JMIRx Med

Background: Diabetes mellitus and hypertension are increasingly prevalent non-communicable diseases that often coexist due to their interrelated pathophysiology and commonalities of risk factors. Effective management of these two comorbid conditions often involves polypharmacy, defined as the concurrent use of five or more medications, which for therapeutically relevant outcomes requires a high-medication adherence. Limited data exist on the extent of polypharmacy and its impact on adherence among Tanzanian patients with these comorbidities. This study therefore aimed at evaluating the prevalence of polypharmacy and its impact on medication adherence levels among this population. Methodology: A cross-sectional study involving 396 outpatients was conducted at Muhimbili National Hospital. Consecutive sampling was used to recruit eligible participants. Data was collected using structured-questionnaire which captured information on socio-demographics, clinical characteristics and adherence behaviors. Polypharmacy was defined as using five or more medications. Medication adherence was assessed using the Medication Adherence Report Scale (MARS-5). Multivariable logistic regression was performed to identify factors associated with adherence. Results: 71% of the study participants were on five or more medications, indicating high polypharmacy prevalence, with a median of six medications. Medication adherence was reported at 55.1%. Factors associated with lower adherence included moderate (APR: 0.83, P = 0.001) and high fasting glucose (APR: 0.66, P < 0.001), herbal medicine use (APR: 0.72, P < 0.001), and uncontrolled blood pressure. Conclusion: This study reveals a high prevalence of polypharmacy with moderate medication adherence among patients with comorbid T2DM and hypertension. These findings suggest a targeted intervention utilizing such as patient education and medication reviews are essential to improve adherence and management in Tanzania.

Background: Digital mental health applications offer scalable pathways to expand mental healthcare access in low and middle-income countries, yet limited evidence exists on factors predicting willingness to use such applications in South Asia. This study examined associations between digital mental health literacy (DMHL), Technology Acceptance Model (TAM) constructs, mental health symptoms, and willingness to use smartphone-based mental health applications among adults in Bangladesh. Methods: Cross-sectional study conducted from February to June 2026 across urban (Dhaka), semi-urban (Chattogram), and rural (Sylhet) divisions of Bangladesh. Adults aged 18-60 years attending primary care facilities with smartphone access (n = 400) completed a face-to-face interview in Bangla assessing sociodemographic, depression (PHQ-9), anxiety (GAD-7), DMHL (6-item scale, = .762), TAM perceived usefulness (5-item, = .937) and ease of use (5-item, = .924), and willingness to use mental health applications (5-item scale, = .946). Hierarchical binary logistic regression examined associations with willingness (dichotomized at mean [&ge;]3.5). Results: Greater DMHL was associated with higher willingness (adjusted odds ratio [aOR] = 1.24, 95% CI: 1.11-1.38). Both perceived usefulness (aOR = 1.29, 95% CI: 1.18-1.41) and perceived ease of use (aOR = 1.17, 95% CI: 1.07-1.28) independently predicted willingness. Anxiety symptoms were positively associated (aOR = 1.08 per 1-point increase, 95% CI: 1.01-1.15), whereas depression symptoms, age, and sex were not independently significant after adjustment for other variables. Conclusions: Digital literacy, perceived utility of technology, and symptom-specific phenomenology but not demographics alone are associated with willingness to use digital mental health applications. Building DMHL, optimizing the usefulness and usability of the app, and overcoming implementation barriers should all be given priority.

Background: Academic achievement is crucial for university students, but various factors affect their performance. This study explores the impact of anxiety, sleep quality, social media use, and socioeconomic status on academic performance (CGPA) among public university students in Bangladesh. Data and Methods: Data were collected from 225 students using a structured questionnaire that assessed anxiety (GAD-7), sleep quality (PSQI), social media use (SMUQ), and socioeconomic status (income, parental education). Structural Equation Modeling (SEM) was used to analyze the relationships between these variables. Outcomes: The results showed that socioeconomic status had a strong positive effect on academic performance ({beta} = 0.745, p < 0.001), while anxiety negatively impacted academic outcomes ({beta} = -0.675, p < 0.001). Sleep quality was positively related to academic performance ({beta} = 0.113, p < 0.05), but with a weaker effect. Social media usage is found to have a negative significant effect on academic performance ({beta} = -0.137, p < 0.001). Conclusion: These findings highlight the importance of controlling social media usage and anxiety to enhance academic performance among adult students. Sleep quality and socioeconomic background of the students are also found to be meaningfully associated with their educational progress.

