Journal of Medical Internet Research最新文献

{"title":"National Electronic Health Record Coverage in Pacific Island Countries and Territories: Environmental Scan.","authors":"E Emily Porrello, Amy Peden, Michael Nunan, Rohina Joshi","doi":"10.2196/71212","DOIUrl":"https://doi.org/10.2196/71212","url":null,"abstract":"<p><strong>Background: </strong>Pacific Island countries and territories (PICTs) face unique challenges in delivering health care and sustaining digital health systems. These challenges include geographically dispersed populations and service delivery points, workforce shortages, and poor infrastructure. National electronic health records (EHRs) can strengthen health systems by facilitating continuity of care but are only available in 47% of countries worldwide. The status of national EHRs in PICTs has not been previously described in the published literature.</p><p><strong>Objective: </strong>This study aimed to map national EHR coverage in 14 PICTs of the World Health Organization (WHO) Western Pacific Region classified as Small Island Developing States (SIDS). This included the presence or absence of a national EHR; identification of EHR software used; coverage nationally and across primary, secondary, and tertiary facilities; presence or absence of supporting digital health or health information system strategies and policies; comparison of national EHR coverage in PICTs with national EHR coverage globally; and exploration of a relationship between EHR coverage and country income in PICTs.</p><p><strong>Methods: </strong>Given the absence of peer-reviewed literature on EHRs in PICTs, an environmental scan methodology was selected to review gray literature sources. We conducted a 3-stage environmental scan to systematically search publicly available websites across government, bilateral, multilateral, and philanthropic organizations for documents describing the status of national EHR implementations in the aforementioned 14 PICTs.</p><p><strong>Results: </strong>Of the 14 PICTs assessed, 12 countries (86%) have an EHR implemented at some level of the public health system, and 8 (57%) have a single national system implemented at more than one facility. Although this is higher than national EHR coverage rates globally (57/122, 47%), average coverage across the 12 PICTs using EHRs was only 39% (median 16%). We also identified a positive relationship between EHR coverage and country income status and generally medium to high EHR coverage across tertiary hospitals (19/41, 46%) and secondary care facilities (29/77, 38%) but low implementation at primary care facilities (61/4158, 1.5%). EHR coverage across all facilities in the 14 countries assessed was 2.5% (108/4267). EHR software used includes Tamanu (Nauru, Palau, Samoa, Kiribati, Fiji [Aspen Medical public-private partnership hospitals]), Medtech (Cook Islands, Niue), Vesalius (Tonga), PATIS Plus (Fiji), and custom systems.</p><p><strong>Conclusions: </strong>Our findings demonstrate, for the first time, that EHRs are being implemented in PICTs, including at scale in some settings. Despite high apparent coverage in some PICTs, the success of implementation and health worker usage remains unclear. Gray literature indicates that some EHRs currently available are failing or incapable of scaling nat","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e71212"},"PeriodicalIF":6.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225309","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":"Opportunities and Challenges of Using Artificial Intelligence in Predicting Clinical Outcomes and Length of Stay in Neonatal Intensive Care Units: Systematic Review.","authors":"Samantha Tudor, Risha Bhatia, Michael Liem, Tafheem Ahmad Wani, James Boyd, Urooj Raza Khan","doi":"10.2196/63175","DOIUrl":"https://doi.org/10.2196/63175","url":null,"abstract":"<p><strong>Background: </strong>The use of artificial intelligence (AI) in health care has been steadily increasing for over 2 decades. Integrating AI into neonatal intensive care units (NICUs) has promise as it has the potential to reshape neonatal care and improve outcomes. However, challenges such as data quality, clinical interpretation, and ethical considerations may hinder AI's practical implementation in NICUs.</p><p><strong>Objective: </strong>This study aims (1) to analyze the current AI research landscape for predicting clinical outcomes and length of stay in the NICU and (2) to explore the benefits and challenges of using AI in the NICU for these predictions.</p><p><strong>Methods: </strong>A systematic review was conducted across 6 databases-PubMed, Embase, CINAHL, Cochrane Library, Informit, and La Trobe Library-to identify English-language peer-reviewed articles published between January 2017 and March 2023 that focused on the use of AI for predicting length of stay and clinical outcomes for NICU patients. Eligibility criteria excluded studies outside the NICU context or lacking predictive focus. Both prospective and retrospective designs were included. A thematic analysis of AI applications in NICUs from the articles identified was conducted.