Tag: pubmed

BMC Public Health. 2026 May 4. doi: 10.1186/s12889-026-27512-z. Online ahead of print.

ABSTRACT

BACKGROUND: The main aim of this study is to investigate the connection between a high workload and health-related quality of life among in-home care workers in northern Sweden during the COVID-19 pandemic. We also investigate whether social support and control at work can prevent poor health due to high workload.

METHODS: A cross-sectional survey was conducted during the pandemic, with 629 (response rate 33 per cent) of an estimated 1,900 in-home care workers responding. Results were compared with a nearly identical survey conducted prior to the pandemic in which 1,154 (response rate 58 per cent) of an estimated 2000 in-home care workers responded. Psychosocial factors were measured using QPSNordic and health-related quality of life using EuroQol 5 Dimensions (EQ-5D). EQ-5D responses were translated into quality-adjusted life year (QALY) scores. Propensity scores were used with absolute risk differences.

RESULTS: During the pandemic, staff with high workload had a statistically significantly (6.2%) lower QALY score (confidence interval 2.2%-10.3%) compared to staff with a normal workload. This was also the case for the usual activities and the anxiety/depression dimensions of EQ-5D. These risk differences were greater, but not statistically significant, during the pandemic than before. The combination of a normal workload and a high degree of control over one’s work appeared to protect against a low QALY score, while social support at work did not seem to be protective.

CONCLUSIONS: High workload is related to poorer health-related quality of life. This is mainly attributable to anxiety/depression. In-home care organisations need to manage workload better to prevent poor health among staff during strained situations such as a pandemic. The results of our study indicate that in-home care organisations should increase their readiness to promote opportunities for staff to maintain a high degree of control over their work, in order to counteract variations in workload that ultimately appear to have a negative impact on HRQoL.

PMID:42082951 | DOI:10.1186/s12889-026-27512-z

BMC Nurs. 2026 May 4. doi: 10.1186/s12912-026-04714-9. Online ahead of print.

ABSTRACT

BACKGROUND: Nursing is intrinsically demanding, exposing practitioners to substantial workloads, emotional labour, and systemic healthcare challenges that contribute to significant psychological distress. In Ghana, the compounding effects of structural deficiencies within the healthcare system make nurses particularly vulnerable. However, research on culturally informed coping strategies within this population remains limited. This study examined the association between psychological distress and Africentric coping strategies among 248 nurses in public healthcare facilities in the Central and Greater Accra regions of Ghana.

METHODS: Data were collected using the Hospital Anxiety and Depression Scale (HADS) and the Africultural Coping Systems Inventory (ACSI). Psychological distress was operationalised as the summed HADS total score (range: 0-42). Descriptive statistics, Pearson correlation analysis, and multiple linear regression models were used to examine associations.

RESULTS: The mean HADS anxiety score was 12.22 (SD = 3.14) and mean depression score was 11.27 (SD = 3.06), indicating elevated anxiety and moderate depressive symptoms. Mean ACSI subscale scores were: Cognitive/Emotional Debriefing M = 2.11 (SD = 0.61), Spiritual-Centred Coping M = 2.18 (SD = 0.73), Collective Coping M = 1.96 (SD = 0.58), and Ritual-Centred Coping M = 0.75 (SD = 0.34). Spiritual (r = – .268, p < .05) and collective coping (r = – .587, p < .05) were significantly and negatively associated with psychological distress; cognitive and ritual coping were not. In regression models, only spiritual (β = -2.681) and collective (β = -0.811) coping demonstrated significant negative associations with distress. Demographic factors including gender, marital status, and professional rank were significant predictors of distress.

CONCLUSION: These findings highlight the importance of culturally and contextually tailored mental health support that incorporates spiritual resources and peer support networks. The study provides empirical evidence to guide healthcare policy, workplace mental health programming, and culturally responsive nursing practice in sub-Saharan Africa.

CLINICAL TRIAL: Not applicable.

PMID:42082950 | DOI:10.1186/s12912-026-04714-9

BMC Infect Dis. 2026 May 4. doi: 10.1186/s12879-026-13454-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Hepatitis B virus (HBV) coinfection worsens HIV care outcomes and liver disease risk, but genotype-specific data in the World Health Organization (WHO) Africa Region is limited. To address this gap, we assessed HBV genotype distribution and genotype-specific clinical features in a cohort of people living with HIV (PLHIV) in Maputo City, Mozambique.