Background A culture of patient safety is a significant determinant of healthcare quality and the prevention of patient harm. The objective of this study was to evaluate patient safety culture among healthcare workers at a tertiary-care hospital in India using the Indian-adapted Hospital Survey on Patient Safety Culture (I-HSOPSC 2.0). Method The survey was descriptive and cross-sectional, carried out among 96 healthcare practitioners, comprising 32 doctors, 32 nurses, and 32 allied health professionals. Also, a validated version of the Hospital Survey on Patient Safety Culture (I-HSOPSC 2.0) was used to measure patient safety culture in India. Descriptive statistics, Shapiro-Wilk test, Kruskal-Wallis test, Fishers exact test, and positive response rate analysis were used for the data analysis. Result The overall patient safety culture score was 3.72 {+/-} 0.52, indicating a positive view of patient safety culture. In terms of domains, Communication about Errors, Management Support for Patient Safety, and Teamwork scored highest, while Staffing, Work Pace, and Response to Errors scored lowest. Considerable discrepancies were observed across professions, with allied health professionals giving more favourable answers than nurses. Conclusion Overall, the culture around patient safety was good, but areas such as staffing, pace of work, and error response need targeted attention to sustain patient safety and improve the quality of care in healthcare services.

Healthcare access barriers among Nigerian university students remain under-researched, particularly regarding localized digital health interventions. This study designed, developed, and evaluated a mobile health platform integrating AI-assisted triage, teleconsultation, appointment scheduling, and records management for students at the University of Abuja Teaching Hospital (UATH). A single-group pre-post design was conducted with 50 enrolled student-patients, with each participant observed for 30 days. The platform's triage feature utilized MedGemma, deployed locally via Ollama on UATH infrastructure using a multi-turn conversational architecture. Evaluation metrics included a survey operationalizing the Penchansky and Thomas access framework, the System Usability Scale (SUS), and triage validation against two independent clinicians using weighted Cohen's kappa. Among 61 in-scope triage sessions from 28 participants, mean triage response time was 34.8 seconds with no performance degradation. Among 22 participants completing the SUS, the mean score was 73.2, significantly exceeding the standard 68 benchmark (p = .046). Healthcare access improved directionally across four of five measured dimensions. AI triage classifications demonstrated substantial agreement with independent clinicians (kappa = 0.66-0.72), strengthening in longer conversations. No significant access equity differences were detected between on-campus and off-campus participants in the underpowered pilot subgroup analysis. This study demonstrates the technical feasibility, usability, and clinical concordance of a locally deployed, AI-assisted health platform in a resource-constrained Nigerian setting, providing, to our knowledge, the first evaluation of MedGemma for AI-assisted triage among Nigerian university students and justifying a larger, fully powered follow-up study.

