JMIR Public Health and Surveillance最新文献

{"title":"Effects of Maternal Use of the Continuum of Care on Complementary Feeding Practices in Bangladesh: Cross-Sectional Study.","authors":"M A Rifat, Rokibul Islam, Rinath Bintey Didar, Joya Bhowmick, Plabon Sarkar, Md Ruhul Amin, Sanjib Saha","doi":"10.2196/76666","DOIUrl":"https://doi.org/10.2196/76666","url":null,"abstract":"<p><strong>Background: </strong>The continuum of care (CoC) for maternal health, which includes ≥4 antenatal care (ANC) visits, delivery assisted by skilled birth attendants, and a postnatal care (PNC) visit within 48 hours of delivery, is a crucial health care package associated with survival and improved health outcomes for children and mothers. In addition, the CoC serves as a platform for delivering messages and counseling on child feeding practices. However, the effect of maternal use of the CoC on complementary feeding practices in Bangladesh remains unexamined.</p><p><strong>Objective: </strong>This study aimed to estimate the effect of maternal use of CoC on complementary feeding practices among children aged 6 to 23 months in Bangladesh.</p><p><strong>Methods: </strong>Data from 2 consecutive nationally representative surveys-the Bangladesh Demographic and Health Survey 2017-2018 and 2022-were analyzed. Observations corresponding to the CoC for maternal health and complementary feeding indicators, including (1) timely introduction of solid, semisolid, and soft food (ISSSF); (2) minimum meal frequency (MMF); (3) minimum dietary diversity (MDD); and (4) minimum acceptable diet (MAD), were merged to prepare the analyzed samples. The differences in complementary feeding practice indicators by maternal use of the CoC were observed using chi-square tests. Multivariable logistic regression models were used to observe the associations.</p><p><strong>Results: </strong>The analysis included 887, 4967, 4967, and 4967 mother-child pairs for the timely ISSSF, MMF, MDD, and MAD indicators, respectively. The status of complementary feeding indicators was significantly different (P<.05) by maternal use of the full CoC, ≥4 ANC visits, status of receiving PNC within 48 hours of birth, maternal educational level, husband's educational level, maternal occupation, wealth index of families, maternal perceived problems with accessing health care, and division of residence. Mothers who received the full CoC were 29% and 32% more likely to meet the MDD (adjusted odds ratio [AOR] 1.29, 95% CI 1.10-1.51; P=.002) and MAD (AOR 1.32, 95% CI 1.13-1.55; P=.001) than those who did not receive the full CoC, respectively. Among the individual components of the CoC, mothers who received ≥4 ANC visits were 23%, 31%, and 34% more likely to meet the MMF (AOR 1.23, 95% CI 1.05-1.45; P=.01), MDD (AOR 1.31, 95% CI 1.13-1.51; P<.001), and MAD (AOR 1.34, 95% CI 1.15-1.56; P<.001) than those with fewer ANC visits, respectively. Furthermore, the effects of delivery assisted by skilled birth attendants and receiving PNC within 48 hours of delivery on complementary feeding indicators were also statistically insignificant (P≥.05).</p><p><strong>Conclusions: </strong>Maternal use of the CoC appears to be effective in improving MDD and MAD among children aged 6 to 23 months in Bangladesh. The findings highlight the pivotal role of recommended ANC visits in promoting complementary feeding","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e76666"},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251002","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":"Unmet Health Care Use Among Socially Withdrawn Youth (Hikikomori) in South Korea: Cross-Sectional Survey Study.","authors":"Eunjeong Choi, Seoyeong Choi, Sukyong Jang","doi":"10.2196/79043","DOIUrl":"10.2196/79043","url":null,"abstract":"<p><strong>Background: </strong>Hikikomori, a condition of severe social withdrawal, is a global public health issue characterized by prolonged isolation. Despite its growing prevalence, little is known about the health care needs and use patterns of socially withdrawn youth.</p><p><strong>Objective: </strong>The study aimed to examine the association between hikikomori status and unmet health care use to inform targeted interventions.