Tag: pubmed

Neurology. 2026 May 26;106(10):e218009. doi: 10.1212/WNL.0000000000218009. Epub 2026 May 4.

ABSTRACT

BACKGROUND AND OBJECTIVES: The frequency and cognitive trajectory of cerebral amyloid angiopathy (CAA) in patients from memory clinics is uncertain. We aimed to determine whether patients with CAA have an increased risk of dementia in nondemented individuals presenting with a cognitive complaint.

METHODS: We retrospectively analyzed data of the MEMENTO prospective cohort that enrolled outpatients from 26 centers in France presenting with a cognitive complaint and a Clinical Dementia Rating (CDR) scale score ≤0.5. Participants aged >50 years who had interpretable baseline brain MRI were eligible for this study and followed every 6 months for 5 years with systematic assessment of dementia. Based on MRI analysis, participants were classified into 4 categories using the Boston criteria V2.0 and V1.5: probable CAA, possible CAA, deep/mixed small vessel disease (SVD), or controls (without imaging markers of SVD). The primary outcome was the progression to dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision criteria) evaluated by an expert committee. Cox proportional hazards models were used to determine hazard ratios (HRs) and CIs for the primary outcome.

RESULTS: Of 2,323 MEMENTO participants, 2,136 (92%) were included in this study. The mean age (SD) at baseline was 71.3 (7.9) years and 1,320 (62%) were women. Probable CAA was diagnosed in 413 (19.3%) patients using the Boston criteria V2.0, and 144 (7.0%) using the Boston criteria V1.5. During a median follow-up of 5.0 years (interquartile range 3.1-5.1), 307 participants developed dementia. Compared with controls, patients with probable CAA according to the Boston criteria V2.0 (HR 1.73, 95% CI 1.23-2.42) and V1.5 (HR 2.23, 95% CI 1.56-3.20) had increased risk of dementia. After adjusting for age, sex, baseline Mini-Mental State Examination score and hippocampal volume, patients with probable CAA per Boston criteria V1.5 but not V2.0 had an increased risk of dementia compared with controls. This association was not significant when further adjusting with APOE ε4.

DISCUSSION: CAA is a common condition in outpatients with mild cognitive symptoms. Patients with probable CAA according to the Boston criteria V1.5 but not V2.0 have increased risk of dementia. Further studies are required to externally validate these findings and evaluate potential mediation effect of APOE genotype.

PMID:42081781 | DOI:10.1212/WNL.0000000000218009

Health Aff (Millwood). 2026 May;45(5):570-579. doi: 10.1377/hlthaff.2025.01639.

ABSTRACT

Latino communities in California experience disproportionate climate-related health risks, including extreme heat and air pollution. Despite the state’s leadership in climate and environmental justice policy, existing data systems often do not integrate climate exposures, health outcomes, or neighborhood-level vulnerability in ways that meaningfully inform policy action. This Analysis draws on insights from the Latino Climate and Health Dashboard, a publicly available, neighborhood-level data tool that documents disparities between Latino and non-Latino White neighborhoods across California. The dashboard was developed with advisory board guidance, using the EPIS (exploration, preparation, implementation, sustainment) framework to structure data development and engagement. After the dashboard’s release, we convened community policy dialogues (“policy pláticas”) in which community organization leaders, practitioners, advocates, and legislative staff interpreted the findings and identified five policy priorities: coordinated climate and air quality governance, sustained community monitoring and early warning systems, equitable cooling and infrastructure investments, stronger connections between climate policy and health outcomes, and climate-resilient access to health care and worker protections. A participatory data tool can support equity-oriented climate-health policy making and inform efforts to translate data into policy action.

PMID:42081763 | DOI:10.1377/hlthaff.2025.01639

Health Aff (Millwood). 2026 May;45(5):462-470. doi: 10.1377/hlthaff.2025.01652.