Introduction We are currently working on the BEARS (Both Ears) virtual reality (VR) Randomised Controlled Trial. We are recruiting 272 deaf children and young people who use bilateral (both ears) cochlear implants (CI) to examine if using the BEARS VR games helps their hearing in background noise and ultimately their quality of life. Clinical trial participants should be representative of the population with the health condition, although this is rarely achieved in practice as people from ethnic minorities or those from more deprived areas may face barriers to participation. Study Design Mixed methods design Objectives Use a literature review and collection of data from cochlear implant centres to establish the sociodemographic characteristics of deaf children aged 8 to 16 years with bilateral cochlear implants in the United Kingdom (UK). a. Establish the sociodemographic characteristics of the families recruited to the BEARS clinical trial in the first six months, and compare with the age-matched population of deaf children with bilateral cochlear implants in the UK. b. Analyse the BEARS clinical trial pre-screening diversity data. c. Implement an established recruitment intervention method in a workshop to explore and optimise recruitment number and diversity. d. Compare the final six months of recruitment data diversity with the initial six months. Use interviews and focus groups to collect qualitative data from children and their families who chose not to take part in BEARS, clinicians, and family representatives (e.g. teachers) to explore barriers and facilitators to families taking part in BEARS. Amend the BEARS scale-up plan based on new learning. Methods Literature and scoping reviews, quantitative analysis of BEARS recruitment data, in-depth interviews, paired interviews, focus groups Sample size Qualitative sample: 10-15 children aged 8-16 with bilateral CI, 10-15 parents/carers of children with bilateral CI, 10-12 clinicians and 10-12 family representatives. Significance This work will evaluate how diverse the BEARS clinical trial recruitment is and whether it is representative of the UK population of children with bilateral cochlear implants. We will investigate recruitment barriers and implement measures to try to improve recruitment diversity.

Background Surveillance of adverse events following immunization (AEFI) and appropriate reporting are essential ingredients of an effective immunization programme. Despite increasing recognition by caregivers, the response to it remains a major problem, with the majority being inappropriate. This study is therefore intended to determine the prevalence, pattern, and determinants of caregivers response regarding AEFI in Nigerian hospitals. Methodology A descriptive cross-sectional study was conducted among 368 caregiver-infant pairs across 3 Nigerian hospitals, using semi-structured questionnaires to document sociodemographic characteristics and the prevalence, pattern, and determinants of caregivers response. Statistical analyses were performed using SPSS version 27. Predictors of AEFI and determinants of caregivers response were assessed using Pearsons chi-square and logistic regression. A p-value < 0.05 was considered statistically significant. Results The prevalence of AEFI was 71.7%, with inconsolable crying/irritability, fever, and swelling at the vaccination site as the leading cases. Infant age, weight, and gestational status at birth were predictors of AEFI occurrence. Only 8 (3.0%) caregivers presented at a healthcare facility when AEFI was noticed (appropriate response), while 360 (97.0%) did not (inappropriate). The relationship of the caregiver to the vaccinated infant (mother) was found to be a determinant of caregivers response to the occurrence of AEFI. Conclusion An increasing prevalence of AEFI that was not followed by an optimally appropriate response from caregivers has been demonstrated. This calls for more public enlightenment focusing on the need to report AEFI at healthcare facilities, as this will help in ensuring vaccine safety and improvement in the immunization programme.

Background: Dietary supplements (DS) are extensively used in Pakistan, frequently in conjunction with prescription medicines. Pharmacists are well positioned for patient counsesling due to their accessibility. However, their ability to provide evidence-based counseling remains uncertain due to their varying knowledge and training, especially in low- and middle-income countries (LMICs), including Pakistan. The study assessed pharmacists' knowledge, attitudes, and practices (KAP) regarding DS counseling and identified gaps requiring intervention. Methods: A cross-sectional study was conducted among 256 registered pharmacists in Lahore, Pakistan. Data were collected using a validated, self-administered questionnaire assessing knowledge, attitudes, and counseling practices concerning dietary supplements over a period of six months i.e., July to December 2025. Statistical analyses were performed using SPSS version 27. A p-value of < 0.05 was considered statistically significant. Results: Mean age was 31.0 {+/-} 6.2 years, with male predominance (56.3%), Doctor of Pharmacy degree (75.0%), community pharmacy practice (62.5%), and 1-5 years of experience (48.4%). Mean knowledge score was 6.18 {+/-} 1.71, with most (76.6%) exhibiting moderate knowledge. Mean attitude score was 7.01 {+/-} 1.94, with 91.4% demonstrating positive attitudes. Mean practice score was 7.91 {+/-} 2.93, with 68% exhibiting good counseling practices. Knowledge scores were significantly higher among female pharmacists (6.96 {+/-} 1.52 vs. 5.57 {+/-} 1.61, p=0.001), urban residents (6.39 {+/-} 1.61 vs. 4.37 {+/-} 1.30, p<0.001), and clinical pharmacists (7.10 {+/-} 1.68, p=0.001). Conclusion: Pharmacists practicing in Lahore, Pakistan demonstrated positive attitudes but moderate knowledge and inconsistent counseling practices. Key gaps were identified in drug-supplement interaction knowledge and counseling practices. These findings underscore the need for organized education, continued training, and regulatory supervision to improve counseling practices of dietary supplements.

