Journal of Medical Internet Research最新文献_第2页

Seeking But Not Discussing Online Health Information With Physicians: Cross-Sectional Survey Study of eHealth Literacy-Empowerment Profiles and Patient-Centered Communication. 与医生寻求但不讨论在线健康信息：电子健康素养授权概况和以患者为中心的沟通的横断面调查研究。

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-18 DOI: 10.2196/78836

Qianfeng Lu, Wen Jiao, Angela Chang, Peter Johannes Schulz

Background: Patients frequently search for health information online and value physician support in evaluating and interpreting their findings, yet many hesitate to share their online searches with their physicians. This hesitation hinders shared decision-making and compromises patient care. While extensive research has examined patients' online health information-seeking behaviors, little has focused on patients' disclosure of this information to their physicians during consultations.Objective: Guided by the Health Empowerment Model and the Linguistic Model of Patient Participation in Care, this study aims to (1) identify distinct patient profiles based on eHealth literacy and psychological health empowerment levels, (2) examine how these patient profiles differ in online health information seeking and disclosure to physicians, and (3) investigate whether patient-centered communication (PCC) promotes information disclosure and whether this effect varies by patient profile.Methods: This cross-sectional study surveyed 2001 Chinese participants recruited through convenience sampling. Patient profiles were identified using k-means cluster analysis with standardized z scores of eHealth literacy and psychological health empowerment. Differences between profiles in information behaviors were examined using 1-way Welch ANOVA, chi-square tests, and pairwise comparisons. Regression analyses examined the association between PCC and disclosure of online health information. Moderation analyses using the Hayes PROCESS macro assessed whether this association varied across patient profiles.Results: Four distinct patient profiles were identified: effective self-managers (996/2001, 49.8%), moderate-needs dependent patients (408/2001, 20.4%), high-needs patients (68/2001, 3.4%), and dangerous self-managers (529/2001, 26.4%). Profiles differed significantly in information-seeking intentions (F3,289=62.09; P<.001; η²=0.12) and disclosure intentions (F3,299.41=66.08; P<.001; η²=0.09). "Effective self-managers" showed the highest seeking (mean 4.01, 95% CI 3.96-4.06) and disclosure intentions (mean 3.43, 95% CI 3.36-3.50), while "high-needs patients" showed the lowest intentions for both behaviors. Actual information-seeking rates also differed significantly across profiles (χ²3=103.4; P<.001), with "effective self-managers" having the highest rate (800/996, 80.3%) and "high-needs patients" the lowest (25/68, 36.8%). Among seekers, disclosure rates varied significantly (χ²3=23.1; P<.001), with "high-needs patients" showing the highest disclosure (16/25, 64%) despite having the lowest seeking rate. PCC was positively associated with actual information disclosure behavior (odds ratio 1.26, 95% CI 1.04-1.53; P=.02), with no significant moderation by patient profiles (χ²3=1.7; P=.64).Conclusions: This st

背景：患者经常在网上搜索健康信息，并在评估和解释他们的发现时重视医生的支持，但许多人不愿与医生分享他们的在线搜索结果。这种犹豫阻碍了共同决策，并损害了对患者的护理。虽然广泛的研究已经检查了患者的在线健康信息寻求行为，但很少有人关注患者在咨询期间向医生透露这些信息。目的：在健康授权模型和患者参与护理的语言模型的指导下，本研究旨在(1)识别基于电子健康素养和心理健康授权水平的不同患者特征；(2)研究这些患者特征在在线健康信息寻求和向医生披露方面的差异；(3)研究以患者为中心的沟通（PCC）是否促进了信息披露，以及这种影响是否因患者特征而异。方法：采用方便抽样法对2001名中国被试进行横断面调查。使用电子健康素养和心理健康赋权的标准化z分数的k-均值聚类分析确定患者概况。采用单因素韦尔奇方差分析、卡方检验和两两比较检验信息行为的不同。回归分析检验了PCC与在线健康信息披露之间的关系。使用Hayes PROCESS宏观的适度分析评估了这种关联是否因患者的不同而不同。结果：确定了四种不同的患者类型：有效的自我管理者（996/2001,49.8%）、中度需求依赖患者（408/2001,20.4%）、高需求患者（68/2001,3.4%）和危险的自我管理者（529/2001,26.4%）。不同人群在信息寻求意向上存在显著差异（f3289 =62.09; p3299.41 =66.08; P3=103.4; P3=23.1; P3=1.7； P= 0.64）。结论：本研究将现有文献从信息寻求行为扩展到患者向医生披露在线发现。与之前的研究不同，这些研究分别考察了电子健康素养和心理健康赋权，本研究整合了这些结构，以确定具有不同信息行为模式的有意义的患者概况。PCC促进信息披露，而不考虑患者的情况。在实践中，医生应该采用PCC，承认患者的在线研究努力，促进更安全的信息使用和更牢固的医患关系。

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引用次数: 0

Understanding User Intent in Code-Mixed Sexual and Reproductive Health Queries in Urban India: A Hierarchical Classification Approach using LLMs. 理解用户意图在代码混合的性健康和生殖健康查询在印度城市：使用LLMs分层分类方法。

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-18 DOI: 10.2196/86545

Sumon Kanti Dey, Manvi S, Aradhana Thapa, Meet Shah, Zeel Mehta, Shraddha Kale Kapile, Tanvi Divate, Suhani Jalota, Azra Ismail