METHODS: This was a sub-analysis of a prospective cohort study that included newly diagnosed, HIV/HBV coinfected patients who were enrolled from May 2021 to November 2023. DNA extraction and partial-genome nested PCR with Sanger sequencing was performed on plasma samples. HBV genotypes were assigned by BLASTn, Geno2pheno, HBVdb, and NCBI-HBV, and phylogeny was inferred with MAFFT-based alignments and maximum likelihood-based phylogenetics. Clinical/laboratory data (Hepatitis B e antigen, HBV viral load, aspartate aminotransferase, alanine aminotransferase, CD4⁺ T cell count, HIV viral load) were recorded. Fibrosis was estimated using the AST-Platelet Ratio Index (APRI) score and WHO thresholds. R was applied for statistical analyses. Group comparisons used Pearson’s chi-squared or Fisher’s exact and Wilcoxon rank sum tests (complete-case analysis).

RESULTS: Of 1,106 newly diagnosed ART-naïve PLHIV, 81 (7.3%) were hepatitis B surface antigen (HBsAg)-positive and genotyping was successful in 55 (68%). Among HBV genotyped patients, the median age was 33.0 years (IQR 30.0, 39.0), 37 (67.3%) were male, 46 (83.6%) had HBV genotype A (subgenotype A1) and 9 (16.4%) genotype E. Median AST, ALT, and APRI scores tended to be higher in genotype E than subgenotype A1 cases, although differences were not statistically significant (AST 71.9 vs. 37.9 U/L; IQR 26.0-118.0 vs. 29.0-98.1; ALT 36.5 vs. 32.6 U/L; IQR 20.4-63.0 vs. 20.2-57.7; APRI 1.3 vs. 0.5; IQR 0.3-1.8 vs. 0.3-1.3). HBV DNA > 2,000 IU/mL occurred in 52.2% of subgenotype A1 and 55.6% of genotype E cases. Most cases were HBeAg-negative (A1: 36/46, 78.3%; E: 6/9, 66.7%).

CONCLUSION: HBV subgenotype A1 and genotype E are prevalent among HIV/HBV coinfected patients in Maputo, often with high HBV DNA levels and evidence of liver injury. Routine HBV screening, simple fibrosis assessment and further research are recommended.

PMID:42082949 | DOI:10.1186/s12879-026-13454-9

BMC Infect Dis. 2026 May 4. doi: 10.1186/s12879-026-13500-6. Online ahead of print.

ABSTRACT

INTRODUCTION: The Prevention of Mother-To-Child Transmission (PMTCT) of Hepatitis B Virus (HBV) infection is a crucial strategy for achieving global HBV elimination by 2030. As HBV testing forms the foundation of effective PMTCT programs, empowering women of reproductive age to accept HBV testing and screening services is essential. This study applied the Theory of Planned Behaviour to investigate the impact of psychosocial factors, including attitude, subjective norm, perceived behavioural control, and risk perception, on HBV testing intentions among women of reproductive age.

METHODS: A hospital-based cross-sectional study was conducted among 400 non-pregnant women aged 18-49 years attending child welfare and family planning clinics in rural northern Ghana. Participants were selected using simple random sampling and completed a structured, pretested questionnaire based on constructs from the Theory of Planned Behaviour. Composite sum scores were computed for each construct, and internal consistency was assessed using Cronbach’s alpha. Spearman’s correlation and hierarchical multiple regression analyses were performed using SPSS version 26, with statistical significance set at p < .05.

RESULTS: The mean age of participants was 27.12 years (SD = 5.8). In the main-effects regression model, attitude (β = 0.650, p < .001), perceived behavioural control (β = 0.275, p < .001), and risk perception (β = 0.061, p = .022) were significant predictors of HBV testing intention, while subjective norms were not statistically significant. The model explained 75.3% of the variance in testing intention (R² = 0.753). When the interaction between attitude and subjective norms was added, the interaction term was statistically significant (β = -0.108, p < .001), accounting for an additional 1.1% of variance (ΔR² = 0.011).

CONCLUSION: Attitude and perceived behavioural control were the primary predictors of HBV testing intention among women of reproductive age in rural northern Ghana. Risk perception showed a smaller association with intention, while subjective norms did not independently predict intention but moderated the relationship between attitude and intention. Interventions aimed at increasing HBV testing intention should prioritise strengthening positive attitudes and enhancing women’s perceived ability to access testing services.

