Tag: nevin manimala

BMC Public Health. 2025 May 30;25(1):1997. doi: 10.1186/s12889-025-22997-6.

ABSTRACT

BACKGROUND: Contaminated sites are among the main worldwide environmental health priorities. The health impact on population living in Italian contaminated sites of national concern for remediation (CSs) with petrochemical/refineries (P&R) and steel plants (S) was estimated. Since these CSs include the major Italian facilities located widespread on the territory are representative of the national reality. Furthermore, the population exposed in P&R and S is significant since it represents about 3% of the national population.

METHODS: Two groups of CSs were defined: twelve CSs with P&R and eight with S. Cause-specific mortality (2013-2017) and hospitalization (2014-2018) in both groups were analysed. Pooled Standardized Mortality/Hospitalization Ratios (SMR_pooled/SHR_pooled) were estimated through random-effect meta-regression of individual site SMR/SHR (reference: CS regional rate). The main groups of diseases and those for which the evidence of an association with the residential exposure to P&R and S was defined limited were analysed in adult while only the main groups of diseases were analysed in paediatric-adolescent and juvenile ages subgroups (0-1, 0-19, 20-29 years). All the analyses were performed separately for the two groups of CSs, and by sex.

RESULTS: In the two CSs groups, the overall and the main causes mortality and hospitalization, including all cancers, exceeded in both sexes. Specifically, for lung cancer in the P&R group, among males SMR_pooled=1.11 (CI90% 1.00-1.23) and SHR_pooled=1.18 (0.99-1.40) and among females SMR_pooled=1.13 (1.03-1.25) and SHR_pooled=1.20 (1.05-1.38), while in the S group, SMR_pooled=1.17 (1.02-1.34) and SHR_pooled=1.27 (0.87-1.86) among males and SMR_pooled=1.21 (0.93-1.59) and SHR_pooled=1.19 (0.91-1.57) among females. The mortality and hospitalization exceeded also for breast cancer in the P&R group. Hospitalization for leukaemia and respiratory diseases increased in the S group. In both CSs groups, among 20-29 years old sub-population, mortality for all tumours and hospitalization for respiratory diseases was worthy of note and hospitalization for all tumours exceeded among 0-1-year age-subgroup.

CONCLUSIONS: The results suggest that living in petrochemical/refineries and steel plants CSs is associated with increased risk for specific diseases. The meta-analytical estimates could contribute to assess the order of magnitude of health impacts of contaminated sites and to perform integrated evaluation of health and environmental impact.

PMID:40448093 | DOI:10.1186/s12889-025-22997-6

BMC Public Health. 2025 May 30;25(1):2003. doi: 10.1186/s12889-025-23218-w.

ABSTRACT

BACKGROUND: Perinatal mortality, which includes stillbirths and early neonatal deaths, is a critical indicator of maternal and newborn health, especially in developing countries. It highlights the effectiveness of healthcare systems and socioeconomic inequalities. Despite global efforts, such as the Sustainable Development Goals (SDGs), to reduce perinatal mortality, developing countries continue to experience high rates due to factors like inadequate access to quality healthcare, maternal health issues, and socioeconomic disparities. Since, there is limited evidence in the region, this study investigates perinatal mortality in East Africa, using data from Demographic and Health Surveys (DHS) to identify key determinants and inform policy interventions aimed at improving health outcomes.

METHODS: This study utilized data from the DHS conducted in East Africa. A weighted sample of 101,728 children was included in the analysis using R-4.4.0 software. Descriptive data, including frequencies and texts, were performed. A multilevel modeling analysis was employed to analyze perinatal mortality, considering both individual-level factors and contextual factors. The multilevel model accounts for clustering within countries and allows for the examination of both fixed and random effects that influence perinatal mortality. For the multivariable analysis, variables with a p-value ≤ 0.2 in the univariate analysis were considered. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a p-value < 0.05 was reported to indicate statistical significance and degree of association in the final model.