ABSTRACT

Nonprofit hospitals conduct a community health needs assessment every three years to maintain federal tax-exempt status. Federal rules do not require these assessments to consider climate-related health risks, despite evidence that climate change affects health and health care delivery. This study examined the extent to which hospitals address climate-related health in community health needs assessments. We reviewed a nationally representative sample of 566 community health needs assessments (2021-24) from 3,468 US hospitals. Climate-related content was scored on an eighteen-point rubric including climate hazards and health risks (for example, extreme heat and flooding). The assessments’ climate-related content was limited (mean score, 2.51 of 18). Hospitals serving more climate-vulnerable communities, especially those with greater socioeconomic disadvantage, were less likely to identify climate-related health risks. Scores in the Northeast and West were nearly twice those in the South and Midwest, although they were still low. Federal requirements should better align community health needs assessments with emerging public health risks, including climate change, to improve health system resilience.

PMID:42081759 | DOI:10.1377/hlthaff.2025.01652

Health Aff (Millwood). 2026 May;45(5):516-524. doi: 10.1377/hlthaff.2025.01557.

ABSTRACT

Cold-related illnesses (CRIs) are preventable yet often deadly. Using twenty-five years of data from the National Inpatient Sample (1998-2022), we assessed nationwide trends in CRI hospitalizations and concomitant alcohol use, substance use, and mental health disorders and housing insecurity. We identified 345,314 (weighted) CRI hospitalizations and found that age- and sex-adjusted rates tripled from 42.0 to 122.5 per 100,000 hospitalizations. CRI inpatients were more likely than others to die during hospitalization, live in high-poverty ZIP codes, be publicly insured or uninsured, and have behavioral health conditions and housing instability. These findings highlight the rising and unequal toll of CRIs in the context of social instability and increasingly severe cold events associated with climate change. Expanded access to behavioral health treatments, increased subsidies for home heating, investments in affordable and supportive housing and shelter capacity, and public health measures to increase resilience to extreme weather events could reduce CRI morbidity and mortality.

PMID:42081755 | DOI:10.1377/hlthaff.2025.01557

Health Aff (Millwood). 2026 May;45(5):535-544. doi: 10.1377/hlthaff.2025.01659.

ABSTRACT

Outdoor workers face growing exposure to poor air quality, wildfire smoke, and extreme heat, yet protections remain uneven across states and incomplete federally, and little is known about outdoor workers. We combined data from national labor-force surveys with occupation-based exposure data and county-level environmental indicators on air quality, wildfire, and heat waves to describe and compare outdoor and indoor workers. Outdoor workers accounted for 21.9 percent of the workforce in 2023. About 16.9 percent of outdoor workers lived in counties with the highest frequency of unhealthy air quality days, and nearly one-third lived in counties with the highest wildfire (32.4 percent) and heat wave (31.4 percent) risks. Compared with indoor workers, outdoor workers had higher rates of uninsurance, more self-employment, lower access to paid sick leave, and higher rates of work injuries. Results identified outdoor workforces with elevated climate-related risks and differences in coverage and job arrangements, informing federal, state, and local prevention, standards, and enforcement.

PMID:42081754 | DOI:10.1377/hlthaff.2025.01659

JMIR Form Res. 2026 May 4;10:e80255. doi: 10.2196/80255.

ABSTRACT

BACKGROUND: The increasing reliance on patient portals for electronic health records has widened the digital health care access gap, particularly among low-income and Medicaid-insured populations. However, resources exist to assist low-income patients with portal enrollment; in obtaining a free smartphone; and, in New York, in obtaining low-cost internet. Automated bidirectional SMS text messaging offers a scalable and cost-effective strategy for identifying low-income patients’ digital health needs and eligibility for resources by using screening questions and providing tailored information on how to access available resources.

OBJECTIVE: This study aimed to increase portal access among low-income patients using automated bidirectional SMS text messaging and assess its feasibility and acceptability.

