Tag: pubmed

JMIR Hum Factors. 2025 Jul 15;12:e70034. doi: 10.2196/70034.

ABSTRACT

BACKGROUND: Malaysia, an upper middle-income country in the Asia-Pacific region, has an HIV epidemic that has transitioned from needle sharing to sexual transmission, mainly in men who have sex with men (MSM). MSM are the most vulnerable population for HIV in Malaysia. In 2022, our team developed a web-based artificial intelligence (AI) chatbot and tested its feasibility and acceptability among MSM in Malaysia to promote HIV testing. To enhance the usability of the AI chatbot, we made it accessible to the public through the website called MYHIV365 and tested it in an observational study.

OBJECTIVE: This study aimed to test the usability of an AI chatbot in promoting HIV testing among MSM living in Malaysia.

METHODS: This observational study was conducted from August 2023 to March 2024 among 334 MSM. Participants were recruited through community outreach and social-networking apps using flyers. The interactions between participants and the AI chatbot were documented and retrieved from the chatbot developer’s platform. Data were analyzed following a predefined metrics using R software (Posit Software, PBC).

RESULTS: The AI chatbot interacted with 334 participants, assisting them in receiving free HIV self-testing kits, offering information on HIV, pre-exposure prophylaxis (PrEP), and mental health, and providing details of 220 MSM-friendly clinics, including their addresses, phone numbers, and operating hours. After the study, 393 human-chatbot interactions were documented on the chatbot developer’s platform. Most participants (304/334, 91.0%) interacted with the AI chatbot once, 30 (9.0%) engaged 2 or more times at different intervals. Participants’ interaction time with the chatbot varied, ranging from 1 to 31 minutes. The AI chatbot properly addressed most participants’ questions (362/393, 92.1%) about HIV and PrEP. However, in 31 interactions, participants posed additional questions to the chatbot that were not programmed into the chatbot algorithms, resulting in unanswered interactions.

CONCLUSIONS: The web-based AI chatbot demonstrated high usability in delivering HIV self-testing kits and providing clinical information on HIV testing, PrEP, and mental health services. To enhance its usability in community and clinical settings, the chatbot must offer personalized health information and precise interaction, powered by sophisticated machine learning algorithms. In addition, establishing an effective connection between the AI chatbot and health care systems to eliminate stigma and discrimination toward MSM is crucial for the future implementation of AI chatbots.

PMID:40663792 | DOI:10.2196/70034

JMIR Public Health Surveill. 2025 Jul 15;11:e72322. doi: 10.2196/72322.

ABSTRACT

BACKGROUND: Influenza and respiratory syncytial virus (RSV) predominantly circulate during the winter season and cause acute respiratory illness (ARI). Deploying molecular point-of-care testing (POCT) in primary care can inform whether a patient presenting with an ARI has influenza or RSV. An early virological diagnosis could facilitate appropriate use of antivirals and enable better antimicrobial stewardship.

OBJECTIVE: This study aimed to report the impact of POCT for influenza and RSV on antimicrobial prescribing, including antiviral therapy in primary care.

METHODS: The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care was a nested cohort study undertaken from January 20 to May 31, 2023, after the period of peak virus circulation, within practices that contribute data to the English sentinel network. People presenting with ARI had a nasopharyngeal swab performed and were tested for influenza and RSV with a molecular POCT analyzer located within the practice. Data on antimicrobial prescribing and other study outcomes were collected by linking information from the analyzer to coded data from the patient’s computerized medical record.

RESULTS: In total, 323 swabs were collected from 10 PIAMS study practices. In total, 59.7% (197/323) of swabbed patients were female, and the mean age was 37.28 (SD 25.05) years. Furthermore, 2.9% (9/323) of all swabs were positive, with 0.3% (1/323) positive for influenza A, 1.6% (5/323) positive for influenza B, and 0.9% (3/323) positive for RSV. In total, 80 patients were prescribed antibiotics 7 days following POCT testing. There were no instances of antiviral prescribing in the 7 days post testing. A statistically significant difference in antibiotic prescribing given a positive POCT result compared with a negative test was not found with an unadjusted odds ratio (OR) of 7 days post testing. A statistically significant difference in antibiotic prescribing given a positive POCT result compared with a negative test was not found with an unadjusted OR of 1.54 (95% CI 0.38-6.30; P=.55) and adjusted OR of 1.21 (95% CI 0.00-1.78).

