JMIR Formative Research

Support from peers has long been considered an alternative support resource than professional healthcare ones. Despite the inconclusive findings of previous studies regarding the effects of peer support, the integration of Peer Support Networks (PSNs) for youth and adolescents appears to offer promising outcomes. However, many existing digital peer support systems operate as proprietary platforms, lacking transparency in monitoring the efficacy of support and in understanding how personality traits influence outcomes. However, many existing digital peer support systems operate as proprietary platforms lacking transparency in monitoring the effect of peer support and understand the influence of personality traits on its outcomes. To address these limitations, we utilized our research platform, Peer2S, a digital PSN designed to facilitate connections based on shared lived experiences while simultaneously monitoring users mental well-being and personality traits. We conducted a four-week within-subjects experiment with 28 Japanese university students to examine the PSN systems impact on anxiety and perceived social support. Following a two-week baseline control period, participants interacted with the system for two weeks. Pre- and post-intervention assessments utilized generalized anxiety and multidimensional social support measures, alongside personality evaluations. The results indicated that participants experienced a significant reduction in anxiety after using the system, whereas no significant changes occurred during the control period. Perceived general social support showed a borderline significant increase, though specific college-context support dimensions remained unchanged. Furthermore, multiple regression analysis revealed that personality traits moderated anxiety outcomes. Contrary to typical protective associations, higher agreeableness significantly predicted increased anxiety during the intervention, which may reflect cultural tendencies toward conflict avoidance and over-accommodation in Japan. Conscientiousness demonstrated a marginally significant protective effect against anxiety, while personality traits did not predict changes in perceived social support. These findings suggest that short-term, algorithmically mediated peer support can yield measurable improvements in mental well-being, particularly in reducing anxiety. Moreover, the varying impacts of personality traits highlight the necessity of considering sociocultural contexts when designing and deploying digital mental health interventions. Authors summaryThe formation of social bonds is often selective, established through shared values, cultural interests, or significant life experiences among "peers." In some populations such as adolescents and young adults, peer support is regarded as a promising source of empathy, understanding, and psychological support. We report a study conducted using our customized digital peer matchmaking system with Japanese university students to examine if this novel approach to peer support impacts mental well-being. We found that after just two weeks of using the system, participants experienced a significant reduction in their anxiety levels. We also dove deeper to look at if individual personality traits influence their use outcomes. Interestingly, our results revealed that highly agreeable individuals actually experienced increased anxiety while using the system. In a Japanese cultural context, this may occur because agreeable users tend to avoid conflict and over-accommodate others at their own expense. Ultimately, our research demonstrates that matchmaking algorithms can effectively facilitate digital peer support to improve mental well-being, provided we carefully consider how different personality traits and cultural backgrounds shape user experiences.

Background: Mental health issues are prevalent among men, yet help-seeking remains low due to stigma, masculinity norms and access barriers. Digital mental health (DMH) screening questionnaires offer opportunities for early detection, but their uptake among men is limited. Objective: This study explored the barriers and facilitators influencing mens willingness to use DMH screening questionnaires, with the aim of informing user-centered design that supports early detection and engagement. Methods: This interpretive qualitative study was conducted through semi-structured interviews with 17 purposively sampled Estonian men (aged 20-54) in a highly digitalized context until data saturation was reached. Thematic analysis followed a mixed deductive-inductive approach: deductive codes were derived from theoretical frameworks (Technology Acceptance Model, Health Belief Model, User-Centered Design, Behavioral Design), while inductive themes emerged from participants responses across the three research questions, including their evaluations of four screening questionnaire (PHQ-2, PHQ-9, EEK-2, WHO-5). Results: Key barriers included data privacy fears, distrust of digital solutions, lengthy questionnaires, and poor user experience (UX). Facilitators were anonymity, institutional trust, short (5-10 min) questionnaires, mobile-optimized design, personalized feedback, and clear next steps. As main contribution, four archetypes were identified: Skeptic, Self-Manager, Explorer, and Situational Seeker. They reflected distinct patterns across privacy concerns, institutional trust, user experience preferences, and help-seeking orientations. Skeptics were characterized by low institutional trust, high concern about data misuse, and a preference for anonymous, low-friction interactions, often delaying help-seeking. In contrast, Self-Managers emphasized autonomy, transparency, and evidence-based support, engaging in structured self-monitoring and purposeful help-seeking. Explorers showed openness to experimentation and engagement, particularly when supported by intuitive, interactive, and visually clear UX, while data sharing depended on perceived value. Situational Seekers demonstrated episodic engagement patterns, where trust, data-sharing, and help-seeking were highly context-dependent, preferring fast, low-effort interactions when needed. Conclusions: Mens uptake of DMH screening questionnaires is influenced by a combination of social, psychological, and usability factors. Effective design should integrate anonymity, institutional credibility, and user-centered features to support engagement and early mental health detection. Personalized, actionable feedback with transparency, user control, and clear next-step guidance emerged as key drivers of sustained engagement, while poor usability and lack of meaningful feedback led to disengagement. Importantly, the proposed archetypes capture how these factors co-occur in dynamic, context-dependent user profiles, offering a more actionable alternative to one-size-fits-all and demographic approaches for designing DMH questionnaires tailored to male users.

