Category: Nevin Manimala

Popul Health Manag. 2026 Mar 20:19427891261434673. doi: 10.1177/19427891261434673. Online ahead of print.

ABSTRACT

The COVID-19 pandemic highlighted pediatric health care disparities and disrupted routine care, including social needs assessments. The American Academy of Pediatrics recommends universal screening for Social Determinants of Health (SDOH), yet implementation remains inconsistent in primary care settings. This quality improvement (QI) project aimed to implement a standardized, sustainable SDOH screening and referral process in pediatric primary care, hypothesizing that structured interventions would improve screening rates. This QI initiative was conducted from January to September 2023 across six practices within a large pediatric health system. Eligible patients (ages 0-19) included those attending their first well visit of the calendar year. The SMART aim targeted a 50% increase in SDOH screening compliance, from 28% at baseline to 42% over 9 months. Using the Consolidated Framework for Implementation Research and two Plan-Do-Study-Act cycles, the team addressed key implementation barriers and refined interventions. The primary measure was screening completion rate; the balancing measure was the number of refusals to screen. SDOH screening rates increased from 28% to 55%, with eligible patient volumes ranging from 2400 to 5500. All six practices demonstrated statistically significant improvements (P < 0.001). Positive screens ranged from 3.3% to 8% of patients screened. Screening refusals increased significantly (P < 0.001). Standardized SDOH screening, implemented through structured QI methods and stakeholder engagement, significantly improved screening rates in pediatric primary care. Future studies should assess referral effectiveness, clinical outcomes, cost-effectiveness, and strategies to mitigate patient discomfort and systemic barriers.

PMID:41862289 | DOI:10.1177/19427891261434673

J Child Adolesc Psychopharmacol. 2026 Mar 20:10445463261436795. doi: 10.1177/10445463261436795. Online ahead of print.

ABSTRACT

OBJECTIVES: Pediatric mental health prevalence rates have increased in recent years, while gaps remain in the number of available providers. Ongoing evaluation and understanding of treatment progress and engagement are critical to psychiatric care, and these details are often documented in the electronic health record (EHR). Given the utility of retrospective chart review (RCR) as a tool for psychiatrists, we developed a coding system examining common comorbid conditions (anxiety and attention-deficit/hyperactivity disorder [ADHD]) and adherence and evaluated interrater reliability.

METHODS: We created a coding system with a comprehensive manual and coding instructions that explore both symptom severity domains (anxiety, ADHD, and global) and adherence to medication. Codes were rated using Likert scales, and two independent raters coded all data.

RESULTS: RCR was completed for 142 patients with a total of 1139 visits over 2 years. Weighted linear kappa statistics ranged between 0.77 and 0.95, and weighted quadratic kappa statistics ranged between 0.74 and 0.96, suggesting substantial to almost perfect agreement. Interrater agreement was highest for anxiety severity.

CONCLUSIONS: We created a novel coding system for RCR and found substantial to almost perfect interrater reliability for assessing ADHD severity, anxiety severity, global severity, and medication adherence using psychiatry encounter notes documented in an EHR. Our coding system explores conditions that are often heterogeneous and have waxing and waning presentations, using a continuum that captures the complexity of symptoms. Future directions include utilization of coding systems to explore emotion and behavior change over time to optimize treatment.

PMID:41862288 | DOI:10.1177/10445463261436795

Nefrologia (Engl Ed). 2026 Mar;46(3):501468. doi: 10.1016/j.nefroe.2026.501468.

ABSTRACT

BACKGROUND: Diabetes mellitus is the leading cause of end-stage renal disease, accounting for approximately 40% of cases. Data on glycaemic metrics in diabetic population on maintenance haemodialysis is sparse. The role of continuous glucose monitoring in this population remains underexplored.

METHODS: This prospective observational study aimed to comprehensively characterize glycaemic variability using continuous glucose monitoring in patients with type 2 diabetes mellitus undergoing maintenance haemodialysis. 25 patients aged between 18 and 70 years with more than 3 months of dialysis vintage were included in the study. After collecting socio-demographic and clinical data, an ambulatory glucose profile sensor was applied to the patient’s upper limb before starting their scheduled dialysis session. Sensors measured the interstitial fluid glucose every 15min, and a total of 96 readings were taken per day, continuously for 14 days (336h).