CONCLUSIONS: This study illustrates the risk of having a narrow study window; our observation period was not aligned with when influenza was circulating. The peak of weekly incidence of influenza in the sentinel network was in the last week of 2022, and RSV was circulating before this. Further evidence is needed to assess the impact of POCT on antimicrobial prescribing. The viruses tested for using POCT could be aligned with the circulating viruses identified by the sentinel network.

PMID:40663790 | DOI:10.2196/72322

JMIR Med Inform. 2025 Jul 15;13:e63036. doi: 10.2196/63036.

ABSTRACT

BACKGROUND: Between 2020 and 2022, the Philippine Primary Care Studies program, a government-funded initiative supporting universal health care implementation, piloted two electronic health records (EHR) systems across urban, rural, and remote primary care sites.

OBJECTIVE: The study aimed to evaluate the implementation of two EHR systems in diverse primary care settings in the Philippines over a three-year period.

METHODS: This implementation study used an explanatory mixed methods design. Two EHR systems were deployed: an Open Medical Records System (OpenMRS)-based platform in 2016, and a Microsoft-based system in 2021. Both systems integrated clinical documentation, pharmacy, laboratory, and reporting modules. Implementation strategies included training workshops and materials, iterative user feedback loops, and infrastructure cofinancing with local governments. Surveys were administered yearly to all end users. The primary outcome was behavioral intention to use the system. Quantitative data were supplemented by inductive content analysis of qualitative responses to explain observed trends.

RESULTS: A total of 351 survey responses were collected from 2020 to 2022. In 2020, the intention to use the OpenMRS-based EHR was high across all sites. By 2022, following the launch of the Microsoft-based EHR, acceptability declined significantly among doctors and administrative staff, particularly at the urban site. In contrast, the remote site which retained the OpenMRS-based system maintained high acceptability levels. Qualitative findings revealed that while the new EHR system provided a more privacy-focused design, users preferred a cross-platform EHR to allow more flexible access to patient data. At the rural site where the EHR was used to facilitate task-shifting among nurses involved in clinical management, users were less impacted by this shift.

CONCLUSIONS: The disparities in EHR acceptability across urban, rural, and remote sites were influenced by contextual, technical, and demographic factors. The decline in acceptability following the EHR system transition highlights the importance of implementation strategies that reflect the specific needs and capacities of each setting. These findings offer practical insights for adapting EHR systems to diverse primary care contexts.

PMID:40663789 | DOI:10.2196/63036

Blood. 2025 Jul 15:blood.2025029628. doi: 10.1182/blood.2025029628. Online ahead of print.

ABSTRACT

Advanced mycosis fungoides (MF) and Sézary syndrome (SS) have a poor prognosis with overall survival <5 years. Studies have found the current clinical staging (IA-IVB) inadequate for risk stratification. Developing a prognostic index in MF/SS will identify patients with poor outcomes and may allow better management decisions and improved survival.PROCLIPI (Prospective Cutaneous Lymphoma International Prognostic Index) Study was launched in 2015 at 46 international expert MF/SS Centers, prospectively collecting pre-defined datasets in newly diagnosed MF/SS patients to determine a cutaneous lymphoma IPI (CLIPI).552 advanced stage MF/SS patients were recruited. The 5-year overall survival (OS) was IIB=50.0%, IIIA=64.8%, IIIB=43.9%, IVA1=50.8%, IVA2=25.9%, IVB=36.9%. Factors at diagnosis associated with a significantly worse survival were N3 status; p<0.001, age>60yrs; p<0.001, raised serum lactate dehydrogenase; p=0.005 and large-cell transformation in skin; p=0.006. Modelling these 4 independent risk-factors into a CLIPI found there was a statistically significant worse OS in high-versus low-risk p<0.001, high-versus intermediate-risk p=0.002 as well as intermediate-versus low-risk p=0.010. 5 Year OS were 63.3%, 44.7% and 18.3% in the low-, intermediate- and high-risk PROCLIPI cohort respectively.In advanced stage MF/SS there was a low 5-year survival rate and increasing stage was not associated with worsening survival. The use of CLIPI to stratify patients into low, intermediate, and high-risk prognostic groups has the potential to improve patient outcomes by helping guide optimal treatment selection. CPMS ID 17662 (PROCLIPI), RRK4970, ClinicalTrials.Gov ID: NCT02848274.