Background: Concerns about "AI psychosis" have swirled in the media since ChatGPT's release, but few systematic analyses exist. We therefore conducted an electronic health record (EHR) analysis to identify the frequency, clinical characteristics, and quality of AI interactions in patients experiencing psychosis treated in a medical center. Methods: AI keywords (e.g., ChatGPT, AI) were used to search Vanderbilt University Medical Center's EHR from 12/1/2022-4/1/2026. Records were discarded if they were not AI-related or if the primary diagnosis did not include psychosis. Three raters read notes to determine if a patient was experiencing AI psychosis and classified the interactions using 4 a-priori categories (Catalyst, Amplifier, Co-Author, Object) formulated to explain how AI-related negative outcomes emerge. Findings: 73 patients met our criteria. 28 patients were rated as experiencing AI psychosis, 17 had neutral interactions, and 28 expressed delusional content related to AI without documented evidence of conversational AI use. ChatGPT was the matching keyword for 53.6% patients experiencing AI psychosis. The majority of AI psychosis cases were documented after ChatGPT's "4o" model was released in May 2024. Notably, the AI Psychosis group had significantly more patients experiencing a first psychotic episode (60.7%) compared to the other two groups. Amplifier was the most common (64.3%) qualitative rating in the AI Psychosis group. Interpretation: "AI psychosis" is an infrequent but real phenomenon observed in clinical practice. Most affected patients were experiencing their first psychotic episode and presented with AI psychosis following the release of the more sycophantic GPT-4o. Among the affected patients, AI most often exacerbated an existing condition by reinforcing distorted ideas.

Abstract Background People with disabilities use technology, like search engines, to seek health information online. This health information includes information on coronavirus disease, or COVID-19. COVID-19 remains a public health concern. Research shows that people with disabilities encounter frustrations, or "pain points," when seeking online information, but little is known about these specific pain points and who encounters them. Objective The goals of this study are to determine pain points for people with disabilities who seek health information online, and to assess how pain points impact the experience of technology use and information seeking. Methods Ten participants recruited from a prior quantitative survey completed the concurrent think-aloud study over a month-long period. Participants completed four online search tasks and narrated their experiences in real-time while doing so. Transcripts were stored in Taguette; thematic analysis was performed on these transcripts. Findings Participants were predominantly white, with three identifying as Asian. All ten participants reported having disabilities. Participants with attention deficit hyperactivity disorder (ADHD) reported distracting webpage layout, whereas participants with physical disabilities reported physical fatigue while navigating online information. All participants encountered AI-generated information; only one participant indicated trust in the AI-generated information. Other common sources of information included hospital and governmental webpages, peer-reviewed articles, and news and advertising results. News and advertising results were especially common with respect to search results for "COVID-19 vaccine." Themes identified included the following: accessibility/usability, AI-generated information, government/hospital and related sources of information, peer-reviewed articles, news and advertising, and sentiment and trust. Conclusions Information can be fatiguing, distracting, or otherwise difficult to navigate for people with diverse disabilities searching for COVID-19 related information online. Further work should incorporate user feedback from people with disabilities when designing online content.

