JMIR Public Health and Surveillance最新文献

{"title":"Integrating AI Into Governmental Public Health Decision Making: Challenges, Considerations, and a Path Forward.","authors":"Elizabeth Campbell, Oluremilekun Oyefolu, Sarah Gillani, Hannah Goodtree, Alison Kelly, Caitlin Rivers, Crystal Watson","doi":"10.2196/88470","DOIUrl":"https://doi.org/10.2196/88470","url":null,"abstract":"<p><strong>Unlabelled: </strong>Public health emergencies such as pandemics, natural disasters, and epidemics may require rapid, high-stakes decisions often made by elected officials with limited public health training. Artificial intelligence (AI) holds significant promise to enhance the quality, transparency, and timeliness of governmental decision-making during such crises. This paper examines the potential of AI as a decision-support tool for elected officials while identifying key technical, logistical, ethical, and policy challenges. Technical considerations include model accuracy, data representativeness, and privacy protection, while ethical imperatives center on fairness, transparency, and accountability to prevent amplification of existing health disparities. The paper further explores workforce development needs, emphasizing AI literacy and cross-sector collaboration to enable informed use of AI insights. This viewpoint presents a novel AI Decision Support Lifecycle framework specifically designed for governmental public health emergency response, mapping six phases from problem definition through post-emergency evaluation. We provide stakeholder-specific recommendations for model developers, health agencies, and elected officials, and illustrate practical application through a detailed case example and use cases. Drawing on empirical evidence regarding digital health technologies and AI governance, we emphasize that technology deployment alone is insufficient. Successful implementation requires complementary investments in organizational capacity, data infrastructure, workforce training, community engagement, and continuous evaluation. AI integration also requires robust governance frameworks, continuous model evaluation, and alignment with existing crisis management structures. Policy recommendations highlight the importance of ethical AI frameworks, risk assessments, and public engagement to foster trust. Ultimately, AI can strengthen public health decision-making if developed and implemented responsibly within transparent and equitable systems.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e88470"},"PeriodicalIF":3.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771998","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":"Active Surveillance for COVID-19 Vaccine Safety Using Sequential Analysis in Korea: Population-Based Retrospective Observational Study.","authors":"Na-Young Jeong, Haerin Cho, Heehyun Won, Suvin Park, Joongyub Lee, Hyesook Park, Nam-Kyong Choi","doi":"10.2196/75094","DOIUrl":"https://doi.org/10.2196/75094","url":null,"abstract":"<p><strong>Background: </strong>With the advent of new vaccines, including the COVID-19 vaccines introduced during the recent pandemic, the need for near real-time active surveillance has increased to support timely regulatory decision-making.</p><p><strong>Objective: </strong>This study aimed to assess the feasibility of sequential monitoring for potential adverse events following immunization in Korea, focusing on COVID-19 vaccines.</p><p><strong>Methods: </strong>This population-based study used a linked database that combined the COVID-19 registry with national health insurance claims data. Participants included individuals older than 12 years who received either monovalent or bivalent COVID-19 vaccines in Korea between February 2021 and March 2023. Monthly retrospective sequential testing was performed for 3 prespecified outcomes (acute myocardial infarction, myocarditis, and anaphylaxis) as well as a negative control event (colonic diverticulitis). A Poisson-based maximized sequential probability ratio test was applied to compare postvaccination incidence rates with historical background rates, accounting for multiple testing and claims processing delays. Analyses were stratified by age group, vaccine platform, and dose.</p><p><strong>Results: </strong>This study included over 43 million monovalent and 6.3 million bivalent vaccine recipients. Sequential analyses identified statistical signals for myocarditis following mRNA vaccines in individuals aged 12 to 64 years and protein subunit vaccines in those aged 40 to 64 years. Signals for anaphylaxis were observed following mRNA and nonreplicating viral vector vaccines in individuals older than 18 years. No safety signals were identified for acute myocardial infarction or colonic diverticulitis. Sequential monitoring detected signals for myocarditis and anaphylaxis before regulatory authorities took safety actions, with the earliest signals observed on September 30, 2021, and April 30, 2021, respectively.