Category: Nevin Manimala

JMIR Cancer. 2025 Nov 14;11:e67911. doi: 10.2196/67911.

ABSTRACT

BACKGROUND: Cutting-edge oncology care often depends on patients’ ability to use rapidly evolving health technology. Digital health literacy (DHL; the capacity to understand health-related information with electronic media) is an emerging, yet underexplored social determinant of health in patients with cancer.

OBJECTIVE: We aimed to characterize sociodemographic and clinical factors associated with DHL in patients with cancer and explore whether a single-item screener could be derived from a widely-used DHL questionnaire to detect low DHL.

METHODS: Patients (N=105) who received systemic treatment in the past year for colorectal carcinoma (CRC) or non-Hodgkin lymphoma (NHL) were recruited through collaborating clinics. Participants self-reported DHL using the eHealth Literacy Scale (eHEALS). They also reported general health literacy and sociodemographic and clinical characteristics. Correlations and group comparisons (independent sample t tests and χ2 tests, as appropriate) were used to evaluate links between DHL and sociodemographic and clinical characteristics. Receiver operating characteristic (ROC) curve analysis was used to determine whether a single eHEALS item could effectively screen for low DHL (eHEALS score ≤20).

RESULTS: Patients with a lower education level (Spearman ρ=0.29; P=.004) and lower general health literacy (r=0.25; P=.009) had lower DHL. Patients with NHL reported lower DHL than those with CRC (t103=2.72; P=.008). Additionally, the subset of patients who reported participation in a clinical trial (n=10) exhibited lower DHL than nonparticipants (t100=3.08; P=.003). Other sociodemographic and clinical characteristics were not significantly associated with DHL (all P>.21). The ROC curve analysis showed that eHEALS item 4 (“I know where to find helpful health resources on the Internet”) was a strong predictor of high versus low DHL (area under the curve=0.975, 95% CI 0.949-1.00; P<.001).

CONCLUSIONS: In this convenience sample, DHL varied based on cancer type, education level, general health literacy, and clinical trial participation. Furthermore, we found that a single item from the eHEALS has strong potential for identifying those with low DHL. These findings may inform which patients have higher need for or may benefit from DHL interventions and suggest avenues for detecting low DHL in oncology clinics.

PMID:41237283 | DOI:10.2196/67911

JMIR Mhealth Uhealth. 2025 Nov 14;13:e72009. doi: 10.2196/72009.

ABSTRACT

BACKGROUND: Canada, Mexico, and the United States are primary transit destinations for migrants in the Western Hemisphere. Migrants face barriers to accessing health services, including HIV and AIDS and sexually transmitted infection (STI) prevention. Mobile apps may enhance public health access for these populations.

OBJECTIVE: This study aims to systematically identify and evaluate mobile apps supporting HIV and STI prevention in Canada, Mexico, and the United States.

METHODS: An environmental scan of 357 mobile apps from the Google Play and Apple App stores was conducted on June 18, 2024, following the rigorous 6-step framework proposed by Fernández-Sánchez to ensure a systematic and comprehensive evaluation of apps for HIV and STI prevention. Predefined inclusion and exclusion criteria were applied, resulting in 6 eligible apps. Each app was assessed using the 29-item Mobile App Rating Scale (MARS), scored on a 5-point Likert scale (1=inadequate, 5=excellent), and categorized as high (3), medium (2), or low (1) based on mean scores. Internal consistency was excellent (Cronbach α=0.90), and interrater reliability demonstrated near-perfect agreement (Cohen κ=0.862). Data analyses were performed using SPSS (version 27; IBM Corp).

RESULTS: All 6 apps were available in Canada, Mexico, and the United States, with 33.3% (2/6) from Google Play, 16.7% (1/6) from Apple, and 50% (3/6) from both platforms. MARS evaluation revealed high quality ratings for engagement (83.0%), functionality (88.9%), aesthetics (83.3%), and information quality (100%), as well as high subjective quality (83.3%) and app-specific quality (88.9%). Life4Me+ was the highest-rated app (4.6), while HIV-TEST received the lowest rating (3.4). Most apps (5/6, 83.3%) were only available in English, and 16.7% (1/6) supported multiple languages, which may limit accessibility for non-English-speaking migrant populations. In addition, 83.3% (5/6) were updated in 2024, 33.3% (2/6) were linked to nongovernmental organization, 16.7% (1/6) to a university, and 50% (3/6) had no clear affiliation. Regarding their focus, 50% (3/6) addressed STI prevention, diagnosis, and treatment, 16.7% (1/6) combined HIV and STI prevention, and 33.3% (2/6) provided pre-exposure prophylaxis-related resources.

