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Background Deep South states, particularly Alabama, experience disproportionately higher opioid prescribing rates versus national rates. Considering limited opioid use disorder (OUD) providers in this region, collaborative efforts between non-healthcare professionals is critical in mitigating overdose mortality. The Alabama Opioid Training Institute (OTI) was created in 2019 to empower community members to take action in combatting OUD in local regions. The OTI included: 1) eight full-day in-person conferences; and 2) an interactive mobile-enabled website ( https://alabamaoti.org ). This study assessed the impact of the OTI on influential community members’ knowledge, abilities, concerns, readiness, and intended actions regarding OUD and opioid overdose mitigation. Methods A one-group prospective cohort design was utilized. Alabama community leaders were purposively recruited via email, billboards, television, and social media advertisements. Outcome measures were assessed via online survey at baseline and post-conference, including: OUD knowledge (percent correct); abilities, concerns, and readiness regarding overdose management (7-point Likert-type scale, 1 = strongly disagree to 7 = strongly agree); and actions/intended actions over the past/next 6 months (8-item index from 0 to 100% of the time). Conference satisfaction was also assessed. Changes were analyzed using McNemar or Marginal Homogeneity tests for categorical variables and two-sided paired t-tests for continuous variables (alpha = 0.05). Results Overall, 413 influential community members participated, most of whom were social workers (25.7%), female (86.4%), and White (65.7%). Community members’ OUD knowledge increased from mean [SD] 71.00% [13.32] pre-conference to 83.75% [9.91] post-conference ( p  < 0.001). Compared to pre-conference, mean [SD] ability scale scores increased (3.72 [1.55] to 5.15 [1.11], p  < 0.001) and concerns decreased (3.19 [1.30] to 2.64 [1.17], p  < 0.001) post-conference. Readiness was unchanged post-conference. Attendees’ intended OUD-mitigating actions in the next 6 months exceeded their self-reported actions in the past 6 months, and 92% recommended the OTI to others. Conclusions The Alabama OTI improved community leaders’ knowledge, abilities, and concerns regarding OUD management. Similar programs combining live education and interactive web-based platforms can be replicated in other states.

Background Potentially inappropriate medications (PIM) are associated with adverse health outcomes. The use of PIM among persons living with HIV (PLHIV) could be more problematic due to peculiarities such as antiretroviral toxicity and drug-disease interactions. However, PIM among PLHIV continues to receive little attention. Therefore, we aimed to systematically review and estimate the prevalence of PIM among PLHIV. Methods We searched the PubMed, Scopus, and Web of Science databases to identify relevant studies from 1 January 2014 to 30 June 2024. Studies included were peer-reviewed articles that determined PIM prevalence using validated explicit or implicit tools and provided statistical information on the measured outcomes. Systematic, narrative, and literature reviews as well as case studies, commentaries, and editorials were excluded. Risk of bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Subgroup analysis was performed for the different geographic regions, PIM criteria, age, study period, and median numbers of medicines. Statistical heterogeneity was assessed using the I2 statistic. Sensitivity analyses, publication bias, and cumulative meta-analysis were conducted. Results A total of 13 articles, including 3200 PLHIV, were included for the systematic review, while meta-analysis was conducted using 8 studies comprising 2546 PLHIV. Most of the studies (46%) employed a cross-sectional study design. 11 out of the 13 studies were conducted in Europe. Most studies reported benzodiazepines as the most common PIM among PLHIV, while hypertension and dyslipidaemia were identified as the most frequent comorbidities. Overall, the pooled prevalence of PIM was 44.8% (95% CI, 32%-58%) using a random-effect model. PIM prevalence among PLHIV was higher among those exposed to polypharmacy (59.3%; CI: 48.9% – 68.9%), those aged > 70 years (44.6%; CI: 24.1–67.1), and post-COVID (48.9%; CI: 39%-59%). Conclusion This study suggests that PIM exposure among PLHIV is a budding issue. Findings from this review advocate for mitigating measures against PIM use. Also, this review contributes data on the use of PIM across different cohorts, creating awareness for policymakers and health managers. Review registration PROSPERO – CRD42024529411.