</p><p><strong>Conclusions: </strong>Near real-time sequential testing detected statistical safety signals for myocarditis and anaphylaxis following COVID-19 vaccination. These signals were recognized by the regulatory authority as being associated with the vaccines, demonstrating the potential of this approach to detect signals requiring further causality assessments, particularly for newly introduced vaccines at an early stage.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e75094"},"PeriodicalIF":3.9,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771920","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":"Health Care Providers' Perspectives on Early Warning Systems for Acute Respiratory Infections in Canada: Qualitative Study.","authors":"Jinfan Qiang, Kevin Maruthananth, Maaha Farrukh, Andrew David Pinto, Banafshe Hosseini","doi":"10.2196/85244","DOIUrl":"https://doi.org/10.2196/85244","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute respiratory infections (ARIs) remain a significant global health challenge and are the second leading cause of disease burden and mortality. Early warning systems (EWS) play a key role in detecting clinical deterioration, alerting health care providers (HCPs), and supporting pandemic surveillance. While existing literature highlights HCPs' positive experiences with EWS in confirming clinical assessments and guiding escalation, perspectives on how these systems can be optimized for ARI management remain underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;As Canada continues to develop and operationalize EWS for outbreak and pandemic preparedness, this study aims to explore the experiences and insights of primary care providers, emergency department (ED) physicians, and researchers regarding the use of EWS for ARI management in Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Eleven participants, including primary care providers, ED physicians, and researchers from urban and rural settings across 5 Canadian provinces (Ontario, Newfoundland and Labrador, Quebec, British Columbia, and Manitoba), were recruited in 2024. All participants regularly managed patients with ARIs or played key roles in pandemic response. A codebook thematic analysis was conducted to identify patterns and themes, with subthemes organized under broader thematic categories. Data saturation was assessed during the analysis phase. The study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 11 participants, there was approximately equal representation across gender and age groups, and more than 90% had over ten years of experience in ARI management. Three overarching themes emerged. First, participants demonstrated general awareness of the use of EWS in ARI management, including outbreak detection, screening and triage support, and informing clinical decision-making. Technologies and surveillance tools used during the COVID-19 pandemic were frequently referenced; however, understanding of specific EWS and their application to ARI management was often limited. Second, participants identified key attributes of an effective EWS as accuracy, timeliness, integration, and equity, emphasizing the need for seamless integration into existing Canadian health care workflows without increasing administrative burden. Third, anticipated challenges were described across 4 stages of EWS development, including initiation (funding and privacy concerns), implementation (outdated data systems and limited legislation), use (staff shortages and capacity constraints), and evaluation (lack of standardized and innovative evaluation approaches).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study engaged 11 experienced HCPs and researchers who were directly involved in patient care and public health response to ARI outbreaks and qualitatively explored their perspectives on EWS for ARI management and pan","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e85244"},"PeriodicalIF":3.9,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771948","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 Family Health and Proactive Health Risk Management With the Mediating Role of Health Literacy: Nationwide Cross-Sectional Study.","authors":"Shangfeng Tang, Yilin Wei, Heng Dong, Kangkang Zhang, Chunying Wang, Jia Song, Hua Qing, Yibo Wu","doi":"10.2196/73659","DOIUrl":"https://doi.org/10.2196/73659","url":null,"abstract":"<p><strong>Background: </strong>Modifiable unhealthy behaviors account for over two-thirds of new cases of noncommunicable diseases. Behavioral risk factor reduction is a potentially cost-effective means to improve long-term health outcomes. Although family serves as a pivotal cornerstone for fostering and maintaining individuals' health, the associations between family health (FH) and the proactive health risk management index (PHRMI) remain unclear.