Nevin Manimala

J Med Internet Res. 2026 May 4;28:e87158. doi: 10.2196/87158.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) integration in mobile health (mHealth) apps offers health care access opportunities in low-resource settings, yet opaque AI recommendations undermine trust and adoption. Existing explainable AI (XAI) frameworks, designed in Western contexts, fail to address the linguistic, cultural, and infrastructural realities of South Asian populations, creating barriers where users cannot understand AI recommendations, clinicians cannot validate outputs, and developers lack implementation guidance. Thus, understanding explainability requirements among educated, digitally literate populations provides foundational insights for future development of inclusive mHealth technologies.

OBJECTIVE: This study aims to (1) investigate stakeholder perceptions of trust and explainability in AI-driven mHealth in Bangladesh; (2) identify demographic predictors of trust; and (3) develop and propose a context-adapted framework benefiting developers, policymakers, clinicians, and end users in resource-constrained settings.

METHODS: This study used a sequential mixed methods design that combined a quantitative survey (n=137) with a qualitative phase involving 20 stakeholders. This qualitative cohort consisted of developers (n=4), XAI experts (n=6), and clinicians (n=10) who participated through either focus groups or individual interviews. We used statistical analysis to examine demographic predictors and applied thematic analysis to identify explainability needs specific to each stakeholder group.

RESULTS: Education level showed a significant effect on trust (F3, 133=2.81, P=.042). Completed undergraduate students reported lower trust (mean 3.14, SD 1.10) compared with current undergraduates (mean 3.66, SD 0.93), suggesting that undergraduate completion develops critical evaluation skills that may decrease uncritical acceptance of AI systems. Despite recognizing AI’s utility for preliminary guidance, users emphasized the necessity of human validation and expressed concerns about understanding AI’s decision-making logic. Interviews with different stakeholder groups revealed critical gaps. Developers acknowledged minimal explainability implementation in current mHealth apps, while medical professionals unanimously prioritized clinical judgment over automated outputs and advocated for physician-mediated AI systems. Synthesizing findings across all stakeholder groups revealed five core requirements: (1) Human-AI collaboration and clinical validation, (2) Transparent logic paths, (3) Contextual personalization, (4) Cultural and linguistic relevance, and (5) Trust calibration and ethical safeguards.

CONCLUSIONS: The framework bridges stakeholder misalignments and offers actionable guidance for design, deployment, and policy alignment in resource-constrained environments. By situating explainability within the sociocultural realities of South Asia, this research advances XAI beyond algorithmic transparency toward equity, inclusion, and user empowerment in digital health.

PMID:42081827 | DOI:10.2196/87158

JMIR Serious Games. 2026 May 4;14:e79976. doi: 10.2196/79976.

ABSTRACT

BACKGROUND: The relationship between video game experience and cognitive plasticity remains a central focus of research, particularly given its potential applications in clinical rehabilitation. Although both first-person shooter (FPS) and multiplayer online battle arena (MOBA) games have been shown to enhance cognitive functions, the specific associations between the cognitive effects of different game genres and brain network structure remain unclear.

OBJECTIVE: This study aimed to examine whether long-term experience with FPS and MOBA games is associated with genre-specific patterns of cortical thickness covariation across brain regions.

METHODS: A total of 116 male participants (mean age 21.2, SD 1.9 y) were recruited via online advertisements for this cross-sectional study. On the basis of strict inclusion criteria (gaming experience >5 years, gaming frequency >5 hours per week, and ranking within the top 15%), participants were categorized into FPS players (n=39, 33.6%) and MOBA players (n=40, 34.5%). An additional group of healthy controls (n=37, 31.9%) with no gaming experience in the past 2 years was also included. High-resolution structural magnetic resonance imaging data were acquired using a 3-T scanner. Individualized differential structural covariance networks were constructed based on the cortical thickness values extracted from 68 brain regions using the Desikan-Killiany atlas. Statistical analysis included one-way ANOVA to identify significant structural covariance edges (SCEs), network-based statistic prediction analysis for weekly gaming hours, and support vector machine analysis for group classification.

RESULTS: One-way ANOVA identified 30 significant SCEs across the 3 groups (P<.001, false discovery rate corrected). Post hoc analysis (P<.02, Bonferroni corrected) revealed that, compared to the MOBA and control groups, the FPS group exhibited 2 dominant networks: a temporo-fronto-parietal network anchored in auditory regions and a visuo-sensorimotor network. Both gaming groups showed enhanced SCEs in visual-attentional networks compared to the control group. The network-based statistic-predict analysis demonstrated that structural covariance matrices could effectively predict weekly gaming hours in FPS players (r=0.34, 95% CI 0.26-0.42). The positive edges primarily formed a temporo-fronto-parietal-occipital network, whereas the negative edges were centered on the entorhinal cortex. The support vector machine classifier successfully differentiated FPS players from controls (area under the curve=82.95%) and from MOBA players (area under the curve=72.37%).

