Tag: pubmed

JMIR Serious Games. 2026 Apr 30;14:e93412. doi: 10.2196/93412.

ABSTRACT

BACKGROUND: Internet gaming disorder (IGD) is increasingly prevalent among adolescents. Although socially prescribed perfectionism (SPP) and resilience are both related to IGD, longitudinal evidence on their temporal relationships and underlying mechanisms remains limited.

OBJECTIVE: This study aimed to examine the longitudinal associations among SPP, resilience, and IGD in Chinese adolescents; test the mediating role of resilience; and explore potential sex differences.

METHODS: A 3-wave prospective longitudinal study was conducted among students from 4 middle schools in Zhejiang Province, China. Adolescents who had played online games in the past 12 months were recruited using convenience sampling. Data were collected at 6-month intervals: time 1 (T1; March 2024), time 2 (T2; September 2024), and time 3 (T3; March 2025). A total of 1332 Chinese adolescents (875/1332, 65.7% male; mean age 13.61, SD 0.70 years) participated in the baseline survey. SPP, resilience, and IGD were assessed using the Hewitt-Flett Multidimensional Perfectionism Scale-Short Form, the 10-item Connor-Davidson Resilience Scale, and the 9-item Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) IGD Checklist, respectively. Cross-lagged panel model (CLPM) and multigroup analyses across sex were conducted.

RESULTS: All statistical tests were 2-tailed with α=.05. The CLPM demonstrated good fit to the data (χ²38=163.34; comparative fit index [CFI]=0.945; Tucker-Lewis index [TLI]=0.932; root mean square error of approximation [RMSEA]=0.054; standardized root mean square residual [SRMR]=0.047). Higher SPP predicted later IGD (T1→T2: β=0.10, 95% CI 0.04 to 0.16, P<.001; T2→T3: β=0.09, 95% CI 0.03 to 0.15, P=.004) and lower resilience (T1→T2: β=-0.09, 95% CI -0.16 to -0.02, P=.007; T2→T3: β=-0.12, 95% CI -0.18 to -0.06, P<.001). In contrast, SPP was not significantly predicted by prior IGD nor resilience. Higher resilience predicted lower subsequent IGD (T1→T2: β=-0.09, 95% CI -0.15 to -0.03, P=.001; T2→T3: β=-0.09, 95% CI -0.15 to -0.03, P=.001), whereas higher IGD predicted lower subsequent resilience (T1→T2: β=-0.19, 95% CI -0.27 to -0.11, P<.001; T2→T3: β=-0.09, 95% CI -0.15 to -0.03, P=.003). Bootstrapped mediation analysis showed a significant indirect effect of SPP at T1 on IGD at T3 via resilience at T2 (β=0.008, 95% CI 0.004 to 0.012, P=.005). However, multigroup analyses revealed no significant sex differences.

CONCLUSIONS: This study provides novel insights into the longitudinal associations among SPP, resilience, and IGD in adolescents. Unlike previous research based mainly on cross-sectional data, this 3-wave CLPM study clarifies the temporal relationships among these variables and shows that resilience mediates the association between SPP and subsequent IGD. These findings advance the field by identifying a temporal psychological pathway underlying adolescent IGD. They also have practical implications for early screening and for developing resilience-focused interventions for adolescents at risk of IGD.

PMID:42060935 | DOI:10.2196/93412

JMIR Public Health Surveill. 2026 Apr 30;12:e89295. doi: 10.2196/89295.

ABSTRACT

BACKGROUND: Hypertensive disorders of pregnancy (HDP) may cause lasting vascular, cardiac, and renal damage, potentially increasing the risk of postpartum cardiovascular disease.

OBJECTIVE: This study aimed to examine the association between gestational blood pressure (BP) trajectories in HDP and the risk of unrecovered BP at 6 weeks post partum.

METHODS: A total of 3162 women with HDP were obtained from the antenatal care and the postpartum follow-up information system, between January 1, 2018, and December 31, 2024. Of the 3162 women included, 1674 had gestational hypertension, 607 had preeclampsia, 246 had chronic hypertension with superimposed preeclampsia, and 635 had chronic hypertension. Group-based trajectory modeling was used to fit systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) trajectories during pregnancy. Modified Poisson regression was used to assess the association between gestational BP trajectories and the risk of unrecovered BP at 6 weeks post partum.

