Tag: nevin manimala

JMIR Public Health Surveill. 2026 Apr 8;12:e81412. doi: 10.2196/81412.

ABSTRACT

BACKGROUND: Ambient ozone (O3) exposure has been found to be associated with gestational hypertension, which, in turn, increases the risk of term low birth weight (LBW). As such, gestational hypertension acts as a potential mechanism mediating restricted fetal growth; however, few epidemiological studies have quantified this specific mediation pathway.

OBJECTIVE: This study aims to examine whether gestational hypertension serves as a mediator of the association between prenatal O3 exposure and term LBW.

METHODS: We conducted a population-based cohort study using the Cheeloo Lifespan Electronic Health Research Data-library, including 3,394,739 singleton term live births in Shandong Province, China, from January 1, 2016, to December 31, 2022. We used high-resolution spatiotemporal models based on residential addresses for exposure assessment. In addition to term LBW, we examined term small for gestational age (SGA) to capture fetal growth restriction while accounting for gestational age at birth. Given the low prevalence of these outcomes, we used logistic regression models where odds ratios approximated relative risks. A 4-step mediation analysis using logistic regression was conducted, followed by a counterfactual-based causal mediation analysis, to test the mediating role of gestational hypertension.

RESULTS: The mean (SD) O3 concentration was 113.90 (13.03) μg m-3. Each IQR increase in O3 was positively associated with the risks of term LBW (relative risk 1.055, 95% CI 1.034-1.077) and term SGA (relative risk 1.037, 95% CI 1.026-1.048). Using the traditional approach, gestational hypertension mediated 19.94% of the risk for term LBW and 13.41% for term SGA. Under the counterfactual framework, the contribution rates were 38.82% (term LBW) and 19.96% (term SGA) when excluding exposure-mediator interaction, and 35.15% (term LBW) and 18.82% (term SGA) when accounting for such interaction.

CONCLUSIONS: Our findings showed that gestational hypertension was a significant mediator of the association between O3 exposure and risks of term LBW. Consequently, a multitiered strategy-encompassing stricter air quality standards, integrating O3 risk education into routine prenatal care, and taking proactive measures to minimize personal exposure-is essential to prevent potential adverse impacts on developing fetuses and mothers.

PMID:41950506 | DOI:10.2196/81412

JMIR Mhealth Uhealth. 2026 Apr 8;14:e56824. doi: 10.2196/56824.

ABSTRACT

BACKGROUND: Problematic social media use has been linked to reduced well-being and impulse control difficulties. While digital self-control apps show potential for reducing general app usage, they often lack customization, leading to limited effectiveness and increased user resistance. Their impact on problematic social media use remains uncertain.

OBJECTIVE: This study evaluates the effectiveness of the Wellspent app, a customizable mobile intervention app designed to promote self-regulated social media use by targeting user-defined problematic app use and offering tailored behavioral nudges.

METHODS: In a 3-week randomized controlled trial, 70 iPhone users (mean age 26.2, SD 5.6 years; 47/70, 67% female), regularly using at least 1 social media app, were randomly assigned to an intervention (n=35) or control group (n=35). The intervention group received personalized full-screen reminders with the option to quit or continue social media app use whenever an app session exceeded a self-defined time limit. Participants completed weekly online surveys measuring problematic social media use, problematic smartphone use, self-efficacy, and daily screen time on their most problematic app. Linear mixed models tested intervention effects.

RESULTS: While no significant reduction in problematic social media use or increase in self-efficacy was observed, the intervention group showed a significant reduction in daily screen time on their most problematic app by approximately 29 minutes (estimate=-29.35, SE 6.84, 95% CI -42.79 to -15.99; P<.001), and a significant decrease in perceived problematic smartphone use (estimate=-0.46, SE 0.18, 95% CI -0.80 to -0.11; P=.01).

CONCLUSIONS: The Wellspent app demonstrated short-term efficacy in reducing problematic smartphone use. By allowing users to tailor interventions to their personal goals, the app shows promise as a self-directed tool to support healthier digital habits. Further research should explore long-term effects and feature-specific impacts.

PMID:41950504 | DOI:10.2196/56824

Hepatology. 2026 Apr 8. doi: 10.1097/HEP.0000000000001765. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: OCE-205 is a mixed agonist-antagonist selective for the vasopressin 1a (V1a) receptor with no vasopressin 2 (V2) receptor activity. Safety and efficacy of OCE-205 were evaluated in patients with hepatorenal syndrome-acute kidney injury (HRS-AKI).

