BMC Infect Dis. 2025 Apr 18;25(1):555. doi: 10.1186/s12879-025-10879-6.

ABSTRACT

BACKGROUND: The COVID-19 pandemic represented a healthcare challenge of unparalleled magnitude worldwide. As patients recovered from the acute infection, a new challenge emerged, i.e., the development of post-acute symptoms. The main goal of this study was to evaluate the trajectory of cognitive symptoms since the acute phase of COVID-19 among patients followed through a telehealth program in Brazil.

METHODS: A retrospective cohort study was conducted with confirmed COVID-19 patients followed by a Brazilian telehealth program who presented cognitive symptoms in the acute phase of infection. The objective of the current analysis was to assess the persistence or remission of cognitive symptoms at 24 weeks after the onset of acute COVID-19 symptoms, as well as the factors associated with such manifestations. The study used chi-square tests and multivariate logistic regression models to assess the association between patients' parameters and the presence of cognitive symptoms. A backward stepwise method was applied to define significant characteristics, which were then evaluated using odds ratios and 95% confidence intervals.

RESULTS: Among 319 patients who had cognitive symptoms during acute COVID-19, 89 (27.9%) reported persistence of cognitive symptoms for more than 24 weeks from the acute onset of the infection. Female sex (OR 2.33 [95% CI 1.23-4.43]) and having been infected during the second wave of COVID-19 (OR 2.30 [95% CI 1.34-3.96]) were associated with the persistence of symptoms beyond 24 weeks.

CONCLUSIONS: Approximately one-third of patients with COVID-19, mainly women and people infected during the second wave of infection, experienced persistent cognitive symptoms.

PMID:40251531 | DOI:10.1186/s12879-025-10879-6

BMJ Open. 2025 Apr 17;15(4):e091052. doi: 10.1136/bmjopen-2024-091052.

ABSTRACT

INTRODUCTION: The use of teleneuropsychology or neuropsychological remote assessment increased during and after the COVID-19 pandemic in 2020. Teleneuropsychology facilitates remote assessment for populations that do not have access to neuropsychological services as well as individuals who are vulnerable or have physical restrictions that would otherwise make it difficult for individuals to receive appropriate care. However, there are many instruments that are not validated or lack normative data for the overall population. Therefore, this study aims to develop normative data for a neuropsychological battery administered on telehealth with commonly used tools to identify cognitive performance in older adults.

METHODS AND ANALYSIS: The following study will use a previously informatics-generated list of participants who have a lower risk of developing Alzheimer's disease and other related dementias. Participants will complete screening surveys related to cognitive and health status. They will also complete questionnaires related to sociodemographic information, depression, functionality and social determinants of health. Participants will undergo a teleneuropsychological battery examination via remote assessment. We estimate recruiting 500 participants to establish normative data.

ETHICS AND DISSEMINATION: The current protocol is approved by the University of Florida's Institutional Review Board. Results will be analysed and disseminated in a research paper once sample number goals are completed.

PMID:40250879 | DOI:10.1136/bmjopen-2024-091052

BMJ Open. 2025 Apr 17;15(4):e091046. doi: 10.1136/bmjopen-2024-091046.

ABSTRACT

INTRODUCTION: Guideline-directed medical therapy (GDMT) for heart failure (HF) reduces adverse events, but is underused. Global barriers to GDMT optimisation include low frequency of visits, clinician inertia and poor patient knowledge, which may be mitigated by digital health interventions (DHI). In Brazil, low digital literacy and reduced access to technology may compromise these potential DHI's beneficial effects. Our objective is to develop and test the effectiveness of a DHI to optimise GDMT in patients recently hospitalised for HF in the Brazilian public health system (Sistema Único de Saúde (SUS)).

METHODS AND ANALYSIS: This is a randomised, controlled, multicentre, parallel-group, clinical trial in which 154 patients being discharged from an HF-related hospitalisation will be randomised. Inclusion criteria are ≥18 years of age, reduced ejection fraction HF (EF<50%) and medication optimisation gaps (at least one GDMT class not started or two among those with prescribed dosage≤50% of the target dose). All participants will receive a written booklet and SUS usual care. Randomisation will be stratified by site. The intervention includes a mobile application (app) to engage patients, developed through a human-centred design. The app's main features are a check-in page for daily collection of participants' health status, vital signs and weight; a remote educational programme; a chat function during working hours and longitudinal graphical representations of participants' data. The participants' data will be managed daily by a nurse, linked to a cardiologist for teleconsultations. Predefined clinical decision trees will guide actions, including alarm signs and GDMT optimisation. The primary outcome will be changes in GDMT from baseline to end of follow-up in 90 days. Secondary outcomes will include all-cause readmission, HF-related rehospitalisation, change in health status and HF knowledge, and implementation outcomes based on the RE-AIM framework. The analysis of outcomes will follow the intention-to-treat principle.

