When decision makers use evidence from a randomized trial to inform population-level decisions, the target population they envision rarely aligns with the population of individuals who enrolled in the trial. Here, we extend inferences from the VALIDATE-SWEDEHEART randomized trial (hereafter, the index trial), which compared the effects of bivalirudin and heparin during percutaneous coronary intervention on the risk of death, reinfarction, and bleeding, to two clinically relevant target populations: first, the trial-eligible population of individuals eligible for the index trial regardless of enrollment, and second, the treatment-candidate population of individuals who are considered candidates for bivalirudin and heparin under routine care, regardless of eligibility for the index trial. Using data from the index trial, we fit logistic regression models for the outcome at 180 days in each group based on assigned treatment. We then standardized risk estimates to the baseline covariate distribution of the trial-eligible and treatment-candidate target populations, which were characterized using data from Swedish healthcare registries. The estimated risk difference comparing bivalirudin vs. heparin was -1.1% (-3.1%, 0.9%) in the trial-eligible population and -1.0% (-3.0%, 1.0%) in the treatment-candidate population. The corresponding risk ratios were 0.92 (0.80, 1.07) and 0.93 (0.80, 1.07), respectively, aligning closely with estimates from the index trial. Absolute risks in each treatment group were, however, between 0.8 and 1.2 percentage points higher in comparison with the index trial. Estimated risk ratios for the broader trial-eligible and treatment-candidate populations generally align with the findings from the index trial. While trials provide essential evidence for healthcare, questions often arise about wider, clinically relevant populations beyond the population of trial participants. By leveraging data from trials and observational data sources, we can attempt to address questions in these wider target populations.
Orthographic knowledge is crucial for spelling words correctly and is deficient in children with poor spelling skills. However, the cognitive processes involved in building-up orthographic representations still need to be identified. A total of 343 second-graders (83 poor spellers and 260 typical spellers) completed an orthographic learning task that focused on pseudowords differing in the complexity of the underlying German spelling phenomena: st/sp spelling (simple) or double-consonant spelling (complex). To identify, where in the learning process difficulties emerge, we assessed for both phenomena: (a) learning of novel pseudowords, (b) generalization, and (c) storing. Results showed that learning was dependent on the complexity of the spelling phenomenon: for both groups, pseudowords of the complex phenomenon were more difficult to learn, to generalize, and to store. Children with poor spelling skills produced fewer items correctly already at the beginning of the learning process and showed more difficulties in learning, but their progress in generalization and memorization was comparable to that of children with typical spelling abilities. Regression analyses further revealed that the orthographic learning task explains unique variance in spelling performance beyond well-known cognitive predictors of spelling.
End-point binding free energy (BFE) methods, such as molecular mechanics Poisson-Boltzmann surface area (MMPBSA), are widely used to estimate protein-ligand binding affinity due to their favorable balance between accuracy and computational efficiency. Their reliability, however, is fundamentally constrained by inherent statistical thermodynamic approximations and the limited accuracy of classical potential energy surfaces (PES). To overcome the PES bottleneck, we developed AIQM-PBSA, a novel hybrid framework integrating the ONIOM scheme with the PBSA model. Within this framework, the AIQM3 machine learning interatomic potential (MLIP)─an advanced Δ-learning quantum mechanical (QM) model─is employed to refine the molecular mechanics (MM) energy term, while solvation contributions are evaluated under the PBSA formalism. Extensive validation across diverse protein-ligand systems demonstrates that AIQM-PBSA substantially improves predictive accuracy, achieving Pearson R values of 0.84 and 0.82 on two primary benchmark data sets. On the rigorous Schrödinger JACS set, it yielded Pearson, Spearman, and Kendall correlations of 0.59, 0.58, and 0.42, respectively. By replacing classical force fields with MLIPs to describe gas-phase interaction energies, AIQM-PBSA significantly outperforms traditional MMPBSA and the classic ANI-2x. In summary, AIQM-PBSA offers a robust and generalizable framework that leverages advanced MLIPs to achieve QM-level accuracy while maintaining high computational efficiency, substantially improving the reliability of end-point free energy calculations in biomolecular recognition.
