Tag: pubmed

JMIR Res Protoc. 2025 Jun 27;14:e65351. doi: 10.2196/65351.

ABSTRACT

BACKGROUND: Regular testing is recognized as a key strategy for HIV control. The 2023 Integrated Biological and Behavioral Survey (IBBS) in Cambodia revealed that nearly one-third of men who have sex with men (MSM) and one-fourth of transgender women (TGW) were never tested for HIV or not for more than 12 months. The majority of MSM and TGW were tested at community-based organizations (CBOs) facilities and by CBO outreach workers, while private facilities are poorly used for HIV testing (6% for MSM and 9% for TGW). Private pharmacies could be able to deliver HIV self-testing kits giving the advantage of confidentiality, anonymity, and time savings, in particular for those reluctant to visit CBOs. The recruitment of participants using a respondent-driven sampling method could provide the opportunity to reach MSM and TGW outside the network of CBOs.

OBJECTIVE: This pilot study aims to evaluate the feasibility of free HIV self-testing delivery by a private pharmacy combined with a respondent-driven sampling method to improve HIV testing among MSM and TGW in Phnom Penh, Cambodia.

METHODS: Both qualitative and quantitative approaches are used in this prospective feasibility study. The protocol was approved by the National Ethics Committee for Health Research in Cambodia (N0 351 NECHR). MSM and TGW aged more than 18 years old will be recruited via a respondent-driven sampling method with seeds recruited at hot spots and on social networks. The seeds will then distribute electronic and paper coupons to their networks physically and via social media, messaging, and calling applications. Each recruited peer will bring the coupon to receive direct and free access to one HIV self-testing kit at partner pharmacies as well as 10 additional coupons to recruit members of their networks. As for quantitative analysis, data from the study website will be imported, appended into a single matrix using Stata version 18SE (StataCorp), and analyzed using descriptive statistics, with a statistical significance level of .05. After 6 months, a qualitative assessment will be conducted among users, providers, and policymakers or key stakeholders to evaluate the acceptability and appropriateness of the strategy and to identify the barriers, facilitators, and recommendations. All transcripts will be analyzed according to the 6-phase reflexive thematic approach by Braun and Clarke. The results will be reported by participant-based and provider-based issues. QSR NVivo V.14 for Windows will be used to manage the data.

RESULTS: The study was funded by Agence nationale de recherches sur le sida, les hépatites, et les maladies infectieuses émergentes (ANRS) in September 2023. Approval of the study protocol was successfully obtained from the NECHR in Cambodia and the Commission Nationale de l’Informatique et des Libertés (CNIL) in France (Autorisation Tacite) in February 2025. Data collection will be conducted between September 2024 and December 2025. The initial results are expected to be published in February 2026.

CONCLUSIONS: This public-private partnership intervention could allow the hidden population of MSM and TGW in Phnom Penh to be reached and tested.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05745168; https://clinicaltrials.gov/study/NCT05745168.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/65351.

PMID:40577719 | DOI:10.2196/65351

JMIR Form Res. 2025 Jun 27;9:e63713. doi: 10.2196/63713.

ABSTRACT

BACKGROUND: Patients’ web-based access to their medical records and secure messaging (SM) via patient portals is becoming increasingly prevalent worldwide. SM offers several potential benefits, including improved health outcomes and increased patient engagement. However, SM also raises concerns about effects on the therapeutic relationship and may be constrained by factors such as limited digital literacy and access to digital devices. Evidence on the use of SM in mental health is limited, and results are inconclusive.

OBJECTIVE: This study aimed to examine (1) the purposes for which health care professionals (HCPs) and patients with psychiatric disorders use SM to communicate and (2) the specific use patterns associated with both patients and HCPs.

METHODS: The secure messages (n=274) of 38 patients with psychiatric disorders and 4 HCPs (psychiatrists) from 3 psychiatric outpatient clinics in Brandenburg, Germany, was analyzed using thematic analysis. The data selected for this study represent a subsample from a larger study comprising a total of 116 patients. The subsample consists of the patients and HCPs who used SM.