</p><p><strong>Methods: </strong>Data were obtained from the 2022 Korean Youth Living Conditions Survey, a nationally representative cross-sectional survey of 14,966 participants aged 19 to 34 years. Survey weights were applied to account for the sampling design. Hikikomori status was classified based on self-reported withdrawal behaviors, stratified by severity and duration. Unmet health care use in physical and mental health was assessed. Adjusted prevalence ratios (aPRs) with 95% CIs were estimated using generalized estimating equation models, and logistic regression was applied for subgroup analyses.</p><p><strong>Results: </strong>The weighted prevalence of perceived need for mental health services was 63.9% in the hikikomori group versus 50.5% in the non-hikikomori group (aPR 1.27, 95% CI 1.15-1.41). Unmet health care use was higher among individuals with hikikomori for physical care (aPR 3.33, 95% CI 2.16-5.13) and mental health care (aPR 4.46, 95% CI 2.92-6.81). Associations strengthened with greater severity and longer duration: for unmet mental health care use, aPRs were 4.14 (95% CI 2.64-6.49) for stage 1 and 9.52 (95% CI 3.67-24.65) for stage 2; by duration, aPRs were 2.57 (95% CI 1.11-5.96) for pre-hikikomori and 5.44 (95% CI 3.44-8.58) for hikikomori. Effect modification was observed by labor force participation, with higher risks among those not in the labor force (P for interaction <.05).</p><p><strong>Conclusions: </strong>Hikikomori is strongly associated with unmet health care use, particularly in mental health, with risks amplified by severity and duration. Tailored policies, including community-based outreach and remote health care interventions, are urgently needed to address these gaps.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e79043"},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212700","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":"Severity Classification of Anxiety and Depression Using Generalized Anxiety Disorder Scale and Patient Health Questionnaire: National Cross-Sectional Study Applying Classification and Regression Tree Models.","authors":"Andre Faro, Julian Tejada, Wael Al-Delaimy","doi":"10.2196/72591","DOIUrl":"10.2196/72591","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Scalable and accurate screening tools are critical for public mental health strategies, especially in low- and middle-income countries (LMICs). While the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) are widely used, their full application in large-scale programs can pose feasibility challenges. By contrast, shorter versions like GAD-2 and PHQ-2 reduce burdens but fail to capture symptom diversity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to optimize screening for anxiety and depression severity using classification and regression tree (CART) models, identifying concise and high-performing decision rules based on the GAD-7 and PHQ-9 items, and to test their reproducibility in 5 independent datasets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional, nonprobabilistic study was conducted with 20,585 Brazilian adults from all 27 states and more than 3,000 cities, collected using digital outreach. Anxiety and depression symptoms were assessed using the GAD-7 and PHQ-9. CART models were trained and tested on bootstrapped samples (70% training, 30% testing), totaling 45,000 trees per scale. Each model used combinations of scale items and sociodemographic predictors. Robustness was evaluated via 10-fold cross-validation and evaluation across 3 hyperparameter configurations (minsplit and minbucket=500, 1000, 2000). Performance metrics included accuracy, sensitivity, specificity, precision, F1-score, and area under the curve (AUC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The CART models produced concise, high-performing decision rules-using only 2 items for the GAD-7 and 3 for the PHQ-9. No sociodemographic variable appeared in the final classification paths. For GAD-7, the models achieved an accuracy of 86.1% for minimal or mild severity and 85.1% for severe cases, with both categories showing AUC values above 0.900. By contrast, the moderate severity class had lower performance, with accuracy around 51% and an AUC of 0.728. For PHQ-9, the models achieved 81.7% accuracy for minimal or mild cases and 78.8% for severe cases, with AUCs again exceeding 0.900 for the extreme classes; the moderate or moderately severe class showed 66.9% accuracy and an AUC of 0.776. The most frequently repeated rules included the following: \"GAD2&lt;2 and GAD4&lt;2\" for identifying minimal or mild anxiety and \"GAD2≥2 and GAD4=3\" for severe anxiety; for depression, \"PHQ2&lt;2and PHQ4&lt;2\" for minimal or mild cases and \"PHQ2≥2 and PHQ8≥2\" for severe cases. These rule-based models demonstrated stable performance across thousands of bootstrapped replications and showed reproducibility in 5 independent datasets through external validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CART models enabled simplified, symptom-specific pathways for stratifying anxiety and depression severity with high precision and minimal item burden. These rule-based shortcuts offer an efficient alternative to fixed short forms (eg, GAD-2, PHQ-2) by","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e72591"},"PeriodicalIF":3.