Tag: pubmed

J Psychiatr Res. 2026 Jun 22;201:225-230. doi: 10.1016/j.jpsychires.2026.06.025. Online ahead of print.

ABSTRACT

INTRODUCTION: Major depressive disorder (MDD) is strongly associated with suicidal ideation, a major predictor of suicide attempts and completed suicide. Transcranial magnetic stimulation (TMS) has shown promise in improving suicidal ideation, though the generalizability of these findings to routine clinical practice remains uncertain. This study evaluated whether TMS exposure was associated with recurrent suicidal ideation among adults with moderate-to-severe MDD using real-world electronic health record data.

METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Adults with moderate-to-severe MDD and documented suicidal ideation who received TMS were compared with matched patients not exposed to TMS. Propensity score matching and Kaplan-Meier and Cox proportional hazards analyses were performed. A landmark sensitivity analysis excluding outcomes within the first 30 days after index was conducted to address potential immortal time bias.

RESULTS: After matching, 1193 patients per cohort were included. Recurrent suicidal ideation occurred in 22.5% of TMS-exposed patients versus 33.9% of controls (HR 0.584, 95% CI 0.500-0.681; p < 0.001). In the landmark sensitivity analysis, recurrent suicidal ideation occurred in 17.5% of the TMS cohort and 14.5% of controls, and the association was no longer statistically significant (HR 1.203, 95% CI 0.954-1.516; p = 0.118).

CONCLUSION: The initially observed association between TMS exposure and lower recurrent suicidal ideation attenuated substantially after landmark sensitivity analysis addressing potential immortal time bias. These findings do not provide robust evidence that TMS independently reduces recurrent suicidal ideation in adults with moderate-to-severe MDD.

PMID:42335495 | DOI:10.1016/j.jpsychires.2026.06.025

J Psychiatr Res. 2026 Jun 6;201:198-206. doi: 10.1016/j.jpsychires.2026.05.037. Online ahead of print.

ABSTRACT

BACKGROUND: Late-life depression (LLD) is a growing public health concern in aging populations. Although digital mindfulness interventions show promise for depression, anxiety, and insomnia, their efficacy and electroencephalogram (EEG) correlates in older adults with LLD remain unclear. This study evaluated the FocusZen Mindfulness Stress Reduction System, a digital mindfulness intervention with EEG feedback, in mild-to-moderate LLD.

METHODS: Fifty-four participants with mild-to-moderate LLD were randomly assigned to a 6-week intervention group (n = 27; daily FocusZen sessions) or a control group (n = 27; general health education). The primary outcome was the change in HAMD-17 score. Secondary outcomes included anxiety, sleep quality, cognition, and frontal EEG spectral activity. Data were analyzed using mixed-effects models and intention-to-treat principles.

RESULTS: The intervention group demonstrated significant reductions in depressive symptoms [HAMD-17: F(3, 132.69) = 8.83, P < 0.001], anxiety [HAMA: F(3, 129.95) = 8.34, P < 0.001], and sleep disturbances [PSQI: F(3, 128.91) = 5.55, P = 0.01], alongside improved cognition [MOCA: F(3, 133.19) = 5.14, P = 0.01]. Response and remission rates were higher in the intervention group. Exploratory EEG analysis showed increased frontal theta [F(1.96, 43.12) = 25.28, P < 0.001] and alpha activity [F(1.44, 31.73) = 22.92, P < 0.001].

CONCLUSIONS: FocusZen-based digital mindfulness reduced depressive, anxiety, and sleep symptoms and improved cognition in mild-to-moderate LLD, potentially accompanied by enhanced frontal theta and alpha activity.

TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2400086063; https://www.chictr.org.cn/.

PMID:42335492 | DOI:10.1016/j.jpsychires.2026.05.037

J Psychiatr Res. 2026 Jun 17;201:190-197. doi: 10.1016/j.jpsychires.2026.06.021. Online ahead of print.

