Tag: nevin manimala

J Med Internet Res. 2026 Jun 23;28:e90152. doi: 10.2196/90152.

ABSTRACT

BACKGROUND: Public health crises often reshape online discourse by amplifying uncertainty, frustration, stigma, and misinformation, with important implications for risk communication.

OBJECTIVE: This study examines these dynamics on Reddit (Reddit Inc) during a recent outbreak, using Mpox as a case study.

METHODS: We analyzed sentiment, topical themes, and audience engagement in posts and comments drawn from 4 Mpox-related subreddits. Using natural language processing methods, we applied sentiment analysis and latent Dirichlet allocation to classify 1169 posts and 6571 comments (from July 21, 2021, to July 16, 2025) into sentiment categories and 9 distinct topics. Of the 1169 posts, 611 (52.3%) were neutral, 370 (31.6%) were negative, and 188 (16.1%) were positive. Among comments, 2825 of 6571 (43%) were neutral, 1962 (29.9%) were negative, and 1784 (27.1%) were positive. We then used Kruskal-Wallis tests, Dunn post hoc comparisons, and Vargha-Delaney A to assess relationships among sentiment, topic, and engagement metrics.

RESULTS: Engagement differed significantly by sentiment (P<.001) and topic (P<.001). Negative posts had higher median scores (median 7, IQR 2-27) than positive ones (median 5, IQR 2-16; z score=6.02; adjusted P<.001; Vargha-Delaney A=0.55). Posts about systemic public health failures (Topic 4) received lower median scores (median 4, IQR 1.75-14.25) than other topics. Topic 9 accounted for 980 of 6571 (14.9%) comments, dominating discussions regardless of original post topic. Positive posts generated 284 of 922 (30.8%) positive comments, whereas negative posts received 526 of 1615 (32.6%) negative comments. Comments on positive posts had higher sentiment scores (Vargha-Delaney A=0.550), whereas comments on negative posts had lower sentiment scores (Vargha-Delaney A=0.463). Topic-level differences in comment sentiment were also observed: comments responding to posts on scientific- and policy-related debates (Topic 8) were more positive (Vargha-Delaney A=0.531), whereas those on systemic failures (Topic 4) were more negative (Vargha-Delaney A=0.478).

CONCLUSIONS: Overall, the findings highlight how audience reactions can amplify emotionally charged narratives and reframe technical information into socially and politically charged debates. These insights can inform public health communication strategies by anticipating likely audience responses, mitigating stigma and misinformation, and fostering constructive dialogue during health crises.

PMID:42335474 | DOI:10.2196/90152

JMIR Serious Games. 2026 Jun 23;14:e78169. doi: 10.2196/78169.

ABSTRACT

BACKGROUND: Exposure and response prevention is a first-line intervention for obsessive-compulsive disorder (OCD), yet many individuals with contamination concerns do not access care. Virtual reality exposure-based therapy (VRET) may improve scalability and acceptability.

OBJECTIVE: This pilot study evaluated the feasibility and acceptability of a standardized single-session VRET protocol targeting contamination concerns and whether it elicited within-session anxiety and exploratory contamination symptom change at 1-month follow-up.

METHODS: We conducted a single-arm pilot study in adults with elevated contamination concerns and no formal OCD diagnosis, recruited via convenience sampling. Participants completed a baseline survey, an in-laboratory VRET session using a standardized virtual public toilet environment, and a follow-up survey. Outcomes included momentary anxiety (Subjective Units of Distress Scale) during exposure, affect (positive and negative affect schedule) across time points, and contamination symptoms (Obsessive-Compulsive Inventory-Revised contamination subscale) at baseline and follow-up. Usability (System Usability Scale) and VR sickness were also assessed. Within-session outcomes used repeated-measures ANOVA or Friedman tests; symptom change used paired t tests (α=.05); point estimates include 95% CIs. Missing data were addressed using multiple imputation (random forest; m=5); 37.5% of participants did not complete the follow-up survey (overall missingness: 5.47%).

RESULTS: Sixteen participants were included (aged 18-32 years). Anxiety increased during exposure tasks and decreased after virtual hand washing in both trials (Exposure 1 Friedman Test: χ²3=28.56; P<.001; W=0.6); Exposure 2 repeated measures ANOVA: F1.85, 27.81=5.35; P=.01; Greenhouse-Geisser corrected=0.058. Negative and positive affect both changed significantly across time points (negative affect: Friedman Test: χ²3=13.76; P=.003; W=0.29 and positive affect: repeated measure ANOVA: F3, 45=4.60-4.71; P=.006-.007; Greenhouse-Geisser corrected=0.07-0.073). Contamination symptoms did not significantly change from baseline to follow-up (mean change 1.30, SD 3.39; 95% CI -0.36 to 2.96; P=.12). Usability was adequate (System Usability Scale mean 69.5, 95% CI 62.79-76.21).