Studies employing and evaluating hearing-aid self-adjustments frequently label the resulting settings as 'preferences' without questioning that label. There is a lack of inquiries into the rationale behind participants' choices or their approach to self-adjustment. We here employed a think-aloud protocol concurrent with individuals' self-adjustments to capture qualitative perspectives on these processes. Thirty-six adult hearing-aid users were asked to verbalise what they were thinking while adjusting to their preference three stimuli (music, speech or speech in noise) using three control interfaces (1 slider jointly controlling bass/treble, 2 sliders separately controlling bass and treble or 3 sliders controlling bass, mid and treble). Audio-video recordings were transcribed, annotated and analysed using inductive content coding and thematic analysis. Participants' approach and navigation of the self-adjustment process was best defined as a continuum between exploratory and anticipatory archetypes, with both types sometimes occurring at different stages within the same adjustment. The exploratory type initially assesses control functions, then selects the optimal setting from available options, and evaluates sound changes affectively in isolation or comparatively against prior settings. The anticipatory type begins by evaluating the sound, identifying issues, adjusting settings guided by past experiences, and evaluating adjustments against the identified issues. Additionally, the descriptors elicited during adjustments generally agreed with expert-based data. The resulting qualitative framework of self-adjustment helps explain both how hearing-aid users navigate the personalisation process and how self-adjustment can promote greater understanding of the options available and greater ownership in that process.

Abstract Background: Even though significant advances in diagnosis, treatment, and prevention strategies have been implemented, neonatal sepsis remains a common concern in clinical practice, especially in low-resource countries. It is one of the major causes of death during the first month of life. This study aimed to assess clinical outcomes and predictors of mortality among neonates with neonatal sepsis admitted to public hospitals in selected Hospitals in Addis Ababa, Ethiopia. Methods: A hospital-based prospective cohort study design was conducted among 466 neonates admitted with neonatal sepsis from September 2024 to January 2025. All neonates who were admitted to selected Hospitals of Addis Ababa city after being clinically or laboratory-diagnosed with neonatal sepsis by the attending physician were included in the study. Data were entered into EpiData 4.2 and analyzed by SPSS version 26. Bivariate and multivariate Cox regression were used to identify the relationship between dependent and independent variables. Finally, variables with p-value [&le;] 0.05 were taken as significant factors associated with poor clinical outcome. Results: The study was conducted among 466 neonates admitted with neonatal sepsis. Of all neonates admitted with neonatal sepsis, 372 (79.8%) were discharged with good outcomes, and 94 (20.2%) had a poor outcome/died. Duration of ruptured membrane being >12hr (AOR=7.02, 95 % (CI: 1.85, 26.57), marital status /divorced (AOR=3.12, 95 % (CI: 1.67, 7.45),rural residence (AOR= 6.05, 95 % (CI: 2.03-16.53), assisted instrumental delivery (AOR= 5.99, 95 % (CI: 1.46-17.11), meconium-stained amniotic fluid ((AOR= 9.48, 95 % (CI: 0.49-18.61)), no initiate exclusive breast feed within one hour (AOR= 3.20, 95 % (CI: 0.90-7.52), chest in drawing (AOR= 5.81, 95 % (CI: 1.75-11.23) were significantly associated with neonatal mortality. Conclusion: Neonatal mortality was moderately high. Meconium-stained amniotic fluid, prolonged duration of ruptured membrane (>12hr), Mode of delivery (instrumental delivery), and chest in drawing are among the predictors of neonatal mortality. Keywords: -Clinical outcome,Neonatal sepsis, Mortality, predictors, Ethiopia.

