Tag: pubmed

Am J Public Health. 2026 Apr 2:e1-e11. doi: 10.2105/AJPH.2025.308379. Online ahead of print.

ABSTRACT

Objectives. To examine the relationship between housing insecurity and lesbian, gay, bisexual, pansexual, transgender, gender-expansive, queer, and questioning (LGBTQ+) identity with mental health burdens from climate events among California adults. Methods. We used cross-sectional data from 2023 California Health Interview Survey (n = 14 307). The outcome was self-reported mental health burden from climate events. Primary predictors were LGBTQ+ identity and housing insecurity. We conducted survey-weighted descriptive statistics and multivariable logistic regression, adjusting for covariates, with an interaction term assessing synergistic effects of primary predictors. Results. Transgender or gender-expansive (adjusted odds ratio [AOR] = 4.05; 95% confidence interval [CI] = 2.66, 6.15) and bisexual or pansexual individuals (AOR = 1.67; 95% CI = 1.19, 2.33) had significantly higher odds of climate-related mental health burden. High housing insecurity was also associated with greater odds (AOR = 1.26; 95% CI = 1.07, 1.48). Among gay respondents, experiencing housing insecurity was associated with approximately threefold higher odds of climate-related mental health burden (adjusted ratio of odds ratios = 3.1; 95% CI = 1.40, 6.82). Conclusions. Bisexual or pansexual and transgender or gender-expansive individuals reported higher mental health burdens from climate events. Housing insecurity appears to be a key social driver shaping disparities in climate-related mental health among LGBTQ+ populations. (Am J Public Health. Published online ahead of print April 2, 2026:e1-e11. https://doi.org/10.2105/AJPH.2025.308379).

PMID:41926729 | DOI:10.2105/AJPH.2025.308379

Am J Public Health. 2026 Apr 2:e1-e9. doi: 10.2105/AJPH.2026.308429. Online ahead of print.

ABSTRACT

Objectives. To determine if street cleaning interventions reduce gun violence and street crime. Methods. We conducted a stratified randomized controlled trial of 300 high gun violence street segments in Philadelphia, Pennsylvania, assigned to either a street cleaning intervention or a no-intervention control. The intervention provided biweekly or monthly trash removal, weeding, and sidewalk sweeping. Some segments received enhanced services, including free trash and recycling bins. Results. The biweekly and monthly intervention significantly reduced visible litter, by 16% (95% confidence interval [CI] = -24%, -8%; P < .01) and 17% (95% CI = -28%, -5%; P < .05), respectively. The biweekly and monthly intervention yielded a statistically insignificant reduction in gun violence of 27% (incident rate ratio [IRR] = 0.73; 95% CI = 0.42, 1.28) and 4% (IRR = 0.96; 95% CI = 0.44, 2.06). Street crime outcomes were similarly insignificant. Conclusions. Basic environmental cleanups reduce visible litter but do not significantly reduce gun violence or street crime. More comprehensive place-based prevention strategies are likely needed. Public Health Implications. Scalable, nonpolicing public health approaches to reduce violence and serious crime should consider interventions that target broader environmental factors beyond basic street cleaning until further study demonstrates otherwise. (Am J Public Health. Published online ahead of print April 2, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308429).

PMID:41926728 | DOI:10.2105/AJPH.2026.308429

Am J Public Health. 2026 Apr 2:e1-e12. doi: 10.2105/AJPH.2026.308461. Online ahead of print.

ABSTRACT

Objectives. To describe rates and characteristics of homicides of women across racial/ethnic groups, and describe intimate partner violence (IPV)-related and non-IPV-related homicide circumstances across racial/ethnic groups. Methods. We used National Vital Statistics System data to calculate homicide rates by racial/ethnic group of US women (aged ≥ 18 years) who were homicide victims from 2018 to 2022. We used National Violent Death Reporting System data to characterize the circumstances and suspects in these homicides by racial/ethnic group and IPV involvement. Results. The age-adjusted homicide rate was 3.2 per 100 000 women. Rates for non-Hispanic Black women and non-Hispanic American Indian/Alaska Native women were more than twice as high as those for other races/ethnicities. Most women were killed by a firearm (67.9%), fatally injured in a residence (64.8%), or killed by a male (92.5%). About half (47.3%) of homicides were IPV related. Non-IPV-related homicides were often perpetrated by family members (39.0%). Circumstances differed by racial/ethnic group. Conclusions. Homicide disproportionally affects certain racial/ethnic groups of women, and the characteristics of homicides differ across groups. Thorough examination of these differences could aid in effective, targeted homicide prevention. (Am J Public Health. Published online ahead of print April 2, 2026:e1-e12. https://doi.org/10.2105/AJPH.2026.308461).