METHODS: This quality improvement initiative involved sending automated, bidirectional SMS text messages in English to 12,381 Medicaid-insured and/or low-income patients from a primary care practice. Messages assessed patients’ digital health needs and provided adaptive, personalized resources and assistance for enrolling in the patient portal and for accessing digital technology. We assessed response rates and follow-up portal enrollment rates. We surveyed participants regarding the acceptability, appropriateness, and usability of the SMS text messaging intervention, as well as their subsequent use of the patient portal. We performed descriptive statistics and a binomial probability test.

RESULTS: In total, 9.2% (1140/12,381) of patients responded to the SMS text messages, with 3.9% (481/12,381) opting out and 5.3% (659/12,381) actively engaging. Among respondents, 71.1% (469/659) completed the follow-up survey. Respondents were predominantly female (336/469, 71.6%), with ages ranging from 18 to 65 years or older. Most respondents rated the message’s clarity (420/469, 89.6%), its usefulness (400/469, 85.2%), and the demonstration of care by their health team (350/469, 74.6%) favorably. Concerns regarding privacy (61/469, 13%) and trustworthiness (71/469, 15%) were noted. Notably, 71% of initially unenrolled patients activated their patient portals after the intervention (P=.007), exceeding the hypothesized expectations.

CONCLUSIONS: Automated bidirectional SMS text messaging had mixed effects on promoting patient portal use among low-income patients. Response rates to SMS text messages were low when delivered from an unknown phone number. Among responders, most reported that these messages were useful and that they would recommend them to others. Research is needed to determine optimal strategies for introducing the program and vendor phone numbers to patients to improve engagement.

PMID:42081747 | DOI:10.2196/80255

JMIR Serious Games. 2026 May 4;14:e85673. doi: 10.2196/85673.

ABSTRACT

BACKGROUND: Asthma is a prevalent chronic respiratory condition among children worldwide. Inhalation therapy is the primary treatment method, but children often make errors in its use and exhibit poor adherence, which impacts treatment effectiveness. Therefore, interventions to improve inhalation techniques and enhance adherence are urgently needed.

OBJECTIVE: This study aimed to develop and evaluate BreatheBuddy, developed by Haoyu Zhang, a training system incorporating gamified feedback designed to enhance inhalation skills and treatment adherence in children with asthma.

METHODS: This study used a single-factor repeated-measures design and recruited 20 children aged 6 to 8 years (10 boys and 10 girls), all of whom had prior experience with inhalers. The experimental group used the BreatheBuddy system, which combines a physical inhaler with an interactive game-based software. The system provides real-time animated feedback based on data from inhalation, breath-holding, and exhalation to guide the rhythm and depth of inhalation. The control group used a conventional inhaler method without a gamified system. Inhalation accuracy, adherence, and satisfaction were assessed using the respiration sensor, the Player Experience of Need Satisfaction scale, the Game User Experience Satisfaction Scale (GUESS), and the System Usability Scale (SUS) scales. Statistical comparisons between the groups were conducted using paired t tests and Mann-Whitney U tests to analyze differences.

RESULTS: The experimental group demonstrated significant improvements in inhalation accuracy, with longer breath-holding times and more stable breathing patterns compared to the control group (P<.001). The experimental group also exhibited significantly higher engagement and motivation, with Player Experience of Need Satisfaction (standardized score=93.83) and GUESS (median 87.92, IQR 86.54-88.46) scores markedly higher than those of the control group. Usability scores for the experimental group were also superior, with an SUS score of 88.96 (P<.001). Additionally, children in the experimental group showed reduced anxiety and improved focus during training.

CONCLUSIONS: BreatheBuddy effectively optimized children’s inhalation skills, boosted treatment adherence, and relieved inhalation-related anxiety. Different from conventional non-gamified training or simple game-based distraction, this study integrated breathing behaviors into core game interaction. With dynamic respiratory rhythm feedback, the system unifies skill training, motivation promotion, and emotional regulation. Combined with standard inhaler operation and immersive gamified interaction, it presents a novel behavior-oriented design paradigm. This work provides empirical evidence for gamified intervention in pediatric respiratory treatment and offers a practical auxiliary tool for clinical daily training to strengthen children’s self-management. Further research will focus on personalized adjustment and wider clinical application of the system.

