JMIR Public Health and Surveillance最新文献

{"title":"Endemic Channel Parametrization in Dengue Surveillance: Methodological Assessment of Retrospective Windows, Outbreak Trends, and Zero-Case Periods in Colombia.","authors":"Juan D Umaña, Juan Montenegro-Torres, Julian Otero, Maria Camila Tavera-Cifuentes, Natalia Niño-Machado, Catalina González-Uribe, Juan Manuel Cordovez, Mauricio Santos-Vega","doi":"10.2196/79914","DOIUrl":"10.2196/79914","url":null,"abstract":"<p><strong>Background: </strong>The endemic channel is a surveillance method that presents statistical indicators and visual representations of a disease's historical dynamics. Its epidemic curve defines the central tendency of cases and their expected variation, providing 3 levels (ie, \"safety,\" \"warning,\" and \"epidemic\") to assess the epidemiological status of a region. Parameters include the central tendency used as the epidemiological warning threshold (EWT), the size of the retrospective window, and the handling of previous outbreaks and zero values in data. The absence of clear guidelines for the selection of these parameters may compromise reproducibility and hinder outbreak definitions and responses for endemic diseases such as dengue.</p><p><strong>Objective: </strong>This study aimed to review the parameters of the endemic channel used for the definition and monitoring of dengue outbreaks in Colombia while quantitatively assessing the performance of the method.</p><p><strong>Methods: </strong>We reviewed institutional epidemiological bulletins in Colombia and quantitatively assessed the endemic channel in two main aspects: (1) the impact on the EWT of parameter selection regarding the retrospective data window, previous epidemic years handling, and zero-value handling, using a statistical framework; and (2) the endemic channel's performance based on the windows of opportunity, outbreak detection capacity, and the ratio of warnings that correspond to actual outbreaks.</p><p><strong>Results: </strong>The endemic channel's performance is higher as transmission increases due to more robust data that facilitate a timely detection of outliers, while lower-transmission areas show a sharper rise in cases when outbreaks are missed, indicating limited detection capacity. Reducing the retrospective data window improved metrics across all transmission profiles by 6.34% on average, while extending it decreased performance due to changes in detection capacity. There was no significant difference (P value >.01) in performance when data from epidemic years were included or excluded for municipalities with high or very high transmission levels. Instead of adding an entire unit, shifting the data by 0.001 prevents the estimation of null values for the EWT and thresholds and significantly improves performance across all transmission levels (P value <.01) by 23.07% on average.</p><p><strong>Conclusions: </strong>The endemic channel's performance varies with the outbreak definition and the municipality's transmission level. Encouraging an optimal retrospective window is challenging, as data are computed over the years. Nevertheless, the improved performance with shorter retrospective windows is likely due to reduced overlap in seasonal outbreaks. Shifting data by a limiting-to-zero value, instead of adding a complete unit, improves performance and can be easily integrated into existing surveillance templates. Windows of opportunity should be considered when","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e79914"},"PeriodicalIF":3.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population Estimates and Hypertension and Diabetes Prevalence: Cross-Sectional Quantitative Study Comparing Electronic Health Record-Derived Counts, Census, and Centers for Disease Control and Prevention Population Level Analysis and Community Estimates.","authors":"Tyler Na Winkelman, Kelly Bergmann, Peter Bodurtha, Alanna M Chamberlain, R Adams Dudley, David Haynes, Steven G Johnson, Thomas E Kottke, Karen L Margolis, Gabriela Vazquez Benitez, Devon Nerstad, Patrick Olson, James M Peacock, Nayanjot Kaur Rai, Stephen C Waring, Bjorn Westgard, Paul Englund Drawz","doi":"10.2196/86337","DOIUrl":"https://doi.org/10.2196/86337","url":null,"abstract":"<p><strong>Background: </strong>Accurate small-area estimates of vaccination rates and disease burden can inform public health interventions.</p><p><strong>Objective: </strong>This study aimed to compare population denominators derived from census data and electronic health record (EHR) data from a statewide collaboration in Minnesota and examine concordance between Centers for Disease Control and Prevention and EHR-based estimates of diabetes and hypertension prevalence at the census tract level.