameworks necessitate systematic evaluation and analysis of current research frontiers and emerging trends to inform strategic reforms in dermatology education. Objective: Objective: This study evaluates global trends in dermatology medical education over the past decade, offering insights to enhance education and professional development in the field. Methods: Methods: A systematic review of literature published between 2014 and 2023 was conducted using the Web of Science (WOS) Core Collection database. CiteSpace 6.1.R6 software was used for bibliometric analysis, including author contributions, institutional output, keyword clustering, and burst detection. Results: Results: The United States and the United Kingdom dominate dermatology education research. Key research focuses include disease prevention, comprehensive management, and postgraduate education. Emerging topics involve subspecialty preferences and cosmetic dermatological surgery. Conclusions: Conclusion: Dermatology education is shifting towards integrating multidisciplinary knowledge, addressing comorbidities, and emphasizing subspecialty training to meet the increasing complexity of clinical practice.
Background: Adolescents living with HIV (ALHIV) often experience poor anti-retroviral therapy (ART) outcomes due to multiple barriers affecting medication adherence. Effective self-care interventions...
Background: Adolescents living with HIV (ALHIV) often experience poor anti-retroviral therapy (ART) outcomes due to multiple barriers affecting medication adherence. Effective self-care interventions are needed to address these challenges. Mobile phones are widely used by the adolescent population, thus present an opportunity to be used as a tool to enhance ART adherence using mobile phones as a targeted intervention. However, research on ALHIV's mobile phone access, usage patterns, and perceptions of mobile phone-based interventions is limited in Eswatini. Objective: This study explored the mobile phone access, usage patterns, and perceptions of mobile phone-based interventions among ALHIV in Eswatini to inform effective mobile health strategies for enhancing ART adherence among ALHIV. Methods: We conducted a qualitative study using in-depth interviews in the month of December 2023. A total of 29 ALHIV aged 10 to 19 years and enrolled on ART were purposively sampled were interviewed from five Teen Clubs in the Hhohho region in Eswatini. Topic areas covered were “mobile phone accessibility, usage patterns, and perceptions on the use of mobile phones to facilitate ART adherence.” Results: The study findings indicated high mobile phone access among participants, with primary usage focused on making and receiving calls, as well as engaging with social media. Three themes emerged regarding the use of gamified interventions to support ART adherence. Firstly, the use of gamified interventions aimed at ART adherence among ALHIV was deemed feasible, based on mobile phone access and past experiences with mobile game. Secondly, three main qualities of successful gamified interventions were identified as: being supportive, educational, and ensuring privacy in the design of the game. Lastly, confidentiality and mobile phone access factors were highlighted as potential concerns when designing gamified ART adherence interventions. Conclusions: The findings suggest potentially high access and usage of mobile phones among ALHIV on ART in Eswatini. This provides an opportunity to leverage mobile technology to enhance ART adherence through gamified interventions. However, it is essential to carefully consider ALHIV-specific needs and concerns in the design of these interventions to ensure their successful uptake and sustainability.
Background: Aggression and violence are prevalent in forensic psychiatric inpatient care. These behaviours significantly impact treatment outcomes, work environments for staff, and strain relationship...
Background: Aggression and violence are prevalent in forensic psychiatric inpatient care. These behaviours significantly impact treatment outcomes, work environments for staff, and strain relationships among patients and caregivers. Managing such behaviours poses a formidable challenge that necessitates innovative approaches and evidence-based interventions. Objective: The aim of this project is to evaluate the violence prevention method Therapeutic Meeting with Aggression (TERMA) regarding perceived safety by patients and staff and adverse events within forensic psychiatric inpatient care. Additionally, the project will investigate whether the organisational culture affect the implementation of the TERMA method. Methods: The project includes an observational study with a before and after design. Implementation of TERMA consists of an eight-seminar staff training program. Data sources include questionnaires, medical records, and registries. Quantitative data will be analysed with descriptive and comparative statistics. The project will also include qualitative interview studies. Results: Participant enrollment began in February 2024 and will continue through 2025. Data collection and analysis are expected to be completed by early 2026, after which the study findings will be submitted for publication in peer-reviewed scientific journals. Conclusions: Patients and staff at a forensic psychiatry inpatient facility in Western Sweden. Clinical Trial: NCT05932108
Background: The growing population of cancer survivors faces persistent physical and emotional challenges that significantly impact health-related quality of life (HRQL). To address these multifaceted...
Background: The growing population of cancer survivors faces persistent physical and emotional challenges that significantly impact health-related quality of life (HRQL). To address these multifaceted needs, robust and culturally adapted patient-reported outcome measures, such as the Measure Yourself Concerns and Wellbeing (MYCaW®) questionnaire, are essential for understanding and improving survivors’ subjective experiences. Objective: This protocol outlines the systematic translation and cultural adaptation of the Measure Yourself Concerns and Wellbeing (MYCaW®) questionnaire into German. The MYCaW® questionnaire, a patient-reported outcome measure, is designed to capture individualized concerns and assess overall well-being, particularly in cancer care settings. By adhering to common guidelines, this research will provide a tool for assessing individualized concerns and patient needs among German-speaking cancer patients. Methods: The present study is approved by the ethics committee of the Medical Association Berlin with the reference number Eth-27/10. Following International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines, this study will employ a structured methodology involving forward and backward translation, expert review, patient review process, and preliminary validation to ensure linguistic and cultural equivalence. A standardized coding framework will be developed for analyzing patient concerns, with inter-rater reliability assessed to ensure consistency. Results: The trial is ongoing, with recruitment expected to conclude in the second quarter 2025 and follow-up by year-end. Data analysis is planned for the third quarter 2025, with findings published in the fourth quarter 2025. Results will be presented at conferences, submitted to journals, and the study will conclude in December 2025. The final German MYCaW® version is expected to maintain the conceptual integrity of the original while being accessible and meaningful for German-speaking oncology patients. Conclusions: The translation and adaptation of MYCaW® into German will contribute to expanding the availability of validated patient-reported outcome measures for German-speaking populations. By following rigorous international guidelines, this study aims to produce a reliable and culturally appropriate tool for assessing patient concerns and well-being in oncology and supportive care settings. Future validation studies will be necessary to assess the psychometric properties of the adapted questionnaire and its applicability in clinical and research contexts. Potential challenges, such as maintaining conceptual equivalence in translation and ensuring broad representativeness in the validation process, will be addressed through iterative refinement. Once validated, the German MYCaW® will provide a valuable resource for patient-centered research and care, helping to capture individualized concerns that might be overlooked by standardized instruments. Clinical Trial: The study is registered at the German Register for Clinical Trials under DRKS00013335 on 27/11/2017.