PMID:41926727 | DOI:10.2105/AJPH.2026.308461

JCO Clin Cancer Inform. 2026 Apr;10:e2500316. doi: 10.1200/CCI-25-00316. Epub 2026 Apr 2.

ABSTRACT

PURPOSE: The exponential growth of scientific publications presents increasing challenges for clinicians and patients seeking to access up-to-date medical information. Language models (LMs) have emerged as powerful tools for generating and summarizing scientific content, but their performance in oncology remains insufficiently characterized from both professional and patient perspectives.

MATERIALS AND METHODS: We conducted a prospective, survey-based pilot study evaluating four LMs: Llama 3, Mistral Large 2, Gemma 2B, and Consensus, applied to the summarization and French translation of seven recent prostate cancer (PCa) abstracts. Each model received a standardized prompt to generate the summary of each abstract. Physicians (medical and radiation oncologists, urologists) and patients treated for PCa independently assessed the outputs using structured Likert-scale questionnaires covering qualitative criteria such as accuracy, usefulness, organization, and comprehensibility. Descriptive statistical analyses were then performed to characterize the distribution of responses across evaluation items.

RESULTS: A total of 40 respondents (14 physicians, 26 patients) provided 280 individual evaluations. Across physicians, consensus received the highest proportion of strongly agree ratings for all criteria, including completeness, accuracy, currency, organization, and usefulness. Only two physicians evaluated this model. Among patients, Gemma 2B achieved the highest strongly agree ratings for conciseness and comprehensibility, whereas Consensus obtained the highest score for organization; both models were similarly rated for usefulness. When considering overall positive evaluations (agree or strongly agree), Llama 3 and Mistral Large 2 performed well across groups but generated fewer strongly agree responses. Descriptive analyses demonstrated clear differences in perceived accuracy, completeness, and clarity across model architectures.

CONCLUSION: Perceived quality varied across models and user groups. Consensus was preferred by physicians, whereas patients more often favored Gemma. These differences underscore the importance of selecting models aligned with specific clinical communication tasks when deploying generative artificial intelligence in oncology.

PMID:41926718 | DOI:10.1200/CCI-25-00316

Health Policy Plan. 2026 Apr 2:czag044. doi: 10.1093/heapol/czag044. Online ahead of print.

ABSTRACT

In Uganda, frequent shortages of antihypertensive medications hinder continuity of care, undermining blood pressure management. Building on preliminary ethnographic research, this study evaluates a community-led, mobile-wallet-based pooling intervention- MoPuleesa-designed to improve medication access at a rural clinic in Nakaseke District, Uganda. Over a seven-month period, 183 patients enrolled and were linked to a digital savings platform that required monthly contributions of 5000 UGX (∼ USD 1.39) into a communal fund to bulk-purchase medications at a discounted cost. Using survey data, transaction logs, and clinic records, we assessed contribution behaviour, risk of adverse selection, equity, changes in medication availability, and patient blood pressure levels. On average, 48% participants contributed each month. Contribution rates showed no significant differences across education levels or medication costs, suggesting minimal equity concerns or adverse selection. Government pharmacies fulfilled only 8% of total prescriptions; however, for contributors, MoPuleesa closed 84% of the remaining medication gap. However, despite improvements in medication supply, we did not observe statistically significant improvements in blood pressure. Our findings demonstrate the feasibility and effectiveness of mobile money pooling in addressing chronic medication shortages. MoPuleesa achieved broad participation and equitable outcomes in a resource-constrained setting and significantly improved medication availability. We conclude that mobile-based fund pooling for medication can significantly improve medication supply and, with improvements in eligibility assessments, could serve as a complementary or intermediate solution to structural barriers in under-resourced health systems.