METHODS: A randomized, double-blind, placebo-controlled, dose-ranging study was conducted at 23 North American centers. Patients received a continuous infusion of OCE-205 at 8, 15, 30 or 50 µg/hr or placebo. Primary endpoint was time to confirmed clinical improvement, defined as serum creatinine (sCr) <1.5 mg/dL, with at least an absolute reduction of ≥0.3 mg/dL, for 2 days. Following terlipressin’s approval, this study was stopped early due to lack of equipoise in conducting a placebo-controlled trial.

RESULTS: Baseline characteristics between OCE-205 (n=37) vs. placebo (n=10) groups were: sCr 2.6 vs 2.3 mg/dL, MELD 27.9 vs 25.8, alcohol-related cirrhosis 51.4% vs 60.0%. The primary endpoint was met in 48.6% vs. 30.0% (p=0.48 by Log-rank test and NS by Bayesian analysis). Bradycardia was the most common adverse event (21.6% vs 0%). Most events were asymptomatic, requiring no intervention. No new/unexpected safety findings, no events of ischemia, and no related events of respiratory failure occurred.

CONCLUSIONS: OCE-205 was well tolerated, with no evidence of excessive vasoconstriction or related events of ischemia or respiratory failure at any dose level. OCE-205 had a predictable, capped maximal efficacy that improved HRS-AKI in numerically more patients than placebo, though was underpowered for statistical significance. OCE-205 warrants additional investigation as a novel HRS therapy with a favorable benefit/risk profile.

PMID:41950496 | DOI:10.1097/HEP.0000000000001765

JMIR Serious Games. 2026 Apr 8;14:e72498. doi: 10.2196/72498.

ABSTRACT

BACKGROUND: Virtual reality (VR) technology has been increasingly explored in stroke rehabilitation due to its immersive and interactive features. However, considerable heterogeneity exists in intervention designs, study populations, and outcome measures, limiting the feasibility of conducting a systematic review.

OBJECTIVE: This scoping review aims to comprehensively map randomized controlled trials (RCTs) investigating the use of VR interventions in stroke rehabilitation, with particular focus on upper limb function, gait and balance, cognitive function, and quality of life.

METHODS: Following the Arksey and O’Malley framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review of RCTs published in databases from their inception to January 4, 2025. Seven databases were searched, including PubMed, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM. Studies were included if they met predefined eligibility criteria, including adult patients with stroke receiving VR-based rehabilitation and a randomized controlled trial design. Exclusion criteria included non-Chinese or non-English literature, literature with unavailable full text, studies with duplicate publication or data, and studies that were irrelevant to the research topic or did not incorporate VR technology in their intervention measures. Data extracted included intervention type, sample size, training frequency and duration, outcomes, and study setting. Due to significant heterogeneity across studies, a narrative synthesis approach was used. No formal risk of bias or quality appraisal was conducted.

RESULTS: Fifteen RCTs involving 804 patients with stroke were included. Intervention modalities varied significantly in terms of type, content, frequency, and duration. Nonimmersive VR (NIVR) interventions were more frequently applied in studies targeting upper limb function and gait training, while fully immersive VR (FIVR) was assessed in 2 head-mounted display (HMD)-based trials, whereas most studies used NIVR for upper-limb and gait-related outcomes. Many studies reported positive trends in motor function, cognitive performance, gait balance, and quality of life. However, findings were inconsistent, and not all outcomes reached statistical significance. Mild adverse events, such as fatigue or dizziness, were occasionally reported; however, no serious events occurred.

CONCLUSIONS: This scoping review outlines the research status of VR in stroke rehabilitation. VR may offer potential benefits; however, existing studies have limitations, including substantial heterogeneity in intervention protocols, limited long-term follow-up, and baseline imbalances in some trials. In addition, because this review did not include a formal quality or risk-of-bias assessment, the observed effects should be interpreted as preliminary signals rather than definitive evidence of efficacy, and the certainty of the evidence cannot be determined. Future research should standardize outcome measures, improve methodological rigor, and incorporate quality and risk-of-bias evaluation to strengthen the evidence base and support clinical implementation.

PMID:41950465 | DOI:10.2196/72498

Am J Public Health. 2026 May;116(5):594-595. doi: 10.2105/AJPH.2026.308478.