Background: Sexual and reproductive health (SRH) remains a stigmatized and taboo topic in many parts of the world, limiting access to reliable information. These challenges are heightened in the Global South, where linguistic and cultural diversity further complicate information access. In India (our study context), many individuals frequently express SRH concerns in code-mixed language, such as Hinglish (code-mixed Hindi and English), and use colloquial terms. Large language models (LLMs) could help answer SRH questions, but most systems are trained for English and may perform poorly on code-mixed text and cultural context. Our research aims to address this gap by assessing the current state of LLMs in understanding user intent in SRH queries for a low-resource language.Objective: We evaluate the effectiveness of proprietary, multilingual open-weight, and Indic LLMs in zero-shot settings for identifying user intent in code-mixed Hinglish SRH queries. Our goal is to assess how well LLMs assign the correct label in a two-level hierarchical classification (topic and subtopic). We take a hierarchical approach because SRH queries are complex and context-dependent; flat labels could obscure clinically important distinctions and can lead to misdirected guidance. We also characterize common error types that drive misclassification.Methods: We analyzed 4,161 de-identified questions about SRH in Hinglish, collected by our partner nonprofit health organization (Myna Mahila Foundation) in an underserved community in urban Mumbai. Queries were annotated into 8 topics and 40 subtopics using a hierarchical framework that captured linguistic, cultural, and contextual variation. We evaluated proprietary, multilingual open-weight, and Indic-specific LLMs in zero-shot settings. Performance was measured using hierarchical F1 (hF1), Exact Match, and topic- and subtopic-level accuracy.Results: Proprietary models achieved the strongest results, with GPT-5 performing best overall (hF1= 0.784). Among open-weight systems, Sarvam-M emerged as the top-performing Indic model (hF1 = 0.757), ranking just below the top-performing proprietary model and performing comparably with Claude-3.5-Sonnet (0.745) as well as large multilingual systems such as Llama-3.3-70B-Instruct (0.742) and Gemma-3-27B-IT (0.739). Other Indic models performed considerably lower (e.g., Llama-3-Gaja-Hindi-8B, 0.596; Krutrim-2-Instruct, 0.558; Airavata, 0.404). Smaller multilingual open-weights models, including Mixtral-8x7B-Instruct (0.593), Llama-3.1-8B-Instruct (0.630), Gemma-2-9B-IT (0.657), consistently outperformed them, showing that parameter size alone does not explain performance gaps. While models generally captured broad topical intent, they frequently failed at fine-grained intent recognition, especially with euphemisms, colloquial expressions, and local and culturally situated questions.<strong

背景：性健康和生殖健康在世界许多地方仍然是一个被污名化和禁忌的话题，限制了获得可靠信息的机会。这些挑战在语言和文化多样性进一步使信息获取复杂化的南方国家更为突出。在印度（我们的研究背景），许多人经常用编码混合的语言表达SRH关注，例如印度英语（编码混合印地语和英语），并使用口语术语。大型语言模型（llm）可以帮助回答SRH问题，但是大多数系统都是针对英语进行训练的，在代码混合的文本和文化背景上可能表现不佳。我们的研究旨在通过评估llm在理解低资源语言的SRH查询中的用户意图方面的现状来解决这一差距。目的：我们评估专有的、多语言开放权重和印度llm在零射击设置中识别代码混合的印度英语SRH查询中的用户意图的有效性。我们的目标是评估法学硕士在两级层次分类（主题和子主题）中分配正确标签的效果。我们采用分层方法，因为SRH查询复杂且依赖于上下文；扁平标签可能模糊临床重要的区别，并可能导致误导的指导。我们还描述了导致错误分类的常见错误类型。方法：我们分析了4161个关于印度英语中SRH的去识别问题，这些问题由我们的合作伙伴非营利性卫生组织（Myna Mahila基金会）在孟买城市一个服务不足的社区收集。使用捕获语言、文化和上下文差异的分层框架，将查询注释为8个主题和40个子主题。我们在零射击环境中评估了专有的、多语言开放重量的和印度特定的llm。使用分层F1 （hF1）、精确匹配以及主题和子主题级别的准确性来衡量性能。结果：专有模型效果最强，其中GPT-5整体表现最佳（hF1= 0.784）。在开权重系统中，sarvamm - m成为表现最好的印度模型（hF1 = 0.757），仅次于表现最好的专有模型，其表现与Claude-3.5-Sonnet（0.745）以及Llama-3.3-70B-Instruct（0.742）和Gemma-3-27B-IT（0.739）等大型多语言系统相当。其他印度模型的表现相当低（例如，Llama-3-Gaja-Hindi-8B, 0.596; Krutrim-2-Instruct, 0.558; Airavata, 0.404）。较小的多语言开放权重模型，包括Mixtral-8x7B-Instruct (0.593), Llama-3.1-8B-Instruct (0.630), Gemma-2-9B-IT(0.657)，始终优于它们，表明参数大小本身并不能解释性能差距。虽然模型通常捕获广泛的主题意图，但它们经常在细粒度的意图识别上失败，特别是在委婉语、口语表达以及当地和文化情境问题上。结论：层次分类揭示了llm如何处理代码混合查询的持续差距。专有模型表现最好，但Sarvam-M表明，在强大的训练数据、文化适应性和适当的模型规模的支持下，开放权重指数系统可以达到接近最先进模型的性能。这些发现突出了本地化的、与文化相一致的模型在推进语言包容性人工智能工具和扩大全球服务不足人群公平获取性健康和生殖健康信息方面的潜力。临床试验:

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引用次数: 0

Developing a Service Quality Index System for AI Health Care Chatbots: Mixed Methods Study. 人工智能医疗聊天机器人服务质量指标体系的开发：混合方法研究

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-18 DOI: 10.2196/83051

Yu Gu, Xinyi Wang

Background: Artificial intelligence (AI) health care chatbots are gaining widespread adoption worldwide. It is imperative to understand the service quality of AI health care chatbots. However, there is limited guidance on how to comprehensively evaluate their service quality.