Background: The study aimed to adapt a stress and well-being intervention delivered via a mobile health (mHealth) app for Latinx Millennial caregivers. This demographic, born between 1981 and 1996, re...
Background: The study aimed to adapt a stress and well-being intervention delivered via a mobile health (mHealth) app for Latinx Millennial caregivers. This demographic, born between 1981 and 1996, represents a significant portion of caregivers in the United States, with unique challenges due to higher mental distress and poorer physical health compared to non-caregivers. Latinx Millennial caregivers face additional barriers, including higher uninsured rates and increased caregiving burdens. Objective: We used a community-informed and user-centered design approach to tailor an existing mHealth app to better meet the stress and well-being needs of Latinx Millennial caregivers. Methods: We employed a two-step, multi-feedback approach. In step one, Latinx Millennial caregivers participated in focus groups to evaluate wireframes for the proposed mHealth app. In step two, participants engaged in usability testing for one week, concluding with short interviews for feedback. Participants were recruited through various channels, including social media and community clinics. Data were analyzed inductively using a rapid qualitative content analysis approach Results: A total of 29 caregivers (69% women, mean age 31) participated in the study. Participants had a mean age of 31 (SD=4.10), with most (n=28, 96%) caring for an adult and one (4%) caring for children with chronic conditions. All participants completed the step one focus groups, with a subset of 3 caregivers completing usability testing in step two. The most liked features included the: 1) stress rating scale because it helped them understand stress and mental health, 2) mindfulness options because it allowed for flexible timing of activities, 3) journaling prompts because it was a way to address daily challenges and contemplate positives, and 4) resource list for its employment and financial content. One concern was that the journaling prompts may take too much time or effort to complete after a long and hard day. Some suggestions for improvement included: a better tracking system, gamification, caregiving education, a checklist of emotions to use on the journal, tailored resources, and ways to connect with a community of similar caregivers. During step two, participants noted the app was user-friendly but had some glitches and unclear privacy policies. Participants liked the meditation options, resource variety, and daily stress log but wanted more journaling space, longer meditations, and additional relaxation activities. Conclusions: Caregivers highlighted the need for tailored resources and additional stress-relief activities. Future iterations should consider integrating more personalized and community-specific resources, leveraging platforms like podcasts for broader engagement, and the use of information-based videos to support caregiver skill acquisition. Caregivers expressed needs beyond the scope of the app, such as resource access, demonstrating the need for upstream and downstream interventions. The study underscores the importance of ongoing user feedback in developing effective mHealth interventions for diverse caregiver populations. Clinical Trial: N/A
Background: EHealth can help healthcare service users take a more active role in decision-making and help healthcare professionals guide the patient in this process. Even though usability and health l...
Background: EHealth can help healthcare service users take a more active role in decision-making and help healthcare professionals guide the patient in this process. Even though usability and health literacy strategies should guide the development of mHealth apps, the number of digital health apps publishing their usability evaluation results is still small Objective: The aim of this study was to explore the perceptions of users of the EMAeHealth digital app about its acceptance, usability, strengths and weaknesses for its implementation. Methods: This is an exploratory sequential mixed-method research study, where a qualitative study was followed by a quantitative study. Qualitative results were collected through individual semi-structured interviews between January and March 2024. Participants were identified through purposive sampling. Saturation was reached once 10 interviews had been carried out. In the quantitative part, 106 out of 400 responded to an anonymous online survey created ad hoc in December 2024 based on the results of the qualitative study. Results: Two categories were drawn up during the analysis: (1) “The best thing about this app”, with accessibility, quantity, quality, good organization of the information and the credibility of the source among the reasons for this positive evaluation. (2) “What could be improved”: here, participants considered the app had the potential to become essential if new functions related to healthcare provision were incorporated by linking it to individual health records, as well as making the app more individualized in some different aspects such as receiving notifications. Women commented on the lack of opportunities to share experiences with other women in the same situation and consequently the opportunity to develop networks. The survey gave similar results, with both positive assessments and areas for improvement Conclusions: Although women value the accessibility and reliability of an app designed by the public healthcare service positively, areas for improvement were seen, such as the combination of digital intervention with face-to-face care and, above all, the individualization and adaptation of information, notifications or recommendations to the culture, health situation, or stage of each woman
Background: Cardiovascular diseases are the leading global cause of death, with sudden cardiac arrest contributing significantly. Traditional training methods often deteriorate, and feedback-based app...
Background: Cardiovascular diseases are the leading global cause of death, with sudden cardiac arrest contributing significantly. Traditional training methods often deteriorate, and feedback-based approaches can improve long-term skill retention. Objective: This review assesses the effectiveness of feedback-integrated training compared to traditional Basic Life Support methods in promoting sustained retention of knowledge and skills among healthcare providers in clinical settings. Methods: This systematic review followed PRISMA guidelines, analyzing twelve quasi-experimental and randomized controlled trials published between 2014 and 2024. A comprehensive search was conducted in PubMed, Cochrane Library, Scopus, and Web of Science using keywords related to BLS training and skill retention. Studies were included if they involved healthcare providers, compared feedback-integrated and traditional BLS training, and assessed knowledge or skill retention over time. Excluded studies lacked retention assessments, did not involve healthcare professionals, or were not published in English. Study characteristics, interventions, and outcomes were systematically extracted and synthesized for analysis. Results: Database searches in PubMed, Cochrane Library, Scopus, and Web of Science identified 211 articles, with 98 remaining after removing 113 duplicates. After screening, 55 full-text articles were assessed, and 12 met the inclusion criteria. These studies showed that feedback-integrated training- automated, video-based, and simulation feedback—led to better long-term retention of CPR skills and knowledge among healthcare providers. While traditional methods improved performance initially, skills declined significantly after six months, whereas feedback-integrated training maintained competency for up to twelve months, enhancing compression depth, ventilation quality, and overall resuscitation outcomes. Conclusions: Feedback-integrated Basic Life Support training enhances skill retention and adaptability to diverse clinical settings, requiring future research to evaluate long-term impacts, cost-effectiveness, and comparison with other resuscitation techniques.
