Nevin Manimala

JMIR Form Res. 2025 Oct 3;9:e81753. doi: 10.2196/81753.

ABSTRACT

BACKGROUND: Substance use and HIV epidemics have disproportionately affected sexual and gender minoritized (SGM) communities, with heightened risks among men who have sex with men (MSM) and transgender women of color due to intersecting challenges like poverty, mental health issues, and discrimination. Despite overall declines in substance use and sexual risk behaviors in the general population, these issues persist within SGM communities, exacerbated by stigma and systemic barriers to care. Digital health interventions have emerged as promising tools to address these disparities, offering accessible and stigma-reducing alternatives to traditional care, particularly effective among younger individuals and in underserved areas.

OBJECTIVE: This study seeks to examine the social correlates of substance use and sexual risk perception among an online sample of help-seeking MSM and transgender women in San Francisco, California.

METHODS: We recruited 409 help-seeking MSM and transgender women by using social media advertisements on Facebook, Instagram, and Grindr in 2022-2024. Participants provided informed consent and completed a baseline assessment.

RESULTS: Utilization of testing resources for HIV and hepatitis was high among the participants (401/409, 98.04% and 360/409, 88.02%, respectively). Knowledge of HIV or other sexually transmitted infection health services was also high (379/409, 92.67%). Fewer participants (264/409, 64.55%) were knowledgeable about substance use-related services. Although many participants reported that using substances posed a high risk of harm, some perceived engaging in condomless sex, using prescription opioid drugs without a prescription, and using substances during sex as low risk (122/409, 29.83%, 41/409, 10.02%, and 60/409, 14.67%, respectively). Participants who reported experiencing unstable housing were more likely to report perceiving sharing needles (adjusted odds ratio [aOR] 7.20, 95% CI 1.99-27.80) and nonprescription opioid use (aOR 4.02, 95% CI 1.08-14.90) as low risk. Participants who reported an income below the federal poverty level were more likely to report perceiving sharing needles (aOR 6.35, 95% CI 1.84-23.40), prescription opioid use (aOR 2.89, 95% CI 1.32-6.18), and substance use during sex (aOR 2.29, 95% CI 1.14-4.48) as low risk. Participants who have not been tested for hepatitis in the past have 3.31 times the odds of perceiving prescription opioid use as low risk compared to counterparts who have been tested for hepatitis before (95% CI 1.36-7.68).

CONCLUSIONS: This study underscores the importance of social determinants in shaping low risk perception of the harm associated with substance use behaviors among online help-seeking SGM people in San Francisco. These systemic inequities structure participants’ perceptions, access, and utilization of preventive and public health services. Our findings identify critical opportunities for outreach and preventative efforts needed to serve vulnerable populations.

PMID:41043143 | DOI:10.2196/81753

JMIR Form Res. 2025 Oct 3;9:e70602. doi: 10.2196/70602.

ABSTRACT

BACKGROUND: Syndrome differentiation is crucial in traditional Chinese medicine (TCM) diagnosis and treatment, but it heavily relies on expert experience, limiting systematic standardization.

OBJECTIVE: This study developed and validated a BERT (bidirectional encoder representations from transformers)-based model, the traditional Chinese medicine pancreatic cancer syndrome differentiation bidirectional encoder representations from transformers (TCMPCSD-BERT), using in-house pancreatic cancer medical records, to digitalize expert knowledge and support standardized syndrome differentiation in TCM.

METHODS: A retrospective dataset of pancreatic cancer cases (2011-2024) from Fudan University Shanghai Cancer Center was annotated into 4 TCM syndrome types by 2 experts (Cohen κ=0.913). The proposed TCMPCSD-BERT model was compared with conventional models (long short-term memory and text convolutional neural network) embedded in TCM diagnostic tools and with large language models (LLMs; ChatGPT-4o, Kimi, Ernie Bot 4.0 Turbo, and Zhipu Qingyan) under a prompt engineering framework. Performance evaluation on in-house data was supplemented with attention visualizations and integrated gradients analyses for interpretability. The McNemar test assessed classification accuracy differences, while bootstrap 95% CIs quantified statistical uncertainty and stability. The Welch t test (2-tailed) was used to evaluate mean differences between TCMPCSD-BERT and the comparator models.

