Tag: pubmed

JMIR Hum Factors. 2025 Nov 13;12:e64471. doi: 10.2196/64471.

ABSTRACT

BACKGROUND: Mobile health (mHealth), defined as health care facilitated by mobile devices, offers a promising strategy for enhancing disease management and treatment for patients with chronic conditions. However, there is limited information about how patients with inflammatory bowel disease (IBD) use mHealth and their digital preferences.

OBJECTIVE: The aim of the study was to investigate the use of mHealth as well as the preferences, obstacles, and eHealth literacy reported by patients with IBD in Germany.

METHODS: In April and May 2023, we sequentially enrolled patients diagnosed with IBD, including Crohn disease and ulcerative colitis, to participate in a paper-based survey. The survey included questions on sociodemographic details, health characteristics, mHealth use, internet use, eHealth literacy (measured with the eHealth Literacy Scale), and preferences regarding communication and information.

RESULTS: Of the 200 surveyed participants, almost all (197/200, 98.5%) reported regular smartphone use, and more than two-thirds (139/200, 69.5%) indicated regular engagement with social media. Most of the respondents (168/200, 84%) expressed the belief that incorporating medical apps into their routine could positively impact their health. However, only 25 (12.5%) of the 200 patients acknowledged using medical apps, of which just 2 apps were IBD specific, used by only a few (n=3, 12%). Furthermore, awareness of useful websites or mobile apps tailored for IBD was limited (45/200, 22.5%). Nearly all participants (196/200, 98%) expressed willingness to share app data for research purposes, and most (171/200, 85.5%) consented to transmit app data to their treating physicians. A large majority (175/200, 87.5%) indicated readiness to regularly input data into an app, with a preferred duration of up to 5 minutes (109/200, 54.5%) and weekly input frequency (76/200, 38%). For an IBD-specific app, the most frequently requested functions were electronic prescriptions (110/200, 55%) and a newsletter about new scientific work and clinical studies (94/200, 47%). Usability and security were identified as key app attributes. The internet was the predominant source of health-related information (180/200, 90%). The average eHealth literacy score, measured with the eHealth Literacy Scale, was high (mean 28.9, SD 5.4; range 8-40), with a positive correlation observed between higher eHealth literacy and factors such as younger age and more frequent internet use for health information.

CONCLUSIONS: Patients with IBD are well prepared and motivated to use mHealth technologies to better understand their chronic condition and optimize treatment. However, their enthusiasm is tempered by the currently low adoption of mHealth. To fully harness the potential of mHealth in IBD treatment, effective and tailored mHealth solutions, guidance for their implementation, and patient education are needed.

PMID:41232095 | DOI:10.2196/64471

JCO Clin Cancer Inform. 2025 Nov;9:e2500186. doi: 10.1200/CCI-25-00186. Epub 2025 Nov 13.

ABSTRACT

PURPOSE: Acute care use (ACU) is more costly and prolonged for oncology patients and often leads to treatment disruptions and worsened outcomes. Reducing ACU requires understanding risk factors and proactively identifying at-risk patients. This study addresses research gaps by developing predictive models to assess all-cause acute care use (A-ACU) versus preventable acute care use (P-ACU) and rural-specific barriers.

PATIENTS AND METHODS: We conducted a retrospective cohort study of adult oncology patients who received intravenous cancer treatment between October 2021 and April 2024 within a rural midwestern regional cancer network. We used predictor and outcome data from electronic medical records and insurance claims. We defined P-ACU using the Centers for Medicare & Medicaid Services’ OP-35 criteria and classified A-ACU as any emergency department visit or hospitalization, regardless of reason. We trained LASSO and Random Forest models on 80% of the cohort to predict 30-, 90-, and 180-day risk of P-ACU and A-ACU after regimen initiation.

RESULTS: Among 2,922 patients, 45.3% experienced A-ACU and 10.3% had P-ACU within 180 days of chemotherapy regimen initiation. Key predictors included number of previous inpatient stays and comorbidities. Insurance type and age were more influential in predicting P-ACU, whereas laboratory values (albumin, sodium, and neutrophil-to-lymphocyte ratio) were more important in A-ACU models. Nearly all LASSO and Random Forest models showed strong performance (mean area under the receiver operating characteristic curve = 0.73, mean F1 score = 0.79).

CONCLUSION: Our models effectively identify patients at high risk for ACU using routinely collected data and validate known risk factors in a large rural oncology population. Future work should integrate these tools into practice and address rural-specific challenges to reduce ACU during chemotherapy.