PMID:41926709 | DOI:10.1093/heapol/czag044

JMIR Nurs. 2026 Apr 2;9:e85780. doi: 10.2196/85780.

ABSTRACT

BACKGROUND: There is limited evidence on how brief, optional virtual reality (VR) experiences can be used with first-semester nursing students as experiential learning strategies to support understanding of foundational nursing concepts, outside of mandatory coursework or full-scale simulations. Additionally, little is known about students’ and teachers’ perceptions of VR as a low-stakes, supplemental learning strategy introduced early in nursing education. Examining these experiences can provide insight into the pedagogical value and scalability of VR-enhanced learning within the formal nursing curriculum.

OBJECTIVE: This study explored students’ and teachers’ experiences of a brief, optional, VR-enhanced workshop offered outside mandatory coursework in first-semester nursing education and described students’ perceptions of cognitive, social, and teaching presence.

METHODS: This was a cross-sectional evaluation at a Swedish public university. A single-session workshop, co-designed by nursing teachers and the university library makerspace (implementation context), combined brief headset exposures (sympathetic arousal via a short roller coaster experience and parasympathetic engagement via a short guided meditation), peer vital-sign practice (instructional aid), small-group synthesis, and a guided debrief aligned with the community of inquiry (CoI) framework. Immediately after the session, students completed a demographics questionnaire, a 7-item workshop-specific VR-perception set, and the 34-item CoI instrument, plus 2 open-ended items; teachers provided short reflections. Analyses were descriptive for quantitative data and summative content analysis of open-ended responses. Participants included 11.9% (16/134) of the invited first-semester students (mean age 25 years, SD 5.1; 15/16, 93.8% women; 6/16, 37.5% with prior VR exposure) and 3 teachers.

RESULTS: Most students agreed or strongly agreed that VR enhanced analysis and observation (12/16, 75%), exploration of phenomena (14/16, 87.5%), conceptual understanding and engagement (13/16, 81.3%), teacher support (13/16, 81.3%), and relevance to the session (14/16, 87.5%). CoI ratings indicated moderately positive perceptions (total mean 3.36, SD 0.44 on a 5-point scale), with cognitive presence rated the highest (mean 3.48, SD 0.41) and exploration being the top subdomain (mean 4.48, SD 0.49); design and organization and facilitation were similar (mean 3.42, SD 0.55 each), whereas direct instruction was rated lower (mean 2.88, SD 0.92). Open-ended remarks described links between theory and embodied experience and noted practical challenges.

CONCLUSIONS: This study used an early, optional format; the results showed that brief, contrastive VR exposures paired with scaffolded inquiry and a guided debrief were perceived as pedagogically valuable for exploring foundational physiological concepts, while also highlighting feasibility and logistical considerations for routine teaching. Findings are preliminary and reflect session-level perceptions from a small, self-selected sample; nevertheless, they suggest that structured, low-stakes VR may serve as a feasible supplemental strategy in first-semester nursing education, with implications for potential scalability.

PMID:41926702 | DOI:10.2196/85780

JMIR Form Res. 2026 Apr 2;10:e76037. doi: 10.2196/76037.

ABSTRACT

BACKGROUND: Individuals with one or more socially stigmatized identities experience extensive health disparities, resulting in poorer health outcomes. However, most studies consider the effects of only individual stigmatized identities.

OBJECTIVE: We aimed to quantitatively estimate the additive and multiplicative effects of stigmatized identities on self-reported overall health.

METHODS: We used survey data from 387,411 participants in the All of Us Research Program, which has assembled a disease-agnostic cohort intended to reflect the US population, to statistically estimate the first- and second-order effects of 47 stigmatized identities on self-reported overall health. We used a linear model to estimate the effects of individual and pairwise stigmas on self-ratings of overall health.