</p><p><strong>Objective: </strong>This study aimed to construct a comprehensive index to measure the PHRMI and examine the mediating effect of health literacy on the association between FH and the PHRMI, as well as the moderating effect of family communication on the associations among the PHRMI, health literacy, and FH.</p><p><strong>Methods: </strong>A cross-sectional questionnaire survey was conducted with 30,044 participants from 34 provinces or regions in China who were recruited using a multistage stratified sampling strategy from June 20, 2023, to August 31, 2023. This study constructed the PHRMI for the general population by encompassing BMI, physical activity (International Physical Activity Questionnaire-Short Form), depression (Patient Health Questionnaire-9), sleep quality (Brief version of the Pittsburgh Sleep Quality Index), smoking behavior, and drinking behavior. Further, we assessed FH (Short Form of the Family Health Scale), health literacy (Short-Form Health Literacy Questionnaire-4), and family communication (Family Communication Scale-Short Form). In addition, we collected the sociodemographic characteristics of the participants. We used model 4 of the IBM SPSS macro PROCESS to verify the mediating effect of health literacy between FH and the PHRMI, while model 7 was adopted to test the moderated mediation of family communication among the PHRMI, health literacy, and FH.</p><p><strong>Results: </strong>Higher levels of FH were significantly associated with higher PHRMI levels (β=.710, 95% CI 0.669-0.752). Health literacy significantly mediated the association between FH and the PHRMI (β=.207, 95% CI 0.168-0.245), playing a partial mediating role. Family communication significantly moderated the association between FH and health literacy (β=.117, 95% CI 0.105-0.130). The simple slope analysis showed that higher levels of family communication exacerbated the effects of FH on health literacy. Subsequently, we performed a sensitivity analysis, and the main results aligned with the findings of prior studies. Nevertheless, the subgroup analysis revealed that the mediating effect of health literacy was not significant in the group aged >60 years (β=.066, 95% CI -0.024 to 0.157).</p><p><strong>Conclusions: </strong>FH can be an important target that appears to be positively linked to proactive health risk management and health literacy. FH promotion for older adults should pay more attention to family or intergenerational communication.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e73659"},"PeriodicalIF":3.9,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771994","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":"Multidimensional Discrimination Toward Single-Parent Families and Its Association With Depressive Symptoms of Parents: Cross-Sectional Study in South Korea.","authors":"Seong-Uk Baek, Jin-Ha Yoon","doi":"10.2196/83771","DOIUrl":"https://doi.org/10.2196/83771","url":null,"abstract":"<p><strong>Background: </strong>Discrimination toward single-parent families (SPFs) is prevalent at structural and individual levels.</p><p><strong>Objective: </strong>This study examined the association between perceived discrimination toward SPFs and parental depressive symptoms in South Korea.</p><p><strong>Methods: </strong>This study included a nationally representative sample of 3300 single mothers (n=2205, 66.8%) and fathers (n=1095, 33.2%). Single parents' perceptions of discrimination toward SPFs were measured using eight items evaluating the discrimination toward both participants and their children, which were categorized into four groups (lowest, low, high, and highest). Depressive symptoms were evaluated using the 9-item Patient Health Questionnaire. To examine the association between discrimination toward SPFs and depressive symptoms in single mothers and fathers, logistic regression models were used, and adjusted odds ratios and 95% CIs were calculated.</p><p><strong>Results: </strong>Of all participants, 11.7% (n=386) reported depressive symptoms. The prevalence of depressive symptoms was 7.7% (57/744), 6.4% (44/684), 8.2% (54/659), and 21.7% (155/714) among individuals with the lowest, low, high, and highest levels of discrimination, respectively. Compared to those experiencing the lowest level of discrimination, the highest level of discrimination was associated with 5.10-fold (95% CI 3.33-7.79) and 6.12-fold (95% CI 2.80-13.39) higher odds of depressive symptoms among single mothers and fathers, respectively. Further analyses demonstrated that discrimination directed toward both oneself and one's children was associated with depressive symptoms.</p><p><strong>Conclusions: </strong>Discrimination against SPFs was prevalent in Korea and associated with depressive symptoms in both single mothers and fathers.