Gestational diabetes mellitus (GDM) is an increasingly common high-risk pregnancy condition requiring intensive daily self-management, placing the burden of care directly on the patient. Understanding personal and cultural differences among patients is critical for delivering optimal support for GDM self-management, particularly in high-risk populations. Although mobile apps for GDM self-management are being used, limited research has been done on the personalized and culturally tailored features of these apps and their impact on patient self-management. This scoping review aims to explore the extent to which published studies report the integration and effectiveness of personalized and culturally tailored features in GDM mobile apps for patient self-management support. We examined English-language peer-reviewed articles published between October 2016 and May 2023 from PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, Proquest Research Library, and Google Scholar using search terms related to digital tools, diabetes, pregnancy, and cultural tailoring. We reviewed eligible articles and extracted data using the Arskey and O'Malley methodological framework. Our search yielded a total of 1772 articles after the removal of duplicates and 158 articles for full-text review. A total of 21 articles that researched 15 GDM mobile apps were selected for data extraction. Our results demonstrated the stark contrast between the number of GDM mobile apps with personalized features for the individual user (all 15 mobile apps) and those culturally tailored for a specific population (only 3 of the 15 mobile apps). Our findings showed that GDM mobile apps with personalized and culturally tailored features were perceived to be useful to patients and had the potential to improve patients' adherence to glycemic control and nutrition plans. There is a strong need for increased research and development to foster the implementation of personalized and culturally tailored features in GDM mobile apps for self-management that cater to patients from diverse backgrounds and ethnicities. Personalized and culturally tailored features have the potential to serve the unique needs of patients more efficiently and effectively than generic features alone; however, the impacts of such features still need to be adequately studied. Recommendations for future research include examining the cultural needs of different ethnicities within the increasingly diverse US population in the context of GDM self-management, conducting participatory-based research with these groups, and designing human-centered mobile health solutions for both patients and providers.

Young adults take their asthma maintenance medication 67% of the time or less. Understanding the specific needs and behaviors of young adults with asthma is essential for developing targeted interventions to improve disease self-management. Artificial intelligence (AI) has demonstrated its utility in summarizing and identifying patterns in qualitative research and may support or augment human coding efforts. However, there is pause literature to support this assertion. The objective of this study is to begin to explore the medication management-related needs of young adults with asthma via a pilot feasibility study. We aim to understand how to best assist young adults with asthma self-management and to identify potential areas where digital health interventions can provide support. We further aimed to understand the comparative outcome of human versus multiple AI platforms in performing thematic analysis. This study purposefully sampled young adults between the ages of 18 years and 29 years who had a prescription for an inhaled corticosteroid (ICS) and were either students or staff of a large metropolitan university in the northeastern United States. Semistructured interviews lasting 40 minutes on average were conducted with 4 participants via a teleconferencing application to elicit young adults' opinions on the topic. Interviews were recorded and transcribed verbatim using Otter.ai (Otter.ai, Inc). Investigators listened to the recording to confirm the accuracy of transcriptions and to make corrections when necessary. After performing a second round of line-by-line coding, the codes were reviewed by investigators and grouped into broader, overarching themes. All investigators reviewed and discussed the final codes. Human qualitative data analyses were performed using NVivo 14 software (QSR International). After completing human analyses, the investigators performed thematic analysis with multiple AI platforms (Google Gemini, Microsoft Copilot, and OpenAI's ChatGPT) to compare the final themes with investigator-derived themes. Human analysis yielded 4 themes: support from clinicians, social support, digital self-management support, and educational support. The AI-based analysis also generated similar themes with different labels. The level of overlap on the underlying concept between humans, Gemini, Copilot, and ChatGPT was high, accounting for the fact that, although the specific labels differed, they referred to the same concept. Findings from our pilot exploratory study offer insights into the necessity for a holistic approach in supporting young adults with asthma. Based on the health belief model, if the identified multifaceted needs are addressed, health care systems may support medication adherence and improve health outcomes for this understudied patient population. Our pilot study also offers preliminary findings that artificial intelligence may be leveraged for successful thematic analysis of qualitative data with appropriate caution.