The concept of ideology is central to political discourse and dynamics, and is often cast as falling primarily on a one-dimensional scale from "left-wing/liberal" to "right-wing/conservative", but the validity of this simple quantitative treatment is uncertain. Here we investigate and compare various high-resolution measures of ideology, both internal (self-identification and policy-stance agreements) and external (estimating the ideological position of political opinion statements). We find strong consistency between internal measures, although policy-stance agreement ideology yields a systematically centralizing and liberalizing portrait relative to more abstract "liberal/conservative" measures. More remarkably, we find that external assessments of ideology, while noisy, are largely consistent across observers, even for highly dissonant ideas and regardless of speaker identity markers. This supports the use of these responses as meaningful, comparable quantities, which general members of the public reliably project from the abstract space of political thought onto a shared one-dimensional domain.
The objective of this study is to comprehensively investigate associations between cognitive function and lifestyle factors. We analyzed data from a cross-sectional study of Japanese adults that included approximately 1,800 variables (e.g., physical characteristics, body composition, and lifestyle habits) and cognitive function assessed using CNS Vital Signs. For participants aged 40 years or older (n = 710), we performed partial correlation analysis and analysis of covariance adjusted for sex, age, and years of education. Given the large number of variables, we controlled the false discovery rate within predefined data types (real, positive, ordered categorical, categorical) using the Benjamini-Hochberg procedure. We adjusted p-values to q-values and identified variables with q < 0.1 for exploratory purposes. In total, 28 variables met this criterion, with particularly prominent associations for gait characteristics, vascular function, grip strength, and oral conditions, whereas blood components and other general biomarkers did not meet the threshold. These exploratory findings identify candidate correlates of cognitive function in this relatively healthy, primarily urban Japanese cohort and require confirmation in independent longitudinal studies.
Mother-to-child transmission accounts for most new hepatitis B (HBV) infections in high-burden regions globally. The World Health Organization recommends antiviral prophylaxis for pregnant women with high hepatitis B viral load levels, but access to viral load testing remains limited and untimely in many countries, due to centralized testing. We assessed the operational feasibility, accessibility, and cost of implementing the Xpert HBV DNA assay in antenatal care settings. This was a two-phase study at 10 high-volume hospitals across nine regions of Uganda. Phase I verified the diagnostic accuracy of Xpert HBV DNA assay against the COBAS Taqman platform, while Phase II assessed feasibility, usability, and cost of integrating PoC testing into routine antenatal care using GeneXpert systems. Quantitative data were extracted from facility registers, entered into ODK, and analysed using SPSS 19 and Excel. Qualitative data, consisting of feedback from study teams, were analysed thematically. Xpert HBV DNA assay demonstrated full concordance with the COBAS platform. Overall, 96.7% of samples were processed, 92% returned to providers, and 61% of mothers received their results on the same day. Of 181 pregnant women provided HBV DNA testing, 12% had viral loads >200,000 IU/mL, thus eligible for antiviral prophylaxis. Among pregnant women eligible for prophylaxis, 14 had received antiviral prophylaxis. Birth records were available for 15 pregnant women, and 73.3% of their newborns had received the hepatitis B birth dose vaccine. Coordination between ANC and laboratory services, including the timely dispatch of results to pregnant women, was generally smooth and enabled prompt decision-making. However, some challenges were reported, such as stockout of screening kits and competing testing priorities within laboratories. At USD 15.37 per test, its cost was comparable to centralized testing (USD 15.26), but it offered advantages such as reduced delays and fewer client visits. The Xpert platform offers a timely, accurate, operationally feasible solution for accessing hepatitis B antiviral prophylaxis or treatment, improving quality of care for hepatitis B-positive mothers. With rapid turnaround time and cost comparable to centralized testing, it presents a valuable tool for improving HBV prevention and treatment in Uganda and similar resource-limited settings.