RESULTS: A total of 274 messages were analyzed: 22.3% (61/274) were initial notes from HCPs, 44.5% (122/274) were patient responses, and 33.2% (91/274) were HCP replies. Patients sent between 1 and 15 messages (mean 4.16, SD 3.42) and logged in 1 to 42 times (mean 10.78, SD 9.38). Most messages were sent during the day, although some were also sent at night and in the early morning. Regarding the purposes of SM, 4 core functions of SM were identified: reporting and feedback, interpersonal uses, intrapersonal uses, and organizational uses. Both patients and HCPs used SM to share treatment-relevant information and elicited feedback on treatment and medication. Furthermore, secure messages included expressions of gratitude by the patients, in addition to well-wishes and emotional support from the HCPs. SM allowed patients to reflect on their treatment and provide self-encouragement. Finally, secure messages were used to address organizational aspects such as scheduling, appointments, and administrative tasks.

CONCLUSIONS: SM in outpatient mental health care is multifaceted and holds the potential to enhance therapeutic contact and improve access to care by enabling quick, low-threshold communication between patients and HCPs, allowing treatment-related concerns to be addressed promptly and effectively. However, the asynchronous nature of SM also poses new challenges, particularly in managing acute mental health crises and in setting boundaries to prevent HCPs from being perceived as constantly available. Therefore, specific training for HCPs-both during medical education and in clinical practice-is essential, along with clear guidelines on handling crises and managing sensitive information.

PMID:40577718 | DOI:10.2196/63713

JMIR Form Res. 2025 Jun 27;9:e69075. doi: 10.2196/69075.

ABSTRACT

BACKGROUND: Large language model (LLM)-assisted content analysis (LACA) is a modification of traditional content analysis, leveraging the LLM to codevelop codebooks and automatically assign thematic codes to a web-based reviews dataset.

OBJECTIVE: This study aims to develop and validate the use of LACA for analyzing hospital web-based reviews and to identify themes of issues from web-based reviews using this method.

METHODS: Web-based reviews for 53 private hospitals in Selangor, Malaysia, were acquired. Fake reviews were filtered out using natural language processing and machine learning algorithms trained on yelp.com validated datasets. GPT-4o mini model application programming interface (API) was then applied to filter out reviews without any quality issues. In total, 200 of the remaining reviews were randomly extracted and fed into the GPT-4o mini model API to produce a codebook validated through parallel human-LLM coding to establish interrater reliability. The codebook was then used to code (label) all reviews in the dataset. The thematic codes were then summarized into themes using factor analysis to increase interpretability.

RESULTS: A total of 14,938 web-based reviews were acquired, of which 1121 (9.3%) were fake, 1279 (12%) contained negative sentiments, and 9635 (88%) did not contain any negative sentiment. GPT-4o mini model subsequently inducted 41 thematic codes together with their definitions. Average human-GPT interrater reliability is perfect (κ=0.81). Factor analysis identified 6 interpretable latent factors: “Service and Communication Effectiveness,” “Clinical Care and Patient Experience,” “Facilities and Amenities Quality,” “Appointment and Patient Flow,” “Financial and Insurance Management,” and “Patient Rights and Accessibility.” The cumulative explained variance for the six factors is 0.74, and Cronbach α is between 0.88 and 0.97 (good and excellent) for all factors except factor 6 (0.61: questionable). The factors identified follow a global pattern of issues identified from the literature.

CONCLUSIONS: A data collection and processing pipeline consisting of Python Selenium, the GPT-4o mini model API, and a factor analysis module can support valid and reliable thematic analysis. Despite the potential for collection and information bias in web-based reviews, LACA of web-based reviews is cost-effective, time-efficient, and can be performed in real time, helping hospital managers develop hypotheses for further investigations promptly.

PMID:40577714 | DOI:10.2196/69075

West J Emerg Med. 2025 May 20;26(3):425-430. doi: 10.5811/westjem.21279.

