Tag: pubmed

Int J Adolesc Med Health. 2025 Jun 6. doi: 10.1515/ijamh-2025-0012. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate adolescents’ knowledge, attitude, and risk perceptions regarding e-cigarette usage and examine the associations and differences across various socio-demographic characteristics.

METHODS: A cross-sectional study was conducted in two government secondary schools in Johor. A total of 391 respondents were enrolled conveniently using a pre-validated questionnaire. The data were analysed using SPSS descriptive and inferential statistics.

RESULTS: Most participants demonstrated a moderate level of knowledge regarding e-cigarettes (77.5 %), achieving an average score of 3.82 (±0.89). A significant portion of the respondents were female (56.3 %) and Chinese (57.5 %), predominantly aged between 16 and 17 years (53.7 %). Presently, 11.5 % of the participants reported using e-cigarettes, while 6.6 % reported using traditional tobacco cigarettes. Notably, 12.3 % of adolescents correctly identified nicotine as a common component in e-cigarettes, highlighting its addictive nature. Furthermore, significant association and differences were observed between e-cigarette usage and a positive attitude towards them (86.7 %, p<0.001), as well as the perception of reduced health risks associated with e-cigarette consumption (9.11 ± 2.68, p<0.001). Adolescents who were susceptible to e-cigarette use were more inclined to support their usage (63.1 %, p<0.001) and perceived fewer health consequences (6.91 + 3.12, p=0.019) in comparison to those who were not susceptible.

CONCLUSIONS: E-cigarette users exhibited a moderate level of understanding along with a positive stance towards e-cigarettes, viewing them as less risky compared to non-e-cigarette users. As a result, collaborative endeavours are essential to enhance adolescent knowledge about e-cigarettes via community outreach initiatives. Consequently, all governing bodies must explore effective strategies to tackle this issue by implementing strict legislation.

PMID:40472268 | DOI:10.1515/ijamh-2025-0012

J Particip Med. 2025 Jun 5;17:e69253. doi: 10.2196/69253.

ABSTRACT

BACKGROUND: Patient portals demonstrate significant potential for improving health care engagement but face critical adoption challenges. Disparities persist across different demographic groups, creating a digital divide in health care access. Targeted training strategies, particularly personalized and one-on-one approaches, show promise in increasing portal utilization. Innovative solutions, like community health workers specializing in digital navigation, offer a potential pathway to reduce enrollment barriers. The key challenge remains developing a scalable, cost-effective training model.

OBJECTIVE: Our quality improvement (QI) project aimed to assess the feasibility and effectiveness of a collaborative effort between a free community-based digital navigation program and an urgent care clinic in facilitating patient access to their portal.

METHODS: We created the Digital Health Equity Navigation Training (DHENT) program to improve patient portal access and usage. The program used a train-the-trainer model to scale up patient portal training across the community. DHENT trainers partnered with urgent care physicians to enroll patients in the portal. Physicians briefly explained portal benefits and referred interested patients for DHENT assistance. Trainers then contacted patients by phone to help with enrollment and navigation. We employed 3 Plan-Do-Study-Act cycles to understand the feasibility of the collaboration. We used descriptive statistics to describe participant characteristics and referral processes.

RESULTS: The collaboration was marginally successful, exceeding referral targets by 27.7% (115/90). Most patients were under 60 years old (94/115, 81.7%) and White (78/115, 67.8%). There was a significant delay in contact, averaging 37 days. While 4.8% (5/104) of patients accessed the portal with DHENT trainer assistance, 9.6% (10/104) had already signed up independently after their urgent care visit.

CONCLUSIONS: Overall, we found our partnership had a moderate impact, and only a low dose of intervention and resources were needed.

PMID:40472267 | DOI:10.2196/69253

JMIR Aging. 2025 Jun 5;8:e64974. doi: 10.2196/64974.

ABSTRACT

BACKGROUND: With an aging population driven by advances in medical technology, digital literacy has become essential for improving the quality of life of older adults, enhancing access to health information, and promoting healthy lifestyles. Furthermore, the COVID-19 pandemic may have influenced the subjective health perceptions and healthy lifestyle behaviors of older adults. However, there is limited research exploring the relationship between digital literacy, subjective health perceptions, and healthy lifestyle behaviors in Korea.

