Tag: nevin manimala

J Med Internet Res. 2025 May 27;27:e69729. doi: 10.2196/69729.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) is a leading cause of cervical cancer. It has a substantial impact on global public health, with low- and middle-income countries, including India, facing the highest burden. In 2022, India reported 127,526 new cases and 79,906 deaths due to cervical cancer, projected to increase by 61% by 2040. Although the National Technical Advisory Group on Immunization recommended the HPV vaccine for cervical cancer prevention, it is yet to be a part of India’s universal immunization program.

OBJECTIVE: This study aims to examine online interest in the HPV vaccine in India from January 2010 to April 2024 using Google Trends.

METHODS: A cross-sectional analysis of Google Trends data was performed, using the relative search volume to track interest on a scale of 0-100. Trends were analyzed annually using 1-way ANOVA and joinpoint regression to identify significant changes in search behavior related to public health events. Statistical significance was set at P<.05.

RESULTS: The average annual growth in HPV vaccine-related searches was 13.7% (95% CI 7.9%-19.1%), with the highest relative search volume in 2024 (49.5) and the lowest in 2017 (3.38). Spikes in search interest aligned with key events like the 2018 National Technical Advisory Group on Immunization recommendation and the 2022 launch of the indigenous HPV vaccine. The results highlight online search data’s value in tracking public interest, which fluctuates in response to health policy changes or developments on social media. In India, targeted digital strategies will be vital for addressing vaccine hesitancy and increasing HPV vaccine uptake.

CONCLUSIONS: Google Trends data can inform public health strategies by identifying periods of high interest, aiding in the promotion of HPV vaccination in India.

PMID:40424583 | DOI:10.2196/69729

JMIR Pediatr Parent. 2025 May 27;8:e64831. doi: 10.2196/64831.

ABSTRACT

BACKGROUND: The COVID-19 pandemic significantly impacted primary health care-seeking behavior of the general population. The extent to which health care-seeking behavior of pregnant women in general practitioner (GP) care was affected remains largely unknown. The unique health care needs of pregnant women necessitate regular monitoring and care to ensure the well-being of expectant mothers, fetuses, and neonates, as timely interventions and screenings can profoundly influence the long-term health outcomes. Understanding how pandemic-related changes have influenced pregnant women’s primary health care-seeking behavior is essential for developing targeted interventions and informing policy decisions to improve health outcomes for expectant mothers, fetuses, and neonates, both during public health emergencies and in routine health care settings.

OBJECTIVE: This study aims to examine the impact of different COVID-19 pandemic phases on health care-seeking behavior among pregnant women in Dutch GP practices throughout 2020 and 2021. By analyzing clinical electronic health record (EHR) GP data, we aim to evaluate the health care consumption, occurrence of pregnancy-relevant symptoms and diagnoses, and types of contact (ie, regular consultations, phone consultations, home visits, and digital consultations) during different pandemic phases.

METHODS: Using a retrospective cohort design, EHRs of selected pregnant women from 3 Dutch GP networks between 2019 and 2021 were analyzed, comparing 6 pandemic phases divided into 13 subphases with a prepandemic phase. Contact rates were analyzed by interrupted time-series analyses, pregnancy-relevant symptoms, and diagnoses by comparing the frequency of pregnancy-relevant International Classification of Primary Care (ICPC) code registrations and type of contact by descriptive statistics.

RESULTS: In total, 10,985 pregnant women were included, yielding 39,023 patient-GP contacts. Contact rates fluctuated significantly across pandemic phases, with the sharpest declines at the onset and the end of the pandemic. Pregnancy-relevant symptoms and diagnosis in the category related to pregnancy showed the highest variability across the pandemic phases, such as an increase in the frequency of health care consumption concerning gestational diabetes mellitus and nausea or vomiting of pregnancy. Detailed statistical results are reported in the main text. Contacts for symptoms and diagnosis like digestive or urinary tract problems did not fluctuate across the pandemic phases. The number of physical contacts decreased, while telephone contacts increased.

CONCLUSIONS: By analyzing EHR data from over 10,000 pregnant women, this study highlights the pandemic’s impact on pregnant women’s GP health care-seeking behavior, including declining health care consumption trends during the initial and end phases of the pandemic (2020-2021). The observed increase in GDM and its potential long-term effects underscore the need for enhanced public health strategies within GP practices, ensuring continuous access to prenatal care and striving for improved outcomes of expectant mothers, their fetuses, and neonates during times of pandemics and in routine health care settings.

PMID:40424580 | DOI:10.2196/64831

JMIR Diabetes. 2025 May 27;10:e62926. doi: 10.2196/62926.