Objective: This study aimed to develop an index system based on the SERVQUAL framework for evaluating the service quality of AI health care chatbots.

Methods: An initial indicator pool was compiled through a comprehensive literature review and consultations with 4 experts. These indicators were mapped and categorized into 5 domains adapted from the SERVQUAL framework. The experts were recruited from hospital, university, and health commission settings by purposive sampling. The service quality index system was identified using a 2-round Delphi process, which included a virtual meeting between the 2 rounds. In the third round, indicator weights within each quality domain and subdomain were determined using the analytic hierarchy process.

Results: There were 26 indicators identified in the literature, based on which the 2-round Delphi process was conducted. A total of 20 experts were invited. The response rates in both rounds of Delphi and the analytic hierarchy process were 100%, and the authoritative coefficients were both >0.7. The final service quality index system for AI health care chatbots comprises 5 primary indicators and 17 secondary indicators. There were 3 (18%) indicators on assurance, 4 (24%) on reliability, 3 (18%) on human-likeness, 4 (24%) on tangibility, and 3 (18%) on responsiveness. The primary indicators, ranked from highest to lowest weight, were assurance (0.239), reliability (0.237), human-likeness (0.187), tangibility (0.170), and responsiveness (0.167).

Conclusions: This study pioneers the development of a service quality index system for AI health care chatbots adapted from the SERVQUAL framework. The results provide a validated tool for evaluating the performance of chatbots and offer valuable insights for health service managers and developers to enhance AI-driven medical consultation services.

背景：人工智能（AI）医疗保健聊天机器人在全球范围内得到广泛采用。了解人工智能医疗聊天机器人的服务质量是当务之急。然而，如何对其服务质量进行综合评价的指导有限。目的：建立基于SERVQUAL框架的人工智能医疗聊天机器人服务质量评价指标体系。方法：通过全面查阅文献并咨询4名专家，编制初步指标库。这些指标被映射并分类为根据SERVQUAL框架改编的5个领域。专家是通过有目的的抽样从医院、大学和卫生委员会机构招募的。采用两轮德尔菲法确定服务质量指标体系，其中包括两轮之间的虚拟会议。第三轮，采用层次分析法确定各质量域和子域内指标的权重。结果：文献共识别出26个指标，并以此为基础进行2轮德尔菲法。总共邀请了20位专家。两轮德尔菲法和层次分析法的应答率均为100%，权威系数均为>0.7。最终的AI医疗聊天机器人服务质量指标体系包括5个一级指标和17个二级指标。保证指标有3个（18%），可靠性指标有4个（24%），人的相似性指标有3个（18%），可触性指标有4个（24%），反应性指标有3个（18%）。主要指标的权重从高到低依次为保证（0.239）、信度（0.237）、与人相似（0.187）、可触性（0.170）和反应性（0.167）。结论：本研究为基于SERVQUAL框架的人工智能医疗聊天机器人服务质量指标体系的开发开辟了先路。研究结果为评估聊天机器人的性能提供了一个经过验证的工具，并为卫生服务管理人员和开发人员提供了有价值的见解，以增强人工智能驱动的医疗咨询服务。

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引用次数: 0

Framing the Convergence of One Health and Digital Health in the Global South With a Gender-Sensitive Foresight Perspective: Delphi Study Using Latent Semantic Analysis. 框架融合的一个健康和数字健康在全球南方与性别敏感的前瞻性观点：德尔菲研究使用潜在语义分析。

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-18 DOI: 10.2196/78702

Jude Kong, Nicola Luigi Bragazzi

Background: The convergence of digital health and One Health represents an emergent paradigm in global health governance. While widely discussed in high-income settings, there is limited understanding of how this convergence is conceptualized in the Global South, particularly when viewed through a gender- and equity-sensitive foresight lens.Objective: This study aimed to map and classify expert discourse on digital health, One Health, and their convergence in the Global South using latent semantic analysis, with particular attention to structural drivers, emerging issues, weak signals, and gendered patterns of anticipation.Methods: A 3-round online Delphi survey was conducted with 45 experts from 19 countries across the Global South. Open-ended responses were analyzed using latent semantic analysis and stratified by gender. A foresight framework was applied to categorize topics as structural drivers, emerging issues, or weak signals, based on their temporal persistence, salience, and consensus.Results: In digital health, structural drivers included the systemic integration of digital technologies into public health systems, strategic alignment, and infrastructure development. Emerging issues comprised the adoption of artificial intelligence, chronic disease management via mobile health, and concerns about digital inclusion and interoperability. Weak signals included feminist digital ethics, trust in digital systems, and relational accountability-more frequently emphasized by female experts. In One Health, structural drivers were centered on intersectoral coordination, ecological integration, and the institutionalization of health-environment frameworks. Emerging issues encompassed anticipatory risk governance, food system sustainability, and the integration of environmental and population-level data. Weak signals included indigenous knowledge systems, subnational antimicrobial resistance governance, and structural underinvestment in ecological public health, with gendered divergence in framing. In the convergence discourse (digital health and One Health), structural drivers focused on the integration of digital surveillance systems, data infrastructures, and health information platforms to operationalize One Health. Emerging issues included climate-triggered system redesign, artificial intelligence and ecological monitoring, and the governance of cross-sectoral data. Weak signals pointed to algorithmic bias in zoonotic prediction, digital sovereignty in environmental health, and feminist critiques of convergence-all thematically rich but peripheral in consensus.Conclusions: This study revealed a multilayered and gender-influenced foresight architecture shaping the future of digital health and One Health in the Global South. Structural drivers denote maturing domains of implementation, while emerging issues and weak signals highlight