CONCLUSIONS: This study is among the first to systematically evaluate a standardized single-session contamination-focused VRET protocol in adults with elevated contamination concerns who did not meet diagnostic criteria for OCD, a subthreshold population underrepresented in prior VRET research, which has focused on clinically diagnosed samples and multisession protocols. The protocol proved feasible and acceptable, eliciting within-session anxiety and providing benchmarks in existing clinical literature. Contamination symptom change at 1-month follow-up was not statistically significant, and the effect size estimate was sensitive to the missingness assumption, underscoring the need for adequately powered multisession designs in future trials. The usability profile and VR sickness levels that did not prevent session completion suggest self-administered or minimally supervised delivery warrants evaluation, with implications for scalable early intervention in individuals with elevated contamination concerns who have not accessed formal treatment.

PMID:42335471 | DOI:10.2196/78169

JMIR Med Inform. 2026 Jun 23;14:e81317. doi: 10.2196/81317.

ABSTRACT

BACKGROUND: Patient-generated health data (PGHD) can enhance patient-centered care by improving disease awareness and preparedness for clinical encounters. However, automated incorporation of PGHD into electronic medical records (EMRs), which is a prerequisite for broader clinical implementation, remains technically and administratively challenging.

OBJECTIVE: This study describes the development of Miri-Alimi, a PGHD collection platform that delivers mobile social networking service-based previsit questionnaires with automated transfer of structured patient responses into the EMR, and evaluates patient participation, EMR documentation quality, and user satisfaction in a cardiology outpatient clinic.

METHODS: This single-center observational study was conducted between August and November 2024 and included 751 consecutive cardiology outpatients, comprising 282 first-visit patients and 469 patients attending follow-up visits for heart failure. All eligible patients received a previsit electronic questionnaire link via KakaoTalk or multimedia messaging service prior to their scheduled visit. The primary outcomes were the overall survey response rate among all enrolled patients and EMR documentation completeness among follow-up patients with heart failure. Documentation quality was evaluated based on 3 prespecified parameters relevant to routine heart failure care-dyspnea, peripheral edema, and medication adherence status-and was quantified using an EMR completeness score ranging from 0 to 3. Secondary outcomes included patient and provider satisfaction assessed using postvisit 5-point Likert-scale surveys. Firth penalized logistic regression was used to evaluate the association between survey response status and EMR completeness, with adjustment for age and sex.

RESULTS: The response rate was 38.5% (289/751), including 48.9% (138/282) of new patients and 32.2% (151/469) of follow-up patients with heart failure. Responders were younger than nonresponders (mean 62.0, SD 15.7 years vs mean 69.8, SD 12.5 years; P<.001). Among the follow-up patients with heart failure, EMR completeness was higher among responders (median score 3, IQR 3-3) than among nonresponders (median score 0, IQR 0-1; P<.001). Patient satisfaction was high: 82.9% (63/76) to 92.1% (70/76) agreed that the system was appropriate, easy to use, and helpful, and 78.9% (60/76) completed the survey in <10 minutes. Both cardiologists and 7 of the 8 participating nurses supported continued use of the system, citing workflow efficiency gains.

CONCLUSIONS: Miri-Alimi enabled patient-friendly PGHD collection without requiring log-ins or a dedicated app and demonstrated direct transfer of patient responses into the EMR. Its use was associated with effective transfer and structured integration of PGHD into the EMR, as well as high satisfaction among survey respondents and participating staff. Further studies should evaluate sustainability and associations with long-term clinical outcomes across diverse care settings.

PMID:42335468 | DOI:10.2196/81317

JMIR Dermatol. 2026 Jun 23;9:e91126. doi: 10.2196/91126.

ABSTRACT

BACKGROUND: Acne is a chronic skin condition that primarily affects adolescents and young adults but can persist into adulthood. It can have repercussions on physical and mental health, self-esteem, and body image. The increasing use of social media for health information and peer support offers an opportunity to explore real-life experiences with acne.