</p><p><strong>Methods: </strong>A retrospective study was conducted using EHR data from 2018 to 2022 from the Minnesota EHR Consortium (MNEHRC), population estimates from the 2020 census, and disease prevalence estimates among adults from the Centers for Disease Control and Prevention Population Level Analysis and Community Estimates (PLACES) project. Patients were included if they had a Minnesota address and a clinic visit in the last 3 years. Patients with hypertension and diabetes were identified based on the presence of at least 1 diagnosis code in the Observational Medical Outcomes Partnership condition occurrence table in the last 5 years or an elevated outpatient blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) on 2 or more days in the last 3 years for hypertension or at least 1 hemoglobin A<sub>1c</sub> value of ≥6.5 in the last 3 years for diabetes.</p><p><strong>Results: </strong>The 2020 census estimate for the population of Minnesota was 5,707,254. A total of 5,271,191 (92.4% of the census estimate) unique individuals visited 1 of the 11 MNEHRC health care systems in 3 years (2018-2020). The ratio of MNEHRC patients to the Minnesota statewide 2020 census estimate was higher for female individuals (0.97) than for male individuals (0.88) and higher for older age groups (individuals aged 65 years and older: 1.05) than for younger age groups (individuals aged 0-17 years: 0.83). The MNEHRC patient-to-census ratio also differed by race-the ratio was the highest for Black Minnesotans (1.17) and the lowest for American Indian and Alaska Native Minnesotans (0.68). According to MNEHRC data, the percentage of adults in Minnesota with diabetes in 2022 was 9.5% (415,914/4,376,805), and the percentage of adults in Minnesota with hypertension in 2021 was 32.2% (1,365,413/4,234,000). Estimates from PLACES for diabetes were 9.9% (435,481/4,389,028) and for hypertension were 29.9% (1,311,459/4,389,028). The percentage of census tracts where the MNEHRC estimate was within 10% of the PLACES estimate was 40.3% (605/1500) for diabetes and 42.3% (635/1500) for hypertension; 77.9% (1168/1500) of census tracts for diabetes and 79.7% (1195/1500) for hypertension were within 25% agreement.</p><p><strong>Conclusions: </strong>Our analysis suggests that there are both similarities and important differences between small-area estimates derived from EHR and survey data. Such differences suggest that further research is needed to de","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e86337"},"PeriodicalIF":3.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Distribution Characteristics of Tuberculosis Among Older Adults in Chongqing (2020-2024): Spatial-Temporal Analysis.","authors":"Bojie Gao, Yu Xin, Wenping Liao, Lin Shi, Chengguo Wu, Jun Fan, Qingya Wang, Shanrong Huang, Xinyuan Yi, Yong Li, Wen Zhang, Chuan Pu","doi":"10.2196/89671","DOIUrl":"10.2196/89671","url":null,"abstract":"<p><strong>Background: </strong>With global aging, the burden of tuberculosis (TB) among older adults escalates, yet spatial studies on this group are scarce. In Chongqing, where 18.87% of the population are aged 65 years and older and TB burden is high, controlling older adult TB remains a major challenge.</p><p><strong>Objective: </strong>This study analyzed the spatiotemporal patterns of TB among adults aged 65 years and older in Chongqing, China, to inform local prevention and control strategies.</p><p><strong>Methods: </strong>The study data were obtained from the Tuberculosis Information Management System of China. Global and local spatial autocorrelation analyses were conducted using ArcGIS (version 10.7) to identify high-risk spatial clusters and visualize their distribution. Spatiotemporal scan statistics were performed using SaTScan (version 10.3.2) to detect clusters of TB cases among the older adult population. Statistical significance was set at P<.05.</p><p><strong>Results: </strong>The average annual incidence of TB among older adults in Chongqing was 69.59 per 100,000 population, with peaks occurring in spring and summer. The global Moran I ranged from 0.618 to 0.756 (P<.001 in all cases), indicating significant clustering. Persistent high-risk areas were identified in the northeastern and southeastern parts of Chongqing. Spatiotemporal scan statistics detected 1 most likely cluster (relative risk=3.52, 95% CI 3.37-3.68; log-likelihood ratio=1017.43; P<.001) and 3 secondary clusters.</p><p><strong>Conclusions: </strong>Significant seasonal patterns of TB among older adults were observed in Chongqing. High-risk areas were predominantly concentrated in the northeastern and southeastern parts of the municipality. More targeted public health interventions are imperative.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e89671"},"PeriodicalIF":3.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Detection Intervals for Evaluating Event-Based Surveillance System: Reference Dataset Development Study.","authors":"Yannan Shen, Philip AbdelMalik, Russell J Steele, David L Buckeridge","doi":"10.2196/87030","DOIUrl":"https://doi.org/10.2196/87030","url":null,"abstract":"<p><strong>Background: </strong>Early detection of health threats is an objective of public health surveillance, and event-based surveillance (EBS) using unstructured information from diverse sources has played an increasingly important role in achieving this objective. However, the evaluation of EBS systems has been hindered by the lack of reference data on outbreak onsets.