背景：数字健康和“一个健康”的融合代表了全球卫生治理的新兴范式。虽然在高收入环境中进行了广泛讨论，但人们对这种趋同如何在全球南方国家概念化的理解有限，特别是从性别和平等敏感的远见角度来看。目的：本研究旨在利用潜在语义分析绘制和分类关于数字健康、一个健康及其在全球南方的融合的专家话语，特别关注结构驱动因素、新出现的问题、弱信号和预期的性别模式。方法：对来自南半球19个国家的45位专家进行了3轮在线德尔菲调查。使用潜在语义分析对开放式回答进行分析，并按性别分层。根据主题的时间持久性、显著性和一致性，应用前瞻性框架将主题分类为结构性驱动因素、新出现的问题或弱信号。结果：在数字卫生中，结构性驱动因素包括数字技术与公共卫生系统的系统集成、战略协调和基础设施发展。新出现的问题包括采用人工智能、通过移动医疗进行慢性病管理，以及对数字包容和互操作性的担忧。弱信号包括女权主义数字伦理、对数字系统的信任和关系问责制——女性专家更经常强调这一点。在“同一个健康”中，结构性驱动因素集中于部门间协调、生态一体化和卫生-环境框架的制度化。新出现的问题包括预期风险治理、粮食系统可持续性以及环境和人口数据的整合。弱信号包括土著知识系统、次国家抗菌素耐药性治理和生态公共卫生结构性投资不足，在框架方面存在性别差异。在融合论述（数字健康和统一健康）中，结构性驱动因素侧重于数字监测系统、数据基础设施和卫生信息平台的整合，以实现统一健康。新出现的问题包括气候引发的系统重新设计、人工智能和生态监测，以及跨部门数据的治理。微弱的信号指向人畜共患疾病预测中的算法偏见，环境健康中的数字主权，以及女权主义者对趋同的批评——所有这些主题都很丰富，但在共识中处于边缘地位。结论：这项研究揭示了一个多层的、受性别影响的预见架构，塑造了全球南方数字健康和“一个健康”的未来。结构性驱动因素表示成熟的实施领域，而新出现的问题和弱信号则突出了潜在的、往往被忽视的机会和紧张局势。纳入对公平敏感和有性别意识的前瞻性方法对于制定包容性和前瞻性卫生治理战略至关重要。

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引用次数: 0

Associations Among Cyberbullying Victimization, Inhibitory Control, Neural Activation of Error Processing, and Mental Health Problems in Adolescents: Neuroimaging, Retrospective Longitudinal Cohort Study Using the Adolescent Brain Cognitive Development Data. 青少年网络欺凌受害、抑制控制、错误处理神经激活与心理健康问题的关系：基于青少年大脑认知发展数据的神经影像学、回顾性纵向队列研究

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-18 DOI: 10.2196/75126

Xuanyu Zhang, Chengyan Xie, Yu Chen, Boyu Qiu

Background: Cyberbullying victimization is prevalent and closely linked to mental health problems. However, existing research, often limited by cross-sectional designs and a focus on direct relationships, has yielded inconsistent results. Furthermore, the biological mechanisms underlying the relationship between cyberbullying victimization and psychopathological outcomes remain largely unclear at present.Objective: This retrospective cohort study aimed to explore the longitudinal associations among cyberbullying victimization, inhibitory control, brain activation during error processing, and mental health problems among adolescents.Methods: We curated the clinical, behavioral, and neuroimaging data (551/1186, 46.5% girls; 9-10 years at baseline) from the Adolescent Brain Cognitive Development study, a nationally representative cohort established through school-based probability sampling (selected factors included gender, race/ethnicity, socioeconomic status, and urbanicity). Participants were assessed by the cyberbullying question, the functional magnetic resonance imaging stop signal task for inhibitory control and error processing, and the Child Behavioral Checklist for externalizing and internalizing problems at 2-year (T1) and 4-year follow-up (T2). Linear mixed models were used to examine the retrospective longitudinal associations between these clinical, behavioral, and neuroimaging factors.Results: Linear mixed models showed that victims of cyberbullying at T1 exhibited significantly greater externalizing problems at T2 (β=0.25, 95% CI 0.06-0.45, PFDR=.02), but not for internalizing problems (β=-0.01, 95% CI -0.20 to 0.19, PFDR=.99) or deficits in inhibitory control (Correct Stop Rate: β=-0.02, 95% CI -0.26 to 0.21, PFDR=.85; Stop Signal Reaction Time: β=-0.07, 95% CI -0.27 to 0.13, PFDR=.85). Furthermore, cyberbullying victimization at T1 contributed to higher activation in the bilateral superior parietal gyri (left: β=0.36, 95% CI 0.10-0.61, PFDR=.04; right: β=0.34, 95% CI 0.08-0.59, PFDR=.04), right inferior parietal gyrus (β=0.32, 95% CI 0.07-0.57, PFDR=.04), and right posterior cingulate cortex (β=0.34, 95% CI 0.09-0.60, PFDR=.04) during error processing at T2. However, these neural alterations did not significantly mediate between cyberbullying victimization at T1 and externalizing problems at T2.Conclusions: This longitudinal functional magnetic resonance imaging study investigates neural correlates of cyberbullying victimization in adolescents. By extending prior research that has relied primarily on cross-sectional or behavioral data, this research demonstrates that this form of victimization is associated with altered neural activation during error processing in later development. The pattern of nonsignificant impairment in inhib

