Tag: pubmed

JMIR Res Protoc. 2026 Feb 13;15:e85493. doi: 10.2196/85493.

ABSTRACT

BACKGROUND: In the United States, Asian American people represent the fastest growing population group, and are highly diverse linguistically, culturally, and demographically. Yet, in most national studies, Asian American groups are aggregated, masking potential health disparities. Racial and ethnic minorities, especially first-generation immigrants, are also at a particularly elevated risk of cognitive impairment.

OBJECTIVE: The Aging in Kerala Americans Research (AKKARE) study aims to examine both positive and negative migration effects on health in the first-generation Kerala American population, focusing on cognition and dementia. We will assess the effect of immigrant and cultural factors and social relations on cognitive aging from epidemiological, biological, and vascular perspectives. This protocol describes the study design and procedures for the AKKARE study.

METHODS: The AKKARE study proposes to enroll 400 older first-generation Kerala American individuals from the tristate area. A smaller subset of these participants will complete blood tests (n=360) and neuroimaging studies (n=160). We will assess the role of immigration and cultural effects on cognitive function, mood, and quality of life, as well as biological and vascular aging. We will conduct follow-up assessments at 12-month intervals for up to 5 years.

RESULTS: The AKKARE study (grant #1R01AG084567-01) was funded by the US National Institutes of Health in 2024 and received approval from the Stony Brook University Institutional Review Board to start the study in 2025. Enrollment began in September 2025.

CONCLUSIONS: As there is presently a lack of fundamental data on the epidemiology in diseases of aging in Indian American immigrants, the AKKARE study will provide new insights into factors of risk and resilience associated with cognitive impairment in this group and in the broader older adult population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/85493.

PMID:41687108 | DOI:10.2196/85493

JMIR Public Health Surveill. 2026 Feb 13;12:e89473. doi: 10.2196/89473.

ABSTRACT

BACKGROUND: Despite major biomedical advances in HIV testing, prevention, and treatment, annual HIV transmissions in the United States remain above 30,000. Geographic access to pre-exposure prophylaxis (PrEP) is critical to HIV prevention efforts, particularly in regions with high HIV burdens, such as metro-Atlanta. Community-based organizations (CBOs) play a central role in delivering culturally competent prevention services, yet many rely on federal funding that is increasingly unstable. Understanding the potential impact of CBO closures on geographic access to PrEP is essential for anticipating inequities and informing policy.

OBJECTIVE: The aim of this study was to estimate how hypothetical closures of federally funded CBOs providing PrEP affect geographic access to PrEP clinics by car and public transit across metro-Atlanta and to assess whether impacts differ by community racial/ethnic composition.

METHODS: We identified 71 PrEP-providing clinics in metro-Atlanta (August 2025), including 12 CBOs. Using 3 simulated closure scenarios in which 25% of CBOs were randomly closed, we calculated one-way travel times from 2466 census block group (CBG) centroids to the nearest PrEP-providing clinic. Travel times were estimated for car and public transit across 3 weekdays and timepoints and then averaged per CBG. Two-sided paired t tests were used to compare the change in travel time compared to baseline. Logistic regression assessed associations between racial/ethnic plurality and increased travel times.

RESULTS: Under baseline conditions, 100% of CBGs had car access to a PrEP clinic within 30 minutes compared to only 41.6% (1027/2466) via public transit. Across closure scenarios, 732 CBGs (29.6%; representing over 1 million residents) experienced increased transit times (mean increase 1.2 minutes; range 0.0-11.6; P<.001), and 7 CBGs lost transit access entirely. For car travel, 1184 CBGs (48%; representing approximately 1.7 million residents) experienced increased drive times (mean increase 0.5 minutes; range 0.0-6.4; P=.03). Black-plurality CBGs had higher odds of increased drive times compared to White-plurality CBGs (odds ratio 1.37, 95% CI 1.15-1.63).

CONCLUSIONS: Even limited closure of CBO PrEP providers meaningfully reduces geographic access to HIV prevention services, disproportionately affecting communities already experiencing transportation and HIV-related vulnerabilities. Sustained federal investment in CBOs is essential to preserve equitable PrEP access and prevent avoidable HIV infections.

PMID:41687101 | DOI:10.2196/89473

J Particip Med. 2026 Feb 13;18:e83149. doi: 10.2196/83149.

ABSTRACT

BACKGROUND: The Veterans Health Administration is promoting patient-reported outcome measure (PROM) collection for measurement-based mental health care. Understanding veteran preferences about how and when to complete PROMs is critical to support their implementation.

OBJECTIVE: We examined veteran preferences for timing and use of different technology platforms to complete mental health-related PROMs.