</p><p><strong>Objective: </strong>We introduce the concept of an \"early detection interval\" and create a dataset of these intervals across multiple countries for the epidemic caused by the Omicron variant of SARS-CoV-2.</p><p><strong>Methods: </strong>We defined the early detection interval as the time between the date of introduction of an infectious agent to a country and the date at which an increase is detectable in traditional public health surveillance data. To determine the date of the introduction of the Omicron variant, we analyzed phylogenetic studies and genome databases. We estimated the end of the interval by applying Bayesian online change point detection to reported COVID-19 case counts. In addition to the early detection intervals, this dataset also contains variables indicating data quality. To further understand the variation in the lengths of the early detection intervals, stratified analysis and univariate Cox proportional hazards were implemented.</p><p><strong>Results: </strong>This dataset contains early detection intervals for the Omicron variant in 117 countries. The intervals have a median length of 28 (IQR 18-44) days, with a median beginning date of November 27, 2021 (IQR November 17, 2021, to December 12, 2021), and a median ending date of January 2, 2022 (IQR December 19, 2021, to January 9, 2022). Countries with high sequencing availability tend to have earlier start dates with a maximum difference across data sources of only 15 (IQR 7-39) days and consequently a prolonged interval length with a median length of 29 (20-47) days. Countries with low incomes were underrepresented in this dataset, with only 12 (29.27%) out of 41 included, and they tended to have shorter intervals with a median duration of 16 (IQR 12-23) days. The univariate Cox proportional hazards ratio regression analysis confirmed prolonged interval length in countries with high sequencing availability (hazard ratio 0.59, 95% CI 0.38-0.92) and shortened interval length in low-income countries (hazard ratio 2.37, 95% CI 1.29-4.36).</p><p><strong>Conclusions: </strong>The dataset of early detection intervals created in this study can serve as reference data and facilitate the evaluation of the timeliness of alerts generated by EBS systems. Systematic and comprehensive evaluation of EBS is important to guide the development of EBS and motivate the integration of EBS into public health practice. Our study also highlights cross-country disparities in data quality, particularly for genomic evidence, and the need for data collection and sharing focused on low-resource settings.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e87030"},"PeriodicalIF":3.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Gestational Blood Pressure Trajectories and Postpartum Normotension Recovery in Hypertensive Disorders: Retrospective Cohort Study.","authors":"Zhijiang Liang, Huili Wei, Xiaojun Xu, Rong Xu, Xinyue Yang, Jinlian Dong, Xiaoyan Fan, Yukun Chen, Meiling Feng, Xin Zhou, Yijun Cai, Lijuan Lv","doi":"10.2196/89295","DOIUrl":"https://doi.org/10.2196/89295","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy (HDP) may cause lasting vascular, cardiac, and renal damage, potentially increasing the risk of postpartum cardiovascular disease.</p><p><strong>Objective: </strong>This study aimed to examine the association between gestational blood pressure (BP) trajectories in HDP and the risk of unrecovered BP at 6 weeks post partum.</p><p><strong>Methods: </strong>A total of 3162 women with HDP were obtained from the antenatal care and the postpartum follow-up information system, between January 1, 2018, and December 31, 2024. Of the 3162 women included, 1674 had gestational hypertension, 607 had preeclampsia, 246 had chronic hypertension with superimposed preeclampsia, and 635 had chronic hypertension. Group-based trajectory modeling was used to fit systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) trajectories during pregnancy. Modified Poisson regression was used to assess the association between gestational BP trajectories and the risk of unrecovered BP at 6 weeks post partum.</p><p><strong>Results: </strong>Trajectories of SBP, DBP, and MAP during pregnancy were significantly associated with unrecovered BP at 6 weeks post partum. For gestational hypertension, those with the high-consistent rise (adjusted relative risk [aRR] 2.493, 95% CI 1.093-5.689) and high-late surge SBP trajectories (aRR 4.535, 95% CI 1.884-10.917) were associated with a significantly increased risk of BP nonrecovery at 6 weeks post partum. Similar associations were observed for DBP and MAP. For chronic hypertension with superimposed preeclampsia, women with high-late surge in SBP (aRR 2.792, 95% CI 1.081-7.214), DBP (aRR 4.043, 95% CI 1.327-12.324), or MAP (aRR 4.018, 95% CI 1.462-11.045) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with chronic hypertension, those with the high-consistent rise trajectories of SBP (aRR 2.557, 95% CI 1.256-5.207), DBP (aRR 3.862, 95% CI 1.673-8.913), and MAP (aRR 3.714, 95% CI 1.682-8.201) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with preeclampsia, only high-consistent rise SBP trajectory remained significantly associated with unrecovered BP post partum (aRR 3.355, 95% CI 1.140-9.873). The high-consistent rise and high-late surge trajectories of SBP, DBP, and MAP in gestational hypertension started at similar initial levels and crossed at approximately 22 weeks of gestation.