RESULTS: Among 6830 records, case counts were damp-heat syndrome (n=1694), spleen-deficiency syndrome (n=1185), damp-heat with spleen-deficiency syndrome (n=1178), and others (n=2773). On the test set, McNemar test showed significantly higher accuracy for TCMPCSD-BERT than the 3 baseline models and generally better performance than LLMs. In all comparisons, TCMPCSD-BERT achieved higher mean macroprecision, macrorecall, macro-F₁-score, and accuracy, with nonoverlapping 95% bootstrap CIs and significant Welch t test results (P<.01). The model achieved a macroprecision of 0.935 (95% CI 0.918-0.951), macrorecall of 0.921 (95% CI 0.900-0.942), macro-F₁-score of 0.927 (95% CI 0.908-0.945), and accuracy of 0.919 (95% CI 0.899-0.939). Attention visualizations suggested the model could capture less common TCM term associations, while integrated gradients highlighted high-attribution diagnostic features (eg, “gray-white stool” 0.933 in damp-heat syndrome; “indigestion” 1.204 in spleen-deficiency syndrome). Misclassification analyses indicated challenges in handling overlapping or atypical symptom presentations. Compared with LLMs, web-based platforms, and diagnostic instruments, TCMPCSD-BERT appeared to provide relatively higher accuracy, interpretability, and efficiency in processing long unstructured texts for syndrome differentiation.

CONCLUSIONS: The TCMPCSD-BERT model shows potential for automated syndrome differentiation from unstructured clinical texts and broader application in TCM. Based on this study, it appears to improve operability over 4-diagnostic instruments and web-based platforms, and offers greater stability and accuracy than LLMs in specific tasks. However, these findings should be interpreted cautiously, given the subjectivity of syndrome definitions, data imbalance, and reliance on preprocessed, expert-annotated data. Further studies involving larger and more diverse populations are needed to validate its generalizability and support its broader application in real-world settings.

PMID:41043140 | DOI:10.2196/70602

JMIR Mhealth Uhealth. 2025 Oct 3;13:e59144. doi: 10.2196/59144.

ABSTRACT

BACKGROUND: Adolescent pregnancy is of public health concern due to high rates of pregnancy-related complications and lower antenatal attendance among adolescent girls and young women. Mobile health (mHealth) interventions have the potential to improve pregnancy health behaviors and thereby birth outcomes.

OBJECTIVE: This pilot randomized controlled trial with pre-post design evaluated user acceptability and preliminary efficacy of an mHealth intervention to improve antenatal appointment attendance and its determinants among pregnant adolescent girls and young women in South Africa.

METHODS: The “Teen MomConnect” intervention entailed both fixed and 2-way tailored SMS text messages about antenatal appointment keeping and pregnancy health behaviors. The intervention content and functionality were adapted from MomConnect, a national mHealth program that sends fixed SMS text messages to pregnant women in South Africa. Pregnant adolescent girls and young women aged 13-20 years were recruited from health facilities and community networks in Cape Town during May-December 2018. Simple 1:1 randomization was used to allocate participants into the control group that received the standard MomConnect maternal health messages or the experimental group that received the Teen MomConnect intervention. A subset of experimental group participants received an in-person motivational interviewing session. Questionnaires were administered at baseline and after the end of the participants’ pregnancies. Appointment attendance data were obtained from clinic records. ANOVA, ANCOVA, and logistic regression models assessed the differences in appointments attended, awareness of HIV status, and the psychosocial determinants of antenatal attendance between the control and experimental groups.

RESULTS: Overall, 412 adolescent girls and young women were enrolled, of which 254 (62%) completed the posttest survey (64% control, 59% intervention). Patient record data were obtained for 222 of the 412 (54%; in both control and intervention) participants. A total of 84% (63/75) and 72% (54/75) rated the intervention messages highly regarding their content value and their motivational nature for behavior change, respectively. Participants responded to an average of 20% of the 2-way messages they received. Mean appointment attendance did not differ significantly between the experimental (4.86, SD 1.76) and control (4.79, SD 1.74; P=.79) groups. Appointment attendance was higher among intervention participants who responded to ≥50% of messages (“high-responders”; 5.08, SD 1.66) than intervention participants who responded to fewer messages (4.82, SD 1.79) and control participants (4.79, SD 1.74; P=.86). The mean increase in knowledge scores was significantly higher among experimental group high-responders (2.1, SD 3.17) than the control group (0.7, SD 2.73; β=1.50; P=.045).

CONCLUSIONS: Engagement with the intervention’s 2-way messaging was low, which could have impacted the outcomes. However, the intervention content was deemed acceptable. Appointment attendance did not vary significantly between the intervention and control groups. More intensive intervention may be needed to impact appointment adherence.