RESULTS: The overall pooled effect size of perinatal mortality is 3.67 (2.92, 4.59), with Tanzania having the highest rate and Comoros having the lowest rate. Women aged 25-34 years (AOR = 0.86, 95% CI: 0.81, 0.95), 35-49 years (AOR = 0.89, 95% CI: 0.79, 0.97), and 35-49 years (AOR = 0.89, 95% CI: 0.79, 0.97) compared to women aged 15-24 years, gave birth the first before the age of 20 (AOR = 1.09, 95% CI: 1.03, 1.28), have secondary or higher education (AOR = 0.76, 95% CI: 0.69, 0.81), not being married (AOR = 1.11, 95% CI: 1.05, 1.21), poorer (AOR = 0.94, 95% CI: 0.89, 0.98), and richest women (AOR = 0.95, 95% CI: 0.91, 0.97) compared to the poorest women, mass media exposure (AOR = 1.09, 95% CI: 1.03, 1.15), women with 3-5 children (AOR = 1.16, 95% CI: 1.08, 1.21), and with more than 5 children had even greater odds (AOR = 1.36, 95% CI: 1.29, 1.44), twin births (AOR = 3.62, 95% CI: 3.41, 3.79), modern contraceptive (AOR = 0.82, 95% CI: 0.81, 0.91), had history of abortion (AOR = 8.53, 95% CI: 8.29, 8.79), birth interval of 24-36 (AOR = 0.68, 95% CI: 0.65, 0.73), and 37-59 months (AOR = 0.61, 95% CI: 0.55, 0.67) compared to intervals of < 24 months respectively, having health insurance (AOR = 0.87, 95% CI: 0.82, 0.92), rural residence (AOR = 1.05, 95% CI: 1.02, 1.18), residing in low-income (AOR = 1.33, 95% CI: 1.28, 1.49), and higher literacy rates (AOR = 0.81, 95% CI: 0.79, 0.89) were statistically associated with perinatal mortality respectively.

CONCLUSIONS: The study reveals several significant factors associated with perinatal mortality in East Africa. Factors such as women who gave birth before the age of 20, not married, mass media exposure, having more children, twin births, history of abortion, residing in rural areas, and in low-income countries were linked to higher odds of perinatal mortality, however, being older age, better education, better wealth, modern contraception, longer birth intervals, have health insurance, and high literacy rate countries were linked to lower odds of perinatal mortality. To reduce perinatal mortality in East Africa, targeted interventions should focus on improving educational attainment for women, enhancing access to health insurance, and promoting the use of modern contraceptive methods. Additionally, policies aimed at supporting unmarried mothers, managing multiple births, and addressing rural healthcare disparities are essential.

PMID:40448089 | DOI:10.1186/s12889-025-23218-w

BMC Psychiatry. 2025 May 30;25(1):556. doi: 10.1186/s12888-025-06987-x.

ABSTRACT

BACKGROUND: Given the changes in global environmental conditions and dietary patterns, understanding the potential impact of dietary factors on the risk of depression is crucial. The Planetary Health Diet Index (PHDI) is a dietary scoring system that integrates human health and environmental sustainability. This study aims to evaluate the association between the PHDI, the risk of depression, and mortality.

METHODS: Data from the National Health and Nutrition Examination Survey 2005-2018. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9), with a score ≥ 10 indicating depression. PHDI calculated from 14 self-reported dietary groups, ranges from 0 to 140. Multivariable weight logistic and linear regression explored the association of PHDI with depression and total PHQ-9 score. Cox proportional hazards regression examined PHDI associations with mortality. Additional analyses included restricted cubic spline (RCS), threshold analyses, subgroup analyses, and multiple imputation.

RESULTS: Adjusting for confounding variables, each 10-point increase in PHDI was associated with an 11% lower risk of depression (OR = 0.89, 95% CI = 0.84, 0.94), 0.13 score of total PHQ (β=-0.13, 95% CI=-0.18, -0.08), and 17% of all-cause mortality (HR = 0.83, 95% CI = 0.73, 0.95). RCS indicated an inverse L-shaped association between PHDI and depression, and threshold effects analyses showed that the above associations were more significant in those with PHDI ≥ 76.01.

CONCLUSIONS: Adherence to the PHDI dietary pattern is associated with a reduced risk of both depression and all-cause mortality. PHDI may provide dietary guidance for the early prevention and intervention of depression.