OBJECTIVE: This study aimed to investigate digital literacy’s impact on Korean older adults’ subjective health status and healthy lifestyle behaviors.

METHODS: Data of 8664 respondents (aged 65 years and older) from the 2020 National Survey of the Older Koreans were analyzed. Digital literacy was measured based on the use of IT devices (ITDs), difficulty using online information, and inconvenience of ITDs. Statistical analyses, such as the Rao-Scott chi-square test, Wilcoxon rank sum test, and multiple regression analysis, were conducted.

RESULTS: Respondents with above-average ITD use (adjusted odds ratio [aOR] 1.73, 95% CI 1.50-1.99) and less difficulty using online information (aOR 1.41, 95% CI 1.24-1.61) had higher odds of perceiving themselves as healthy. Conversely, high difficulty using ITDs was associated with lower odds of respondents perceiving themselves as healthy (aOR 0.84, 95% CI 0.82-0.87). Furthermore, high ITD use predicted engagement in healthy lifestyle behaviors (aOR 1.51, 95% CI 1.33-1.72), whereas high difficulty using ITDs predicted lower odds of engagement (aOR 0.94, 95% CI 0.92-0.97). In contrast, there was no difference in the odds of engaging in healthy lifestyle behaviors regardless of difficulty using online information (aOR 1.03, 95% CI 0.92-1.15).

CONCLUSIONS: This study underscores the significant association between digital literacy and improved health outcomes among older adults. Promotion of digital literacy and relevant policies is essential to help older adults effectively obtain health information online, thereby improving their quality of life and overall health.

PMID:40472263 | DOI:10.2196/64974

JMIR Form Res. 2025 Jun 5;9:e67906. doi: 10.2196/67906.

ABSTRACT

BACKGROUND: While mobile health (mHealth) apps have been made for various diseases, including sickle cell disease (SCD), most focus on a single purpose. SCD is a chronic disease that requires knowledge of the disease, self-management, and adherence to treatment plans. While mHealth apps have been made with single features for SCD, there is limited understanding of using an mHealth app with a more comprehensive set of features that could engage adults with SCD, depending on what features they prefer and need to engage and empower them in living with their disease.

OBJECTIVE: We evaluated the usage of an mHealth app with various features, including pain tracking, quizzes for patient-facing guidelines, pain and asthma action plans, and goal setting.

METHODS: Adults with SCD were enrolled at 2 sickle cell centers between 2018 and 2022 as part of a 6-month feasibility randomized controlled trial with participants completing surveys at baseline and 6 months. Participants were randomized into receiving either an mHealth app and booklet with patient-facing guidelines or a booklet with the guidelines alone. The mHealth app comprised web pages with patient-facing guideline material and a Research Electronic Data Capture (REDCap) project. The REDCap project included a personal profile, a pain tracker, goal setting, quizzes about the guidelines, and pain or asthma action plans. The REDCap project also included the ability to send daily text messages at a time they chose, which contained a message they could create and a link to their profile. Outcomes included SCD-specific knowledge and acute health care utilization (emergency room visits and hospitalizations). We evaluated the usage of these different features and relationships with baseline variables, each other, and study outcomes.

RESULTS: Approximately 75% (50/67) of the enrolled and randomized participants completed all the study components, and 100% (26/26) of the participants who were randomized to the mHealth app arm and completed the study used the mHealth app. Further, 15/30 (50%) participants used multiple features. Baseline sickle cell knowledge and female gender were associated with more usage of pain diary (P=.04) and mission (P=.046) features, respectively. While not significant, mission completion was associated with lower hospitalizations (P=.06).

CONCLUSIONS: Adults with SCD engaged differently with an mHealth app with multiple features. As this study was not focused on one part of our app, engagement with features in this app was entirely patient-driven, which may demonstrate the expected real-world use of an mHealth app in this population. A multipurpose app can help engage participants in self-management strategies through different features and potentially improve outcomes.

PMID:40472251 | DOI:10.2196/67906

Pediatr Infect Dis J. 2025 Jun 3. doi: 10.1097/INF.0000000000004860. Online ahead of print.