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e83771"},"PeriodicalIF":3.9,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772002","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":"Factors Affecting Acceptance of Life Education in Mainland China: National Cross-Sectional Study.","authors":"Xinyue Zhang, Nana Huang, Yuyang Yi, Yinlin Wang, Wai-Kit Ming, Yibo Wu, Xiaohong Ning, Chen Wang","doi":"10.2196/78844","DOIUrl":"https://doi.org/10.2196/78844","url":null,"abstract":"<p><strong>Background: </strong>In traditional Chinese culture, discussing death has always been taboo. The social environment characterized by fear, reluctance, and apprehension toward death significantly impedes the development of palliative care. Therefore, establishing a correct view of life and death and promoting life education are prerequisites for the successful implementation of palliative care.</p><p><strong>Objective: </strong>This study aimed to investigate the public acceptance of life education among individuals in China and analyze the explanatory variables.</p><p><strong>Methods: </strong>This national cross-sectional study was conducted from June 20 to August 31, 2022, encompassing 23 provinces, 5 autonomous regions, and 4 municipalities directly under the central government. A total of 21,875 participants were included. The generalized linear model was used to analyze influencing factors. Gender, major in medicine, place of residence, education level, family health, media use, etc, were analyzed as the potential variables. Acceptance scores were calculated based on a visual analog scale (VAS). Further subgroup analyses were carried out in different age and major subgroups.</p><p><strong>Results: </strong>The median (P25, P75) acceptance score for life education in the survey was 71.00 (50.00-95.00) points. Compared with females, males had lower acceptance (β=-2.39; 95% CI -3.08 to -1.69). Respondents who were majoring in medicine (β=3.13; 95% CI 1.11-5.14), residing in urban areas (β=1.25; 95% CI 0.46-2.04), processing a bachelor's degree or higher (β=4.05; 95% CI 2.97-5.12), or having higher scores on the media use (β=0.49; 95% CI 0.41-0.57) had higher acceptance. Compared with people aged 12-17 years, those aged 25-44 years (β=-6.00; 95% CI -7.34 to -4.66), aged 45-64 years (β=-4.55; 95% CI -5.88 to -3.22), and 65 years or older (β=-2.16; 95% CI -3.78 to -0.55) had lower acceptance. For people majoring in medicine, place of residence, family health, and media use were uniquely relevant factors. Higher scores on the Perceived Social Support Scale (PSSS) and Health Literacy Scale-Short Form (HLS-SF) were also significantly associated with greater acceptance of life education.</p><p><strong>Conclusions: </strong>Gender, place of residence, education level, age, media use, perceived social support, and health literacy were identified as key factors influencing acceptance of life education, providing important evidence to inform targeted policy and educational interventions.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e78844"},"PeriodicalIF":3.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771951","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":"Urinary Sodium Excretion and the Risk of Prevalent Anemia: Nationwide Population-Based Cross-Sectional Study.","authors":"Sang Heon Suh, Dohyeon Lee, Seong Kwon Ma, Sunyong Yoo, Soo Wan Kim","doi":"10.2196/88408","DOIUrl":"10.2196/88408","url":null,"abstract":"<p><strong>Background: </strong>While excessive dietary sodium intake is an established risk factor for cardiovascular and renal complications, its potential association with anemia remains largely unexplored.</p><p><strong>Objective: </strong>We hypothesized that, based on the observed benefits of sodium-glucose cotransporter 2 inhibitors in correcting anemia through alterations in renal tubular metabolism and oxygen homeostasis, elevated urinary sodium excretion, as a surrogate of dietary sodium intake, may increase the risk of prevalent anemia.</p><p><strong>Methods: </strong>This nationwide cross-sectional study analyzed 54,802 adults from the Korea National Health and Nutrition Examination Survey (2014-2023). Participants were stratified by spot urine sodium-to-creatinine ratio (Na⁺/Cr) quartiles (first quartile [Q1], second quartile [Q2], third quartile [Q3], and fourth quartile [Q4]). Anemia was defined as hemoglobin <13 g/dL for men and <12 g/dL for women.