JMIR Public Health and Surveillance最新文献

{"title":"Survival Tree Analysis of Interactions Among Factors Associated With Colorectal Cancer Risk in Patients With Type 2 Diabetes: Retrospective Cohort Study.","authors":"Sarah Tsz Yui Yau, Chi Tim Hung, Eman Yee Man Leung, Albert Lee, Eng Kiong Yeoh","doi":"10.2196/62756","DOIUrl":"https://doi.org/10.2196/62756","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC development among patients with diabetes.</p><p><strong>Objective: </strong>This study aimed to identify the interaction patterns among factors associated with the risk of CRC incidence among patients with diabetes.</p><p><strong>Methods: </strong>This is a retrospective cohort study conducted using electronic health records from Hong Kong. Patients who were diagnosed with type 2 diabetes and received care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. A conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC.</p><p><strong>Results: </strong>A total of 386,325 patients were included. During a median follow-up of 6.2 years (IQR 3.3-8.0), 4199 patients developed CRC. Patients were first partitioned into 4 age groups by increased levels of CRC risk (≤54 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged more than 54 years, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median 12, IQR 7-18 vs median 4, IQR 1-11 years) were identified as key risk factor for CRC among men aged between 62 and 73 years and women aged more than 73 years, respectively.</p><p><strong>Conclusions: </strong>This study suggests the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC incidence among patients with diabetes. Findings of the study may help identify target groups for public health intervention strategies.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e62756"},"PeriodicalIF":3.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017884","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":"Use of Behavior Change Techniques in Digital HIV Prevention Programs for Adolescents and Young People: Systematic Review.","authors":"Phoenix Kit-Han Mo, Luyao Xie, Tsz Ching Lee, Angela Yuen Chun Li","doi":"10.2196/59519","DOIUrl":"10.2196/59519","url":null,"abstract":"<p><strong>Background: </strong>HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Digital health interventions have been increasingly used to prevent the rising HIV epidemic. Behavior change techniques (BCTs) are intervention components designed to modify the underlying processes that regulate behavior. The BCT taxonomy offers a systematic approach to identifying, extracting, and coding these components, providing valuable insights into effective intervention strategies. However, few reviews have comprehensively identified the use of BCTs in digital HIV interventions among adolescents and young people.</p><p><strong>Objective: </strong>This study aimed to synthesize existing evidence on the commonly used BCTs in effective digital HIV prevention programs targeting adolescents and young people.</p><p><strong>Methods: </strong>In total, 4 databases (PubMed, Embase, Cochrane Library, and APA PsycINFO) were searched, and studies from January 2008 to November 2024 were screened. Reference lists of relevant review studies were reviewed to identify any additional sources. Eligible randomized controlled trials with 1 of 3 HIV prevention outcomes (ie, HIV knowledge, condom-use self-efficacy, and condom use) were included. Basic study characteristics, intervention strategies, and study results were extracted and compared for data analysis. For the included interventions, BCTs were identified according to the BCT taxonomy proposed by Abraham and Michie in 2008, and the frequencies of BCTs used in these interventions were counted.</p><p><strong>Results: </strong>Searches yielded 383 studies after duplicates were removed, with 34 (8.9%) publications finally included in this review. The most frequently used BCTs included prompting intention formation (34/34, 100%), providing information about behavior-health link (33/34, 97%), providing information on consequences (33/34, 97%), and providing instruction (33/34, 97%). Interventions with significant improvements in HIV knowledge (11/34, 32%) more frequently used BCTs with a provision nature, such as providing information about behavior-health link (11/11, 100%), information on consequences (11/11, 100%), encouragement (10/11, 91%), and instruction (10/11, 91%). Those with significant increases in condom-use self-efficacy (7/34, 20%) used BCTs toward initiating actions, such as prompts for intention formation (7/7, 100%), barrier identification (7/7, 100%), and practice (5/7, 71%). In addition, studies showing significant improvements in condom use (14/34, 41%) included BCTs focused not only on provision and initiation but also on behavioral management and maintenance, such as use follow-up prompts (5/14, 36%), relapse prevention (4/14, 29%), prompt self-monitoring of behavior (3/14, 21%), and prompt review of behavioral goals (3/14, 21%).