Visual selection is often conceptualized as emerging from goal-, stimulus- and history-driven processes within spatial priority maps. Although extensive work detailed the interplay between goal- and stimulus-driven selection, it is largely unknown how goal- and history-driven processes jointly drive selection. While persistent neural firing likely underlies goal-driven selection, it is generally assumed that activity-silent mechanisms effectuate history-driven selection. Due to these different underlying neural mechanisms, simultaneously tracking goal- and history-driven influences neurally has proven difficult. We here employed EEG decoding techniques to simultaneously track and compare goal- and history-driven influences on search. We first established a history-driven signal: Neural decoding closely tracked the target location from the preceding trial. We further demonstrated simultaneous, distinct neural representations of the current and preceding target locations. Strikingly, even when participants attended an upcoming target location before search could commence, prior target locations were reactivated. Our results show that past experiences are reactivated in an inflexible fashion, and do so even when prior targets are completely task-irrelevant. Together, we demonstrate that goal- and history-driven selection are neurally distinct, and reveal that both influences are represented in parallel.
Spasticity is a frequent neuromuscular impairment associated with cerebral palsy, stroke, and spinal cord injury, commonly assessed using subjective clinical scales. This exploratory pilot study aimed to develop and preliminarily validate a multimodal instrument for the objective quantification and stratification of spasticity in nine individuals (3 female, 6 male) with upper-limb spasticity due to cerebral palsy (n = 5) or stroke (n = 4). A wearable system integrating surface electromyography, inertial measurement units, and force sensing resistors was designed to simultaneously capture muscle activation, joint kinematics, and generalized resistance force during standardized passive mobilizations. Simple indicators six area under the curve-based indicators were derived: force, sEMG, and angular velocity under two conditions (R1, R2) and given distinct weights depending on their contribution. Principal component analysis revealed that three latent components accounted for 83.86% of the total variance observed across participants. Based on these indicators, a Composite Index was constructed using min-max normalization and weighted linear aggregation. Within the pilot study, the Composite Index could differentiate between spasticity severity levels (F = 6.38, p = 0.0327, η² = 0.68), with sEMG activity during slow stretch (AUC sEMG R2) the most influential contributor indicators. The proposed multimodal instrument demonstrates preliminary feasibility as a non-invasive and portable approach for objective spasticity quantification, warranting further validation in larger cohorts.
Malassezia folliculitis (MF), commonly referred to as "fungal acne" is a dermatological condition caused by colonization of the commensal fungus Malassezia, which turns pathogenic under certain conditions. MF presents as pruritic, erythematous papules and pustules and is often mistaken for other dermatological conditions, including acne vulgaris (AV). Interest in MF has intensified in recent years, likely due to social media trends, leading to concern regarding patients inappropriately applying antifungals without a confirmed diagnosis. This narrative review summarizes the prevalence of MF, risk factors for the condition, MF pathogenesis, diagnosis, and treatment options. MF prevalence varies by geographic region and is higher in patients diagnosed with AV versus the general population. Risk factors include hot, humid weather, hair follicle occlusion, and immunocompromise. Increased sebum production, lipase activity, and inflammation contribute to the pathogenesis of both MF and AV. MF diagnosis includes clinical presentation and confirmatory tests such as direct microscopy and histopathology. The mainstay of treatment is antifungal medication, though given shared pathogenic mechanisms between AV and MF, acne topicals that target pathogenesis of both conditions, including benzoyl peroxide and retinoids, may be beneficial. Clinical presentation of MF resembles that of AV and other skin conditions, leading to misdiagnosis, delays in treatment, and persistence of MF in patients for years. This underscores the need for appropriate diagnosis and timely treatment. Given shared pathogenic mechanisms between AV and MF, further investigation of acne topicals that target the pathogenesis of both conditions for the treatment of MF is warranted.
Protein kinases regulate almost every major signaling pathway. Visualizing spatiotemporal dynamics of kinase activity is thus essential to understand cell signaling. Here, we report a de novo-designed activity reporter of kinase, dubbed NOVARK, which contains a single polypeptide chain with multiple modular motifs that act as specific kinase substrates and reporters. NOVARK undergoes phosphorylation-induced higher-order assembly, which are detectable as ultrabright green fluorescent protein (GFP) droplets with a large dynamic range. We designed versions of NOVARK that rapidly and reversibly report intracellular activity of protein kinase A, C, and extracellular signal-regulated kinase (ERK) following stimulation/inhibition by upstream G protein-coupled receptor (GPCR) agonists. Our work provides a generalizable platform that enables the design of ultrabright biosensors for illuminating dynamic architecture of kinase signaling.