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199375","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":"Comparison of Virus Watch COVID-19 Positivity, Incidence, and Hospitalization Rates With Other Surveillance Systems: Surveillance Study.","authors":"Wing Lam Erica Fong, Vincent Grigori Nguyen, Sarah Beale, Thomas E Byrne, Cyril Geismar, Ellen Fragaszy, Jana Kovar, Alexei Yavlinsky, Ibrahim Abubakar, Andrew C Hayward, Robert W Aldridge","doi":"10.2196/69655","DOIUrl":"10.2196/69655","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Effective disease surveillance is essential for understanding pathogens' epidemiology, detecting outbreaks, and enabling timely public health responses. In the United Kingdom, large-scale studies, such as the Office for National Statistics COVID-19 Infection Survey (CIS), have monitored SARS-CoV-2 transmission but required significant resources, making them challenging to sustain when pandemic-specific funding ends and also in resource-limited settings. In contrast, the Virus Watch study, at lower cost, relied on self-reported and linked national testing data as well as symptomatic testing, while Severe Acute Respiratory Infections Watch (SARI) leveraged hospital data for cost-effective surveillance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the effectiveness of Virus Watch as a surveillance system in monitoring COVID-19 positivity, incidence, and hospitalization rates in England and Wales, using data from the CIS and SARI as benchmarks for comparison, while considering the key differences in the study designs, including recruitment strategies, incentives, and testing criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used the Virus Watch prospective community cohort study to estimate COVID-19 positivity, incidence, and hospitalization rates in England and Wales from June 2020 to March 2023. Rate estimates were compared with CIS modeled positivity and incidence rates, and with SARI COVID-19 hospitalization rates. Global synchrony between datasets was measured using overall Spearman ⍴ and local synchrony using 9-week rolling Spearman ⍴. For England, comparisons with CIS estimates used Virus Watch rates calculated with and without linked national testing data. Positivity rates were also assessed overall and separately before and after the end of free national testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 58,628 participants were recruited into the Virus Watch study, of whom 52,526 (89.6%) were resident in England and 1532 (2.6%) in Wales; region was missing for the remainder. Virus Watch-estimated COVID-19 positivity and incidence rates in England, calculated with and without linked testing data, showed strong global synchrony with CIS estimates (positivity ⍴: 0.91 and 0.90; both P&lt;.001 and incidence ⍴: 0.92 and 0.90; both P&lt;.001) and strong local synchrony (positivity ⍴: median 0.75, IQR 0.53-0.85 and median 0.67, IQR 0.47-0.83, and incidence ⍴: median 0.76, IQR 0.49-0.88 and median 0.66, IQR 0.45-0.82), despite having lower absolute values. Global and local synchrony of positivity rates were similar for periods before and after the end of free national testing, although the difference between Virus Watch and CIS estimates was greater post-free testing. COVID-19 hospitalization rates were also lower and less synchronized with SARI estimates. In Wales, Virus Watch estimates exhibited greater variability (positivity ρ: 0.75, P&lt;.001; incidence rate ρ: 0.85, P&lt;.001) and lower local synchrony (positi","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e69655"},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191874","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":"Small-Area Lung Cancer Incidence and Mortality: Cross-Sectional Population-Based Study Using Hospital Discharge and Death Registration Data.","authors":"Yu He, Xinxin Xia, Qing Wang, Yaoyun Zhang, Ying Meng, Xiaokang Ji, Qingbo Zhao, Yongchao Wang, Yifu Zhao, Fuzhong Xue, Jin Xu","doi":"10.2196/74062","DOIUrl":"10.2196/74062","url":null,"abstract":"<p><strong>Background: </strong>Despite rapid development, cancer registries in low- and middle-income countries, such as China, have the persistent problems with up to 6-year delay and a lack of reported details about small areas.