Tag: nevin manimala

Cytokine. 2026 Aug 5;206:157196. doi: 10.1016/j.cyto.2026.157196. Online ahead of print.

ABSTRACT

BACKGROUND: Cutaneous verrucae (warts) are benign epidermal proliferations caused by human papillomavirus (HPV) infection. The host immune response particularly T helper 17 (Th17) related cytokines such as interleukin-17A (IL-17A) and interleukin-23 (IL-23) plays a critical role in the regulation of viral control and inflammatory responses. However, the systemic levels of these cytokines in patients with verrucae have not been sufficiently characterized.

OBJECTIVE: To investigate serum IL-17A and IL-23 levels in patients with cutaneous verrucae, to compare them with those of healthy controls, and to evaluate their associations with age, sex, number of lesions, disease duration, and lesion localization.

METHODS: In this case-control study, 49 patients with palmoplantar or anogenital verrucae and 41 age- and sex-matched healthy controls were included. Serum IL-17A and IL-23 levels were measured using enzyme-linked immunosorbent assay (ELISA). Continuous variables were analyzed using the Mann-Whitney U test, and categorical variables using the chi-square test. Correlations between variables were assessed using Spearman correlation analysis.

RESULTS: The median serum IL-23 level was 11.8 pg/mL (interquartile range, IQR: 7.8-21.3) in patients with cutaneous verrucae and 8.8 pg/mL (IQR: 7.2-12.0) in controls, with a statistically significant difference (p = 0.018). The median serum IL-17A level was 16.6 pg/mL (IQR: 8.7-37.9) in patients and 16.4 pg/mL (IQR: 10.9-24.5) in controls, with no significant difference between the groups (p = 0.755). A strong positive correlation was observed between IL-17A and IL-23 levels in patients (rs = 0.880, p < 0.001). No significant associations were found between cytokine levels and age, sex, number of lesions, disease duration, or localization.

CONCLUSION: Elevated IL-23 levels and its strong positive correlation with IL-17A suggest that the IL-23/IL-17Axis may play a role in immune activation associated with HPV-related cutaneous verrucae. IL-23 may represent a potential indicator of immune activation associated with cutaneous verrucae; however, its standalone diagnostic utility appears limited. Future studies with larger cohorts and tissue-level analyses are needed to further elucidate the role of Th17-related cytokines in the pathogenesis of verrucae.

PMID:42556008 | DOI:10.1016/j.cyto.2026.157196

JMIR Form Res. 2026 Aug 5;10:e87124. doi: 10.2196/87124.

ABSTRACT

BACKGROUND: Adolescents and young adults with chronic health conditions often struggle to adhere to their daily oral medications. Transdiagnostic mobile health (mHealth) interventions have the potential to promote medication adherence by reaching youth at a large scale.

OBJECTIVE: This study aimed at designing an adaptive medication adherence mHealth intervention (Adaptive Cell Phone Support), guided by iterative feasibility, usability, and acceptability feedback. A secondary objective was to explore changes in self-reported medication adherence during a field trial.

METHODS: Using human-centered design methods, researchers collaborated with a community advisory board of young adult patients to conduct 3 cycles of iterative design and usability testing. Adolescents and young adults aged 15-20 years (N=22) were recruited from a large pediatric hospital to user-test the intervention. Data collection included self-report questionnaires, think-aloud usability testing, semistructured interviews, and a 3-week field trial. Quantitative measures included the mHealth App Usability Questionnaire Ease of Use and Usefulness subscales, the Theoretical Framework of Acceptability Questionnaire, and visual analogue scales assessing medication adherence, as well as enrollment and engagement metrics. Qualitative data were analyzed using rapid assessment methods to identify actionable design insights, while quantitative data were analyzed using descriptive statistics and paired-samples t tests with a Holm-Bonferroni correction.