</p><p><strong>Results: </strong>A total of 24 studies were included in the review, comprising 15 retrospective and 9 prospective designs. These studies primarily originated from the United States (13 studies), with others from Austria, Taiwan, and other countries. The studies evaluated AI applications in NICU settings to predict comorbidities (18/24), mortality (4/24), and length of stay (2/24). Sixteen studies were in the exploration stage, lacking cohesive AI strategies, while 8 demonstrated systematic exploration but no fully integrated solutions. The synthesis of results identified key applications of AI in NICU care, including data-driven insights and predictive models, advancements in medical imaging, improved risk stratification, and personalized neonatal care. AI showed promise in enhancing diagnostic accuracy and care planning, but significant challenges persist, such as data quality, model generalization, and ethical concerns. No studies reported a fully integrated AI ecosystem, highlighting the need for further research to bridge gaps and realize AI's transformative potential in neonatal care.</p><p><strong>Conclusions: </strong>This review highlights the potential of AI in improving NICU care, particularly through predictive models, medical imaging, and personalized interventions. However, the evidence is limited by significant methodological variability, small sample sizes, risk of bias, and a lack of external validation in included studies. Many studies remain in exploratory phases without cohesive AI strategies or integration into clinical practice, limiting the practical applicability of findings. These results underscore the importance of addressing challenges such as data qua","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e63175"},"PeriodicalIF":6.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225525","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":"Clinical Decision Support Systems Using Home Blood Pressure Readings to Manage Patients With Hypertension: Scoping Review.","authors":"Aminath Shiwaza Moosa, Jun Jie Benjamin Seng, Chirk Jenn Ng","doi":"10.2196/75551","DOIUrl":"https://doi.org/10.2196/75551","url":null,"abstract":"<p><strong>Background: </strong>Home blood pressure (HBP) is an important parameter that guides clinicians in managing hypertension in patients. However, in using these records to manage patients, physicians face challenges, particularly regarding access, integration, and interpretation of the records when making clinical decisions. Clinical decision support systems (CDSSs) have been proposed to address these challenges; however, current literature reveals significant heterogeneity and gaps in CDSSs used for hypertension management.</p><p><strong>Objective: </strong>This study aimed to summarize existing studies on CDSSs that use HBP readings to manage patients with hypertension.</p><p><strong>Methods: </strong>We conducted a scoping review, with searches performed in PubMed, Embase, and Scopus on April 1, 2024. The results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Studies that used CDSSs integrated with HBP monitoring among adult patients with hypertension in outpatient settings were included. Non-English studies were excluded. Outcomes assessed included the theoretical frameworks used for CDSS development, CDSS components (data capture, processing, and output), clinical outcomes, user experiences, and implementation processes.</p><p><strong>Results: </strong>Of the 5023 articles screened, 33 (0.66%) were included. Most of the studies were conducted in the United States (16/33, 49%) and were randomized controlled trials (21/33, 64%). Nearly two-thirds of the CDSSs (21/33, 64%) were computerized. Only 1 (3%) of the 33 studies reported using a theoretical framework for CDSS development. HBP recording and uploading were predominantly automatic (23/33, 70%). All computerized CDSSs (21/33, 64%) used rule-based algorithms, and most (19/21, 91%) incorporated alert triggers for results outside the reference range. More than a third of the studies (13/33, 39%) were based on hypertension guidelines. Among studies that reported outcomes, most reported improved blood pressure (25/29, 86%) and adjustment in antihypertensive medications (16/19, 84%). Patients and clinicians appreciated the convenience and remote monitoring (10/33, 30%) but reported challenges with usability and access to computerized CDSSs (2/21, 10%). Of the studies using noncomputerized CDSSs (12/33, 36%), all incorporated patient education, while nearly two-thirds of the studies using computerized CDSSs (13/21, 62%) did the same. Clinician training was reported in 5% (1/21) of the computerized CDSSs and 25% (3/12) of the noncomputerized CDSSs.