CONCLUSIONS: Long-term FPS and MOBA gaming experiences are associated with different brain structural network architectures. The uniqueness of FPS gaming lies in the extensive structural covariance between the primary auditory cortex and regions supporting visual attention and sensorimotor processing, which may reflect higher demands on cognitive skills. This suggests potential utility in auditory-visual rehabilitation and provides a theoretical basis for the assessment and selection of professional electronic sports players. However, the negative edges involving the entorhinal cortex in FPS players indicate that an overreliance on response learning strategies may come at the expense of the spatial memory system. Consequently, caution is warranted when applying such games to ameliorate age-related memory decline.

PMID:42081801 | DOI:10.2196/79976

JMIR Hum Factors. 2026 May 4;13:e73524. doi: 10.2196/73524.

ABSTRACT

BACKGROUND: In Bangladesh, as well as throughout the world, children’s screen time has significantly increased. Children spend a lot of time on the internet and digital screens for entertainment, education, and communication, which has 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 screens on the health and mental well-being of school-going children and adolescents in Dhaka, Bangladesh.

METHODS: This cross-sectional descriptive study was conducted from July 2022 to June 2024. A total of 420 school-going children and adolescents aged 6 to 14 years were enrolled from 3 English-language and 3 Bangla-language schools in Dhaka using a stratified random sampling technique. Anthropometric measurements, a semistructured questionnaire, and the Pittsburgh Sleep Quality Index, the Development and Well-Being Assessment scale, and the Strengths and Difficulties Questionnaire, all of which were validated in Bangla, were used to gather data. We considered students who were exposed to screens for less than 2 hours a day as the low-exposure group and those who were exposed for more than 2 hours a day as the high-exposure group.

RESULTS: A total of 83.3% (350/420) of the students were in the high-exposure group, and their average screen time per day was 4.6 (SD 2.3) hours. Eye problems were reported by 35.7% (150/420) of the students, and a significant difference was found between the low- and high-exposure groups. In total, 96% (144/150) of the students with eye problems were from the high-exposure group, whereas 4% (6/150) were from the low-exposure group. Headaches were reported by 80% (336/420) of the students, and they were common in the high-exposure group (279/336, 83%). Moreover, students from the high-exposure group had a short duration and poor quality of sleep (mean 7.3, SD 1.4 hours), which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (P<.001). Our study revealed that, overall, 31% (130/420) of the students had at least one mental health problem and 9.8% (41/420) had more than one mental health problem using the Development and Well-Being Assessment scale, and mental health problems were greater in the high-exposure group than the low-exposure group. Although behavioral problems such as conduct issues (119/420, 28.3%) and peer difficulties (121/420, 28.8%) were observed among the participants, no statistically significant difference was found between the 2 groups.

CONCLUSIONS: A collaborative and coordinated multistage approach is essential 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 a larger scale can be conducted to determine the impacts of screen time on aspects of health.

PMID:42081800 | DOI:10.2196/73524

JMIR Hum Factors. 2026 May 4;13:e78430. doi: 10.2196/78430.

ABSTRACT

BACKGROUND: Despite their benefits, digital health tools often face adoption barriers because of the digital divide. Identifying the fundamental user skills required to effectively navigate these tools and the usability barriers is essential to addressing disparities in use.

OBJECTIVE: This study aimed to identify the skill and usability barriers to using digital health tools.

METHODS: This study included English-, Spanish-, or Cantonese-speaking patients, aged ≥50 years, who received care at an urban safety net health system in the United States. Participants completed a survey examining sociodemographic characteristics and digital health tool use and were observed and video recorded as they navigated four digital health care tasks: (1) launch a video visit, (2) visit a health website through a URL, (3) log in to the patient portal, and (4) sign up for a patient portal account. Participants who could not independently perform the tasks received additional support. Tasks were conducted in English, while instructions and additional assistance were provided in each participant’s preferred language. Video recordings were thematically coded to identify the fundamental skills needed for effective digital tool use and usability barriers in the design of digital tools. We examined whether task independence was associated with participant demographics and thematic categories using Kruskal-Wallis, χ2, and Fisher exact tests.