</p><p><strong>Results: </strong>Anemia prevalence increased progressively across spot urine Na⁺/Cr quartiles (Q1: 925/13,700, 6.8%, Q2: 1126/13,701, 8.2%, Q3: 1393/13,701, 10.2%, and Q4: 1893/13,700, 13.8%). Multivariable logistic regression demonstrated that participants in the highest quartile had 43% higher odds of anemia compared with the lowest quartile (adjusted odds ratio 1.429, 95% CI 1.269-1.610; P<.001). Each 1-unit log increase in spot urine Na⁺/Cr conferred a 67% increase in odds of anemia (adjusted odds ratio 1.674, 95% CI 1.452-1.930; P<.001). Sensitivity analyses using tertiles, quintiles, estimated 24-hour sodium excretion, and restriction to preserved kidney function consistently confirmed these associations.</p><p><strong>Conclusions: </strong>Higher urinary sodium excretion exhibits a robust, graded association with increased anemia prevalence in the general population. These findings suggest that dietary sodium restriction may provide additional benefits beyond cardiovascular protection.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e88408"},"PeriodicalIF":3.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13146232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771493","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":"Global Heated Tobacco Product User Estimates, 2014-2024: Descriptive Surveillance Study Using Manufacturer Disclosures.","authors":"Giorgi Mzhavanadze, Gerry V Stimson, Tomasz Jerzyński","doi":"10.2196/88761","DOIUrl":"10.2196/88761","url":null,"abstract":"<p><strong>Background: </strong>Heated tobacco products (HTPs) expanded rapidly after 2014; yet globally, comparable estimates of the number of HTP users remain limited. National surveys rarely include standardized HTP measures, and international surveillance systems do not provide harmonized global user counts.</p><p><strong>Objective: </strong>The aim of the study is to construct a reproducible annual global time series of HTP user estimates for 2014-2024 using publicly available manufacturer disclosures, quantify uncertainty, and compare these estimates with user counts derived from nationally representative survey prevalence data where available.</p><p><strong>Methods: </strong>We compiled annual HTP user counts and heated-tobacco stick shipment volumes from publicly available reports of major transnational tobacco companies. In the primary series, we used company-reported user counts when available. For company-year observations without reported user counts, we estimated user numbers by converting reported shipment volumes into implied user counts, applying brand-specific assumptions on average daily consumption per user. As an alternative sensitivity analysis, all company user counts were excluded, and all shipments were converted using a common literature-based consumption parameter. As a complementary check, nationally representative current-use prevalence data from 35 countries were converted to user counts.</p><p><strong>Results: </strong>Global HTP users reached 48.9 million in 2024 in the primary series (range 45.6-52.1 million). The shipment-only series showed higher totals (67.9 million; range 59.7-78.7 million). Survey-based estimates yielded 21.8 million users across 35 countries, reflecting partial geographic coverage.</p><p><strong>Conclusions: </strong>A transparent, updateable global time series documents rapid HTP growth from 2014 to 2024, with 2024 totals ranging from 45.6 to 78.7 million users depending on the estimation approach. As standardized HTP measures are incorporated into national surveys, future estimates can be refined, and uncertainty reduced.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e88761"},"PeriodicalIF":3.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729027","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":"Prevalence of Early Rheumatic Heart Disease Among Asymptomatic Students in Underserved Communities in Ethiopia: Cross-Sectional Observational Study.","authors":"Amsalu Tomas Chuma, Desalew Mekonnen Kassie, Jens-Uwe Voigt, Melkamu Hunegnaw Asmare, Ahmed Saeed Youssef, Carolina Varon, Rik Willems, Michelle Yates, Adane Petros Sikamo, Yidnekachew Asrat Birhan, Chunzhuo Wang, Bart Vanrumste","doi":"10.2196/87039","DOIUrl":"10.2196/87039","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic heart disease (RHD) is a sequela of recurrent, untreated group A Streptococcus infections. RHD disproportionately affects children and young adults in the Global South. Intermittent mass screening of early RHD by using affordable tools in these disease-endemic regions is essential for effective prevention.</p><p><strong>Objective: </strong>This study examined multimodal physiological data for assessing the prevalence of early RHD in a cohort of asymptomatic, at-risk students in rural Ethiopia.</p><p><strong>Methods: </strong>A total of 584 asymptomatic children aged 10 to 20 years were randomly selected for screening and stratified into 2 groups (≤14 and >14 years). Electrocardiogram, phonocardiogram, and echocardiography screening were performed, with diagnoses based on the 2012 World Heart Federation criteria.