Nevin Manimala

JMIR Res Protoc. 2025 Oct 6;14:e74174. doi: 10.2196/74174.

ABSTRACT

BACKGROUND: Most nursing home residents do not meet physical activity guidelines. Many interventions to promote physical activity and prevent falls in nursing home residents have low adherence rates, lack a theoretical foundation, or require much time from staff for preparation or delivery.

OBJECTIVE: This study aims to describe the rationale, development, and implementation approach of the BeSt Age app through a cluster randomized controlled trial. We also provide baseline characteristics of the study sample and discuss possible implications for further app developments.

METHODS: We iteratively developed a novel, tablet-based mobile app (BeSt Age) that enables nursing home staff to deliver individualized physical exercise training to residents with or without motor or cognitive impairments. The app was designed and developed based on an intervention-mapping approach. A needs assessment was performed, followed by defining objectives, theory-based methods, program development, implementation, and evaluation. We took several steps to ensure that the app was based on a sound theoretical background and considered limitations identified in prior research. For implementation and evaluation purposes, we conducted a study among 229 older adults from 19 nursing homes (171 females, 58 males; mean age 85, SD 7 years). Results will be used to examine the effectiveness of the app with regard to different outcomes. Primary outcomes among participating nursing home residents are quality of life, fall risk evaluated through 2 performance-oriented balance tests, and fall incidence. Secondary outcomes include motor performance, cognition, activities of daily living, physical activity behavior, and fall efficacy. In this paper, we examined differences between intervention group (IG) and control group (CG) participants at baseline using the chi-square test, the Mann-Whitney U test, or the t test.

RESULTS: The IG (n=137 from 11 nursing homes) received a 12-week intervention with the BeSt Age app in small, homogenous groups of 5-7 nursing home residents, with 2 exercise sessions per week, each lasting 25-30 minutes. The CG (n=92 from 8 nursing homes) received usual care. At baseline, the IG had a statistically significantly larger number of females, participants had a higher BMI, and more participants rated attending physical activity programs as important. There were no further statistically significant differences between the groups. Results with regard to the effectiveness of the BeSt Age app are expected to be published in spring 2026.

CONCLUSIONS: If proven effective, the BeSt Age app may be a viable solution for physical activity promotion and fall prevention among older adults residing in nursing homes, thereby contributing to maintaining quality of life and overall well-being in this vulnerable population. The app can support nursing home staff in delivering exercise training to residents with minimal additional workload and without requiring specific resources.

PMID:41052426 | DOI:10.2196/74174

JMIR Cancer. 2025 Oct 6;11:e77214. doi: 10.2196/77214.

ABSTRACT

BACKGROUND: Traditional education for patients with cancer faces challenges related to timeliness, accessibility, and a personalized approach. Social media has emerged as a novel platform for delivering cancer-related educational content, garnering growing academic interest. However, a comprehensive assessment of the current research landscape in this domain is lacking.

OBJECTIVE: This study aimed to identify research hotspots; trace the evolution of social media-based education for patients with cancer; and map the leading journals, institutions, and international collaboration networks in this field.

METHODS: A bibliometric and thematic analysis was conducted using tools, such as VOSviewer, Bibliometrix, and CiteSpace, to examine articles indexed in the Web of Science Core Collection from 2011 to 2025. The analysis explored publication trends, author and institutional collaboration networks, keyword co-occurrence, factor analysis, thematic clusters, and the evolution of disciplinary keyword categories.

RESULTS: A total of 119 publications were retrieved. The Journal of Medical Internet Research was the most productive journal in this field, publishing 13 articles (10.9%). The University of Minnesota was the most productive institution, contributing 6 publications (5.0%). The United States accounted for the largest proportion of publications (56/119, 47.1%), with 5 of the top 10 institutions based in the country. The United States also led the international collaboration network. Keyword analysis identified key research hotspots, including platform-specific information dissemination, tailored educational interventions for diverse patient populations, efforts to enhance quality of life, and challenges related to health misinformation. Thematic evolution demonstrated a shift from basic information-seeking behaviors to broader topics such as digital health and health equity, indicating a multidimensional and interdisciplinary research trajectory.

CONCLUSIONS: This study represents the first bibliometric analysis of social media-based cancer education, providing actionable insights to inform digital health literacy strategies and advance patient-centered, equitable health care.

PMID:41052420 | DOI:10.2196/77214

JMIR Form Res. 2025 Oct 6;9:e73279. doi: 10.2196/73279.