Daboia siamensis envenoming is a major cause of hematotoxicity and acute kidney injury in Southeast Asia. In Thailand, D. siamensis is a clinically important snake, yet detailed national data on its bites are limited. Hence, we aimed to determine the clinical characteristics, management, and outcomes of D. siamensis bites in Thailand, identify factors associated with acute kidney injury and hemodialysis, and analyze antivenom administration with reference to acute kidney injury and hemodialysis. We conducted a 10-year retrospective cross-sectional study using data from the Ramathibodi Poison Center Toxic Exposure Surveillance System (2014-2023). All diagnosed D. siamensis bites were reviewed. Definite cases were defined when the snake species was identified via a live specimen, carcass, or photograph. A total of 185 patients were included, with 101 definite cases. Most (82.7%) were male, and the mean (±SD) age was 43.0 ± 16.6 years. Overall clinical manifestations included local effects (20.5%), coagulopathy (89.2%), acute kidney injury (50.3%), thrombocytopenia (31.4%), and rhabdomyolysis (28.1%). Antivenom was administered in 89.2% of cases. The median (IQR) length of hospital stay was 5 (3-7) days. The mortality rate was 3.8%. Tachycardia at presentation, initial proteinuria, and rhabdomyolysis were found to prognosticate the development of acute kidney injury. Metabolic acidosis at presentation and rhabdomyolysis were predictors of the requirement for hemodialysis. In addition, receiving antivenom within two hours may reduce the need for hemodialysis (odds ratio 0.153, 95% CI 0.035-0.674). Discrepancies between our findings and those of others on D. siamensis bites may have resulted from geographic variation in the venom composition and/or differences in the study period and population. Although antivenom treatment did not reverse renal injury, it may have prevented progression. Systemic hematotoxicity and nephrotoxicity generally developed after a D. siamensis bite. Several clinical characteristics are potential markers of acute kidney injury and hemodialysis requirement after a D. siamensis bite, and early administration of antivenom may reduce the need for hemodialysis.
Hospitalization for alcohol use disorder (AUD) offers an opportunity to initiate evidence-based medications for alcohol use disorder (MAUDs). To describe patterns and factors associated with hospital initiation of MAUD. Retrospective cohort study. Veterans Health Administration (VHA). Veterans hospitalized with a primary diagnosis of AUD in 2022 or 2023. Patients had MAUD initiated as an inpatient or within 7 days of discharge. Logistic regression models estimated the predicted probabilities of MAUD initiation based on hospital fixed effects and demographic and clinical characteristics. Among 29 041 hospitalizations for AUD of veterans without MAUD at baseline in 142 hospitals (median age, 55 years; 94% male), in 8932 hospitalizations (30.8%), MAUD was initiated as an inpatient or within 7 days; MAUDs were naltrexone (57.9%), acamprosate (16.5%), and injectable naltrexone (13.9%). Of MAUD initiations, 6221 (69.6%) were during an inpatient stay and the rest were within 7 days. Of the 6221 inpatient initiations, 97.7% had a prescription for MAUD within 30 days after discharge. In adjusted analyses, MAUD initiation was more likely for hospitalizations with a specialty addiction consultation and those receiving psychiatry versus medicine service. Initiation of MAUD was less likely for persons aged 65 years or older, men, American Indian or Alaska Native versus White veterans, frail veterans, veterans diagnosed with opioid use disorder, and those in the intensive care unit. The median hospital-level rate of MAUD initiation was 29.9% (IQR, 22.6% to 36.3%). Generalizability to other health care systems. Within the VHA, 30% of hospitalizations for AUD resulted in MAUD initiation as an inpatient or within 7 days of discharge, with substantial variation across hospitals and patient demographic and clinical factors. These data indicate a need to identify and disseminate successful hospital-based strategies to increase prescribing of MAUD. U.S. Department of Veterans Affairs and National Institute on Aging.