We aimed to examine the effects of framed mobile messages (messages emphasizing losses or gains because of a behavior) on young adults’ beliefs about their daily Inhaled Corticosteroids (ICS), intentions to take their ICS, adherence, and asthma control. College students (18–29 years) who owned a mobile phone and had a diagnosis of asthma with a prescription for an ICS were recruited. Participants (n = 43) were randomized to receive either gain- or loss-framed mobile messages three times per week for eight weeks. Engagement rates with messages were calculated. Outcomes included beliefs, intentions, adherence, and asthma control. Data collection was performed at baseline, week 4, and week 8. Mixed-design ANOVA assessed whether outcomes improved differentially from baseline to week eight between gain- and loss-framed groups. Twenty-two participants were randomly assigned to the gain-framed group and 21 to the loss-framed group. There was a 100% retention rate. The engagement rate with the text messages was 85.9%. There was a significant difference in participants’ intentions to take medication and asthma control from baseline. There were no significant changes in other outcomes from baseline. There was no difference in changes in all outcomes between participants receiving gain- versus loss-framed messages. Framed mobile messages improved young adults’ asthma control and intentions to take their medication as prescribed.

The goal of this study was to describe the development of an educational brochure for pregnant women with opioid use disorders (OUDs) about treatment options. Based on findings from a preliminary review of the literature, we drafted a brochure that addressed the following questions: (1) What are your options (Medication-Assisted Treatment (MAT) versus no treatment)? (2) What are the benefits of MAT? (3) What are the risks of MAT? (4) Can I take buprenorphine or methadone while breastfeeding? (5) Which medication should I choose? Clinicians and doulas (n = 19) who provide care to pregnant women with OUDs were recruited. Semi-structured interviews elicited participants’ feedback on brochure content and their perceptions about brochure use for patient education. Thematic data analyses were performed. Three emergent themes were identified (suggested uses and settings of use, content revisions, and perceptions about the brochure) and used to refine the final brochure. This study provides valuable insights into the desired content of an educational brochure describing treatment options for pregnant women with OUDs from the provider’s standpoint. Research is needed to assess the use of the brochure in shared decision-making conversations with providers about treatment.

Despite the global scale up of dolutegravir (DTG)-based regimens as the preferred first-line therapy for persons living with HIV (PLHIV), no comprehensive evidence exists on its effect on patient-reported outcomes such as Quality of Life (QoL) and patient satisfaction (PS). We conducted a systematic review and meta-analysis to provide the first comprehensive quantitative synthesis of the effect of DTG-based regimens on QoL and PS among PLHIV. We conducted literature search on PubMed, Scopus, Embase and Cochrane Library databases for peer-reviewed, primary studies published from January 2015 to January 2025. Studies using validated tools to evaluate QoL and PS among PLHIV exposed to DTG were eligible. Standardised Mean Differences (SMD) were computed using DerSimonian-Laird random-effects model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The study protocol was registered on PROSPERO (CRD42025643301). Seventeen out of the 214 (n = 4064) identified studies met the inclusion criteria, with six contributing to the QoL meta-analysis and four to the PS meta-analysis. The pooled QoL estimate showed a small improvement favoring DTG-based regimens compared to other antiretroviral therapy (ART) though not statistically significant (SMD: 0.094, 95% CI: -0.034-0.223; p = 0.15; GRADE: Very Low). With the WHOQOL-HIV BREF tool subgroup, a positive directional effect was also observed (SMD: 0.09, 95% CI: -0.042-0.22, p = 0.18; I2 = 0.0%) compared to other ART, though not statistically significant. DTG-based regimens were associated with a statistically significant improvement in PS (SMD = 0.3; 95% CI: 0.2-0.4; p < 0.001; I2 = 10.7; GRADE: Low). Among studies that used the HIV Treatment Satisfaction Questionnaire to evaluate PS, the effect of DTG-based regimens was also statistically significant (SMD: 0.32, 95% CI: 0.2-0.45, p < 0.001; I2 = 34%). This review identified a directional improvement in QoL and a statistically significant small improvement in PS among PLHIV on DTG-based regimens. Findings from this study were supported by low between-study heterogeneity. However, findings should be interpreted in the context of low and very low certainty of evidence for both outcomes. Additionally, results from this study are best characterized as hypothesis-generating and supportive of person-centered HIV care, underscoring the need for more well-designed trials to generate high-certainty evidence on patient-reported outcomes among PLHIV. Not applicable.