RESULTS: Enrollment was 63% and participants completed a mean of 67.2% (SD 23.5) of automated check-ins. Usability and acceptability ratings were relatively high across prototypes (eg, mHealth App Usability Questionnaire Ease of Use was mean 6.40, SD 0.64 for the initial prototype and mean 6.31, SD 0.61 for the third prototype, on a 7-point scale; Theoretical Framework of Acceptability was mean 4.33, SD 0.52 for the initial prototype and mean 4.50, SD 0.53 for the third prototype, on a 5-point scale). Qualitative data emphasized that the intervention was simple, easy to use, convenient, appropriate, and helpful for staying accountable for medication adherence, while also highlighting areas for improvement. Uncontrolled, 2-tailed, pre-post t tests estimated medium-sized improvements in self-reported medication adherence. However, only the percentage of time taking medications over the past month significantly increased (t21=3.26, d=0.70, 95% CI 0.22-1.16; P=.004).

CONCLUSIONS: Integrated qualitative and quantitative results still suggest that more refinement is needed to optimize the intervention. Partnering with community members early in the development of an intervention may improve the ultimate feasibility, usability, and acceptability of digital health tools. Human-centered design offers a rapid, practical, and creative framework for identifying what works and what needs to be improved early in the lifecycle of a new intervention.

PMID:42555969 | DOI:10.2196/87124

JMIR Public Health Surveill. 2026 Aug 5;12:e89958. doi: 10.2196/89958.

ABSTRACT

BACKGROUND: Infectious disease-specific health literacy (IDSHL)-the capacity to obtain, process, and understand basic infectious disease information needed to make appropriate health decisions-is a critical determinant of public health outcomes. The COVID-19 pandemic created an unprecedented global public health education context; yet, its long-term association with population-level IDSHL beyond the pandemic remains unclear. In China, stringent public health measures and digital information campaigns were implemented, yet their lasting impact on IDSHL across different disease domains has not been systematically evaluated over a full pandemic cycle.

OBJECTIVE: This study aimed to evaluate the longitudinal trends in IDSHL among residents of Zhejiang Province, China, from 2019 (prepandemic) to 2024 (postpandemic), and to assess whether the pandemic period was temporally associated with sustained improvements in IDSHL.

METHODS: Six annual cross-sectional surveys were conducted from 2019 to 2024 across 30 counties in Zhejiang Province using consistent multistage stratified random sampling. A validated 12-item IDSHL questionnaire assessed knowledge, behavior, and skills. Annual sample sizes ranged from 17,131 to 19,257 (N=112,917). Data were weighted to the 2020 census population by age and urban or rural residence. Joinpoint regression identified inflection points in the annual proportion of residents with adequate IDSHL (score≥12). Multivariate logistic regression estimated adjusted odds ratios (ORs) for adequate IDSHL by year, with 2021 as the reference (the peak acute pandemic phase), controlling for sociodemographics. All analyses incorporated sampling weights.

RESULTS: Population-weighted overall IDSHL scores increased from 2019 (mean 10.46 SD 3.09) to 2024 (mean 11.40 SD 2.88; P<.001). All subscale scores (knowledge, behavior, and skills) showed upward trends (all P<.001). Joinpoint regression revealed a rapid annual increase in adequate IDSHL during 2019-2021 (annual percent change 9.42%, 95% CI 6.10-13.45; P<.001), which slowed post-2021 (annual percent change 2.28%, 95% CI -0.38 to 3.73; P=.07). Correct response rates surged for pandemic-salient items (eg, respiratory etiquette from 28.44% to 39.67%), while hepatitis B transmission knowledge fluctuated (63.28% in 2019, 60.71% in 2022, 63.84% in 2024), indicating that not all non-COVID-19 content improved monotonically. Adjusted logistic regression showed the lowest odds of adequate IDSHL in 2019 (OR 0.74, 95% CI 0.71-0.78) and highest in 2024 (OR 1.10, 95% CI 1.05-1.15) compared to 2021.