RESULTS: Trajectories of SBP, DBP, and MAP during pregnancy were significantly associated with unrecovered BP at 6 weeks post partum. For gestational hypertension, those with the high-consistent rise (adjusted relative risk [aRR] 2.493, 95% CI 1.093-5.689) and high-late surge SBP trajectories (aRR 4.535, 95% CI 1.884-10.917) were associated with a significantly increased risk of BP nonrecovery at 6 weeks post partum. Similar associations were observed for DBP and MAP. For chronic hypertension with superimposed preeclampsia, women with high-late surge in SBP (aRR 2.792, 95% CI 1.081-7.214), DBP (aRR 4.043, 95% CI 1.327-12.324), or MAP (aRR 4.018, 95% CI 1.462-11.045) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with chronic hypertension, those with the high-consistent rise trajectories of SBP (aRR 2.557, 95% CI 1.256-5.207), DBP (aRR 3.862, 95% CI 1.673-8.913), and MAP (aRR 3.714, 95% CI 1.682-8.201) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with preeclampsia, only high-consistent rise SBP trajectory remained significantly associated with unrecovered BP post partum (aRR 3.355, 95% CI 1.140-9.873). The high-consistent rise and high-late surge trajectories of SBP, DBP, and MAP in gestational hypertension started at similar initial levels and crossed at approximately 22 weeks of gestation.

CONCLUSIONS: The gestational BP trajectories in women with HDP are positively associated with the risk of unrecovered BP at 6 weeks post partum. Early identification of women at high risk for poor postpartum BP recovery through BP trajectory analysis may have important clinical implications for improving long-term cardiovascular outcomes in this population.

PMID:42060921 | DOI:10.2196/89295

J Med Internet Res. 2026 Apr 30;28:e76236. doi: 10.2196/76236.

ABSTRACT

BACKGROUND: Digital oral health builds on the broader framework of eHealth, leveraging digital technologies to improve patient care, increase access to dental services, and enhance oral health outcomes. However, health care organizations and institutions encounter challenges in implementing digital oral health interventions across various levels. Addressing these challenges requires a comprehensive understanding of the barriers and facilitators that influence its successful adoption.

OBJECTIVE: This study aimed to explore the facilitators of and barriers to the implementation of digital oral health programs from the perspective of chief dental officers from countries across the World Health Organization (WHO) regions.

METHODS: This study is part of a broader investigation into global readiness for digital oral health. Participants were the 144 chief dental officers or designated oral health officials within ministries of health across the 6 WHO regions. An explanatory sequential mixed methods design was used across 2 phases. In the quantitative phase, an online survey was administered using the WHO’s global survey on eHealth instrument. Some items were modified slightly to be applied to the field of dentistry. Descriptive statistics were used to present the quantitative data. In the qualitative phase, data were collected through virtual interviews, using an interview guide developed based on preliminary findings from the quantitative phase, the technology acceptance model, and the eHealth readiness assessment tool. The qualitative data were analyzed using thematic analysis.

RESULTS: The survey response rate was 70.1% (101/144). The qualitative phase involved in-depth interviews with 15 participants. The findings were integrated under 2 broad themes of facilitators and barriers. Perceived facilitators included the existence of national policies and guidelines on eHealth. Approximately 63.9% (53/83) of the respondents indicated the presence of a national oral health policy in their countries. Capacity building, motivation of health care providers and academic leadership, digital health training for students or professionals, and WHO support to implement the mOral Health program were the other facilitators. The strongest barriers were a lack of funding to develop and support digital health programs, lack of norms and standards to guarantee application interoperability, and lack of equipment and/or connectivity. Approximately 45.1% (37/82) of the participants reported having government-sponsored mobile health programs, while 31.7% (26/82) reported having no financial support for the implementation of national digital oral health programs. Furthermore, lack of evidence on the effectiveness and cost-effectiveness of programs was highlighted as a barrier by 73.8% (59/80) and 73% (57/78) of the participants, respectively.

CONCLUSIONS: The results of this study enabled the identification of key barriers to and enablers of the implementation of digital oral health programs in WHO member countries. Supportive governmental policies and adequate funding and investment in digital infrastructure and technologies are essential to mitigate digital oral health-related challenges.

PMID:42060912 | DOI:10.2196/76236

JMIR Aging. 2026 Apr 30;9:e87070. doi: 10.2196/87070.