Patient-generated streaming data from wearable and digital technologies is increasingly promoted as a means of supporting mental health monitoring and clinical decision-making. While patient acceptance of these technologies has been reported, clinician perspectives remain underexplored despite their central role in determining whether streaming data are meaningfully integrated into routine care. This study explored clinicians experiences, as well as perceived facilitators and barriers, related to integrating patient-generated streaming data into routine mental health practice. A qualitative, exploratory interview study was conducted to examine clinicians experiences and perspectives on integrating patient-generated streaming data into mental health care. Semi-structured interviews were conducted with 33 clinicians, including family physicians (n=11), psychiatrists (n=12), and psychologists (n=10). Data were analyzed using reflexive thematic analysis guided by Braun and Clarkes six-step approach. Six themes were identified. Clinicians described variable use of digital and streaming technologies, ranging from routine engagement to deliberate non-use. Streaming data were viewed as clinically valuable when they provided longitudinal and objective insights, identified physiological and behavioural pattern changes, and supported patient engagement. However, clinicians emphasized that clinical usefulness was contingent on interpretability, contextual information, and relevance to decision-making. Major barriers included poor integration with electronic medical records, time constraints, data volume, limited organizational support, and uncertainty regarding data reliability and validity. Clinicians also expressed persistent concerns about privacy, governance, and regulatory oversight, highlighting the need for clear safeguards and accountability structures. Clinicians view patient-generated streaming data as a promising adjunct to mental health care, particularly for capturing longitudinal change between visits. However, meaningful clinical integration remains constrained by usability, workflow, organizational, and regulatory challenges, as well as limited confidence in data interpretation. Addressing these barriers through improved system integration, interpretive support, validation, and governance will be essential for translating the potential of streaming data into routine clinical practice. Author SummaryMental health symptoms can change between appointments yet care often depends on periodic visits and patient recall. Devices such as smartwatches and other digital tools can continuously collect information, from mood and sleep to activity and related measures, offering a possible way to support care outside the clinic. While patients are often seen as the main users of these tools, clinicians play a central role in deciding whether such technology is implemented in care. This study interviewed 33 mental health clinicians, including family physicians, psychiatrists, and psychologists, about their views on using patient-generated streaming data in routine care. Clinicians saw promise in these data as they help track changes over time, support discussions with patients, and provide additional insight between visits. However, they also described important barriers, including managing large amounts of data, limited integration with health record systems, uncertainty about data quality, and concerns about privacy and regulation. These findings suggest that successful implementation of streaming data in mental health care will depend on designing systems that are clinically relevant, easy to interpret, and supported by appropriate safeguards and infrastructure.

Patient portals are online tools that enhance patients access to various aspects of their health care, including provider communication, medication information, and lab results. As portals continue to be integrated into health systems, it is imperative to understand the experiences of various groups who utilize their functions. Womens experiences of using patient portals have been scantly explored in the literature, including their perceptions about use for mental health care. The purpose of this study was to explore womens experiences of accessing and using a variety of patient portals, including their perceptions of usefulness for mental health care. A qualitative descriptive methodology was used to explore womens experiences of accessing and using patient portals across Canada. Purposive sampling was used to recruit ten women, who completed semi-structured, one-to-one interviews between April-June 2025. Conventional qualitative content analysis was used to analyze the data. Each woman had used at least one patient portal for their health care at the time of their interview. Four main themes emerged from the data, including: (1) the health care lived experience, (2) individual autonomy, (3) provider partnership, and (4) portal improvement. The interrelated themes contain narrative descriptions of individual experiences of accessing and using patient portals, and implications for using portals for womens mental health care. These results demonstrate a variety of womens experiences. Patient portals were found to impact their lived experiences with health care, enhance individual autonomy, and foster partnerships with their health care providers. The women also suggested various areas of improvement in portal design elements, features, and privacy functions. Future research should focus on evaluating the design of new portals to ensure they meet the needs of the population they serve. Author SummaryA patient portal is an example of a digital tool that is being integrated into various health organizations to supplement in-person care. Depending on the design and the complexity of the portal, patients may be able to complete online prescription renewals, access medication schedules, virtually communicate with their providers, and review their clinical notes. However, as digital tools continue to be produced and adapted within health settings, it is crucial to understand how they can best serve different populations. In this study, we explored womens experiences with using patient portals for their health care in Canada. We also aimed to understand womens perspectives on how patient portal use can be optimized for mental health care. We performed virtual interviews with 10 women who had used at least one patient portal for their health care, and gained their perspectives on accessibility, useful features, and how using a patient portal impacted their experiences of receiving health care. The women discussed how portal use improved their health care experiences and they suggested a variety of features to support mental health care as patient portal designs continue to be adapted to different settings.