ABSTRACT

BACKGROUND: Diabetes management involves a large degree of data collection and self-care in order to accurately administer insulin. Several mobile apps are available that allow people to track and record various factors that influence their blood sugar levels. Existing diabetes apps offer features that enable integrations with various devices that streamline diabetes management, such as continuous glucose monitors, insulin pumps, or regular activity trackers. While this reduces the tracking burden on the users, the research highlighted several issues with diabetes apps, including issues with reliability and trustworthiness. As pumps and continuous glucose monitors are safety-critical systems-where issues can result in serious harm or fatalities-it is important to understand what issues and vulnerabilities could be introduced by relying on popular diabetes apps as an interface for interacting with such devices.

OBJECTIVE: As there is a lack of research examining in detail the integrations and potential suitability of apps as part of a wider self-management ecosystem, our goal was 2-fold. First, we aimed to understand the current landscape of device integrations within diabetes apps and how well they meet users’ needs. Second, we identified the key issues users of the most popular apps face currently and what features are the source of these issues.

METHODS: Through searches in Android and iPhone app stores, we systematically identified 21 diabetes apps that offer integrations. We conducted a detailed analysis of 602 user reviews. For each review, we recorded its sentiment, features and issues, and additional contextual information provided by the review writers. We used descriptive statistics to analyze the features and issues. We also analyzed the reviews thematically to identify additional trends related to the context of use and the consequences of issues reported by the users.

RESULTS: The reviews focused on key features that users found the most important, including device integrations (n=259, 43%), tracking (n=194, 32.2%), data logging (n=86, 14.3%), and notifications (n=70, 11.6%). We found that 327 (54.3%) of the reviews were negative versus 187 (31.1%) positive and 88 (14.6%) neutral or mixed, and the majority of reviews (n=378, 62.8%) mentioned issues. The biggest issues related to device integrations included inability to connect with external devices (n=95, 25.1%), inability to store, manage, or access data (n=49, 22%), unreliable notifications and alerts (n=35, 9.2%), issues caused by or related to software updates (n=31, 8.5%), hardware issues (n=24, 6.4%), and issues with accessing the app, related services, or associated hardware (n=12, 3.2%).

CONCLUSIONS: Apps for diabetes management are a useful part of self-care only if they are reliable and trustworthy, reduce burden, and increase health benefits. Our results provide a useful overview of desired features for diabetes apps alongside key issues for existing integrations and highlight the future challenges for artificial pancreas system development.

PMID:40424579 | DOI:10.2196/62926

JMIR Hum Factors. 2025 May 27;12:e63841. doi: 10.2196/63841.

ABSTRACT

BACKGROUND: Readmission avoidance initiatives have been a priority for the Centers for Medicare & Medicaid Services for over a decade; however, interventions are often high-intensity, costly, and resource-intensive, and therefore, rarely scalable or sustainable. Large national payers are in a unique position to leverage data to identify members in real-time who are at high risk of readmission to prioritize the scaled delivery of tailored behavior change techniques to provide an educational intervention to modify health behaviors.

OBJECTIVE: This study aims to examine the impact of an informatics-driven, multichannel educational messaging campaign implemented to decrease 30- and 90-day acute inpatient readmissions and emergency department (ED) visits among Medicare Advantage members of a large national payer.

METHODS: A quality improvement initiative was designed and implemented to provide an evidence-based outreach campaign using human-centered design and behavior change principles to deliver multiple intervention functions, including timely, contextual, and relevant delivery of education, enablement, and persuasion, to reinforce health-promoting behaviors related to planned or unplanned inpatient admissions. Outcomes, including 30- and 90-day acute inpatient readmissions and ED visits, were retrospectively evaluated from Medicare Advantage members enrolled in a large national health plan residing across the United States between May 2020 and July 2022. Leveraging utilization management data, rules-based logic identified members (N=368,393) with a planned acute inpatient procedure (ie, preadmission) or discharged from an acute hospital stay (ie, postdischarge) within 15 days. Members were sequentially assigned to a standard (N=141,223) or an enhanced (N=227,470) messaging group, whereby the standard group received usual outreach and the enhanced group received an educational intervention via a messaging campaign deployed through multiple low-intensity communication channels (eg, text message, email, direct mail) in addition to standard outreach.