RESULTS: In total, 74% (34/46), 52% (31/60), 71% (44/62), and 70% (43/61) of participants (N=64) independently completed digital tasks 1, 2, 3, and 4, respectively. Older age, minoritized races and ethnicities, non-English language preference, lower educational attainment, access to cellular data only or no internet access, and lack of a portal account were associated with a higher likelihood of requiring assistance or being unsuccessful at completing each task (P<.001, except for older age [P=.004]). The qualitative coding of video recordings identified 3, 4, and 6 categories of typing, navigation, and human-computer interaction (HCI) skills, respectively, as fundamental skills required to independently complete digital tasks. χ2 and Fisher exact tests indicated significant associations between most typing, navigation, and HCI categories and independent task completion. We coded usability barriers as one of 6 learnability challenges or 3 operability challenges.

CONCLUSIONS: This study identified that independent use of digital health tools requires fundamental typing, navigation, or HCI skills as well as high usability of digital tools. The inclusion of 4 different digital tasks added specificity to the type of skills and usability considerations necessary to ensure accessibility of digital health tools to diverse older adults. This study underscores the need for vendors to cocreate digital health tools with historically excluded end users in mind. As health care systems expand digital tool adoption, they must distinguish fundamental skill gaps from usability barriers, as each may require different intervention strategies.

PMID:42081796 | DOI:10.2196/78430

Eval Rev. 2026 May 4:193841X261449106. doi: 10.1177/0193841X261449106. Online ahead of print.

ABSTRACT

We re-analyze two research articles with results showing that Sweden’s criminalization of purchasing sex triggered a large increase in rape. Our analysis documents discrepancies that produce unreliable results in five identification strategies in the first paper (Ciacci, 2024), and in all specifications indicating a large reform effect in the other (Ciacci, 2025). These discrepancies include estimating different statistical relationships, using different methods, or employing different variables than the paper describes. Correcting them by implementing the analysis described in the text yields no evidence that the Swedish reform increased rape.

PMID:42081792 | DOI:10.1177/0193841X261449106

Neurology. 2026 May 26;106(10):e218032. doi: 10.1212/WNL.0000000000218032. Epub 2026 May 4.

ABSTRACT

OBJECTIVES: Medical assistance in dying (MAiD) has been available across Canada since 2016 for patients with amyotrophic lateral sclerosis (ALS). We aimed to characterize MAiD use, identify associated factors, and compare survival and location of death in a Canadian ALS cohort.

METHODS: We retrospectively reviewed patients with ALS followed at a Canadian multidisciplinary clinic who died between January 1, 2019 and December 31, 2024. Patient characteristics were described by MAiD status. Factors associated with MAiD utilization were evaluated using regression analyses, and survival and location of death were compared between patients who did and did not pursue MAiD.

RESULTS: Of 255 patients (median age 67 years [IQR 60-75]; 42% female), 55 (21.6%) underwent MAiD. Percutaneous endoscopic gastrostomy (PEG) use was inversely associated with MAiD utilization (OR 0.34, 95% CI 0.15-0.78), whereas demographic and disease characteristics were not associated with MAiD. Survival from diagnosis to death was shorter among patients who underwent MAiD (median 12 vs 14 months; p = 0.019), with no difference from symptom onset. Death at home was more frequent with MAiD (62% vs 35%; p < 0.001).

DISCUSSION: MAiD is a common end-of-life option in ALS, reflecting patient values and is associated with lower PEG use, shorter postdiagnosis survival, and more frequent death at home.

PMID:42081784 | DOI:10.1212/WNL.0000000000218032

Neurology. 2026 May 26;106(10):e218009. doi: 10.1212/WNL.0000000000218009. Epub 2026 May 4.

ABSTRACT

BACKGROUND AND OBJECTIVES: The frequency and cognitive trajectory of cerebral amyloid angiopathy (CAA) in patients from memory clinics is uncertain. We aimed to determine whether patients with CAA have an increased risk of dementia in nondemented individuals presenting with a cognitive complaint.

METHODS: We retrospectively analyzed data of the MEMENTO prospective cohort that enrolled outpatients from 26 centers in France presenting with a cognitive complaint and a Clinical Dementia Rating (CDR) scale score ≤0.5. Participants aged >50 years who had interpretable baseline brain MRI were eligible for this study and followed every 6 months for 5 years with systematic assessment of dementia. Based on MRI analysis, participants were classified into 4 categories using the Boston criteria V2.0 and V1.5: probable CAA, possible CAA, deep/mixed small vessel disease (SVD), or controls (without imaging markers of SVD). The primary outcome was the progression to dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision criteria) evaluated by an expert committee. Cox proportional hazards models were used to determine hazard ratios (HRs) and CIs for the primary outcome.