Background: Post-market surveillance (PMS) is essential for medical device safety, requiring systematic mapping of adverse events from scientific literature to standardized terminologies like the Inte...
Background: Post-market surveillance (PMS) is essential for medical device safety, requiring systematic mapping of adverse events from scientific literature to standardized terminologies like the International Medical Device Regulators Forum (IMDRF) Adverse Event (AE) Terminology. This process faces challenges in maintaining semantic interoperability across data sources. Objective: This study evaluates whether large language models (LLMs) can effectively automate the mapping of adverse events from orthopedic literature to IMDRF terminology. Methods: A validation approach assessed LLM performance using 309 randomly selected adverse events (23.6% of 1,251 unique events) from orthopedic literature published between 2010-2023. The events were previously mapped by the Harms Mapping Working Group (HMWG) consisting of six Safety Clinicians and seven Safety Coders with extensive clinical and industry experience. Structured prompts were developed following established prompt engineering principles. Accuracy was conservatively measured as correct identification of both appropriate IMDRF terms and codes. Results: LLMs achieved an accuracy rate of 82.52% (255/309 events correctly mapped). Error analysis revealed challenges with AEs lacking sufficient context, gaps in specialized clinical knowledge, and occasional inferential overreach. Concordance between independent Safety Clinician evaluators was complete. Conclusions: While LLMs show promise as assistive tools for AE mapping, they require expert oversight. The findings support a two-stage workflow where LLMs provide initial mapping followed by clinician verification, potentially improving efficiency without compromising quality. Future research should explore enhanced prompt engineering, expanded dictionary integration, and more sophisticated models to address identified limitations.
This systematic literature review investigates the role of Assistive Technology and digital skills in enhancing learning outcomes for Kingdom of Saudi Arabia (KSA) students having learning disabilitie...
This systematic literature review investigates the role of Assistive Technology and digital skills in enhancing learning outcomes for Kingdom of Saudi Arabia (KSA) students having learning disabilities. This review aims to explore the extent of technology applications to support individuals who face learning disabilities. The reviews aim to identify; the core skills that require further enrichment and the technological tools used for skill development; the impact of technological tools on the performance of students with learning disabilities; and investigate a variety of research on technological amelioration to assist KSA students with learning disabilities. The study also covers various research domains where further exploration is vital. The review encompasses a detailed investigation of 25 research articles in the specific range of 2014-2024. The review revealed that past studies focused on multiple baseline designs in many studies, primarily involving elementary school students and other educational settings. The review also highlighted key skills where research elevation is of utmost value and fruitful outcomes can be attained along with the technological tools applied to support these skills. The review outcome demonstrates that technological tools applications have a positive impact on students’ performance. The review outcome recommends various elucidation including expanding teacher training programs, addressing infrastructural gaps, and conducting more localized studies in Saudi Arabia.
Background: Personalised Interactive Music Systems (PIMS) are emerging as promising devices for enhancing physical activity and exercise outcomes. By leveraging real-time data and adaptive technologie...
Background: Personalised Interactive Music Systems (PIMS) are emerging as promising devices for enhancing physical activity and exercise outcomes. By leveraging real-time data and adaptive technologies, PIMS align musical features, such as tempo and genre with users’ physical activity patterns, including frequency and intensity, enhancing their overall experience. Objective: This exploratory systematic review and exploratory meta-analysis evaluates the effectiveness of PIMS across physical, psychophysical, and affective domains. Methods: Searches across nine databases identified 18 eligible studies, of which six (comprising 17 intervention arms) contained sufficient data for meta-analysis. Random-effects meta-analyses and meta-regression were performed to assess outcomes for physical activity levels, physical exertion, ratings of perceived exertion (RPE), and affective valence. Results: Results showed significant improvements in physical activity levels (g = 0.49, CI [0.07, 0.91], p = .02, k = 4) and affective valence (g = 1.68, CI [0.15, 3.20], p = .03, k = 4), with faster music tempo identified as a significant moderator (p = 0.04). No significant effects were observed for RPE (g = 0.72, CI [-0.14, 1.59], p = .10, k = 3) or physical exertion (g = 0.79, CI [-0.64, 2.10], p = .28, k = 5). Conclusions: Substantial heterogeneity and limited study quality indicate the need for more robust, randomised controlled trials to establish the efficacy of PIMS in diverse populations. Clinical Trial: Review registration (CRD42023465941)
Background: A decline in applications to vital medical specialties, particularly general surgery, obstetrics and gynecology, and pediatrics in Republic of Korea threatens the nation's healthcare infra...
Background: A decline in applications to vital medical specialties, particularly general surgery, obstetrics and gynecology, and pediatrics in Republic of Korea threatens the nation's healthcare infrastructure. Despite multiple contributing factors, there is limited qualitative research exploring medical students' specialty choice decisions. Objective: This study aimed to examine the key factors influencing Korean medical students' specialty selection processes, identify how recent healthcare policy changes affect their career decisions, and understand their preferences for training. Methods: We conducted 24 semi-structured interviews with medical students at various educational stages, exploring their demographics, career plans, and specialty preferences. Questions covered motivations for specialization choices, preferred practice locations, and the impact of government policies. Interviews were conducted from March to April 2024, with data coded using ATLAS.ti. Results: Career decisions were influenced by three main categories: personal factors (academic interest, self-perceived competence, sense of calling), social factors (legal risk, remuneration, long-term outlook), and inherent factors of specialties (workload). Recent healthcare policy changes significantly impacted students' career prospects, with some considering practice abroad. Training location preferences were primarily influenced by hospital volume and residency possibilities. Conclusions: Medical students' specialty choices are shaped by personal, social, and inherent factors. Policy implementation should protect students from deterrents like legal risks, enabling choices based on aptitude and interest rather than external pressures, to maintain a well-balanced healthcare system.