</p><p><strong>Objective: </strong>This study aimed to develop an approach to provide more up-to-date localized cancer surveillance using linked administrative data. We used lung cancer as an example.</p><p><strong>Methods: </strong>Based on data of hospitalization record front pages (HRFPs) between 2013 and 2022 from all the secondary and tertiary hospitals in Shandong Province, China, we identified incident cases of lung cancer in 2022 with 2013-2021 being the washout period. Deaths from lung cancer were ascertained for 2022 using linked HRFPs and death registration data. We estimated age-standardized incidence and mortality rates (ASIR and ASMR) of lung cancer in 2022 using Segi world standard population, age-specific incidence and mortality rates by sex, and county-level ASIR and ASMR to illustrate regional disparity. We grouped the counties by municipalities and calculated the Theil indices for within-municipality inequality and between-municipality inequality.</p><p><strong>Results: </strong>The HRFPs captured 79,672 incident cases of lung cancer in Shandong in 2022 (45,527 males, 34,145 females). The ASIR of lung cancer in Shandong was 42.46 per 100,000 in both sexes (49.19/100,000 in males vs 36.67/100,000 in females). A total of 40,626 lung cancer-specific deaths were ascertained (28,185 men and 12,441 women). The ASMR was 19.76/100,000 in both sexes, 26.29/100,000 and 11.38/100,000 in males and females, respectively. The IQR of county-level ASIR and ASMR were 17.13/100,000 and 10.41/100,000, respectively. The inequality was primarily due to within-municipality disparities, with within-municipality Theil T indices higher than between-municipality Theil T indices (0.0572 vs 0.0033 for ASIR, 0.0824 vs 0.0011 for ASMR).</p><p><strong>Conclusions: </strong>The cancer surveillance approach based on linked administrative data could provide up-to-date small-area estimates of cancer burden, when cancer registry data are not yet reported and for areas not covered by cancer registries. It could reveal disparity of cancer epidemiology, which provides leads for further investigation into the underlying causes and potential solutions for equity improvement.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e74062"},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191796","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":"Secondary Distribution of Dual HIV/Syphilis Self-Testing Among Men Who Have Sex With Men: Pragmatic Randomized Controlled Trial in China.","authors":"Min Wang, Yun Zhang, Weiyi Tian, Jinli Mo, Haimei Huang, Jiawen Zhu, Sumin Tan, Yingqiong Huang, Li Jiang, Ping Cen, Guanghua Lan, Hao Wang, Wei Pan, Joseph D Tucker, Chuanyi Ning","doi":"10.2196/70775","DOIUrl":"10.2196/70775","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The World Health Organization recommends dual HIV/syphilis testing, but this approach has not been examined in many low- and middle-income countries. Dual HIV/syphilis self-testing may accelerate secondary distribution of self-test kits. Preliminary studies in Guangdong, China, have demonstrated the feasibility and cost-effectiveness of dual HIV/syphilis self-testing distribution via social media, but evidence comparing dual HIV/syphilis self-testing to single HIV self-testing for secondary distribution within social networks remains limited in resource-limited settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to evaluate the effectiveness of secondary distribution of dual HIV/syphilis self-testing kits in promoting HIV testing uptake among men who have sex with men (MSM) in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a pragmatic 3-arm randomized controlled study in the Guangxi Zhuang Autonomous Region, China. MSM aged 18 years or older who were HIV-negative were enrolled and randomly assigned (1:1:1) to either the site-based HIV testing (SBT) group (110/330, 33.3%), single HIV self-testing (SST) group (110/330, 33.3%), or dual HIV/syphilis self-testing (DST) group (110/330, 