CONCLUSIONS: The COVID-19 pandemic was temporally associated with significant and sustained population-level improvements in IDSHL, particularly for pandemic-relevant knowledge and behaviors. However, gains were time-sensitive and not uniform across all disease domains or demographic groups. These findings underscore the need for postpandemic health strategies that reinforce comprehensive IDSHL through sustained education and address digital divides to bridge persistent equity gaps. Policymakers should prioritize low digital-literacy populations through hybrid (offline+online) educational interventions, and sustain routine surveillance of IDSHL to detect declines in nonpandemic disease knowledge. This study is the first to document six-year population-level IDSHL trends across the full pandemic cycle, providing evidence for future crisis communication and routine health promotion.

PMID:42555965 | DOI:10.2196/89958

JMIR Nurs. 2026 Aug 5;9:e91083. doi: 10.2196/91083.

ABSTRACT

BACKGROUND: Socioemotional competencies (SEC) are essential for nurses to provide quality care and to maintain their own health. Historically underrepresented, nursing programs are changing their curricula to incorporate SEC development more strongly. Although it is recommended to practice SEC during clinical placement, studies on how to support nursing students in developing these competencies are lacking.

OBJECTIVE: Our study explores second-year nursing students’ perceived and actual use of a reflection tool during their first 20-week clinical placement. Designed to support SEC development, the study focuses on how students incorporate the application in their learning process for SEC development.

METHODS: An embedded mixed method study was conducted with 15 students from a nursing program in the Netherlands. Qualitative surveys and semistructured interviews were used to capture students’ experiences with the application both during and at the end of the clinical placement. Log data from the application provided insight into how the app was used. The mixed methods data were analyzed using warranted assertion analysis.

RESULTS: The app helped students relate learning goals to clinical experiences, identify learning opportunities, and experience a sense of growth. Features that removed practical barriers to reflecting were experienced as most beneficial. Although SEC-focused use was limited (n=7), involved students used the app over a longer period of time and reported greater benefits. Nevertheless, 13 students stopped using the app halfway through their clinical placement, as their attitude shifted from learning to working.

CONCLUSIONS: This study gives a rich description of how nursing students used a reflection app to structure their learning process during clinical placement. It reveals that smartphone-based reflection supports students in clinical placement learning. Specifically, the app lowers barriers to engaging in structural reflection and decreases the mental burden of self-regulated learning. However, more guidance and a multimodal intervention approach seem necessary for SEC development. Further research into how to account for students’ shifting attitudes toward learning is needed.

PMID:42555959 | DOI:10.2196/91083

JMIR Form Res. 2026 Aug 5;10:e85102. doi: 10.2196/85102.

ABSTRACT

BACKGROUND: Infant feeding practices, including breastfeeding, are known to benefit maternal and child health outcomes. Therefore, parent access to evidence-based infant feeding advice is critical. In recent years, there has been increased use of digital health technologies to support infant feeding. Despite its potential, using AI to complement existing health care and connect families to timely infant feeding support remains relatively unexplored.

OBJECTIVE: This study aims to explore women’s perceptions of using AI-enabled infant feeding support within mobile health (mHealth) interventions. The study investigates (A) openness to AI-enabled support, (B) experiences with existing AI-enabled support, (C) preferences for SMS text messages generated by AI versus “child and family health” nurses, and (D) opinions on infant feeding topics suitable for AI.

METHODS: Two data collection activities were undertaken with women (primary caregivers) of infants aged 6-14 months, residing in the Hunter New England Local Health District (HNELHD) of New South Wales, Australia. Different women who received antenatal care in HNELHD were recruited for quantitative and qualitative data collection. Quantitative surveys assessed women’s openness to receiving AI-enabled support (objective A). Descriptive and logistic regression analyses were conducted to explore associations between participant characteristics and openness to AI. Qualitative data collection involved focus groups to explore women’s perceptions and preferences on infant feeding topics suitable for AI (objectives B, C, and D). Thematic analysis was used to analyze focus group transcripts.