PMID:40448075 | DOI:10.1186/s12888-025-06987-x

Reprod Health. 2025 May 31;22(Suppl 1):79. doi: 10.1186/s12978-025-01985-4.

ABSTRACT

BACKGROUND: Malaria, acute respiratory infections (ARIs), and diarrhoea are primary causes of morbidity and mortality among children under five years old in Ghana. Despite the implementation of various interventions, the nation struggles to meet relevant health and policy targets. While the potential of mobile health interventions to enhance child health outcomes has been recognized, their impact on prevalent childhood illnesses remains insufficiently explored. This implementation research study aimed to evaluate the effect of a mobile health information system (mHIS) intervention on common childhood illnesses among under-five children residing in rural health districts of Ghana.

METHODS: In this quasi-experimental study, we enrolled all children under five years old from randomly selected clusters within the rural intervention and control health districts in the Ashanti region, Ghana between November 2018 and December 2021. The Reach, Effectiveness, Adoption Implementation and Maintenance (RE-AIM) framework was used to design and implement the intervention. The intervention involved a mobile phone-based information system to monitor childhood conditions, offer telemedicine consultations, and deliver child health promotion messages on nutrition and management of common childhood illnesses to caregivers. By employing the average treatment effect (ATET) and difference-in-difference (DiD) analyses, we assessed outcome disparities in diarrhoea, cough, and presumptive malaria.

RESULTS: The incidence of diarrhoea and malaria decreased in the intervention group. The ATET analysis indicated pre-intervention disparities in presumptive malaria with a post-intervention difference between the groups for diarrhoea and presumptive malaria. Results related to cough, used as a proxy for ARIs, did not provide conclusive results across the intervention and control sites based on this intervention. However, the DiD model highlighted an overall statistically significant reduction in diarrhoea and presumptive malaria.

CONCLUSION: This study underscores the effectiveness of a mobile phone-based health information system intervention in curbing common childhood morbidities, particularly diarrhoea and presumptive malaria, among under-five children in rural Ghana. This approach demonstrates promise in advancing child health outcomes and contributing to the reduction of prevalent illnesses in resource-constrained settings.

PMID:40448074 | DOI:10.1186/s12978-025-01985-4

JMIR Med Educ. 2025 May 30;11:e69521. doi: 10.2196/69521.

ABSTRACT

BACKGROUND: Programmatic assessment supports flexible learning and individual progression but challenges educators to develop frequent assessments reflecting different competencies. The continuous creation of large volumes of assessment items, in a consistent format and comparatively restricted time, is laborious. The application of technological innovations, including artificial intelligence (AI), has been tried to address this challenge. A major concern raised is the validity of the information produced by AI tools, and if not properly verified, it can produce inaccurate and therefore inappropriate assessments.

OBJECTIVE: This study was designed to examine the content validity and consistency of different AI chatbots in creating single best answer (SBA) questions, a refined format of multiple choice questions better suited to assess higher levels of knowledge, for undergraduate medical students.

METHODS: This study followed 3 steps. First, 3 researchers used a unified prompt script to generate 10 SBA questions across 4 chatbot platforms. Second, assessors evaluated the chatbot outputs for consistency by identifying similarities and differences between users and across chatbots. With 3 assessors and 10 learning objectives, the maximum possible score for any individual chatbot was 30. Third, 7 assessors internally moderated the questions using a rating scale developed by the research team to evaluate scientific accuracy and educational quality.

RESULTS: In response to the prompts, all chatbots generated 10 questions each, except Bing, which failed to respond to 1 prompt. ChatGPT-4 exhibited the highest variation in question generation but did not fully satisfy the “cover test.” Gemini performed well across most evaluation criteria, except for item balance, and relied heavily on the vignette for answers but showed a preference for one answer option. Bing scored low in most evaluation areas but generated appropriately structured lead-in questions. SBA questions from GPT-3.5, Gemini, and ChatGPT-4 had similar Item Content Validity Index and Scale Level Content Validity Index values, while the Krippendorff alpha coefficient was low (0.016). Bing performed poorly in content clarity, overall validity, and item construction accuracy. A 2-way ANOVA without replication revealed statistically significant differences among chatbots and domains (P<.05). However, the Tukey-Kramer HSD (honestly significant difference) post hoc test showed no significant pairwise differences between individual chatbots, as all comparisons had P values >.05 and overlapping CIs.