RESULTS: For statistical analysis, the study population was broadly divided into 2 major groups, one which required insulin for their glycaemic management and the other requiring an oral hypoglycaemic agent, linagliptin. Statistical analysis was performed using SPSS software version 26.0 (IBM Corp., Armonk, NY). In both the groups, glycaemic excursion was observed, with dialysis days having high mean glucose values than non-dialysis days, and the observation was more prominent in the insulin-treated group. The mean glucose levels were lower in the nocturnal period in both the groups. It was noticed that the overall glycaemic variability, glycaemic variability in both dialysis and non-dialysis days were lower in linagliptin-treated group.

CONCLUSION: This study demonstrated significant differences in glycaemic variability based on antidiabetic treatment modality in haemodialysis population. Continuous glucose monitoring is an invaluable tool to study glycaemic metrics and guide therapy in haemodialysis population.

PMID:41862265 | DOI:10.1016/j.nefroe.2026.501468

Lancet Psychiatry. 2026 Apr;13(4):316-326. doi: 10.1016/S2215-0366(26)00034-9.

ABSTRACT

BACKGROUND: To our knowledge, there are no evidence-based implementation strategies for care cascade optimisation of mental, neurological, and substance use (MNS) disorder treatment in low-income and middle-income countries. This trial evaluated the effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) implementation strategy to improve MNS disorder care cascade outcomes in Mozambique.

METHODS: We conducted a 3-year, cluster-randomised trial comparing an 8-month baseline period with a 2-year implementation period. All patients diagnosed with MNS disorders across government facilities in Mozambique were eligible. Eligible facilities were required to be naive to the SAIA-MH implementation strategy; currently providing MNS disorder services including prescribing medication; within a 3-h one-way drive from Chimoio City, Manica or Beira City, Sofala; have at least one psychiatric technician and one psychologist currently practising; and have at least 100 annual outpatient MNS disorder visits during 2020-21. Facilities were allocated to the SAIA-MH intervention or attentional placebo control (1:1) using constrained randomisation. Statistical analysts were masked during initial primary outcome assessment. The SAIA-MH strategy combines external facilitation, clinical consultation, and provider team meetings with system-engineering tools in a continuous quality improvement framework. The primary outcome was a combination of low functional impairment or functional improvement measured using the WHODAS 2.0. Secondary outcomes were medication adherence and appointment attendance. We involved people with related lived experience in all elements of the research and writing process. The study was registered at Clinicaltrials.gov, NCT05103033, and is completed.

FINDINGS: Between Feb 4, 2022, and Oct 14, 2024, 3837 patients with MNS disorders (2153 in the intervention group and 1684 in the control group) attended 33 055 outpatient visits across 16 government facilities in Mozambique (eight intervention; eight attentional placebo control). The mean age was 26·0 years (SD 15·4; range 0-103), 2038 (53·1%) were male and 1800 (46·9%) were female, and 2581 (67·3%) were diagnosed with epilepsy. Ethnicity data were not collected. 966 patients in the intervention group (with 7697 visits) and 785 in the control group (with 3804 visits) who had their first visit during the study period, who completed the WHODAS 2.0 measurement at that visit, and who were aged 15 years or older, were included in the primary analysis of patient-visit-level functional improvement or low functional impairment to allow for examination of change from baseline. The SAIA-MH group showed 46·0 percentage points (95% CI 34·0 to 58·0; p<0·0001) higher functional improvement or low functional impairment, 18·1 percentage points (15·4 to 20·7; p<0·0001) higher medication adherence, and 18·4 percentage points (15·1 to 21·7; p<0·0001) higher appointment attendance than observed in the control group. Among non-adherent patient visits, the intervention group had 11·9 fewer non-adherent days than controls (95% CI -17·6 to -6·2; p<0·0001). WHODAS 2.0 scores decreased by 5·9 points more in the intervention group than the control group (95% CI -6·5 to -5·2; p<0·0001). One adverse event was reported during study implementation in the attentional placebo control group and was determined to be unrelated to study participation.

INTERPRETATION: The SAIA-MH implementation strategy shows evidence of effectiveness in increasing patient functioning, appointment attendance, and medication adherence for patients with MNS disorders treated in outpatient primary care. Our findings warrant further research across implementation contexts to determine how differences in diagnostic and comorbidity case mix might influence the ability of SAIA-MH to reduce gaps in task-shared MNS care.

FUNDING: National Institute of Mental Health TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

PMID:41862257 | DOI:10.1016/S2215-0366(26)00034-9

Rev Esc Enferm USP. 2026 Mar 16;60:e20250167. doi: 10.1590/1980-220X-REEUSP-2025-0167en. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the effectiveness of the oral administration of rosemary dry extract capsules (Rosmarinus officinalis L.) (1g/day) on the estimated cardiovascular risk, over ten years, in nursing professionals working in emergency and urgent care services.