ABSTRACT

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant public health threat, causing skin and soft tissue infections (SSTIs) and severe complications in children. Virulence factors such as Panton-Valentine leucocidin (PVL) enhance its pathogenicity. This study investigates the epidemiology, antibiotic resistance and PVL production of community-acquired MRSA (CA-MRSA) infections among children.

METHODS: A nationwide multicenter retrospective study was conducted on children under 18 years diagnosed with CA-MRSA infections in Spain between 2018 and 2020. Positive MRSA cultures were obtained from biological samples within the first 48 hours of hospital or primary care contact and analyzed for antibiotic susceptibility and PVL production. Epidemiological, clinical and microbiological data were described and compared with previous colonization data. Statistical analyses, including multivariate logistic regression, were performed to identify factors associated with infection.

RESULTS: A total of 252 children with CA-MRSA infections were included, with a median age of 5.5 years (interquartile ranges: 2-10). SSTIs accounted for 89.3% of cases, and 23.6% required hospitalization. Migrant status (52.5%) and prior SSTIs (39.1%) were significantly associated with MRSA infection (P < 0.05). MRSA strains causing infection exhibited high resistance to ciprofloxacin (32.2%) and clindamycin (18.3%). No differences in antibiotic susceptibility were observed between strains causing infection and colonization. Reinfection occurred in 21% of cases, despite 45.3% undergoing decolonization. PVL genes were detected in 76.9% of MRSA strains, and were significantly more frequent in infection compared to colonization (P < 0.001).

CONCLUSIONS: Migrant status and PVL toxin production are significant risk factors for MRSA infections. The high prevalence of antibiotic resistance highlights the importance of tailoring empirical treatment strategies based on local resistance patterns.

PMID:40472240 | DOI:10.1097/INF.0000000000004860

JMIR Rehabil Assist Technol. 2025 Jun 5;12:e70063. doi: 10.2196/70063.

ABSTRACT

BACKGROUND: With the rapid advancement of technology, using wearable devices and mobile health (mHealth) apps to monitor and promote physical activity (PA) has become increasingly popular among individuals with various chronic conditions. However, such work remains limited among individuals with spinal cord injury (SCI), especially those who use a manual wheelchair for mobility.

OBJECTIVES: The study aims to describe the development of the WheelFit mHealth app for monitoring and promoting PA in manual wheelchair users (MWUs) with SCI and evaluate its feasibility and usability in free-living conditions.

METHODS: The WheelFit app, based on the Fogg Behavioral Model with inputs from stakeholders, including MWUs, physical therapists, and personal trainers, was developed to promote PA in MWUs. It works with two commercial wearable devices, that is, an Android smartwatch and a wheel sensor, which stream users’ upper extremity and wheelchair movement to the app to calculate PA variables using custom algorithms. Users can set personal goals, review daily progress and PA history, and access an adaptive workout library within the app. A 4-week single-group pre-post study, consisting of a 1-week baseline and 3-week intervention phase, was conducted to evaluate WheelFit’s feasibility and usability. Feasibility was evaluated using the session attendance rate, device and app usage, and implementation of action plans. Usability was assessed using the system usability scale. The preliminary effectiveness was assessed by comparing preintervention and postintervention PA variables and scores from the SCI exercise self-efficacy scale.

RESULTS: A total of 16 participants completed the study protocol with 100% session attendance and maintained 14.2 hours of daily device and app connection. Participants demonstrated varying levels of adherence to their action plans. The excellent usability of WheelFit was indicated by an average system usability scale score of 81.8 (SD 19.2) points. Statistically significant increases between pre-post daily exercise times (preintervention: mean 26.4, SD 16.9 minutes; postintervention: mean 33.3, SD 24.9 minutes; P=.049) and exercise self-efficacy scale scores (preintervention: mean 33.9, SD 4.5 points; postintervention: mean 35.9, SD 3.2 points; P=.043) were observed.

CONCLUSIONS: The WheelFit app demonstrated promising feasibility, usability, and a positive impact on promoting PA in MWUs with SCI. Future investigation exploring the potential integration of the WheelFit app into clinical practice is warranted.