CLINICAL TRIAL REGISTRATION: The study is a cross-sectional study and hence did not involve any experimentation or trial; clinical trial registration was not applicable in this case.

PMID:42082944 | DOI:10.1186/s12879-026-13500-6

J Med Internet Res. 2026 May 4;28:e87158. doi: 10.2196/87158.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) integration in mobile health (mHealth) apps offers health care access opportunities in low-resource settings, yet opaque AI recommendations undermine trust and adoption. Existing explainable AI (XAI) frameworks, designed in Western contexts, fail to address the linguistic, cultural, and infrastructural realities of South Asian populations, creating barriers where users cannot understand AI recommendations, clinicians cannot validate outputs, and developers lack implementation guidance. Thus, understanding explainability requirements among educated, digitally literate populations provides foundational insights for future development of inclusive mHealth technologies.

OBJECTIVE: This study aims to (1) investigate stakeholder perceptions of trust and explainability in AI-driven mHealth in Bangladesh; (2) identify demographic predictors of trust; and (3) develop and propose a context-adapted framework benefiting developers, policymakers, clinicians, and end users in resource-constrained settings.

METHODS: This study used a sequential mixed methods design that combined a quantitative survey (n=137) with a qualitative phase involving 20 stakeholders. This qualitative cohort consisted of developers (n=4), XAI experts (n=6), and clinicians (n=10) who participated through either focus groups or individual interviews. We used statistical analysis to examine demographic predictors and applied thematic analysis to identify explainability needs specific to each stakeholder group.

RESULTS: Education level showed a significant effect on trust (F3, 133=2.81, P=.042). Completed undergraduate students reported lower trust (mean 3.14, SD 1.10) compared with current undergraduates (mean 3.66, SD 0.93), suggesting that undergraduate completion develops critical evaluation skills that may decrease uncritical acceptance of AI systems. Despite recognizing AI’s utility for preliminary guidance, users emphasized the necessity of human validation and expressed concerns about understanding AI’s decision-making logic. Interviews with different stakeholder groups revealed critical gaps. Developers acknowledged minimal explainability implementation in current mHealth apps, while medical professionals unanimously prioritized clinical judgment over automated outputs and advocated for physician-mediated AI systems. Synthesizing findings across all stakeholder groups revealed five core requirements: (1) Human-AI collaboration and clinical validation, (2) Transparent logic paths, (3) Contextual personalization, (4) Cultural and linguistic relevance, and (5) Trust calibration and ethical safeguards.

CONCLUSIONS: The framework bridges stakeholder misalignments and offers actionable guidance for design, deployment, and policy alignment in resource-constrained environments. By situating explainability within the sociocultural realities of South Asia, this research advances XAI beyond algorithmic transparency toward equity, inclusion, and user empowerment in digital health.

PMID:42081827 | DOI:10.2196/87158

JMIR Serious Games. 2026 May 4;14:e79976. doi: 10.2196/79976.

ABSTRACT

BACKGROUND: The relationship between video game experience and cognitive plasticity remains a central focus of research, particularly given its potential applications in clinical rehabilitation. Although both first-person shooter (FPS) and multiplayer online battle arena (MOBA) games have been shown to enhance cognitive functions, the specific associations between the cognitive effects of different game genres and brain network structure remain unclear.

OBJECTIVE: This study aimed to examine whether long-term experience with FPS and MOBA games is associated with genre-specific patterns of cortical thickness covariation across brain regions.

METHODS: A total of 116 male participants (mean age 21.2, SD 1.9 y) were recruited via online advertisements for this cross-sectional study. On the basis of strict inclusion criteria (gaming experience >5 years, gaming frequency >5 hours per week, and ranking within the top 15%), participants were categorized into FPS players (n=39, 33.6%) and MOBA players (n=40, 34.5%). An additional group of healthy controls (n=37, 31.9%) with no gaming experience in the past 2 years was also included. High-resolution structural magnetic resonance imaging data were acquired using a 3-T scanner. Individualized differential structural covariance networks were constructed based on the cortical thickness values extracted from 68 brain regions using the Desikan-Killiany atlas. Statistical analysis included one-way ANOVA to identify significant structural covariance edges (SCEs), network-based statistic prediction analysis for weekly gaming hours, and support vector machine analysis for group classification.