RESULTS: A total of 164 women completed the quantitative survey. Approximately 53% (87/164) of participants were open to receiving AI recommendations to see a health professional for infant feeding support, 34% (56/164) were open to AI assessing their breastfeeding experiences, and 41% (67/163) were open to AI providing advice to prevent or address breastfeeding challenges. Fewer Aboriginal and Torres Strait Islander participants were open to receiving AI-generated support (adjusted odds ratio 0.41, 95% CI 0.19-0.92) or advice to see a health professional (adjusted odds ratio 0.29, 95% CI 0.13-0.64). Twelve women participated in 3 online focus groups. Thematic analysis resulted in three overarching themes: (1) opportunities to fill gaps in support, (2) variable confidence engaging with AI for information and advice, and (3) potential convenience of AI and mHealth to offer timely support.

CONCLUSIONS: The study highlights the potential of AI and barriers to women’s acceptability and engagement. While women recognized the potential for AI to fill health care gaps in infant feeding support, including after business hours, there was less interest in AI replacing “in-person” support or information easily located via online search. Women’s concerns regarding the credibility and trustworthiness of AI-enabled support should be addressed to maximize their use of emerging AI-enabled tools, embedded within digital technologies and mHealth. There is potential for AI to complement rather than replace usual care.

PMID:42555955 | DOI:10.2196/85102

JMIR Ment Health. 2026 Aug 5;13:e77507. doi: 10.2196/77507.

ABSTRACT

BACKGROUND: The burden of mental disorders is high in conflict-affected populations. In Palestine, we piloted Inuka Coaching, a digital intervention adapted from the Friendship Bench delivered by trained and supervised lay coaches. This paper documents the implementation of the intervention in this highly volatile context after October 7, 2023.

OBJECTIVE: This study aimed to describe the implementation of Inuka Coaching, a digital mental health tool based on task shifting, in Palestine and examine contextual challenges, fidelity to the coaching model, and lessons learned regarding recruitment, retention, and delivery during escalating ethnic cleansing.

METHODS: Two Palestinian mental health professionals were trained and certified in the Inuka method as head coaches, and subsequently trained 5 lay coaches. Palestinian adults in Gaza and the West Bank were recruited primarily through social media and received up to 4 structured, text-based coaching sessions typically delivered over 4 weeks depending on participant availability and preference. Standardized mental health screening questionnaires (Self-Reporting Questionnaire-20 [SRQ-20] and Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) were collected at baseline, immediately after the first coaching session, and 3 months after the final session. Session transcripts were reviewed to assess coaches’ fidelity to the Inuka method, and a focus group discussion explored coaches’ experiences with training, delivery, and contextual challenges.

RESULTS: Between August 2023 and February 2024, a total of 70 participants were enrolled. Baseline assessments indicated high levels of psychological distress: 95.7% (67/70) scored above the PCL-5 threshold of 31, suggesting likely posttraumatic stress disorder, and 69.4% (43/62) scored in the “at risk” range on the SRQ-20. The effectiveness of the method could not be determined as retention was low, with only 7.1% (5/70) completing the program. Coach fidelity was high, with 94.6% (35/37) of transcripts adhering to all 5 steps of the intervention. Coaches reported positive experiences with the method but identified challenges related to recruitment, session continuity, platform usability, and the need for flexibility during acute crises. Key implementation learnings included the importance of early in-person collaboration and training, culturally sensitive framing, flexible delivery and session structures, and robust support for lay coaches.

CONCLUSIONS: While digital, task-shifted mental health interventions can be delivered with fidelity in conflict settings, sustaining engagement during escalating violence remains challenging. Future implementations require flexible design, context-sensitive recruitment and retention strategies, adaptive delivery models, and strong support for lay coaches.

PMID:42555954 | DOI:10.2196/77507

JMIR Public Health Surveill. 2026 Aug 5;12:e97009. doi: 10.2196/97009.

ABSTRACT

BACKGROUND: Blood exposure accidents (BEAs) remain a major occupational hazard for health care providers, particularly in low‑resource settings. Despite their preventable nature, BEAs continue to occur frequently due to gaps in compliance with standard precautions and limited institutional surveillance.