PMID:41232065 | DOI:10.1200/CCI-25-00186

Neurology. 2025 Dec 9;105(11):e214385. doi: 10.1212/WNL.0000000000214385. Epub 2025 Nov 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Temporal lobe epilepsy (TLE) is a highly prevalent neurologic disorder, with 30%-50% of patients developing drug-resistant epilepsy. Pharmacoresistant seizures remodel critical arousal and respiratory networks, impairing autonomic function and chemoreception and putting patients at increased risk of adverse respiratory events and sudden unexpected death (SUDEP). Given that the bed nucleus of stria terminalis (BNST) serves as a key relay between brainstem respiratory nuclei and cortical arousal networks, we characterized interictal BNST connectivity alterations in patients with TLE.

METHODS: We conducted a case-control study of patients with drug-resistant TLE evaluated for epilepsy surgery at Vanderbilt University Medical Center, compared with healthy controls with no history of neurologic disease. Inclusion criteria for patients included clinical TLE diagnosis and age 18-65 years. Using resting-state fMRI (multiband factor = 3, repetition time [TR] = 1.3 seconds), we measured functional connectivity (FC) and effective connectivity through Granger causality (GC) between BNST and whole-brain cortical networks, and brainstem nuclei. Graph theoretical network metrics assessed BNST hub properties. Statistical analyses used multiple comparison corrections and age-corrected z-scores.

RESULTS: Thirty-seven patients with TLE (mean age 42.5 ± 12.1 years, 43.2% female) and 33 healthy controls (mean age 36.2 ± 12.0 years, 54.5% female) were studied. Patients demonstrated bilateral reductions in BNST connectivity and causal influence with the whole brain (FC: -2.31 ± 2.87, p = 0.0032; GC: -0.18 ± 0.08, p = 0.0025). While FC showed preserved BNST-brainstem connectivity, GC revealed ipsilateral disruptions in BNST influence over ventral tegmental area (0.023 ± 0.026, p = 0.0067), median raphe (-0.009 ± 0.029, p = 0.0038), and cuneiform nuclei (0.012 ± 0.062, p = 0.0153). Critical respiratory circuits showed divergent reorganization: dorsal raphe-parabrachial complex pathways exhibited 57.2% efferent reduction (p = 0.0028), with 204.6% compensatory afferent increase (p = 0.0020), while dorsal raphe-locus coeruleus circuits showed bilateral deterioration (66.2% reduction in dorsal raphe-locus coeruleus [DR→LC], p = 0.0015; 56.4% reduction in LC→DR, p = 0.0189). Graph analyses confirmed compromised BNST network integration bilaterally (p < 0.05).

DISCUSSION: Our findings reveal network reorganization in TLE that compromises autonomic and arousal circuit integrity, leading to failed respiratory-autonomic integration that may underlie respiratory vulnerability and increased SUDEP risk; however, we did not directly study SUDEP cases.

PMID:41232063 | DOI:10.1212/WNL.0000000000214385

Neurology. 2025 Dec 9;105(11):e214316. doi: 10.1212/WNL.0000000000214316. Epub 2025 Nov 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by 3 core symptom complexes: parkinsonism, cerebellar syndrome, and dysautonomia. Recent Movement Disorder Society (MDS) criteria allow for the clinical diagnosis of MSA based solely on motor symptoms, without requiring dysautonomia. This study aimed to evaluate the frequency and disease trajectory of MSA patients without dysautonomia compared with those with autonomic involvement.

METHODS: A multicenter cohort of autopsy-confirmed patients with MSA was analyzed for demographic characteristics, symptom onset, and progression of parkinsonism, cerebellar syndrome, and dysautonomia. Clinical data were collected through standardized chart reviews across participating centers and categorized using the MDS-MSA criteria. Patients were grouped according to their initial symptom complex and tracked for the evolution of additional symptoms. Analyses included time to development of further symptom complexes, age at symptom onset, disease duration, and phenotype at the last recorded visit. Patients with motor symptoms only were matched to patients with similar demographics but with dysautonomia. Statistical methods included ANOVA, t tests, Welch t tests, and χ² tests, with significance set at p < 0.05.

RESULTS: Among 140 patients (mean age at onset 62.3 ± 8.9 years; 44% female), 81 (58%) initially presented without dysautonomia (57 with parkinsonism only, 17 with cerebellar syndrome only, 7 with both). At final follow-up, 12 patients (9%) had not developed dysautonomia. These patients showed significantly longer disease duration (mean 8.1 ± 2.1 years) than matched patients with dysautonomia (mean 6.3 ± 2.6 years; p = 0.035). Overall, 51% of patients developed all 3 symptom complexes. Patients with cerebellar onset progressed more rapidly to multisystem involvement than those with parkinsonian onset (mean interval to second symptom: 2.0 vs 3.4 years; p < 0.05).