CONCLUSIONS: AI chatbots can aid the production of questions aligned with learning objectives, and individual chatbots have their own strengths and weaknesses. Nevertheless, all require expert evaluation to ensure their suitability for use. Using AI to generate SBA prompts us to reconsider Bloom’s taxonomy of the cognitive domain, which traditionally positions creation as the highest level of cognition.

PMID:40446330 | DOI:10.2196/69521

JMIR Form Res. 2025 May 30;9:e58163. doi: 10.2196/58163.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) is one of the most prevalent sexually transmitted infections in the United States; however, vaccination uptake falls far below the goal of 80% of the population set forth by Healthy People 2030. Specifically, within the LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) population, HPV vaccination adherence remains a complex issue. Due to the widespread use of technology within the young adult population, digital health tools such as digital storytelling (DST) have been promoted as an effective way to increase vaccination uptake.

OBJECTIVE: The purpose of this study was to conduct a formative inquiry into (1) what components should be considered for inclusion in an HPV documentary tailored for sexual and gender minority populations and (2) what dissemination channels would be more effective and impact the uptake and completion of the HPV vaccine among sexual and gender minority populations. Additionally, this study aims to provide insight into perceived HPV risk and its implications on the HPV vaccine uptake within the LGBTQ+ population.

METHODS: A mixed methods study was conducted between January 2021 and September 2021 in Atlanta, Georgia. Intake surveys were distributed to individuals identifying as members of the LGBTQ+ community to examine demographic characteristics, barriers to vaccine adherence, and current HPV vaccination status. Perceived HPV risk was assessed using 5 statements on a 1 to 7 Likert scale. Key informant interviews were conducted via Zoom with participants who completed the intake surveys and consented to be interviewed. Transcripts were coded and analyzed using the constant comparison method for emergent themes surrounding components of effective DST campaigns.

RESULTS: Forty-seven individuals completed the intake survey and interview. A total of 13 out of 47 (27.7%) of participants indicated that they were not sure when provided with the statement “I am likely to get HPV”, whereas 12 out of 47 (29.8%) participants strongly disagreed with the statement “I am at high risk for getting HPV” and 13 out of 47 (27.7%) participants indicated that they were not sure when presented with the statement “HPV would be a serious threat to the quality of my life.” A total of 14 out of 47 (29.8%) participants responded that they were not sure to the statement “HPV would be a severe threat to my health” and 13 out of 47 (27.7%) participants strongly agreed that “HPV would be a severe threat to my sex life.” Qualitative analysis indicated a high level of stigma experienced in interactions between the LGBTQ+ population and private practitioners. Major barriers to vaccination hesitancy were concerns about age, perceived reduced risk, and lack of provider recommendation. Participant interviews revealed that “Real Outcomes,” and “Accurate Representation” were the main components that should be considered for inclusion in an HPV documentary tailored for sexual and gender minority populations.

CONCLUSIONS: Creation of a DST intervention within the LGBTQ+ population should include information surrounding the real outcomes of HPV and accurate representation.

PMID:40446324 | DOI:10.2196/58163

JMIR Hum Factors. 2025 May 30;12:e67884. doi: 10.2196/67884.

ABSTRACT

BACKGROUND: The transfer of patients between hospitals, that is, interhospital transfer (IHT), introduces discontinuity of care, including gaps in health information transfer, which may worsen patient outcomes.

OBJECTIVE: This is the first phase of a 5-year research study. Our goals are (1) to understand the gaps in health information exchange (HIE) and the clinician experience in accessing and using the electronic health record (EHR) during IHT and (2) to identify clinician user requirements for the development of an internal EHR solution for IHT.

METHODS: We used prior work on HIE during IHT, coupled with a user-centered design (UCD) process to engage in discussions with clinical users and gather input on EHR workflow during IHT patient admission and planning. A total of 8 UCD sessions were held between February and July 2023, involving 18 clinicians who interact with the EHR during IHT, including 3 medicine residents, 10 advanced practice providers (APPs), and 5 direct care attendings-all responsible for caring for IHT patients at Brigham and Women’s Hospital Cardiology, Medicine, Oncology, and intensive care unit services. Discussions highlighted facilitators and barriers and suggested improvements for data access and availability at the time of transfer. UCD sessions were recorded, analyzed, and coded by 2 independent reviewers to identify common themes driving suboptimal HIE. User requirements were derived from the sessions with users and iteratively refined throughout the process.