RESULTS: Of 2,323 MEMENTO participants, 2,136 (92%) were included in this study. The mean age (SD) at baseline was 71.3 (7.9) years and 1,320 (62%) were women. Probable CAA was diagnosed in 413 (19.3%) patients using the Boston criteria V2.0, and 144 (7.0%) using the Boston criteria V1.5. During a median follow-up of 5.0 years (interquartile range 3.1-5.1), 307 participants developed dementia. Compared with controls, patients with probable CAA according to the Boston criteria V2.0 (HR 1.73, 95% CI 1.23-2.42) and V1.5 (HR 2.23, 95% CI 1.56-3.20) had increased risk of dementia. After adjusting for age, sex, baseline Mini-Mental State Examination score and hippocampal volume, patients with probable CAA per Boston criteria V1.5 but not V2.0 had an increased risk of dementia compared with controls. This association was not significant when further adjusting with APOE ε4.

DISCUSSION: CAA is a common condition in outpatients with mild cognitive symptoms. Patients with probable CAA according to the Boston criteria V1.5 but not V2.0 have increased risk of dementia. Further studies are required to externally validate these findings and evaluate potential mediation effect of APOE genotype.

PMID:42081781 | DOI:10.1212/WNL.0000000000218009

Health Aff (Millwood). 2026 May;45(5):570-579. doi: 10.1377/hlthaff.2025.01639.

ABSTRACT

Latino communities in California experience disproportionate climate-related health risks, including extreme heat and air pollution. Despite the state’s leadership in climate and environmental justice policy, existing data systems often do not integrate climate exposures, health outcomes, or neighborhood-level vulnerability in ways that meaningfully inform policy action. This Analysis draws on insights from the Latino Climate and Health Dashboard, a publicly available, neighborhood-level data tool that documents disparities between Latino and non-Latino White neighborhoods across California. The dashboard was developed with advisory board guidance, using the EPIS (exploration, preparation, implementation, sustainment) framework to structure data development and engagement. After the dashboard’s release, we convened community policy dialogues (“policy pláticas”) in which community organization leaders, practitioners, advocates, and legislative staff interpreted the findings and identified five policy priorities: coordinated climate and air quality governance, sustained community monitoring and early warning systems, equitable cooling and infrastructure investments, stronger connections between climate policy and health outcomes, and climate-resilient access to health care and worker protections. A participatory data tool can support equity-oriented climate-health policy making and inform efforts to translate data into policy action.

PMID:42081763 | DOI:10.1377/hlthaff.2025.01639

Health Aff (Millwood). 2026 May;45(5):462-470. doi: 10.1377/hlthaff.2025.01652.

ABSTRACT

Nonprofit hospitals conduct a community health needs assessment every three years to maintain federal tax-exempt status. Federal rules do not require these assessments to consider climate-related health risks, despite evidence that climate change affects health and health care delivery. This study examined the extent to which hospitals address climate-related health in community health needs assessments. We reviewed a nationally representative sample of 566 community health needs assessments (2021-24) from 3,468 US hospitals. Climate-related content was scored on an eighteen-point rubric including climate hazards and health risks (for example, extreme heat and flooding). The assessments’ climate-related content was limited (mean score, 2.51 of 18). Hospitals serving more climate-vulnerable communities, especially those with greater socioeconomic disadvantage, were less likely to identify climate-related health risks. Scores in the Northeast and West were nearly twice those in the South and Midwest, although they were still low. Federal requirements should better align community health needs assessments with emerging public health risks, including climate change, to improve health system resilience.

PMID:42081759 | DOI:10.1377/hlthaff.2025.01652

Health Aff (Millwood). 2026 May;45(5):516-524. doi: 10.1377/hlthaff.2025.01557.

ABSTRACT

Cold-related illnesses (CRIs) are preventable yet often deadly. Using twenty-five years of data from the National Inpatient Sample (1998-2022), we assessed nationwide trends in CRI hospitalizations and concomitant alcohol use, substance use, and mental health disorders and housing insecurity. We identified 345,314 (weighted) CRI hospitalizations and found that age- and sex-adjusted rates tripled from 42.0 to 122.5 per 100,000 hospitalizations. CRI inpatients were more likely than others to die during hospitalization, live in high-poverty ZIP codes, be publicly insured or uninsured, and have behavioral health conditions and housing instability. These findings highlight the rising and unequal toll of CRIs in the context of social instability and increasingly severe cold events associated with climate change. Expanded access to behavioral health treatments, increased subsidies for home heating, investments in affordable and supportive housing and shelter capacity, and public health measures to increase resilience to extreme weather events could reduce CRI morbidity and mortality.

PMID:42081755 | DOI:10.1377/hlthaff.2025.01557