BACKGROUND: War refugees are prone to psychiatric ailments due to multiple psychosocial stressors. Afghan refugees remain underrepresented in psychiatric studies. Therefore, a study exploring factors contributing to their mental health disorders is essential to guide rehabilitation efforts worldwide. METHODS: This descriptive cross-sectional study evaluates the demographics, psychosocial stressors, psychiatric illnesses, and psychotropic drug use among Afghan refugees visiting the Psychiatry Outpatient Department (OPD) in Islamabad, Pakistan. Convenience sampling was employed on a sample population (n) of 75 participants. Data was collected via a structured questionnaire and analyzed using SPSS v21.0. Qualitative and quantitative variables were analyzed statistically. RESULTS: Nearly 64%(n=48) of the participants were female. About 46.7%(n=35) of participants were uneducated, and 53.3%(n=40) were unemployed. 86.7%(n=65) of participants were married, while 2.7%(n=2) were divorced. 91%(n=61) of the married and divorced participants had an arranged marriage, 46.3%(n=31) had 5-8 children, and 67.2%(n=45) had experienced physical and/or emotional abuse. 74.7%(n=56) of the total participants reported a loss in the family, while 77.3%(n=58) had experienced trauma. 62.7%(n=47) had depression and associated psychotropic use, e.g., SSRIs (42.7%), TCAs (16%), and Benzodiazepines (13.3%). Alarmingly, 37.3%(n=28) reported a previous suicide attempt. CONCLUSION: This study explores the psychosocial stressors faced by Afghan refugees in Pakistan, including displacement, abuse, trauma, and family/income loss. It emphasizes the importance of evidence-based psychiatric care, rehabilitative interventions, and culturally sensitive care to counter psychiatric morbidities and underscores the need for future research to improve the mental health of refugees globally.

Purpose: Conventional clinical acoustic analysis systems are confined to specialized clinical environments, which limits scalable and remote voice monitoring. This study aimed to validate LIS-N, a web-based prototype of a novel mobile application that uses the open-source Praat-Parselmouth library for acoustic feature extraction, against the Computerized Speech Lab (CSL), the clinical reference standard, to assess its potential for telehealth and longitudinal voice assessment before integration into clinical or research workflows. Method: Twenty adult volunteers without voice complaints or diagnosed dysphonia completed three voice tasks across three consecutive days at a tertiary academic voice center in quiet isolated rooms. All participants completed the full protocol across three consecutive days. Voice tasks included Rainbow Passage reading, sustained vowel /i/, and maximum phonation time /a/. Audio was captured concurrently using CSL and the LIS-N prototype, which uses Praat-Parselmouth for acoustic feature extraction. To isolate the contributions of recording hardware and analysis software, four cross-system conditions were also examined. Agreement was assessed using Pearson correlation and Bland-Altman analyses. Session-to-session trajectory correlations were computed to evaluate temporal consistency across systems. Results: Fundamental frequency and Pitch Mean demonstrated excellent agreement across all tasks and conditions (r > 0.98), with robustness to hardware and software differences. Pitch Minimum and Pitch Maximum showed strong agreement during sustained vowel tasks. Energy-based features showed moderate agreement, with variability driven primarily by microphone differences, and same-microphone conditions yielded substantially stronger energy agreement. Perturbation measures including jitter, shimmer and CPP showed consistently poor cross-platform agreement, consistent with prior literature. Conclusion: This study provides proof of concept for the viability of open-source acoustic frameworks as accessible alternatives to proprietary clinical systems, while also identifying limitations. Both systems should be interpreted separately, as each remains reliable within its own framework. The LIS-N prototype demonstrated strong agreement for frequency-based voice measures and consistent longitudinal monitoring, supporting adoption of open-source acoustic tools in telehealth and remote voice monitoring.