</p><p><strong>Conclusions: </strong>The gestational BP trajectories in women with HDP are positively associated with the risk of unrecovered BP at 6 weeks post partum. Early identification of women at high risk for poor postpartum BP recovery through BP trajectory analysis may have important clinical implications for improving long-term cardiovascular outcomes in this population.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e89295"},"PeriodicalIF":3.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Motives for Reducing Alcohol Consumption Among Users of an Alcohol Reduction App: Content Analysis.","authors":"Lucille P Seppi, Olivia M Maynard, Dimitra Kale, John A Cunningham, Claire Garnett","doi":"10.2196/88992","DOIUrl":"10.2196/88992","url":null,"abstract":"<p><strong>Background: </strong>It is important to understand the motives behind why people want to reduce their alcohol consumption to inform messaging for public health campaigns.</p><p><strong>Objective: </strong>This study aimed to identify the motives for reducing alcohol consumption among users of the Drink Less app in the United Kingdom.</p><p><strong>Methods: </strong>Content analysis of Drink Less app users' responses to the prompt \"I want to drink less because...\" Users were aged 18 years or older, lived in the United Kingdom, and had downloaded the app between May 20, 2016, and June 24, 2024 (n=2520). Inductive content analysis was conducted to analyze users' motives to drink less, and the frequencies were stratified by age, sex, and Alcohol Use Disorders Identification Test (AUDIT) score categories.</p><p><strong>Results: </strong>The most common motives to drink less were wanting to improve their physical health (1329/2520, 52.7%), feel better in their body (823/2520, 32.7%), improve their mental well-being (567/2520, 22.5%), regain agency (483/2520, 19.2%), live a different life (321/2520, 12.7%), and have better relationships (309/2520, 12.3%). The motives for drinking less,\"improve physical health\" and \"feel better in their body,\" had a lower prevalence among users in higher AUDIT risk zones compared with low-risk, while wanting to \"improve their mental well-being,\" \"regain agency,\" \"live a different life,\" and \"have better relationships\" had a higher prevalence among users in higher AUDIT risk zones.</p><p><strong>Conclusions: </strong>Users of an alcohol reduction app in the United Kingdom most commonly reported wanting to improve their physical health, feel better in their bodies, and improve their mental well-being as their motives for drinking less alcohol. The pattern of prevalence of different motives varied by AUDIT risk zones, highlighting the importance of tailoring interventions based on what is most likely to be motivating for individuals.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e88992"},"PeriodicalIF":3.9,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Self-Reported Recovery for Substance Use in Illinois: Statewide Representative Epidemiological Study.","authors":"Douglas C Smith, Crystal A Reinhart, Shahana Begum, Tarjani Bhatt","doi":"10.2196/82792","DOIUrl":"10.2196/82792","url":null,"abstract":"<p><strong>Background: </strong>Although recovery is a central tenet of the US substance use disorder service delivery system, empirical research on youth recovery remains limited and underdeveloped. Notably, no population-based representative surveys, either in the United States or internationally, currently assess recovery status among secondary school-aged youth (aged 14-18 years). Consequently, little is known about how many youth identify as being in recovery or about their characteristics and needs.</p><p><strong>Objective: </strong>This study presents the first statewide representative estimate of adolescent self-reported recovery (ASR), derived from a large Midwestern state in the United States.</p><p><strong>Methods: </strong>We used data from the 2024 Illinois Youth Survey, a weighted, statewide representative survey of students from 8th, 10th, and 12th grades across Illinois. We examined the prevalence of ASR with a widely used single-item question, \"Do you consider yourself to be in recovery?\" The question was presented after an instruction directing students to consider only substance use when responding. We estimated the prevalence of ASR and conducted descriptive analyses to characterize this group.</p><p><strong>Results: </strong>Among the 6871 participating students from the 10th and 12th grades, the prevalence of ASR was 3.3% (95% CI 2.6%-4.1%). Among participants with ASR, 51.1% (118/231) were female, 39% (90/231) identified as Latino or Latina, 38.1% (88/231) identified as White, and 13% (30/231) identified as Black or African American. The average age of participants with ASR was 16.5 (SD 1.14) years. Participants with ASR were demographically diverse, and a little over half received free or reduced-price lunch.