RESULTS: Qualitative analysis revealed that a significant number of frontline clinicians experience suboptimal availability of clinical information in the EHR at the time of IHT, including gaps in communication, incomplete data, and inefficient access to clinical data. User requirements emerged from these themes and primarily focused on information prioritization, data accessibility, and workflow and efficiency.

CONCLUSIONS: Notable levels of missing information and inefficient access to clinical data were reported by end users caring for IHT patients at the time of transfer. Conducting user research to understand the current process of IHT, involving users in conceptual design and information architecture, and generating prototypes for feedback from users can aid in designing a solution that meets user needs. The results of these early UCD activities will be used to develop and implement a data platform to support clinicians during IHT.

PMID:40446323 | DOI:10.2196/67884

JMIR Form Res. 2025 May 30;9:e65559. doi: 10.2196/65559.

ABSTRACT

BACKGROUND: In the field of mental health care, the incorporation of wearable devices into routine clinical practice continues to face significant challenges, despite the presence of supporting scientific evidence. Crossing the wasteland between the trial world and the real world is full of obstacles that often only become apparent during the implementation process.

OBJECTIVE: The objective of this paper was to evaluate the feasibility of using wearables in real-world clinical settings for children with severe developmental problems to help understand and manage disruptive behavior and to gain insights for the development of forthcoming implementation strategies.

METHODS: A mixed methods design was used to examine two different aspects of the use of wearables in a clinical setting. The first quantitative part of this study focuses on the feasibility of using wearables to collect reliable data on psychophysiological measures during daily activities in children at a children’s psychiatric center. The second qualitative part focuses on the evaluation of the implementation process using the Consolidated Framework for Implementation Research (CFIR) to identify essential steps to successfully incorporate wearable technology in clinical care for children with severe behavioral problems. Empatica E4 wristbands collected data on children’s psychophysiological arousal (eg, heart rate [HR] and skin conductance level [SCL]). Staff reported aggressive behavior and daily activities. Data were processed and visualized in a dashboard. User experiences were assessed through interviews with clinical staff. The implementation process was evaluated using the CFIR.

RESULTS: A total of 30 children (27 boys and 3 girls, aged 6 to 14 y; mean age 9.3 y, SD 1.95) wore the wearable for 5 consecutive days. As expected, the children found it easy to wear the device and the clinical staff predominantly expressed positive attitudes toward its use. The data collection proceeded relatively smoothly, and the collected data were of sufficient quality. In total, 315 observations of aggressive behavior were reported, including 54 red incidents (from 18 unique participants) and 261 orange incidents (from 26 unique participants). An exploratory analysis on the association between psychophysiological measures and aggressive behavior revealed that children’s HR was significantly higher during aggressive incidents compared to nonaggressive incidents (P=.007). Although not statistically significant, there was a trend suggesting higher peaks per minute during aggressive incidents (P=.07). No significant differences between aggressive and nonaggressive incidents were found for SCL and movement (P=.33 and P=.60). The most challenging CFIR domains in our study were the “characteristics of the intervention” and “the inner setting,” reflected in the fact that that the majority of implementation activities were focused on these two domains.

CONCLUSIONS: The use of wearables in a real-world study setting is considered feasible and valuable. However, for broader scaling in daily clinical practice, coherent actions on different domains of implementation are required.

PMID:40446322 | DOI:10.2196/65559

JMIR Med Inform. 2025 May 30;13:e58125. doi: 10.2196/58125.

ABSTRACT

BACKGROUND: Digital health is a critical driver of quality, safety, and efficiency in health care. However, poor quality of clinical information in digital health technologies (DHTs) can compromise the quality and safety of care. The Clinical Information Quality (CLIQ) framework was developed, based on a systemic review of literature and an international eDelphi study, as a tool to assess the quality of clinical information in DHTs.

