Nevin Manimala

J Med Internet Res. 2026 May 29;28:e89067. doi: 10.2196/89067.

ABSTRACT

BACKGROUND: Reducing 30-day hospital readmissions has been a long-standing goal across health systems in the United States. While nurse-led phone outreach has been widely adopted to support transitional care, its reach is constrained by staffing and time limitations. Mobile health (mHealth) interventions, such as automated SMS text messaging and patient portals, offer scalable alternatives but have shown mixed effectiveness in reducing readmissions. Understanding how patients engage with mHealth after discharge may help optimize these tools for postdischarge care.

OBJECTIVE: This study aimed to characterize patients in an mHealth transitional care program who experienced hospital revisits within 30 days of discharge, comparing demographic and clinical characteristics, intervisit interactions, and revisit features between those who engaged with mHealth and those who did not.

METHODS: We conducted a secondary analysis of patients in the intervention arm of the Mobile Outreach to Reduce Emergencies-Primary Care randomized clinical trial. Participants received automated SMS text messages for 30 days after discharge alongside usual transitional care. We identified patients with a 30-day hospital revisit and conducted manual chart reviews to assess mHealth engagement and other forms of health care contact. We compared patient characteristics, intervisit interactions, and revisit features (time to revisit, relatedness to index hospitalization, and predictability of revisit) between mHealth users and nonusers.

RESULTS: Among 496 patients with a 30-day revisit, 185 (37%) engaged with mHealth before their return. mHealth users were younger (n=47, 26% aged <50 years vs n=41, 14% among nonusers; P=.004) and more likely to have commercial insurance (n=43, 23% mHealth users vs n=35, 11% mHealth nonusers; P=.005). Revisits were more likely to be rated highly or somewhat predictable among mHealth users compared to nonusers (n=105, 56% vs n=152, 49%; P=.04), while relatedness to the index hospitalization was similar (n=98, 53% vs n=173, 55%; P=.09). mHealth users had a longer mean time to revisit than nonusers (15.2, SD 8.1 vs 11.3, SD 8.4 days; P<.001) and were more likely to contact their practices via telephone (n=100, 54% vs n=136, 44%; P=.03) or attend a clinic visit (n=112, 61% vs n=131, 42%; P<.001).

CONCLUSIONS: Among patients enrolled in an mHealth postdischarge program who experienced hospital revisits, fewer than half engaged with mHealth prior to their return. Revisits among mHealth users occurred later and were more predictable, suggesting that engagement may enhance situational awareness but not necessarily prevent revisits. Future work should focus on strategies to increase engagement across groups and integrate mHealth with existing transitional care infrastructure.

PMID:42214074 | DOI:10.2196/89067

JMIR Infodemiology. 2026 May 29;6:e82221. doi: 10.2196/82221.

ABSTRACT

BACKGROUND: The COVID-19 pandemic highlighted the importance of effective health communication and reliable information for crisis management, particularly following the introduction of vaccinations. Varied attitudes toward COVID-19 vaccination and an overwhelming amount of online information complicated communication and pandemic management. Previous studies have often focused on general vaccination behavior and its correlation with vaccination attitudes, establishing a link between information-seeking and vaccination decisions. However, there is insufficient analysis distinguishing specific user groups based on their actual online information behavior regarding COVID-19 vaccination and examining its correlation with vaccination behavior.

OBJECTIVE: This study aims to fill this research gap by identifying user groups based on their information behavior and investigating its influence on vaccination uptake.

METHODS: As part of the “Internetnutzung zur COVID-19-Impfung” (INCOVI) study, 1000 individuals in Germany were surveyed online (November 26 to December 8, 2021) regarding their internet usage related to COVID-19 vaccination. A hierarchical cluster analysis was conducted to identify user groups. Logistic regression analyses were then used to explore correlations among the user groups and their demographic characteristics, readiness to vaccinate, knowledge of vaccination, and health literacy. Additionally, a logistic regression analysis was performed to identify the influence of user groups and other factors on vaccination behavior.

RESULTS: A total of 3 user groups were identified: frequent and critical information evaluators (454/778, 58.4%), who primarily relied on official information sources, exhibited a higher level of health literacy, and were older than the other groups; infrequent and passive recipients (222/778, 28.5%), who rarely sought information actively and were younger than the other groups; and frequent and multichannel, interaction-focused users (102/778, 13.1%), who actively searched across multiple channels and engaged in information exchange. Notably, the user groups did not significantly differ in knowledge or willingness to vaccinate. User group affiliation, knowledge, and health literacy did not significantly influence vaccination behavior. The strongest predictor of vaccination was preexisting willingness to vaccinate. Additionally, women were more likely to be vaccinated than men, and individuals with medium or higher education levels were 6-11 times more likely to be vaccinated compared to those with only a basic level of education.