BackgroundContinuous adhesive patch electrocardiographic (ECG) wearables are increasingly prescribed. Patient experience with these devices can influence adherence, but research in this area is limited. This study aimed to explore the perceptions and experiences of patients receiving wearable cardiac monitoring technology as part of their routine care through the lens of treatment burden. MethodsThis was a qualitative study with semi-structured phone interviews conducted between February and May 2024. We recruited participants from primary care and outpatient clinics using maximum variation sampling to ensure diversity in sex, ethnicity, and education levels. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. ResultsSixteen participants (mean age 51 years, 63% female) were interviewed (average duration: 33 minutes). Three themes were developed: 1) Experience using the device: Burden vs Ease of Use, which captured participants perceptions of how easily they could integrate the device in their daily lives; 2) Individual variability in responses to ECG self-monitoring covered participants emotional and cognitive response to knowing their heart rhythm was monitored; and 3) The care process shapes patient experiences reflected support preferences during the set-up and monitoring period and the uncertainty regarding timely clinical and device feedback. ConclusionsPatients valued cardiac wearables for facilitating diagnosis and felt reassured knowing they were clinically monitored. However, gaps in information provided to patients seemed to cause anxiety for some participants. These concerns could be mitigated through clearer clinician communication and patient education at the time of prescription.

Purpose: To understand how the Philips PAP device recall affected patient experiences, clinical practice, and health system responses. Methods: From November 2022 to August 2023, we interviewed individuals with OSA, physicians, respiratory therapists and health system leaders. We also received emailed responses from Health Canada. Interviews explored participants' experiences with the recall announcement and communication, their own responses and perceptions of actions taken by others, the overall impact of the recall and suggestions for improving future recall processes. Interviews were analyzed using an inductive thematic approach. Results: We interviewed 47 participants (16 individuals with OSA, 10 physicians, 17 public or private respiratory therapists, five health system leaders). Themes were organized into four domains: recall communication, execution, participant experiences, and the policy and regulatory context. Participants were confused due to inadequate information from Philips throughout the process. The burden of notifying patients and tracing devices mostly fell to healthcare providers and vendors, while replacement efforts were disorganized and frustrating. Individuals with OSA experienced emotional distress over therapy decisions and difficulties navigating the recall. Healthcare providers described moral distress from being unable to support patients adequately, and vendors faced additional logistical and financial strain. While regulatory authorities reported that Philips followed standard procedures, participants expressed a loss of trust in both the manufacturer and oversight systems. Conclusions: Interviews revealed that poor communication and execution of the Philips recall caused confusion, frustration and significant emotional and financial burden. Collaborative, context-specific strategies are required to improve future recalls.

Background. Complex cases in specialized pediatric care require consistent adherence to evidence-based clinical pathways and protocols to ensure safe, high-quality, and equitable care. Currently, clinical pathways and supporting documentation are frequently distributed across multiple platforms, leading to fragmentation. Human-centered design principles can guide the development of healthcare technologies that minimize cognitive load and support rapid, efficient access to relevant information in clinical settings. The purpose of this study is to design and evaluate perceived usability of a pediatric cardiac center digital guideline management system that is embedded within the electronic health record leveraging human-centered design. Methods. This study used a mixed-methods usability evaluation to assess a digital guideline management system prototype embedded into clinical workflow. Through human-centered design principles, the prototype provides a centralized digital document library that organizes cardiac-specific clinical pathways, guidelines, procedures, and related resources. A small but diverse sample, encompassing a wide variety of roles and clinical areas within the pediatric cardiac center, was recruited to evaluate the perceived usability of the prototype. Usability was evaluated by stakeholders using the validated System Usability Scale (SUS) with additional optional questions to understand perceptions of the information architecture and clinical value. Results. Preliminary usability testing showed a mean SUS composite score of 76.5, indicating above average usability. Questions related to the complexity of the system and user confidence received high scores across participants. Lower scores were observed for questions related to usage frequency and ability to learn the system very quickly. Conclusion. Leveraging human-centered design when building a digital guideline management system embedded within clinical workflow revealed positive perception from participants. By centralizing access to clinical resources, this prototype can reduce current-state fragmentation. Further evaluation of larger samples is needed to develop a list of future recommendations.