The availability of hearing aids that can connect wirelessly to smartphone technologies via Bluetooth has grown exponentially in recent years. However, there is limited evidence assessing the benefits of user-adjustability afforded by these devices. This study aimed to assess the benefits of smartphone-connected hearing aids and an accompanying application (or app) in new and existing hearing aid users. In this single-centre, prospective, observational study, 44 adult hearing aid users (14 new and 30 existing) were recruited. Participants were fitted bilaterally with smartphone-connected hearing aids that could be adjusted by the user via an app. Self-reported outcome measures were collected at fitting and after seven-weeks of using the device in everyday life. For both new and existing hearing aid users, significant improvements in social participation, hearing-related fatigue, and hearing aid benefit and satisfaction were found. For existing hearing aid users, all outcomes were significantly better for the smartphone-connected hearing aids plus app in comparison to their existing hearing aids that did not connect to a smartphone, all with moderate-to-large clinical effect sizes (d> .6). User-controllability via the app was identified as the key benefit, and most participants (68%) reported that the app met their needs 'extremely' or 'very well'. These results suggest that, when used in conjunction with an app, smartphone-connected hearing aids can improve hearing outcomes due to greater user-controllability to improve listening. Thus, smartphone-connected hearing aids have the potential to facilitate patient-centred care, empowering the individual to successfully manage their hearing loss.

This study examined the prevalence of domestic elder abuse and examined factors in a province with a high aging index in Vietnam in 2025. Elder abuse was measured using the validated Vietnamese Domestic Elder Abuse Scale, covering psychological abuse, physical abuse, financial exploitation, neglect/abandonment. Logistic regressions identified factors associated with abuse. 29.44% of participants reported at least one abuse subtypes, with psychological abuse being the most common subtype (24.73%) and 9.82% experienced polyvictimization. Higher educational attainment was consistently associated with lower odds of all abuse subtypes. Having [&ge;]4 chronic conditions was associated with higher odds of psychological abuse compared with having none (OR= 2.79, 95%CI: 1.29-6.00). Difficulties in daily basic activities were associated with physical abuse (OR=5.42, 95%CI: 1.80-16.36), financial exploitation (OR=3.66, 95%CI: 1.34-10.01), and neglect/abandonment (OR=4.09, 95%CI: 1.72-9.70) compared with no difficulties. Findings highlight the need for stronger policy implementation and lifelong learning to prevent elder abuse in Vietnam.

Background: This research article explores a novel framework for assessing the Quality of Healthcare based on principles of Clinical Risk Management, including the development of a theoretical construct for the quality of healthcare services based on stakeholder needs, and a conceptual model for managing risks at an institutional level. Methodology: The study consisted of a cross-sectional secondary assessment of healthcare service and system-level indicators, guided by a structured decision tree based on face, construct, content, and criterion validity. Established performance measures identified from international benchmarking and institutional quality improvement frameworks were classified and validated for assessment of clinical risks according to indicator type. Results: A total of 233 performance indicators were evaluated, of which 200 (86%) consisted of measures for assessing failures in clinical practice. According to the proposed framework, (30%) and (14%) of indicators met the criteria for assessing risks associated with clinical processes and organizational systems design respectively. Conclusion: More targeted use of indicators is required in order to achieve a greater degree of accuracy and actionability of performance assessment measures in healthcare practice. The proposed framework offers an applied method to enhance the specificity of quality indicators and direct efforts to improve systems design and decision-making capability.