Certain factors, such as food quality, label content and grocery characteristics, may be considered when purchasing foods. Food availability in the home has been shown to influence dietary behaviours, also associated with delay discounting (DD). The present study sought to characterize the relationships between DD, food purchasing considerations and healthfulness of foods in the home. A cross-sectional, online survey of adults (n 477) was conducted with the following measures: DD, consideration of food quality (nutrition, taste) and grocery characteristics (price, ease of preparation, shelf-life) while shopping, use of food labels and food availability in the home. DD was assessed by the area under the delay discounting curve (AUC) using a binary choice task. Greater AUC reflects lower DD. Structural equation modelling was used to allow AUC to simultaneously predict purchasing considerations and foods in the home. Online survey.ParticipantsAdult employees in south-east Alabama, USA. DD was negatively associated with food label use and emphasis on food quality when shopping (P<0·001). In the final model, DD was associated with availability of healthful foods in the home and emphasis on food quality and grocery characteristics. About 33 % of the variance in shopping behaviours, 5 % in food label use, 7 % in availability of healthful foods and 4 % in availability of unhealthful foods was explained by DD. Individuals with lower DD appear to be more thoughtful in making food purchasing decisions and have healthful foods available in the home more frequently than individuals with higher DD.

Background: Asthma remains a burden to society with approximately $80 billion per year spent on asthma-related medical expenses in the United States. Inhaled corticosteroids (ICS), a mainstay medication for managing persistent asthma, have the potential to reduce the morbidity and frequent exacerbations associated with persistent asthma. However, young adults, in particular, are less likely to take their ICS as prescribed given their transition from adolescence to adulthood and decreased parental supervision. Message framing, a psychological approach which emphasizes losses or gains in message presentation and capitalizes on an individual’s risk perceptions to influence his or her decision-making, may help.Objectives: This study aims to: 1) develop gain- and loss-framed messages for medication adherence targeted at young adults with asthma; 2) examine the effects of gain- and loss-framed messages on Beliefs, Intentions to take medications, Medication Adherence, and Asthma Control; and 3) examine an hypothesized relationship between Message Frame, Beliefs, Intentions, Medication Adherence, and Asthma Control. The overall goal is to improve asthma control among young adults enrolled in college by utilizing message framing to address nonadherence.Methods: First, a qualitative meta-synthesis of studies examining the experience of living with asthma among young adults was undertaken. Literature searches were conducted in PubMed, CINAHL, and PsycINFO, from inception through March 2019. A high sensitivity search of Google Scholar through March 2019 was also performed to identify additional articles. Qualitative and mixed study designs (studies using quantitative and qualitative methods) exploring the experiences of young adults with asthma were included. The rigor of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Grounded theory approach was used in synthesizing the data. Themes from the review were used in developing gain- and loss-framed messages for the promotion of medication adherence among young adults in college. Second, college students were recruited and randomized to receive either gain- or loss-framed messages three times per week for eight weeks. Data collection was performed at baseline, week four, and week eight. Measures included Beliefs, Intentions, Medication Adherence, and Asthma Control. Path analysis was used to assess the relationship between Message Frame, Beliefs, Intentions, Medication Adherence, and Asthma Control. Mixed-design ANOVA was used to assess whether Beliefs, Intentions, Medication Adherence or Asthma Control improved differentially from baseline across gain- and loss-frame groups.Results: Seven high-quality studies with MMAT scores between 75-100% were identified for inclusion in the qualitative meta-synthesis. Five categories related to “living with asthma as a young adult” emerged: 1) needs (e.g., information on weather); 2) barriers (e.g., decreased parental support); 3) enablers (e.g., knowledge of asthma management); 4) behaviors (positive e.g., taking medication as prescribed; negative behaviors e.g., stopping medications when better); and 5) outcomes (disease, interpersonal, and personal outcomes). The emerging theory on the experience of living with asthma as a young adult posits that when needs are met, enablers are present, and barriers are removed, young adults are more likely to exhibit positive behaviors with desired outcomes.