背景：网络欺凌受害者普遍存在，并与心理健康问题密切相关。然而，现有的研究往往受限于横断面设计和对直接关系的关注，得出了不一致的结果。此外，网络欺凌受害与精神病理结果之间关系的生物学机制目前仍不清楚。目的：通过回顾性队列研究，探讨青少年网络欺凌受害、抑制控制、错误处理过程中的脑激活与心理健康问题之间的纵向关系。方法：我们整理了来自青少年大脑认知发展研究的临床、行为和神经影像学数据（551/1186,46.5%女孩，基线为9-10岁），这是一个通过基于学校的概率抽样（选择的因素包括性别、种族/民族、社会经济地位和城市化）建立的具有全国代表性的队列。在2年（T1）和4年随访（T2）中，通过网络欺凌问题、抑制控制和错误处理的功能性磁共振成像停止信号任务、外化和内化问题的儿童行为检查表对参与者进行评估。线性混合模型用于检查这些临床、行为和神经影像学因素之间的回顾性纵向关联。结果：线性混合模型显示，网络欺凌受害者在T1时表现出更大的外化问题（β=0.25, 95% CI 0.06-0.45， PFDR= 0.02），但在T2时表现出更大的内化问题（β=-0.01, 95% CI -0.20 - 0.19， PFDR= 0.99）或抑制控制缺陷（正确停止率：β=-0.02, 95% CI -0.26 - 0.21， PFDR= 0.85；停止信号反应时间：β=-0.07, 95% CI -0.27 - 0.13， PFDR= 0.85）。此外，T1时的网络欺凌受害导致T2时错误处理过程中双侧顶叶上回（左：β=0.36, 95% CI 0.10-0.61， PFDR= 0.04；右：β=0.34, 95% CI 0.08-0.59， PFDR= 0.04）、右侧顶叶下回（β=0.32, 95% CI 0.07-0.57， PFDR= 0.04）和右侧后扣带皮层（β=0.34, 95% CI 0.09-0.60， PFDR= 0.04）的激活增加。然而，这些神经变化在网络欺凌受害和外化问题之间并没有显著的中介作用。结论：本纵向功能磁共振成像研究探讨了青少年网络欺凌受害的神经相关因素。通过扩展先前主要依赖于横截面或行为数据的研究，本研究表明，这种形式的受害与后期发展中错误处理过程中改变的神经激活有关。抑制控制和外化问题调解的非显著损伤模式表明，这些神经影响可能更好地以高度敏感和代偿参与状态为特征，而不是直接损害。总之，本研究指出错误处理网络是认知干预的潜在目标，并为进一步探索网络欺凌受害与心理健康结果之间的其他神经机制奠定了基础。

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引用次数: 0

Associations Between Smartphone-Based Finger Tapping and Cognitive Performance in Older Adults: Observational Study. 基于智能手机的手指敲击与老年人认知表现之间的关系：观察性研究。

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-18 DOI: 10.2196/82463

Huitong Ding, Taylor A Orwig, Jian Rong, Heaven Y Tatere, Chunyu Liu, Eric Schramm, Chathurangi H Pathiravasan, Joanne M Murabito, Honghuang Lin

Background: Finger tapping tasks assess fine motor control and have been proposed as potential markers of cognitive function. With smartphones widely available, these tasks can be easily administered at home or in other nonclinical settings. However, the relationship between smartphone-based finger tapping measures and cognitive performance is still not well understood.Objective: This study aimed to examine the association between smartphone digital finger tapping features and cognitive performance in an aging population.Methods: Participants were enrolled in the study as part of the electronic Framingham Heart Study. They were instructed to perform a 2-finger tapping task every 2 months over a 1-year period. In each session, they tapped with 2 fingers of the left hand for 10 seconds and then with 2 fingers of the right hand for 10 seconds, for a total of 20 seconds. Global cognition performance and 4 cognitive domains, including memory, executive function, language, and visuospatial function, were assessed using a standardized neuropsychological battery. Fifteen tapping features were extracted to capture aspects of motor performance, including the mean, SD, skewness, and slope of the intertap interval (ITI). Associations between tapping-derived features and cognitive performance were assessed using linear regression models, adjusting for age, sex, handedness, education, cohort, and the time interval between cognitive and tapping assessments.Results: A total of 302 participants (mean age 74.7, SD 6.3 years; n=169, 56% female participants, and n=40, 13.2% non-White participants) completed the digital finger tapping tasks. Eleven tapping features such as basic temporal properties (eg, number of taps and mean ITI), temporal variability (eg, SD and coefficient of variation of ITI, ITI range, and Microfluctuation Index), and fatigue/temporal drift (ITI slope) were significantly associated with global cognitive function (all P<.001). Each 1 SD increase in the number of taps was associated with a 0.14-unit higher global cognitive function score (β=.14, 95% CI 0.07-0.21). Furthermore, finger tapping features were significantly associated with multiple cognitive domains, with the greatest number of associations observed for executive function (11 significant features), including a strong association with mean ITI (β=-0.27, 95% CI -0.33 to -0.20). Stratified analyses by hand showed consistent effect directions across both hands. The aggregated composite scores derived from finger tapping features demonstrated significant associations with their respective cognitive test scores, with partial correlation coefficients ranging from 0.21 for memory function to 0.41 for global cognitive function.Conclusions: Digital finger tapping features, particularly those reflecting ITI variability, are significantly associated with cognitive performance. These