OBJECTIVES: The aim of this study is to assess the applicability, internal consistency, and construct validity of the CLIQ framework.

METHODS: This study was conducted as a cross-sectional survey of health care professionals across the United Kingdom who regularly use SystmOne electronic health records. Participants were invited through emails and social media platforms. The CLIQ questionnaire was administered as a web-based survey. Spearman correlation coefficients were computed to investigate the linear relationship between the dimensions in the CLIQ framework. The Cronbach α coefficients were computed to assess the internal consistency of the global scale (ie, CLIQ framework) and the subscales (ie, the informativeness, availability, and usability categories). Confirmatory factor analysis was used to assess the extent to which the survey data supported the construct validity of the CLIQ framework.

RESULTS: A total of 109 health care professionals completed the survey, of which two-thirds (67, 61.5%) were doctors and a quarter (26, 23.9%) were nurses or advanced nurse practitioners. Overall, the CLIQ dimensions had good quality scores except for portability, which had a modest score. The inter-item correlations were all positive and not likely due to chance. The Cronbach α coefficient for the overall CLIQ framework was 0.89 (95% CI 0.85-0.92). The confirmatory factor analysis provided a modest support for the construct validity of the CLIQ framework with the comparative fit index of 0.86 and standardized root mean square residual of 0.08.

CONCLUSIONS: The CLIQ framework demonstrated a high reliability and a modest construct validity. The CLIQ framework offers a pragmatic approach to assessing the quality of clinical information in DHTs and could be applied as part of information quality assurance systems in health care settings to improve quality of health information.

PMID:40446314 | DOI:10.2196/58125

JMIR Hum Factors. 2025 May 30;12:e59558. doi: 10.2196/59558.

ABSTRACT

BACKGROUND: Abnormal brain activity is the source of epileptic seizures, which can present a variety of symptoms and influence patients’ quality of life. Therefore, it is critical to track epileptic seizures, diagnose them, and provide potential therapies to manage people with epilepsy. Electroencephalography (EEG) is helpful in the diagnosis and classification of the seizure type, epilepsy, or epilepsy syndrome. Ictal EEG is rarely recorded, whereas interictal EEG is more often recorded, and the results can be abnormal or normal even in the case of epilepsy. The current digital care pathway for epilepsy (DCPE) lacks the integration of data-driven seizure detection, which could potentially enhance epilepsy treatment and management.

OBJECTIVE: This study aimed to determine the requirements for integrating data-driven medical software into the DCPE to meet the project’s goals and demonstrate practical feasibility regarding resource availability, time constraints, and technological capabilities. This adjustment emphasized ensuring that the proposed system is realistic and achievable. Perspectives on the feasibility of data-driven medical software that meets the project’s goals and demonstrates practical feasibility regarding resource availability, time constraints, and technological capabilities are presented.

METHODS: A 4-round Delphi study using focus group discussions was conducted with 7 diverse panels of experts from Oulu University Hospital to address the research questions and evaluate the feasibility of data-driven medical software for monitoring individuals with epilepsy. This collaborative approach fostered a thorough understanding of the topic and considered the perspectives of various stakeholders. In addition, a qualitative study was carried out using semistructured interviews.

RESULTS: Drawing from the findings of the thematic analytics, a detailed set of guidelines was created to facilitate the seamless integration of the proposed data-driven medical software for EEG seizure monitoring into the DCPE. These guidelines encompass system requirements, data collection and analysis, and user training, offering a comprehensive road map for the effective implementation of the software.

CONCLUSIONS: The study outcome presents a comprehensive strategy for improving the quality of care, providing personalized solutions, managing health care resources, and using artificial intelligence and sensor technology in clinical settings. The potential of artificial intelligence and sensor technology to revolutionize health care is exciting. The study identified practical strategies, such as real-time EEG seizure monitoring, predictive modeling for seizure occurrence, and data-driven analytics integration to enhance decision-making. These strategies were aimed at reducing diagnostic delays and providing personalized care. We are actively working on integrating these features into clinical workflows. However, further case studies and pilot implementations are planned for future studies. The results of this study will guide system developers in the meticulous design and development of systems that meet user needs in the DCPE.

PMID:40446306 | DOI:10.2196/59558