ABSTRACT

Previous studies have linked opioid use to altered metabolic profiles, but findings have been inconsistent and mechanisms remain unclear. One potential mechanism involves increased adiposity, leading to chronic low-grade inflammation that elevates metabolic risk. Here, we examined metabolic profiles in individuals with opioid use disorder (OUD) and matched non-OUD controls, focusing on the sequential mediating roles of BMI and inflammation. Data from individuals with OUD (n = 281) and non-OUD (n = 246) were drawn from a natural history screening protocol from the National Institute on Alcohol Abuse and Alcoholism intramural program. Groups were matched on age, sex, race, ethnicity, socioeconomic status, and education via propensity score matching. Metabolic measures included body mass index (BMI), hemoglobin A1c (HbA1c), and lipid profiles, with lipid imbalance indexed by the atherogenic index of plasma (AIP). Inflammatory markers included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Individuals with OUD had significantly higher BMI (F_1,481 = 12.9, p < 0.001), higher HbA1c (F_1,481 = 10.5, p = 0.001), lower high-density lipoprotein cholesterol (HDL-C; F_1,481 = 46.2, p < 0.001), higher low-density lipoprotein cholesterol (LDL-C; F_{1, 481} = 11.9, p < 0.001), and higher AIP (F_1,481 = 20.7, p < 0.001) compared to non-OUD. Inflammatory markers were also elevated in individuals with OUD, including CRP (F_1,481 = 9.4, p = 0.002) and ESR (F_1,481 = 7.4, p = 0.007),and statistically mediated group differences in AIP and HbA1c, respectively. Our results are consistent with prior evidence of metabolic dysfunctions in individuals with OUD and suggest inflammation as a contributing mechanism. Targeting metabolic health and inflammation may offer new avenues for improving long-term health outcomes in OUD.

PMID:42335491 | DOI:10.1016/j.jpsychires.2026.06.021

Ticks Tick Borne Dis. 2026 Jun 23;17(4):102675. doi: 10.1016/j.ttbdis.2026.102675. Online ahead of print.

ABSTRACT

Illinois is known to have established populations of four vector tick species of human health concern: Ixodes scapularis, Dermacentor variabilis, Amblyomma americanum, and Amblyomma maculatum. These ticks can transmit pathogens causing eight reportable tick-borne diseases (TBDs): anaplasmosis, babesiosis, ehrlichiosis, Lyme disease, spotted fever group rickettsioses (SFG rickettsioses), Powassan virus disease, Heartland virus disease, and Bourbon virus disease. The incidence of these diseases is spatially varied and has been changing over time. The purpose of this research is to describe factors associated with human incidence of the various tick-borne diseases in Illinois and to compare this to factors associated with canine seroprevalence to similar tick-borne diseases. All cases of tick-borne diseases in humans reported to the Illinois Department of Public Health (IDPH) between 2004 (when reporting began) and 2022 were reviewed (n = 6423), with all county-level seropositivity and canine test data reported by the Companion Animal Parasite Council between 2009 (when reporting began) and 2022. Descriptive statistics were performed to identify spatial and temporal variation. Comparison with known risk factors was conducted using zero-inflated spatiotemporal modeling for anaplasmosis, ehrlichiosis, Lyme disease, and SFG rickettsioses in humans and anaplasmosis, ehrlichiosis, and Lyme disease in dogs. Every county in Illinois reported at least one case of a human TBD from 2004 to 2022. Most reported cases were in males (61%), white (71%), and non-Hispanic (64%) residents over 40 years of age (56%). On average, the annual number of human cases increased by 23 cases every year (95% CI: 15, 31), despite large year-to-year fluctuations, with 343 in 2022 and 645 in 2021. The spatial hotspots were noted in southern Illinois for human TBDs associated with A. americanum, and D. variabilis, and for dog exposure associated with A. americanum. Hotspots were also noted in northern Illinois for diseases and exposure associated with I. scapularis for both humans and dogs and across the 2004-2022 study period. Case incidence was higher in rural counties, counties with higher deer harvests, and counties with lower median household income. These findings can be used to guide public health efforts that target self-prevention strategies to decrease the risk of a tick bite and tick-borne diseases in Illinois and are applicable in similar midwestern states with expanding TBD risk.

PMID:42335481 | DOI:10.1016/j.ttbdis.2026.102675

J Med Internet Res. 2026 Jun 23;28:e90152. doi: 10.2196/90152.

ABSTRACT

BACKGROUND: Public health crises often reshape online discourse by amplifying uncertainty, frustration, stigma, and misinformation, with important implications for risk communication.

OBJECTIVE: This study examines these dynamics on Reddit (Reddit Inc) during a recent outbreak, using Mpox as a case study.

METHODS: We analyzed sentiment, topical themes, and audience engagement in posts and comments drawn from 4 Mpox-related subreddits. Using natural language processing methods, we applied sentiment analysis and latent Dirichlet allocation to classify 1169 posts and 6571 comments (from July 21, 2021, to July 16, 2025) into sentiment categories and 9 distinct topics. Of the 1169 posts, 611 (52.3%) were neutral, 370 (31.6%) were negative, and 188 (16.1%) were positive. Among comments, 2825 of 6571 (43%) were neutral, 1962 (29.9%) were negative, and 1784 (27.1%) were positive. We then used Kruskal-Wallis tests, Dunn post hoc comparisons, and Vargha-Delaney A to assess relationships among sentiment, topic, and engagement metrics.