</p><p><strong>Conclusions: </strong>This is","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e59519"},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004512","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":"Analyzing Satellite Imagery to Target Tuberculosis Control Interventions in Densely Urbanized Areas of Kigali, Rwanda: Cross-Sectional Pilot Study.","authors":"Mauro Faccin, Caspar Geenen, Michiel Happaerts, Sien Ombelet, Patrick Migambi, Emmanuel André","doi":"10.2196/68355","DOIUrl":"https://doi.org/10.2196/68355","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis and treatment initiation for tuberculosis (TB) not only improve individual patient outcomes but also reduce circulation within communities. Active case-finding (ACF), a cornerstone of TB control programs, aims to achieve this by targeting symptom screening and laboratory testing for individuals at high risk of infection. However, its efficiency is dependent on the ability to accurately identify such high-risk individuals and communities. The socioeconomic determinants of TB include difficulties in accessing health care and high within-household contact rates. These two determinants are common in the poorest neighborhoods of many sub-Saharan cities, where household crowding and lack of health-care access often coincide with malnutrition and HIV infection, further contributing to the TB burden.</p><p><strong>Objective: </strong>In this study, we propose a new approach to enhance the efficacy of ACF with focused interventions that target subpopulations at high risk. In particular, we focus on densely inhabited urban areas, where the proximity of individuals represents a proxy for poorer neighborhoods with enhanced contact rates.</p><p><strong>Methods: </strong>To this end, we used satellite imagery of the city of Kigali, Rwanda, and computer-vision algorithms to identify areas with a high density of small residential buildings. We subsequently screened 10,423 people living in these areas for TB exposure and symptoms and referred patients with a higher risk score for polymerase chain reaction testing.</p><p><strong>Results: </strong>We found autocorrelation in questionnaire scores for adjacent areas up to 782 meters. We removed the effects of this autocorrelation by aggregating the results based on H3 hexagons with a long diagonal of 1062 meters. Out of 324 people with high questionnaire scores, 202 underwent polymerase chain reaction testing, and 9 people had positive test results. We observed a weak but statistically significant correlation (r=0.28; P=.04) between the mean questionnaire score and the mean urban density of each hexagonal area.</p><p><strong>Conclusions: </strong>Nine previously undiagnosed individuals had positive test results through this screening program. This limited number may be due to low TB incidence in Kigali, Rwanda, during the study period. However, our results suggest that analyzing satellite imagery may allow the identification of urban areas where inhabitants are at higher risk of TB. These findings could be used to efficiently guide targeted ACF interventions.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e68355"},"PeriodicalIF":3.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019498","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":"The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study.","authors":"Qiang Wang, Ana Bolio, Leesa Lin","doi":"10.2196/66872","DOIUrl":"https://doi.org/10.2196/66872","url":null,"abstract":"<p><strong>Background: </strong>Social norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior.</p><p><strong>Objective: </strong>We aimed to explore the association between cultural tightness and COVID-19 vaccine hesitancy.</p><p><strong>Methods: </strong>A total of 44,339 participants aged 18 years and older were enrolled from 28 different countries between 2020 and 2022. We used the Vaccine Confidence Index (3 items related to evaluation of importance, effectiveness, and safety) with a 5-point Likert scale to collect COVID-19 vaccine confidence. Demographic information at the individual-level was obtained through the survey, while national-level data were sourced from the World Bank and Hofstede insights. Multilevel linear regressions with random effects for country were used to examine the association between cultural tightness and COVID-19 vaccine confidence.</p><p><strong>Results: </strong>Of the participants, 21,968 (50.2%) were male and 18,957 (43.3%) had an education level of university or above. Vietnam exhibited the highest level of confidence (mean 13.31, SD 1.71) on COVID-19 vaccine and Slovakia had the lowest level (mean 9.52, SD 0.14). The higher levels of cultural tightness were positively linked to greater vaccine confidence (β=1.94, 95% CI 1.72-2.15; P<.001) after controlling individual- and national- level variables. Individuals who were younger in age, female, had lower levels of educational level, or belonged to minority religious groups demonstrated a positive association with lower vaccine confidence. Hofstede's 5 cultural dimensions were not significantly associated with vaccine confidence. The level of vaccine confidence in 2021 (β=-0.54, 95% CI -0.67 to -0.37; P<.001) and 2022 (β=-0.23, 95% CI -0.34 to -0.10; P<.001) was lower than that observed in 2020.</p><p><strong>Conclusions: </strong>Lower level of cultural tightness might be positively associated with low vaccine confidence. Our findings offered the insight for designing tailor interventions to vaccine hesitancy in different cultural tightness context.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e66872"},"PeriodicalIF":3.