OBJECTIVE: This study aims to analyze social media messages from users in the United States and the United Kingdom using artificial intelligence to assess the impact of acne on quality of life (QoL), identify discussion topics, and explore unmet needs.

METHODS: The data were extracted from public platforms using a query containing the word “acne” between January 1 and December 31, 2024. Data cleaning and filtering were performed using natural language processing, machine learning methods, and algorithms. Biterm topic modeling was used to identify the main discussion topics, and QoL impact was assessed using a deep learning algorithm adapted from the EuroQol 5-Dimension Questionnaire or the 36-Item Short Form Health Survey. Unmet needs were identified through manual annotation using the saturation method.

RESULTS: A total of 646,809 messages posted by 432,234 users were identified. The main topics included skincare routines and product recommendations (n=154,907, 23.9%), acne scars (n=135,643, 21%), and general treatment information (n=97,177, 15%). Engagement varied across topics and platforms. On Instagram, dietary and nutritional strategies (0.16%, SD 6.36%) showed the highest mean engagement, followed by skincare routines and product recommendations (0.11%, SD 4.81%). In general, engagement scores were higher in the United Kingdom compared to the United States across all topics. On TikTok, content about makeup and acne had the highest mean engagement score (3.03%, SD 92.65%). Overall, 52.9% (228,613/432,234) of the users expressed at least 1 QoL impact, most frequently related to signs and symptoms (175,604/228,613, 76.8%), social functioning (n=149,234, 65.3%), mental health (n=107,155, 46.9%), and cost (n=62,008, 27.1%). Of 3200 annotated messages, 582 contained unmet needs, including effective solutions for hormonal acne (111/582, 19.1%), clarity in identifying acne triggers (n=84, 14.4%), treatment guidance (n=68, 11.7%), and psychological support (n=68, 11.7%).

CONCLUSIONS: This study revealed the significant physical, psychological, social, and financial impact of acne on QoL and identified several unmet needs. Given the growing role of social media, these findings highlight opportunities for dermatologists and health professionals to educate and engage with the acne community through digital platforms.

PMID:42335467 | DOI:10.2196/91126

JMIR Form Res. 2026 Jun 23;10:e90020. doi: 10.2196/90020.

ABSTRACT

BACKGROUND: Leisure-time physical activity (LTPA) participation among Chinese college students remains insufficient despite growing public health concerns regarding sedentary lifestyles and obesity. Social media platforms have increasingly become important channels for delivering social support related to physical activity (PA); however, different dimensions of social support on social media may exert distinct psychological influences on exercise intentions.

OBJECTIVE: Guided by the theory of planned behavior, this study aimed to examine the direct and indirect relationships between different dimensions of social support on social media and Chinese college students’ intentions to engage in LTPA.

METHODS: A cross-sectional online survey was conducted among undergraduate and graduate students from a comprehensive university in East China between February and June 2022. A total of 310 valid responses were analyzed using structural equation modeling in R. Three dimensions of social support on social media, including companionship support, informational support, and self-esteem support, were examined as predictors of LTPA intention, with the theory of planned behavior constructs (attitude, subjective norms, and perceived behavioral control) modeled as mediators. Demographic characteristics, BMI, social media use, and prior PA behaviors were included as covariates.

RESULTS: Companionship support demonstrated the strongest positive association with LTPA intention, including both a direct effect (β=.348; P=.005) and an indirect effect through attitudes toward PA (β=.286; P=.002). Self-esteem support also showed a significant positive indirect association with LTPA intention via attitude (β=.138; P=.02). In contrast, informational support demonstrated a significant negative indirect effect on LTPA intention through attitude (β=-.291; P<.001). Subjective norms and perceived behavioral control did not significantly mediate the relationships between social support dimensions and LTPA intention. The findings suggest that companionship-oriented interactions on social media may strengthen positive exercise attitudes, whereas excessive or low-credibility informational content may undermine exercise motivation.

CONCLUSIONS: Different dimensions of social support on social media play distinct roles in shaping Chinese college students’ intentions to engage in LTPA. Social media-based PA interventions should prioritize companionship and esteem support while improving the credibility, personalization, and quality of informational support to reduce potential negative effects associated with misinformation and information overload.

PMID:42335465 | DOI:10.2196/90020

JMIR Nurs. 2026 Jun 23;9:e94722. doi: 10.2196/94722.

ABSTRACT

BACKGROUND: Nursing students are the future workforce, and their readiness to use digital health tools is important. Previous studies have focused on knowledge and attitudes; however, they have not examined the wide range of digital health literacy levels that may influence nursing students’ attitudes toward using telehealth in clinical settings.