RESULTS: Engagement differed significantly by sentiment (P<.001) and topic (P<.001). Negative posts had higher median scores (median 7, IQR 2-27) than positive ones (median 5, IQR 2-16; z score=6.02; adjusted P<.001; Vargha-Delaney A=0.55). Posts about systemic public health failures (Topic 4) received lower median scores (median 4, IQR 1.75-14.25) than other topics. Topic 9 accounted for 980 of 6571 (14.9%) comments, dominating discussions regardless of original post topic. Positive posts generated 284 of 922 (30.8%) positive comments, whereas negative posts received 526 of 1615 (32.6%) negative comments. Comments on positive posts had higher sentiment scores (Vargha-Delaney A=0.550), whereas comments on negative posts had lower sentiment scores (Vargha-Delaney A=0.463). Topic-level differences in comment sentiment were also observed: comments responding to posts on scientific- and policy-related debates (Topic 8) were more positive (Vargha-Delaney A=0.531), whereas those on systemic failures (Topic 4) were more negative (Vargha-Delaney A=0.478).

CONCLUSIONS: Overall, the findings highlight how audience reactions can amplify emotionally charged narratives and reframe technical information into socially and politically charged debates. These insights can inform public health communication strategies by anticipating likely audience responses, mitigating stigma and misinformation, and fostering constructive dialogue during health crises.

PMID:42335474 | DOI:10.2196/90152

JMIR Serious Games. 2026 Jun 23;14:e78169. doi: 10.2196/78169.

ABSTRACT

BACKGROUND: Exposure and response prevention is a first-line intervention for obsessive-compulsive disorder (OCD), yet many individuals with contamination concerns do not access care. Virtual reality exposure-based therapy (VRET) may improve scalability and acceptability.

OBJECTIVE: This pilot study evaluated the feasibility and acceptability of a standardized single-session VRET protocol targeting contamination concerns and whether it elicited within-session anxiety and exploratory contamination symptom change at 1-month follow-up.

METHODS: We conducted a single-arm pilot study in adults with elevated contamination concerns and no formal OCD diagnosis, recruited via convenience sampling. Participants completed a baseline survey, an in-laboratory VRET session using a standardized virtual public toilet environment, and a follow-up survey. Outcomes included momentary anxiety (Subjective Units of Distress Scale) during exposure, affect (positive and negative affect schedule) across time points, and contamination symptoms (Obsessive-Compulsive Inventory-Revised contamination subscale) at baseline and follow-up. Usability (System Usability Scale) and VR sickness were also assessed. Within-session outcomes used repeated-measures ANOVA or Friedman tests; symptom change used paired t tests (α=.05); point estimates include 95% CIs. Missing data were addressed using multiple imputation (random forest; m=5); 37.5% of participants did not complete the follow-up survey (overall missingness: 5.47%).

RESULTS: Sixteen participants were included (aged 18-32 years). Anxiety increased during exposure tasks and decreased after virtual hand washing in both trials (Exposure 1 Friedman Test: χ²3=28.56; P<.001; W=0.6); Exposure 2 repeated measures ANOVA: F1.85, 27.81=5.35; P=.01; Greenhouse-Geisser corrected=0.058. Negative and positive affect both changed significantly across time points (negative affect: Friedman Test: χ²3=13.76; P=.003; W=0.29 and positive affect: repeated measure ANOVA: F3, 45=4.60-4.71; P=.006-.007; Greenhouse-Geisser corrected=0.07-0.073). Contamination symptoms did not significantly change from baseline to follow-up (mean change 1.30, SD 3.39; 95% CI -0.36 to 2.96; P=.12). Usability was adequate (System Usability Scale mean 69.5, 95% CI 62.79-76.21).

CONCLUSIONS: This study is among the first to systematically evaluate a standardized single-session contamination-focused VRET protocol in adults with elevated contamination concerns who did not meet diagnostic criteria for OCD, a subthreshold population underrepresented in prior VRET research, which has focused on clinically diagnosed samples and multisession protocols. The protocol proved feasible and acceptable, eliciting within-session anxiety and providing benchmarks in existing clinical literature. Contamination symptom change at 1-month follow-up was not statistically significant, and the effect size estimate was sensitive to the missingness assumption, underscoring the need for adequately powered multisession designs in future trials. The usability profile and VR sickness levels that did not prevent session completion suggest self-administered or minimally supervised delivery warrants evaluation, with implications for scalable early intervention in individuals with elevated contamination concerns who have not accessed formal treatment.