33.3%). Participants in the SST and DST groups received free finger-prick-based HIV self-testing or HIV/syphilis self-testing kits at enrollment and during the 12-month follow-up. The primary outcome was the mean number of social network members motivated by the participant and the mean frequency of HIV tests per participant within a 3-month period. The data were analyzed using an intention-to-treat analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 330 MSM were recruited, among whom 319 (319/330, 96.7%) completed at least 1 follow-up survey and were subsequently included in the analysis. Among the participants, 245/319 (77%) had a college education or above. Compared to social network members in the SBT group, those in the intervention SST and DST groups were more likely to motivate others for HIV testing over a 3-month average duration. The mean number of motivated individuals was 0.42 in the SST group versus 0.20 in the SBT group, a mean difference (MD) of 0.22 (95% CI 0.12-0.33; P&lt;.001). The mean was 0.51 in the DST group versus 0.20 in the SBT group, with an MD of 0.32 (95% CI 0.20-0.43; P&lt;.001). The mean frequency of total HIV tests per participant in the SST group (1.33) was higher than that in the SBT group (0.87), with an MD of 0.46 (95% CI 0.31-0.62; P&lt;.001) over 3 months. Over a 3-month period, the mean number of HIV tests per participant was higher in the DST group (1.43) than in the SBT group (0.87), with an MD of 0.57 (95% CI 0.41-0.73; P&lt;.001). A total of 4 (1.3%) individuals had a new HIV positive result, while 11 (3.4%) had a new syphilis positive result. All individuals who had positive self-test results underwent laboratory-based confirmation tests. There were no adverse events reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e70775"},"PeriodicalIF":3.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149137","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":"Effectiveness of Antivirals Nirmatrelvir-Ritonavir and Molnupiravir in Viral Sepsis: Retrospective Cohort Study.","authors":"Teddy Tai Loy Lee, Alex Chang-Hao Lyu, Ting Ting Jiang, Sunny Ching Long Chan, Crystal Ying Chan, Edmond Tsz Fung Yip, Luke Yik Fung Luk, Joshua Wing Kei Ho, Kevin Wang Leong So, Omar Wai Kiu Tsui, Man Lok Lam, Shi Yeow Lee, Tafu Yamamoto, Chak Kwan Tong, Man Sing Wong, Eliza Lai Yi Wong, Abraham Ka Chung Wai, Timothy Hudson Rainer","doi":"10.2196/72124","DOIUrl":"10.2196/72124","url":null,"abstract":"<p><strong>Background: </strong>Viral infections, including those leading to sepsis, are common but often overlooked in clinical practice, yet the treatment strategies for viral sepsis remain inadequately defined.</p><p><strong>Objective: </strong>This study aims to investigate the effectiveness of antivirals nirmatrelvir-ritonavir and molnupiravir in the treatment of culture-negative sepsis.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted across public hospitals in Hong Kong. We included patients diagnosed with COVID-19 between February 22, 2022, and June 30, 2023, who had no secondary bacterial or fungal infections. Propensity score matching was used to assess the efficacy of the antivirals nirmatrelvir-ritonavir and molnupiravir in patient subgroups with or without organ dysfunction at hospital admission, including circulatory shock, respiratory failure, acute kidney injury, coagulopathy, acute liver impairment, a composite of all organ dysfunctions, or no organ dysfunction. Key outcomes were in-hospital mortality and length of stay, reported as hazard ratios (HR) and mean differences, respectively.</p><p><strong>Results: </strong>The study included 15,599 COVID-19 patients with a mean age of 75.1 (SD 15.9) years. Molnupiravir treatment was associated with a significantly lower risk of mortality in patients in both the presence of any organ dysfunction (HR 0.75, 95% CI 0.58 to 0.96) and without organ dysfunction (HR 0.29, 95% CI 0.15-0.56). Nirmatrelvir-ritonavir was associated with decreased mortality with respiratory failure (absolute risk difference: 9.5%, 95% CI 6.26-12.72) and without organ dysfunction (HR 0.17, 95% CI 0.05-0.56). Antivirals also reduced the length of hospital stay; nirmatrelvir-ritonavir reduced length of stay in respiratory failure by an average of 3.37 (95% CI 2.32-4.42) days, acute kidney injury by 7.25 (95% CI 2.97-11.52) days, and coagulopathy by 7.04 (95% CI 2.99-4.05) days. Molnupiravir reduced the length of stay in acute kidney injury by an average of 6.7 (95% CI 2.39-11.08) days and coagulopathy by 5.68 (95% CI 1.20-10.16) days.