</p><p><strong>Conclusions: </strong>While CDSSs hold promise for improving hypertension management, gaps remain in their development and implementation. Future efforts should focus on integrating robust frameworks; aligning with guidelines; enhancing manual data integration; and addressing usability to maximize effectiveness, adoption, ","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e75551"},"PeriodicalIF":6.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Attitudes and Obstacles Around Digital Public Health Tools: Insights From a Statewide Cross-Sectional Survey on Washington's Vaccine Verification System.","authors":"Andrea R Molino, Debra Revere, Rebecca A Hills, Adam S Elder, Laura M West, Bryant T Karras, Chris Baumgartner, Janet G Baseman","doi":"10.2196/66550","DOIUrl":"10.2196/66550","url":null,"abstract":"<p><strong>Background: </strong>Development and use of digital public health tools surged during the COVID-19 pandemic. Among these tools, vaccine verification systems emerged as alternatives to paper vaccine records, aiming to help limit the spread of disease. In November 2021, the Washington State Department of Health launched \"WA Verify,\" a QR code-based vaccine verification system built on the SMART Health Card framework, providing residents with a convenient way to store and share proof of vaccination digitally. However, WA Verify was developed and deployed before assessments and public input regarding potential adoption challenges-such as concerns about privacy, surveillance, data sharing, trust in the technology, and the managing organizations-could be completed.</p><p><strong>Objective: </strong>This analysis used statewide survey data from Washington to identify and characterize barriers and facilitators to the adoption of WA Verify, and to understand how factors such as data privacy, security, attitudes toward public health policies and communication, and technological proficiency may influence acceptance and uptake of digital public health tools.</p><p><strong>Methods: </strong>A cross-sectional statewide survey was distributed between September 2022 and January 2023 to a random sample of 5000 Washington households. Respondents were categorized into 3 groups based on their responses indicating WA Verify \"users,\" \"potential users,\" or \"unlikely users.\" Comparisons were made between groups regarding experiences with and opinions on COVID-19 vaccine and test verification, public health policies, communication, digital tools, technological proficiency, sociodemographic characteristics, and health history. Poststratification weights were applied to reduce nonresponse bias.</p><p><strong>Results: </strong>Of the 1401 respondents, 359 (25.6% unweighted, 25.8% weighted) were users, 662 (47.3% unweighted, 49.8% weighted) were potential users, and 380 (27.1% unweighted, 24.4% weighted) were unlikely users. All percentages reported are based on weighted data. Compared with users and potential users, unlikely users were more likely to oppose policies requiring proof of COVID-19 vaccination or negative test results (users: 6.0%, potential users: 13.6%, unlikely users: 65.9%). Unlikely users were more likely to cite concerns about personal health data security and phone hacking or tracking, though these concerns were also notable among potential users and users. Users and potential users were more likely to perceive a digital vaccine verification system as convenient (users: 96.5%, potential users: 92.3%, unlikely users: 38.1%) and indicated openness to receiving relevant information from a range of sources. Unlikely users were more likely to report not owning a smartphone and demonstrated lower technological proficiency (users: 12.3%, potential users: 15.9%, unlikely users: 32.3%), indicating a technological divide between groups.</p><p><strong>Con","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e66550"},"PeriodicalIF":6.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213003","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":"Decoding the Public's Real-Time Emotional and Cognitive Responses to the Changing Climate on Social Media: Computational Analysis Using Weibo and Meteorological Data.","authors":"Yucan Xu, Jiehu Yuan, Sijia Li, Qiuyan Liao","doi":"10.2196/70336","DOIUrl":"https://doi.org/10.2196/70336","url":null,"abstract":"<p><strong>Background: </strong>Climate change poses a significant threat to mental health and well-being worldwide. Existing research on the associations between climate change-related events and mental well-being primarily focuses on clinical outcomes and often measures associations at single time points. The long-term effects and variability of the changing climate on more subtle nonclinical but widespread mental well-being remain relatively unexplored. Additionally, the underlying mechanisms that link changing climate events to real-time emotional well-being and pro-environmental actions have rarely been studied. Revealing real-time nonclinical mental well-being and its underlying mechanism is crucial for the early detection of at-risk individuals. This knowledge can also inform future interventions aimed at improving the public's risk perception and empowering communities to manage related challenges effectively.