METHOD: Quasiexperimental study conducted in Southern Brazil. Participants completed a sociodemographic and clinical questionnaire, had blood collected for glycemic and lipid profile analysis, and took oral capsules containing 500 mg of dry rosemary extract twice a day for 8 weeks; subsequently, a new blood sample was taken. The Framingham Global Risk Score was used to estimate cardiovascular risk. Data analysis used descriptive and inferential statistics; significance level of 5%.

RESULTS: The study included 36 professionals, predominantly obese and those with elevated total cholesterol. When comparing the variables before and after the intervention, differences were found in blood pressure (p = 0.048), in total cholesterol (p < 0.001), and in the Framingham Global Risk Score (p = 0.047).

CONCLUSION: Dry rosemary extract was effective in reducing the estimated cardiovascular risk of nursing professionals. Brazilian Registry of Clinical Trials No. RBR 88hrnnw.

PMID:41861393 | DOI:10.1590/1980-220X-REEUSP-2025-0167en

JMIR Med Educ. 2026 Mar 20;12:e82885. doi: 10.2196/82885.

ABSTRACT

BACKGROUND: Generative artificial intelligence tools such as ChatGPT are increasingly used by medical students for self-directed learning. Although these models demonstrate linguistic fluency, their reliability as supplementary resources for preclinical education remains uncertain. In particular, comparisons with evidence-based references such as UpToDate are lacking.

OBJECTIVE: This study evaluated the similarity between responses generated by ChatGPT (with GPT-4o mini) and those from UpToDate to preclinical medical education questions to assess ChatGPT’s potential as an adjunctive learning tool.

METHODS: We conducted a cross-sectional comparison study using 150 first-order questions derived from a preclinical question bank at a single allopathic institution under the oversight of a medical educator with more than 25 years of teaching experience. Each question was entered into ChatGPT 10 times in separate chat sessions, and responses from UpToDate were retrieved from the most relevant articles. The responses were preprocessed through lemmatization, stop-word removal, punctuation removal, and numeric normalization. Similarity between ChatGPT and UpToDate responses was quantified using term frequency-inverse document frequency (TF-IDF) cosine similarity. To determine whether the observed similarities exceeded chance, ChatGPT outputs were compared with a null distribution generated from randomized text.

RESULTS: ChatGPT responses demonstrated statistically significant similarity to UpToDate in 59.3% (89/150) of questions. Across subject areas, pharmacology showed the highest concordance (mean cosine similarity 0.338, SD 0.134), followed by pathology (mean 0.321, SD 0.142), biochemistry (mean 0.296, SD 0.120), microbiology (mean 0.297, SD 0.108), and immunology (mean 0.275, SD 0.102). All subject-level similarity scores exceeded those generated from randomized text, confirming that the observed overlap was nonrandom.

CONCLUSIONS: ChatGPT with GPT-4o mini exhibited moderate but meaningful alignment with UpToDate across preclinical topics, performing best in fact-based disciplines such as pharmacology. Although it is not a substitute for evidence-based resources, ChatGPT may serve as an accessible adjunctive tool for medical students. Integration into preclinical learning should be coupled with artificial intelligence literacy training to promote responsible use and critical appraisal.

PMID:41861392 | DOI:10.2196/82885

JMIR Mhealth Uhealth. 2026 Mar 20;14:e58835. doi: 10.2196/58835.

ABSTRACT

BACKGROUND: Internet-based cognitive behavioral therapy (iCBT) for the treatment of depression has proven to be an effective and accessible option. However, iCBTs tend to have low adherence rates, which may negatively impact their effectiveness. One such iCBT program is the browser-based, proven-effective iFightDepression (iFD) tool. An app-based version of the iFD tool is the iFD app, which was developed to improve usability with a smartphone. The iFD app provides enhanced usability and a more optimized user experience on mobile devices. Additionally, it offers more comfortable interaction with worksheets, reduced text with added videos, and quicker access to the program via the smartphone icon. These improved usability on smartphones and could have an impact on adherence.

OBJECTIVE: This study investigated (1) whether adherence parameters, that is, the number of worksheets, the number of sessions, and the number of workshops, significantly differed between users of the iFD app and the iFD tool and (2) exploratorily whether symptom reduction (delta Patient Health Questionnaire-9 [PHQ-9] scores) differed after 5 to 9 weeks between the iFD app and the iFD tool, after controlling for covariates.