PMID:42335471 | DOI:10.2196/78169

JMIR Med Inform. 2026 Jun 23;14:e81317. doi: 10.2196/81317.

ABSTRACT

BACKGROUND: Patient-generated health data (PGHD) can enhance patient-centered care by improving disease awareness and preparedness for clinical encounters. However, automated incorporation of PGHD into electronic medical records (EMRs), which is a prerequisite for broader clinical implementation, remains technically and administratively challenging.

OBJECTIVE: This study describes the development of Miri-Alimi, a PGHD collection platform that delivers mobile social networking service-based previsit questionnaires with automated transfer of structured patient responses into the EMR, and evaluates patient participation, EMR documentation quality, and user satisfaction in a cardiology outpatient clinic.

METHODS: This single-center observational study was conducted between August and November 2024 and included 751 consecutive cardiology outpatients, comprising 282 first-visit patients and 469 patients attending follow-up visits for heart failure. All eligible patients received a previsit electronic questionnaire link via KakaoTalk or multimedia messaging service prior to their scheduled visit. The primary outcomes were the overall survey response rate among all enrolled patients and EMR documentation completeness among follow-up patients with heart failure. Documentation quality was evaluated based on 3 prespecified parameters relevant to routine heart failure care-dyspnea, peripheral edema, and medication adherence status-and was quantified using an EMR completeness score ranging from 0 to 3. Secondary outcomes included patient and provider satisfaction assessed using postvisit 5-point Likert-scale surveys. Firth penalized logistic regression was used to evaluate the association between survey response status and EMR completeness, with adjustment for age and sex.

RESULTS: The response rate was 38.5% (289/751), including 48.9% (138/282) of new patients and 32.2% (151/469) of follow-up patients with heart failure. Responders were younger than nonresponders (mean 62.0, SD 15.7 years vs mean 69.8, SD 12.5 years; P<.001). Among the follow-up patients with heart failure, EMR completeness was higher among responders (median score 3, IQR 3-3) than among nonresponders (median score 0, IQR 0-1; P<.001). Patient satisfaction was high: 82.9% (63/76) to 92.1% (70/76) agreed that the system was appropriate, easy to use, and helpful, and 78.9% (60/76) completed the survey in <10 minutes. Both cardiologists and 7 of the 8 participating nurses supported continued use of the system, citing workflow efficiency gains.

CONCLUSIONS: Miri-Alimi enabled patient-friendly PGHD collection without requiring log-ins or a dedicated app and demonstrated direct transfer of patient responses into the EMR. Its use was associated with effective transfer and structured integration of PGHD into the EMR, as well as high satisfaction among survey respondents and participating staff. Further studies should evaluate sustainability and associations with long-term clinical outcomes across diverse care settings.

PMID:42335468 | DOI:10.2196/81317

JMIR Dermatol. 2026 Jun 23;9:e91126. doi: 10.2196/91126.

ABSTRACT

BACKGROUND: Acne is a chronic skin condition that primarily affects adolescents and young adults but can persist into adulthood. It can have repercussions on physical and mental health, self-esteem, and body image. The increasing use of social media for health information and peer support offers an opportunity to explore real-life experiences with acne.

OBJECTIVE: This study aims to analyze social media messages from users in the United States and the United Kingdom using artificial intelligence to assess the impact of acne on quality of life (QoL), identify discussion topics, and explore unmet needs.

METHODS: The data were extracted from public platforms using a query containing the word “acne” between January 1 and December 31, 2024. Data cleaning and filtering were performed using natural language processing, machine learning methods, and algorithms. Biterm topic modeling was used to identify the main discussion topics, and QoL impact was assessed using a deep learning algorithm adapted from the EuroQol 5-Dimension Questionnaire or the 36-Item Short Form Health Survey. Unmet needs were identified through manual annotation using the saturation method.

RESULTS: A total of 646,809 messages posted by 432,234 users were identified. The main topics included skincare routines and product recommendations (n=154,907, 23.9%), acne scars (n=135,643, 21%), and general treatment information (n=97,177, 15%). Engagement varied across topics and platforms. On Instagram, dietary and nutritional strategies (0.16%, SD 6.36%) showed the highest mean engagement, followed by skincare routines and product recommendations (0.11%, SD 4.81%). In general, engagement scores were higher in the United Kingdom compared to the United States across all topics. On TikTok, content about makeup and acne had the highest mean engagement score (3.03%, SD 92.65%). Overall, 52.9% (228,613/432,234) of the users expressed at least 1 QoL impact, most frequently related to signs and symptoms (175,604/228,613, 76.8%), social functioning (n=149,234, 65.3%), mental health (n=107,155, 46.9%), and cost (n=62,008, 27.1%). Of 3200 annotated messages, 582 contained unmet needs, including effective solutions for hormonal acne (111/582, 19.1%), clarity in identifying acne triggers (n=84, 14.4%), treatment guidance (n=68, 11.7%), and psychological support (n=68, 11.7%).