RESULTS: We began by aiming to create cohorts for all 93 stigmatized identities previously found to affect health, of which 47 (51%) could be practicably examined. We first modeled individual stigmas alone to contrast the results with those that included both individual and pairwise stigmas. After using the false discovery rate to adjust for testing multiple hypotheses in the collective model, 29 individual and 116 pairs of stigmas had statistically significant effects on self-reported overall health. All significant individual effects were negative or neutral except for skin cancer. Those with the largest negative effect on self-rated overall health were difficulty walking or climbing stairs, unemployed or unable to work, difficulty with errands, and low educational attainment. Pairs of intersecting stigmas had a mix of negative and positive incremental effects, indicating that some stigmatized identities are negative modifiers, such as depression, and other combinations are less negative than the sum of their individual negative effects, such as having difficulty with multiple types of activities of daily living. The individual stigmas with the largest number of statistically significant stigma pairs were unemployed or unable to work (14/47, 30%); depression and low income (11/47 each, 24%); and difficulty walking or climbing stairs, cognitive difficulties, obesity, and skin cancer (8/47 each, 17%).

CONCLUSIONS: Taken together, numerous pairs of stigmatized identities significantly affect self-reported overall health. While each stigmatization has both direct and indirect effects on health, the relative importance of direct and indirect effects will vary. Many of these are aligned with prior literature, and others warrant further exploration. While the large sample size of this study is a strength, we were unable to model higher-order intersectionality and encourage future research exploring this. The individual and pairwise identities with significant negative effects should be incorporated into research and clinical care by considering the multidimensionality of individuals and how that affects their overall health.

PMID:41926700 | DOI:10.2196/76037

J Clin Gastroenterol. 2026 Apr 3. doi: 10.1097/MCG.0000000000002376. Online ahead of print.

ABSTRACT

INTRODUCTION: Data collection on food insecurity and barriers to a healthy diet is not routinely done in hepatology clinics, although the prevalence of food insecurity is likely high. This is a pilot study to estimate the prevalence of food insecurity and characterize food-insecure patients with cirrhosis who receive routine outpatient care.

METHODS: Prospective survey of outpatients with cirrhosis to screen for food insecurity in the waiting room on the day of their appointment. Responses were linked to electronic medical record data for demographic, comorbidity, and health care utilization data. Descriptive statistics were calculated for patients who were food insecure versus food secure. Univariate and multivariable models were constructed to evaluate the relationships between patient factors and food insecurity.

RESULTS: Of 150 respondents, 25% (n=38) screened positive for food insecurity. In total, 69% (n=104) reported difficulty making the best food choices for their cirrhosis, 89% (n=34) among the food insecure, and 54% (n=60) among the food secure. Compared with food-secure individuals, those with food insecurity were younger (mean age 58.1 vs. 63.5 y, P=0.02), had lower BMI (mean 27.9 vs. 30.9, P=0.03), and were more likely to be Hispanic (15.8% vs. 4.5%, P=0.05) and Medicaid-insured (28.9% vs. 10.7%, P=0.01). Both groups had similar cirrhosis etiologies, co-morbidities, decompensation events, ED visits, and hospital admissions within the past year.

CONCLUSION: One in 4 patients screened during a routine outpatient hepatology visit reported food insecurity. Over 69% of patients reported difficulties with making cirrhosis-specific food choices, most of whom did not screen positive for food insecurity. Our findings underscore an urgent need for tailored screening and for interventions that address the unique barriers faced by cirrhosis patients.

PMID:41926693 | DOI:10.1097/MCG.0000000000002376

JMIR Aging. 2026 Apr 2;9:e84962. doi: 10.2196/84962.

ABSTRACT

BACKGROUND: Being socially connected is essential for health and well-being. Nonetheless, many older adults face social isolation, especially in ethnically diverse societies. Digital technologies offer a pragmatic approach to addressing problems with social connectedness; however, a consolidated understanding of their association with social connectedness among ethnic minority older adults remains unaddressed.

OBJECTIVE: We conducted a systematic review and meta-analysis to investigate the prevalence and utility of digital resources in promoting social connectedness among ethnic minority older adults.