OBJECTIVE: This study aimed to determine the relationship between nursing students’ digital health literacy and their attitudes toward telehealth use in practice.

METHODS: A cross-sectional design was used. The sample consisted of undergraduate nursing students enrolled in a Bachelor of Nursing program at a selected Saudi Arabian university. The online survey used 2 scales: the Digital Health Care Literacy Scale and the Nurses’ Attitudes Toward Use of a Telehealth Scale.

RESULTS: A total of 273 students participated (mean age 21.3, SD 1.9 years). Most of the nursing students demonstrated a high digital health literacy level (n=184, 67.4%; mean Digital Health Care Literacy Scale score 11.9 out of 15, SD 3.1). Digital health literacy was a significant predictor of positive attitudes toward telehealth use in practice (adjusted odds ratio 1.48, 95% CI 1.28-1.71; P<.001). Male students were significantly less likely to report positive attitudes than female students (adjusted odds ratio 0.62, 95% CI 0.39-0.97; P=.03). However, academic year, telehealth workshops, and informatics courses were not significantly associated with positive attitudes toward telehealth use in practice.

CONCLUSIONS: Higher levels of literacy appear to correlate with more positive attitudes toward telehealth use in practice. However, current formal education and workshops had no apparent influence on digital health literacy. This suggests a potential need for strengthening digital training and development in nursing education. This may enhance telehealth readiness and support future digital health care delivery.

PMID:42335464 | DOI:10.2196/94722

JMIR Med Educ. 2026 Jun 23;12:e81570. doi: 10.2196/81570.

ABSTRACT

BACKGROUND: The number of 1-year Accreditation Council for Graduate Medical Education (ACGME) fellowships continues to grow. The ACGME recommends a holistic curriculum with nonclinical areas, inclusive of educational sessions. Given the competing demands between clinical skill development, educational pursuits, and work-hour restrictions, we propose an andragogic curriculum using pediatric anesthesiology as the model fellowship.

OBJECTIVE: The primary objective was to improve fellows’ perceptions of their educational experience during their fellowship year after implementing an andragogic holistic curriculum. Secondary objectives assessed improvements in diversity, equity, and inclusion (DEI) training and resources.

METHODS: This was a single-center educational improvement project completed at Lucile Packard Children’s Hospital Stanford. Data were collected between 2014 and 2024. The new curriculum was introduced in 2021-2022 and involved 12 different teaching modalities rooted in andragogic principles. A statistical process control p-chart was used to analyze the primary outcome based on the ACGME annual program evaluation. Outcomes were analyzed using censored regression modeling or a t test, depending on the presence of ceiling effects.

RESULTS: From 2014 to 2024, 58 of 60 pediatric anesthesiology fellows completed the ACGME survey. A break in the statistical process control p-chart for educational content scores occurred during 2021-2022, when the new curriculum was introduced. The mean difference was 0.89 (P<.001). Scores in DEI improved (mean difference 0.52; P=.03), and no difference was noted in resources (mean difference -0.13; P=.98).

CONCLUSIONS: Introduction of an andragogic curriculum into a pediatric anesthesiology fellowship program was associated with more favorable perceptions of educational content and DEI training.

PMID:42335453 | DOI:10.2196/81570

JCO Oncol Pract. 2026 Jun 23:OP2501413. doi: 10.1200/OP-25-01413. Online ahead of print.

ABSTRACT

PURPOSE: Multiple reports have suggested that receiving immunotherapy infusions earlier in the day is associated with improved outcomes, including longer overall survival (OS) and lower toxicity rates. However, the definition of early varies between publications. Reports also fail to account for confounding factors (including distance to infusion center), are subject to survivor bias (analyzing postbaseline factors at baseline), and do not adjust P values for multiple comparisons when evaluating multiple potential thresholds for early versus late time of day of infusion.

METHODS: We analyzed a previously reported multicenter clinical trial evaluating pembrolizumab as adjuvant therapy for participants with resectable high-risk melanoma. Standard statistical methodologies that account for potential biasses were used to evaluate the association between time of day of infusion and clinical outcomes.