CONCLUSIONS: These 6 apps stand out for their high functionality, engagement, and accessibility, establishing themselves as effective tools for HIV and STI prevention education among migrant populations. This study highlights the critical role of digital resources in addressing public health challenges faced by vulnerable and minority groups. Integrating these apps into health promotion strategies is essential to improve health literacy and encourage preventive behaviors. Moreover, ensuring the quality, credibility, linguistic diversity, and continuous updating of these digital interventions is crucial to achieving a real and sustained impact on public health. Policies should promote clear standards that guarantee accessibility, transparency, and accuracy, thereby facilitating access to health care services in complex migratory contexts.

PMID:41237280 | DOI:10.2196/72009

JMIR Mhealth Uhealth. 2025 Nov 14;13:e67721. doi: 10.2196/67721.

ABSTRACT

BACKGROUND: The health impact of summer heat on older adults is a growing public concern, yet the physiological responses, particularly changes in resting heart rate (RHR), and the role of personal heat adaptation behaviors remain underexplored. Wearable devices offer an opportunity to objectively monitor physiological responses and evaluate the effectiveness of adaptation strategies in real-world settings.

OBJECTIVE: This study aimed to quantify the short-term association between summer temperatures and RHR in older adults and to examine how individual heat adaptation behaviors modify this relationship, with additional consideration of personal characteristics such as age, sex, BMI, and chronic disease status.

METHODS: We conducted a panel study among 83 community-dwelling older adults (≥65 y) in Taipei City during the summer of 2021 (May to September). Participants wore Garmin smartwatches to continuously monitor heart rate. Daily RHR was defined as the lowest 30-minute average heart rate. In September, heat adaptation behaviors were assessed via structured telephone interviews. Ambient temperature and relative humidity were obtained from a nearby monitoring station. Linear mixed-effect models were used to estimate temperature-RHR associations, and interaction terms were included to examine behavioral modifications. Subgroup analyses were conducted to explore effect modification by individual characteristics such as age, sex, BMI, and chronic disease status.

RESULTS: Each 1 °C increase in daily mean temperature over lag days 0-1 was associated with a 0.11 (95% CI 0.07-0.15; P<.001) beats/min increase in RHR. After mutual adjustment for behaviors, several heat adaptation strategies showed significant protective effects, including reducing physical activity (β=-.15, P=.001), drinking cold beverages (β=-.24, P<.001), increasing naps or sleep duration (β=-.28, P=.003), drinking additional water ≥500 mL (β=-.10, P=.02), using air conditioner (AC) before (β=-.15, P=.002) and during sleep (β=-.13, P=.007), and using electric fans during sleep (β=-.12, P=.01). Subgroup analyses revealed stronger effects for certain behaviors in vulnerable populations: reduced physical activity was particularly beneficial for those with higher BMI; AC use and cold beverage intake were more effective in people with diabetes; increased naps yielded the largest benefits in individuals with hypertension; and the use of AC or fans during sleep was especially protective for older adults and females.

CONCLUSIONS: Summer heat is associated with elevated RHR in older adults, but this effect can be mitigated through targeted heat adaptation behaviors. Smartwatch monitoring provides a feasible and informative approach for capturing physiological changes, supporting the development of personalized heat-health recommendations for aging populations in a warming climate.

PMID:41237278 | DOI:10.2196/67721

Med Decis Making. 2025 Nov 14:272989X251388915. doi: 10.1177/0272989X251388915. Online ahead of print.