TRIAL REGISTRATION: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/43654.

PMID:41043139 | DOI:10.2196/59144

J Med Internet Res. 2025 Oct 3;27:e71212. doi: 10.2196/71212.

ABSTRACT

BACKGROUND: Pacific Island countries and territories (PICTs) face unique challenges in delivering health care and sustaining digital health systems. These challenges include geographically dispersed populations and service delivery points, workforce shortages, and poor infrastructure. National electronic health records (EHRs) can strengthen health systems by facilitating continuity of care but are only available in 47% of countries worldwide. The status of national EHRs in PICTs has not been previously described in the published literature.

OBJECTIVE: This study aimed to map national EHR coverage in 14 PICTs of the World Health Organization (WHO) Western Pacific Region classified as Small Island Developing States (SIDS). This included the presence or absence of a national EHR; identification of EHR software used; coverage nationally and across primary, secondary, and tertiary facilities; presence or absence of supporting digital health or health information system strategies and policies; comparison of national EHR coverage in PICTs with national EHR coverage globally; and exploration of a relationship between EHR coverage and country income in PICTs.

METHODS: Given the absence of peer-reviewed literature on EHRs in PICTs, an environmental scan methodology was selected to review gray literature sources. We conducted a 3-stage environmental scan to systematically search publicly available websites across government, bilateral, multilateral, and philanthropic organizations for documents describing the status of national EHR implementations in the aforementioned 14 PICTs.

RESULTS: Of the 14 PICTs assessed, 12 countries (86%) have an EHR implemented at some level of the public health system, and 8 (57%) have a single national system implemented at more than one facility. Although this is higher than national EHR coverage rates globally (57/122, 47%), average coverage across the 12 PICTs using EHRs was only 39% (median 16%). We also identified a positive relationship between EHR coverage and country income status and generally medium to high EHR coverage across tertiary hospitals (19/41, 46%) and secondary care facilities (29/77, 38%) but low implementation at primary care facilities (61/4158, 1.5%). EHR coverage across all facilities in the 14 countries assessed was 2.5% (108/4267). EHR software used includes Tamanu (Nauru, Palau, Samoa, Kiribati, Fiji [Aspen Medical public-private partnership hospitals]), Medtech (Cook Islands, Niue), Vesalius (Tonga), PATIS Plus (Fiji), and custom systems.

CONCLUSIONS: Our findings demonstrate, for the first time, that EHRs are being implemented in PICTs, including at scale in some settings. Despite high apparent coverage in some PICTs, the success of implementation and health worker usage remains unclear. Gray literature indicates that some EHRs currently available are failing or incapable of scaling nationally. To support sustainability of national EHRs in PICTs, governments should prioritize the implementation of fit-for-purpose, open-source, and scalable EHRs, and future studies should assess the success of EHR adoption and impact in the region.

PMID:41043138 | DOI:10.2196/71212

JMIR Aging. 2025 Oct 3;8:e73254. doi: 10.2196/73254.

ABSTRACT

BACKGROUND: Disability is a global public health challenge, with its prevalence increasing, particularly among older adults, and it exerts a profound impact on both health outcomes and mortality rates.

OBJECTIVE: This study investigates the associations between age at disability onset, severity at disability onset, and all-cause mortality in community-dwelling adults.

METHODS: We analyzed data from waves 10 to 16 (2010-2023) of the Health and Retirement Study, a nationally representative longitudinal survey of US adults aged ≥51 years. Participants without disabilities in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) from the Health and Retirement Study were followed biennially until December 31, 2023. During the follow-up period, 4500 participants developed ADL disability and 4260 developed IADL disability. For each case participant, a control participant matched for age (+1 to -1 y) and sex was randomly selected. Multivariable Cox proportional hazards models were used to assess hazard ratios (HRs) for all-cause mortality among participants with new-onset disabilities, stratified by age groups and severity at disability onset.

RESULTS: Over a median follow-up duration of 8.58 years, 1709 (37.98%) deaths occurred in the ADL group and 1832 (43%) deaths occurred in the IADL group. Individuals who developed ADL disability before the age of 55 years exhibited the highest all-cause mortality risk compared to matched controls (HR 3.12, 95% CI 1.85-5.26), which further increased with severe disability (HR 4.07, 95% CI 2.03-8.19). The mortality risk was inversely associated with age at onset. A parallel trend was identified in the IADL cohort. Notably, men demonstrated a significantly elevated mortality risk compared to women, emphasizing the need for gender-specific interventions.