METHODS: We invited a national sample of 1373 veterans to complete a survey; 858 (62.5%) responded. Surveys asked about veteran preferences for how and when to complete mental health-related PROMs. We characterized responses using descriptive statistics and estimated multiple logistic regression models to examine associations between veteran demographic and health characteristics and preferences for completing PROMs.

RESULTS: Most veterans preferred completing PROMs between appointments (607/801, 75.8%) using features of a patient portal (410/801, 51.2%), during appointments (589/801, 73.5%) verbally (413/801, 51.6%), and while at the medical center (480/801, 59.9%) on paper (189/801, 23.6%) or a tablet computer (180/801, 22.5%). Hispanic (vs non-Hispanic) veterans had 3.32 (95% CI 1.04-10.58) times higher odds of preferring to complete PROMs at the medical center, and veterans with lower (vs higher) socioeconomic status had lower odds (odds ratio 0.61, 95% CI 0.40-0.93) of preferring to complete PROMs in between appointments but 1.97 (95% CI 1.23-3.16) times higher odds of preferring to complete PROMs during appointments.

CONCLUSIONS: As the Veterans Health Administration and other health care systems seek to expand the integration of PROM data into health care services, adaptive and flexible approaches to PROM administration that align with patient preferences, including those that leverage technology platforms in the remote collection of these data, may bolster implementation. Our results indicate that such implementation efforts should consider patient ethnicity and socioeconomic status. Our findings further suggest that these efforts could benefit from incorporating PROM administration into online patient portals, developing mobile health apps that support PROM completion through patients’ personal devices in between clinical encounters, and engaging care team members in PROM administration during appointments.

PMID:41687098 | DOI:10.2196/83149

JMIR Public Health Surveill. 2026 Feb 13;12:e82496. doi: 10.2196/82496.

ABSTRACT

BACKGROUND: In France, reluctance toward hepatitis B vaccination remains high, despite the availability of a safe and effective vaccine to prevent this infection. To boost vaccination coverage, it is therefore essential to identify the factors that are likely to encourage a more favorable opinion of this vaccine. Health literacy (HL) is one such factor. It refers to the individual ability to access, understand, critically appraise, and apply health information to make informed decisions about health issues for oneself and for others.

OBJECTIVE: This study explored the mechanisms through which HL might affect opinions about hepatitis B vaccination, both directly and indirectly, by relevant factors, including opinions about vaccination in general, trust in government health agencies, and trust in medical doctors.

METHODS: The analysis used data from the SLAVACO-Wave 3 (Suivi Longitudinal des Attitudes à l’Égard d’un Vaccin Contre la COVID-19) survey, conducted in December 2021 among a representative sample of French adults (N=1932). Favorable and unfavorable opinions of hepatitis B vaccination were measured using a 5-point Likert scale, while HL was assessed using the HLS₁₉-Q12 questionnaire (12-item general health literacy questionnaire used in Health Literacy Survey 2019-2021). A structural equation model examined the relationship between HL and hepatitis B vaccination opinions, taking into account the potential mediating role of trust in the health care system (ie, government health agencies and medical doctors).

RESULTS: Findings showed that individuals with a favorable opinion of hepatitis B vaccination (1437/1932, 74.4%) had a higher HL level than those with a negative or neutral opinion (62.6 vs 57.0, P<.001). The association between HL and hepatitis B vaccination opinions was fully mediated by trust in the health care system. The indirect effect of HL was estimated at 0.068 (95% CI 0.042-0.093), accounting for 52.4% (0.068/0.1297) of the total effect. This effect was particularly pronounced in people over 50 years (0.084, 95% CI 0.042-0.126, accounting for 0.084/0.1306, 64.3% of the total effect). Goodness-of-fit indicators were satisfactory.

CONCLUSIONS: Enhancing HL might positively influence hepatitis B vaccination opinions and uptake through greater trust in the health care system. From a public health perspective, strategies should go beyond providing clear information and access to vaccines and actively work to strengthen trust in health care institutions and professionals. National campaigns correcting misconceptions about hepatitis B vaccination could be complemented by targeted interventions for groups most likely to hold negative opinions. Repeating this survey in the post-COVID-19 context could also reveal different trends, given evolving public perceptions of vaccines and health authorities.

PMID:41687090 | DOI:10.2196/82496

J Neurosurg Pediatr. 2026 Feb 13:1-12. doi: 10.3171/2025.9.PEDS25180. Online ahead of print.