</p><p><strong>Objective: </strong>This study aimed to understand the association between the changing climate and expressed emotional well-being by integrating multiple data sources, including social media posts about climate change on Weibo (N=76,514), 20 years of regional meteorological data (N=216,476 records), and regional vulnerability data in China.</p><p><strong>Methods: </strong>This study proposed and tested a new mechanism that connects meteorological factors with expressed emotional well-being through three cognitive responses identified from social media posts: thinking styles, social affiliations, and somatosensory experiences. Psycholinguistic analysis, structural equation modeling (SEM), and multiple regression models were used to examine the mediation of these three conceptual factors, as well as the moderating effects of regional vulnerability and seasonal changes on the influence of climate change on the public's expressed emotional well-being and downstream pro-environmental tendencies.</p><p><strong>Results: </strong>The SEM results revealed that extreme hot days are associated with decreased emotional well-being when talking about climate change (total effect=-0.712, 95% CI -0.894 to -0.531, P<.001), and these effects were mediated by three proposed mediators: social affiliations (indirect effect=-0.445, 95% CI -0.537 to -0.347, P<.001), analytical-intuitive thinking style (indirect effect=-0.100, 95% CI -0.126 to -0.073, P<.001), and somatosensory experiences (indirect effect=0.022, 95% CI 0.005-0.041, P=.02). Additionally, regression analysis indicated that the association between increased temperatures and expressed emotional well-being is moderated by seasonal changes (β=-.091, 95% CI -0.159 to -0.023, P=.009) and regional population density (β=-.068, 95% CI -0.118 to -0.018, P=.007). In the crude model examining associations between weather indices and expressed pro-environmental tendencies, the results showed that extreme hot days are associated with reduced pro-environmental tendencies (odds ratio [OR]=0.","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e70336"},"PeriodicalIF":6.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225068","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":"Regional Disparities in the Use and Demand for Digital Health Services for Autism Spectrum Disorder in China: Cross-Sectional Survey of Stakeholder Perspectives.","authors":"Mingyang Zou, Xiaomei Gong, Liwen Feng, Shengqi Li, Chenyang Lu, Zhuoqiong Liu, Caihong Sun, Lijie Wu","doi":"10.2196/77157","DOIUrl":"https://doi.org/10.2196/77157","url":null,"abstract":"<p><strong>Background: </strong>Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition, the prevalence of which is increasing in China and worldwide. Digital health technologies offer promising solutions for improving screening, diagnosis, and rehabilitation of children with ASD, particularly in resource-limited settings. However, digital health technologies for ASD have not been adopted in China. Understanding utilization patterns, influencing factors, and user needs is essential to inform equitable, effective digital health strategies.</p><p><strong>Objective: </strong>This study aimed to assess the current use, influencing factors, and perceived needs of digital health services among parents of children with ASD and rehabilitation therapists in 2 distinct provinces in China.</p><p><strong>Methods: </strong>A cross-sectional survey was carried out between November 2023 and February 2024 in Heilongjiang and Fujian provinces. Purposive sampling recruited a total of 780 parents and 745 rehabilitation therapists to complete a structured questionnaire. Data were analyzed using descriptive statistics, stepwise multivariable logistic regression, and multiple response analysis.