Background: Population-wide genomic screening (PGS) for genetic conditions such as Hereditary Breast and Ovarian Cancer Syndrome, Lynch Syndrome, and Familial Hypercholesterolemia presents opportuniti...
Background: Population-wide genomic screening (PGS) for genetic conditions such as Hereditary Breast and Ovarian Cancer Syndrome, Lynch Syndrome, and Familial Hypercholesterolemia presents opportunities to reduce morbidity and mortality among the 1-2% of the population at elevated risk for these serious, preventable diseases. With decreasing sequencing costs and growing support from national bodies, there are increasing numbers of PGS programs in the US. However, guidelines and strategies to support implementation are limited, especially regarding equitable access to PGS. Contextual factors, such as organizational structures and processes impact PGS implementation, often failing to benefit underrepresented populations. Objective: To address these challenges, we are completing the FOCUS project, which will develop and test a freely available, equity-centered online implementation toolkit to guide best practices for implementing PGS. Methods: The FOCUS project aims to 1) examine barriers and facilitators of equitable PGS implementation at sites at various stages of implementation, 2) develop implementation strategies with input from a diverse advisory panel and package them into the FOCUS toolkit, and 3) evaluate the toolkit's impact on improving PGS reach, effectiveness, adoption, and maintenance using a hybrid stepped-wedge cluster randomized trial design. Results: Results: This project was funded in 8/2024 per the funding acknowledgement. Implementation Team Member (ITM) data collection began in 10/2024 and Patient (PAT) data collection began in 1/2025. As of 3/2025, we have enrolled 9 PAT subjects and 32 ITM subjects. Of these 32 ITM subjects, we have completed qualitative data analyses on 18 of them in accordance with our described methods for Study Aim 1. Conclusions: With a focus on health equity and stakeholder engagement, the FOCUS toolkit will establish a standardized approach to scaling PGS programs across diverse populations and settings, ensuring genomics benefits are accessible to all.
Background: - Objective: This study investigated the use of social networks as educational tools in the university environment, with the aim of designing and validating the Questionnaire of Satisfacti...
Background: - Objective: This study investigated the use of social networks as educational tools in the university environment, with the aim of designing and validating the Questionnaire of Satisfaction with Educational Activities Performed on Social Networks (CuSAERS). Methods: Employing a mixed and sequential methodology, we explored the perceptions of Bachelor’s and Master’s degree students in Physiotherapy who participated in teaching activities via X.com (formerly Twitter) and Instagram. The first phase of the project identified key dimensions of satisfaction from the literature, expert interviews and cognitive interviews. The second phase assessed the psychometric properties of the CuSAERS in a sample of 150 students, addressing construct validity, internal reliability, concurrent validity and discriminant validity. Results: Exploratory factorial analysis revealed 4 dimensions: Perception of Learning, Task Satisfaction, Self-Fulfilment and Motivation. Reliability was adequate, with the robustness of the Perception of Learning dimension standing out. Concurrent validity was confirmed by moderate correlations with the Academic Satisfaction Scale, which supports the usefulness of the CuSAERS in assessing the impact of social networks on student satisfaction. Significant differences were also observed between Bachelor’s and Master’s students, with the latter showing the highest level of satisfaction, possibly due to greater academic experience and digital competence. Conclusions: The results suggest that CuSAERS appears to be a valid and reliable tool for measuring student satisfaction with teaching activities on social networks. This instrument could guide teaching practice, optimize pedagogical strategies in digital environments and ultimately promote more meaningful and collaborative learning. Clinical Trial: No applicable.
Background: SPAN@DEM emerged from the recognition that existing cluster-level advocacy groups are inadequate to address the specific needs of the emergency department (ED). Moreover, the fast-paced, h...
Background: SPAN@DEM emerged from the recognition that existing cluster-level advocacy groups are inadequate to address the specific needs of the emergency department (ED). Moreover, the fast-paced, high-pressure nature of emergency medicine presents distinct challenges for patient advocacy. As the first ED-specific advocacy group in Singapore, SPAN@DEM represents a significant step forward in local patient advocacy efforts because it uses a shared collaborative model to address patient needs and concerns within the unique context of the ED environment. Objective: In this article, we aim to share our journey in setting up our patient advocacy group, discuss the challenges and considerations and reflect on our lessons learnt throughout this process. Methods: A start-up committee comprising emergency physicians and patient advocates was formed to explore the processes required to create such an organisation. Some important features of SPAN@DEM include co-leadership between emergency physician and patient advocate, and diverse composition with equal representation from healthcare workers and advocates. SPAN@DEM conducts quarterly meetings with informal luncheons during meetings to foster open communication between advocates and healthcare staff. Membership is voluntary and based purely on altruism and members must participate in mandatory advocacy trainings to empower them to provide more actionable insights. Results: SPAN@DEM has initiated several projects thus far, such as PIKACHU (a quality improvement project which led to improved patient and next-of-kin satisfaction rates and decreased formal communication-related complaints) and Digital FAQ (a patient-friendly resource to explain ED processes) in addition to communication workshops for junior doctors and wayfinding projects. SPAN@DEM advocates have also actively contributed to the planning, design and transition to the new Emergency Medicine Building. More importantly, SPAN@DEM has fostered a cultural shift towards patient-centric care within the department as the department now works closely with patient advocates on day-to-day decisions for matters concerning patient and next-of-kin experience. Conclusions: SPAN@DEM demonstrates the value of specialised department-specific advocacy groups in shaping the future of patient-centred emergency care. This model may serve as an exemplar for other healthcare institutions seeking to promote patient advocacy efforts. Clinical Trial: N/A
Background: Hydronephrosis is a condition characterized by the swelling of one or both kidneys due to urine buildup, often resulting from an obstruction in the urinary tract. In pediatric patients, gr...