ABSTRACT

OBJECTIVE: Neural tube defects (NTDs) represent a significant global concern, impacting an estimated 300,000 individuals each year. Sub-Saharan Africa (SSA) is considerably affected due to various biopsychosocial factors, dietary issues such as folic acid deficiency, and fumonisin-contaminated maize consumption, and sex-based disparities. This study sought to understand epidemiology and trends in NTD in SSA from 1990 to 2021.

METHODS: The Global Burden of Disease database was utilized to obtain epidemiological data on the variables of interest, which included disability-adjusted life years (DALYs), incidence, prevalence, and mortality of patients with NTD in SSA. The countries in SSA were divided into 4 separate regions-Central, Eastern, Western, and Southern-based on the designations by the African Union. Variations in measurements of NTDs between regions in SSA were assessed using R Studio, and statistical significance was determined with a threshold p value of < 0.05.

RESULTS: The global burden of NTDs was significantly lower than the burden of NTDs in Central, Eastern, and Western SSA (p < 0.0001). Among the regions, Southern SSA experienced better outcomes in terms of DALYs, mortality, incidence, and prevalence, compared to the other regions of SSA (p < 0.001). When a sex-specific burden analysis was performed, female sex was associated with higher DALYs and mortality of NTDs within SSA, especially in Western SSA (p < 0.0001). Other regions of the world, including North America, Latin America and Caribbean, Europe and Central Asia, and Middle East and Northern Africa, also showed associations between female sex and higher DALYs and mortality of NTDs (p < 0.05). When the incidence and prevalence of NTDs was analyzed, there were mixed results, as female sex was associated with higher and lower rates in different regions of the world.

CONCLUSIONS: Understanding the epidemiology of NTDs in SSA underscores the need for quality interventions that not only increase disease awareness and healthcare access but strive for prevention. With identification of the multifaceted factors contributing to NTDs and promotion of proactive health practices, significant strides could be made toward reducing the incidence of NTDs. Partnerships between governments and international agencies are vital to mobilize resources and reduce the burden and related health disparities.

PMID:41687089 | DOI:10.3171/2025.9.PEDS25180

Prim Care Companion CNS Disord. 2026 Feb 12;28(1):25m04071. doi: 10.4088/PCC.25m04071.

ABSTRACT

Objective: To examine the prevalence and clinical correlates of suicidal mental imagery among individuals who have attempted suicide in India.

Methods: This cross-sectional study included 63 participants who recently attempted suicide. Assessments included the Mini-International Neuropsychiatric Interview, Version 6, suicidality subscale; Patient Health Questionnaire-9; Beck Suicide Intent Scale; Scale for Assessment of Lethality of Suicide Attempt; and a sociodemographic data questionnaire. Data were collected from June 2023 to April 2024.

Results: The majority of participants were unemployed, educated, unmarried, and from nuclear families and rural backgrounds. Common attempt methods were drug overdose and poisoning. Of the participants, 79.4% reported past mental illness. Suicidal mental imagery was present in 38.1% of participants. Associations were found with female sex, unemployment, past mental illness, and higher depression/suicidality scores.

Conclusions: The relationship between depression, suicidality, and mental imagery suggests that addressing imagery could be important for treatment and prevention.

Prim Care Companion CNS Disord 2026;28(1):25m04071.

Author affiliations are listed at the end of this article.

PMID:41687087 | DOI:10.4088/PCC.25m04071

Acta Med Port. 2026 Feb 13. doi: 10.20344/amp.23078. Online ahead of print.

ABSTRACT

Survival analysis is a fundamental tool in clinical research for evaluating time-to-event outcomes. While the Kaplan-Meier method remains a widely used univariable approach for estimating survival probabilities and comparing groups, it does not account for multiple risk factors simultaneously. To address this limitation, multivariable regression models are employed, with the Cox proportional hazards model (Cox regression) being the most commonly used. This paper provides a practical guide to Cox regression for clinicians, emphasizing its application in survival analysis rather than focusing on mathematical derivations. We discuss key concepts, including hazard ratios, model assumptions, variable selection, and interpretation of results. Additionally, we explore essential methodological considerations, such as assessing proportional hazards assumptions, handling missing data, and avoiding overfitting. By offering a step-by-step approach to implementing Cox regression in clinical research, this article aims to enhance understanding and improve the quality of survival analysis in medical studies. Practical examples illustrate how to interpret Cox regression results and their relevance in clinical decision-making.

PMID:41687085 | DOI:10.20344/amp.23078

Can J Physiol Pharmacol. 2026 Feb 13. doi: 10.1139/cjpp-2025-0274. Online ahead of print.