ABSTRACT

BackgroundCervical cancer, driven predominantly by persistent high-risk human papillomavirus (HPV) infection, ranks as the fourth most common malignancy in women worldwide. China faces barriers to achieving the World Health Organization (WHO) 2030 elimination targets due to low vaccination rates and complex demographics. Strategic intervention optimization is critical for accelerating elimination.MethodsWe developed an age-stratified deterministic compartmental model integrating demographic data and HPV transmission dynamics, capturing heterogeneity in age, sex, sexual activity, and intervention efficacy. The model simulated cervical cancer natural history, including HPV infection, progression to precancerous lesions, and invasive cancer and was calibrated using epidemiological data from the Global Burden of Disease. We evaluated multiple vaccination scenarios (varying coverage rates, age groups, and durations) to project incidence trajectories, estimate elimination timelines, and calculate the reproduction number. Sensitivity analyses were conducted to assess parameter effects.ResultsWithout vaccination, HPV infection becomes endemic (R₀ = 1.38), causing 2.92 million cervical cancer cases in China during 2021 to 2070. Maintaining the 2020 vaccination rate would prevent 1.01 million cases in this period. While prioritizing females aged 15 to 26 y maximizes the per-dose impact, expanding vaccination to all females aged ≥15 y is essential for achieving elimination before 2040. Even single-year vaccination would confer >50-y protection. A higher vaccination rate accelerates elimination: annual rates of 0.09, 0.15, and 0.21 among females aged ≥15 y achieve elimination by 2037, 2035, and 2034, respectively, accelerating timelines by 15 to 20 y compared with strategies targeting only 15- to 26-y-olds.ConclusionsHPV vaccination is pivotal for reducing cervical cancer burden in China, with prioritizing women aged 15 to 26 y as the optimal strategy. Expanding vaccination to all women aged ≥15 y can accelerate the achievement of WHO elimination targets.HighlightsAn age-stratified model simulates HPV transmission patterns and assesses cervical cancer interventions.Without intervention, HPV remains endemic (R₀ = 1.38), causing 2.92 million cervical cancer cases in China (2021-2070).Prioritizing 15- to 26-y-olds maximizes the per-dose impact, but expanding to 15+ y cohorts is essential for elimination.Even a single year of vaccination offers >50 y of protection.Females ≥15 y vaccinated annually at rates of 0.09, 0.15, and 0.21 achieve elimination by 2037, 2035, and 2034, respectively.

PMID:41237272 | DOI:10.1177/0272989X251388915

Sci Adv. 2025 Nov 14;11(46):eadz2616. doi: 10.1126/sciadv.adz2616. Epub 2025 Nov 14.

ABSTRACT

Photosynthesis in vivo is driven by sunlight, an ultraweak incoherent thermal source. However, most experiments and theories have studied photosynthetic light harvesting driven by strong coherent laser sources. The quantum states of light are characterized by their photon statistics, in addition to classical properties such as intensity and frequency spectrum. Here, we report experiments that investigate how photon statistics affect a natural photosynthetic system and vice versa. We directly compare how single photons and pseudothermal light from spontaneous parametric down-conversion drive light harvesting in the light-harvesting 2 complex from a purple bacterium. We find that the fluorescence lifetime and quantum efficiency are unchanged while the fluorescence photon statistics are markedly different, resembling that of the incident light, implying that the dynamics do not fundamentally modify the photon statistics. This represents a step toward clarification of the similarities and differences between photosynthetic light harvesting in laboratory and in natural sunlight conditions.

PMID:41237251 | DOI:10.1126/sciadv.adz2616

Sci Adv. 2025 Nov 14;11(46):eady1674. doi: 10.1126/sciadv.ady1674. Epub 2025 Nov 14.

ABSTRACT

Sicily, situated at the heart of the Mediterranean Sea, has been a crossroads of people of different origins since the Paleolithic. To gain further insight into the genetic history of this island from a matrilineal viewpoint, we investigated 15 millennia of human mitogenome evolution. A unique Sicilian mitochondrial DNA (mtDNA) dataset, represented by 116 ancient mitogenomes (including two newly sequenced) collected from 16 archeological sites dating from 14,700 to 545 years ago, was compared with a collection of 236 modern mitogenomes covering all districts of the island. By integrating demographic modeling with phylogeographic analyses, we identified a statistically supported genetic discontinuity between the Paleolithic/Late Mesolithic and Early Neolithic periods and two mtDNA lineages (U5b and U8b/K) that specifically mark this transition. The extensive variation and lack of genetic structure among modern mitogenomes suggest the presence of a continuous, maternally inherited gene flow from different regions of Western Eurasia (since the Paleolithic) and Africa (since the Bronze Age).

PMID:41237225 | DOI:10.1126/sciadv.ady1674

JMIR Serious Games. 2025 Nov 14;13:e71823. doi: 10.2196/71823.