RESULTS: Members who received enhanced outreach had fewer relative 30-day acute inpatient readmissions (-4.1%, 95% CI -5.5% to -2.7%; P<.001) and ED visits (-3.4%, 95% CI -5.0% to -1.7%; P<.001) compared with members receiving standard outreach. Similarly, these findings persisted for relative 90-day outcomes such that members receiving enhanced outreach experienced fewer acute inpatient readmissions (-5.4%, 95% CI -6.5% to -4.3%; P<.001) and ED visits (-3.8%, 95% CI -5.0% to -2.5%; P<.001) compared with members receiving standard outreach messaging.

CONCLUSIONS: Behavior change techniques deployed via educational interventions as low-intensity multi-channel outreach is an effective strategy to reduce avoidable 30- and 90-day inpatient readmissions and ED visits in recently discharged Medicare Advantage members (primarily >65 years).

PMID:40424576 | DOI:10.2196/63841

JMIR Form Res. 2025 May 27;9:e65489. doi: 10.2196/65489.

ABSTRACT

BACKGROUND: The adult Hispanic population of the United States faces an increased risk of dementia compared to non-Hispanic White adults. Physical activity (PA) can help reduce dementia risk, but culturally adapted interventions for Hispanic populations are lacking. Culturally adapted interventions are needed to increase uptake and adherence to brain health promotion strategies in the Hispanic community.

OBJECTIVE: The De Pie y a Movernos intervention aims to reduce barriers to participation in clinical research by culturally adapting a remotely based PA intervention for middle-aged and older Hispanic adults and establish its feasibility and acceptability through a pre-post pilot study. Findings from the cultural adaptation process will inform a stage II PA randomized controlled trial.

METHODS: The adaptation process followed Barrera and Castro’s 2006 cultural adaptation framework and included a literature review, translation of intervention materials, review by a Hispanic-comprised community advisory board and bilingual staff, and a pre-post pilot study (N=10) with subsequent focus groups to refine the intervention. The pilot intervention included the use of Fitbit activity trackers and 2 individualized goal-setting calls with a health coach over a period of 3 weeks. Feasibility and acceptability were assessed using both quantitative methods and qualitative focus groups. Primary quantitative outcomes included enrollment, recruitment, and completion rates, as well as acceptability (predetermined satisfaction survey scores ≥3). Focus groups were thematically coded to identify themes for participants’ opinions about several aspects of the intervention and explore key barriers and facilitators to PA engagement to improve the planned stage II trial.

RESULTS: Ten Hispanic adults (age: mean 62.7, SD 5.3 years; education: mean 11.8, SD 3.8 years; n=9, 90% female; n=9, 90% Spanish-speaking) participated in the pre-post pilot, with a 100% completion rate, 50% enrollment rate, and a recruitment rate of 5 participants per month. Acceptability was high (mean score 4.6, SD 0.3; range 1-5). Qualitative analyses indicated that participants had high satisfaction with the intervention. They expressed a preference for adding group-based activities and increased interaction with study staff. Key barriers to PA included lack of awareness about the benefits of PA, low self-efficacy, time constraints, health conditions, and weather, while facilitators included awareness of PA’s cognitive benefits, social support from family or friends, accountability, enjoyable activities, self-efficacy, and Fitbit use. Insights from participants and community advisory board recommendations led to modifications for the larger trial, such as incorporating group-based elements for those who want them and adding an option for teleconference coaching calls.

CONCLUSIONS: The cultural adaptation process was essential in refining the intervention to align with the preferences of older Hispanic adults, which resulted in a feasible and acceptable intervention. Findings will inform a planned stage II randomized controlled trial aimed at promoting PA and reducing dementia risk in older Hispanic adults.

PMID:40424571 | DOI:10.2196/65489

J ECT. 2025 May 20. doi: 10.1097/YCT.0000000000001161. Online ahead of print.

ABSTRACT

OBJECTIVES: Electroconvulsive therapy (ECT) is an important treatment method that is widely used in psychiatric conditions resistant to pharmacological treatments.

METHODS: This prospective, randomized study included 100 patients undergoing ECT. Group D received dexmedetomidine and propofol, while group R received remifentanil and propofol. In this study, key parameters such as seizure duration, hemodynamic changes, and recovery time were analyzed.

RESULTS: The investigation revealed no statistically significant differences between the groups with regard to mean age, gender distribution, or seizure duration (P > 0.05). Subsequent to induction, group R exhibited statistically significantly lower systolic blood pressure, diastolic blood pressure, and mean arterial pressures in comparison to group D (P < 0.05). Conversely, heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure levels in group R were found to be statistically significantly higher than in group D (P < 0.05). The recovery time in group D was found to be statistically significantly longer than in group R (P < 0.05).