CONCLUSIONS: Segmenting the population into different user groups allows for more targeted communication tailored to the specific needs and beliefs of each group. Because these groups stem from observable usage patterns, they constitute a transferable framework for other health topics. For frequent and critical information evaluators, providing well-founded and detailed information on public channels is important. Infrequent and passive recipients benefit from straightforward formats, such as short explanatory videos, while frequent and multichannel, interaction-focused users are better reached through interactive offerings on social media. By specifically targeting these groups, informed decision-making about vaccinations can be supported.

PMID:42214069 | DOI:10.2196/82221

JMIR Res Protoc. 2026 May 29;15:e92574. doi: 10.2196/92574.

ABSTRACT

BACKGROUND: Physical activity (PA) is safe and beneficial for children and adolescents diagnosed with cancer, yet most engage in low levels of PA. We developed IMPACT (IMplementation of Physical Activity for Children and adolescents on Treatment), a PA intervention delivered by videoconference to enhance PA among young people during treatment for cancer and blood disorder diagnoses. IMPACT is being evaluated in a type II hybrid effectiveness-implementation trial in Alberta, Canada. While referral rates are high and early visual analyses suggest IMPACT may enhance PA and aspects of quality of life and physical function, participation, retention, and adherence rates are low. Findings signal the positive effect of IMPACT for those who participate and underscore the necessity of implementation adaptations. On the basis of these early findings, a demonstrated desire, and funding for PA at sites across Canada, we must first reimagine IMPACT through active collaboration with research users-those who will refer to and/or use or benefit from the intervention.

OBJECTIVE: Over the next 5 years, our larger research program will (1) co-adapt IMPACT and prepare for scaling (phase 1) and (2) implement and evaluate co-adapted IMPACT across additional provinces in Canada (phase 2). Specific aims for phase 1 are detailed herein and include (1) identifying necessary IMPACT modifications, (2) examining site-specific factors influencing IMPACT implementation, and (3) developing an implementation research logic model to guide continued scaling.

METHODS: An integrated knowledge translation and patient-oriented research approach and pragmatic orientation have been adopted. A multiple-perspective mixed methods study is underway. Descriptive surveys and interviews, guided by the Consolidated Framework for Implementation Research 2.0, are being conducted with key research user groups, including children and adolescents diagnosed with cancer and blood disorders (on- and off-treatment), carers, health care providers, and support organization personnel. Data will be analyzed using descriptive statistics and framework analysis. An implementation research logic model will be developed with participants and IMPACT co-adaptation advisory board members and program partners and collaborators.

RESULTS: Funding was secured, and initial ethics approval was granted on June 10, 2025. Additional administrative and full approvals were secured subsequently. Recruitment started in July 2025 in British Columbia and is commencing across sites in a staggered manner. Full results (ie, all site-specific modifications and implementation strategies and the final version of the implementation research logic model) are expected to be submitted for publication late 2026.

CONCLUSIONS: Co-adaptation of IMPACT with research users will enhance the likelihood of relevance, acceptability, and uptake nationally. The resulting data will inform a model to guide continued scaling and a larger trial evaluating the co-adapted IMPACT intervention across British Columbia, Ontario, and the Maritime provinces. This work reimagines IMPACT for broader applicability across varied Canadian contexts..

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/92574.

PMID:42214066 | DOI:10.2196/92574

JCO Oncol Pract. 2026 May 29:OP2501244. doi: 10.1200/OP-25-01244. Online ahead of print.

ABSTRACT

PURPOSE: Information regarding treatment toxicity obtained from phase I clinical trials is crucial to inform drug development and patient care, yet no mandatory standards exist for adverse event (AE) reporting within early-phase studies, nor any uniform criteria that define tolerability. Management of plasma cell dyscrasias has changed dramatically in recent years, because of development of novel therapies, which may have unexpected and potentially severe side effects. Outcomes-based reporting is therefore critical to ensure the safety of new treatment regimens in plasma cell dyscrasia (PCD) and all other cancer diagnoses. We sought to assess the current practices in toxicity reporting in phase I PCD abstracts.

METHODS: Toxicity reporting was analyzed in 250 plasma cell dyscrasia phase I trial abstracts from the American Society of Hematology, ASCO, or the European Hematology Association annual conferences between 2019 and 24.