</p><p><strong>Conclusions: </strong>Findings suggest that financial recovery capital may be particularly important for participants with ASR. This study provides the first population-based estimate of the prevalence of ASR and underscores the importance of including recovery status in large-scale surveys to inform and strengthen recovery support systems.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e82792"},"PeriodicalIF":3.9,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Antimicrobial Consumption in Pakistan (2016-2028): Retrospective Observational Study With Forecasting.","authors":"Zikria Saleem, Brian Godman, Zunaira Akbar, Abdul Haseeb, Muhammad Usman Qamar, Anees Ur Rehman, Mahmoud E Elrggal","doi":"10.2196/81288","DOIUrl":"10.2196/81288","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance is a public health crisis exacerbated by the irrational use of antibiotics, particularly in low- and middle-income countries. Pakistan, one of the highest consumers of antibiotics globally, faces unique challenges, including unregulated sales, overuse of broad-spectrum antibiotics, and inadequate stewardship programs.</p><p><strong>Objective: </strong>This study aimed to analyze antibiotic consumption trends in Pakistan from 2016 to 2023, project future use through 2028, and evaluate the subsequent implications for antimicrobial resistance and antimicrobial stewardship programs.</p><p><strong>Methods: </strong>Antibiotic sales data were retrieved for Pakistan from the IQVIA MIDAS database spanning 2016 to 2023. Data were converted to defined daily doses (DDDs) and DDD per 1000 inhabitants per day (DID) using the World Health Organization Anatomical Therapeutic Chemical classification system. Data cleaning, statistical analyses, and data visualization were performed using R software (version 4.3.2) and Microsoft Excel. Trends were analyzed using linear regression, while future projections (2024-2028) were developed using trend-based models. Descriptive analysis was performed, and visualizations were used to illustrate findings.</p><p><strong>Results: </strong>The total antibiotic consumption in Pakistan from 2016 to 2023 was 12.88 billion DDDs. Broad-spectrum penicillins and fluoroquinolones, each accounting for 37.7 DID, were the most consumed classes. The analysis revealed significant increases in the consumption of macrolides (+76%; rising from 2.26 to 3.99 DID) and cephalosporins (+36%; from 2.87 to 3.89 DID) from 2016 to 2023, with macrolides projected to reach 5.79 DID by 2028. Reserve antibiotics, including oxazolidinones (+354%; from 0.03-to 0.014 DID) and glycylcycline (+236%; from 0.001 to 0.0003 DID), also showed appreciable increases, reflecting greater reliance on last-line therapies. In contrast, aminoglycosides (-36%; from 0.013 to 0.14 DID) and narrow-spectrum penicillins (-30%; from 0.008 to 0.005 DID) experienced notable declines.</p><p><strong>Conclusions: </strong>The study highlights a concerning overreliance on broad-spectrum and reserve antibiotics in Pakistan, thus underscoring the urgent need for robust antimicrobial stewardship programs and stricter regulation of over-the-counter antibiotic sales to rationalize antibiotic use. Future efforts should focus on addressing gaps in prescribing practices, improving diagnostic capacity, and monitoring stewardship program outcomes to mitigate resistance development and preserve antibiotic efficacy.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e81288"},"PeriodicalIF":3.9,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everyday Digital Technology Use and Youth Health: Scoping Review of Longitudinal Studies.","authors":"Preetika Banerjee, Louise Holly","doi":"10.2196/85094","DOIUrl":"https://doi.org/10.2196/85094","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Everyday digital technologies such as social media, gaming, and internet use are deeply integrated into the lives of children, adolescents, and young adults. While these platforms can foster connection, learning, and entertainment, concerns have grown about their potential to influence mental, physical, and social well-being. Research on this topic has expanded rapidly over the past decade, yet much of it remains cross-sectional, limiting insights into long-term outcomes. Longitudinal studies are essential to capture evolving patterns of digital engagement, identify causal relationships, and guide effective policies and interventions that support youth in navigating digital environments. In particular, evidence is needed to distinguish between beneficial and harmful forms of digital engagement, such as social connection versus problematic use, and to understand how these impacts differ across diverse populations and contexts. The COVID-19 pandemic further accelerated young people's technology use, underscoring the urgency of examining both risks and opportunities. This review, therefore, synthesizes longitudinal research to map trends, identify knowledge gaps, and inform future directions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The study aimed to systematically identify and map longitudinal studies examining associations between everyday digital technology