ETHICS AND DISSEMINATION: This study was approved by the Universidade Federal de Minas Gerais. Recruitment started in November 2023, and patients involved will sign an informed consent form. Results will be presented at scientific meetings and published in scientific journals in 2025, and will be disclosed in social media and presented to public health stakeholders.

TRIAL REGISTRATION NUMBER: Universal Trial Number U1111-1295-1864 Brazilian Clinical Trials Registry (https://ensaiosclinicos.gov.br/rg/RBR-10vpf9bm).

PMID:40250873 | DOI:10.1136/bmjopen-2024-091046

JMIR Res Protoc. 2025 Apr 18;14:e62874. doi: 10.2196/62874.

ABSTRACT

BACKGROUND: Tailored text messaging is a low-cost mobile health intervention approach shown to effectively improve self-care behaviors and clinical outcomes for patients with chronic cardiometabolic conditions. Given the ubiquitous nature of mobile phones, text messages have the potential to reach a large audience. However, automating and disseminating tailored text messages to large populations at low cost presents major logistical challenges that serve as barriers to implementation.

OBJECTIVE: This study aimed to describe the protocol for a longitudinal observational study designed to assess the feasibility of an innovative approach for automating and disseminating personalized and tailored text messages to large populations at risk of cardiovascular events using a low-cost registry-based tailored text messaging system known as the Heart Health Messages (HHM) program. Further, it describes the technical requirements, architectural design, automation process, and challenges associated with program implementation.

METHODS: Patients at high risk of cardiovascular diseases are identified using a statewide population health registry known as the Tennessee Population Data Network. Tailored invitation messages and enrollment surveys are sent to eligible patients via Twilio. Upon completion of the receipt of consent and enrollment forms, participants receive tailored text messages from a library of generic messages based on participant-selected frequency of message delivery (daily or every other day). In addition, participants receive monthly text-based check-in survey messages designed to assess intervention adherence and improvement in self-care. Participants are also sent quarterly follow-up surveys to update enrollment information and preferences. All enrolled participants will receive tailored text messages for a 12-month intervention period.

RESULTS: Since the start of the program, 18,974 patients from 2 major health systems have met the inclusion criteria and were eligible for the HHM program. A total of 3 phases of HHM 1.0 have been implemented so far, reaching 225 eligible patients in phase 1, a total of 5288 patients in phase 2, and 13,461 patients in phase 3, with an enrollment of approximately 2% (n=4/225), 3% (n=137/5228), and 3% (n=350/13461), respectively. Efforts are underway to implement strategies in collaboration with the health systems to enhance the HHM program rollout and patient participation.

CONCLUSIONS: The HHM program is a low-cost tailored text messaging intervention set for broader dissemination and potential replication. The program has the capacity to improve outcomes for people with chronic medical conditions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/62874.

PMID:40250839 | DOI:10.2196/62874

Cancer Control. 2025 Jan-Dec;32:10732748251334435. doi: 10.1177/10732748251334435. Epub 2025 Apr 18.

ABSTRACT

IntroductionWhile ultrasound-guided breast biopsy (UGBB) performed by a radiologist is the standard of care in high-income countries for diagnosing breast cancer, blind or surgical biopsy has been the norm in low-and middle-income countries (LMIC) in part because LMIC radiologists lack the skill to perform UGBB. We present the study protocol of a competency-based UGBB training program for LMIC Nigerian radiologists that leverages mobile health technology.MethodsThis institutional review board-approved prospective multi-institutional single-arm clinical trial (ClinicalTrials.gov identifier: NCT04501419) involves 13 Nigerian radiologists from eight tertiary hospitals in South West and South East Nigeria. Our training program is unique because it uses a competency-based curriculum developed specifically for LMIC radiologists. The competency-based curriculum incorporates blended learning (e-learning and trainer-led), simulation (supervised and unsupervised), and patient biopsy (supervised and unsupervised) components. The study time frame is two years: 1 year for the trainees to complete active training and patient recruitment and another 1 year for patient follow-up. Primary outcome measures include trainees' competency (measured using the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE)), the radiology-pathology concordance rate, and the complication rate. Secondary outcome measures include the diagnostic interval and the positive predictive value of UGBB.ConclusionBuilding capacity for UGBB in Nigeria and other LMIC can potentially improve breast cancer outcomes through early diagnosis. This training program is part of an implementation multi-component strategy package in Nigeria to improve breast cancer outcomes. This training program can also be adapted for other image-guided procedures that could impact global cancer control through diagnosis, therapeutic intervention, and/or palliation.