背景：手指敲击任务评估精细运动控制，并被认为是认知功能的潜在标志。随着智能手机的广泛使用，这些任务可以在家中或其他非临床环境中轻松完成。然而，基于智能手机的手指敲击测量和认知表现之间的关系仍然没有得到很好的理解。目的：本研究旨在探讨智能手机数字手指敲击特征与老年人认知表现之间的关系。方法：参与者作为电子弗雷明汉心脏研究的一部分被纳入研究。他们被要求在一年的时间里每两个月用两根手指敲击一次。在每次实验中，他们先用左手的两个手指敲打10秒，然后用右手的两个手指敲打10秒，总共20秒。使用标准化的神经心理学电池评估整体认知表现和4个认知领域，包括记忆、执行功能、语言和视觉空间功能。我们提取了15个敲击特征来捕捉运动性能的各个方面，包括敲击间隔（ITI）的平均值、SD、偏度和斜率。使用线性回归模型评估敲击衍生特征与认知表现之间的关系，调整年龄、性别、利手性、教育程度、队列以及认知和敲击评估之间的时间间隔。结果：共有302名参与者（平均年龄74.7岁，SD 6.3岁；n=169, 56%的女性参与者和n= 40,13.2%的非白人参与者）完成了数字手指敲击任务。11个敲击特征，如基本时间属性（如敲击次数和平均ITI）、时间变异性（如ITI的SD和变异系数、ITI范围和微波动指数）和疲劳/时间漂移（ITI斜率）与整体认知功能显著相关(所有结论：数字手指敲击特征，特别是反映ITI变异性的特征，与认知表现显著相关。这些发现表明，手指敲击任务可以作为评估认知表现的无创、可扩展的工具。需要进一步的研究来验证它们在监测老年人认知健康方面的应用。

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引用次数: 0

Effectiveness of the Mobile-Based Diabetes Little Helper Video Intervention on Medication Adherence Among Older Adults Living With Type 2 Diabetes Mellitus, Henan, China: Randomized Controlled Trial. 基于移动设备的糖尿病小助手视频干预对老年2型糖尿病患者服药依从性的影响，河南，中国：随机对照试验

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-17 DOI: 10.2196/78731

Meng Wang, Khuan Lee, Hui Zhu Thew, Siti Noorkhairina Sowtali, Qiuhuan Jiang, Zhengyan Zhao, Yu Liu, Poh Ying Lim

Background: Medication adherence is vital for older adults living with type 2 diabetes mellitus (T2DM), but it remains low and needs improvement. Current interventions have limited effectiveness, while video-based interventions show promising potential for enhancing adherence.

Objective: To evaluate the impact of the "Diabetes Little Helper" video intervention, developed based on the information-motivation-behavioral skills model, on improving medication adherence in older adults living with T2DM in Henan.

Methods: This parallel-group randomized controlled trial was conducted in 2 hospitals in Zhengzhou, involving 68 patients from each hospital. The intervention group (IG) received standard care plus the video intervention for one month, while the control group (CG) received only standard care. The primary outcome was medication adherence, and secondary outcomes included medication knowledge, attitude, behavior, belief, and social support. Data were collected at baseline, postintervention, and at 3-month follow-up. Intention-to-treat analysis and the last observation carried forward method were applied for missing data, with the generalized estimating equation model used for effect assessment (P<.05 considered statistically significant).

Results: The average age of participants in the IG was 67.5 (SD 8.0) years, while in the CG, the average age was 66.0 (SD 7.0) years. Sex distribution was nearly identical, with 51.5% (n=35) of participants in the IG and 50.0% (n=34) in the CG being male. After the intervention, the IG and CG had retention rates of 95.6% (n=65) and 97.1% (n=66), respectively. At the 3-month follow-up, the retention rates for the IG and CG were 92.6% (n=63) and 92.2% (n=62), respectively. Both postintervention (β=4.956, 95% CI 3.702-6.210, P<.001) and at the 3-month follow-up (β=3.691, 95% CI 2.379-5.003, P<.001), medication adherence score for the IG was significantly higher than that for the CG. In addition, the IG showed significant improvements in secondary outcome, with medication knowledge (β=11.592, 95% CI 6.923-16.260, P<.001), attitude (β=5.467, 95% CI 4.531-6.763, P<.001), behavior (β=4.176, 95% CI 3.220-5.133, P<.001), and belief (β=2.882, 95% CI 1.990-3.775, P<.001) compared with the CG postintervention. However, there was no statistically significant difference in the secondary outcome of social support (β=0.008, 95% CI -1.834 to 2.011, P=.928).

Conclusions: The Diabetes Little Helper video intervention effectively improved medication adherence in older adults living with T2DM in Henan, highlighting the potential of digital health tools for managing chronic diseases in older adult populations.

Trial registration: Chinese Clinical Trial Registry ChiCTR2400083282; https://www.chictr.org.cn/showprojEN.html?proj=214847.

背景：药物依从性对老年2型糖尿病患者（T2DM）至关重要，但它仍然很低，需要改善。目前的干预措施效果有限，而基于视频的干预措施在加强依从性方面显示出很大的潜力。目的：评价基于信息-动机-行为技能模型开发的“糖尿病小帮手”视频干预对改善河南省老年T2DM患者服药依从性的影响。方法：在郑州市2家医院进行平行组随机对照试验，每家医院68例患者。干预组（IG）采用标准护理加视频干预1个月，对照组（CG）仅采用标准护理。主要结局是药物依从性，次要结局包括药物知识、态度、行为、信念和社会支持。在基线、干预后和3个月随访时收集数据。缺失资料采用意向治疗分析和最后一次观察结转法，效果评价采用广义估计方程模型(结果：IG组参与者平均年龄为67.5 （SD 8.0）岁，CG组参与者平均年龄为66.0 （SD 7.0）岁。性别分布几乎相同，IG组51.5% （n=35）的参与者为男性，CG组50.0% （n=34）的参与者为男性。干预后IG和CG的保留率分别为95.6% （n=65）和97.1% （n=66）。随访3个月时，IG和CG的保留率分别为92.6% （n=63）和92.2% （n=62）。干预后（β=4.956, 95% CI 3.702-6.210, p）结论：糖尿病小帮手视频干预有效改善了河南省老年T2DM患者的药物依从性，突出了数字健康工具在老年人群慢性疾病管理中的潜力。试验注册：中国临床试验注册中心ChiCTR2400083282；https://www.chictr.org.cn/showprojEN.html?proj=214847。