RESULTS: Significant variation in reporting was seen. Only 70.4% of abstracts reported all-grade toxicity, 80% grade ≥3 toxicity, and 36.8% reported deaths. We observed statistically significant differences in reporting of toxicity grades, deaths, severe AEs, and AEs of special interest according to study sponsor type (industry versus investigator-initiated), timing of analysis (interim versus other), and type of investigational agent. Minimizing language was identified in 77.6% of abstracts. Only 27.3% of these reported all-grade toxicity, of which 66% had an AE rate of ≥90%. Within studies using minimizing language, deaths occurred in up to 15% of patients and treatment discontinuations in up to 28%.

CONCLUSION: Toxicity reporting in phase I PCD studies demonstrates marked heterogeneity. Minimizing language is used in the majority of abstracts despite significant toxicity. Minimum standards for toxicity reporting in early phase hemato-oncology clinical trial abstracts are urgently required to improve accuracy and transparency.

PMID:42214053 | DOI:10.1200/OP-25-01244

JCO Glob Oncol. 2026 May;12(5):e2600114. doi: 10.1200/GO-26-00114. Epub 2026 May 29.

ABSTRACT

PURPOSE: Lung cancer remains the leading cause of cancer-related mortality worldwide. Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway have significantly improved survival outcomes in non-small cell lung cancer (NSCLC), and treatment selection is influenced by the degree of PD-L1 expression. Although ICI use began in 2017, there is a lack of data on PD-L1 expression in NSCLC among Jordanian patients. This study aimed to estimate the prevalence of PD-L1 expression and its association with demographic, clinical, and molecular characteristics, including EGFR mutation and ALK rearrangements.

METHODS: This retrospective observational study reviewed electronic medical records for all patients with lung cancer diagnosed at King Hussein Cancer Center from January 1, 2017, to April 1, 2024. Included patients had histologically confirmed NSCLC and were tested for PD-L1 expression. PD-L1 expression was considered positive if the tumor proportion score (TPS) was ≥1%. Descriptive statistics were performed to summarize patient characteristics. Comparisons between TPS 1%-49% and TPS ≥50% groups were performed using chi-square tests.

RESULTS: Of the 1,872 screened patients, 1,508 met the inclusion criteria and were included in the analysis. In this sample, the majority of patients were male (79%), former smokers (70%), presented with advanced disease (stage III/IV, 86%), and had adenocarcinoma histology (71%). Approximately 25% presented with squamous cell carcinoma. The prevalence of PD-L1 positivity was 68% (n = 1,022). Among the PD-L1-positive patients, 59% had TPS 1%-49% and 41% had TPS ≥50%. Among patients tested for EGFR mutation and ALK fusion, alterations were identified in 16.6% and 8.4% of tested patients, respectively. In PD-L1-positive tumors, EGFR wild-type status was significantly associated with high PD-L1 expression (TPS ≥50%) compared with EGFR-mutated tumors (56% v 44%, P = .007).

CONCLUSION: This first comprehensive analysis of PD-L1 prevalence in patients with NSCLC in Jordan demonstrates a relatively high prevalence of both PD-L1 positivity (≥1%) and high expression (≥50%) compared with reported data from other regions. Distinct molecular associations were observed, with higher PD-L1 expression in ALK-rearranged and EGFR wild-type tumors. These findings underscore the need for prospective and multicenter studies to further identify the biologic and clinical implications of PD-L1 expression in Jordanian patients with NSCLC.

PMID:42214046 | DOI:10.1200/GO-26-00114

JCO Glob Oncol. 2026 May;12(5):e2600137. doi: 10.1200/GO-26-00137. Epub 2026 May 29.

ABSTRACT

PURPOSE: Cancer represents a growing public health challenge in Kyrgyzstan, with increasing incidence and cumulative prevalence in recent years. This study aimed to evaluate national cancer prevalence and incidence trends in Kyrgyzstan between 2020 and 2026 and to assess epidemiologic patterns and public health implications.

METHODS: A population-based descriptive analysis was conducted using publicly available national oncology registry reports, Ministry of Health statistical publications, and international cancer databases. Annual incidence, prevalence, and crude incidence rates per 100,000 population were calculated using national demographic estimates. Temporal trends were evaluated using joinpoint regression modeling.