</p><p><strong>Conclusions: </strong>Antivirals reduced mortality among hospitalized COVID patients, with the greatest reduction observed in patients without organ dysfunction. Antivirals were also effective in reducing the length of hospital stay.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e72124"},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086274","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":"Clustering of Lifestyle Behaviors and Their Association With Risk of Metabolic Syndrome Among Adults in Taiwan: Nationwide Cross-Sectional Study.","authors":"Ya-Hui Chang, Chung-Yi Li, Hon-Ping Ma, Chien-Yuan Wu, Yann-Yuh Jou, Chiachi Bonnie Lee","doi":"10.2196/73114","DOIUrl":"10.2196/73114","url":null,"abstract":"<p><strong>Background: </strong>Metabolic syndrome (MetS) is a multifaceted health condition influenced by physiological and lifestyle factors, leading to increased risks of cardiovascular disease and other chronic health issues. Lifestyle behaviors often manifest in various clustering patterns, and evidence of their impact on MetS remains limited.</p><p><strong>Objective: </strong>This study explores the relationship of latent classes of lifestyle behaviors with the risk of MetS and its components.</p><p><strong>Methods: </strong>This cross-sectional study used data from Taiwan's 2020-2022 Adult Preventive Health Services Database, which was linked to 2020-2022 National Health Insurance claim data. The study included 241,156 adults aged 40 years and older who participated in adult preventive health services between 2020 and 2022. Lifestyle behaviors were assessed through smoking, alcohol consumption, betel quid chewing, and physical activities. Latent class analysis was used to identify lifestyle behavior patterns, while binary logistic regression examined the association of these patterns with MetS risk and its components.</p><p><strong>Results: </strong>The latent class analysis identified 5 distinct lifestyle behavior patterns, with an overall MetS prevalence of 35.72% (86,143/241,156). Compared to the \"healthy lifestyle\" group (27,465/241,156, 11.39% prevalence), the \"insufficiently physically active (IPA)\" group (182,101/241,156, 75.51%, adjusted odds ratio [aOR] 1.41, 95% CI 1.37-1.45; P<.001), the \"occasional drinking but physically active\" group (18,244/241,156, 7.57%, aOR 1.27, 95% CI 1.21-1.32; P<.001), the \"occasional drinking and regular smoking with IPA\" group (9539/241,156, 3.96%, aOR 2.38, 95% CI 2.26-2.50; P<.001), and the \"unhealthy in all behaviors\" group (3807/241,156, 1.58%, aOR 2.38, 95% CI 2.22-2.55; P<.001) showed significantly higher odds of developing MetS. Compared to the \"healthy lifestyle\" group, all other lifestyle patterns were also associated with significantly higher odds of central obesity (P<.001), elevated blood pressure (P<.001), elevated fasting blood glucose (P<.001), elevated fasting triglycerides (P<.001), and reduced high-density lipoprotein cholesterol (P<.001), with the most potent effects observed in the \"occasional drinking and regular smoking with IPA\" group and the \"unhealthy in all behaviors\" group. An exception was noted for the \"occasional drinking but physically active\" group, which showed a significantly lower likelihood of reduced high-density lipoprotein cholesterol (aOR 0.90, 95% CI 0.85-0.94; P<.001).</p><p><strong>Conclusions: </strong>Engaging in sufficient physical activity and adopting multibehavior interventions tailored to specific lifestyle patterns are crucial for effectively preventing MetS in adults.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e73114"},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086265","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":"Social Media Recruitment in Indigenous and Native American Populations: Challenges in the AI Age.","authors":"Nadia Diamond-Smith, Alison Comfort, Anna Epperson, Alicia R Riley, Natalie Beylin, Mary Garcia, Sarah Francis, Lucía Abascal Miguel","doi":"10.2196/76677","DOIUrl":"10.2196/76677","url":null,"abstract":"<p><strong>Unlabelled: </strong>Using social media recruitment for public health research presents both opportunities and challenges. Despite its increased use, few studies have detailed the practical issues, challenges encountered, and alternative strategies available for social media recruitment. This