Tag: nevin manimala

J Med Internet Res. 2025 Sep 29;27:e74226. doi: 10.2196/74226.

ABSTRACT

BACKGROUND: The Ministry of Health Malaysia integrated the Casemix System into the Total Hospital Information System (THIS) to improve care delivery, resource efficiency, and cost-effectiveness. Casemix, a patient classification tool, supports clinical documentation, hospital financing, and management by grouping patients according to diagnoses and resource use. Within THIS, it enables automated coding, streamlined workflows, and better hospital performance. Its success, however, relies on acceptance by medical doctors who ensure accurate documentation and coding. Despite its importance, limited empirical research has examined factors influencing Casemix acceptance in Malaysia’s hospital information system context. Understanding these factors is critical for effective implementation and sustained use.

OBJECTIVE: This study aims to investigate the interrelationships between critical success factors namely system quality (SY), information quality (IQ), service quality (SQ), organizational characteristic (ORG), perceived ease of use (PEOU), perceived usefulness (PU), and intention to use (ITU) on user acceptance of the Casemix system in hospitals equipped with THIS.

METHODS: This study used a cross-sectional design, using a self-administered digital questionnaire that was developed by adopting and adapting previously validated instruments, grounded in the Human-Organization-Technology Fit and Technology Acceptance Model (TAM) frameworks. The instrument underwent rigorous validation and reliability procedures, including content and criterion validation through expert review, exploratory factor analysis to assess item appropriateness, and confirmatory factor analysis to establish construct, convergent, and discriminant validity. Proportionate stratified random sampling was used to ensure equitable representation of medical doctors across 5 Ministry of Health hospitals, each representing 1 of Malaysia’s geographical zones. The minimum required sample size of 375 was proportionally distributed across 4 categories of medical doctors within these hospitals. Based on structural equation modeling standards, a total of 343 valid responses were obtained, yielding a response rate of 91.5%. Path analysis was conducted using covariance-based structural equation modeling with SPSS Amos (version 24.0; IBM Corp) to assess the direct relationships among the constructs in this study.

RESULTS: Path analysis revealed that SY (β=-0.262, P=.043) and IQ (β=0.307, P=.01) significantly influenced PEOU. PEOU (β=0.105, P=.02) and PU (β=0.580, P<.001) significantly influenced ITU, which strongly predicted user acceptance (β=0.788, P<.001). PEOU did not substantially impact PU (β=0.086, P=.07), nor did SQ (β=0.146, P=.19) and ORG (β=0.197, P=.21) significantly influence PEOU. Based on the β coefficients and statistical significance, the critical success factors were categorized into 2 groups: higher-ranked predictors (ITU, PU, IQ, and SY) and lower-ranked predictors (ORG, SQ, and PEOU). Higher-ranked predictors demonstrated statistically significant relationships and relatively stronger β coefficients.

CONCLUSIONS: This study offers empirical insights into key factors influencing Casemix system acceptance and informs strategies to support its successful implementation in THIS-equipped hospitals. The findings also contribute to addressing current research gaps and guiding future evaluations of health care information systems.

PMID:41021917 | DOI:10.2196/74226

J Med Internet Res. 2025 Sep 29;27:e67640. doi: 10.2196/67640.

ABSTRACT

BACKGROUND: Nutrition misinformation is pervasive on frequently accessed online sources such as social media platforms and websites. Young adults are at a high risk of viewing or engaging with this content due to their high internet and social media usage.

OBJECTIVE: This study aimed to understand young adults’ preferences, perceptions, and use of online nutrition content.

METHODS: Young Australian adults (aged 18-25 years) were recruited and interviewed individually via video calling (Zoom; Zoom Video Communications) between December 2023 and February 2024. Participants were recruited via convenience sampling using Facebook advertising. The interviewer followed a semistructured format, and questions were guided using a piloted template. Reflexive thematic analysis was conducted using NVivo (Lumivero) to explore the preferences, perceptions, and use of online nutrition content among the sample.