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990431","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":"The Effect of a Brief Video-Based Intervention to Improve AIDS Prevention in Older Men: Randomized Controlled Trial.","authors":"Tian Huaju, Xie Rendie, Xiao Lu, Li Mei, Luo Yue, Zhang Daiying, Chen Yanhua, Ren Jianlan","doi":"10.2196/65674","DOIUrl":"https://doi.org/10.2196/65674","url":null,"abstract":"<p><strong>Background: </strong>The AIDS epidemic among older people is becoming more serious. Evidence-based, acceptable, and effective preventive interventions are urgently needed. Video-based interventions have become an innovative way to change behaviors, and we have developed a brief video-based intervention named Sunset Without AIDS.</p><p><strong>Objective: </strong>In this study, we tested the effectiveness of a brief video-based intervention targeting older men's understanding of AIDS prevention.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from June 20 to July 3, 2023. In total, 100 older men were randomly divided into the intervention group (n=50) and the control group (n=50) using the envelope extraction method. The intervention group was shown the Sunset Without AIDS video; the control group viewed a standard AIDS education video. A questionnaire was used to measure the effect of Sunset Without AIDS after 2 interventions. AIDS-related high-risk behaviors were followed up 1 and 3 months after the intervention. The difference was statistically significant at P≤.05.</p><p><strong>Results: </strong>After 2 interventions, the total awareness rates (%) of AIDS-related knowledge in the intervention and control groups were 84% (42/50) and 66% (33/50), respectively (P=.04). The mean stigma attitude scores of the 2 groups were 2.53 (SD 0.45) and 2.58 (SD 0.49), respectively (P=.55), but there was a statistically significant difference in the first dimension (fear of infection) between the 2 groups (P<.001). The mean positive scores of attitudes of AIDS-related high-risk behaviors of the 2 groups were 83.33 (SD 21.56) and 75.67 (SD 26.77), respectively (P=.58). In addition, 82% reported that they were satisfied with the educational content within the Sunset Without AIDS video. At 1- and 3-month follow-ups conducted after the intervention, participants in the 2 groups did not report AIDS-related high-risk behaviors. After watching the 2 videos, more people accepted and were satisfied with Sunset Without AIDS.</p><p><strong>Conclusions: </strong>Sunset Without AIDS could improve the ability of older men in China to follow best practices for AIDS prevention and provide a certain basis for the innovation of AIDS education in the older adult population.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e65674"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12025342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991128","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 Social Distancing Compliance and Public Place Crowding During the COVID-19 Pandemic: Cross-Sectional Observational Study Using Computer Vision to Analyze Surveillance Footage.","authors":"Lasse Suonperä Liebst, Wim Bernasco, Peter Ejbye-Ernst, Nigel van Herwijnen, Thomas van der Veen, Dennis Koelma, Cees G M Snoek, Marie Rosenkrantz Lindegaard","doi":"10.2196/50929","DOIUrl":"https://doi.org/10.2196/50929","url":null,"abstract":"<p><strong>Background: </strong>Social distancing behavior has been a critical nonpharmaceutical measure for mitigating the COVID-19 pandemic. For this reason, there has been widespread interest in the factors determining social distancing violations, with a particular focus on individual-based factors.</p><p><strong>Objective: </strong>In this paper, we examine an alternative and less appreciated indicator of social distancing violations: the situational opportunity for maintaining interpersonal distance in crowded settings. This focus on situational opportunities is borrowed from criminology, where it offers an alternative to individual-based explanations of crime and rule violations. We extend this approach to the COVID-19 pandemic context, suggesting its relevance in understanding distancing compliance behavior.</p><p><strong>Methods: </strong>Our data comprise a large collection of video clips (n=56,429) from public places in Amsterdam, the Netherlands, captured by municipal surveillance cameras throughout the first year of the pandemic. We automatized the analysis of this footage using a computer vision algorithm designed for pedestrian detection and estimation of metric distances between individuals in the video still frames. This method allowed us to record social distancing violations of over half a million individuals (n=539,127) across more and less crowded street contexts.</p><p><strong>Results: </strong>The data revealed a clear positive association between crowding and social distancing violations, evident both at the individual level and when aggregated per still frame. At the individual level, the analysis estimated that each additional 10 people present increased the likelihood of a distancing violation by 9 percentage points for a given pedestrian. At the aggregated level, there was an estimated increase of approximately 6 additional violations for every 10 additional individuals present, with a very large R² of 0.80. Additionally, a comparison with simulation data indicated that street spaces should, in principle, provide sufficient room for people to pass each other while maintaining a 1.5-meter distance. This suggests that pedestrians tend to gravitate toward others, even when ample space exists to maintain distance.