CONCLUSIONS: Dexmedetomidine provides superior hemodynamic stability, while remifentanil ensures faster recovery. Dexmedetomidine has been shown to be more advantageous in terms of hemodynamic stability, while remifentanil has been demonstrated to result in shorter recovery times. Clinicians should tailor anesthetic choices based on patient profiles and therapeutic goals.

PMID:40424541 | DOI:10.1097/YCT.0000000000001161

Schizophr Bull. 2025 May 27:sbaf070. doi: 10.1093/schbul/sbaf070. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Schizophrenia presents significant treatment challenges, particularly due to medication resistance observed in some patients receiving antipsychotics. Emerging research suggests a potential link between impaired reinforcement learning, the severity of psychotic symptoms, and dopamine system abnormalities. Exploring reinforcement learning in therapeutic settings could provide critical insights into the efficacy of antipsychotic treatments. This study aimed to investigate whether neurocognitive profiles, specifically choice strategies and model fitting parameters assessed using the Dynamic Reward Task (DRT), could provide insights into treatment response variability among patients with schizophrenia.

STUDY DESIGN: We conducted a comprehensive neurocognitive assessment on chronic schizophrenia patients experiencing psychotic relapse, categorized by treatment response (high-response vs low-response). Participants underwent DRT, Wisconsin Card Sorting Test (WCST), and Continuous Performance Test (CPT) to evaluate reward processing, executive function, and sustained attention, respectively. We employed statistical analyses to compare task performance between groups and assess changes before and after antipsychotic treatment.

STUDY RESULTS: We identified significant differences in treatment effects across different response groups in DRT scores, choice strategies, and model-fitting parameters. Conversely, all schizophrenia groups had consistent abnormalities on the WCST and CPT evaluations compared to controls.

CONCLUSIONS: Our findings highlight the efficacy of DRT, WCST, and CPT in delineating neurocognitive profiles relevant to treatment response in schizophrenia. Specifically, the DRT effectively differentiated between high- and low-response patients. Distinct deficits in reward processing and executive function identified here may serve as potential indicators, informing personalized treatment strategies tailored to individual responses to antipsychotic medication.

PMID:40424533 | DOI:10.1093/schbul/sbaf070

Iran J Kidney Dis. 2025 May 16;19(2):84-88.

ABSTRACT

INTRODUCTION: Autosomal Dominant Polycystic kidney disease (ADPKD) is defined as one of the most common genetic disorders and the cause of kidney failure or end-stage kidney disease (ESKD). Several studies have shown that renin-angiotensin system has an important role in pathogenesis of ADPKD. The aim of this study was to examine the association between the angiotensin converting enzyme (ACE) gene Deletion/Deletion (D/D) polymorphism and risk of ADPKD among Iranian patients from west Azerbaijan province of Iran.

METHODS: This case-control study was conducted on 40 patients and 72 controls. Genetic polymorphism of the ACE gene was determined using polymerase chain reaction (PCR) and electrophoresis.

RESULT: The frequency (frequency%) of ACE gene I/I, I/D, D/D genotypes were 5 (12.5%), 12 (30%), 23 (57.5%) in cases and 16 (22.22%), 30 (41.67%), 26 (36.11%) in controls, respectively. The frequency (frequency%) of ACE gene I and D alleles were 22 (27.5%) and 58 (72.5%) in cases and, 62 (43.06%) and 82 (56.94%) in controls, respectively. Statistical analysis indicated that there were significant differences among the cases and controls regarding ACE gene D/D genotypes (P = .028). The ACE gene D/D genotype was associated with increased ADPKD susceptibility with an OR of 2.39, (95%) CI = (1.09-5.28), and P = .028. But in the case of ACE gene, I/I and I/D genotypes, there were no statistically significant differences between cases and controls (P > .05). Considering allelic comparison, the ACE gene D allele was associated with ADPKD susceptibility with an OR of 1.99, (95%) CI = (1.1-3.6), and P = .021.

CONCLUSION: Our findings suggest that ACE gene D/D genotype was associated with ADPKD.

PMID:40424488

PLoS Negl Trop Dis. 2025 May 27;19(5):e0013134. doi: 10.1371/journal.pntd.0013134. Online ahead of print.

ABSTRACT

BACKGROUND: Advanced schistosomiasis imposed a heavy economic burden on society and had a high rate of mortality and disability. However, methods for assessing its long-term prognosis were currently insufficient, and there was a lack of predictive tools to aid clinical decision-making and personalized follow-up plans for patients. We sought to determine risk factors associated with six-year all-cause mortality in advanced schistosomiasis, deriving and validating a six-year all-cause mortality prediction model through a retrospective cohort study based on a large population-based cohort.