ABSTRACT

INTRODUCTION: Pain is a common chief complaint in the emergency department (ED), and there are known disparities in the management of pain among racial/ethnic minorities, women, and older adults. Transgender and gender diverse (TGD) individuals comprise another under-represented patient population in emergency medicine and are also at risk of disparities in care. To measure and evaluate the magnitude of care inequities among TGD individuals, first we need to be able to accurately identify the right cohort and comparison groups. The primary objective of this study was to establish an accurate and generalizable process for identifying TGD patients through the electronic health record (EHR). Secondary objectives included creating and validating a method for matching and comparing of TGD patients to cisgender patients.

METHODS: This was a retrospective, observational cohort study that included patients presenting to Mayo Clinic EDs with a chief complaint of abdominal pain across four states (MN, WI, AZ, FL) between July 1, 2018-November 15, 2022. Patients ≥12 years of age were included. Patients’ sex assigned at birth and gender identity was extracted from the EHR via patient-provided registration fields. Two independent investigators independently reviewed each medical record of the identified TGD patient to validate the accuracy of pulled gender identity. Discrepancies were resolved by a third reviewer. Each transgender patient was matched to cisgender GBQ males (gay, bisexual, queer), cisgender LBQ (lesbian, bisexual, queer) females, cisgender heterosexual males, and cisgender heterosexual females using propensity score (PS) matching. We calculated the PS values using a multivariable logistic regression model where being transgender was the outcome, and covariates in the model included age, site, mental health history, and gastrointestinal history.

RESULTS: We initially identified 300 patients as TGD based on electronic data pull. An additional 1,000 patients were also included in the cohort for matching purposes. The agreement between electronic and manual review was 99.9%, and the kappa was 0.998 (95% confidence interval 0.994-1.000). We were able to match patients except for GBQ males due to low numbers. There is a significant difference in age between groups (P <0.001) with GBQ males being older than other groups.

CONCLUSION: The methodology for identifying transgender and gender diverse patients in the EHR was accurate compared to manual review of gender identity. The TGD patients were able to be well matched, except to GBQ males. This provides a validated method to identify TGD patients in the EHR and further study disparities they may receive in care.

PMID:40577712 | DOI:10.5811/westjem.21279

J Med Entomol. 2025 Jun 19:tjaf065. doi: 10.1093/jme/tjaf065. Online ahead of print.

ABSTRACT

Vertebrate and plant hosts provide arthropods with a range of stimuli to aid in their localization, among which semiochemicals, volatile cues enabling hosts to be located through their odours, stand out as particularly important. Recognizing their potential in vector control, this study investigates semiochemicals as viable alternatives for effective vector management strategies. In this study, behavioral responses of Phlebotomus papatasi (Scopoli, 1786) adults to 11 semiochemicals, derived from plant and vertebrate hosts and previously tested on various vector species, across 3 concentrations (10-2%, 10-3%, and 10-4%) were evaluated using a dual-choice olfactometer. A total of 1,110 females and 1,110 males were individually assayed, with behavioral responses quantified through trap selection and response times. Notably, 1-octanol (10-2%) consistently exhibited the lowest attractiveness, whereas octanal, decanal, 1-hexanol, 1-octen-3-ol, ocimene, linalool oxide, and sulcatone elicited significant attractive effects, with pronounced sex-specific and concentration-based differences. Mixtures, formulated from the most attractive individual concentrations, revealed both synergistic and antagonistic interactions, underscoring the complexity of chemical interplay in mediating host-seeking behavior. Statistical models demonstrated significant interactions among semiochemical type, concentration, and sex, influencing both behavior and decision latency. This study marks the first investigation into the attractant effects of plant- and animal-derived semiochemicals on Ph. papatasi adults within an olfactometer system. The results are expected to provide critical insights into sand fly ecology and the epidemiology of sand fly-borne diseases while contributing to the development of integrated vector management strategies.

PMID:40577701 | DOI:10.1093/jme/tjaf065

Child Maltreat. 2025 Jun 27:10775595251352200. doi: 10.1177/10775595251352200. Online ahead of print.