PMID:40250340 | DOI:10.1177/10732748251334435

Hormones (Athens). 2025 Apr 18. doi: 10.1007/s42000-025-00662-2. Online ahead of print.

ABSTRACT

Type 1 diabetes (T1D) is an autoimmune condition affecting approximately 1.5 million children and adolescents worldwide, with an incidence of approximately 2-3% each year and rising. During the recent COVID-19 pandemic, a significant increase in incidence of T1D in children and adolescents was observed in numerous countries worldwide, with an increased number of newly-diagnosed cases presenting with diabetic ketoacidosis. The increased frequency of T1D presenting with diabetic ketoacidosis has been attributed not only to the SARS-CoV-2 virus itself but also to the restrictions imposed by the pandemic. The shift to telemedicine and unwillingness to seek medical care due to fear of infection contributed to delayed diagnosis and more severe disease presentation. Furthermore, the periods of lockdown that were implemented during the pandemic presented multiple challenges for children and adolescents living with T1D and disrupted the management of their condition. Changes in physical activity and diet as well as shortage of medical supplies during that period have been linked to worsening of glycemic control, which were at least partly offset by increased parental involvement and use of telemedicine.

PMID:40249463 | DOI:10.1007/s42000-025-00662-2

Mhealth. 2025 Mar 10;11:22. doi: 10.21037/mhealth-24-61. eCollection 2025.

ABSTRACT

The use of telehealth in the United States accelerated in 2020 when a coronavirus disease of 2019 (COVID-19) related public health emergency (PHE) was declared. Centers for Medicare and Medicaid Services issued emergency waivers that relaxed restrictions imposed by regulations on geographic locations, originating and distant sites, audio-video-conferencing technology and re-imbursement. This review focuses on the history of telehealth usage for patients with end-stage kidney disease. Patients who receive home dialysis gained widespread access to telehealth in 2019, following passage of the Bipartisan Budget Act of 2018, Sec 50302 by the US Congress. For the first time in telehealth application, the patient's home could be an originating site without geographic restrictions for telemedicine. These earlier regulations will continue even after the PHE expires. While they made telemedicine possible for many patients receiving home dialysis, in practice, the uptake of telemedicine in the home setting may have been sluggish following the 2018 law. Rules governing the frequency of telemedicine visits and other stipulations for home dialysis that were specified in the 2018 law were relaxed in the setting of the COVID-19 waivers, further facilitating the use of telemedicine for home dialysis care. Meanwhile, the in-center dialysis unit became an originating site for the first time during the COVID-19 PHE, with a corresponding sharp increase in the use of telemedicine for in-center hemodialysis care. The waivers enabling the use of telemedicine for patients who receive in-center hemodialysis and further facilitating the use of telemedicine in home dialysis, expire with the end of the COVID-19 PHE unless Congress passes new legislation. Comparisons among the periods before, during and after the PHE can illustrate telehealth's impact and some of its challenges. Most of the literature on telehealth represents observational data. Future studies on telehealth, including clinical trials, could provide information on outcomes and cost savings.

PMID:40248758 | PMC:PMC12004311 | DOI:10.21037/mhealth-24-61

Mhealth. 2025 Mar 18;11:21. doi: 10.21037/mhealth-24-53. eCollection 2025.