ABSTRACT

BACKGROUND: Depression and anxiety are associated with excess morbidity and mortality, constituting a major health care challenge. The prevalence of these conditions is increasing. In the United States, the health-related burden of depression and anxiety may disproportionately affect Black adults, who face unique stressors impacting their mental health and barriers to accessing treatment, including but not limited to systemic racism, discrimination, underdiagnosis of common mental health concerns (ie, depression, anxiety), limited access to culturally sensitive care, and mental health stigma within and outside Black communities.

OBJECTIVE: This study aimed to explore the mental health experiences of nontreatment-seeking Black adults, and how these experiences relate to their needs and preferences for the design of digital mental health (DMH) tools through user-centered design methods.

METHODS: This study included 25 nontreatment-seeking Black adults (aged 18-61 years) with experiences of depression or anxiety to share their perspectives on how DMH tools can meet their needs. Participants were recruited either through social media advertisements or depression and anxiety questionnaires. All participants engaged in an asynchronous online discussion group in which they discussed their past and current mental health experiences, distinct challenges faced by Black Americans, and perceptions of DMH tools, as well as how such tools can be tailored to meet their mental health needs. Participants also completed a technology probe in which they used an automated mental health self-management text messaging tool (Small Steps SMS; Audacious Software) for 18 days. They shared their perceptions of the tool and ideas for specific design improvements in the discussion group. A subset (n=6) completed follow-up interviews to elaborate on their online discussion group posts.

RESULTS: All participants reported significant mental health concerns and difficulty managing related symptoms. A majority of participants (22/25, 88%) expressed that racism and mental health stigma severely impacted their mental health and limited opportunities to discuss their experiences within and outside Black communities. They were interested in the use of DMH tools for mental health self-management and nearly all participants (23/25, 92%) endorsed text messaging as a convenient way to introduce techniques for coping with symptoms of depression and anxiety; however, some participants strongly advocated for additional design features that they believed would improve the program, including the integration of content that centers the experiences of Black individuals, creating nonjudgmental spaces for discussing mental health experiences, and linking formal mental health treatment resources for those who want them.

CONCLUSIONS: These findings suggest that our participants hold generally favorable views toward DMH tools, which can provide psychoeducation, self-management support tailored to the needs of Black adults, and a safe environment to address mental health concerns. Furthermore, it is critical to consider the role of racial discrimination and mental health stigma when designing inclusive and culturally sensitive DMH tools.

PMID:41052419 | DOI:10.2196/73279

JMIR Form Res. 2025 Oct 6;9:e76723. doi: 10.2196/76723.

ABSTRACT

BACKGROUND: YouTube has become a major source of health information, with 2.5 billion monthly users. Despite efforts taken to promote reliable sources, misinformation remains prevalent, particularly regarding medical cannabis.

OBJECTIVE: This study aims to evaluate the quality and reliability of medical cannabis information on YouTube and to examine the relationship between video popularity and content quality.

METHODS: A systematic review of YouTube videos on medical cannabis was conducted. Search terms were selected based on Google Trends, and 800 videos were retrieved on July 8, 2024. After applying exclusion criteria, 516 videos were analyzed. Videos were categorized by content creators: (1) nonmedical educational channels, (2) medical education channels, and (3) independent users. Two independent reviewers (SK and SE) assessed content quality using the DISCERN grade and the Health on the Net (HON) code. Statistical analysis included one-way ANOVA and Pearson correlation coefficient.

RESULTS: Of the 516 videos analyzed, 48.5% (n=251) were from the United States, and 17.2% (n=89) from the United Kingdom. Only 12.2% (n=63) were produced by medical education channels, while 84.3% (n=435) were by independent users. The total views reached 119 million, with nonmedical educational channels having the highest median views with 274,957 (IQR 2161-546,887) and medical education channels having the lowest median views at 5721 (IQR 2263-20,792.50). The mean DISCERN and HON code scores for all videos were 34.63 (SD 9.49) and 3.93 (SD 1.20), respectively. Nonmedical educational creators had the highest DISCERN score (mean 47.78, SD 10.40) and independent users had the lowest score (mean 33.5, SD 8.50; P<.001). Similarly, nonmedical educational creators had the highest HON code score (mean 5.33, SD 1.22), while independent users had the lowest (mean 3.78, SD 1.10; P=.007). Weak positive correlations were found between video views and DISCERN scores (r=0.34, P<.001) and likes and DISCERN scores (r=0.30, P<.001).