ABSTRACT

This study used a subset of data from a randomized controlled trial that evaluated the effects of an in-home substance use and dyadic therapy model that provides treatment to child welfare-involved parents. Participants (N = 388) were randomly assigned to Family-Based Recovery (FBR) (n = 268) or treatment-as-usual (TAU) (n = 120). Two child welfare outcomes were examined 18 months post-randomization: out-of-home placements (OOHP) and child protective service (CPS) re-referrals. Overall, 17.3% of parent-child dyads experienced OOHP and 24% CPS re-referrals. Fourteen percent of FBR-assigned dyads experienced an OOHP compared to 24% of TAU dyads. There were no differences in the CPS re-referral outcome by group assignment (FBR: 23.9%; TAU: 24.2%). Cox Proportional Regression results showed adjusted hazard rates of OOHP for FBR-assigned dyads were half compared to TAU-assigned dyads (.52, 95% CI [.32, .85], p = .009). Survival curves showed FBR had fewer dyads with OOHP episodes, and the OOHP event was statistically delayed compared to those assigned to TAU (Wald X² = 6.89; p = .009). Hazard rates of CPS re-referrals were similar for both groups, and no differences were found in the survival curves for CPS re-referrals between FBR and TAU. Results indicate that FBR is an effective model for caregivers experiencing SUD while reducing the likelihood of OOHP.

PMID:40577698 | DOI:10.1177/10775595251352200

JMIR Pediatr Parent. 2025 Jun 27;8:e65581. doi: 10.2196/65581.

ABSTRACT

BACKGROUND: We evaluated a pilot mobile health (mHealth) intervention aimed at improving postnatal maternal and infant health. The intervention featured provider-led group sessions for education, health care communication, in-person care referrals, and virtual mHealth support for postpartum mothers through weekly calls, texts, interactive voice response (IVR), and a phone app.

OBJECTIVE: We aimed to assess the preliminary effectiveness of the pilot mHealth intervention, MeSSSSage (Maa Shishu Swasthya Sahayak Samooh, which means maternal and child health support group), on infant health knowledge, behaviors, and outcomes at 6 months post partum. We focus on maternal knowledge of infant danger signs and optimal young child feeding practices at 6 months post partum and also evaluate maternal care-seeking behaviors for infants, adherence to age-appropriate immunization, and infant and young child feeding practices such as early initiation of breastfeeding and complementary feeding.

METHODS: We evaluated the preliminary effectiveness of an intervention on maternal health knowledge among 135 participants in Punjab, India, who completed pre- and postintervention surveys. The intervention, led by research personnel with backgrounds similar to community health officers, aimed to empower society and support universal health coverage if successful. We assessed changes in knowledge of maternal danger signs and the appropriate age for introducing different food groups over 6 months post partum. Additionally, we examined postintervention differences in health-seeking behavior for infants, adherence to age-appropriate immunizations, and adoption of breastfeeding and complementary feeding practices among women in the synchronous (group call), asynchronous (IVR and app), and control arms.

RESULTS: Of 12 infant risk factors, maternal knowledge of infant danger signs remained low (mean range: 1.85-2.31 preintervention and 1.81-2.22 postintervention). Participants in the synchronous arm had a statistically significant higher mean increase (mean difference: 0.87, 95% CI 0.06-1.69) compared to the control arm. Participants in synchronous arms had nearly 3-fold increased odds of infant health checkup by a clinical provider than asynchronous arm participants (odds ratio [OR] 2.72, 95% CI 1.02-7.23). No significant differences were noted in age-appropriate vaccine coverage among infants between arms, though vaccination coverage was more than 80% across all arms. Early initiation of breastfeeding remained low across all arms (~47%).

CONCLUSIONS: Our pilot study on group-based mHealth education and virtual social support during the postnatal phase showed modest yet promising results. Rigorous testing is crucial to strengthening the limited evidence base for group-oriented mHealth approaches.