METHODOLOGY: We collected information from 4,136 patients with advanced schistosomiasis who were discharged between December 2014 and January 2015. After excluding 17 patients with the less common subtypes of colonic tumoroid proliferation and dwarfism, as well as 92 patients who were lost to follow-up or had incomplete information, data from 4,027 patients were included in the study. These patients were randomly assigned to the derivation cohort and the external validation cohort in a 7:3 ratio, with 1,400 patients randomly selected from the derivation cohort for internal validation. Sixteen candidate variables were collected: age, gender, nutritional status, splenectomy history, presence of other conditions (such as cardiovascular and digestive diseases), clinical classification, disease duration, ascites occurrence frequency, levels of serum total bilirubin (TBil), direct bilirubin (DBil), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), alkaline phosphatase (ALP), Hepatitis B surface antigen (HBsAg), and alpha-fetoprotein (AFP). High-risk factors associated with the 6-year mortality outcome were identified through univariate and multivariate Cox proportional hazards regression analyses. The predictive value of different models was evaluated and compared using the receiver operating characteristic (ROC) curves, Akaike information criterion (AIC), net reclassification improvement (NRI), C statistic, and integrated discrimination improvement (IDI).

FINDINGS: The derivation cohort comprised 2819 patients and we randomly selected 1400 cases from this cohort for internal validation. The external cohort consisted of 1208 patients. The mortality rate for three groups was around 27%-28%. We identified ten variables associated with increased risk of death, including age, course of disease, frequence of ascites, hepatitis B co-infection, and levels of DBil, ALT, AST, ALP, ALB, and AFP at baseline. Using these variables, we developed a ten-variable model and three simpler models. In the derivation cohort, the ten-variable model showed the highest C statistic (0.759; 95% CI, 0.739-0.778) and the lowest AIC (2834.2). ROC curves indicated an AUC of 0.759 for the ten-variable model, outperforming the simpler models. External validation also demonstrated superior performance of the ten-variable model with a higher C statistic (0.774; 95% CI, 0.749-0.797). This model consistently showed better results in ROC curves, IDI, continuous NRI, and categorical NRI analyses compared to the reduced models in external validation cohort.

CONCLUSIONS: This study developed a multivariate model to predict the 6-year all-cause mortality rate in patients with advanced schistosomiasis, which demonstrated good performance. This convenient tool may potentially assist clinicians in formulating patient follow-up plans.

PMID:40424464 | DOI:10.1371/journal.pntd.0013134

PLoS One. 2025 May 27;20(5):e0322132. doi: 10.1371/journal.pone.0322132. eCollection 2025.

ABSTRACT

BACKGROUND: Measuring person-centered maternity care outcomes typically consists of two types of measures: experiences of care and satisfaction with care. There are limited validated measurement tools for these measures, particularly in low- and middle-income countries (LMICs). The QUALI-DEC study aims to improve decision-making around caesarean section. We describe development of the QUALI-DEC Study Birth Experience and Satisfaction (QD-BES) scale, and scale validation in Argentina, Burkina Faso, Thailand, and Viet Nam.

METHODS: We used a three-phase scale development and validation approach: 1) item development, 2) scale development, and 3) scale evaluation. We systematically identified existing tools, and assessed them using the QUALI-DEC theory of change, study context, and psychometric qualities. We proposed the 10-item QD-BES scale to balance feasibility, theoretical coverage, and comprehensiveness. We conducted a baseline exit survey with post-partum women in 32 hospitals in 4 countries. We conducted exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

RESULTS: 3127 women participated, most were multiparous (61.0%), without previous caesarean section (77.2%), and preferred vaginal birth (72.8%) despite high rates of caesarean section (39.4%). EFA identified three dimensions: emotional satisfaction (3-items), support and respect by providers (4-items), and communication with providers (3-items), with high loading coefficients (0.5-0.97). CFA confirmed the three-dimension scale, with good model fit (CFI and IFI: 0.95, Cronbach’s alpha: 0.70-0.90). Criterion validity was assessed by exploring characteristics of women, obstetric histories, and birth experiences.

CONCLUSIONS: We present psychometric validation of a scale measuring women’s satisfaction with care and experiences of childbirth care, using a systematic approach to development and validation in four LMICs. The 10-item QD-BES-scale is short, easily-administered, valid, and reliable. The QD-BES-scale is useful to contribute to the generation of new knowledge about quality of maternity care in LMICs, as well as help to meet the major challenge of implementing and measuring respectful care at scale.

PMID:40424400 | DOI:10.1371/journal.pone.0322132