use (eg, social media, gaming, and internet use) and the health and well-being of youth (25 years or younger) and to chart the types of evidence available by technology category, outcomes, and geographical setting in order to highlight key gaps for future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of PubMed, Embase, and PsycArticles (2014-2024) was conducted and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Data extraction covered demographics, digital technology categories, and health outcomes. Studies were grouped into 6 key themes: social media use and mental health, digital addiction and behavioral outcomes, physical activity and digital technology, digital health technologies and cognitive development, parental influence and digital technology, and digital well-being and risk behaviors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 456 studies identified, 267 were longitudinal studies relevant to our research aims. Internet use (n=201 studies), social media (n=140 studies), and gaming (n=83 studies) dominated the themes. Mental health was the most frequently assessed outcome, with a focus on anxiety and depression. Geographically, 15% (40/267) of studies originated from low- and middle-income countries, with the majority from high-income settings such as the United States (n=76 studies) and Australia (n=15 studies). Nearly half (131/267, 49%) were published post 2020, reflecting heightened interest during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/str","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e85094"},"PeriodicalIF":3.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stigma, Food Insecurity, and Limited Social Support as Psychosocial Correlates of Antiretroviral Therapy Adherence Among Pregnant Women Living With HIV: Cross-Sectional Study.","authors":"Setor K Sorkpor, Ibrahim Yigit, Rachel G A Thompson, Brittany L Lane, Geoffrey Anguyo, Jerry John Ouner","doi":"10.2196/84914","DOIUrl":"https://doi.org/10.2196/84914","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adherence to antiretroviral therapy (ART) during pregnancy is critical for maternal health and the prevention of vertical HIV transmission. In Uganda, where HIV prevalence remains high, pregnant women living with HIV face intersecting structural and psychosocial challenges, including stigma, food insecurity, and limited social support. Although each factor has been linked to ART nonadherence, less is known about how these factors co-occur within individuals and jointly shape vulnerability to nonadherence during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study used latent profile analysis to identify empirically derived psychosocial vulnerability profiles reflecting the co-occurrence of stigma, food insecurity, and limited social support among pregnant women living with HIV in Uganda and examine whether profile membership is associated with ART adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional analysis of 167 pregnant women living with HIV recruited from 6 health facilities in Uganda between June and December 2020. Measures included experienced HIV stigma, internalized HIV stigma, household food insecurity, and interpersonal social support. Latent profile analysis identified psychosocial profiles, and linear regression models assessed associations between profile membership and ART adherence, adjusting for sociodemographic covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A 2-class solution provided the best model fit (entropy=0.93). The higher-risk profile (75/167, 45.1%) was characterized by increased experienced stigma (mean score 1.97, SE 0.05), higher internalized stigma (mean score 2.66, SE 0.07), severe food insecurity (mean score 7.53, SE 0.20), and lower social support (mean score 2.06, SE 0.04). The lower-risk profile (92/167, 54.9%) showed significantly lower internalized stigma (mean score 2.32, SE 0.04; P&lt;.001), lower experienced stigma (mean score 1.72, SE 0.05; P&lt;.001), minimal food insecurity (mean score 0.82, SE 0.15; P&lt;.001), and slightly higher social support (mean score 2.14, SE 0.04; P&lt;.001). Membership in the higher-risk profile was associated with significantly lower ART adherence compared with membership in the lower-risk profile (B=0.88; β=0.40, 95% CI 0.02-0.78; P=.04).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Distinct psychosocial profiles are meaningfully associated with ART adherence among pregnant women living with HIV in Uganda. By moving beyond single-risk models, these findings demonstrate the added value of person-centered analytic approaches for identifying subgroups of pregnant women living with HIV exposed to clustered psychosocial and structural vulnerabilities. The findings underscore the need for multicomponent, person-centered interventions that simultaneously address stigma, food insecurity, and limited social support rather than treating these challenges in isolation. Identifying empirically derived vulnerability profiles provides a targeted framework fo","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e84914"},"PeriodicalIF":3.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}