ABSTRACT

BACKGROUND: Individuals with mild intellectual disabilities (ID) often face cognitive and functional challenges, which can lead to low physical activity (PA) and a higher risk of obesity. While virtual reality (VR) exergames show promise for promoting PA in typically developing children, a key barrier for individuals with ID is the lack of a structured teaching methodology. This study argues that a tailored approach is essential to help children with mild ID gain independence in gameplay. By learning specific patterns, they can achieve greater autonomy, which not only facilitates increased PA but also improves motor competence, physical fitness, functional abilities, and overall well-being.

OBJECTIVE: This study aims to evaluate the effectiveness of the WISH (Warm-up, Imitation, Settings, Half-hour exergame session) and WON (Warm-up, Objective evaluation, No problem!) training protocols in improving participant independence, exergame performance, and overall gameplay experience in VR.

METHODS: We used a multisession, single-group research design involving 16 training sessions in this pilot study. The 16 sessions were conducted during scheduled physical education classes at a special school in Poland from October 2023 to May 2024. The intervention comprised two main protocols: the WISH protocol (sessions 1-4), an introductory phase focused on familiarization with VR technology and gameplay mechanics, and the WON protocol (sessions 5-16), designed for gradual reduction of trainer assistance to promote gameplay independence.

RESULTS: The statistical analysis confirmed the effectiveness of both the WISH and WON protocols. A Wilcoxon signed-rank test on the WISH protocol revealed a statistically significant improvement in understanding instructions for the warm-up (r=0.87; P=.009), the projector imitation (r=0.91; P=.007), and participant exergame performance (r=0.90; P=.03). Within the WON protocol, the Wilcoxon test also showed a significant increase in participant exergame performance (r=0.89; P=.008). Further analysis using Spearman rank-order correlation indicated a very strong association between increased independence and better exergame performance (ρ=0.91; P=.002) and overall gameplay experience (ρ=0.63; P<.05).

CONCLUSIONS: This pilot study suggests that the structured WISH and WON training protocols may have the potential to enhance functional autonomy, exergame performance, and overall gameplay experience in individuals with mild ID. The observed improvements indicate that such structured pedagogical approaches could be beneficial for this population. These preliminary findings warrant further investigation through larger-scale, controlled studies to confirm efficacy and explore the transferability of these benefits to broader contexts and other VR exergames.

PMID:41236816 | DOI:10.2196/71823

Technol Cancer Res Treat. 2025 Jan-Dec;24:15330338251394573. doi: 10.1177/15330338251394573. Epub 2025 Nov 14.

ABSTRACT

IntroductionBody mass index (BMI) is a common clinical parameter associated with cancer prognosis, but its association with survival outcomes in lung cancer patients receiving immune checkpoint inhibitors (ICIs) remains unclear. This study aimed to clarify the prognostic value of BMI in ICI-treated lung cancer patients.MethodsA systematic review and meta-analysis were conducted based on online databases including PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov up to December 1, 2024. Eligible studies included lung cancer patients treated with ICIs and reported hazard ratios (HRs) for overall survival (OS) and/or progression-free survival (PFS) stratified by BMI. Random-effects models were used to determine HRs with 95% confidence intervals (CIs).ResultsA total of 30 studies involving 5987 patients were included. High BMI was significantly associated with better OS (HR = 0.69, 95%CI = 0.60-0.80) and PFS (HR = 0.82, 95%CI = 0.72-0.93). The subgroup analysis showed improved survival outcomes particularly in patients with BMI ≥ 30 kg/m² as compared with others. However, this association was not statistically significant in small-cell lung cancer.ConclusionHigh BMI was associated with a better prognosis than low BMI in ICI-treated patients with lung cancer. Due to study limitations, the prognostic impact of BMI still requires further clarification with additional evidence.

PMID:41236792 | DOI:10.1177/15330338251394573

Hum Vaccin Immunother. 2025 Dec;21(1):2583804. doi: 10.1080/21645515.2025.2583804. Epub 2025 Nov 14.