Heterozygous variants in the KAT6A gene encoding the histone lysine acetyltransferase KAT6A (MOZ, MYST3) cause Arboleda-Tham syndrome, a cognitive impairment syndrome. Histone acetylation is generally associated with active gene transcription. Genetic deletion of both alleles of the Kat6a gene in mice causes developmental defects including anterior homeotic transformation, cleft palate, interrupted aortic arch and cardiac septal defects. Loss of KAT6A impairs expression of HOX, DLX and TBX genes, which are essential for body segment identity specification, palate, heart and aortic arch development. However, the effects of loss of KAT6A on chromatin modifications and gene expression in neural cells, which are relevant to normal brain development and function, is still poorly understood. In this study, we used an automated high-throughput chromatin profiling method and RNA sequencing in mouse neural system and progenitor cells to assess the effects of loss of one or two alleles of Kat6a on gene expression, histone acetylation and methylation. We also assessed occupancy by a trithorax group protein and RNA polymerase II. Our data suggests two modes of action for KAT6A: (1) acetylation of histone H3 on lysine 23 at promoters and enhancers and (2) recruitment of the trithorax group protein MLL1 (KMT2A) to promote the expression of developmental genes, including SOX and homeodomain genes. Together, these two functions appear to be required for normal gene expression in neural progenitors and essential for proliferation and neuronal differentiation.
Ischemic stroke (IS) accounts for 87% of all strokes and is a leading cause of disability worldwide. Women face higher lifetime IS risk and worse functional outcomes, yet predictive biomarkers remain limited. Moreover, inflammation is increasingly recognized as a contributor to IS pathogenesis, with inflammatory markers such as C-reactive protein (CRP) positively associated with IS. Yet, the metabolic pathways linking chronic inflammation to IS risk are poorly understood. We aimed to identify a metabolomic signature reflecting systemic inflammation and evaluate its association with incident IS in women. This study used nested case-control designs within the Nurses' Health Study (NHS), a prospective cohort of US female registered nurses aged 30-55 at enrollment. Using elastic net regression in a derivation cohort with inflammatory biomarker (high-sensitive CRP, interleukin 6, tumor necrosis factor receptor 2, adiponectin) and metabolomic data, we developed a metabolomic signature index of inflammation (i-MSI). The i-MSI's association with incident IS was examined in an independent NHS nested case-control study using conditional logistic regression, adjusting for cardiovascular risk factors. Generalizability to atherosclerotic disease was evaluated in a coronary heart disease (CHD) nested case-control study from the Women's Health Initiative (WHI). The derivation cohort included 1,699 women (mean age 58 years, 94% White). The i-MSI comprised 102 metabolites, with lysophosphatidylcholine species-promoters of endothelial activation, vascular inflammation, and plaque instability-contributing most significantly. In the independent IS case-control study (454 cases, 454 controls; mean age 66 years), women in the highest compared with lowest i-MSI quartile had a multivariable-adjusted odds ratio (OR) of 1.76 (95% CI 1.02-3.03) for IS, whereas each 1-SD increase in the i-MSI was associated with an OR of 1.35 (95% CI 1.09-1.67). In the WHI study (793 cases, 795 controls; mean age 67 years), each SD increase in the i-MSI was associated with an OR of 1.20 (95% CI 1.05-1.37) for CHD. An inflammatory metabolomic signature was associated with higher IS risk, independent of traditional cardiovascular disease risk factors, with consistent findings for CHD. Future studies should replicate these findings in other populations and evaluate whether these metabolites can improve risk stratification and serve as biomarkers for atherosclerotic cardiovascular diseases.
A robust characterization of geomagnetic field strength in the Southern Hemisphere over the past millennia is critical for understanding the (multi)centennial evolution of the South Atlantic Anomaly (SAA), one of the most prominent geomagnetic features at Earth's surface. Yet, robust absolute paleointensity records remain scarce in this region, introducing significant uncertainty into geomagnetic field reconstructions. Here, we present 41 absolute archeointensity determinations obtained using the Thellier-Thellier method from central South America spanning the last two millennia. Combined with a selection of high-quality records from the same region, these new data yield virtual axial dipole moment values broadly consistent with the other few available Southern Hemisphere datasets but generally lower than those from Europe, indicating a persistent north-south asymmetry in geomagnetic field strength. A new global geomagnetic field model incorporating these new data suggests that the observed asymmetry reflects a persistently northward-shifted eccentric dipole. In addition, the model tentatively suggests a westward migration of a nondipolar low-intensity anomaly between 1 and 850 CE, from the Indian Ocean to northern South America, following a trajectory broadly similar to that of the modern SAA, which appears in the Indian Ocean after 1100 CE and progresses across Africa before reaching South America. These findings support the hypothesis of a recurrent large-scale geomagnetic pattern and highlight multiscale geodynamic control on geomagnetic field morphology, in which mantle and core processes interact to shape secular variation patterns on centennial to millennial timescales.