PMID:40577696 | DOI:10.2196/65581

Neurology. 2025 Jul 22;105(2):e213832. doi: 10.1212/WNL.0000000000213832. Epub 2025 Jun 27.

ABSTRACT

BACKGROUND AND OBJECTIVES: Stroke is known for its poor prognosis. Although genetic instruments have shown promise in stratifying first stroke risk in the general population, it is unknown whether they are associated with stroke prognosis. Our study aims to explore the role of genetic risk of stroke in the progression from stroke-free to first stroke and then to recurrent stroke, subsequent coronary heart disease (CHD), and death in China and the United Kingdom.

METHODS: We used data from 2 prospective population-based cohorts, China Kadoorie Biobank (CKB) and UK Biobank (UKB). Participants who were unrelated and free of stroke and CHD at baseline were included. Genetic risks of stroke were quantified using integrative polygenic risk scores (iPRSs), which incorporated summary statistics from multiple genome-wide association studies for stroke outcomes and its subtypes, and vascular-risk traits. We used a multistate model to analyze the roles of genetic risk in the transitions from baseline to first incident stroke and then to recurrent stroke, subsequent CHD, and death.

RESULTS: Our study included 80,908 CKB participants and 380,348 UKB participants, with mean ages (% female) of 54.0 years (58.6%) and 56.1 years (55.4%). During median follow-ups of 11.9 years and 13.4 years in the CKB and UKB, respectively, 13,481 and 5,772 participants had their first stroke, neither experienced a CHD, or died within 28 days. These survivors had 5,707 and 943 recurrent strokes, as well as 1,196 and 418 CHD events, respectively. iPRSs were associated with recurrent stroke and CHD among stroke survivors in both populations. The corresponding hazard ratios (HRs) and 95% CIs per SD of iPRSs were 1.08 (1.05-1.11) and 1.08 (1.02-1.15) in CKB and 1.11 (1.03-1.19) and 1.23 (1.10-1.37) in UKB, respectively. There was no association between iPRSs and mortality risk. When we further divided the first stroke into 4 pathologic subtypes, both populations revealed statistically significant associations between iPRSs and the transitions from first ischemic stroke to recurrent stroke and CHD.

DISCUSSION: Our study shows that the genetic risk of first stroke also influences the prognosis of stroke survivors, indicating that PRS has the potential to improve stroke prognosis.

PMID:40577674 | DOI:10.1212/WNL.0000000000213832

JMIR Cancer. 2025 Jun 27;11:e70275. doi: 10.2196/70275.

ABSTRACT

BACKGROUND: Blood tests used to identify patients at increased risk of undiagnosed cancer are commonly used in isolation, primarily by monitoring whether results fall outside the normal range. Some prediction models incorporate changes over repeated blood tests (or trends) to improve individualized cancer risk identification, as relevant trends may be confined within the normal range.

OBJECTIVE: Our aim was to critically appraise existing diagnostic prediction models incorporating blood test trends for the risk of cancer.

METHODS: MEDLINE and EMBASE were searched until April 3, 2025 for diagnostic prediction model studies using blood test trends for cancer risk. Screening was performed by 4 reviewers. Data extraction for each article was performed by 2 reviewers independently. To critically appraise models, we narratively synthesized studies, including model building and validation strategies, model reporting, and the added value of blood test trends. We also reviewed the performance measures of each model, including discrimination and calibration. We performed a random-effects meta-analysis of the c-statistic for a trends-based prediction model if there were at least 3 studies validating the model. The risk of bias was assessed using the PROBAST (prediction model risk of bias assessment tool).