PMID:40472238 | DOI:10.2196/70063

Ocul Immunol Inflamm. 2025 Jun 5:1-8. doi: 10.1080/09273948.2025.2507709. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the risk of osteonecrosis (ON) among patients with Vogt-Koyanagi-Harada (VKH) receiving varying cumulative corticosteroid dosages and to evaluate changes in risk over time.

METHODS: We retrospectively analyzed data from 1,512 patients with VKH in Taiwan’s National Health Insurance Research Database from 2000 to 2019. Patients were categorized based on cumulative prednisone-equivalent dosages in the first 3 months of treatment as follows: low dose (n = 544; 0 < dose ≤ 2 g), medium dose (n = 369; 2 < dose ≤ 4 g), high dose (n = 332; > 4 g), and non-users (n = 267; 0 g).

RESULTS: Among VKH patients, combined immunotherapy (IMT) was used in 13.1% within 3 months. After adjustments for age, sex, Charlson Comorbidity Index score, disease stage and the IMT use within the first 3 months, the cumulative risk of ON became significant in the fourth and fifth years for both the low-dose group (HR = 4.59, p = 0.047) and the high-dose group (HR = 5.02, p = 0.043).

CONCLUSIONS: In this study, only 13.1% of VKH patients received combined IMT within the first 3 months, indicating substantial room to increase early IMT utilization. Early use of combination therapy may potentially reduce corticosteroid exposure, lower the risk of ON, and improve visual outcomes. Patients should be informed of the prolonged risk of corticosteroid-induced ON, which can persist for up to four years, to ensure appropriate monitoring and prevention.

PMID:40472209 | DOI:10.1080/09273948.2025.2507709

J Cardiovasc Med (Hagerstown). 2025 Jun 1;26(6):314-319. doi: 10.2459/JCM.0000000000001736. Epub 2025 May 13.

ABSTRACT

INTRODUCTION: Arrhythmia-induced cardiomyopathy (AIC) due to atrial fibrillation is probably related to high ventricular rates and irregular rhythm caused by atrial fibrillation. We sought to investigate the efficacy of pulmonary vein isolation (PVI) using radiofrequency catheter ablation (RFCA) compared to conventional medical therapy in terms of rate of hospitalizations and atrial fibrillation recurrence.

METHODS: All patients diagnosed with atrial fibrillation associated with heart failure and left ventricular ejection fraction (LVEF) less than 50%, with no other identifiable cause of heart failure aside from the tachyarrhythmia, were included. A 1 : 1 propensity score matching was carried out including age, sex, diabetes, LVEF and BMI in the logistic regression model. The primary endpoint was to assess recurrences of hospitalizations for heart failure; secondary endpoints included hospitalizations for all causes and recurrence of atrial fibrillation during the follow-up.

RESULTS: Seventeen patients who had undergone RFCA were matched and compared with 17 patients under conventional medical therapy. Over a median follow-up of 26 months [interquartile range (IQR) 13.4-32], the RFCA group exhibited a significantly lower rate of heart failure-related hospitalization compared with the control group (23.5 versus 58.8%, P = 0.04). The rates of all-cause hospitalizations and atrial fibrillation recurrence were also significantly lower in the RFCA group. The RFCA group also showed a significant increase in LVEF and a significant reduction in left atrial volume compared with medical therapy alone.

CONCLUSION: In patients with AIC due to atrial fibrillation, catheter ablation seems to favor the reverse remodeling and to be effective in reducing atrial recurrence and the rate of all-cause and heart failure-related hospitalizations.

PMID:40472176 | DOI:10.2459/JCM.0000000000001736

J Cardiovasc Med (Hagerstown). 2025 Jun 1;26(6):284-296. doi: 10.2459/JCM.0000000000001733. Epub 2025 May 21.

ABSTRACT

BACKGROUND: Dilated cardiomyopathy (DCM) is a common cause of heart failure with reduced ejection fraction (HFrEF) in industrialized countries and a major contributor to morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in HFrEF management; however, their impact on endothelial function in this patient population remains less explored. This study aims to evaluate the effects of SGLT2i on endothelial function and echocardiographic parameters in patients with DCM.