Background: Hydronephrosis is a condition characterized by the swelling of one or both kidneys due to urine buildup, often resulting from an obstruction in the urinary tract. In pediatric patients, grading and assessing the severity of hydronephrosis are crucial for determining appropriate treatment and predicting outcomes. Objective: The objective of this study is to systematically review and analyze the use of AI-based models for grading and assessing hydronephrosis severity in pediatric patients, evaluating their methodologies, diagnostic performance, and potential for clinical integration. Methods: This systematic review and meta-analysis will systematically search for studies published up to 1 March 2025 in databases including MEDLINE, Cochrane, IEEE Xplore, Scopus, Google Scholar, and Taylor & Francis, as well as grey literature sources like ProQuest, OpenGrey, and conference proceedings. Eligible studies must involve AI-based models for segmentation, classification, or prediction of hydronephrosis severity in patients aged 0–18 years, utilizing imaging modalities such as ultrasound, CT, or MRI. Studies will be assessed for risk of bias using a modified version of QUADAS-2, and a narrative synthesis will be conducted. If sufficient data homogeneity exists, a meta-analysis will be performed using random-effects models. Results: The study began in March 2025 with completion expected by July 2025. Conclusions: This systematic review and meta-analysis will be the first review to provide insights into the potential of AI in pediatric hydronephrosis assessment, supporting its integration into clinical practice or identifying limitations in its application.
Background: Driven by technological advancements, the proliferation of mobile sports and health applications (apps) has revolutionized health management by improving efficiency, cost-effectiveness, an...
Background: Driven by technological advancements, the proliferation of mobile sports and health applications (apps) has revolutionized health management by improving efficiency, cost-effectiveness, and accessibility. While the widespread adoption of these platforms has transformed public health practices and social well-being in China, emerging evidence suggests that inadequacies in their privacy policies may compromise personal information (PI) protection. Objective: This study conducts a systematic evaluation of privacy policy compliance among 100 leading mobile sports and health apps in mainland China, benchmarking them against the Personal Information Protection Law (PIPL) and associated regulatory guidelines. Methods: This study develops a privacy policy compliance indicator scale based on the information life cycle and the legal framework for PI protection in the Mainland of China. This scale consists of 5 level 1 indicators and 37 level 2 indicators that assess the privacy policy compliance. Results: The mean compliance score of the 100 sports and health apps is 58.375. 42% of the 100 apps score below the average, with 57.14% (n=24) scoring less than 40 points and 20% (n=20) scoring more than 80 points. The 5 level 1 indicators have the following scores: 75.22% for the collection of PI, 52% for the storage of PI, 52.21% for the use of PI, 61% for the entrusted processing, the sharing, the transfer, and the disclosure of PI, and 60.6% for the consultation and feedback on PI. The compliance level among Apple system apps surpasses that of Android system apps. Despite identical qualified rates for Apple and Android apps, both at 17 out of 50, the proportion of Apple apps rated as excellent (12%) and good (12%) markedly surpasses that of Android apps, which stand at 6% for excellent and 10% for good. The compliance evaluations for these 37 level 2 indicators, 18 show a mean compliance rate below 60%. Three indicators exhibit compliance rates below 20%: de-identified display and use of PI at 16%, storage of sensitive PI at 13%, and processing rules of deceased users at 11%. While the majority of 100 apps indicate that the collected PI will be retained in the Mainland of China for a reasonably necessary duration (mean 71%[SD 45.60%]), and that separate authorization will be required otherwise (mean 80%[SD 40.20%]), in accordance with the principle of necessity outlined in Article 19 and the principle of domestic storage in Article 39 of the PIPL, fewer than half (mean 44%[SD 49.89%]) of the evaluated apps will de-identify the data promptly through security measures after PI collection. Conclusions: Although some apps establish commendable policies, there are some shortcomings that compromise the efficacy of PI protection. In light of this, this paper puts forward suggestions from the perspective of privacy policy formulation, regulatory reform, and legislative improvement.
Background: Groundwater contamination poses a significant public health risk, particularly in urban areas with inadequate waste management. Dumpsites serve as major sources of pollutants, including he...
Background: Groundwater contamination poses a significant public health risk, particularly in urban areas with inadequate waste management. Dumpsites serve as major sources of pollutants, including heavy metals, which infiltrate aquifers through leachate migration. Port Harcourt, Nigeria, faces increasing groundwater quality concerns due to the proliferation of uncontrolled waste disposal sites. Objective: This study aims to evaluate the spatial and seasonal variations in groundwater quality around dumpsites in Port Harcourt and determine the suitability of groundwater for drinking based on WQI values. It also seeks to identify contamination patterns and assess the influence of rainfall on pollutant dispersion. Furthermore, the study compares findings with global research to establish broader implications for waste management and public health. By doing so, it provides a scientific basis for policy recommendations aimed at mitigating groundwater pollution. Methods: Groundwater samples were collected from various locations around major dumpsites in Port Harcourt during dry and rainy seasons. Physicochemical parameters, including heavy metal concentrations, were analyzed to compute WQI values. Comparative analysis with previous studies was conducted to validate observed contamination trends. The impact of leachate migration on water quality was assessed using seasonal variations in WQI values. Results: Findings reveal significant spatial and seasonal fluctuations in groundwater quality. While Choba exhibited excellent water quality, Sasun, Olumeni, and Epirikom recorded dangerously high WQI values, indicating unsuitability for drinking. Seasonal variations showed that rainfall exacerbated contamination levels, as seen in Eleme, where WQI increased from 56.362 in the dry season to 140.928 in the rainy season. The study aligns with previous research from India, China, and Ghana, demonstrating that landfill leachates and surface runoff are key contributors to groundwater degradation. Conclusions: The study confirms that dumpsite leachates significantly impact groundwater quality, posing a major risk to public health. The high WQI values in several locations highlight the need for urgent interventions. Findings align with global research on groundwater contamination, emphasizing the critical role of effective waste management in reducing environmental pollution. To mitigate groundwater pollution from dumpsite leachates, it is essential to implement stringent waste management policies that regulate landfill operations and prevent leachate infiltration into aquifers. Establishing continuous groundwater monitoring programs can help detect contamination trends early and guide timely intervention measures. Additionally, promoting alternative potable water sources in highly contaminated areas is crucial to reducing health risks for affected communities. The adoption of modern landfill technologies, such as leachate treatment and containment systems, should be prioritized to minimize pollution and safeguard water resources for future generations. This study contributes to the growing body of research on groundwater contamination by providing empirical evidence of the impact of dumpsites in an urban African setting. The findings underscore the urgent need for improved waste management policies and public health interventions. By aligning with global research, this study reinforces the importance of sustainable environmental practices to safeguard water resources and protect communities from the adverse effects of pollution.