ABSTRACT

This study evaluated the presence of bacterial species in the placenta of women with pre-eclampsia and compared with that of normotensive women. One hundred and twenty participants, comprising 60 pre-eclamptic (30 early- and late-onset, respectively) and 60 age-matched normotensive women (30 early and late-gestation normotensive, respectively) were recruited. After informed consent was obtained, the placenta were obtained through caesarean section with sterile and standardized clinical procedures. DNA was extracted from each tissue, and the samples were pooled into six libraries and sequenced on Illumina NextSeq500 using a shotgun metagenomic approach. Bioinformatics was used to analyse the reads with the implementation of Kraken2/MetaPhlAn classification methods and complemented by multi-layered contamination assessment strategy that included frequency-based decontam filtering. Most reads were classified as belonging to the phyla Cutibacterium acnes, Staphylococcus epidermidis, and various Bradyrhizobium species. PE samples showed notable Corynebacterium tuberculostearicum and Pseudomonas species, while Bradyrhizobium and Cutibacterium acnes dominated normotensive samples. Further analysis showed no significant difference between bacterial species of pre-eclamptic and normotensive placental samples. The results show very low levels of bacteria in the placental samples. In addition, a little difference was observed between the bacterial compositions of pre-eclamptic and age-matched normotensive placental tissues, but not statistically significant.

PMID:41687083 | DOI:10.1139/cjpp-2025-0274

Ophthalmic Plast Reconstr Surg. 2026 Feb 13. doi: 10.1097/IOP.0000000000003188. Online ahead of print.

ABSTRACT

PURPOSE: To determine current dacryocystorhinostomy (DCR) practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery members and identify surgeon and case-related factors impacting preference for endoscopic versus external DCR and the use of preoperative imaging.

METHODS: A cross-sectional web-based anonymous 16-question survey was distributed to 277 American Society of Ophthalmic Plastic and Reconstructive Surgery members enrolled in survey-based research. The survey assessed surgeons’ demographics, practice settings, surgical preferences, and imaging practices. Responses were summarized and compared using statistical tests for frequency distribution.

RESULTS: A total of 111 surgeons (40.0%) responded to the survey. Utilization of endoscopic DCR (endoDCR) was highly variable, with 57% of junior surgeons (<5 years in practice) using it for >66% of their cases, compared with only 18.3% of surgeons with >15 years postfellowship experience. High utilization of endoDCR (>66% of cases) was more common in academic surgeons compared with private practice (48.4% vs. 19.6%, p < 0.01). The most cited reasons for endoDCR were scar avoidance and revision surgery. For external DCR, anatomical barriers and concern for mass/need for biopsy were common indications. Most surgeons only order imaging for certain indications, such as prior sinonasal surgery, facial trauma, suspected tumor, or atypical presentation.

CONCLUSION: Utilization of endoDCR was correlated with years in practice, with younger surgeons preferring the endoscopic technique. A large majority felt that the relevance of imaging is low in most patients. Future research is needed to standardize case-based indications for endoscopic versus external approaches and preoperative imaging.

PMID:41687079 | DOI:10.1097/IOP.0000000000003188

MSMR. 2026 Feb 4;32(12):36-43.

ABSTRACT

Although mental health conditions are the leading underlying cause of maternal mortality, there is limited research on the prevalence of perinatal mental health conditions among active duty service women (ADSW). In this study of live-born deliveries among U.S. ADSW (n=62,729) with pregnancy start and end dates (i.e., dates of last menstrual period and infant delivery, respectively) from October 1, 2016 through December 31, 2021, International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes were used to identify mental health conditions: trauma and stressor-related disorders, anxiety and panic disorders, depressive disorders, suicidal ideation or attempt, and eating disorders. Data were collected through 1 year postpartum, until December 31, 2022. The prevalence of diagnosed mental health conditions from 1 year prior to pregnancy through 1 year postpartum was 33.8%. Trauma and stressor-related disorders were most prevalent (23.1%), followed by anxiety and panic disorders (16.9%), depressive disorders (14.6%), suicidal ideation or attempt (1.6%), and eating disorders (0.4%). The prevalence of mental health conditions was higher in the postpartum period (22.0%) compared to pregnancy (18.4%) and prior to pregnancy (15.0%). Overall, higher prevalence of these conditions was found among non-Hispanic Black ADSW (37.4%), and those who were unmarried (38.4%), never deployed (34.9%), or in the Army (37.4%) and Navy (36.4%). One in 3 active duty service women were diagnosed with a mental health condition in the year preceding pregnancy through 1 year postpartum. Overall, non-Hispanic Black and junior enlisted active duty service women demonstrated higher prevalences of mental health conditions compared to all other racial and ethnic groups and military ranks.

PMID:41687061