RESULTS: Annual newly diagnosed cancer cases increased from approximately 5,471 in 2020 to 6,651 in 2024. Crude incidence rates rose from 83 per 100,000 population in 2020 to more than 92 per 100,000 in 2024. National registry estimates indicate that over 35,000 individuals will be living with a cancer diagnosis by 2025. Stomach, breast, lung, cervical, and colorectal cancers accounted for the largest proportion of cases. A temporary stabilization in incidence was observed between 2022 and 2023, followed by an increase again in 2024.

CONCLUSION: Cancer burden in Kyrgyzstan increased steadily during the study period, with rising incidence and expanding national prevalence. These findings highlight the importance of strengthening national cancer surveillance systems, expanding screening programs, and improving oncology care infrastructure.

PMID:42214045 | DOI:10.1200/GO-26-00137

J Magn Reson Imaging. 2026 May 29. doi: 10.1002/jmri.70356. Online ahead of print.

ABSTRACT

BACKGROUND: MRI is sensitive for detecting hepatocellular carcinoma (HCC), but its routine use is hindered by low accessibility.

PURPOSE: To evaluate the performance of non-contrast abbreviated MRI (NC-AMRI) alone and in combination with alpha-fetoprotein (AFP) and protein induced by vitamin K absence II (PIVKA-II) compared to a complete MRI protocol for intrahepatic recurrent HCC detection.

STUDY TYPE: Retrospective.

POPULATION: 190 patients (male = 167, mean age 56.7 ± 11.2 years) undergoing post-hepatectomy MRI surveillance, including 88 with recurrent HCCs.

FIELD STRENGTH/SEQUENCE: T2-weighted fast spin echo (conventional and PROPELLER), diffusion-weighted imaging (DWI), and dynamic T1-weighted gradient echo sequences at 1.5 T and 3.0 T.

ASSESSMENT: The NC-AMRI set consisted of T2WI and DWI data and was extracted from the complete MRI study. Three radiologists independently evaluated the presence of recurrent HCC in two separate reading sessions (NC-AMRI and complete MRI). Pairwise comparisons were then made among three strategies: a combination of NC-AMRI, AFP, and PIVKA-II; NC-AMRI alone; and complete MRI.

STATISTICAL TESTS: The diagnostic performance of the three strategies was compared using a marginal logistic regression with generalized estimating equations and McNemar test. Significance level was p < 0.05.

RESULTS: The sensitivity of NC-AMRI was not significantly different to that of complete MRI for detecting recurrent HCC (Reviewer 1: 94.3% vs. 95.5%, p = 0.655; Reviewer 2: 96.6% vs. 96.6%, p > 0.999; Reviewer 3: 95.5% vs. 94.3%, p = 0.655), including small and medium size HCCs (p > 0.999 for all comparisons). Adding tumor markers to NC-AMRI did not significantly improve HCC detection compared to NC-AMRI alone or complete MRI.

DATA CONCLUSION: NC-AMRI demonstrated no significant difference in diagnostic performance compared to that of complete MRI in detecting intrahepatic recurrent HCCs, including small-sized lesions. Additionally, the incorporation of AFP and PIVKA-II did not significantly improve the diagnostic sensitivity of NC-AMRI.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 2.

PMID:42214033 | DOI:10.1002/jmri.70356

JMIR Mhealth Uhealth. 2026 May 29;14:e73019. doi: 10.2196/73019.

ABSTRACT

BACKGROUND: Lupus erythematosus (LE) is a chronic autoimmune disease that significantly impacts patients’ quality of life. Photosensitivity is a key impairment that severely limits the quality of life, especially in cutaneous lupus erythematosus (CLE), where exposure to sunlight can lead to rashes, exacerbations, and pain. In systemic lupus erythematosus (SLE), other manifestations such as joint pain, fatigue, and organ damage may contribute to decreased physical function and emotional distress. Mobile health apps (MHA) offer potential support for comprehensive disease management for the symptoms mentioned above. However, there is a lack of systematic analysis of available lupus management apps.

OBJECTIVE: This study aims to systematically identify publicly available German or English MHA for lupus management as well as to assess their quality by surveying both patients and physicians.

METHODS: A systematic search and assessment of German or English mobile apps for patients with lupus, available in the Google Play Store and Apple App Store, was conducted independently by two reviewers. The two apps that met all relevant criteria were then reviewed independently by seven physicians using the German Mobile Application Rating Scale (MARS) and the System Usability Scale (SUS). Subsequently, they were reviewed by five patients (three with SLE and two with CLE), using the user version of MARS (uMARS) and SUS. Additionally, the Affinity for Technology Interaction (ATI) scale was collected from both patients and physicians to evaluate the technical affinity in both groups.