NO ABSTRACT

PMID:41950459 | DOI:10.2105/AJPH.2026.308478

Am J Public Health. 2026 May;116(5):619-624. doi: 10.2105/AJPH.2025.308390.

ABSTRACT

Evidence-based interventions for Ending the HIV Epidemic inadequately reach Latino men who have sex with men, particularly in Florida and Puerto Rico, stressing the need for implementation strategies. SOMOS Alianza (San Juan, Orlando, Miami Organizational Strategic Alliance) connects implementers, community members, and researchers pursuing Ending the HIV Epidemic goals among Latino men who have sex with men. We describe SOMOS Alianza, present its post-one-year outcomes, and explore how strategic alliances serve as implementation strategies that reduce HIV disparities. (Am J Public Health. 2026;116(5):619-624. https://doi.org/10.2105/AJPH.2025.308390).

PMID:41950451 | DOI:10.2105/AJPH.2025.308390

Am J Public Health. 2026 May;116(5):657-664. doi: 10.2105/AJPH.2025.308362.

ABSTRACT

The COVID-19 pandemic has renewed attention to farmworker health disparities, prompting scholars to examine the structural determinants of agricultural worker health. Through analysis of archival materials, government documents, and period newspapers, we trace the evolution and institutionalization of migrant farm labor on Maryland’s Eastern Shore from 1900 to 1950. We identify four key periods of transformation: the postemancipation agricultural adjustment (1900-1915), the rise of seasonal commodity agriculture (1915-1930), the response to mass displacement (1930-1940), and wartime labor management (1940-1950). At each stage, we demonstrate how agricultural industry interests deliberately cultivated conditions of racial stratification, worker precarity, and social isolation to establish and maintain the migrant labor system. Although contemporary public health frameworks often treat these conditions as independent social determinants of health, this history reveals them as essential, deliberately produced features of the migrant labor system itself. Understanding this historical context is crucial for public health practitioners working to address persistent health disparities in agricultural work, particularly as the COVID-19 pandemic has heightened attention to farmworker vulnerability. (Am J Public Health. 2026;116(5):657-664. https://doi.org/10.2105/AJPH.2025.308362).

PMID:41950448 | DOI:10.2105/AJPH.2025.308362

Am J Public Health. 2026 May;116(5):711-721. doi: 10.2105/AJPH.2025.308407.

ABSTRACT

Objectives. To determine whether optimism and anger modify the association between neighborhood disadvantage and incident cardiovascular disease (CVD) and whether these relationships vary by ethnoracial group. Methods. We drew data from 4326 participants in the Multi-Ethnic Study of Atherosclerosis (MESA: 2000-2019), a cohort of US adults aged 45 to 84 years without baseline CVD. We measured neighborhood disadvantage using the Area Deprivation Index. We assessed optimism and anger (reaction and temperament) by self-report. We used multilevel Cox proportional hazards models to estimate hazard ratios for incident CVD over 19 years of follow-up, adjusting for demographic, behavioral, and clinical factors. Results. A total of 879 incident CVD events occurred. Greater neighborhood disadvantage was associated with higher CVD risk. Tract-level optimism attenuated this association, whereas tract-level anger amplified it. Effects of optimism were stronger among Black participants, whereas anger more strongly exacerbated risk among Hispanic participants. Conclusions. Psychosocial resilience and risk factors modify the impact of neighborhood disadvantage on CVD, with important ethnoracial differences. Public Health Implications. Structural and community-partnered strategies are needed to address ethnoracial differences in how psychosocial factors modify the cardiovascular effects of neighborhood disadvantage. (Am J Public Health. 2026;116(5):711-721. https://doi.org/10.2105/AJPH.2025.308407).

PMID:41950447 | DOI:10.2105/AJPH.2025.308407

Prehosp Emerg Care. 2026 Apr 8:1-9. doi: 10.1080/10903127.2026.2655289. Online ahead of print.

ABSTRACT

OBJECTIVES: Trauma remains the leading cause of death among Canadians under 45, with over 70% of these deaths occurring in the prehospital setting. In Ontario, Canada, paramedics’ decision to initiate or withhold resuscitation in traumatic cardiac arrest (TCA) is governed by basic life support (BLS) and advanced life support (ALS) patient care standards. This study explores paramedics’ decisions to withhold cardiopulmonary resuscitation (CPR) in cases of prehospital TCA.