PMID:42081746 | DOI:10.2196/85673

JMIR Mhealth Uhealth. 2026 May 4;14:e85353. doi: 10.2196/85353.

ABSTRACT

BACKGROUND: Problematic smartphone use among adolescents is a growing public health concern closely associated with psychological distress and loneliness. Effective, culturally grounded, school-based interventions are needed.

OBJECTIVE: The aim of this study was to assess the effects of a 12-week program combining traditional social sports games and mental exercises on smartphone addiction, nomophobia, psychological distress, and loneliness in adolescents.

METHODS: In this randomized controlled trial, 69 school-recruited Tunisian adolescents (aged 14-16 years) with clinically elevated smartphone addiction scores were assigned to an experimental group (n=36, 52.2%) or a control group (n=33, 47.8%). The experimental group received a 12-week intervention comprising 4 weekly sessions integrating traditional social sports games with mental exercises, whereas the control group continued standard physical education. Outcomes (smartphone addiction, nomophobia, psychological distress, and loneliness) were assessed at baseline and after the intervention using scales validated in Arabic.

RESULTS: Linear mixed-effects models adjusted for age, sex, and BMI revealed significant group × time interactions of moderate magnitude across all outcomes (P<.05 in all cases) favoring the experimental group. Adjusted postintervention comparisons confirmed significantly lower scores in the experimental group for smartphone addiction, nomophobia, psychological distress, and loneliness (P<.05 in all cases; partial ηp2=0.08-0.12). Mediation analysis indicated that reductions in loneliness accounted for 34.4% of the intervention’s effect on smartphone addiction, consistent with partial mediation.

CONCLUSIONS: A culturally adapted, school-based intervention combining traditional social sports games and mental exercises significantly reduced problematic smartphone use and improved psychological well-being. The partial mediation through reduced loneliness highlights the critical role of social connectedness in adolescent digital health interventions.

PMID:42081744 | DOI:10.2196/85353

J Med Internet Res. 2026 May 4;28:e81070. doi: 10.2196/81070.

ABSTRACT

BACKGROUND: Obesity is a major global health concern, and scalable digital solutions are urgently needed. While digital lifestyle interventions (DLSIs) have shown promise, prior meta-analyses often included hybrid formats with human support, limiting insights into the effectiveness of fully digital interventions.

OBJECTIVE: This study aimed to evaluate the independent effects of standalone DLSIs-defined as interventions delivered exclusively via digital platforms without in-person or adjunctive support-on anthropometric and dietary outcomes in adults with overweight or obesity.

METHODS: We searched MEDLINE, Embase, PsycINFO, Web of Science, and the Cochrane Library from inception through March 4, 2026. Eligible studies were randomized controlled trials (RCTs) evaluating stand-alone DLSIs in adults with overweight or obesity. Interventions were included if they targeted diet or physical activity exclusively through digital platforms. We included fully automated, asynchronous, or one-to-many synchronous systems without individualized support. Studies involving hybrid interventions, including one-to-one synchronous human interaction, nonadult populations, or non-RCT designs, were excluded. Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (Cochrane Bias Methods Group). Meta-analysis used a random-effects model with the Hartung-Knapp-Sidik-Jonkman method, and heterogeneity was assessed using I2 statistics. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS: A total of 19 RCTs involving 3556 participants were included. Stand-alone DLSIs significantly improved anthropometric outcomes compared to controls (standardized mean difference 0.26, 95% CI 0.14-0.38; 95% prediction interval [PI] -0.16 to 0.68; P<.001; 19 studies; n=3556; I2=56.1%), corresponding to an additional weight loss ranging from 2.62 kg to 6.55 kg, depending on the baseline body weight. Significant improvements were also found in dietary outcomes (standardized mean difference 0.26, 95% CI 0.04-0.48; 95% PI -0.29 to 0.81; P=.008; 8 studies; n=1365; I2=57.5%). Subgroup analyses for anthropometric outcomes revealed significant differences only by control group type (P<.001), with waitlist controls showing the largest effect. For dietary outcomes, no significant subgroup differences were found (P>.05). While most studies showed a low risk of bias, substantial statistical heterogeneity was observed in some outcomes. Consequently, the certainty of evidence for both outcomes was rated as moderate.