RESULTS: One-way ANOVA identified 30 significant SCEs across the 3 groups (P<.001, false discovery rate corrected). Post hoc analysis (P<.02, Bonferroni corrected) revealed that, compared to the MOBA and control groups, the FPS group exhibited 2 dominant networks: a temporo-fronto-parietal network anchored in auditory regions and a visuo-sensorimotor network. Both gaming groups showed enhanced SCEs in visual-attentional networks compared to the control group. The network-based statistic-predict analysis demonstrated that structural covariance matrices could effectively predict weekly gaming hours in FPS players (r=0.34, 95% CI 0.26-0.42). The positive edges primarily formed a temporo-fronto-parietal-occipital network, whereas the negative edges were centered on the entorhinal cortex. The support vector machine classifier successfully differentiated FPS players from controls (area under the curve=82.95%) and from MOBA players (area under the curve=72.37%).

CONCLUSIONS: Long-term FPS and MOBA gaming experiences are associated with different brain structural network architectures. The uniqueness of FPS gaming lies in the extensive structural covariance between the primary auditory cortex and regions supporting visual attention and sensorimotor processing, which may reflect higher demands on cognitive skills. This suggests potential utility in auditory-visual rehabilitation and provides a theoretical basis for the assessment and selection of professional electronic sports players. However, the negative edges involving the entorhinal cortex in FPS players indicate that an overreliance on response learning strategies may come at the expense of the spatial memory system. Consequently, caution is warranted when applying such games to ameliorate age-related memory decline.

PMID:42081801 | DOI:10.2196/79976

JMIR Hum Factors. 2026 May 4;13:e73524. doi: 10.2196/73524.

ABSTRACT

BACKGROUND: In Bangladesh, as well as throughout the world, children’s screen time has significantly increased. Children spend a lot of time on the internet and digital screens for entertainment, education, and communication, which has increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children’s mental, physical, and social health have drawn attention.

OBJECTIVE: This study aimed to explore the effect of high exposure to screens on the health and mental well-being of school-going children and adolescents in Dhaka, Bangladesh.

METHODS: This cross-sectional descriptive study was conducted from July 2022 to June 2024. A total of 420 school-going children and adolescents aged 6 to 14 years were enrolled from 3 English-language and 3 Bangla-language schools in Dhaka using a stratified random sampling technique. Anthropometric measurements, a semistructured questionnaire, and the Pittsburgh Sleep Quality Index, the Development and Well-Being Assessment scale, and the Strengths and Difficulties Questionnaire, all of which were validated in Bangla, were used to gather data. We considered students who were exposed to screens for less than 2 hours a day as the low-exposure group and those who were exposed for more than 2 hours a day as the high-exposure group.

RESULTS: A total of 83.3% (350/420) of the students were in the high-exposure group, and their average screen time per day was 4.6 (SD 2.3) hours. Eye problems were reported by 35.7% (150/420) of the students, and a significant difference was found between the low- and high-exposure groups. In total, 96% (144/150) of the students with eye problems were from the high-exposure group, whereas 4% (6/150) were from the low-exposure group. Headaches were reported by 80% (336/420) of the students, and they were common in the high-exposure group (279/336, 83%). Moreover, students from the high-exposure group had a short duration and poor quality of sleep (mean 7.3, SD 1.4 hours), which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (P<.001). Our study revealed that, overall, 31% (130/420) of the students had at least one mental health problem and 9.8% (41/420) had more than one mental health problem using the Development and Well-Being Assessment scale, and mental health problems were greater in the high-exposure group than the low-exposure group. Although behavioral problems such as conduct issues (119/420, 28.3%) and peer difficulties (121/420, 28.8%) were observed among the participants, no statistically significant difference was found between the 2 groups.

CONCLUSIONS: A collaborative and coordinated multistage approach is essential to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on a larger scale can be conducted to determine the impacts of screen time on aspects of health.

PMID:42081800 | DOI:10.2196/73524

JMIR Hum Factors. 2026 May 4;13:e78430. doi: 10.2196/78430.

ABSTRACT

BACKGROUND: Despite their benefits, digital health tools often face adoption barriers because of the digital divide. Identifying the fundamental user skills required to effectively navigate these tools and the usability barriers is essential to addressing disparities in use.

OBJECTIVE: This study aimed to identify the skill and usability barriers to using digital health tools.