Background: Adolescents’ mental health problems significantly affect their long-term psychological and physical health. Although peer influence grows during adolescence, parental influence remains c...
Background: Adolescents’ mental health problems significantly affect their long-term psychological and physical health. Although peer influence grows during adolescence, parental influence remains critical. Parental smoking is associated with behavioral problems in adolescents. Objective: As research in this area is limited, this study investigated the impact of parental smoking, particularly maternal smoking, on 2,761 adolescents’ mental health outcomes in South Korea. Methods: We analyzed data from a nationwide Korea National Health and Nutrition Examination Survey from 2012 to 2017. We employed analysis of variance and χ2 tests to compare adolescents’ and parents’ baseline characteristics and mental health. Results: Our logistic regression analyses revealed that mothers’ current smoking habits were significantly associated with their adolescents’ cognitive stress (odds ratio [OR] = 1.65 (95% CI: 1.06–2.56)), experiences of melancholy (OR = 2.09 (95% CI: 1.20–3.65)), and suicidal ideation (OR = 2.39 (95% CI: 1.17–4.88)). Furthermore, adolescents whose mothers were current smokers and had cognitive stress demonstrated higher cognitive stress (OR = 2.09), melancholy (OR = 2.27), and suicidal ideation (OR = 2.74) than those whose mothers were not smokers and had no cognitive stress. Conclusions: Efforts to improve adolescents’ mental health require considering their mothers’ smoking status and stress levels. This highlights the need to develop programs to enhance adolescent mental health, manage maternal stress, and promote smoking cessation.
Background: Chemistry education relies heavily on experimentation to bridge theoretical concepts with practical applications. However, universities often face challenges in providing real laboratory e...
Background: Chemistry education relies heavily on experimentation to bridge theoretical concepts with practical applications. However, universities often face challenges in providing real laboratory experiences due to resource limitations, equipment shortages, and logistical constraints. Virtual laboratories have emerged as a promising alternative, offering interactive, computer-based simulations that replicate real lab experiments and enhance learning. Objective: This study investigates the perceived benefits and challenges of implementing virtual laboratories in chemistry education at selected universities in Southern Ethiopia, assessing their effectiveness as a teaching and learning tool. Methods: An explanatory sequential mixed-method design was employed to provide a comprehensive analysis. Quantitative data were collected from 63 chemistry instructors and 143 undergraduate students using structured questionnaires, while qualitative insights were obtained through interviews. Descriptive statistics were used to analyze numerical data, and thematic coding was applied to categorize qualitative responses. Results: The findings indicate that virtual laboratories significantly enhance chemistry education by improving academic achievement and conceptual understanding, particularly in grasping key concepts and complex topics (average mean score: 3.9). They also contribute to the development of essential scientific skills, such as hypothesis formulation, problem-solving abilities, and effective lab report writing (average mean score: 3.8). Additionally, virtual labs offer flexibility in learning by supporting self-paced education and serving as viable alternatives when access to real laboratories is limited (average mean score: 3.8). However, despite these advantages, several challenges were identified. Limited technical expertise (kappa = 0.63), high software costs (kappa = 0.61), difficulties in understanding specific concepts required for virtual experiments (kappa = 0.61), and the absence of engaging virtual lab software (kappa = 0.51) were among the primary obstacles. Furthermore, a lack of preparedness to address real laboratory challenges (kappa = 0.23) and infrastructural limitations, such as insufficient computer facilities (kappa = 0.25), further hinder the effective implementation of virtual laboratories. Conclusions: The study underscores the transformative potential of virtual laboratories in chemistry education, serving as viable alternatives to traditional lab instruction. However, their successful implementation requires addressing existing challenges, such as improving digital infrastructure, providing instructor training, and enhancing accessibility. Universities should consider integrating virtual laboratories alongside real labs to optimize learning outcomes and foster technologically advanced educational environments.
Background: College students commonly struggle with procrastination, which is linked to mental health complaints and poor academic performance. Guided e-health interventions can be effective in reduci...
Background: College students commonly struggle with procrastination, which is linked to mental health complaints and poor academic performance. Guided e-health interventions can be effective in reducing procrastination. Objective: This study aims to examine the feasibility and acceptability of a new e-health intervention targeting procrastination for college students ('GetStarted') with guidance by student e-coaches. Methods: We conducted a single-arm study. Primary outcomes are satisfaction (CSQ-8), usability, (SUS-10) and adherence (completion rate). Secondary outcomes are changes to procrastination (IPS), depression (PHQ-9), stress (PSS-10), quality of life (MHQoL) and e-coaching satisfaction (WAI-I). Results: Of 734 participants that started the intervention, 335 (45.6%) completed the post-test. Students report being satisfied with the intervention (CSQ-8 M= 23.48; SD = 3,.23) and find it very usable (SUS-10 M = 34.39; SD = 4.52). Regarding adherence, 36.65% participants completed the intervention. On average participants completed 68.95% of the intervention. Participants showed a significant decrease in procrastination, depression and stress as well as an increase in quality of life from baseline to post-test to follow-up. Conclusions: The internet-based, student-guided intervention 'GetStarted' targeting procrastination appears to be acceptable and feasible for college students in the Netherlands.