METHODS: We used t tests to compare data from 56 participants using the iFD app for 8 weeks with data from 172 participants using the iFD tool in a previous 6-week study. Exploratively, symptom reduction was compared between formats. A multiple regression model was calculated with the delta PHQ-9 score as the dependent variable and format, baseline PHQ-9 score, adherence, current psychotherapy, antidepressants, age, and sex as independent variables.

RESULTS: There was no significant difference between the iFD tool and the iFD app in terms of the number of sessions per week (t67.393=0.920; P=.36; corrected P=.36), the number of workshops (t76.368=-1.217; P=.30; corrected P=.36), and the number of worksheets per week (t74=0.984; P=.33; corrected P=.36). We found no difference in delta PHQ-9 scores between the iFD app and the iFD tool, and baseline PHQ-9 scores were the only significant predictor (b=-0.61; P<.001).

CONCLUSIONS: Despite the improved availability of the app version in daily life, there were no significant differences in the use parameters we analyzed and no differences in symptom reduction. This study provides the first evidence that adherence to iCBT content is comparable for browser- and app-based interventions and that symptom reduction is similar for both formats. However, this study used a convenience sample, and therefore, the results must be interpreted with caution. Notably, in the study of the iFD tool, guidance was provided by the study assistants in a standardized manner. In the pilot study on the iFD app, the amount of guidance varied substantially, as it was provided by the participants’ health care practitioners. These differences in guidance could also have an influence on adherence.

PMID:41861387 | DOI:10.2196/58835

JMIR Public Health Surveill. 2026 Mar 20;12:e82684. doi: 10.2196/82684.

ABSTRACT

BACKGROUND: Hypertension represents an important global health challenge, closely linked to cardiovascular diseases and elevated premature mortality rates. Prehypertension, defined as elevated blood pressure not meeting the diagnostic criteria for hypertension, necessitates early intervention to prevent disease progression. Health literacy, defined as the capacity to comprehend and use health-related information, is a key determinant of health outcomes but has rarely been studied in the context of prehypertension prevention.

OBJECTIVE: This study investigated the association between health literacy and prehypertension in South Korean adults. Unlike prior research focusing on treatment adherence in diagnosed patients, this study used the most recent nationally representative data to explore how domain-specific health literacy is associated with prehypertension across various subgroups, identifying potential mechanisms for intervention.

METHODS: Data were obtained from the 2023 Korea National Health and Nutrition Examination Survey, a nationally representative cross-sectional study. A stratified, multistage clustered sampling design was used to invite participants. Adults aged 19 years and older (N=1873) who completed the Korean Health Literacy Index were included. Prehypertension was defined as a systolic blood pressure of 130 to 139 mm Hg or a diastolic blood pressure of 80 to 89 mm Hg. A multivariable survey-weighted logistic regression model was used to assess the associations between health literacy and prehypertension, adjusting for sociodemographic and health-related covariates.

RESULTS: Of the 1873 participants, 319 (17.0%) had prehypertension, and 1098 (58.6%) showed low health literacy. After adjustment, those with low health literacy had a 43% higher likelihood of prehypertension (odds ratio 1.43, 95% CI 1.07-1.91) than those with high health literacy. Subgroup analyses revealed that the protective impact of health literacy is not uniform but is modulated by demographic contexts.

CONCLUSIONS: The observed patterns may reflect three potential mechanisms: (1) motivation for and dependency on health information (eg, in women, middle-aged, lower education, and unemployed groups), (2) synergy between health literacy and resources (eg, in high-income, urban, married, and employer-insured groups), and (3) preventive efficacy in low-risk populations. Low health literacy was significantly associated with prehypertension, with variations across subgroups suggesting context-dependent mechanisms. Health literacy may serve as a modifiable determinant and compensatory resource for cardiovascular risk prevention, particularly in populations with limited access to health care. Targeted interventions that address domain-specific health literacy deficits are needed to reduce the prehypertension burden.

PMID:41861384 | DOI:10.2196/82684

JMIR Hum Factors. 2026 Mar 20;13:e73609. doi: 10.2196/73609.

ABSTRACT

BACKGROUND: Although telemedicine grew rapidly during the COVID-19 pandemic, instruments to assess general practitioners’ (GPs) attitudes and behavioral intentions to use it are scarce. In Sweden, the Physicians’ Attitudes and Intentions to use Telemedicine (PAIT) questionnaire was developed from the “theory of planned behavior” in 2019 and translated into English in 2022.