</p><p><strong>Conclusions: </strong>The direct positive relationship between crowding and distancing violations suggests that potential transmission encounters can be identified by simply counting the number of people present in a location. Our findings thus provide a reliable and scalable proxy measure of distancing noncompliance that offers epidemiologists a tool to easily incorporate real-life behavior into predictive models of airborne contagious diseases. Furthermore, our results highlight the need for scholars and public health agencies to consider the situational factors influencing social distancing violations, especially those related to crowding in public settings.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e50929"},"PeriodicalIF":3.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004510","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":"Leveraging Electronic Health Records in International Humanitarian Clinics for Population Health Research: Cross-Sectional Study.","authors":"Sarah Draugelis, Jessica Hunnewell, Sam Bishop, Reena Goswami, Sean G Smith, Philip Sutherland, Justin Hickman, Donald A Donahue, George A Yendewa, Amir M Mohareb","doi":"10.2196/66223","DOIUrl":"https://doi.org/10.2196/66223","url":null,"abstract":"<p><strong>Background: </strong>As more humanitarian relief organizations are beginning to use electronic medical records in their operations, data from clinical encounters can be leveraged for public health planning. Currently, medical data from humanitarian medical workers are infrequently available in a format that can be analyzed, interpreted, and used for public health.</p><p><strong>Objectives: </strong>This study aims to develop and test a methodology by which diagnosis and procedure codes can be derived from free-text medical encounters by medical relief practitioners for the purposes of data analysis.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of clinical encounters from humanitarian clinics for displaced persons in Mexico between August 3, 2021, and December 5, 2022. We developed and tested a method by which free-text encounters were reviewed by medical billing coders and assigned codes from the International Classification of Diseases, Tenth Revision (ICD-10) and the Current Procedural Terminology (CPT). Each encounter was independently reviewed in duplicate and assigned ICD-10 and CPT codes in a blinded manner. Encounters with discordant codes were reviewed and arbitrated by a more experienced medical coder, whose decision was used to determine the final ICD-10 and CPT codes. We used chi-square tests of independence to compare the ICD-10 codes for concordance across single-diagnosis and multidiagnosis encounters and across patient characteristics, such as age, sex, and country of origin.</p><p><strong>Results: </strong>We analyzed 8460 encounters representing 5623 unique patients and 2774 unique diagnosis codes. These free-text encounters had a mean of 20.5 words per encounter in the clinical documentation. There were 58.78% (4973/8460) encounters where both coders assigned 1 diagnosis code, 18.56% (1570/8460) encounters where both coders assigned multiple diagnosis codes, and 22.66% (1917/8460) encounters with a mixed number of codes assigned. Of the 4973 encounters with a single code, only 11.82% (n=588) had a unique diagnosis assigned by the arbitrator that was not assigned by either of the initial 2 coders. Of the 1570 encounters with multiple diagnosis codes, only 3.38% (n=53) had unique diagnosis codes assigned by the arbitrator that were not initially assigned by either coder. The frequency of complete concordance across diagnosis codes was similar across sex categories and ranged from 30.43% to 46.05% across age groups and countries of origin.</p><p><strong>Conclusions: </strong>Free-text electronic medical records from humanitarian relief clinics can be used to develop a database of diagnosis and procedure codes. The method developed in this study, which used multiple independent reviews of clinical encounters, appears to reliably assign diagnosis codes across a diverse patient population in a resource-limited setting.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e66223"},"PeriodicalIF":3.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009812","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":"Assessing COVID-19 Mortality in Serbia's Capital: Model-Based Analysis of Excess Deaths.","authors":"Dane Cvijanovic, Nikola Grubor, Nina Rajovic, Mira Vucevic, Svetlana Miltenovic, Marija Laban, Tatjana Mostic, Radica Tasic, Bojana Matejic, Natasa Milic","doi":"10.2196/56877","DOIUrl":"https://doi.org/10.2196/56877","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital's population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0-19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20-39 years had an estimated increase in mortality of 32.95%. For people aged 60-79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged &gt;80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The finalized mortality dataset for Belgrade can be safely used in COV","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e56877"},"PeriodicalIF":3.