BackgroundHwa-byung (HB) is a Korean culture-bound syndrome characterised by prolonged suppression of anger and somatic complaints. No evidence-based digital therapeutic (DTx) has been developed for HB. We evaluated the feasibility, user experience (UX), and preliminary clinical effect of an acceptance and commitment therapy (ACT)-based DTx application, Hwa-free, for HB. MethodsAdults aged 19-80 years diagnosed with HB were enrolled in a four-week app-based intervention with assessment at baseline (Week 0), Week 2, Week 4, and Week 8 follow-up. The primary outcome was UX assessed via a 22-item survey at Week 4. Secondary outcomes included HB-related symptom and personality scales, depression, anxiety, anger expression, psychological flexibility, health-related quality of life, and heart rate variability. ResultsOf 45 screened, 30 were enrolled and 28 constituted the modified intention-to-treat population. Mean app use was 19.9 {+/-} 7.9 days (71.2% adherence over 28 days). Adverse events were infrequent and unrelated to the intervention. Positive response rates exceeded 80% for video content (items 2-4: 82.8-89.7%), HB self-assessment (86.2%), meditation therapy (86.2%), and in-app guidance (85.7%). Pre-post improvements from baseline to Week 4 were observed in 11 of 18 clinical scales, including HB Symptom Scale ({Delta} = -9.8, Cohens d = -0.92), Beck Depression Inventory-II ({Delta} = -13.3, d = -1.11), and state anger ({Delta} = -7.8, d = -0.96). The HB screening-positive rate declined from 100% at baseline to 55.6% at Week 8. ConclusionsHwa-free demonstrated adequate feasibility, acceptable UX, and preliminary evidence of clinically meaningful improvement in HB-related symptoms. Future randomised controlled trial is warranted. Trial registrationCRIS, KCT0011105

Background: Head and neck cancer (HNC) patients experience clinically significant anxiety and depression in 65-85% of cases during active treatment. Current supportive care lacks personalized, real-time non-pharmacological interventions. Skitii is a novel HRV-adaptive music therapy system that uses continuous RMSSD (root mean square of successive differences) monitoring via a Polar H10 chest sensor to select music in real-time, targeting parasympathetic recovery (RMSSD >=30ms). Methods: This is a prospective, open-label, randomized controlled trial (1:1 allocation) at Yenepoya Medical College Hospital, Mangalore, India. Adults aged 18-75 years with confirmed head and neck cancer (any subsite, Stage I-IV) undergoing radiotherapy and/or chemotherapy with baseline distress (HADS >=8 or NCCN Distress Thermometer >=4) will be enrolled. Participants are randomized to Skitii adaptive music therapy (20-minute sessions, 3 times daily, 3 weeks) or static music therapy control. Skitii uses a two-phase algorithm: Phase 1 (0-2.5 minutes) uses heart rate as a stress proxy for immediate music selection; Phase 2 (2.5-20 minutes) uses RMSSD to adapt music every 2.5 minutes when physiological state changes by >=20%. Primary endpoints are HADS-Anxiety score and resting RMSSD at Week 3. Sample size is 70 (35 per arm), powered at 80% to detect a 2.5-point HADS difference (SD=3.8, alpha=0.05, 15% dropout). Analysis is ANCOVA, intent-to-treat. Discussion: This is the first randomized controlled trial evaluating RMSSD-based adaptive music therapy in cancer patients. The active control design isolates the effect of the adaptive algorithm from music exposure alone. If positive, results will support a scalable, cost-effective supportive care intervention with objective physiological monitoring, and provide the clinical evidence base for CDSCO Class B medical device approval for Skitii in India, with future CE Mark and FDA applications planned. Trial Registration: Clinical Trials Registry - India CTRI CTRI/2025/11/116732