OBJECTIVE: This study aimed to determine the prevalence and factors associated with BEAs among health care providers in Kalemie, Tanganyika Province, Democratic Republic of the Congo.

METHODS: A cross-sectional study was conducted in March 2024 among 316 health care providers randomly selected from 34 health facilities: public facilities (20/34, 58.8%), private facilities (9/34, 26.5%), and faith‑based facilities (5/34, 14.7%). Data were collected using a structured questionnaire adapted from World Health Organization and Centers for Disease Control and Prevention tools. Logistic regression was performed to identify predictors of BEAs, with adjusted odds ratios (AORs), 95% CIs, and P values reported.

RESULTS: The lifetime prevalence of BEAs was 65.8% (208/316), and the 12-month prevalence was 60.4% (191/316). The most frequent causes were unexpected patient movement (81/191, 42.4%) and lack of attention (66/191, 34.6%). Needlestick injuries accounted for 59.2% (113/191) of exposures. Only 36.1% (69/191) of incidents were formally reported. Multivariate analysis identified two independent predictors: (1) noncompliance with standard precautions (AOR 2.921, 95% CI 1.503-5.677; P=.001) and (2) facility type (working in secondary‑level facilities was protective; AOR 0.310, 95% CI 0.144-0.670; P=.003).

CONCLUSIONS: BEAs were highly prevalent among health care providers in Kalemie. Most incidents were preventable, and noncompliance with standard precautions significantly increased risk. Strengthening infection prevention and control measures, ensuring consistent availability of personal protective equipment, and establishing effective surveillance systems are urgently needed to protect health care workers and reinforce health system resilience.

PMID:42555929 | DOI:10.2196/97009

JMIR Dermatol. 2026 Aug 5;9:e98130. doi: 10.2196/98130.

ABSTRACT

BACKGROUND: Outdoor workers receive significantly more UV radiation exposure than indoor workers, increasing their skin cancer risk. Hispanic individuals comprise a large proportion of the outdoor workforce in the United States, but have limited access to culturally tailored prevention resources.

OBJECTIVE: This exploratory study assessed the perceptions of a culturally tailored narrative video to promote skin cancer prevention among Spanish-speaking Hispanic outdoor workers.

METHODS: A qualitative study was conducted using two focus groups with Hispanic outdoor workers. Prior to viewing the video, participants completed surveys assessing sociodemographic factors, sun exposure, and protective behaviors. Focus group discussions explored video comprehension, cultural relevance, emotional engagement, and dissemination strategies. Quantitative data were summarized descriptively, and qualitative data were analyzed using rapid qualitative analysis.

RESULTS: Among 19 participants, the mean age was 46.5 (SD 15.5) years, and 94.7% (18/19) identified as male. While 47.4% (9/19) reported 6-9 hours of outdoor work per day, more than half (10/19, 52.6%) reported not engaging in sun protection. Participants described the video as culturally resonant, realistic, and engaging. Identification with characters and family-centered themes increased perceived relevance and message credibility. Many participants reported increased awareness of skin cancer risk and greater confidence in adopting sun-protective behaviors. Dissemination recommendations included workplaces, social media, schools, daycares, clinics, and other community settings.

CONCLUSIONS: Our video shows promise in improving skin cancer awareness and prevention, reflecting strong acceptability among participants. Future randomized controlled studies are needed to assess its effectiveness in enhancing long-term sun-protective behaviors.

PMID:42555928 | DOI:10.2196/98130

JMIR Med Educ. 2026 Aug 5;12:e89152. doi: 10.2196/89152.

ABSTRACT

BACKGROUND: AI is increasingly discussed and deployed in health care, yet safe and effective implementation depends on the preparedness, trust, and training of the professionals who are expected to use these tools.

OBJECTIVE: This study aimed to assess current AI use, perceived benefits and concerns, confidence, and training needs among French health care professionals and students.