Background: Social media has profoundly transformed consumer behavior and marketing practices within the hospitality industry. Understanding how these changes influence hotel selection and booking dec...
Background: Social media has profoundly transformed consumer behavior and marketing practices within the hospitality industry. Understanding how these changes influence hotel selection and booking decisions, the effectiveness of social media strategies, and shifts in reputation management practices is crucial for hotels aiming to enhance their digital presence and customer engagement. Objective: The study aims to analyze the influence of social media on consumer behavior, audience engagement, and reputation management in hotel selection and booking decisions as well as compare pre- and post-social media reputation management practices. Methods: Data was collected through surveys and interviews with hotel guests and marketing professionals. The analysis included descriptive statistics and comparative assessments of pre- and post-social media reputation management practices. The effectiveness of various social media strategies was evaluated based on respondent feedback. Results: The findings indicate that promotional offers, user reviews, and visual content significantly influence consumer behavior in hotel selection and booking decisions. Collaboration with influencers, user-generated content, live video content, and social media advertising are the most effective strategies for audience engagement and brand building, each with a 100% effectiveness rate. There is a notable shift in reputation management practices, with a decrease in promptly addressing issues and providing compensation, and an increase in seeking private resolutions through direct messages post-social media. Conclusions: Social media plays a critical role in shaping consumer behavior and brand perception in the hotel industry. Effective social media strategies, particularly those involving influencers and user-generated content, are essential for engaging audiences and building brand identity. The transition to social media has also led to changes in reputation management, emphasizing the importance of balancing transparency with discreet conflict resolution. Hotels should prioritize comprehensive social media strategies that include collaboration with influencers, regular updates, and engaging content. Encouraging positive user-generated content and implementing robust monitoring and response systems are essential. Training staff on social media engagement and conflict resolution can further improve reputation management. Ongoing adaptation to emerging social media trends is crucial for maintaining effectiveness. This study provides valuable insights into the impact of social media on consumer behavior and marketing in the hospitality industry. By identifying effective social media strategies and examining changes in reputation management, it offers practical guidance for hotels seeking to enhance their digital presence and customer engagement. The findings underscore the importance of leveraging social media to achieve greater business success and maintain a positive brand reputation.
Background: Noncommunicable diseases (NCDs) pose a significant burden in the Philippines, with cardiovascular and cerebrovascular diseases among the leading causes of mortality. The Department of Heal...
Background: Noncommunicable diseases (NCDs) pose a significant burden in the Philippines, with cardiovascular and cerebrovascular diseases among the leading causes of mortality. The Department of Health implemented the Philippine Package of Essential Non-Communicable Disease Interventions (Phil PEN) to address this issue. However, healthcare professionals faced challenges in implementing the program due to the cumbersome nature of the multiple forms required for patient risk assessment. To address this, a mobile medical app, the PhilPEN Risk Stratification app, was developed for community health workers (CHWs) using the extreme prototyping framework. Objective: This study aimed to assess the usability of the PhilPEN Risk Stratification app using the (User Version) Mobile App Rating Scale (uMARS) and to determine the utility of uMARS in app development. The secondary objective was to achieve an acceptable (>3 rating) score for the app in uMARS, highlighting the significance of quality monitoring through validated metrics in improving the adoption and continuous iterative development of medical mobile apps. Methods: The study employed a qualitative research methodology, including key informant interviews, linguistic validation, and cognitive debriefing. The extreme prototyping framework was used for app development, involving iterative refinement through progressively functional prototypes. CHWs from a designated health center participated in the app development and evaluation process – providing feedback, using the app to collect data from patients, and rating it through uMARS. Results: The uMARS scores for the PhilPEN Risk Stratification app were above average, with an Objective Quality rating of 4.05 and a Personal Opinion/Subjective Quality rating of 3.25. The mobile app also garnered a 3.88-star rating. Under Objective Quality, the app scored well in Functionality (4.19), Aesthetics (4.08), and Information (4.41), indicating its accuracy, ease of use, and provision of high-quality information. The Engagement score (3.53) was lower due to the app's primary focus on healthcare rather than entertainment. Conclusions: The study demonstrated the effectiveness of the extreme prototyping framework in developing a medical mobile app and the utility of uMARS not only as a metric, but also as a guide for authoring high-quality mobile health apps. The uMARS metrics were beneficial in setting developer expectations, identifying strengths and weaknesses, and guiding the iterative improvement of the app. Further assessment with more CHWs and patients is recommended. Clinical Trial: N/A
Among the countless decisions healthcare providers make daily, many clinical scenarios do not have clear guidelines, despite a recent shift towards the practice of evidence-based medicine. Even in cli...
Among the countless decisions healthcare providers make daily, many clinical scenarios do not have clear guidelines, despite a recent shift towards the practice of evidence-based medicine. Even in clinical scenarios where guidelines do exist, these guidelines do not universally recommend one treatment option over others. As a result, the limitations of existing guidelines presumably create an inherent variability in provider decision-making and the corresponding distribution of provider behavioral variability in a clinical scenario, and such variability differs across clinical scenarios. We define this variability as a marker of provider uncertainty, where scenarios with a wide distribution of provider behaviors have more uncertainty than scenarios with a narrower provider behavior distribution. We propose four exploratory analyses of provider uncertainty: (1) field-wide overview; (2) subgroup analysis; (3) provider guideline adherence; and (4) pre-/post-intervention evaluation. We also propose that uncertainty analysis can also be used to help guide interventions in focusing on clinical decisions with the highest amounts of provider uncertainty and therefore the greatest opportunity to improve care.