CONCLUSIONS: YouTube is a key source of information on medical cannabis, but the credibility of videos varies widely. Independent users attract the highest viewers but have reduced reliability according to the DISCERN and HON scores. Educational channels, despite increased reliability received the least engagement. The weak correlation between views and content quality emphasizes the need for content moderation to ensure that the most reliable and accurate information on health issues is widely disseminated. Future research should identify strategies to promote verified sources of information and limit misinformation.

PMID:41052415 | DOI:10.2196/76723

West Afr J Med. 2025 May 30;42(5):413-418.

ABSTRACT

INTRODUCTION: Kidney transplantation is the optimal treatment for improving survival and quality of life for patients with end-stage kidney disease. There was no kidney transplant surgery and acute transplant care services in Southeast Nigeria until 2017 when our institution commenced kidney transplant surgery and acute transplant care. This study aims to share our first eight year experience including graft and patient outcome.

OBJECTIVES: To obtain the transplant rate, short and long term complications and the graft and patient survival over an eight year period in a tertiary hospital in Southeast Nigeria.

METHOD: A retrospective review of the transplant register for patients referred to the kidney transplant unit over an eight year period from January 2017 to January 2025.

RESULT: Complete data for ninety-three patients were analyzed. Out of these, twelve were transplanted giving a transplantion rate of 13%. Financial constraint is the leading reason (40%) for failure to get a kidney transplant done. Hypertension, hyperkalemia, anemia and urinary tract infection were the leading acute complications encountered while cytomegalovirus infection, recurrence of native disease, chronic graft loss and death were the major long term complications. The three-month, one-year, three-year and five-year patient survival in our program were 100%, 90%, 80% and 80% respectively while the graft survival were 90%, 90%, 70% and 60% respectively.

CONCLUSION: The transplant conversion rate is low and a review of atient selection criteria will improve access kidney transplant. Acute complications were treatable in most cases. The patient and graft outcomes appear similar with other centres in Nigeria.

PMID:41052413

JMIR Nurs. 2025 Oct 6;8:e73621. doi: 10.2196/73621.

ABSTRACT

BACKGROUND: This study aimed to adapt a stress and well-being intervention delivered via a mobile health (mHealth) app for Latinx millennial caregivers. This demographic, born between 1981 and 1996, represents a significant portion of caregivers in the United States, with unique challenges due to higher mental distress and poorer physical health than noncaregivers. Latinx millennial caregivers face additional barriers, including higher rates of being uninsured and increased caregiving burdens.

OBJECTIVE: We used a community-informed and user-centered design approach to tailor an existing mHealth app to better meet the stress and well-being needs of Latinx millennial caregivers.

METHODS: We used a 2-step, multifeedback approach. In step 1, Latinx millennial caregivers participated in focus groups to evaluate wireframes for the proposed mHealth app. In step 2, participants engaged in usability testing for 1 week, concluding with short interviews for feedback. Participants were recruited through various channels, including social media and community clinics. Data were analyzed inductively using a rapid qualitative content analysis approach.

RESULTS: A total of 29 caregivers (n=20, 69% women) participated in the study. Participants had a mean age of 31 (SD 4.10) years, with most (n=28, 97%) caring for an adult and 3% (1/29) caring for children with chronic conditions. All participants completed the step 1 focus groups, with a subset of 10% (3/29) of the caregivers completing the usability testing in step 2. The most liked features included (1) the stress rating scale because it helped them understand stress and mental health; (2) the mindfulness options, which allowed for flexible timing of activities; (3) the journaling prompts for addressing daily challenges and positive experiences; and (4) the resource list for its employment and financial content. One concern was that the journaling prompts may take too much time to complete after a long and hard day. Some suggestions for improvement included a better tracking system, gamification, caregiving education, a checklist of emotions to use with the journal, tailored resources, and ways to connect with other caregivers. During step 2, participants noted that the app was user-friendly but had some glitches and unclear privacy policies. Participants liked the meditation options, resource variety, and daily stress log but wanted more journaling space, longer meditations, and additional relaxation activities.

CONCLUSIONS: Future iterations should consider integrating more personalized and community-specific resources, leveraging platforms such as podcasts for broader engagement, and the use of information-based videos to support caregiver skill acquisition. Caregivers expressed needs beyond the scope of the app, such as resource access, demonstrating the need for upstream and downstream interventions. This study reinforces that user-informed design is an ongoing and iterative process that requires balancing the needs of stakeholders and the feasibility of the recommended adaptations.