METHODS: This systematic review and meta-analysis was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were retrieved from 4 electronic databases. A random-effects meta-analysis was used to estimate the pooled prevalence along with its 95% CI.

RESULTS: Twelve studies were included. The research approaches used by the included studies were as follows: quantitative (n=5), qualitative (n=5), and mixed methods (n=2). Overall, the estimated prevalence of internet use, which was defined as engaging in online activities through digital devices, was 81.8%. Commonly used digital devices were computers (66.7%), smartphones (63.2%), and tablets (29.3%). Sociodemographic, economic, and health-related factors influenced the adoption and use of digital resources among ethnic minority older adults. These older adults relied on digital resources to build meaningful social connections through social participation, maintaining cultural and religious ties, promoting transnational social networks, and fostering their potential for social connectedness. However, digital resources were not always useful for social connectedness and adversely affected in-person contact.

CONCLUSIONS: Digital resources can promote social connectedness among ethnic minority older adults by enabling them to maintain their cultural and social values. Cities and regions aiming to promote the social connectedness and well-being of ethnic minority older adults should consider intersectional factors that affect access to digital resources and the sustainable adoption of digital resources.

PMID:41926689 | DOI:10.2196/84962

JMIR Hum Factors. 2026 Apr 2;13:e77033. doi: 10.2196/77033.

ABSTRACT

BACKGROUND: Sleep is essential for overall health and well-being, but assessing sleep architecture is often costly and time-consuming, relying primarily on polysomnography (PSG). While wrist-worn wearables offer alternatives, they face limitations regarding user compliance, such as battery charging and physical discomfort. Nearable devices address these burdens, but they regularly lack rigorous validation, especially in real-world settings.

OBJECTIVE: This study evaluates the accuracy and reliability of the Withings Sleep Analyzer (WSA), a contactless sleep monitoring device, compared to PSG in a home setting using a large and diverse cohort of healthy individuals.

METHODS: A total of 117 healthy volunteers (69 women; mean 39.9, SD 11.4 years), prospectively recruited from the general population, underwent home-based PSG and simultaneous WSA recording. The study was conducted under free-living conditions, without constraints on substance intake, prebedtime activity, or forced sleep schedules. The main outcomes were the device’s performance in sleep-wake distinction and sleep stage identification using accuracy, kappa, sensitivity, specificity, and the mean absolute error of sleep measures on the entire population and demographic, clinical, and environmental subgroups.

RESULTS: WSA demonstrates high sensitivity (93%, 95% CI 92%-94%) for sleep detection and moderate sensitivity (73%, 95% CI 69%-77%) for wakefulness, achieving an overall accuracy of 87% (95% CI 86%-87%) for sleep-wake distinction. The device showed consistent performance across various demographic subgroups, including different age, BMI, mattress, and sleep arrangements (with or without bed partner) categories. Challenges were noted in accurately classifying specific sleep stages, particularly in distinguishing between light and deep sleep, with a mean accuracy of 63% (95% CI 62%-65%) and a Cohen κ of 0.49 (95% CI 0.47-0.51). The WSA tended to overestimate total sleep time (20 min, 95% CI 10 min to 31 min) and light sleep (1 h 21 min, 95% CI 1 h 8 min to 1 h 36 min) while underestimating rapid eye movement (-15 min, 95% CI -23 min to -8 min) and deep sleep (-46 min, 95% CI -59 min to -34 min) durations. Disagreements between expert reviewers were mirrored in part by the WSA’s misclassifications. Participants reported altered perceived sleep quality during the night with the PSG, suggesting discomfort during sleep.

CONCLUSIONS: Being contactless and placed under the mattress, the WSA offers a promising approach to long-term sleep monitoring in natural home environments. It shows competitive performance in sleep-wake and sleep stage identification compared to other consumer devices. Progress in wearable and nearable devices is necessary to enhance their accuracy to better support the monitoring of populations with impaired sleep, although limited by an imperfect gold standard. This work also emphasizes the importance of using large, diverse, and challenging datasets, as well as the need for a standardized methodology for accurate sleep stage classification.

PMID:41926681 | DOI:10.2196/77033