OBJECTIVE: The aim of this study was to explore similarities and differences between behavioral intentions and predictors of intentions to use telemedicine among GPs in England and Sweden.

METHODS: This study compared attitudes, behavioral intentions, and self-reported use of telemedicine after the COVID-19 pandemic among 52 GPs in England and 101 GPs in Sweden. The PAIT questionnaire has 33 items with 7-point Likert scale options ranging from “strongly disagree” to “strongly agree,” examining 3 predictors of intentions: attitudes (12 items), subjective norms (6 items), perceived behavioral control (9 items), and “intentions” (6 items) to use telemedicine; 22 items assess use of telemedicine tools, general questions about telemedicine, training experience, free-text comments, and demographic and background questions.

RESULTS: Both English and Swedish GPs reported little training and low use of telemedicine after the COVID-19 pandemic. Swedish GPs had significantly higher mean scores for intentions to use telemedicine in daily practice compared with English GPs. More positive attitudes and higher perceived behavioral control were significantly associated with higher behavioral intention scores in both English and Swedish GPs.

CONCLUSIONS: While our results are exploratory due to sample size constraints, these findings provide insights into the similarities and differences between English and Swedish GPs regarding telemedicine adoption-attitudes, behavioral intentions, and self-reported use of telemedicine assessed by the PAIT questionnaire-which proved useful for cross-country comparisons and could be used for further international studies.

PMID:41861382 | DOI:10.2196/73609

JMIR Mhealth Uhealth. 2026 Mar 20;14:e73647. doi: 10.2196/73647.

ABSTRACT

BACKGROUND: Fetal alcohol spectrum disorders (FASD) affect 1.1% to 5% of the general population. Yet, most children with FASD and their families cannot access evidence-based interventions. Mobile health (mHealth) interventions have the potential to increase access to care on a broad scale. While numerous self-directed parenting apps exist, none have been tested for FASD. The FMF (Families Moving Forward) Connect app is a self-directed intervention derived from an empirically supported intervention for caregivers raising children with FASD. FMF Connect is the first self-directed parenting app for FASD, and also one of the first parenting apps to be systematically developed and tested.

OBJECTIVE: This study aimed to test the efficacy of FMF Connect for caregivers raising children with FASD on targeted primary (child behavior, caregiver attributions, parenting efficacy and satisfaction, FASD knowledge, and family needs met) and secondary (child adaptive behavior, caregiver self-care, and app satisfaction) outcomes.

METHODS: This study involved a 3-arm randomized controlled trial with equal allocation to groups (1) FMF Connect+coaching, (2) FMF Connect, or (3) waitlist control. Participants from the United States were recruited online through an open access website. Recruitment materials were distributed by the Collaborative Initiative on FASD, FASD listserves, and social media. In total, 129 caregivers of children (aged 3-12 y) with FASD or prenatal alcohol exposure (PAE) were enrolled. Online surveys were administered at baseline, 6 weeks, and 12 weeks. Data were analyzed with linear mixed modeling, linear regressions, and structural equation modeling using SPSS (version 29.0; IBM) and Mplus 8 (Muthén & Muthén).

RESULTS: A total of 43 participants were randomized to each group. Caregivers were predominantly White adoptive mothers. Of the total, 64% (n=83) of participants were retained through the 12-week follow-up. Groups did not differ in terms of demographic characteristics, baseline levels of functioning, or attrition. Usage patterns were similar across groups, suggesting coaching did not increase engagement. Given a few differences, app intervention groups were combined for analyses. Relative to the waitlist group, caregivers in the FMF Connect group evidenced greater improvements in FASD knowledge, child behavior attributions, family needs met, and self-care after 12 weeks (P=.01-.048). After controlling for multiple comparisons, differences in FASD knowledge, self-care, and family needs met approached significance (P=.06-.07). Groups did not differ in parenting satisfaction, child behavior problems, or adaptive functioning. More app usage is related to greater changes in parenting efficacy. Caregiver behavior attributions at 6 weeks did not mediate intervention effects.

CONCLUSIONS: This study demonstrated initial efficacy of the FMF Connect app for targeted caregiver outcomes, with small to medium effect sizes. As an mHealth app, the FMF Connect intervention has potential for scalability and accessibility. This could lead to a substantial public health impact, particularly for families who face challenges accessing evidence-based resources or encounter other barriers to care.

PMID:41861374 | DOI:10.2196/73647