DISCUSSION: The MDS-MSA criteria expand the diagnostic scope by identifying a motor-only subgroup with a distinct and potentially slower disease course. These findings underscore the importance of including motor-only patients in natural history and interventional studies. Limitations include retrospective data collection and potential variability in symptom documentation.

PMID:41232058 | DOI:10.1212/WNL.0000000000214316

Am J Public Health. 2025 Nov 13:e1-e4. doi: 10.2105/AJPH.2025.308289. Online ahead of print.

ABSTRACT

Objectives. To compare changes in the number of facility-based abortions among Texas residents in different age groups following the state’s 2021 law prohibiting abortion after detection of embryonic cardiac activity. Methods. We obtained data from Texas and 6 surrounding states on Texas residents’ age at abortion from state vital statistics and data provided directly by out-of-state abortion facilities. Using negative binomial regression, we estimated the percentage change in abortions before (September 2020-May 2021) and after (September 2021-May 2022) the law went into effect. Results. After the law’s implementation, total (in-state and out-of-state) facility-based abortions decreased by 26.1% (95% confidence interval [CI] = -32.7%, -18.8%) among Texans younger than 18 years, by 19.6% (95% CI = -21.4%, -17.7%) among young adult Texans aged 18 to 24 years, and by 17.0% (95% CI = -19.1%, -14.8%) among Texans aged 25 to 29 years. Conclusions. Texas’s law disproportionately affected access to facility-based abortion care among Texans aged 24 years and younger. Public Health Implications. State laws prohibiting abortions in early pregnancy disproportionately affect young people’s reproductive autonomy, likely by compounding long-standing financial and logistical barriers to facility-based care. (Am J Public Health. Published online ahead of print November 13, 2025:e1-e4. https://doi.org/10.2105/AJPH.2025.308289).

PMID:41232053 | DOI:10.2105/AJPH.2025.308289

Am J Public Health. 2025 Nov 13:e1-e8. doi: 10.2105/AJPH.2025.308284. Online ahead of print.

ABSTRACT

Objectives. To examine how gerrymandering affects federally qualified health center (FQHC) availability in North Carolina. Methods. We used data from 2004 to 2022 and spatial regression models to correlate gerrymandering metrics with FQHC availability and utilization at the zip code level. Results. Gerrymandering severity is inversely associated with FQHC availability and utilization. For example, individuals in communities split evenly between 2 state senate districts in this 18-year period (from the end of 2004 through 2022) traveled about 30% farther to their nearest FQHC in 2022 than individuals in communities entirely within a district, and they were up to 20% less likely to visit an FQHC. Increased electoral competitiveness also reduced FQHC availability and utilization. Residential segregation was not linked to FQHC availability or gerrymandering severity. Conclusions. Gerrymandering weakens local political representation and may lead to reduced access to vital health care services-a structural issue with far-reaching implications for health equity and national policy reform. (Am J Public Health. Published online ahead of print November 13, 2025:e1-e8. https://doi.org/10.2105/AJPH.2025.308284).

PMID:41232048 | DOI:10.2105/AJPH.2025.308284

JCO Oncol Pract. 2025 Nov 13:OP2500306. doi: 10.1200/OP-25-00306. Online ahead of print.

ABSTRACT

PURPOSE: The multicenter Symptom Management Implementation of Patient Reported Outcomes in Oncology Consortium developed electronic Symptom Management (eSyM), an electronic health record-based symptom management program, to reduce acute care utilization. We hypothesized that implementing eSyM would also improve self-reported symptom burden and self-efficacy.

METHODS: eSyM was deployed via a pragmatic stepped-wedge cluster randomized trial for adults who started chemotherapy or had surgery for confirmed or suspected GI, gynecologic, or thoracic malignancies across six cancer centers from 2019 to 2023. In parallel, we administered a survey to two distinct cohorts: patients treated before and after eSyM deployment (ie, pre-live and post-live). A REDCap-based survey collected demographic and clinical characteristics and assessed six Patient-Reported Outcomes Measurement Information System measures: self-efficacy for symptom management, pain interference, anxiety, fatigue, depression, and physical function. Differences in mean T-scores were derived for the post-live versus pre-live cohorts among chemotherapy and surgery recipients. Multivariable regression models controlled for relevant patient and clinical characteristics.