CONCLUSIONS: Early and severe disability onset significantly increases mortality risk, with men experiencing a disproportionately higher risk. Preventive strategies aimed at addressing early-onset and severe disability, with consideration of gender differences, are essential for improving long-term outcomes in affected populations.

PMID:41043133 | DOI:10.2196/73254

Neurology. 2025 Nov 11;105(9):e213904. doi: 10.1212/WNL.0000000000213904. Epub 2025 Oct 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Elevated levels of total tau (t-tau) are a key biomarker of neurodegeneration, often seen in Alzheimer disease (AD). Identifying individuals at increased risk of AD using minimally invasive biomarkers can enable early intervention. We developed a polygenic risk score (PRS) for plasma t-tau and examined its association with the risk for developing clinical endophenotypes of AD pathology.

METHODS: This longitudinal cohort study used data from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study, involving individuals aged 65 years or older, free of AD, or amnestic mild cognitive impairment (aMCI-an AD prodrome) at baseline. Our primary exposure was PRStau, a PRS based on common genetic variants linked to plasma tau levels. The primary outcome was aMCI or AD incidence. We assessed the association between PRStau levels and aMCI/AD risk using Cox regression models adjusted for age, sex, education, APOE ε4 allele carriership, and population structure. We sought replication in a sample of UK Biobank (UKB) participants aged 60 years or older without prevalent dementia.

RESULTS: In the HELIAD sample, among 618 cognitively healthy participants (mean age 73.37 years, 58.4% female), followed for 2.92 ± 0.80 years, 73 developed AD/aMCI. A 1 SD increase in PRStau was linked to a 29% higher AD/aMCI risk (hazard ratio [HR] 1.290, 95% CI 1.006-1.654). Stratified analyses revealed greater effect estimates in women (HR 1.451, 95% CI 1.023-2.058) and younger participants (HR 1.866, 95% CI 1.175-2.962), whereas results in men and older participants did not reach statistical significance. In the UKB sample (n = 142,637, mean age 64.2 years, 52% female), 2,737 participants developed AD over 12.9 ± 2.4 years of follow-up. Higher PRStau was also linked to increased AD risk (HR 1.046, 95% CI 1.007-1.086).

DISCUSSION: These results support the potential utility of PRS for plasma t-tau in predicting AD/aMCI incidence. The relationship between genetic predisposition for elevated plasma t-tau levels and AD pathology might be influenced by sex and age, suggesting that these factors should be considered in AD genetic risk modeling. PRS could serve as an early indicator of genetic propensity for tau pathology, enhancing existing AD diagnostic and risk stratification algorithms.

PMID:41043097 | DOI:10.1212/WNL.0000000000213904

Ann N Y Acad Sci. 2025 Oct 3. doi: 10.1111/nyas.70037. Online ahead of print.

ABSTRACT

Rhythm is ubiquitous in human culture and in nature, but hard to capture in all its complexity. A key dimension of rhythm, integer ratio categories occur when the relationship between temporal intervals can be expressed as small-integer ratios. Recent work has found integer ratio categories in most human musical cultures and some animal species’ vocalizations or behavioral displays. But biological systems are noisy, and empirically measured intervals rarely form an exact small-integer ratio. Here, we mathematically assess whether a leading integer ratio analysis method makes valid statistical and biological assumptions. In particular, we (1) make the temporal properties of empirical ratios explicit, both in general and for the typical use in the literature; (2) show how the choice of ratio formula affects the probability distribution of rhythm ratios and ensuing statistical results; (3) guide the reader to carefully consider the assumptions and null hypotheses of the statistical analysis; and (4) present a comprehensive methodology to statistically test integer ratios for any null hypothesis of choice. Our observations have implications for both past and future research in music cognition and animal behavior: They suggest how to interpret past findings and provide tools to choose the correct null hypotheses in future empirical work.

PMID:41043082 | DOI:10.1111/nyas.70037

Am Surg. 2025 Oct 3:31348251385106. doi: 10.1177/00031348251385106. Online ahead of print.