BackgroundComprehensive sexuality education (CSE) is essential to the health and well-being of young people. In the Democratic Republic of Congo (DRC), where more than 65% of the population is under the age of 25, access to interpersonal CSE remains limited owing to sociocultural and structural barriers. This exposes young people to persistent socio-sanitary vulnerabilities. In this context, mobile health apps (MHAs) constitute a promising solution, supported by the growing use of smartphones among young Congolese. However, this groups intention to use MHAs for CSE has been the subject of little research to date. ObjectiveThe aim of this study was to identify predictors of intention to use MHAs among young Congolese, based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2). MethodsA predictive correlational study was conducted in eight public secondary schools in Bukavu (DRC) with a stratified random sample of 859 students. Predictors of intention to use--performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), and perceived risk (PR)--and moderators--age, gender, and past MHA experience--were measured from data collected through a self-administered UTAUT questionnaire. Descriptive and multivariate analyses were run on SPSS version 28. ResultsMean age of participants was 16.3 years (SD = 1.5). Boys made up 55.1% of the sample. Overall, 51.0% of the sample owned a smartphone, of which 62.3% reported having easy access to mobile data and 16.2% were already using MHAs to learn about sexual health. Intention to use MHAs was positively influenced by PE ({beta} = 0.523, p < 0.001), EE ({beta} = 0.115, p < 0.001), and SI ({beta} = 0.113, p < 0.001). FC (p = 0.260) and PR (p = 0.631), however, had no significant influence. Age moderated all of the relationships tested (F (1, 849-854) = 9.97-20.82; p [&le;] 0.002), with more marked effects observed among younger participants 14-15 years old. The final model explained 44% of the variance, indicating good predictive power. ConclusionIntention to use digital CSE was explained primarily by PE, EE, and SI and moderated by age. To strengthen this intention, stakeholders will need to promote e-interventions that are pertinent, easy to use, socially valorized, and tailored to young peoples needs and to the local context. Author SummaryYoung people in the Democratic Republic of Congo often face barriers to accessing reliable comprehensive sexuality education, including social taboos and limited resources. At the same time, smartphones are becoming more common, creating new opportunities to deliver this information through mobile health applications. In this study, we explored what drives young peoples willingness to use mobile health applications for comprehensive sexuality education. We surveyed 859 students from eight public secondary schools in Bukavu, South Kivu Province, in the eastern Democratic Republic of Congo. We found that young people were more likely to intend to use these applications when they perceived them as useful, easy to use, and socially supported. Concerns about risks, such as privacy, did not reduce their intention. Our findings suggest that mobile health applications could help expand access to comprehensive sexuality education if they are codesigned with young people, tailored to their needs, easy to use, and supported by their social environment. This work highlights the importance of understanding young peoples perspectives before developing digital tools for comprehensive sexuality education, especially in settings where access remains limited.

Medication adherence among patients with diabetes remains suboptimal in low- and middle-income countries, including Nigeria. Emerging digital health interventions such as AI-powered virtual support may be associated with improved adherence behaviours. This study examined self-care competence and perceived AI-powered virtual support as predictors of medication adherence among patients with diabetes. A cross-sectional survey was conducted among 450 patients recruited through multistage sampling across hospitals in Benue State, Nigeria. Standardised measures of self-care competence scale, perceived AI support scale, and medication adherence scale were analysed using correlation and regression analyses. Results showed that, self-care competence significantly predicted medication adherence (R2 = .161), although some components (glucose management, physical activity, healthcare use) showed negative associations. Perceived AI-powered support demonstrated stronger predictive power (R2 = .328), with social presence ({beta} = .311, p < .001) and social interactivity ({beta} = .142, p < .01) emerging as key predictors. The combined model explained 36.3% of variance (R2 = .363). In conclusion, perceived AI-powered virtual support, particularly socially interactive features, plays a significant role in enhancing medication adherence and may complement traditional self-care strategies. It is recommended that clinicians should therefore adopt a hybrid care model that integrates traditional patient education with AI-assisted interventions. This approach can help bridge gaps caused by high patient loads and limited consultation time, while also enhancing personalised care.

Somatic symptoms, such as bodily pain, fatigue, or signs of bodily dissociation, are frequent in the general population, impair mental wellbeing, and form early signs of developing mental disorders, such as depression. Managing somatic symptoms effectively in daily life is a crucial step towards establishing early intervention strategies that prevent the occurrence of mental disorders. Yet, somatic symptoms that occur in daily life have received little scientific attention so far. Here, we ask if mentalizing abilities, specifically the ability to reflect on ones own or others emotion, cognitive, or bodily states, explain somatic symptom burden in daily life. Reflective functioning was assessed in N = 96 healthy individuals via a standardized questionnaire, RFQ-8, in addition to a novel questionnaire focusing on the ability to understand ones own and others bodily reactions, BRFQ-9. Subsequently, over the period of 8 weeks, somatic symptoms were sampled in daily life via a novel Mobile Application that combines standardized questionnaire items of the FFSS, SCL-90, SDQ and SSD-12 with an interactive 3D avatar. 91.7% of participants reported somatic symptoms in the assessment period, and BRFQ scores show a significant negative relationship to overall somatic symptom burden. Such a relationship could not be evidenced for RFQ scores. Body reflective functioning abilities are also a significantly stronger predictor of somatic symptoms and explain more variance than standard reflective functioning abilities. This study introduces a new mobile Application that monitors somatic symptoms in daily life and suggests that body reflective functioning is a novel target for prevention and early intervention techniques with the aim to reduce the negative influence of aberrant bodily feelings on daily life.