METHODS: This study included English-, Spanish-, or Cantonese-speaking patients, aged ≥50 years, who received care at an urban safety net health system in the United States. Participants completed a survey examining sociodemographic characteristics and digital health tool use and were observed and video recorded as they navigated four digital health care tasks: (1) launch a video visit, (2) visit a health website through a URL, (3) log in to the patient portal, and (4) sign up for a patient portal account. Participants who could not independently perform the tasks received additional support. Tasks were conducted in English, while instructions and additional assistance were provided in each participant’s preferred language. Video recordings were thematically coded to identify the fundamental skills needed for effective digital tool use and usability barriers in the design of digital tools. We examined whether task independence was associated with participant demographics and thematic categories using Kruskal-Wallis, χ2, and Fisher exact tests.

RESULTS: In total, 74% (34/46), 52% (31/60), 71% (44/62), and 70% (43/61) of participants (N=64) independently completed digital tasks 1, 2, 3, and 4, respectively. Older age, minoritized races and ethnicities, non-English language preference, lower educational attainment, access to cellular data only or no internet access, and lack of a portal account were associated with a higher likelihood of requiring assistance or being unsuccessful at completing each task (P<.001, except for older age [P=.004]). The qualitative coding of video recordings identified 3, 4, and 6 categories of typing, navigation, and human-computer interaction (HCI) skills, respectively, as fundamental skills required to independently complete digital tasks. χ2 and Fisher exact tests indicated significant associations between most typing, navigation, and HCI categories and independent task completion. We coded usability barriers as one of 6 learnability challenges or 3 operability challenges.

CONCLUSIONS: This study identified that independent use of digital health tools requires fundamental typing, navigation, or HCI skills as well as high usability of digital tools. The inclusion of 4 different digital tasks added specificity to the type of skills and usability considerations necessary to ensure accessibility of digital health tools to diverse older adults. This study underscores the need for vendors to cocreate digital health tools with historically excluded end users in mind. As health care systems expand digital tool adoption, they must distinguish fundamental skill gaps from usability barriers, as each may require different intervention strategies.

PMID:42081796 | DOI:10.2196/78430

Eval Rev. 2026 May 4:193841X261449106. doi: 10.1177/0193841X261449106. Online ahead of print.

ABSTRACT

We re-analyze two research articles with results showing that Sweden’s criminalization of purchasing sex triggered a large increase in rape. Our analysis documents discrepancies that produce unreliable results in five identification strategies in the first paper (Ciacci, 2024), and in all specifications indicating a large reform effect in the other (Ciacci, 2025). These discrepancies include estimating different statistical relationships, using different methods, or employing different variables than the paper describes. Correcting them by implementing the analysis described in the text yields no evidence that the Swedish reform increased rape.

PMID:42081792 | DOI:10.1177/0193841X261449106

Neurology. 2026 May 26;106(10):e218032. doi: 10.1212/WNL.0000000000218032. Epub 2026 May 4.

ABSTRACT

OBJECTIVES: Medical assistance in dying (MAiD) has been available across Canada since 2016 for patients with amyotrophic lateral sclerosis (ALS). We aimed to characterize MAiD use, identify associated factors, and compare survival and location of death in a Canadian ALS cohort.

METHODS: We retrospectively reviewed patients with ALS followed at a Canadian multidisciplinary clinic who died between January 1, 2019 and December 31, 2024. Patient characteristics were described by MAiD status. Factors associated with MAiD utilization were evaluated using regression analyses, and survival and location of death were compared between patients who did and did not pursue MAiD.

RESULTS: Of 255 patients (median age 67 years [IQR 60-75]; 42% female), 55 (21.6%) underwent MAiD. Percutaneous endoscopic gastrostomy (PEG) use was inversely associated with MAiD utilization (OR 0.34, 95% CI 0.15-0.78), whereas demographic and disease characteristics were not associated with MAiD. Survival from diagnosis to death was shorter among patients who underwent MAiD (median 12 vs 14 months; p = 0.019), with no difference from symptom onset. Death at home was more frequent with MAiD (62% vs 35%; p < 0.001).

DISCUSSION: MAiD is a common end-of-life option in ALS, reflecting patient values and is associated with lower PEG use, shorter postdiagnosis survival, and more frequent death at home.

PMID:42081784 | DOI:10.1212/WNL.0000000000218032