RESULTS: The pre-live cohort included 1,043 respondents (490 chemotherapy and 553 surgery); the post-live cohort included 1,046 respondents (535 chemotherapy and 511 surgery). After controlling for other clinical and demographic factors, the post-live chemotherapy cohort reported statistically significantly lower fatigue and anxiety, but the reductions did not meet the clinically meaningful threshold (adjusted mean T-score difference: -1.3 and -1.8, respectively; P < .05). The post-live surgery cohort reported statistically significantly lower fatigue and anxiety; the differences met the clinically meaningful threshold (-2.0 and -2.2, respectively; P < .01).

CONCLUSION: eSyM deployment was associated with reduced symptom burden, but clinically meaningful differences were only observed in fatigue and anxiety scores among surgical patients. Future studies should investigate the mechanisms by which symptom reporting affects patient outcomes, such as improving patient-clinician communication, enhancing clinician attention to symptom management, or increasing patient self-efficacy.

PMID:41232046 | DOI:10.1200/OP-25-00306

JMIR Form Res. 2025 Nov 13;9:e75651. doi: 10.2196/75651.

ABSTRACT

BACKGROUND: Early detection and awareness are critical in reducing the burden of cancer. However, a significant proportion of university students in Bangladesh remains inadequately informed about cancer risks and preventive measures.

OBJECTIVE: This study aimed to assess knowledge gaps and evaluate the attitudes of Bangladeshi university students toward cancer, its prevention, risk factors, and care for affected individuals.

METHODS: A descriptive, cross-sectional survey was conducted among 530 university students aged 20 to 35 years across Bangladesh. Data were collected using an ethically approved, structured internet-based questionnaire between December 2022 and March 2024. The questionnaire assessed sociodemographics, cancer knowledge, awareness of risk factors, personal or familial cancer experiences, and attitudes toward cancer care and policy. Descriptive statistics and chi-square tests were used to analyze categorical data, with a significance threshold of P<.05.

RESULTS: Most participants were aged 21-25 years (406/530, 76.6%) and female (320/530, 60.4%), with the majority enrolled in undergraduate programs (82.8%, 439/530). While 60.8% (322/530) considered themselves somewhat knowledgeable about cancer, only 11.9% (63/530) were very knowledgeable, and 93.6% (496/530) had never undergone any cancer screening. Despite this, 74.3% (394/530) had personal or familial exposure to cancer, with carcinoma reported by 52.8% (280/530) of those affected. Awareness of established risk factors was inconsistent-smoking (90.9%, 482/530) and radiation (86.6%, 459/530) were widely recognized, but only 38.9% (206/530) acknowledged aging, 35.3% (187/530) obesity, and 29.2% (155/530) infectious agents as risk factors. Reproductive factors were least recognized, with just 10.2% (54/530) identifying having more children as a risk factor. Gender differences were significant in cancer-related attitudes. For example, 51.5% (273/530) of female participants versus 33.4% (177/530) of male participants felt comfortable around patients with cancer (P=.01), and 57.2% (303/530) of female participants versus 35.8% (190/530) of male participants supported increased government funding for cancer care (P=.03). Furthermore, 55.1% (292/530) of females and 35.5% (188/530) of males stressed the need for enhanced cancer awareness programs (P=.05). Only 6.4% (34/530) of all participants reported undergoing any form of cancer screening, highlighting a disconnect between awareness and preventive action.

CONCLUSIONS: This study reveals critical gaps in cancer awareness among university students in Bangladesh, with pronounced disparities in knowledge of nonmodifiable risk factors and significant gender-based differences in attitudes toward cancer care. These findings highlight the urgent need for targeted, gender-sensitive educational programs and policy interventions to promote preventive practices, early detection, and equitable cancer care. Such initiatives must emphasize lesser-known risk factors, reduce stigma, and foster more inclusive, culturally competent health education strategies to mitigate the growing cancer burden in Bangladesh.

PMID:41232041 | DOI:10.2196/75651

JMIR Mhealth Uhealth. 2025 Nov 13;13:e63642. doi: 10.2196/63642.

ABSTRACT

BACKGROUND: The rapidly expanding digital health landscape offers innovative opportunities for improving health care delivery and patient outcomes; however, regulatory and clinical frameworks for evaluating their key features, effectiveness, and outcomes are lacking. Cardiovascular and mental health apps represent 2 prominent categories within this space. While mental health apps have been extensively studied, limited research exists on the quality and effectiveness of cardiovascular care apps. Despite their potential, both categories of apps face criticism for a lack of clinical evidence, insufficient privacy safeguards, and underuse of smartphone-specific features alluding to larger shortcomings in the field.

OBJECTIVE: This study extends the use of the MINDApps framework to compare the quality of cardiovascular and mental health apps framework to compare the quality of cardiovascular and mental health apps with regard to data security, data collection, and evidence-based support to identify strengths, limitations, and broader shortcomings across these domains in the digital health landscape.