RESULTS: In total, 29 apps were available on the Apple Store and 26 on the Google Store, with 18 apps being present and downloadable on both platforms. Of the 18 apps, 16 were excluded because they did not meet the inclusion and exclusion criteria. Only two apps, Lupus Log and Lupus Minder met all the required criteria and were included in the study. The mean MARS scores varied from 2.61/5 to 4.17/5 and mean SUS from 17.5/100 to 100/100 between physicians. The app with the highest mean overall MARS score was Lupus Log, which was rated with 3.91/5 on average by the physicians. Patients evaluated the app with a comparably mean uMARS score (3.95/5). Technical affinity, objectified by ATI, was higher in patients than physicians (3.9 vs 3.68).

CONCLUSIONS: Systematic identification and evaluation showed high-quality apps for patient-centered lupus MHA as indicated by MARS and uMARS scores greater than 3 for both Lupus Log and Lupus Minder.

PMID:42214032 | DOI:10.2196/73019

Am J Hum Biol. 2026 Jun;38(6):e70285. doi: 10.1002/ajhb.70285.

ABSTRACT

Occupational heat exposure is considered a major health concern for workers performing strenuous work during hot environmental conditions. This cross-sectional study aimed to assess the biochemical and physiological responses to occupational heat exposure among agricultural and brick-field workers working in hot environmental conditions in eastern India. A sub-sample of 20 agricultural workers and 20 brick-field workers was selected from the larger sample of 200 workers each to assess the physiological and biochemical responses to hot environmental conditions during the summer and winter seasons. Environmental heat exposure was measured using the time-weighted average Wet Bulb Globe Temperature (TWA-WBGT in °C). Venous blood samples were collected to measure the levels of sodium, potassium, and aldosterone. Active sweat gland responses were measured using the modified starch-iodine technique. Multivariate general linear models of repeated measures were used to measure the effect of the following factors: season, exposure day, and occupation. The multivariate analysis showed significant seasonal effects on serum potassium, sodium, and aldosterone levels, and that exposure day influenced only potassium, not occupation. The monitoring sessions showed normal physiological levels of electrolytes in both occupational groups. Sweat gland activation was also significantly higher during the summer season. TWA-WBGT values above 23°C-25°C are associated with a higher probability of hyponatremia, as revealed by the receiver operating characteristic (ROC) analysis. These findings highlight the physiological adjustments associated with occupational heat exposure and emphasize the importance of hydration and heat mitigation strategies for outdoor workers.

PMID:42214031 | DOI:10.1002/ajhb.70285

Eur J Gastroenterol Hepatol. 2026 May 7. doi: 10.1097/MEG.0000000000003214. Online ahead of print.

ABSTRACT

This meta-analysis aimed to systematically evaluate the efficacy (including improvement of biochemical indicators and clinical outcomes) and safety of the molecular adsorbent recirculating system (MARS) in the treatment of hepatic encephalopathy associated with liver failure. PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were systematically searched from inception to April 2024. Predefined inclusion criteria were used to assess study quality, and statistical analyses were performed using RevMan 5.4. Seven studies were included. Results showed that MARS significantly improved hemoglobin [standard mean difference (SMD): -0.81, 95% confidence interval (CI): -1.42 to -0.19, P = 0.01], creatinine (SMD: -0.46, 95% CI: -0.68 to -0.24, P < 0.0001), and international normalized ratio (INR) (SMD: -0.22, 95% CI: -0.43 to -0.01, P = 0.004). However, effects on albumin (SMD: 0.60, 95% CI: -0.22 to 1.41, P = 0.15) and bilirubin (SMD: -0.21, 95% CI: -0.78 to 0.35, P = 0.46) were NS. No significant association was observed between MARS treatment and increased risk of bleeding (risk ratio: 1.23, 95% CI: 0.83 to 1.81, P = 0.30) or infection (risk ratio: 1.23, 95% CI: 0.97 to 1.56, P = 0.09). In conclusion, preliminary analysis suggests that MARS may help improve creatinine and INR levels in hepatic encephalopathy patients without significantly increasing bleeding or infection risks. However, because of the limited number and suboptimal quality of included studies and presence of heterogeneity, current evidence is insufficient. Rigorously designed, adequately powered, high-quality randomized controlled trials are needed to validate the precise efficacy and safety of MARS in hepatic encephalopathy treatment.

PMID:42214012 | DOI:10.1097/MEG.0000000000003214