</p><p><strong>Results: </strong>The use of digital health services was low among parents (46/780, 5.9%) and rehabilitation therapists (161/745, 21.6%), although the demand was substantially higher (621/780, 79.6% and 671/745, 90.0%, respectively). Among parents, higher use was positively associated with younger age (20-29 years), employment, lower income (≤CNY 3000/month [US $421.247/month]), and delayed ASD diagnosis (7-12 years old). Among rehabilitation therapists, male, special education background, and autism-specific training experience predicted higher use (all P<.05). Demand was significantly greater in Fujian than in Heilongjiang and was positively associated with higher education levels in parents and rehabilitation therapists (P<.05). Parents and rehabilitation therapists valued a greater understanding of ASD behaviors and development and easier access to resources as primary benefits. Common barriers to the use of digital health services included high cost, need for additional equipment, and usability challenges. The smartphone-WeChat mini-program was the preferred device and platform, respectively. Parents prioritized access to rehabilitation courses, remote guidance, and policy information, while rehabilitation therapists favored personalized plans and professional skills training.</p><p><strong>Conclusions: </strong>Despite a strong demand, digital health services are underused in ASD care across China, with adoption of digital health services influenced by regional disparities and sociodemographic factors. This study, as the first comparative analysis of parents and rehabilitation therapists in 2 Chinese provinces, provides stakeholder-specific insights to guide targeted, locally relevant interventions. Bridging the digital divide through inclu","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e77157"},"PeriodicalIF":6.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225537","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":"Parallel Corpus Analysis of Text and Audio Comprehension to Evaluate Readability Formula Effectiveness: Quantitative Analysis.","authors":"Arif Ahmed, Gondy Leroy, David Kauchak, Prosanta Barai, Philip Harber, Stephen Rains","doi":"10.2196/69772","DOIUrl":"10.2196/69772","url":null,"abstract":"<p><strong>Background: </strong>Health literacy, the ability to understand and act on health information, is critical for patient outcomes and health care system effectiveness. While plain language guidelines enhance text-based communication, audio-based health information remains underexplored, despite the growing use of digital assistants and smart devices in health care. Traditional readability formulas, such as Flesch-Kincaid, provide limited insights into the complexity of health-related texts and fail to address challenges specific to audio formats. Factors like syntax and semantic features significantly influence comprehension and retention across modalities.</p><p><strong>Objective: </strong>This study investigates features that affect comprehension of medical information delivered via text or audio formats. We also examine existing readability formulas and their correlation with perceived and actual difficulty of health information for both modalities.</p><p><strong>Methods: </strong>We developed a parallel corpus of health-related information that differed in delivery format: text or audio. We used text from the British Medical Journal (BMJ) Lay Summary (n=193), WebMD (n=40), Patient Instruction (n=40), Simple Wikipedia (n=243), and BMJ journal (n=200). Participants (n=487) read or listened to a health text and then completed a questionnaire evaluating perceived difficulty of the text, measured using a 5-point Likert scale, and actual difficulty measured using multiple-choice and true-false questions (comprehension) as well as free recall of information (retention). Questions were generated by generative artificial intelligence (ChatGPT-4.0). Underlying syntactic, semantic, and domain-specific features, as well as common readability formulas, were evaluated for their relation to information difficulty.</p><p><strong>Results: </strong>Text versions were perceived as easier than audio, with BMJ Lay Summary scoring 1.76 versus 2.1 and BMJ journal 2.59 versus 2.83 (lower is easier). Comprehension accuracy was higher for text across all sources (eg, BMJ journal: 76% vs 58%; Patient Instructions: 86% vs 66%). Retention was better for text, with significant differences in exact word matching for Patient Instructions and BMJ journal. Longer texts increased perceived difficulty in text but reduced free recall in both modalities (-0.23,-0.25 in audio). Higher content word frequency improved retention (0.23, 0.21) and lowered perceived difficulty (-0.20 in audio). Verb-heavy content eased comprehension (-0.29 in audio), while nouns and adjectives increased difficulty (0.20, 0.18). Readability formulas' outcomes were unrelated to comprehension or retention, but correlated with perceived difficulty in text (eg, Smog Index: 0.334 correlation).</p><p><strong>Conclusions: </strong>Text was more effective for conveying complex health information, but audio can be suitable for easier content. In addition, several textual features affect information compr","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e69772"},"PeriodicalIF":6.