Objective Influenza-like illness (ILI) is characterized by the sudden onset of systemic and respiratory symptoms such as fever, fatigue and myalgia, requiring prompt management. Anas barbariae 200K, a homeopathic medicinal product, is traditionally used to relieve flu-like symptoms. This study aimed to evaluate its efficacy in alleviating ILI symptoms within 72 hours. Secondary outcomes assessed symptoms relief, adverse effects, functional outcomes, compliance, and participant and investigator satisfaction. Methods This prospective, randomized, double-blind, placebo-controlled multicenter superiority trial with two parallel groups was conducted in primary care in India in 2021. Children (6-12 years) and adults (18-65 years) with ILI symptoms for less than 24 hours were randomized to receive either Anas barbariae 200K (Oscillococcinum(R)) or placebo. Treatment was given three times daily for three days. The primary endpoint was the proportion of participants with alleviation of ILI symptoms within 72 hours following the initiation of treatment. Results A total of 707 participants received Anas barbariae 200K (n = 352) or placebo (n = 355). Within 72 hours, the Anas barbariae 200K group showed significantly greater symptom relief than the placebo group (74% vs. 44.5%; p < 0.0001). Secondary endpoints also favored Anas barbariae 200K group, including faster symptom alleviation (46.7 vs. 67.3 hours; p < 0.0001) and shorter median time, estimated by KM analysis, to return to daily activities (4.0 vs. 6.0 days; p < 0.0001). No serious adverse events were reported. Conclusion Anas barbariae 200K significantly alleviated ILI symptoms within 72 hours, with improvements that were both statistically and clinically significant. Significant benefits were also observed across secondary outcomes, with no safety signal identified. This study showed that Anas barbariae 200K could be an effective and well-tolerated treatment for ILI symptoms. Trial registration Clinical Trials Registry of India, CTRI: 2021/02/031250, registered on February 12, 2021. Keywords Influenza-like illness, Oscillococcinum(R), Respiratory tract infections, Randomized controlled trial, Homeopathy, Respiratory and systemic symptoms, Treatment outcome.

Introduction. Artificial intelligence is entering African primary care partly on the premise that populations underserved by clinicians will accept an algorithm in a clinician's place, a premise rarely tested where it matters. We measured how far Nigerian adults separate health from every other use of AI in their lives. Methods. Cross-sectional national survey of 11,013 adults across Nigeria's 36 states and Federal Capital Territory, July-October 2025. About 60% were recruited face to face, with translation where needed, so neither literacy nor English was required to take part. Each rated willingness to use AI in nine everyday situations on a 1-5 scale, one being health advice when no doctor was available. The primary outcome was a within-person difference: health minus the respondent's mean of the other eight. Associations were estimated by ordinary least squares with cluster-robust (CR2) standard errors by state. Results. Health finished last of the nine (mean 3.10), below promoting one's own political party (3.40). The within-person gap was -0.568 (95% CI -0.594 to -0.543; dz -0.417), widening to -0.904 among the 6,924 who distinguished between domains. Keeping a clinician in view did not relieve it: 22.9% would trust AI to help doctors diagnose against 25.5% who would use it to check their own symptoms. Among barriers respondents named, the gap was wider for language (beta -0.427, 95% CI -0.718 to -0.136) and unfriendly staff (-0.411, -0.616 to -0.207), narrower for missing equipment (+0.231, +0.040 to +0.423) and narrower among fluent English speakers (+0.386 per SD, +0.130 to +0.643). Conclusion. Nigerian adults accept AI across their lives and withhold it from their health, most firmly where care has been unaffordable, unintelligible or unkind. No configuration tested commanded majority willingness, including AI presented as assisting a clinician; willingness belongs alongside connectivity and data in deployment planning, not assumed.

Background: The COVID-19 pandemic disrupted healthcare worldwide, but whether mental health was affected differently from physical healthcare, and whether it recovered following successive waves, has not been described from routine administrative data in a low- or middle-income country. Methods: Interrupted time-series analysis of India's routine Health Management Information System (HMIS), April 2017 to March 2022. We extracted monthly counts of mental-illness outpatient visits and adolescent counseling sessions across ~700 districts, projected expected monthly counts from a log-linear model fitted to pre-pandemic trends, and compared disruption and recovery against an index of routine physical-health services. Results: Mental-illness outpatient visits fell to 31.2% of expected in April 2020 during the national lockdown, a collapse deeper than that observed for routine immunisation (48.3%) or institutional delivery (72.1%). During the Delta wave (April-June 2021), mental-health outpatient visits dropped again to 57.8% of expected. In the post-Delta recovery period (July 2021-March 2022), while immunisation and delivery volumes returned to >95% of expected, mental-illness outpatient visits reached only 58.4% of expected, representing a cumulative two-year deficit of 41.6% (~5.8 million missed outpatient visits). Deficits were widespread across states. Conclusion: Public mental-health outpatient services in India were hit harder than physical-health services by the pandemic and showed essentially no post-Delta volume recovery. As India implements its national digital mental health initiative (Tele-MANAS), these data define the large, quantified outpatient deficit that digital and facility-based services must urgently address.