ABSTRACT

While international and domestic recommendations advocating for influenza vaccination during pregnancy, the vaccination rate among this demographic in China remains low, mainly due to concerns about fetal safety. This retrospective cohort enrolled mothers who registered and delivered between August 2020 and July 2023. The relationship between maternal influenza vaccination and adverse neonatal outcomes was assessed using Poisson regression models and logistic regression analyses. The adverse neonatal outcomes under evaluation included small for gestational age (SGA), large for gestational age (LGA), preterm birth (PTB), low birth weight (LBW), low Apgar score, congenital anomalies, neonatal intensive care unit (NICU) admission or referral, as well as stillbirth or neonatal death. Of the 2,517 women, 203 (8.1%) had received influenza vaccination during their pregnancies. The incidence rate of gestational complications in the vaccinated group being significantly higher than that in the unvaccinated group. In comparison with no vaccination, there was no statistically connection between vaccination and an increased risk of any adverse neonatal outcomes. The adjusted risk ratios (95% CIs) were: SGA 1.354 (0.842-2.177), LGA 1.504 (0.808-2.798), PTB 0.639 (0.257-1.590), LBW 0.294 (0.072-1.211), low Apgar score 0.918 (0.213-3.958), congenital anomaly 0.676 (0.087-5.247), and NICU admission or referral 0.151 (0.021-1.089). In this study, there was only 1 stillbirth and 1 neonatal death in the unvaccinated group, resulting in a cumulative incidence of 0.1%. No stillbirths or neonatal deaths occurred in the vaccinated group. These findings endorse public health initiatives aimed at enhancing vaccination rates among pregnant women.

PMID:41236786 | DOI:10.1080/21645515.2025.2583804

J Manag Care Spec Pharm. 2025 Nov 14:1-10. doi: 10.18553/jmcp.2025.25148. Online ahead of print.

ABSTRACT

BACKGROUND: In the United States, rIX-FP, rFIXFc, and rFIX are approved as treatment options for people with hemophilia B (PwHB). Although clinical trials have demonstrated the efficacy and safety of each product, real-world data can help to understand their use and treatment outcomes in the absence of direct head-to-head trials.

OBJECTIVE: To assess real-world factor IX (FIX) consumption and bleeding outcomes for PwHB receiving rIX-FP, rFIXFc, or rFIX prophylaxis.

METHODS: Retrospective, deidentified medical record information for PwHB with moderate or severe hemophilia B (FIX activity ≤5%) treated with rIX-FP, rFIXFc, or rFIX prophylaxis for at least 12 months was obtained from Hemophilia Treatment Centers in the United States between 2020 and 2023. FIX consumption was calculated using the most recently prescribed dosing frequency and dosage. Annualized bleeding rate (ABR), annualized spontaneous bleeding rate, and annualized joint bleeding rate were calculated based on the number of bleeding events over the observation period. Generalized linear models adjusting for covariates were used to test the statistical significance of the differences of consumption and ABR among the products.

RESULTS: Overall, 213 PwHB (53% with severe disease) aged 12 years and older were included for main analysis, with a mean age (range) of 32.7 (12-84) years. PwHB treated with rIX-FP prophylaxis had significantly lower mean FIX consumption compared with those receiving rFIXFc (45.8 vs 65.4 IU/kg/week; P = 0.0003) and rFIX (95.7 IU/kg/week; P < 0.0001). The mean dosing interval was 10.2, 7.3, and 5.2 days for rIX-FP, rFIXFc, and rFIX, respectively. Mean ABR was significantly lower in PwHB receiving rIX-FP compared with the other 2 products (rIX-FP vs rFIXFc: 1.2 vs 2.1; P = 0.0119; rIX-FP vs rFIX: 1.2 vs 2.3; P = 0.004). Mean annualized spontaneous bleeding rate was 0.4, 1.0, and 0.7 for rIX-FP, rFIXFc, and rFIX, respectively. Mean annualized joint bleeding rate was 0.7, 1.1, and 1.2 for rIX-FP, rFIXFc, and rFIX, respectively. The pattern of results for PwHB of all ages (including those aged <12 years, N = 50) were similar to those reported for PwHB aged 12 years and older. In a subgroup of 16 PwHB who switched to rIX-FP from a previous FIX product, mean FIX consumption was significantly reduced after switching to rIX-FP (49.0 vs 94.2 IU/kg/week; P = 0.0004). Mean ABR was also significantly reduced after switching to rIX-FP (3.2 vs 1.7; P = 0.0009).

CONCLUSIONS: In this retrospective study, rIX-FP prophylaxis was associated with lower FIX consumption and potentially improved protection against bleeds compared with prophylactic treatment with rFIXFc and rFIX.

PMID:41236778 | DOI:10.18553/jmcp.2025.25148