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212985","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":"Effectiveness of a Mindfulness-Based Mobile Intervention for Improving Perinatal Mental Health and Reducing Depression During Pregnancy: Randomized Controlled Trial.","authors":"Minjung Kim, Jin Young Park, Sehwan Park, Kyungmi Chung, Hee Young Cho, Gangho Do, Kyungun Jhung","doi":"10.2196/75630","DOIUrl":"https://doi.org/10.2196/75630","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy is a vulnerable period for women, with an increased risk of mental health issues such as depression and anxiety. The perinatal period is particularly important, as maternal mental health significantly impacts maternal physical health, pregnancy outcomes, postnatal outcomes, and fetal and infant development. Psychotherapeutic interventions for depression are essential, especially given the limitations of medication use during pregnancy. However, perinatal women experiencing depression often encounter barriers to accessing these interventions. Digital health interventions may offer a promising approach to overcome these barriers.</p><p><strong>Objective: </strong>This study aimed to (1) evaluate the effectiveness of Avecmom, a self-help, mindfulness-based mobile intervention, in reducing depression severity among pregnant women with mild to moderate depression; (2) examine its impact on emotional well-being and maternal-fetal attachment; and (3) explore whether the effect on mental well-being is mediated by increased mindfulness and reduced depression severity.</p><p><strong>Methods: </strong>Participants were recruited both online and offline. Of 158 screened individuals, 90 met the inclusion criteria and were randomly assigned to either the intervention or control group. The intervention group used both the Avecmom and Big 4+ apps, while the control group used only the Big 4+ app. Depressive symptoms, anxiety, and stress were assessed as primary outcomes at baseline and postintervention. Mindfulness, mental well-being, positive and negative emotions, and maternal-fetal attachment were assessed as secondary outcomes. Analysis of covariance (ANCOVA) was conducted with postintervention scores as the dependent variable, adjusting for baseline scores. To estimate the mechanism of change following Avecmom mobile app use, the bootstrapping technique with PROCESS Macro Model 6 was employed, applying the difference score from postintervention to baseline.</p><p><strong>Results: </strong>A total of 86 pregnant women (intervention group: n=42; control group: n=42) completed the study and were included in the final analysis, reflecting an overall dropout rate of 4% (4/90). At postintervention, the intervention group demonstrated lower depression severity scores (F1,84=5.69; P=.02; partial ƞ2=0.06) and higher scores of mindfulness (F1,84=11.18; P=.001; partial ƞ2=0.12), maternal-fetal attachment (F1,84=5.54; P=.02; partial ƞ2=0.06), mental well-being (F1,84=8.79; P=.004; partial ƞ2=0.10), and positive affect (F1,84=7.21; P=.009; partial ƞ2=0.08) compared to the control group. Serial mediation analysis revealed that Avecmom app use influenced mental well-being through sequential improvements in mindfulness and decreases in depression severity (standardized β=.33; Boot SE=0.12, 95% CI 0.12-0.58).</p><p><strong>Conclusions: </strong>Mindfulness-based mobile app interventions tailored for pregnant women may be more effect","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e75630"},"PeriodicalIF":6.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213041","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":"Perceptions of Daily and On-Demand HIV Pre-Exposure Prophylaxis and Digital Adherence-Support Needs Among Cisgender Men in Brazil: Qualitative Interview and Focus Group Study.","authors":"Lorruan Alves Dos Santos, Alexandre Grangeiro, Paula Massa, Marcia Thereza Couto","doi":"10.2196/66848","DOIUrl":"10.2196/66848","url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) is a proven effective preventive method in reducing the risk of HIV infection. While daily PrEP is well-established, the on-demand regimen remains less accessible, despite offering advantages, such as a reduced pill burden and lower risk of side effects, particularly for those with variable sexual activity patterns.</p><p><strong>Objective: </strong>This study explored, from the perspective of PrEP use trajectories, how cisgender men in Brazil choose and adhere to daily or on-demand regimens, and identified key user-informed requirements for designing a digital tool to support on-demand PrEP use.</p><p><strong>Methods: </strong>A qualitative study was carried out between July 2022 and December 2023 in 5 Brazilian cities. Overall, 19 individual interviews and 5 in-person focus groups were conducted (N=47). The sample was diverse by age, education, race/color, time of PrEP use, and experiences of treatment failure. The median age of the interviewees was 34 (IQR 30-36.5) years; 10/19 were <35 years and 9/19 were ≥35 years. The majority had completed higher education (15/19, 79%). The thematic saturation criterion was used, and the thematic analysis was conducted by 2 independent researchers with periodic consensus.