RESULTS: A total of 628 participants received pembrolizumab and had time of first infusion recorded. The median age was 55 years, range, 20-82. Odds of infusion before 11:00 hours increased by 32% over 12 months of therapy (P = .013). Participants living further from their treating institution had later infusion times on average: odds of infusion before 11:00 decreased by 9% for each additional 50 miles (P = .017). The optimal cut point for first infusion time for OS was 15:48 with hazard ratio (HR) = 1.40; changing the cut point by 30 minutes earlier to 15:18 decreased HR to 0.98, indicating lack of robustness of the threshold. No significant association was identified between proportion of early infusions and outcomes in multivariable time-dependent Cox regression models.

CONCLUSION: In this multicenter trial of adjuvant pembrolizumab for participants with high-risk melanoma, analyses that account for common sources of bias found no significant association between recurrence-free or OS and time of day of infusion.

PMID:42335437 | DOI:10.1200/OP-25-01413

Eur J Gastroenterol Hepatol. 2026 Aug 1;38(8):971-976. doi: 10.1097/MEG.0000000000003223. Epub 2026 Jun 25.

ABSTRACT

BACKGROUND: Alcohol consumption is associated with increased risk for development of atrial fibrillation. Outcomes of patients with atrial fibrillation in the context of acute alcohol-associated hepatitis have yet to be investigated.

METHODS: We performed a retrospective study of patients with alcohol-associated hepatitis from the National Inpatient Sample (2016-2019), comparing those with and without concurrent atrial fibrillation. Subgroup analysis with and without cirrhosis was alone performed. Statistical analysis performed using STATA 16.1 and multivariate logistic and linear regression.

RESULTS: Among 475 600 patients with alcohol-associated hepatitis, 27 675 (5.8%) had atrial fibrillation. Patients with atrial fibrillation had a nearly two-fold increased in-hospital mortality (6.9%) compared with those without atrial fibrillation (3.9%) [adjusted odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.20-1.53] and higher odds of developing acute kidney injury (OR = 1.23, 95% CI = 1.15-1.32). They also had longer hospital stays and higher total hospital charges (7.5 vs. 6.0 days and $20 005 vs. $14 714, respectively). Among patients with alcohol-associated hepatitis and atrial fibrillation, 33% also had cirrhosis (n = 9190), and these patients had an even higher mortality rate (11.3%) than those with alcohol-associated hepatitis and atrial fibrillation alone (4.7%). Acute coronary syndrome, chronic kidney disease, and obesity were independently associated with increased mortality.

CONCLUSION: Patients with alcohol-associated hepatitis who have atrial fibrillation have an increased risk of in-hospital mortality and underlying cirrhosis compounds this risk. Early recognition of the effect of concomitant atrial fibrillation and alcohol-associated hepatitis could provide an opportunity for intervention.

PMID:42335427 | DOI:10.1097/MEG.0000000000003223

J Trauma Nurs. 2026 Jun 24. doi: 10.1097/JTN.0000000000000929. Online ahead of print.

ABSTRACT

BACKGROUND: Timely transition from the emergency department (ED) to definitive care is critical in severely injured patients. Deploying surgical trauma intensive care nurses (ICU) as trauma response nurses (TRNs) during highest (alpha-level) trauma activations may improve care coordination and expedite transitions; however, evidence supporting this practice remains limited.

OBJECTIVE: To evaluate the effect of the TRN on ED length of stay (LOS) and time to definitive care for alpha trauma activation patients.

METHODS: This single-center, retrospective cohort study analyzed all alpha trauma activations involving patients aged 16 years and older admitted to a Level I trauma center in the southeastern US between July 1, 2022, and June 30, 2024. Clinical outcomes were compared between patients managed with and without a TRN during trauma bay resuscitation.

RESULTS: Among 353 patients, 193 (55%) were in the TRN group and 160 (45%) in the non-TRN group. The median ED LOS was 77 minutes (IQR, 59-105.5) for the TRN group versus 81.5 minutes (IQR, 61.5-127.3) for the non-TRN group (p = .20, r = 0.07). The median time to the operating room (OR) was 63 (IQR, 32-94.5) minutes versus 80 (IQR, 24.8-120.5) minutes (p = .88, r = 0.03). The median time to ICU was 77 (IQR, 62.5-105) minutes with a TRN, compared to 81 (IQR, 65-129.3) minutes (p = .21, r = 0.07). We did not observe statistically significant differences between groups.

CONCLUSION: ED LOS, time to OR, and time to ICU were similar between groups, with slightly lower values in patients with TRN involvement. Further evaluation is needed to determine clinical relevance and impact on trauma protocol adherence.

PMID:42335398 | DOI:10.1097/JTN.0000000000000929