ABSTRACT

The biopsychosocial model of pain acknowledges that pain experiences are shaped by an interplay between biological, psychological, and socio-environmental factors. In clinical practice, two disparate avenues for addressing pain include the widespread interventional paradigm and the rapidly growing holistic model of lifestyle medicine. Traditional pain management often emphasizes pharmacological and invasive approaches. In contrast, lifestyle medicine focuses on optimizing factors such as nutrition, exercise, sleep, stress management, avoidance of toxic substances, and social connectedness to reduce the pain experience. Within the paradigm of lifestyle medicine, specific nutrition plans may help mitigate inflammation, physical activity can alleviate symptoms of chronic pain conditions, and improved sleep can improve pain thresholds. Avoidance of toxic substances like tobacco and illicit drugs, utilization of mind-body stress reduction techniques, and fostering social connections are crucial for enhancing overall well-being and decreasing pain perception. However, there may be some drawbacks to the lifestyle medicine approach. The perception of time investment, the specialized training required for physicians, and the financial aspect can pose significant barriers. Lifestyle medicine is typically more time-intensive, requires more consultation time from physicians and the healthcare team, necessitates stronger adherence from patients, and involves more coaching and follow-up from healthcare providers. The services, treatment, and coaching are often not covered by insurance, which is a financial barrier to providing this kind of care. Despite these challenges, lifestyle medicine offers promising benefits for chronic pain management. Addressing its limitations through telemedicine and integrating it with interventional methods, affords the potential for a comprehensive approach to managing chronic pain in the future.

PMID:40248751 | PMC:PMC12004303 | DOI:10.21037/mhealth-24-53

Cureus. 2025 Mar 18;17(3):e80776. doi: 10.7759/cureus.80776. eCollection 2025 Mar.

ABSTRACT

Diaphragm pacing (DP) is a therapeutic intervention for ventilator-dependent patients with spinal cord injury (SCI) and congenital central hypoventilation syndrome (CCHS). Despite its availability, clinical adoption in Japan remains limited. This systematic review assesses the current state of DP in Japan, its outcomes, and its associated challenges by analyzing 10 case reports from the Ichushi database. Patients ranged from four to 50 years old, predominantly male (90%), with cervical SCI primarily due to traffic trauma (63%). DP was introduced with a median of 24 months post-injury. All patients achieved partial or complete ventilator weaning, with 27% achieving full independence. Reported benefits include improved quality of life (QOL), mobility, and social reintegration. However, complications such as respiratory muscle fatigue (54%), ventilatory issues in a seated position (18%), and pain due to stimulation (9%) were observed. Barriers to DP implementation in Japan include delayed introduction, limited interdisciplinary collaboration, and inadequate home care support. Early DP initiation, structured follow-up, and telemedicine integration could enhance outcomes. Further research is needed to establish standardized guidelines and optimize DP use.

PMID:40248550 | PMC:PMC12004424 | DOI:10.7759/cureus.80776

Glob Heart. 2025 Apr 17;20(1):39. doi: 10.5334/gh.1423. eCollection 2025.

ABSTRACT

BACKGROUND: Hypertension is a leading global cause of morbidity and mortality and is increasing in low- and middle-income countries, where unawareness of hypertension is a primary obstacle to management. Community health workers (CHWs) in combination with mobile health (mHealth) tools are increasingly used in LMIC health systems to strengthen primary care infrastructure. In this study, we applied this care model to hypertension in rural Guatemala by comparing the accuracy of CHWs equipped with an mHealth clinical decision support application in diagnosing hypertension to concurrent physician evaluation.

METHODS: We performed a prospective diagnostic accuracy study in which adults from rural Guatemalan communities were assessed independently by a CHW aided by a mHealth application and a physician. Assessment included medical history; measurement of blood pressure, height and weight; and determination of hypertension status. CHW-physician agreement on hypertension status and past medical history elements was assessed by Kappa analysis and proportional agreement, with a priori thresholds of Kappa = 0.61 and agreement of 90%. Agreement on patient measurements was evaluated using Bland-Altman and regression analyses.

RESULTS: Of 359 participants enrolled, 47 (13%) were confirmed to have hypertension and another 11 (3%) had possible hypertension. CHW-physician agreement was high for hypertension diagnosis, with Kappa = 0.8 (95% CI = 0.72, 0.88) and overall agreement 92.8% (95% CI = 90.1%, 95.4%). Bland-Altman analysis showed small biases toward lower systolic blood pressure, higher height, and lower BMI measurements by CHWs. Most patient history characteristics showed moderate to almost perfect (Kappa: 0.41-1) agreement between physicians and CHWs.

CONCLUSIONS: In this study based in rural Guatemala, CHWs using a mHealth clinical decision support application were found to screen adult patients for hypertension with similar accuracy to a physician. This approach could be adapted to other low-resource settings to reduce the burden of undiagnosed and untreated hypertension.

PMID:40248449 | PMC:PMC12005136 | DOI:10.5334/gh.1423