</p><p><strong>Results: </strong>Participants perceived oral PrEP as highly effective in reducing HIV-related anxiety. On-demand PrEP was valued for its lower pill burden and a perceived lower risk of adverse effects. However, participants reported that adherence to this regimen demands considerable discipline and organization, posing a significant barrier. In this context, a support app was not met with mere acceptance but was conceptualized as a \"cognitive offloading\" tool, capable of transforming the burden of managing the 2+1+1 schedule into a positive and manageable task. Suggested functionalities included pill reminders, appointment scheduling, and geolocation of postexposure prophylaxis services. Nevertheless, significant concerns about data security and privacy were raised, with participants proposing that the state should manage the app to ensure confidentiality.</p><p><strong>Conclusions: </strong>Findings highlight clear generational differences in how cisgender men perceive daily and on-demand PrEP. Older participants draw on memories of the early AIDS crisis, whereas younger men situate PrEP within app-mediated sexual cultures. Importantly, they agree that the on-demand regimen requires not only greater discipline but also a learning process to incorporate and normalize its episodic dosing into everyday life. The positive reception toward a digital adherence support tool demonstrates potential public health value in such technologies, provided privacy and data security concerns are effectively addressed. Efforts to improve adherence and expand access to on-demand PrEP could significantly benefit from incorporating user-driven insights into digital tool development","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e66848"},"PeriodicalIF":6.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212366","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":"Privacy-by-Design Approach to Generate Two Virtual Clinical Trials for Multiple Sclerosis and Release Them as Open Datasets: Evaluation Study.","authors":"Stanislas Demuth, Olivia Rousseau, Igor Faddeenkov, Julien Paris, Jérôme De Sèze, Béatrice Baciotti, Marianne Payet, Morgan Guillaudeux, Alban-Félix Barreteau, David Laplaud, Gilles Edan, Pierre-Antoine Gourraud","doi":"10.2196/71297","DOIUrl":"10.2196/71297","url":null,"abstract":"<p><strong>Background: </strong>Sharing information derived from individual patient data is restricted by regulatory frameworks due to privacy concerns. Generative artificial intelligence can generate shareable virtual patient populations as proxies for sensitive reference datasets. Explicit demonstration of privacy is demanded.</p><p><strong>Objective: </strong>This study evaluated whether a privacy-by-design technique called \"avatars\" can generate synthetic datasets replicating all reported information from randomized clinical trials (RCTs).</p><p><strong>Methods: </strong>We generated 2160 synthetic datasets from two phase 3 RCTs for patients with multiple sclerosis (NCT00213135 and NCT00906399; n=865 and 1516 patients) with different configurations to select one synthetic dataset with optimal privacy and utility for each. Several privacy metrics were computed, including protection against distance-based membership inference attacks. We assessed fidelity by comparing variable distributions and assessed utility by checking that all end points reported in the publications had the same effect directions, were within the reported 95% CIs, and had the same statistical significance.</p><p><strong>Results: </strong>Protection against membership inference attacks was the hardest privacy metric to optimize, but the technique yielded robust privacy and replication of the primary end points (in 72.5% and 80.8% of the 1080 generated datasets). Utility was uneven across the variables and end points, such that information about some end points could not be captured. With optimized generation configurations, we selected one dataset from each RCT replicating all efficacy end points of the placebo and approved treatment arms while maintaining satisfactory privacy (hidden rate: 85.0% and 93.2%).</p><p><strong>Conclusions: </strong>Generating synthetic RCT datasets replicating primary and secondary efficacy end points is possible while achieving a satisfactory and explicit level of privacy. To show the potential of this method to unlock health data sharing, we released both placebo arms as open datasets.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"27 ","pages":"e71297"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206281","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}