</p><p><strong>Results: </strong>After excluding 1.4% (8/584) of the children, who had nonrheumatic findings, 576 participants were analyzed, including 334 (58.0%) female and 242 (42.0%) male children. The mean age was 16.1 (SD 2.4) years (95% CI 15.9-16.3). Echocardiographic screening identified 19 cases of RHD (n=10, 52.6% borderline and n=9, 47.4% definite). Female children accounted for 68.4% (13/19) of cases, and the association between female sex and RHD was not statistically significant (odds ratio 1.59, 95% CI 0.60-4.25; P=.35). The estimated prevalence of RHD was 32.5 per 1000 population (95% CI 18.1-46.9; SE 7.4; 19/576, 3.3%), which was significantly higher than the most recent multicenter prevalence estimate of 19 per 1000 population (95% CI 13.9-23.4; odds ratio 2.12; P=.03). Mitral regurgitation was the predominant lesion (16/19, 84.2%), followed by mitral stenosis (2/19, 10.5%) and aortic regurgitation (1/19, 5.3%). Phonocardiogram analysis showed mitral regurgitation (10/19, 52.6%), mitral stenosis (2/19, 10.5%), and subclinical findings in the rest of patients with RHD. Prolonged PR intervals were observed in 10.5% (2/19) of the RHD-positive participants.</p><p><strong>Conclusions: </strong>This study confirms persistent high prevalence of asymptomatic RHD among students in rural regions of Ethiopia. Although there was a female predominance in RHD incidence, the difference between the sexes was not statistically significant.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e87039"},"PeriodicalIF":3.9,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716936","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":"Moderating Role of Condom-Use Inertia on the Association Between Status Quo Bias and Pre-Exposure Prophylaxis Resistance Intention Among Chinese Men Who Have Sex With Men: Cross-Sectional Study.","authors":"Min Zhao, Shanshan Li, Xiang Zhao, Jincheng Hu, Zhuoheng Yin, Fanpu Ji, Weiming Tang, Lei Zhang","doi":"10.2196/88806","DOIUrl":"10.2196/88806","url":null,"abstract":"<p><strong>Background: </strong>While prior studies have examined structural and individual-level barriers to pre-exposure prophylaxis (PrEP) uptake, little is known about the psychological mechanisms underlying resistance to PrEP, particularly among high-risk groups. The status quo bias (SQB) theory provides a theoretical framework for understanding why individuals may resist beneficial health innovations.</p><p><strong>Objective: </strong>The aim of this study was to examine the associations between SQB and PrEP resistance intention among Chinese men who have sex with men (MSM) and to test whether condom-use inertia moderated these relationships.</p><p><strong>Methods: </strong>We conducted a cross-sectional online survey among 1022 MSM in China from November 2024 to February 2025. Theory-guided multi-item measures were constructed to capture key dimensions of SQB. Their internal consistency and construct validity were examined using confirmatory factor analysis prior to regression modeling. Multiple linear regression models assessed main effects and moderation effects, adjusting for sociodemographic and behavioral covariates.</p><p><strong>Results: </strong>A total of 1022 MSM were included in the final analysis (mean age 29.6 y); the majority identified as homosexual (767/1022, 75.1%) and were unmarried (896/1022, 87.7%). Regression analyses revealed that transition costs were positively associated with PrEP resistance intention (β=0.26, 95% CI 0.17-0.35; P<.001), while social norms were negatively associated (β=-0.19, 95% CI -0.27 to -0.12; P<.001). Condom-use inertia significantly moderated both associations, amplifying the positive relationship between transition costs and resistance (β=0.04, 95% CI 0.01-0.09; P=.03) and enhancing the negative association of social norms (β=-0.05, 95% CI -0.09 to 0.00; P=.04). Subgroup analyses showed that the amplifying effect of condom-use inertia on transition costs was particularly evident among participants with postgraduate education (β=0.13, 95% CI 0.01-0.26; P=.04). Conversely, its strengthening effect on social norms was more pronounced among MSM 30 years or younger (β=-0.11, 95% CI -0.17 to -0.04; P=.001) and those identifying as homosexual (β=-0.07, 95% CI -0.12 to -0.02; P=.01).</p><p><strong>Conclusions: </strong>This study suggests that SQB is an important psychological barrier to PrEP adoption among Chinese MSM. The moderating role of condom-use inertia highlights the relevance of habitual condom-use routines in shaping PrEP resistance. Behaviorally informed strategies that reduce transition costs and leverage social norms may help mitigate resistance and improve PrEP uptake.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"12 ","pages":"e88806"},"PeriodicalIF":3.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654108","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}