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引用次数: 0

Effectiveness of Educational Videos in Encouraging Preferences for Guideline-Based Cancer Screening in Japan: Three-Arm Pseudorandomized Controlled Trial. 在日本，教育视频在鼓励基于指南的癌症筛查偏好方面的有效性：三组伪随机对照试验

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-12 DOI: 10.2196/82322

Kosuke Sakai, Yuko Furuya, Shoko Nakazawa, Kota Fukai, Kei Sano, Masayuki Tatemichi

Background: Although cancer screening is essential for early detection and an improved prognosis, screening beyond the recommended guidelines may increase the risk of false-positive results. Consequently, educating individuals about the potential harm of non-guideline-based cancer screening is essential; however, effective communication methods remain unclear.Objective: This study aimed to evaluate the effectiveness of different types of educational videos in encouraging preferences for guideline-based cancer screening.Methods: This 3-arm pseudorandomized controlled trial was conducted in June 2025 using a Japanese online survey platform. Eligible respondents were working adults aged 30 to 60 years with no history of major cancer. Respondents were assigned to 1 of the following 3 video conditions: video A, which provided a logical explanation of false-positive risks; video B, which presented the narrative of a woman who received a false-positive result from breast cancer screening; and video C, which depicted a man who underwent unnecessary follow-up testing after tumor marker screening. The primary outcome was the preference for guideline-based cancer screening after watching the videos. The secondary outcomes included 7 self-reported video evaluation items, such as perceived relevance and clarity, assessed using a 5-point Likert scale. Differences in the primary outcome between video groups were analyzed using multivariable logistic regression with adjustment for covariates. Means and 95% CIs were calculated for each secondary outcome according to sex and video group. In addition, before-and-after changes in screening preferences were assessed using McNemar test, with a significance level of .05.Results: In total, 1200 respondents (400 per group) completed the survey. No statistically significant differences in the primary outcome were observed among the video groups. With reference to video A, the adjusted odds ratios for preferring guideline-based screening were 0.89 (95% CI 0.59-1.32) for video B and 0.98 (95% CI 0.65-1.46) for video C. Regarding secondary outcomes, male respondents rated video B less favorably than female respondents in terms of relevance and willingness to undergo guideline-based screening. The before-and-after comparison showed a significant change in preference for guideline-based screening (P=.04). These videos appeared to be more effective for individuals with an annual history of colorectal cancer screening than for those without such a history.Conclusions: Educational videos have the potential to influence cancer screening preferences; however, no single video format has demonstrated clear superiority. These findings underscore the importance of tailoring educational materials to the target audience characteristics. Further research is required to develop effective strategies for encouraging guideline-b

背景：尽管癌症筛查对于早期发现和改善预后至关重要，但超出推荐指南的筛查可能会增加假阳性结果的风险。因此，教育个人了解非指南基础癌症筛查的潜在危害至关重要；然而，有效的沟通方法仍然不清楚。目的：本研究旨在评估不同类型的教育视频在鼓励基于指南的癌症筛查偏好方面的有效性。方法：该三组伪随机对照试验于2025年6月在日本在线调查平台进行。符合条件的调查对象是年龄在30至60岁之间、没有重大癌症病史的在职成年人。被调查者被分配到以下3个视频条件中的一个：视频A，它提供了假阳性风险的逻辑解释；视频B，讲述了一名妇女在乳腺癌筛查中得到假阳性结果的故事；视频C，描述了一名男子在肿瘤标志物筛查后进行了不必要的随访测试。主要结果是观看视频后对基于指南的癌症筛查的偏好。次要结果包括7个自我报告的视频评估项目，如感知相关性和清晰度，使用5分李克特量表进行评估。使用多变量逻辑回归分析视频组间主要结局的差异，并对协变量进行校正。根据性别和视频组计算每个次要结局的平均值和95% ci。此外，采用McNemar检验评估筛查偏好前后的变化，显著性水平为0.05。结果：共有1200名受访者（每组400人）完成了调查。在视频组之间的主要结果没有统计学上的显著差异。参考视频A，视频B偏好基于指南的筛查的调整比值比为0.89 (95% CI 0.59-1.32)，视频c偏好基于指南的筛查的调整比值比为0.98 （95% CI 0.65-1.46）。至于次要结果，男性受访者对视频B的评价在相关性和接受基于指南筛查的意愿方面不如女性受访者。前后比较显示对基于指南的筛查的偏好有显著变化（P= 0.04）。这些视频似乎对每年有结直肠癌筛查史的人比没有这种病史的人更有效。结论：教育视频有可能影响癌症筛查的偏好；然而，没有一种视频格式显示出明显的优势。这些发现强调了根据目标受众的特点定制教材的重要性。需要进一步的研究来制定有效的策略来鼓励基于指南的癌症筛查。试验注册：大学医院医学信息网临床试验注册中心UMIN000060549；https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000066119。

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引用次数: 0

Genre-Specific Gaming Addiction and Flourishing in Adolescents: Cross-Sectional Survey Study. 青少年特定类型的游戏成瘾和繁荣：横断面调查研究。

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-12 DOI: 10.2196/89319

Yan Luo, Xiaofei Chen, Yaoyu Liu, Wanjia Hong, Miner Fan, David Thomas, Sean P Mullen