PMID:41052408 | DOI:10.2196/73621

West Afr J Med. 2025 May 30;42(5):405-412.

ABSTRACT

BACKGROUND: Good quality sleep is critical to human functioning as decline in sleep quality has been linked with health issues. One of the factors that has been identified with decline in sleep quality is increasing age, making older persons at risk of significant deleterious consequences on their physical, social, and mental spheres of well-being when they have poor sleep quality.

OBJECTIVES: This study aimed at determining the predictors of sleep quality among older persons aged 60 years and above attending the outpatient clinics of a tertiary hospital in Uyo, South-South Nigeria with a view to suggesting appropriate recommendations for health improvement of participants and clinical practice, where necessary.

METHODOLOGY AND METHODS: This was a cross-sectional study involving two hundred and fourteen (214) respondents. Those who met the inclusion criteria were interviewed with the aid of a semi- structured questionnaire containing items on socio-demographic characteristics, clinical data, and items from the Pittsburgh sleep quality index. Data was analysed using Epi info® version 3.5.1.

RESULTS: Of the 214 respondents recruited, the prevalence of good sleep quality was 63.1% with a higher rate of poor sleep quality observed in males (57%). Factors affecting sleep quality after bivariate analysis in this study were age group (70-74 years), polygamous family type, significant stress, sleep problems, chronic medical illness, routine medication, high blood pressure, overweight and obesity. However, when multiple logistic regression was done on these factors, family type, sleep problems, and chronic medical illness were still statistically significant.

CONCLUSIONS: More than one-third of the older persons had poor quality of sleep in this study, and the predictors of sleep quality were family type (polygamous), sleep problems, and chronic medical illness. Therefore, there is need for a careful routine assessment of sleep among older persons and this should include comprehensive sleep history as well as evaluation and treatment of various co-morbidities in order to improve sleep quality among them.

PMID:41052398

Health Aff (Millwood). 2025 Oct;44(10):1250-1255. doi: 10.1377/hlthaff.2025.00408.

ABSTRACT

Medicare Advantage (MA) provider prices are, on average, similar to those of traditional Medicare; however, prices may vary across hospitals or insurers. Using national data, we found that MA prices averaged 97 percent of traditional Medicare prices. Although only 39 percent of hospitals in our sample had average inpatient MA prices within 5 percent of traditional Medicare prices, MA prices varied far less than commercial or Medicaid prices.

PMID:41052396 | DOI:10.1377/hlthaff.2025.00408

Health Aff (Millwood). 2025 Oct;44(10):1298-1306. doi: 10.1377/hlthaff.2024.01641.

ABSTRACT

The 2021 expanded Child Tax Credit (ECTC) provided families with six monthly cash transfer payments disbursed between July and December 2021, with the goal of alleviating financial strain during the COVID-19 pandemic. These payments reduced child poverty and food insufficiency and may have had beneficial effects on child health. Using 2019-22 Pennsylvania birth certificate data, we examined the association between parental receipt of monthly ECTC payments during pregnancy and infant birth outcomes, exploiting quasi-random variation in ECTC payment amounts based on date of birth and number of siblings. For every $1,000 in ECTC payments received during pregnancy, we observed decreased odds of preterm birth, low birthweight, and very low birthweight among infants of Medicaid-insured pregnant people. Nondirected cash transfer programs such as the ECTC and other income support programs and policies targeting pregnancy may lead to improved birth outcomes.

PMID:41052394 | DOI:10.1377/hlthaff.2024.01641

Health Aff (Millwood). 2025 Oct;44(10):1273-1280. doi: 10.1377/hlthaff.2024.01289.

ABSTRACT

The Affordable Care Act (ACA) enabled states to expand Medicaid to low-income adults and required expansion programs to cover substance use disorder (SUD) treatment. Extending prior research, we analyzed more recent effects of ACA Medicaid expansions on specialty SUD treatment, using 2010-22 all-payer data on treatment episodes. This period coincides with the worsening national drug overdose epidemic, as well as changes to Medicaid policy through program redesign and under the COVID-19 public health emergency. Using difference-in-differences methods, we found that after expansion, episodes to specialty treatment increased by 28 percent in expansion states compared with nonexpansion states. Financial protection through Medicaid as a source of insurance and payment for services also increased significantly in expansion states compared with nonexpansion states. Medicaid expansion is an important program for increasing access to SUD care for a population with high levels of need.

PMID:41052393 | DOI:10.1377/hlthaff.2024.01289