CONCLUSIONS: This review is innovative as it is the first to isolate the pure efficacy of stand-alone DLSIs by excluding synchronous human support. Our findings provide moderate-certainty evidence that these tools are effective for weight management and dietary improvement without human intervention. While stand-alone DLSIs offer a highly scalable, cost-effective first-step intervention, the PIs included zero, and substantial heterogeneity was observed, suggesting that benefits may vary across settings. Future research should identify user characteristics that maximize engagement with unguided digital tools.

PMID:42081742 | DOI:10.2196/81070

J Med Internet Res. 2026 May 4;28:e75675. doi: 10.2196/75675.

ABSTRACT

BACKGROUND: Medical residency is a demanding training stage characterized by high levels of stress and burnout. As digital natives, current medical trainees (ie, residents) are frequent users of social media; however, little is known about how their personal (nonprofessional) use relates to burnout and social media addiction (SMA).

OBJECTIVE: This study aims to characterize the prevalence of SMA among Chinese medical trainees and explore its complex relationships with social media use patterns, occupational burnout, and related risk and protective factors.

METHODS: A nationwide cross-sectional survey was deployed through Wenjuanxing and disseminated via WeChat between August 29 and September 10, 2024. Data included demographics, physical and psychiatric health history, work variables (eg, training year and night shifts), personality traits, and social media use. SMA was assessed using the Bergen Social Media Addiction Scale. Logistic regression was performed to identify predictors of addiction, and mediation and moderation analyses were conducted to clarify the role of occupational burnout.

RESULTS: Of 3621 medical trainees, 211 (5.8%) met the criteria for SMA (Bergen Social Media Addiction Scale ≥24, indicating addiction). Second-year medical trainees reported the highest addiction prevalence (92/1159, 7.9%). Logistic regression analysis revealed that higher burnout (odds ratio [OR] 1.41, 95% CI 1.23-1.62; P<.001), longer daily use (OR 1.39, 95% CI 1.23-1.56; P<.001), physical health problems (OR 1.56, 95% CI 1.13-2.16; P=.006), and psychiatric history (OR 2.00, 95% CI 1.41-2.84; P<.001) significantly increased the odds of addiction, whereas conscientiousness was protective (OR 0.92, 95% CI 0.86-0.99; P=.02). Social media use showed significant U-shaped associations with burnout, physical health problems, psychiatric history, personality characteristics, and mental health outcomes. For example, medical trainees using social media 1 hour or less (104/404, 25.7% with psychiatric history) and more than 4 hours daily (97/419, 23.2% with psychiatric history) both had higher risk profiles than moderate users. Mediation analysis showed that occupational burnout explained 28.1% of the effect of psychiatric history and 29.6% of the effect of physical health problems on addiction risk.

CONCLUSIONS: This large-scale survey provides the first systematic characterization of SMA among Chinese medical trainees and elucidates its associated risks and protective factors. Burnout consistently emerged as a key and pervasive predictor of SMA, functioning both as an independent risk factor and as a mediator amplifying the impact of health-related vulnerabilities. Moreover, the findings highlight that both minimal and excessive daily social media use may signal distinct behavioral manifestations of distress, potentially reflecting different clinical phenotypes: digital disengagement under acute stress versus compulsive engagement driven by chronic burnout. Notably, while mental health symptoms exhibited U-shaped associations with usage, SMA risk increased progressively with daily duration. These results underscore the need for interventions that extend beyond simply monitoring usage duration, emphasizing strategies to reduce burnout and enhance the overall well-being of medical trainees.

PMID:42081741 | DOI:10.2196/75675