RESULTS: The sample (N=20; mean age 22.9 y, SD 2.3 y) was predominantly female (n=13, 65%) and had, or was studying toward, a tertiary qualification (16/17, 94%). Most participants used social media (19/20, 95%) and internet websites (16/20, 80%) to access nutrition content. Other platforms used included generative artificial intelligence (n=1), apps (n=1), eBooks (n=1), newsletters (n=1), and podcasts (n=1). When exploring perceptions, most participants agreed that online nutrition content was quick and easy to find and informative. Furthermore, perceived reliability and engagement depended on several factors such as the creator’s credentials, length and format of content, consensus on topics, and sponsorships. Short-form content was not considered reliable, despite its engaging nature. Content containing sponsorships or product endorsements was met with skepticism. However, participants were more likely to trust content reportedly created by health professionals, but it was unknown whether they were accessing verified professionals. The oversaturation of content demotivated participants from evaluating the reliability of content. When asked about preferences, participants valued both short- and long-form content, and evidence-based content such as statistics and references and preferred casual and entertaining content that incorporated high-quality and dynamic editing techniques such as voiceovers.

CONCLUSIONS: The study identified the online nutrition content sources and topics young Australian adults access and the key factors that influence their perceptions and preferences. Young Australian adults acknowledge that misinformation is not exclusive to certain platforms. The accessibility and engagement of content and the ambiguity of professional “credentials” may lead them to trust information that is potentially of low quality and accuracy. Findings also show that there needs to be a balance between engaging formats and presenting evidence-based information when designing online nutrition content to engage these audiences while combatting nutrition misinformation. Future research should explore how these factors impact usage of online nutrition content and dietary behaviors among young Australian adults. Further consultation with this cohort can inform tailored interventions that aim to enhance their food and nutrition literacy and diet quality.

PMID:41021916 | DOI:10.2196/67640

JMIR Infodemiology. 2025 Sep 29;5:e65319. doi: 10.2196/65319.

ABSTRACT

BACKGROUND: Cannabis is the third most consumed drug worldwide, with its use linked to a high number of substance use disorders, particularly among young men. Associated mortality causes include traffic accidents and cardiovascular diseases. The global expansion of cannabis legalization has sparked debates about its impact on risk perception, with risk perception decreasing in countries with permissive laws. Social media analysis, such as on Twitter (subsequently rebranded as X), is a useful tool for studying these perceptions and their variation by geographic region.

OBJECTIVE: This study aims to analyze Twitter users’ perceptions of cannabis use and legalization, taking into account the geographic location of the tweets.

METHODS: A mixed methods approach was used to analyze cannabis-related tweets on Twitter, using keywords such as “cannabis,” “marijuana,” and “hashish.” Tweets were collected from January 1, 2018, to April 30, 2022, in English and Spanish, and only those with at least 10 retweets were included. The content analysis involved an inductive-deductive approach, resulting in the classification of tweets into thematic categories, including discussions on legalization.

RESULTS: The tweet analysis showed that in America, Europe, and Asia, political discussions about cannabis were the most common topic, while personal testimonies dominated in Oceania and Africa. In all continents, personal experiences with cannabis use were mostly positive, with Oceania recording the highest percentage (1642/2695, 60.93%). Regarding legalization, Oceania also led with the highest percentage of tweets in favor (1836/2695, 68.13%), followed by America and Africa, while support in Europe and Asia was slightly lower, with about half of the tweets in favor.

CONCLUSIONS: The political debate has been the most frequently mentioned topic, reflecting the current situation in which legislative changes are being discussed in many countries. The predominance of opinions in favor of legalization, combined with the prevalence of positive experiences expressed about cannabis, suggests that the health risks associated with cannabis use are being underestimated in the public debate.

PMID:41021906 | DOI:10.2196/65319

Natl Vital Stat Rep. 2025 Sep 16;(10):1. doi: 10.15620/cdc/174607.

ABSTRACT

OBJECTIVES: This report presents final 2023 data on the 10 leading causes of death in the United States by age group, race and Hispanic origin, and sex. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements “Deaths: Final Data for 2023,” the National Center for Health Statistics’ annual report of final mortality statistics.

METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2023. Causes of death classified by the International Classification of Diseases, 10th Revision are ranked according to the number of deaths. Cause-of-death statistics are based on the underlying cause of death.

RESULTS: In 2023, the ranked order of 7 of the 10 leading causes of death changed from 2022. The 10 leading causes of death in 2023 in ranked order were: Diseases of heart; Malignant neoplasms; Accidents (unintentional injuries); Cerebrovascular diseases; Chronic lower respiratory diseases; Alzheimer disease; Diabetes mellitus; Nephritis, nephrotic syndrome and nephrosis; Chronic liver disease and cirrhosis; and COVID-19. These causes accounted for 70.9% of all deaths occurring in the United States. Rankings are presented by age, race, Hispanic origin, and sex. The 10 leading causes of infant death for 2023 in ranked order were: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by maternal complications of pregnancy; Bacterial sepsis of newborn; Newborn affected by complications of placenta, cord and membranes; Respiratory distress of newborn; Intrauterine hypoxia and birth asphyxia; and Diseases of the circulatory system.

PMID:41021892 | DOI:10.15620/cdc/174607

Psychol Health Med. 2025 Sep 29:1-15. doi: 10.1080/13548506.2025.2561741. Online ahead of print.

ABSTRACT

The objective of this study is to ascertain the long-term risk of obesity associated with smartphone addiction in children and adolescents. We utilized a 4-year dataset from the Korean Children and Youth Survey 2018 (2018-2021). At baseline, the sample comprised 2,607 4th-grade elementary school students and 2,590 1st-grade middle school students (mean age: 11.3 ± 0.3, 14.3 ± 0.3 years, respectively). Of these, 2,718 (52.3%) were boys. Obesity was defined as a body mass index Z-score of at least the 95th percentile according to the 2017 Korean National Growth Charts. During the four-year follow-up period, the prevalence of obesity ranged from 6.9% to 8.4%, while the prevalence of being at high risk of smartphone addiction ranged from 2.1% to 4.8%. The logistic generalized estimating equation (GEE) was employed to examine the risk of obesity in those with addiction to smartphones. The risk of obesity was analyzed by adding smartphone screen time in Model 1, smartphone addiction in Model 2, and smartphone screen time and addiction in Model 3. The GEE results indicated that the odds of obesity increased by 16% in the potential-risk group for smartphone addiction compared to the normal group, even with the same duration of smartphone usage (OR [odds ratio] = 1.16, 95% CI [confidence interval] 1.01-1.33). Although the increase was not statistically significant, the odds of obesity were 1.24 times higher in the high-risk smartphone addiction group (OR = 1.24, 95% CI 0.94-1.65). Spending more than 3 hours on a smartphone was linked to 1.37-fold higher odds of obesity compared to spending less than 1 hour (95% CI 1.14-1.63). Smartphone addiction and overuse among children and adolescents can potentially raise obesity risks. Active interventions are needed to promote healthy smartphone behaviors in children and adolescents.

PMID:41021890 | DOI:10.1080/13548506.2025.2561741

Psychol Health Med. 2025 Sep 29:1-14. doi: 10.1080/13548506.2025.2565526. Online ahead of print.

ABSTRACT

This study aimed to explore the development of child anxiety and examine multiple mediating roles of child maltreatment and resilience in the association between caregiver anxiety and child anxiety. The longitudinal study included 1595 preschool children and their caregivers in Anhui Province, China. Paired t-tests were employed to compare differences in child anxiety between the baseline and follow-up. Linear regression analyses were performed to explore predictive effects of individual and family factors on child anxiety, while path analyses were applied to analyze mediating effects. The results indicated that child anxiety decreased during the one year follow-up. Child sex, resilience, mother’s education, caregiver anxiety and child maltreatment could longitudinally predict child anxiety. Child maltreatment and resilience not only independently mediated the association between caregiver anxiety and child anxiety but also played a chain-mediating effect. These results elucidated a complex mechanistic model involving both risk and protective factors, indicating that caregiver anxiety transmits its effects through increased maltreatment risk and diminished child resilience. Consequently, comprehensive intervention strategies should concurrently target the reduction of caregiver anxiety, prevention of maltreatment, and strengthen child resilience to effectively mitigate the development of anxiety in preschool children.