ABSTRACT

BACKGROUND: Falls are prevalent and serious health problems among older adults. Concerns about falling and reduced falls efficacy are common fall-related psychological impairments, representing 2 distinct emotional and cognitive constructs, respectively. The impact of digital-based exercise interventions on these specific constructs remains unclear.

OBJECTIVE: This systematic review and meta-analysis aimed to synthesize current evidence on digital-based exercise interventions for concerns about falling and falls efficacy among older adults, with a specific focus on determining their differential effects on emotional and cognitive constructs and evaluating their impact on physical performance.

METHODS: The PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, CNKI, SinoMed, VIP, and Wanfang databases were systematically searched from their inception dates to May 2025. We searched for published randomized controlled trials on the effects of digital-based interventions on the fear of falling, concerns about falling, and falls efficacy among older adults. The study followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was performed using Stata 17.0 software (StataCorp LLC).

RESULTS: Eighteen studies involving 2435 participants were included. Meta-analyses revealed significant effects of digital-based exercise interventions on falls efficacy (standardized mean difference 0.70, 95% CI 0.51-0.90; P<.001), balance function (mean difference [MD] 4.03, 95% CI 2.57-5.49; P<.001), functional mobility (MD -1.65, 95% CI -2.52 to -0.77; P<.001), and physical function (MD 0.57, 95% CI 0.12-1.02; P=.006) among older adults. However, digital-based exercise interventions had no significant effect on concerns about falling, which is the emotional construct related to falls (standardized MD -0.12, 95% CI -0.28 to 0.05; P>.05).

CONCLUSIONS: The meta-analysis assessed the efficacy of digital-based exercise interventions on fall-related psychological impairments among older adults and revealed that the effects differed across the constructs. These findings suggest that digital-based exercise interventions have potential benefits for improving falls efficacy and physical performance among older adults compared with controls. However, the effect of digital-based exercise interventions on concerns about falling, which is the emotional construct related to falls, remains uncertain among older adults.

PMID:42060908 | DOI:10.2196/87070

JMIR Form Res. 2026 Apr 30;10:e72604. doi: 10.2196/72604.

ABSTRACT

BACKGROUND: This study develops an open-source large language model-based chatbot tailored for Korean health consultations. The chatbot was implemented using the retrieval-augmented generation (RAG) technique alongside metadata filtering to enhance its performance.

OBJECTIVE: This study aims to analyze and compare the performance of a RAG-based chatbot with other leading language models in the context of Korean health consultations.

METHODS: A 10.4 GB Korean medical document corpus (487,277 segments) was constructed from official websites of major Korean hospitals, public health sources, and medical textbooks. This study quantitatively compared 5 open-source large language models (Qwen3:4B, Mistral:7B, Llama-3.1:8B, Gpt-Oss:20B, and Gemma3:27B) in 3 configurations: baseline (model only), RAG-only, and RAG with metadata filtering. The RAG system used a specialized Korean embedding model (upskyy/bge-m3-korean) and an Elasticsearch store. Performance was assessed by an emergency medicine specialist using a validation set of 226 questions across 7 common diseases and scoring responses based on accuracy, safety, and helpfulness.

RESULTS: The application of RAG alone failed to yield statistically significant performance improvements and, in some cases (Llama 3.1: 8B and Gemma 3: 27B), resulted in decreased scores. However, the combination of RAG with metadata filtering yielded statistically significant (P<.05) performance increases in most models. Notably, the average score for Mistral:7B increased from 3.79, SD 0.08, to 4.10, SD 0.10, and Gpt-Oss:20B increased from 4.43, SD 0.05, to 4.51, SD 0.04, with the latter achieving the highest safety score (4.61, SD 0.03). The Gemma3:27B model, which possessed a high baseline performance (4.42, SD 0.03), was an exception, exhibiting no significant improvement (P=.14) even with filtering.

CONCLUSIONS: The effectiveness of RAG for specialized domains such as Korean medical consultation is highly dependent on a metadata filtering process that controls the quality of retrieved information; simple information augmentation is insufficient. Furthermore, the benefit of RAG is limited when a model’s intrinsic knowledge (eg, Gemma3:27B) already meets or exceeds the quality of the external knowledge base. This finding indicates that performance enhancement strategies must account for both the retrieval mechanism’s quality and the model’s preexisting capabilities.