METHODS: We conducted a national web-based cross-sectional survey distributed through the PulseLife professional community between December 4, 2024, and March 5, 2025. The survey instrument was administered in French and included respondent characteristic items together with 12 substantive closed-ended questions covering current AI use, confidence, perceived benefits, and concerns, and interest in AI-related training. Access was restricted to authenticated individual PulseLife accounts, and multiple submissions from the same account were not allowed. Questions were not mandatory; incomplete questionnaires were retained for item-level analyses, and percentages were calculated using item-specific denominators. Because the exact invitation denominator was not retained by the platform, view, participation, and completion rates could not be calculated. Descriptive statistics and Pearson chi-square tests were performed using R. Internal consistency and exploratory psychometric properties were assessed using the Cronbach α, exploratory factor analysis, and confirmatory factor analysis.

RESULTS: A total of 1625 respondents participated, including 1212 (74.6%) health professionals and 413 (25.4%) students. Among professionals, physicians represented the largest group (642/1212, 53%), followed by nurses (232/1212, 19.1%) and pharmacists (92/1212, 7.6%). Only 6.6% (90/1366) of the respondents reported prior AI-specific training, whereas 78.3% (920/1175) wished to receive such training. Confidence in AI for diagnosis and patient management remained limited: only 9.2% (120/1301) of the respondents reported being very confident. Nearly half (673/1455, 46.3%) of the respondents who answered this item reported no current AI use in professional activity, whereas 10.5% (153/1455) reported frequent use. Physicians and younger respondents reported more frequent AI use, and prior AI training was associated with greater confidence (P<.001 in all cases). Commonly perceived benefits included improved diagnosis (774/1625, 47.6%), time savings (685/1625, 42.2%), reduced medical errors (634/1625, 39%), and improved patient follow-up (593/1625, 36.5%). Frequently reported concerns included algorithmic bias (785/1625, 48.3%), limited transparency (666/1625, 41%), deterioration of the patient-health care professional relationship (628/1625, 38.6%), and data confidentiality (557/1625, 34.3%).

CONCLUSIONS: In this national French sample, formal AI training was uncommon despite high interest in receiving it. These findings support the need for more structured educational initiatives in AI literacy across undergraduate, postgraduate, and continuing professional education. Because this study relied on a convenience sample recruited through a digital platform, the findings should be interpreted as descriptive and exploratory rather than nationally representative.

PMID:42555922 | DOI:10.2196/89152

J Acquir Immune Defic Syndr. 2026 Aug 5. doi: 10.1097/QAI.0000000000003947. Online ahead of print.

ABSTRACT

BACKGROUND: The HIV Prevention Trials Network 094 INTEGRA study sought to fill the gap in implementation science literature by exploring the delivery of integrated prevention and care for HIV and opioid use dependence (OUD) through mobile units to people who inject drugs (PWID).

SETTING: Five U.S. INTEGRA sites with diverse implementation landscapes disproportionately affected by the HIV and opioid epidemics (New York, Philadelphia, Washington, DC, Houston, Los Angeles) .

METHODS: In-depth qualitative interviews from an embedded implementation science evaluation were conducted with 37 clinical and research INTEGRA staff delivering integrated care through mobile units. Pragmatic qualitative analysis was guided by the PRISM framework to identify key implementation needs, challenges, and solutions for delivering the INTEGRA intervention via mobile units in local neighborhoods.

RESULTS: Staff described how mobile delivery of INTEGRA reduced key barriers that limit PWID access to HIV and OUD services. Yet, they also detailed complex implementation needs, including the proactive coordination among staff to ensure sustained access to INTEGRA services, navigating internal and external spaces to deliver services, maintenance-related demands to keep the mobile unit’s infrastructure operational, and interdependent efforts that bridged the mobile unit’s service delivery within the extant health systems and community landscapes.

CONCLUSION: Findings demonstrated that mobile integrated care models can reduce access barriers for PWID but require tailored implementation strategies to address operational, spatial, infrastructural, and community-level demands. Results may help inform an implementation blueprint for similar communities working to respond to the intersecting HIV and opioid epidemics affecting PWID across U.S. settings.

PMID:42555913 | DOI:10.1097/QAI.0000000000003947