PMID:41021888 | DOI:10.1080/13548506.2025.2565526

Psychol Health Med. 2025 Sep 29:1-15. doi: 10.1080/13548506.2025.2565525. Online ahead of print.

ABSTRACT

This study investigates whether Tobacco smoke exposure (TSE) is associated with C-reactive protein (CRP) and depression and whether CRP plays a mediating role. The data set, including 8,917 adults aged more than 18 years old, was provided by US National Health and Nutrition Examination Survey during 2005-2010 and 2015-2018. A logistic-regression-based mediation analysis was applied to clarify the direct effect of serum cotinine on depression and the indirect effect mediated by CRP. The results indicated that serum cotinine was positively correlated with the risk of depression (Q4 vs. Q1, OR_{Model 1} = 2.72, 95% CI: 1.95-3.82; OR_{Model 2} = 1.62, 95% CI: 1.10, 2.37 OR_{Model 3} = 1.58, 95% CI: 1.07, 2.34). Active smoking was associated with the risk of depression (OR_{Model 2} = 1.69, 95% CI: 1.23, 2.31; OR_{Model 3} = 1.66, 95% CI: 1.21, 2.28), while passive smoking was not significantly associated with the risk of depression after adjusting for covariates (OR_{Model 2} = 1.02, 95% CI: 0.72, 1.44; OR_{Model 3} = 1.02, 95% CI: 0.72, 1.44). Increased serum cotinine level was associated with an increased risk of depression, and the effect (4.95%) can be explained by a significant indirect effect of CRP (OR = 3.80 × 10^-6, 95% CI: 2.81 × 10^-7, 8.52 × 10^-6). The findings suggest that anti-inflammation may be a potential goal for depression intervention among the tobacco-smoke-exposed population.

PMID:41021887 | DOI:10.1080/13548506.2025.2565525

Psychol Health Med. 2025 Sep 29:1-12. doi: 10.1080/13548506.2025.2565514. Online ahead of print.

ABSTRACT

This study aimed to investigate the effect of childbirth self-efficacy and fear of childbirth on prenatal attachment in patients with risky pregnancies. The study was designed as descriptive and cross-sectional research. Patients with risky pregnancies hospitalized in a perinatology clinic. A total of 210 pregnant women between 28 and 40 weeks of gestation were included in the study. Data were collected using the Personal Information Form, Childbirth Self-Efficacy Inventory Short Version 32 (CBSEI-32), Childbirth Attitudes Questionnaire, and Prenatal Attachment Inventory (PAI). The Statistical Package for the Social Sciences software version 23.0 was used to analyze study data. Pregnant women had moderate levels of childbirth self-efficacy, fear of childbirth, and prenatal attachment. A statistically significant weak positive correlation was observed between the total CBSEI-32 score, its subdimensions of outcome expectancy and efficacy expectancy, and PAI score (p = 0.000, p = 0.002, p = 0.000, respectively). The level of childbirth self-efficacy significantly and positively influenced prenatal attachment, with an explanatory power of 10.1% (F₍₁₎ = 23.254, p = 0.000). In pregnant women, as the childbirth self-efficacy level increased, their prenatal attachment level also increased. However, the level of fear of childbirth did not affect prenatal attachment. Based on these findings, healthcare professionals are recommended to provide specialized care, counseling, and support for patients with risky pregnancies to enhance the perceptions of self-efficacy, thereby improving prenatal attachment levels.

PMID:41021883 | DOI:10.1080/13548506.2025.2565514

JCO Glob Oncol. 2025 Sep;11:e2500304. doi: 10.1200/GO-25-00304. Epub 2025 Sep 29.

ABSTRACT

PURPOSE: This study aimed to assess cancer-related knowledge, attitudes, screening behaviors, and willingness to engage in community-based screening for cervical, breast, and oral cancers among women in rural Bangladesh, with the goal of informing the design of a scalable, national cancer screening strategy.