METHODS: We conducted a systematic review of the Apple App Store and Google Play Store, querying for cardiovascular care apps. Apps were included if they were updated within the past 90 days, available in English, and did not require a health care provider’s referral. Cardiovascular care apps were matched to mental health apps by platform compatibility and cost. Apps were evaluated using the M-Health Index & Navigation Database (MIND; MINDApps), a comprehensive tool based on the American Psychiatric Association’s app evaluation model. The framework includes 105 objective questions across 6 categories of quality, including privacy, clinical foundation, and engagement. Statistical differences between the 2 groups were assessed using two-proportion Z-tests.

RESULTS: In total, 48 cardiovascular care apps and 48 matched mental health apps were analyzed. The majority of apps in both categories included a privacy policy; yet, the majority in both samples shared user data with third-party companies. Evidence for effectiveness was limited, with only 2 (4%) cardiovascular care apps and 5 (10%) mental health apps meeting this criterion. Cardiovascular care apps were significantly more likely to be used in external devices such as smartphone-based electrocardiograms and blood pressure monitors.

CONCLUSIONS: Both categories lack robust clinical foundations and face substantial privacy challenges. Cardiovascular apps have the potential to revolutionize patient monitoring; yet, their limited evidence base and privacy concerns highlight opportunities for improvement. Findings demonstrate the broader applicability of the MINDApps framework in evaluating apps across medical fields and stress the significant shortcomings in the app marketplace for cardiovascular and mental health. Future work should prioritize evidence-based app development, privacy safeguards, and the integration of innovative smartphone functionalities to ensure that health apps are safe and effective for patient use.

PMID:41232040 | DOI:10.2196/63642

JMIR Mhealth Uhealth. 2025 Nov 13;13:e69028. doi: 10.2196/69028.

ABSTRACT

BACKGROUND: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor symptoms that worsen over time, significantly impacting quality of life. While clinical evaluations such as the Unified Parkinson’s Disease Rating Scale (UPDRS) are standard for assessing disease severity, they offer somewhat limited temporal resolution and are susceptible to observer variability. Smartphone apps present a viable method for capturing detailed fluctuations in motor and vocal functions in real-world settings.

OBJECTIVE: This study aimed to use a smartphone-based app to quantitatively evaluate the interaction effect between time and disease severity on motor and vocal symptoms in individuals with PD.

METHODS: This was an exploratory, cross-sectional pilot study. Disease severity in persons with PD was assessed using the modified Hoehn & Yahr Scale, Voice Handicap Index, and UPDRS. We used a custom smartphone app to administer finger-tapping tasks, sustained phonation (/a/ and /i/), and rapid syllable repetition (/dadada/ and /pa-ta-ka/). The total tap counts, tap-to-tap variability, and vocal parameters (loudness, jitter, shimmer, repeat counts, and their variability) were analyzed. Each task was divided into 5 equal time frames to analyze performance changes over a short duration. Time-severity interactions were examined using linear mixed models.

RESULTS: In total, 20 persons with PD and 20 healthy adults were included in this study. Persons with PD showed worse motor and vocal performance compared to healthy adults, with higher dysrhythmia; worse jitter, shimmer, and jitter and shimmer variability; and fewer repeat counts. During finger-tapping tasks, individuals with PD showed an earlier onset of dysrhythmia than their healthy counterparts. While a higher UPDRS part III score was associated with greater finger-tapping variability, there was no significant time-severity interaction for this motor task. However, linear mixed model analysis revealed significant time-severity interaction effects for vocal tasks, including /a/ loudness (P=.001), /a/ jitter (P=.01), /a/ shimmer (P=.001), /i/ loudness (P=.001), /i/ jitter (P<.001), /i/ shimmer (P<.001), and /pa-ta-ka/-variability (P=.04). This indicates that individuals with higher UPDRS part III scores experienced a more rapid decline in vocal control during the assessment period. All measured smartphone-based characteristics showed a significant correlation with UPDRS part III scores, with finger-tapping variability having the strongest correlation.

CONCLUSIONS: This study demonstrates that a smartphone-based assessment, conducted over just a few minutes, can detect subtle temporal changes in fine motor and vocal control. The app successfully captured the earlier onset of dysrhythmia in individuals with PD and, importantly, identified significant time-severity interaction effects in vocal performance. This suggests that such digital tools can provide sensitive, dynamic insights into symptom progression, potentially enabling more precise monitoring and timely clinical interventions for individuals with PD.

PMID:41232035 | DOI:10.2196/69028