RESULTS: We included 16 articles, with a total of 7 models developed and 14 external validation studies. In the 7 models derived, full blood count (FBC) trends were most commonly used (86%, n=7 models). Cancers modeled were colorectal (43%, n=3), gastro-intestinal (29%, n=2), nonsmall cell lung (14%, n=1), and pancreatic (14%, n=1). In total, 2 models used statistical logistic regression, 2 used joint modeling, and 1 each used XGBoost, decision trees, and random forests. The number of blood test trends included in the models ranged from 1 to 26. A total of 2 of 4 models were reported with the full set of coefficients needed to predict risk, with the remaining excluding at least one coefficient from their article or were not publicly accessible. The c-statistic ranged 0.69-0.87 among validation studies. The ColonFlag model using trends in the FBC was commonly externally validated, with a pooled c-statistic=0.81 (95% CI 0.77-0.85; n=4 studies) for 6-month colorectal cancer risk. Models were often inadequately tested, with only one external validation study assessing model calibration. All 16 studies scored a low risk of bias regarding predictor and outcome details. All but one study scored a high risk of bias in the analysis domain, with most studies often removing patients with missing data from analysis or not adjusting the derived model for overfitting.

CONCLUSIONS: Our review highlights that blood test trends may inform further investigation for cancer. However, models were not available for most cancer sites, were rarely externally validated, and rarely assessed calibration when they were externally validated.

PMID:40577667 | DOI:10.2196/70275

JMIR Public Health Surveill. 2025 Jun 27;11:e67005. doi: 10.2196/67005.

ABSTRACT

BACKGROUND: Approximately 30% of people living with HIV in Brazil have suboptimal adherence to antiretroviral therapy (ART). Theoretical models of health behaviors and objective evidence support the role of perceived barriers in hindering health behaviors.

OBJECTIVE: We aimed to evaluate the psychometric properties of the perceived barriers to ART adherence (PEDIA) scale among gay, bisexual, and other men who have sex with men (MSM) and transgender and nonbinary (TGNB) persons in Brazil.

METHODS: Using a cross-sectional study design, we evaluated the factor structure, construct validity, convergent and discriminant factorial validity, and internal reliability of the PEDIA scale using 2 convenience samples of participants aged 18 years or older living in Brazil. Sample 2020 was recruited through an internet-based survey between February and March 2020 and Sample 2021 between May 2021 and January 2022. The study instrument included sociodemographic information, ART use, and the 3 measures of ART adherence. Using Sample 2020, we performed exploratory factor analysis (EFA) with parallel analysis to evaluate PEDIA’s factor structure. Based on the goodness of fit measures and theoretical relevance, we developed a reduced version of PEDIA (PEDIAr). Using Sample 2021, we performed a psychometric evaluation of PEDIAr, which included confirmatory factor analysis (CFA), examination of modification indexes and item-item and item-total correlations, and an assessment of its correlation with different measures of adherence to ART. Goodness of fit was evaluated based on multiple indices.

RESULTS: EFA conducted on Sample 2020 (n=1692) revealed a 2-factor structure with 3 factor loadings <0.4 (excluded). Using Sample 2021 (n=4893), modification indices from the CFA and item-item and item-total correlations along with item relevance analysis suggested the exclusion of 5 additional items. CFA fit indices for PEDIAr were adequate (root mean square error of approximation=0.07, comparative fit index=0.95, Tucker-Lewis Index=0.94, standardized root mean square residual=0.05). Construct validity was supported by factor loadings above 0.6 and negative correlations between PEDIAr scores and 3 measures of adherence to ART. McDonald omega was 0.795 and 0.859 for factors 1 and 2, respectively. The square root of the average variance extracted (AVE) was 0.704 and 0.711 for factors 1 and 2, respectively, and the difference between AVE and the square of the factor correlations with other items was small (0.001 and 0.009, respectively) and not statistically significant for both factors (P=.94 and P=.55, respectively).

CONCLUSIONS: PEDIAr, the 10-item reduced version of PEDIA, proved to be valid among gay, bisexual, and other MSM and TGNB persons in Brazil. This shorter instrument was able to capture 2 distinguished dimensions of the perceived barriers to adherence to ART (practical aspects and psychological aspects). By proactively identifying individuals struggling with adherence to ART, PEDIAr can facilitate timely interventions and improve personalized care.

PMID:40577646 | DOI:10.2196/67005