METHODS: We conducted a retrospective review of case files relating to coroner investigations of prehospital TCA across two emergency medical services (EMS) covering a mixed urban/suburban region in Ontario, Canada, with a population of approximately 4.3 million people, from January 2018 to July 2022. We reviewed all deaths where EMS records were available in the death investigation files and where paramedics did not provide CPR. Paramedics’ documentation of reasons to withhold CPR was reviewed and compared to post-mortem findings. Descriptive statistics were used to describe the findings.

RESULTS: We identified 90 cases of prehospital TCA where no CPR was provided by paramedics. Of these, 55 cases (61%) had documented, injuries incompatible with life (decapitation, open head or torso wounds with visible outpouring of brain or abdominal contents) or signs of irreversible death (rigor mortis, lividity, decomposition). Post-mortem examination confirmed paramedics’ findings of injuries incompatible with life in 29 cases (89%). For the remaining 35 cases (39%), CPR was withheld due to a combination of prolonged time from TCA to EMS contact, severity of injuries deemed non-survivable, significant external blood loss, and following remote physician agreement in 31 (89%) cases. Of these, 29 (83%) had post-mortem findings demonstrating anatomical injuries that made the TCA irreversible.

CONCLUSIONS: The majority of decisions to withhold CPR in prehospital TCA cases are based on signs that are clearly incompatible with life, identified by paramedics with high specificity. In the absence of such findings, paramedics consider factors like prolonged time intervals, overall injury severity, and seek guidance through remote physician supervision before deciding whether to withhold resuscitation efforts.

PMID:41950410 | DOI:10.1080/10903127.2026.2655289

JMIR Aging. 2026 Apr 8;9:e84616. doi: 10.2196/84616.

ABSTRACT

BACKGROUND: Older adults frequently experience cognitive, physical, sensory, motivational, and environmental barriers that affect medication management. Medication adherence technologies (MATs) can support adherence, but their usability varies widely depending on individual abilities and device features. Prior research has largely focused on overall adherence or user experience, providing limited insight into feature-level usability challenges.

OBJECTIVE: The aim of the study is to develop and internally validate a personalized predictive model to predict the success of MAT subtasks for older adults with diverse cognitive, physical, sensory, motivational, and environmental capabilities.

METHODS: A mixed methods approach was used, incorporating the assessment of impairments using various standardized questionnaires, measurement of usability metrics through cognitive walkthroughs, and one-on-one semistructured interviews. For this study, we used “subtasks” as the representative of features of the devices. A subtask is a discrete, individual action that forms part of a larger task, specifically designed to achieve a step in the overall process. Participants tested between 1 and 7 devices from a selection of 13 devices. The proportion of subtask success was taken as the outcome measure. Predictors included demographic, clinical, cognitive, physical, sensory, motivational, and environmental characteristics. Personalized predictive modeling using cosine similarity and generalized linear models were compared with nonpersonalized and naive models. Model performance was evaluated using mean square error (MSE) through cross-validation and held-out validation.

RESULTS: A total of 117 participants (mean age 74.6, SD 7.9 years) were recruited, including 96 participants for usability testing and 21 for the validation, all varying in cognitive, physical, sensory, motivational, and environmental abilities. Both personalized (m=0.25) and nonpersonalized models (m=1.0) outperformed naive predictions (m=1.21), demonstrating that subtask-level success can be predicted using routinely measurable demographic and functional characteristics. During cross-validation, personalized models achieved optimal performance at a matching proportion of m=0.25, with MSEs lower than those observed at higher matching levels, although differences compared with nonpersonalized models were not statistically significant (Self-Medication Assessment Tool [SMAT]: P=.50; Daily Living Tasks Dependent on Vision [DLTV]: P=.43). In the held-out validation cohort, personalized models achieved MSEs of 0.89 (SMAT-based) and 1.16 (DLTV-based) at m=0.20, whereas nonpersonalized models demonstrated better performance with MSEs of 0.726 (SMAT-based) and 0.815 (DLTV-based). Models incorporating performance-based vision measures (SMAT-based) consistently outperformed those using self-reported vision scores (DLTV-based) across both personalized and nonpersonalized settings.

CONCLUSIONS: This study demonstrates the feasibility of predicting subtask success of MATs in older adults. While personalization showed limited added benefit in this dataset, the subtask-focused model provides clinically meaningful insights to support evidence-informed selection of medication technologies, reduce usability-related medication errors, and improve adherence outcomes.

PMID:41950360 | DOI:10.2196/84616