PMID:40663780 | DOI:10.1182/blood.2025029628

Eur J Public Health. 2025 Jul 15:ckaf120. doi: 10.1093/eurpub/ckaf120. Online ahead of print.

ABSTRACT

We explored the association between education and academic ability in childhood and both outpatient appointments and hospital admissions in adulthood, accounting for adult factors, including long-term conditions. The analytical sample consisted of 7183 participants in the Aberdeen Children of the 1950s. Three outcomes were measured using routine Scottish medical records over a five-year period (2004-2008): (1) ≥5 outpatient appointments, (2) ≥2 hospital admissions, or (3) ≥3 outpatient appointments plus ≥1 hospital admission. We constructed a childhood (age 6-11) education and academic ability domain and calculated predicted risk scores of the three outcomes for each cohort member. Nested logistic regression models investigate the association between domain predicted risk scores and odds of each of the three outcomes accounting for childhood confounders and self-reported adult mediators. Adjusting for childhood confounders, lower childhood education and academic ability were positively associated with ≥5 outpatient appointments (OR 1.03, 95% CI 1.01-1.05), ≥2 hospital admissions (OR 1.04, 95% CI 1.03-1.6), and ≥3 outpatient appointments plus ≥1 hospital admissions (OR 1.04, 95% CI 1.02-1.06). Accounting for adult mediators, associations remained statistically significant, but their effect sizes were reduced. When school leaving age was included in the model, the association between the exposure and all three outcomes were attenuated. Education and academic ability in early life may be related to the burden of multiple hospital admissions and outpatient appointments later in life. However, the age at which the participant left school seems to substantially mediate this relationship underscoring the positive impact of time spent in education.

PMID:40663774 | DOI:10.1093/eurpub/ckaf120

JMIR Res Protoc. 2025 Jul 15;14:e63596. doi: 10.2196/63596.

ABSTRACT

BACKGROUND: The rapid proliferation of health care apps has transformed health care delivery, providing patients with unprecedented access to medical information and services. These apps facilitate remote consultations, appointment scheduling, medication reminders, and health monitoring, thereby enhancing patient engagement and improving health outcomes. Despite the widespread benefits, disparities in the adoption and usage of health care apps persist, influenced by demographic and socioeconomic factors. Understanding these disparities is crucial for designing interventions that promote equitable access to digital health tools.

OBJECTIVE: This systematic review aims to identify and synthesize empirical studies on health care app usage disparities, focusing on demographic and socioeconomic factors. This review seeks to inform stakeholders about the key factors influencing app usage and provide insights to improve accessibility and effectiveness. Specifically, this review addresses the following research questions: (1) what are the key demographic and socioeconomic factors associated with health care app usage disparities? (2) how do these factors influence the adoption and utilization of health care apps? and (3) what are the barriers to and facilitators of effective use of health care apps?

METHODS: This review will adhere to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Eight databases-ACM Digital Library, CINAHL, IEEE Xplore, ProQuest Nursing and Allied Health Journals, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science-were searched for studies published in English between January 1, 2014, and June 17, 2024. Eligibility criteria include journal papers focusing on health care app usage across different demographic and socioeconomic groups. Data management will involve using Zotero for reference management and Excel for screening and eligibility assessment. Two reviewers will independently extract the data and assess the study quality and risk of bias. Descriptive statistics will be used to summarize the study characteristics.

RESULTS: As of June 2025, the review is in the screening stage. The completion of data collection is anticipated by November 2025. The final results are expected to be published by late 2025. This review aims to provide comprehensive insights into the disparities in health care app usage.

CONCLUSIONS: The findings of this systematic review will offer valuable insights into demographic and socioeconomic disparities in health care app usage, informing stakeholders on how to address these disparities. By identifying the factors influencing app adoption and usage, this review will contribute to the development of targeted interventions and policies to enhance digital health equity.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63596.