METHODS: This observational, longitudinal, monocentric study enrolled patients with DCM and HFrEF. Endothelial function was assessed using peripheral arterial tonometry (EndoPAT) at baseline, 6 months, and 12 months following the initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i). The enrollment period spanned from November 2021 to November 2022. The primary endpoint was the change in reactive hyperemia index (RHI) over time. In addition, a subgroup analysis was conducted to compare the effects of different SGLT2i agents (empagliflozin vs. dapagliflozin) and DCM etiology (ischemic vs. idiopathic) on endothelial function.

RESULTS: A total of 102 patients were included, predominantly male (72%), with a median age of 75 years and an average baseline left ventricular ejection fraction (LVEF) of 32.9 ± 7.9%. NYHA class II/III was observed in 76% of participants, and ischemic etiology accounted for 53% of DCM cases. The baseline RHI value was 1.15 ± 0.34. At 6 months, it significantly increased to 1.40 ± 0.34 (P < 0.0001), reflecting an absolute change of 0.25 ± 0.03 (ΔRHI baseline – 6 months). Between 6 and 12 months, the RHI showed a further significant increase to 1.69 ± 0.36 (P < 0.0001), with an additional change of 0.29 ± 0.03 (ΔRHI 6 – 12 months). The overall change in RHI from baseline to 12 months (ΔRHI baseline – 12 months) was 0.54 ± 0.04 (P < 0.0001). No significant differences in RHI were observed between patients treated with dapagliflozin and those receiving empagliflozin (P = 0.589), nor between different DCM etiologies (ischemic vs. idiopathic, P = 0.463). The enhancement in RHI was associated with a reduction in the incidence of hospitalization for heart failure (AUC 0.783, P < 0.001). Progressive improvement in left ventricular function was observed through echocardiographic parameters. Although EDV and ESV showed a decreasing trend (EDV: 176.2 ± 64.9 to 167.6 ± 31.1 ml, P = 0.335; ESV: 124.5 ± 52.7 to 116.8 ± 24.6 ml, P = 0.606), these changes were not statistically significant. LVEF improved significantly from 32.9 ± 7.9% at baseline to 36.8 ± 5.5% at 6 months and 37.1 ± 4.9% at 12 months (P < 0.001). The E/A ratio declined from 1.5 ± 0.5 to 1.1 ± 0.3 (P = 0.023) and the E/E’ ratio decreased from 18.1 ± 5.1 to 11.1 ± 2.8 (P = 0.027).Left atrial volume significantly decreased from 108 to 100 ml (P = 0.041), and pulmonary artery systolic pressure dropped from 44 to 39 mmHg at 6 months and 35 mmHg at 12 months (P < 0.001).

CONCLUSION: SGLT2i therapy significantly improves endothelial function in patients with DCM suggesting a potential vascular benefit beyond their well established cardioprotective effects.

PMID:40472172 | DOI:10.2459/JCM.0000000000001733

Aust J Prim Health. 2025 Jun;31:PY25020. doi: 10.1071/PY25020.

ABSTRACT

Background Inaccessibility of primary healthcare services in rural and remote communities is argued to lead to higher rates of potentially preventable hospitalisations. This research aimed to develop an explanatory method that could be applied for investigating a rural setting considered high risk for potentially preventable hospitalisations, and to describe how to improve place-based pathways to primary healthcare services that would prevent potentially preventable hospitalisations. Methods The method described in this paper provides a structured and detailed plan for examining regions identified as high risk for a particular potentially preventable hospitalisation condition. The method was developed and tested through a series of research studies on ear, nose and throat (ENT) conditions in the Murray Primary Health Network, that had regions identified as high-risk hotspots for ear, nose and throat potentially preventable hospitalisations. Results The procedure developed for investigating hotspot regions of potentially preventable ear, nose and throat hospitalisations included six steps: (1) develop investigative questions; (2) identify and select potentially preventable hospitalisations condition and region; (3) literature review of best practice service needs and service mapping; (4) healthcare provider and consumer experiences; (5) illustrate patient journey; and (6) summarise recommendations for primary health care. Conclusions This method provides an understanding of the access pathways to primary healthcare services, and identifies where interventions and prevention strategies would support residents in obtaining equitable health care. This developed method can be further applied and tested as a mechanism for health and service needs assessment by primary healthcare planning and coordination agencies, which in Australia include Primary Health Networks, public health units and hospital networks.

PMID:40472135 | DOI:10.1071/PY25020