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019391","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":"Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial.","authors":"Noah Mancuso, Jenna Michaels, Erica N Browne, Allysha C Maragh-Bass, Jacob B Stocks, Zachary R Soberano, C Lily Bond, Ibrahim Yigit, Maria Leonora G Comello, Margo Adams Larsen, Kathryn E Muessig, Audrey Pettifor, Lisa B Hightow-Weidman, Henna Budhwani, Marie C D Stoner","doi":"10.2196/67370","DOIUrl":"https://doi.org/10.2196/67370","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Negative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Black young adults aged 18-29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI's effects was assessed by latent profiles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (P&lt;.05). Vaccine uptake was not significantly different by subgroup, and the TTC-DHI did not have differing effects on uptake across subgroups. However, the DHI had the strongest effect-with statistically significant measures of association (P&lt;.05) and interaction P values (P&lt;.10)-among the baseline vaccine-resistant and vaccine-neutral subgroups compared to the vaccine-receptive subgroups at three months in improving vaccine hesitancy, confidence, and conspiracy beliefs at three months: vaccine-resistant difference: -0.40 (-0.76 to -0.37), 0.39 (0.02 to 0.75), and -0.47 (-0.86 to -0.09); vaccine neutral difference: -0.36 (-0.52 to -0.19), 0.35 (0.18 to 0.51), and -0.24 (-0.44 to -0.03). The DHI had no effects on these outcomes among the vaccine-receptive subgroup.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine int","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e67370"},"PeriodicalIF":3.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014705","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":"Evaluation of a Digital Media Campaign to Promote Knowledge and Awareness of the GPFirst Program for Nonurgent Conditions: Repeated Survey Study.","authors":"Rebecca Ong Hui Shan, Hong Choon Oh, Priscilla Goh Sook Kheng, Lyndia Lee Sze Hui, Mas Riza Bte Mohd Razali, Edris Atikah Ahmad, Jagadesan Raghuram, Choon How How, Steven Lim Hoon Chin","doi":"10.2196/66062","DOIUrl":"https://doi.org/10.2196/66062","url":null,"abstract":"<p><strong>Background: </strong>GPFirst is a primary care partnership program designed to encourage patients with nonurgent conditions to seek care at participating general practitioner clinics instead of visiting the emergency department. In 2019, a digital media campaign (DMC) was launched to raise awareness and knowledge about GPFirst among residents in eastern Singapore.</p><p><strong>Objective: </strong>This study aims to assess the DMC's impact on awareness and knowledge of GPFirst across different age groups, and the acceptability and satisfaction of GPFirst.</p><p><strong>Methods: </strong>The DMC, comprising Facebook posts and a website designed using the Andersen behavioral model, was evaluated through 2 repeated cross-sectional surveys. The first cross-sectional survey (CS1) was conducted with eastern Singapore residents aged 21 years and older, 2 1 year before the campaign's launch, and the second survey (CS2) 4 months after. Satisfaction was measured on a 5-point Likert scale (very poor to excellent) about GPFirst experiences. Acceptability was assessed with 3 yes or no questions on decisions to visit or recommend GPFirst clinics. Analyses used tests of proportions, adjusted multiregression models, and age-stratified secondary analyses.</p><p><strong>Results: </strong>The Facebook posts generated 38,404 engagements within 5 months, with \"#ThankYourGP\" posts being the most viewed (n=24,602) and engaged (n=2618). Overall, 1191 and 1161 participants completed CS1 and CS2 respectively. Compared to CS1, CS2 participants were more aware (odds ratio [OR] 2.64, 95% CI 2.11-3.31; P<.001) and knowledgeable of GPFirst (OR 4.20, 95% CI 2.62-6.73; P<.001). Awareness was higher among married individuals (OR 1.31, 95% CI 1.04-1.66; P=.03), those without a regular primary care physician (OR 1.79, 95% CI 1.44-2.22; P<.001), and with higher education levels. Similarly, knowledge was greater among individuals with secondary (OR 2.88, 95% CI 1.35-6.17; P=.006) and preuniversity education (OR 2.56, 95% CI 1.14-5.70; P=.02), and those without a regular primary care physician (OR 1.54, 95% CI 1.02-2.34; P=.04). For acceptability, among participants who visited a GPFirst clinic, 98.2% (163/166) reported they would continue to visit a GPFirst clinic before the emergency department in the future, 95.2% (158/166) would recommend the clinic, 60.2% (100/166) cited the clinic's participation in GPFirst as a factor in their provider's choice and 87.3% (145/166) were satisfied with GPFirst. Among those unaware of GPFirst, 88.3% (1680/1903) would consider visiting a GPFirst clinic before the emergency department in the future.</p><p><strong>Conclusions: </strong>The DMC improved awareness and knowledge of GPFirst, with high satisfaction and acceptability among participants. Age-dependent strategies may improve GPFirst participation. The \"#ThankYourGP\" campaign demonstrated the potential of user-generated content to boost social media engagement, a strategy that inte","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e66062"},"PeriodicalIF":3.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005624","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}