PMID:40663773 | DOI:10.2196/63596

Blood. 2025 Jul 15:blood.2025028964. doi: 10.1182/blood.2025028964. Online ahead of print.

ABSTRACT

Tumor inflammation-associated neurotoxicity (TIAN) was recently proposed as a unique complication of immunotherapy in brain tumor patients. Here, we report a first comprehensive characterization of TIAN in CNS lymphoma (CNSL) patients treated with CD19-directed chimeric antigen receptor T-cells (CD19-CAR). TIAN occurred in 10/56 (17.9%) CNSL with clinical onset at a median 3.5 days (range: 1-9) after CD19-CAR infusion. It was less frequently associated with cytokine release syndrome (60% vs 100%, p = 0.009) than immune effector cell-associated neurotoxicity syndrome (ICANS). Although symptoms were usually transient and fully reversible, TIAN was associated with a fatal outcome in one patient. Larger CNS tumor volume at baseline allowed the identification of patients at risk for TIAN (AUC: 0.847, p = 0.002). Maximizing Youden J statistics, a discriminatory tumor volume threshold >3.4cm3 was determined, which carried 87.5% sensitivity and 80.5% specificity. TIAN correlated with higher overall response rates to CD19-CAR (90% vs 52%, p = 0.036) and improved progression-free survival (Hazard ratio: 0.22; 95%-Confidence interval: 0.07-0.61, p = 0.006) on multivariate Cox proportional hazard regression. Post-mortem histopathological evaluation of a TIAN lesion revealed a dense macrophage population with central necrosis and peripheral reactive gliosis, accompanied by loss of white matter and intracytoplasmic myelin in foamy macrophages. Collectively, our work supports TIAN as a localized on-tumor, on-target neurotoxicity syndrome, closely related to pre-existing CNSL lesions and distinct from ICANS. CNS tumor volume at baseline may allow to identify patients at risk and may guide management.

PMID:40663771 | DOI:10.1182/blood.2025028964

Plast Reconstr Surg. 2025 Jul 1. doi: 10.1097/PRS.0000000000012283. Online ahead of print.

ABSTRACT

INTRODUCTION: Lower Extremity Free Flap Reconstruction (LE-FFR) is essential for significant soft tissue defects, but prolonged hospital stays can negatively impact patients and healthcare systems. This study aimed to identify factors associated with post-flap surgery length of stay (pfsLOS) in LE-FFR patients to optimize healthcare delivery and outcomes.

METHODS: This retrospective cohort study included 405 patients who underwent 415 microvascular LE-FFR at two Level I Trauma Centers. The primary outcome was pfsLOS, which was then described in the context of total LOS (tLOS). Statistical analyses involved multivariable linear and Cox regression models, analyzing outcomes as relative percentage changes in pfsLOS.

RESULTS: Across all defect etiologies, median pfsLOS (IQR) was 10 days (8-14), with prolonged pfsLOS (>14 days) in 81 patients (20%). Combined initial plastic and orthopaedic surgery treatment (primary multidisciplinary orthoplastic treatment) was associated with a significant decrease in pfsLOS (-13.58%, p=0.047) in multivariable regression analysis, with the greatest benefit observed in high-severity cases. Other factors significantly affecting pfsLOS included the number of plastic surgery operations (14.47% increase per operation, p<0.001), blood transfusion (13.03% increase, p=0.023), and flap surgery duration (0.06% increase per minute, p=0.041). The time between the first surgery and flap surgery was associated with a significant decrease in pfsLOS (-0.90% per day, p=0.046). Sub-analysis showed that discharge to destinations other than home significantly increased pfsLOS (16.45%, p=0.001), particularly in socially deprived areas.

CONCLUSION: Initial combined orthoplastic intervention reduced pfsLOS by 9.10%-13.58% and overall tLOS by 50.00% for LE-FFR patients. Early coordination between services reduces LOS, optimizes resource utilization, and likely improves cost-effectiveness and patient outcomes in LE-FFR.

LEVEL OF EVIDENCE: III – therapeutic.

PMID:40663765 | DOI:10.1097/PRS.0000000000012283

Chaos. 2025 Jul 1;35(7):073128. doi: 10.1063/5.0273965.