Background: Adolescent gaming addiction (GA) has been linked to a range of adverse health outcomes. However, whether the associated health risks differ across game genres remains poorly understood.Objective: Guided by VanderWeele's multidimensional flourishing framework, this study aims to examine genre-specific associations between GA and flourishing among adolescents.Methods: This study used a cross-sectional observational design. A total of 2194 middle school students were recruited via convenience sampling from a private tutoring center in a northwestern city in China. Eligibility criteria were (1) enrollment in participating classes at the tutoring center, (2) provision of both student and parental consent, and (3) presence during questionnaire administration. The mean age of participants was 14.53 (SD 0.76) years; 985 (44.90%) were boys and 1174 (53.51%) were girls. During class time, students completed paper-based questionnaires that assessed their demographics, gaming addiction, and flourishing. Participants listed up to 3 video games played in the past month and rated their addiction to each. Games were classified into 8 genres: action and adventure (AA), sandbox and simulation (SS), multiplayer online battle arena (MOBA), shooting, strategy, casual, sports, and role-playing. Flourishing was assessed using the Human Flourishing Index across 5 domains: happiness and life satisfaction, mental and physical health, meaning and purpose, character and virtue, and close social relationships.Results: Robust linear regression analyses (α=.05) showed that AA addiction was associated with lower overall flourishing (b=-3.11, 95% CI -4.34 to -1.88) and all 5 subdomains (happiness and life satisfaction: b=-0.46, 95% CI -0.75 to -0.17; mental and physical health: b=-0.61, 95% CI -0.88 to -0.34; meaning and purpose: b=-0.55, 95% CI -0.82 to -0.27; character and virtue: b=-0.74, 95% CI -1.06 to -0.43; and close social relationships: b=-0.62, 95% CI -0.92 to -0.32). MOBA addiction was associated with lower overall flourishing (b=-1.33, 95% CI -2.34 to -0.32), character and virtue (b=-0.34, 95% CI -0.59 to -0.08), and meaning and purpose (b=-0.34, 95% CI -0.56 to -0.11). SS addiction was associated with lower overall flourishing (b=-3.42, 95% CI -5.80 to -1.04), close social relationships (b=-0.86, 95% CI -1.46 to -0.27), and mental and physical health (b=-1.09, 95% CI -1.60 to -0.58).Conclusions: This study provides novel evidence that the association between GA and adolescent flourishing is genre dependent. In contrast to prior research that conceptualizes health narrowly or unidimensionally, a multidimensional perspective provides a more nuanced understanding of the health risks associated with GA. The findings advance the field by showing that addiction to AA, MOBA, and SS games is associated with greater health risks than addiction to ot

背景：青少年游戏成瘾（GA）与一系列不良健康结果有关。然而，相关的健康风险在不同游戏类型中是否存在差异，我们仍然知之甚少。目的：在VanderWeele多维繁荣框架的指导下，本研究旨在研究GA与青少年繁荣之间的特定类型关联。方法：本研究采用横断面观察设计。本研究通过方便抽样的方式，从中国西北某城市的一家私人辅导中心招募了2194名中学生。资格标准是(1)在辅导中心参加班级，(2)提供学生和家长的同意，(3)参加问卷调查。参与者的平均年龄为14.53岁（SD 0.76）；其中男生985例（44.90%），女生1174例（53.51%）。在课堂上，学生们完成了基于纸张的问卷调查，评估他们的人口统计、游戏成瘾和繁荣程度。参与者列出了过去一个月玩过的三款电子游戏，并对每款游戏的上瘾程度进行了评级。游戏被分为8种类型：动作和冒险（AA）、沙盒和模拟（SS）、多人在线竞技（MOBA）、射击、战略、休闲、体育和角色扮演。幸福是通过人类幸福指数在5个领域进行评估的：幸福和生活满意度，心理和身体健康，意义和目的，性格和美德，以及密切的社会关系。结果：稳健的线性回归分析（α= 0.05）显示，AA成瘾与较低的整体繁荣（b=-3.11, 95% CI -4.34至-1.88）和所有5个子领域（幸福和生活满意度：b=-0.46, 95% CI -0.75至-0.17；心理和身体健康：b=-0.61, 95% CI -0.88至-0.34；意义和目的：b=-0.55, 95% CI -0.82至-0.27；品格和美德：b=-0.74, 95% CI -1.06至-0.43；亲密社会关系：b=-0.62, 95% CI -0.92至-0.32）相关。MOBA成瘾与较低的整体繁荣（b=-1.33, 95% CI -2.34至-0.32）、性格和美德（b=-0.34, 95% CI -0.59至-0.08）以及意义和目的（b=-0.34, 95% CI -0.56至-0.11）相关。SS成瘾与较低的整体繁荣（b=-3.42, 95% CI -5.80至-1.04），密切的社会关系（b=-0.86, 95% CI -1.46至-0.27）以及心理和身体健康（b=-1.09, 95% CI -1.60至-0.58）相关。结论：本研究提供了新的证据，证明GA与青少年发育之间存在类型依赖关系。与先前对健康进行狭隘或单一概念化的研究相反，多维视角提供了对GA相关健康风险的更细致入微的理解。研究结果表明，与其他类型的游戏相比，AA、MOBA和SS游戏的成瘾与更大的健康风险相关，从而推动了这一领域的发展。因此，预防、教育和政策努力应优先考虑高风险类型，以促进青少年健康。

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引用次数: 0

Correction: Characterization of Models for Identifying Physical and Cognitive Frailty in Older Adults With Diabetes: Systematic Review and Meta-Analysis. 修正：识别老年糖尿病患者身体和认知虚弱模型的特征：系统评价和荟萃分析。

IF 6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Medical Internet Research

Pub Date : 2026-02-12 DOI: 10.2196/92717

Xia Wang, Shujie Meng, Xiang Xiao, Liu Lu, Hongyan Chen, Yong Li, Rong Zhang, Qiwu Jiang, Shan Liu, Ru Gao

引用次数: 0