PMID:42060907 | DOI:10.2196/72604

MCN Am J Matern Child Nurs. 2026 May-Jun 01;51(3):172. doi: 10.1097/NMC.0000000000001196. Epub 2026 Apr 29.

NO ABSTRACT

PMID:42060899 | DOI:10.1097/NMC.0000000000001196

MCN Am J Matern Child Nurs. 2026 May-Jun 01;51(3):154-161. doi: 10.1097/NMC.0000000000001186. Epub 2026 Apr 29.

ABSTRACT

PURPOSE: The purpose of this study was to gather information that can be used to help inform doula integration into the clinical care setting.

STUDY DESIGN AND METHODS: We conducted a convergent (parallel) mixed-methods online survey study to understand maternity care team members’ perceptions of doulas and their integration into the clinical setting.

RESULTS: One hundred and ten maternity care team members responded to the survey with both open-ended questions. The majority (90.0%) of respondents were nurses, female (94.5%), and White (90.0%). Three quarters (75.5%) reported prior experience working with a doula. Four primary themes related to barriers and facilitators were identified through thematic content analysis: Doula Support and Its Benefits; Uncertainty about Doulas’ Qualifications; Interference with the Maternity Care Team Member; and Integration into the Health Care System. Respondents discussed the benefits of doulas and the valuable support that doulas offered to patients, including: 1a) emotional, physical, and educational support and 1b) advocacy and communication. They expressed concerns about the potential interference with the maternity team, including: 3a) role confusion and influence on clinical decision-making and 3b) disrupting the patient-maternity care team member relationship. Recommendations for successful integration of doulas into the health care system included 4a) clear roles and boundaries, 4b) building relationships of trust and respect, 4c) collaborative communication, and 4d) education of maternity care team members.

CLINICAL IMPLICATIONS: The study will be used to develop a doula integration tool kit. Doulas and maternity care team members should work together to create clear guidelines about the role of doulas within the hospital. Collaborative development of doula-supportive hospital policies and formalized hospital-doula partnership agreements can help reduce role ambiguity and create a more supportive hospital environment.

PMID:42060896 | DOI:10.1097/NMC.0000000000001186

JMIR Aging. 2026 Apr 30;9:e79409. doi: 10.2196/79409.

ABSTRACT

BACKGROUND: As telehealth has become an increasingly common mode of care delivery, older adults may face structural, technological, and interactional barriers that limit their ability to engage with video-based care. Although digital ageism, defined as the presence of age-related stereotypes, lowered expectations, or assumptions about older adults’ technology-related competence, has been described in prior literature, less is known about how such dynamics surface during real-time telehealth encounters and how they may shape participation in technology-focused clinical trials.

OBJECTIVE: This formative ethnographic study aimed to (1) document real-world barriers encountered by older adults immediately before and during video telehealth visits and (2) inform recruitment and implementation procedures for a subsequent telepharmacy randomized controlled trial.

METHODS: We conducted in-home, real-time ethnographic observation of 20 community-dwelling veterans aged ≥65 years participating in pharmacist-led video visits for medication management. Recruitment occurred over approximately 6 to 10 months using mailed invitation letters (>300 sent), supplemented with outbound telephone calls. Data sources included structured field notes completed independently by an in-house anthropologist and the remote clinical pharmacist, as well as observational documentation of previsit preparation, visit navigation, and postvisit reflections. Data were analyzed using qualitative rapid analysis, with iterative team review and triangulation across data sources.

RESULTS: Participants had a mean age of 74 (SD 3.18) years; 19 of 20 (95%) were male, and 18 of 20 (90%) identified as White. All participants completed a video visit with technical support as needed. Structural barriers (eg, broadband access and device availability) and usability challenges (eg, audio-video setup and navigation) were common. Although digital ageism was not a predefined analytical category, age-related assumptions about technology emerged during observation, including participants attributing anticipated or experienced difficulties to age and expressing surprise or pride following successful completion of the visit. These age-related interpretations were analytically distinct from access and usability barriers and were interpreted as manifestations of digital ageism, particularly as internalized age-based expectations.