paper explores strategies for recruiting Indigenous and Native American populations in California for a study on COVID-19 vaccination and social networks. We describe different recruitment approaches, challenges faced, and pros and cons of strategies used to enhance data quality and efficiency, including survey design considerations, Facebook targeting versus use of research panels, quality assurance checks, and decisions around participant incentives. Our local setting involved recruiting Native American and Mesoamerican Indigenous individuals living in California through social media platforms. We highlight key adaptations to survey design, recruitment strategies, and data cleaning processes, noting what approaches that were effective and those that were not. Despite targeted efforts and community collaboration, recruitment was limited, and fraudulent data from bots significantly compromised data quality. Standard Facebook targeting approaches were largely unsuccessful. Our findings suggest that the increasing sophistication of artificial intelligence is becoming a substantial obstacle to authentic participant recruitment through social media. We offer recommendations to improve recruitment of hard-to-reach populations and mitigate AI-related fraud risks in future research.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e76677"},"PeriodicalIF":3.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080740","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":"Identifying Predictors of Cervical Cancer Screening Uptake in Sub-Saharan Africa Using Machine Learning: Cross-Sectional Study.","authors":"Nebebe Demis Baykemagn, Mekuriaw Nibret Aweke, Amare Mesfin, Lemlem Daniel Baffa, Muluken Chanie Agimas, Habtamu Wagnew Abuhay, Dagnew Getnet Adugna, Tewodros Getaneh Alemu, Alemu Teshale Bicha, Gebrie Getu Alemu","doi":"10.2196/71677","DOIUrl":"10.2196/71677","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer has been ranked as the fourth most common cancer affecting women, contributing to approximately 660,000 new diagnoses and 350,000 fatalities worldwide. Effective early screening has been shown to reduce cervical cancer incidence by up to 80% and prevent more than 40% of new cases.</p><p><strong>Objective: </strong>This study aims to assess a machine learning-based prediction model and identify the key predictors influencing cervical cancer screening uptake among women aged 30-49 years in sub-Saharan Africa.</p><p><strong>Methods: </strong>For this study, a weighted dataset of 33,952 individuals from the 2022 Demographic and Health Survey in Ghana, Kenya, Mozambique, and Tanzania was used. STATA version 17 (StataCorp) and Python 3.10 (Python Software Foundation) were used for data preprocessing and analysis. MinMax and standard scaler were applied for feature scaling, and recursive feature elimination was used for feature selection. An 80:20 ratio was applied for data splitting. Tomek links with random oversampling were used for handling class imbalance. A total of 7 models were selected and trained using both balanced and unbalanced datasets. Model evaluation was performed using area under the receiver operating characteristic curve, accuracy, and a confusion matrix.</p><p><strong>Results: </strong>The proportion of cervical cancer screening in sub-Saharan Africa was 13%, which is lower than reported in previous studies. Random forest was the best-performing model, achieving an accuracy of 78%, an area under the curve of 86%, an F1-score of 79%, a recall of 81%, and a precision of 77%. The waterfall plot's Shapley Additive Explanations analysis showed that wealth status, awareness of sexually transmitted infections, HIV testing exposure, age at first sexual intercourse, educational level, residency, smartphone ownership, having a single sexual partner, and previous health status were predictors of cervical cancer screening.</p><p><strong>Conclusions: </strong>Improving education and awareness, expanding access to screening (especially in rural areas), leveraging both digital health and community-based outreach, integrating screening with other health services, and addressing socioeconomic barriers are recommended strategies to increase cervical cancer screening rates in sub-Saharan Africa.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e71677"},"PeriodicalIF":3.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080675","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}