ABSTRACT

In this paper, based on the traditional prisoner’s dilemma model, we introduce time-varying peer pressure and verify the enhancing effect of this time-varying peer pressure model on cooperation in different types of networks. We decompose peer pressure into two aspects: pressure intensity, reflecting the degree of punishment an individual receives due to strategy inconsistency with neighbors, and pressure sensitivity, indicating the likelihood of an individual being influenced by peer pressure, which can be regarded as an individual characteristic. Considering individuals’ continuous development over time, it is possible for individual characteristics to change over time. Thus, we treat pressure sensitivity as a time-varying function in this paper and construct it based on the widely used Sigmoid function, taking into account the differences in sensitivity among different individual types. We apply the time-varying peer pressure model to Watts-Strogatz (WS) and Barabási-Albert (BA) networks and evaluate its effect from two aspects: the increase in the proportion of cooperators compared to the traditional prisoner’s dilemma model, and the range of b within which there are still cooperators that can survive in the system. Overall, we find that the introduction of the time-varying peer pressure can more significantly enhance the evolution of cooperation in WS networks. Specifically, under the time-varying peer pressure model, the range of b that the system can withstand can be expanded to b≤1.95 in WS networks, and the range expands to b≤2.7 in BA networks, while the network scale is 100.

PMID:40663761 | DOI:10.1063/5.0273965

JMIR Cancer. 2025 Jul 15;11:e52627. doi: 10.2196/52627.

ABSTRACT

BACKGROUND: In the modern era, the use of technology can substantially impact care access. Despite the extent of its influence on several chronic medical conditions related to the heart, lungs, and others, the relationship between one’s access to digital resources and oncologic conditions has been seldom investigated in select pathologies among gastrointestinal and head-neck regions. However, studies on the influence of this “digital inequity” on other cancers pertaining to nasal and paranasal sinus cancer (NPSC) have yet to be performed. This remains in stark contrast to the extent of large data approaches assessing the impact of traditional social determinants/drivers of health (SDoH), such as factors related to one’s socioeconomic status, minoritized race or ethnicity, and housing-transportation status, on prognostic and treatment outcomes.

OBJECTIVE: This study aims to use the Digital Inequity Index (DII), a novel, comprehensive tool that quantifies digital resource access on an area- or community-based level, to assess the relationship between inequities in digital accessibility with NPSC disparities in prognosis and care in the United States.

METHODS: Patients with NPSC from 2008 to 2017 in the Surveillance, Epidemiology, and End Results Program were assessed for significant regression trends in the long-term follow-up period and treatment receipt across NPSCs with increasing overall digital inequity, as measured by DII. DII was based on 17 census-tract level variables derived from the summarized values overlapping that same time period from the US Census/American Community Survey and Federal Communications Commission Annual Broadband Report. Variables were categorized as infrastructure-access (ie, electronic device ownership, internet provider availability, and income-broadband subscription ratio) or sociodemographic (education, income, age, and disability), ranked, and then averaged into a composite score to encompass direct and indirect factors related to digital inequity.

RESULTS: Across 8012 adult patients with NPSC, males (n=5416, 67.6%) and White race (n=4293, 53.6%) were the most represented demographics. With increasing digital inequity, as measured by increasing total DII scores, significant decreases in the length of long-term follow-up were observed with nasopharyngeal (P<.01) and maxillary sinus cancers (P=.02), with decreases as high as 19% (35.2 to 28.5 months, nasopharynx). Electronic device and service availability inequities showcased higher-magnitude contributions to observed associated regression trends, while the income-broadband ratio contributed less. Significantly decreased odds of receiving indicated surgery (lowest odds ratio 0.87, 95% CI 0.80-0.95, maxillary) and radiation (lowest odds ratio 0.78, 95% CI 0.63-0.95, ethmoid) for several NPSCs were also observed.

CONCLUSIONS: Digital inequities are associated with detrimental NPSC care and surveillance trends in the United States, even when accounting for traditional SDoH factors. These results prompt the need to include digital factors into the discussion of contextualizing SDoH-based analyses of cancer care disparities, as well as the specific factors from which prospective implementations and initiatives can invest limited public health resources to alleviate the most pertinent drivers of disparities.

PMID:40663723 | DOI:10.2196/52627