The management of human dissection labs and medical education are significantly impacted by the resurgence and spread of monkeypox (Mpox) as a global health issue, especially in Africa. Human dissecti...
The management of human dissection labs and medical education are significantly impacted by the resurgence and spread of monkeypox (Mpox) as a global health issue, especially in Africa. Human dissection, a crucial part of anatomical education, requires strict procedures to protect medical students and instructors from the spread of infectious diseases. This article highlights important hazards and biohazard concerns while examining the difficulties presented by the Mpox pandemic in the context of cadaveric dissection. Through a review of literature, institutional protocols and epidemiological data, we propose improved personal protective equipment (PPE) regulations and disinfection guidelines tailored for African medical facilities. This article highlights the need for capacity-building programs to equip educators and students with skills to manage infectious disease risks effectively. By tackling these challenges, we aim to advance medical education safely while contributing to discussions on public health emergency adaptations and fostering pandemic resilience.
This study investigates the behavioral dynamics of sociopaths, focusing on their reliance on glibness (superficial charm) as a primary manipulation tactic and aggressiveness as a secondary strategy wh...
This study investigates the behavioral dynamics of sociopaths, focusing on their reliance on glibness (superficial charm) as a primary manipulation tactic and aggressiveness as a secondary strategy when charm fails. Sociopathy, characterized by manipulative tendencies and a lack of empathy, often manifests in adaptive yet harmful behaviors aimed at maintaining control and dominance.
Using the Deenz Antisocial Personality Scale (DAPS-24) to collect data from 34 participants, this study examines the prevalence and interplay of these dual strategies. Findings reveal that sociopaths employ glibness to disarm and manipulate, transitioning to aggressiveness in response to resistance. The implications for understanding sociopathic manipulation are discussed, emphasizing the importance of early detection and intervention in both clinical and social contexts.
Background: Abstract (237 words)
The American Civil War has been commemorated with a great variety of monuments,
memorials, and markers. These monuments were erected for a variety of reasons, begi...
Background: Abstract (237 words)
The American Civil War has been commemorated with a great variety of monuments,
memorials, and markers. These monuments were erected for a variety of reasons, beginning with
memorialization of the fallen and later to honor aging veterans, commemoration of significant
anniversaries associated with the conflict, memorialization sites of conflict, and celebration of
the actions of military leaders. Sources reveal that during both the Jim Crow and Civil Rights
eras, many were erected as part of an organized propaganda campaign to terrorize African
American communities and distort the past by promoting a ‘Lost Cause’ narrative. Through
subsequent decades, to this day, complex and emotional narratives have surrounded interpretive
legacies of the Civil War. Instruments of commemoration, through both physical and digital intervention approaches, can be provocative and instructive, as the country deals with a slavery legacy and the commemorated objects and spaces surrounding Confederate inheritances.
Today, all of these potential factors and outcomes, with internationally relevance, are surrounded by swirls of social and political contention and controversy, including the remembering/forgetting dichotomies of cultural heritage. The modern dilemma turns on the question: In today’s new era of social justice, are these monuments primarily symbols of oppression, or can we see them, in select cases, alternatively as sites of conscience and reflection encompassing more inclusive conversations about commemoration? What we save or destroy and assign as the ultimate public value of these monuments rests with how we answer this question. Objective: I describe monuments as symbols in the “Lost Cause” narrative and their place in enduring Confederate legacies. I make the case, and offer documented examples, that remnants of the monuments, such as the “decorated” pedestals, if not the original towering statues themselves, should be left in place as sites of reflection that can be socially useful in public interpretation as disruptions of space, creating disturbances of vision that can be provocative and didactic. I argue that we should see at least some of them as sculptural works of art that invite interpretations of aesthetic and artistic value. I point out how, today, these internationally relevant factors and outcomes of retention vs. removal are engulfed in swirls of social and political contention and controversy within processes of remembering and forgetting and changing public dialogues. Methods: This article addresses several elements within the purview of the Journal: questions of contemporary society, diversity of opinion, recognition of complexity, subject matter of interest to non-specialists, international relevancy, and history. Drawing from the testimony of scholars and artists, I address the contemporary conceptual landscape of approaches to the presentation and evolving participatory narratives of Confederate monuments that range from absolute expungement and removal to more restrained responses such as in situ re-contextualization, removal to museums, and preservation-in-place. In a new era of social justice surrounding the aftermath of dramatic events such as the 2015 Charleston shooting, the 2017 Charlotteville riot, and the murder of George Floyd, should we see them as symbols of oppression, inviting expungement, or selectively as sites of conscience and reflection, inviting various forms of re-interpretation of tangible and intangible relationships?
I describe monuments as symbols in the “Lost Cause” narrative and their place in enduring Confederate legacies. I make the case, and offer documented examples, that remnants of the monuments, such as the “decorated” pedestals, if not the original towering statues themselves, should be left in place as sites of reflection that can be socially useful in public interpretation as disruptions of space, creating disturbances of vision that can be provocative and didactic. I argue that we should see at least some of them as sculptural works of art that invite interpretations of aesthetic and artistic value. I point out how, today, these internationally relevant factors and outcomes of retention vs. removal are engulfed in swirls of social and political contention and controversy within processes of remembering and forgetting and changing public dialogues. Results: I argue that we should see at least some of them as sculptural works of art that invite interpretations of aesthetic and artistic value. I point out how, today, these internationally relevant factors and outcomes of retention vs. removal are engulfed in swirls of social and political contention and controversy within processes of remembering and forgetting and changing public dialogues. Conclusions: Today, all of these potential factors and outcomes, with internationally relevance, are surrounded by swirls of social and political contention and controversy, including the remembering/forgetting dichotomies of cultural heritage. The modern dilemma turns on the question: In today’s new era of social justice, are these monuments primarily symbols of oppression, or can we see them, in select cases, alternatively as sites of conscience and reflection encompassing more inclusive conversations about commemoration? What we save or destroy and assign as the ultimate public value of these monuments rests with how we answer this question.