ABSTRACT

In the practice of breast surgery, positive margins are a troublesome pathologic finding associated with an increased risk of local recurrence and the recommendation of re-excision. For this reason, there is an emphasis placed on negative margins for breast surgeries. In this study, we analyze surgical resident involvement in breast cancer operations and associations with margin status.MethodsA retrospective study was completed of adult female patients who underwent a lumpectomy by a single surgeon. The surgeries were categorized by resident involvement in the surgical procedure. Other variables assessed were cancer type, grade, size, neoadjuvant chemotherapy use, and oncoplastic surgery. Variables were evaluated to determine what associated with a positive margin.ResultsWhen comparing cases with and without resident involvement, no statistically significant differences were noted in patient age (65.46 ± 1.76 years vs. 66.14 ± 9.31 years, P = .560), neoadjuvant therapy (11.8% vs. 8.0%, P =.273), and tumor size (12 mm vs. 13 mm, P =.871). The number of positive margins did not differ statistically whether a resident was involved or not (20.3% vs. 16.7%, P =.420). The only variable associated with increased positive margins was adenocarcinoma mixed with ductal carcinoma in situ (DCIS) and pure DCIS, which was associated with the greatest proportions of positive margins.DiscussionUnlike some previous studies, our data reinforces it is safe to involve residents in breast conservation surgery. Specifically, program year did not significantly impact margin status. Thus, surgical training should continue to involve residents in breast surgery without fear of providing suboptimal care.

PMID:41043064 | DOI:10.1177/00031348251385106

Cutan Ocul Toxicol. 2025 Oct 3:1-8. doi: 10.1080/15569527.2025.2564432. Online ahead of print.

ABSTRACT

Kaposi sarcoma (KS) is a vascular tumour with four main clinical types-classic, endemic, iatrogenic, and epidemic-all linked to infection by human herpesvirus 8 (HHV-8). This retrospective cohort study assessed the relationship between demographic factors and clinical characteristics in 73 patients with biopsy-proven KS treated at a single dermatology centre between 2009 and 2023. Demographic and clinical data, including age, gender, birthplace, blood type, smoking, alcohol use, HIV status, tumour site, and disease stage, were collected and statistically analysed. Most patients were male (77%), with a mean age of 61 years, and the classic KS subtype predominated (86%). The majority (75%) had tumours localised to the extremities. HIV-positive status was diagnosed in 14% of cases and was strongly associated with non-extremity tumour location and increased visceral involvement. Notably, blood type showed a significant association with tumour localisation: 0Rh- and ARh- blood groups were less common in KS patients with extremity tumours. This is the first study to demonstrate a significant relationship between blood group and KS tumour site, introducing a novel epidemiological association. Smoking and alcohol consumption were each significantly linked to higher HIV positivity rates. Patients from the Mediterranean region had a higher frequency of HIV-positive KS, although birthplace did not correlate with disease stage. No associations were observed between gender and disease type. The study is limited by its retrospective design and missing data for certain variables, but it identifies potentially novel patterns-including a possible link between blood group and tumour location-and confirms known associations, such as HIV status with advanced disease. These findings underscore the complexity of KS presentation and suggest that demographic, clinical, and lifestyle factors may shape disease patterns. Prospective, multicentre studies are needed to validate these findings and guide personalised approaches to KS management.

PMID:41043032 | DOI:10.1080/15569527.2025.2564432

Eur J Ophthalmol. 2025 Oct 3:11206721251383750. doi: 10.1177/11206721251383750. Online ahead of print.

ABSTRACT

BackgroundTo examine the correlation between Humphrey visual field analyzer and an automated virtual reality perimetry test (Oculera visual field analyzer) in glaucoma patients and healthy individuals.MethodsThis prospective, single-center study was conducted on 93 eyes of 93 patients, 55 of whom were glaucoma patients (glaucoma group) and 38 healthy subjects (normal group). HFA II (24-2, Swedish Interactive Threshold Algorithm) and Oculera (24-2, Oculera Interactive) tests were applied to all participants. Mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) values of both devices were obtained. The correlation between the two devices was evaluated by statistical analyses of MD, PSD, and VFI.ResultsThe MD values were -6.36 dB (-31.8 to 2.27) for HFA II and -5.80 dB (-29.1 to 2.2) for Oculera. The difference between MDs of Oculera and HFA II was -0.56 dB. Wilcoxon signed-rank test showed a statistically significant difference in MD values between Oculera and HFA II (p < 0.001). However, there was a strong correlation between MDs (r = 0.932 and p < 0.001). With this, the results of the Bland-Altman analysis evaluating the agreement between the two tests showed that the differences between the MD measurements were not within the acceptable error range and that the results of the devices could not be used interchangeably. A strong correlation was found between the two devices in terms of PSD and VFI values (r = 0.752, r = 0.910, respectively).ConclusionsThe current findings are promising for the future use of Oculera in the diagnosis and follow-up of glaucoma patients.

PMID:41043010 | DOI:10.1177/11206721251383750