CONCLUSIONS: This study revealed the significant physical, psychological, social, and financial impact of acne on QoL and identified several unmet needs. Given the growing role of social media, these findings highlight opportunities for dermatologists and health professionals to educate and engage with the acne community through digital platforms.

PMID:42335467 | DOI:10.2196/91126

JMIR Form Res. 2026 Jun 23;10:e90020. doi: 10.2196/90020.

ABSTRACT

BACKGROUND: Leisure-time physical activity (LTPA) participation among Chinese college students remains insufficient despite growing public health concerns regarding sedentary lifestyles and obesity. Social media platforms have increasingly become important channels for delivering social support related to physical activity (PA); however, different dimensions of social support on social media may exert distinct psychological influences on exercise intentions.

OBJECTIVE: Guided by the theory of planned behavior, this study aimed to examine the direct and indirect relationships between different dimensions of social support on social media and Chinese college students’ intentions to engage in LTPA.

METHODS: A cross-sectional online survey was conducted among undergraduate and graduate students from a comprehensive university in East China between February and June 2022. A total of 310 valid responses were analyzed using structural equation modeling in R. Three dimensions of social support on social media, including companionship support, informational support, and self-esteem support, were examined as predictors of LTPA intention, with the theory of planned behavior constructs (attitude, subjective norms, and perceived behavioral control) modeled as mediators. Demographic characteristics, BMI, social media use, and prior PA behaviors were included as covariates.

RESULTS: Companionship support demonstrated the strongest positive association with LTPA intention, including both a direct effect (β=.348; P=.005) and an indirect effect through attitudes toward PA (β=.286; P=.002). Self-esteem support also showed a significant positive indirect association with LTPA intention via attitude (β=.138; P=.02). In contrast, informational support demonstrated a significant negative indirect effect on LTPA intention through attitude (β=-.291; P<.001). Subjective norms and perceived behavioral control did not significantly mediate the relationships between social support dimensions and LTPA intention. The findings suggest that companionship-oriented interactions on social media may strengthen positive exercise attitudes, whereas excessive or low-credibility informational content may undermine exercise motivation.

CONCLUSIONS: Different dimensions of social support on social media play distinct roles in shaping Chinese college students’ intentions to engage in LTPA. Social media-based PA interventions should prioritize companionship and esteem support while improving the credibility, personalization, and quality of informational support to reduce potential negative effects associated with misinformation and information overload.

PMID:42335465 | DOI:10.2196/90020

JMIR Nurs. 2026 Jun 23;9:e94722. doi: 10.2196/94722.

ABSTRACT

BACKGROUND: Nursing students are the future workforce, and their readiness to use digital health tools is important. Previous studies have focused on knowledge and attitudes; however, they have not examined the wide range of digital health literacy levels that may influence nursing students’ attitudes toward using telehealth in clinical settings.

OBJECTIVE: This study aimed to determine the relationship between nursing students’ digital health literacy and their attitudes toward telehealth use in practice.

METHODS: A cross-sectional design was used. The sample consisted of undergraduate nursing students enrolled in a Bachelor of Nursing program at a selected Saudi Arabian university. The online survey used 2 scales: the Digital Health Care Literacy Scale and the Nurses’ Attitudes Toward Use of a Telehealth Scale.

RESULTS: A total of 273 students participated (mean age 21.3, SD 1.9 years). Most of the nursing students demonstrated a high digital health literacy level (n=184, 67.4%; mean Digital Health Care Literacy Scale score 11.9 out of 15, SD 3.1). Digital health literacy was a significant predictor of positive attitudes toward telehealth use in practice (adjusted odds ratio 1.48, 95% CI 1.28-1.71; P<.001). Male students were significantly less likely to report positive attitudes than female students (adjusted odds ratio 0.62, 95% CI 0.39-0.97; P=.03). However, academic year, telehealth workshops, and informatics courses were not significantly associated with positive attitudes toward telehealth use in practice.

CONCLUSIONS: Higher levels of literacy appear to correlate with more positive attitudes toward telehealth use in practice. However, current formal education and workshops had no apparent influence on digital health literacy. This suggests a potential need for strengthening digital training and development in nursing education. This may enhance telehealth readiness and support future digital health care delivery.

PMID:42335464 | DOI:10.2196/94722