Objectives: Older adults with comorbidities and polypharmacy have disproportionately high risk of hospitalization as well as readmission from adverse drug events (ADEs), of which 28%-71% are preventable (pADEs). This paper introduces an LLM application, CommunicADE, designed to support risk-mitigation of pADE-related readmission for the aforementioned population. We aim to evaluate CommunicADE's technical performance with OpenAI's HealthBench criteria: accuracy, completeness, communication quality, context awareness, and instruction following. Materials and Methods: Our technical validation study used an LLM (KimiK2.5) to simulate interviews between CommunicADE and nine high-fidelity synthetic patients hospitalized and at increased risk for pADE-related readmission (65+ years, comorbidities, 5+ medications). Some pADE risk mechanisms clues were visible to CommunicADE in patient H&Ps, but most mechanisms were solely discoverable in interviews. Two pharmacists evaluated CommunicADE's interview questions and EHR notes with HealthBench-informed variables. Analyzes used descriptive statistics. Results: For 35 mechanisms across 9 patients (avg=3.89 mechanisms/patient), CommunicADE's precision and recall were 0.92 and 0.63, respectively. Hallucinations were absent. Coherence and person-centeredness scored 4.28 and 4.44 on a 5-point scale (5=highest). On average, communication was at a 5th grade level and objective for 78% of patients. Most patient-reported quotes included in notes (92%) supported detected mechanisms. CommunicADE followed all instructions regarding interview length and patient approvals. Discussion: CommunicADE's strongest performance was in accuracy (precision, hallucinations), communication quality (coherence, readability), context awareness (person-centeredness). Completeness (recall) and instruction following (objectivity, pADE mechanism/quote alignment) show room for improvement. Conclusion: Findings suggest technical readiness for a feasibility pilot with real-world patients, and key areas for performance improvement.

Objectives: Heart failure is a leading cause of mortality, necessitating identification of patients at increased risk needing intervention. In this study, we investigated if Fitbit data can reveal physiological trends associated with hospital visit risk. Materials and methods: Individuals with heart failure (n=249) were randomized into three arms for prospective 180-day monitoring. All arms received a Fitbit and wireless weight scale. Arm 1 received devices only; Arm 2 received a mobile app with surveys; Arm 3 received the app plus financial incentives. Results: 51 participants had hospital visits during the study period. These individuals took fewer steps (p=.002) and reported increased symptom severity (p=.044). Resting heart rate increased three days prior to a visit (p=.022). Baseline steps revealed a higher visit probability for less active participants (p=.003). Discussion and conclusion: Passive physiological monitoring can effectively identify individuals at risk of health exacerbation, demonstrating the potential of wearable devices for timely clinical intervention.

Background/Objectives: This study aimed to evaluate the efficacy and outcomes of operative hysteroscopy for the removal of endometrial polyps and assess the procedure's impact on pain experienced by patients. The research was conducted to determine whether the minimally invasive nature of operative hysteroscopy compromises patient comfort when compared with diagnostic hysteroscopy. Methods: The study was conducted at the Gynecology and Obstetrics Clinic of Ba[g]clar Training and Research Hospital over a period of four months. It included 200 women over 18 years of age who were indicated for hysteroscopy. Operative hysteroscopy procedures were performed without the use of a speculum, cervical dilation, anesthesia, or analgesic agents, emphasizing the procedure's minimally invasive approach. Pain assessment utilized the Visual Analog Scale (VAS). Patients were stratified into two groups--those undergoing operative and those undergoing diagnostic hysteroscopy--to compare outcomes and pain scores. Results: The study found that operative hysteroscopy successfully removed 85.1% of the lesions, primarily polyps. There was no significant difference in pain scores between the operative and diagnostic hysteroscopy groups, indicating that the minimally invasive procedure does not increase patient discomfort. Conclusions: Operative hysteroscopy is an effective and tolerable procedure for the removal of endometrial polyps, with high success in complete lesion removal and without significantly impacting the pain experienced by patients. The findings support the use of operative hysteroscopy as a first-line treatment option for endometrial polyps, underscoring the importance of patient selection and the need for further studies on long-term outcomes related to fertility and recurrence.