Background Type 2 diabetes mellitus (T2DM) is a rapidly growing public health crisis in Bangladesh, where an estimated 13.1 million adults were living with the condition in 2021, with projections suggesting this figure will nearly 22.3 million by 2045. Poor medication adherence and impaired health-related quality of life (HRQoL) are recognized consequences of long-term T2DM management, yet data from northwestern Bangladesh remain scarce. This study aimed to assess treatment adherence, HRQoL and identify their associated factors among T2DM patients in Rajshahi, Bangladesh. Methods We conducted a cross-sectional study between January and December 2021 among 205 T2DM patients from two tertiary-level hospitals in Rajshahi. Treatment adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), and HRQoL was measured using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L). Results The mean age of participants was 54.43 ({+/-}10.75) years; 50.73% were female. The majority (85.85%) had HbA1c [&ge;]6.5%, reflecting widespread poor glycaemic control. Regarding treatment adherence, 40.98% of patients had low adherence, 26.83% had medium adherence, and 32.19% had high adherence. In terms of HRQoL, only 6.83% were in perfect health state, while 52.68% had slight/moderate problems and 40.49% had severe/extreme problems across EQ-5D-5L domains. The association between treatment adherence and HRQoL was not statistically significant (p=0.265). Multiple regression analysis (Adjusted R{superscript 2}=0.620) identified diabetic complications, illiteracy, primary education, female gender, higher BMI, joint family type, treatment adherence, older age, and two antidiabetic medications as significant predictors of poorer HRQoL, while urban residence and family history of DM were independently associated with better HRQoL. Conclusions A substantial proportion of T2DM patients exhibited low treatment adherence and markedly impaired HRQoL. While adherence and HRQoL were not directly associated, diabetic complications emerged as the strongest independent predictor of poor quality of life. These findings highlight the urgent need for multidisciplinary interventions to prevent complications in this population.

Internet use has increased rapidly around the world, along with reports of overuse among internet users. This can affect not just the psychosocial well-being but also the physical health of the young population, who are its major victims. However, very limited studies have been conducted on internet addiction among the young population in Nepal. This study aims to find the prevalence of internet addiction and its associated factors among undergraduate students of the Institute of Medicine (IOM), Nepal. We conducted a cross-sectional study among 211 undergraduate students of IOM. A structured questionnaire was used to collect socio-demographic, academic, and internet-use-related information. Internet addiction was assessed using Youngs Internet Addiction Test. Descriptive and bivariate analyses were performed. Frequencies and percentages were calculated for univariate analysis, while bivariate analysis was performed to assess the association between the dependent and independent variables. One in two students had internet addiction, with 36.5% having mild addiction, 12.3% having moderate addiction, and 1.4% having severe addiction. The mean age ({+/-}SD) of the students was 21.6 {+/-} 2.0 years. The variable found to be associated with internet addiction was the duration of internet use per day. Students who used the internet for more than five hours per day were about 2.3 times more likely to have internet addiction than those who used the internet for five hours or less (OR = 2.399, 95% CI: 1.334-4.314). Internet addiction is a significant concern among undergraduate students and may increase if not appropriately addressed. Excessive and problematic internet use may contribute to mental health problems such as difficulty concentrating, anxiety, and compulsive behaviors, particularly among young people who are frequent users of the internet.