CONCLUSIONS: Formative ethnographic observation provided critical insights into how older adults experience telehealth encounters in real-world contexts and informed adaptations to recruitment and implementation procedures for a subsequent randomized controlled trial. Although digital ageism was not an original study aim, age-related assumptions about technology emerged as an important interpretive factor shaping engagement with video-based care. Incorporating ethnographic methods prior to trial implementation may help identify otherwise overlooked barriers and improve the inclusivity and feasibility of technology-focused clinical research involving older adults.

PMID:42060893 | DOI:10.2196/79409

Biol Res Nurs. 2026 Apr 30:10998004261445879. doi: 10.1177/10998004261445879. Online ahead of print.

ABSTRACT

IntroductionAn imbalance between pro- and anti-inflammatory factors is implicated in the pathogenesis of preeclampsia (PE). Although IL10 (rs1800896) and IL6 (rs1800795) genotypes are known to influence circulating cytokine levels, their associations with longitudinal inflammatory profiles across pregnancy have not been well characterized.MethodsWe conducted a retrospective case-control study to longitudinally compare nine pro- and four anti-inflammatory cytokines across pregnancy based on IL6 and IL10 genotype. The cohort included 111 women with overweight/obesity (37 with PE; 74 without PE), matched 2:1, and predominantly Black (72%). Separate 3 × 3 mixed multivariate analyses of variance (MANOVAs) assessed interactions between IL6 or IL10 genotype (between-subjects’ factor) and pregnancy trimester (within-subjects factor). Pro- and anti-inflammatory cytokines were analyzed in separate models for each genotype. Due to the exploratory nature of the study and the examination of clinical relevance, statistical significance was set at p = .10.ResultsPro-inflammatory cytokine levels changed over pregnancy (p < .05) but were not associated with IL6 or IL10 genotype (all p > .10). Anti-inflammatory cytokine levels also varied across pregnancy (p < .05). IL6 genotype was not associated with anti-inflammatory cytokine levels (p > .10). In contrast, IL10 genotype was significantly associated with differences in anti-inflammatory cytokine levels across genotypes (V = 0.22, F (8,162) = 2.48, p = .014, η_p² = 0.11) and demonstrated an interaction effect with pregnancy trimester (V = 0.28, F (16,154) = 1.56, p = .087, η_p² = 0.14).ConclusionIL10 genotype may influence circulating anti-inflammatory cytokines across pregnancy and, as such, may contribute to preeclampsia by influencing anti-inflammatory cytokine expression across pregnancy.

PMID:42060858 | DOI:10.1177/10998004261445879

Diabet Med. 2026 Apr 30:e70341. doi: 10.1111/dme.70341. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults with type 2 diabetes mellitus are at elevated risk for severe pneumococcal disease, experiencing higher rates of complications and mortality. However, the evidence for the protective benefits of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against mortality in this demographic remains limited.

METHODS: This retrospective study included 8649 elderly people with type 2 diabetes mellitus in Soochow, China, comprising 3247 PPSV23-vaccinated individuals and 5402 unvaccinated patients. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of the association between PPSV23 vaccination and the risk of all cause mortality, pneumonia-related mortality, cardiovascular disease-related mortality and cancer mortality. Inverse probability weighting (IPW) was applied to estimate the average treatment effect (ATE) of universal PPSV23 vaccination compared to unvaccinated.

RESULTS: During the follow-up period, a total of 1557 deaths were recorded. Compared to unvaccinated elderly people with type 2 diabetes mellitus, those receiving PPSV23 vaccine exhibited significantly lower risks of all-cause mortality (HR: 0.47; 95% CI: 0.42-0.53), with reductions also observed in deaths related to cardiovascular disease (HR: 0.50; 95% CI: 0.41-0.62), pneumonia (HR: 0.62; 95% CI: 0.43-0.89) and cancer (HR: 0.54; 95% CI: 0.42-0.70). Furthermore, IPW estimates indicated that universal PPSV23 vaccination among the elderly people with type 2 diabetes mellitus could prevent an average of 11.4% of all-cause deaths (p < 0.001), 4.0% of cardiovascular disease-related deaths (p < 0.001), 0.8% of pneumonia-related deaths (p = 0.005) and 1.9% of cancer deaths (p < 0.001).

CONCLUSIONS: PPSV23 vaccination is associated with a reduced risk of all cause mortality, cardiovascular disease-related mortality, pneumonia-related mortality and cancer mortality in elderly people with type 2 diabetes mellitus.

PMID:42060856 | DOI:10.1111/dme.70341