BackgroundSmartphone addiction is an emerging public health concern among university students in sub-Saharan Africa. Limited data exist on its prevalence and associated factors in Uganda. ObjectiveThis study aimed to determine the prevalence of smartphone addiction and its associated sociodemographic and economic factors among students at Islamic University in Uganda (IUIU). MethodsA cross-sectional study was conducted among 287 undergraduate students at IUIU Kampala campus. Data were collected using a structured self-administered questionnaire incorporating the Smartphone Addiction Scale Short Version (SAS-SV). Bivariate and multivariate analyses were performed using modified Poisson regression. ResultsThe prevalence of smartphone addiction was 76.7% (95% CI: 71.4 to 81.2). Female students were 1.16 times more likely to be addicted than male students (APR: 1.16; 95% CI: 1.04 to 1.32). Students who spent more time on smartphones than on academic revision were 1.33 times more likely to be addicted (95% CI: 1.11 to 1.61). Those using smartphones for five or more hours daily were 1.32 times more likely to be addicted (95% CI: 1.02 to 1.48). ConclusionSmartphone addiction is highly prevalent at IUIU. Female gender and prolonged daily screen time are significant independent predictors. Targeted digital wellness programmes and institutional policy interventions are urgently needed.

Youth in the United States are experiencing growing mental health challenges, yet many face barriers to accessing timely, affordable, and stigma-free support. At the same time, artificial intelligence (AI) chatbots have become widely available and are increasingly being used by young people as tools for information seeking, coping, and self-reflection. This brief report explores how youth are engaging with AI chatbots for mental health support, drawing from qualitative interviews conducted in New Jersey. Nine semi-structured interviews were completed with participants ages 19-22. Thematic analysis revealed five core themes: (1) generational change, peer communication, and humor as coping and normalization tools; (2) internal and external barriers to self-recognition and help-seeking; (3) AI chatbots as a safe and accessible first step; (4) AI chatbots as a tool for filling information gaps; and (5) limits of AI chatbots and the preference for human connection. These findings indicate that young people see AI chatbots as private, judgment-free starting points for exploring their emotions and seeking early support. However, they also recognize that these tools cannot replace human connection or professional care. For public health, this presents both challenges and opportunities in utilizing the accessibility of AI chatbots while ensuring ethical design, cultural responsiveness, and protections that safeguard youth privacy and equity.

Chronic low back pain (CLBP) is persistent and refractory, affecting 20-30% of population worldwide. Neurofeedback has been explored as a potential non-pharmacological intervention for chronic pain, although evidence in CLBP remains limited. This study evaluated PainWaive, a consumer-grade digitally-delivered neurofeedback intervention targeting multiple pain-related frequency bands recorded over the sensorimotor cortex in individuals with CLBP. In a multiple-baseline experimental design, four participants completed daily assessments of pain severity and pain interference during randomly-assigned baseline phases of 7, 10, 14, and 20 days, followed by 20 sessions of the PainWaive intervention over four weeks. Daily pain assessments continued during the post-intervention and follow-up phases. Participants rated PainWaive's usability and acceptability at post-intervention. Anxiety, depression, wellbeing, and sleep disturbance were assessed at three timepoints. Aggregated Tau-U analyses indicated a large effect (-0.67) on pain severity from baseline to intervention and very large from baseline to post-intervention (-0.92) and follow-up (-0.92) phases. Large effects (-0.63, -0.62, and -0.70) were also observed for pain interference. Individual-level analyses showed significant reductions across all participants, with visual inspection confirming progressive decreases over time. The intervention was rated usable and acceptable by all participants, while psychological outcomes were mixed and varied across participants. The findings provide promising evidence that the PainWaive neurofeedback intervention may reduce pain severity and pain interference in some individuals with CLBP. By prioritising accessibility, usability, and self-administration, PainWaive supports a foundation for more patient-centred, technology-enabled approaches to chronic pain management. Further evaluation of this approach in randomised trials is required to establish efficacy.