METHODS: A cross-sectional survey was conducted among 1,046 eligible women (age ≥ 30 years or married ≥ 10 years) in Nawly village, Jashore, Bangladesh. Trained interviewers administered a structured questionnaire assessing sociodemographics, cancer knowledge, attitudes, screening behaviors, and willingness to participate in organized screening. Descriptive statistics and multivariate logistic regression models identified predictors of knowledge, participation, and willingness.

RESULTS: Although 75.4% of women were aware of cervical cancer, only 28.3% correctly identified screening intervals. Awareness of breast and oral cancer screening was lower (11.5% and 6.2%, respectively). Participation in cervical cancer screening was 18.2%, and <1% for breast or oral cancer. However, willingness to participate in future community-based screening was high (>89% across all cancer types). Higher education and income were significantly associated with better knowledge and increased screening participation. Fear and misconceptions were the most common barriers among those unwilling to participate.

CONCLUSION: Despite limited screening uptake, there is strong community readiness for organized cancer screening. These findings underscore the need for tailored education campaigns and scalable, community-based programs to enhance early cancer detection in low-resource settings such as Bangladesh.

PMID:41021876 | DOI:10.1200/GO-25-00304

Neurology. 2025 Oct;105(8):e214150. doi: 10.1212/WNL.0000000000214150. Epub 2025 Sep 29.

ABSTRACT

BACKGROUND AND OBJECTIVES: Myasthenia gravis (MG) is a chronic antibody-mediated autoimmune neuromuscular disorder causing fluctuating muscle weakness due to autoantibodies that target the acetylcholine receptor (AChR) in the neuromuscular junction (NMJ). Despite extensive research, MG remains unpredictable and heterogeneous, underscoring the need for better insight into disease pathogenesis and clinical course. The objective of this study was to identify clinical and immunologic disease-related parameters that correlate with disease severity.

METHODS: This large-scale, multicenter, cross-sectional study included prospectively recruited patients with MG and MG serum samples procured from reputable biobanks. Inclusion criteria required an MG clinical presentation and a positive anti-AChR immunoglobulin G (IgG) titer (≥0.5 nM), confirmed by 2 independent tests. Enrolled patients underwent profiling of subunit-specific anti-AChR IgG titers. Disease severity patterns and their relation to age, sex, disease onset, thymic involvement, anti-AChR titer, and anti-AChR subunit immunodominance were investigated.

RESULTS: The study included 513 patients with MG (50.5% female) with a median age of 64 years (range 14-98.5). Extended clinical data were available for 232 patients. Anti-AChR titers increased monotonically with disease severity (ρ = 0.31, 95% CI 0.17-0.44, p < 0.0001) and were higher in female patients (median 14.6 nM vs 7.7 nM, 95% CI for Δ 2.1-7.3 nM, p < 0.0001) in whom higher antibody titers decreased monotonically with age. Male patients’ titers were predominantly alpha-immunodominant (male 23.2% vs female 16.6%, 95% CI for Δ 0%-7.6%, p = 0.031), while female patients’ titers were gamma-immunodominant (female 30% vs male 24.5%, 95% CI for Δ 2%-11%, p = 0.0027). Gamma immunodominance correlated with higher anti-AChR titer (ρ = 0.25, 95% CI 0.16-0.33, p < 0.0001) and severe (Myasthenia Gravis Foundation of America IV-V) disease (44% vs 27%, 95% CI for Δ 4%-34%, p = 0.0141). Unsupervised principal component analysis disclosed 2 distinct disease endotypes: female patients with moderate to severe early-onset MG, gamma subunit immunodominance, high anti-AChR titers, and frequent thymic hyperplasia (endotype A) and the remaining patients, mostly patients with late-onset MG, alpha subunit immunodominance, and low anti-AChR titers (endotype B).

DISCUSSION: Two distinct MG endotypes emerge based on sex, age, thymic involvement, autoantibody titer, and immunoglobulin AChR subunit immunodominance-suggesting different underlying etiologies with potential implications for sex-dependent precision medicine, women’s health, and the development of new therapeutic modalities for MG.

PMID:41021867 | DOI:10.1212/WNL.0000000000214150