Local policy makers increasingly have implemented nutrition standards for municipal programs to advance population health and climate change goals. Yet little is known about the impact of these policies. In 2008, New York City established nutrition standards for food purchased and served by city agencies, and in 2022, it revised the standards to limit meat and increase plant-based options. Using menu data from four agencies serving 77 percent of all city meals, we examined changes in their entrée offerings, as well as greenhouse gas and nutrition content associated with their total menu offerings, from fiscal year 2019 through fiscal year 2024. All agencies reduced the frequency of beef entrées offered on menus and increased the frequency of vegetarian entrées. Changes in total menu offerings were associated with an estimated reduction of 0.64 kilograms of carbon dioxide equivalent in greenhouse gas emissions per portion across all agencies and programs, while the nutrition content generally remained consistent. These findings suggest that municipal food standards can support greenhouse gas reductions without compromising nutrition, and they offer a model for other jurisdictions seeking to advance both population and environmental health goals.
To address the challenges of complex acoustic patterns and limited interpretability in pertussis cough sound recognition, this study proposes an interpretable deep learning framework based on adaptive time-frequency fusion and medically guided attention mechanisms. The framework first employs an Adaptive Time-Frequency Fusion Transformer to extract multi-scale temporal and spectral features of cough sounds, followed by a Medically-Guided Interpretable Attention Mapping module that aligns attention distributions with medically relevant acoustic features, achieving explicit interpretability in the diagnostic process. Experiments were conducted on three publicly available pertussis cough sound datasets from Kaggle, containing 68, 66, and 44 recordings, respectively. Under an 8:2 training-testing split with strict data leakage prevention, the proposed method achieved AUC scores of 0.994, 0.984, and 0.996 on the three datasets, outperforming the best existing baselines by an average of approximately 2%. Ablation studies demonstrated that the ATF module significantly enhances time-frequency dependency modeling, while the MGIAM module improves attention consistency in medically relevant regions. In noise robustness experiments, performance degradation remained below 3%, confirming the model's reliability and generalization ability in clinical applications. Overall, the proposed framework achieves unified high accuracy and strong interpretability for pertussis sound recognition, providing a reusable modeling paradigm for medical acoustic analysis.
Students often choose to study for exams with friends. Since active learning in class boosts success, instructors might expect studying with peers to also help. However, research offers little support for this. We investigated whether students study with peers because of low metacognitive knowledge about study strategies. At the start and end of a first-term introductory biology course, students reported their study strategies and their knowledge about their effectiveness. These data were combined with student demographic information and grades. We found that students entered university demonstrating only modest metacognitive knowledge, and this was associated with course performance. Study group use was popular, with students valuing the support and collaboration, but it had no significant effect on exam scores. Students chose encoding over retrieval strategies regardless of whether they studied alone or with others, and students who more often used encoding strategies while studying scored lower on exams. We conclude that studying with friends is not harmful, but it is based on incomplete metacognitive knowledge, and encoding strategies in general are used too close to exams. We recommend that instructors encourage peer study groups to meet during nonexam weeks when students are learning rather than studying.
Large-scale online studies with healthy adults have documented consistent associations between transdiagnostic psychiatric traits and metacognitive biases. Here, analysis of existing and new large-scale datasets reveals that such correlations may be largely due to surface-level dimensions of questionnaire-filling behavior: systematic rating biases and inattentive responding. Specifically, a bias to report positive or negative values in self-report scales may generalize to confidence ratings, producing spurious correlations between the two. Additionally, systematic overconfidence among inattentive responders produces spurious positive correlations between confidence and the endorsement of rare symptoms. We show that previously identified transdiagnostic dimensions of "anxiety-depression" and "compulsivity and intrusive thought," both shown to correlate with decision confidence, map neatly onto these two biases of questionnaire-filling behavior. In a preregistered experiment, we further show that decision confidence and self-reported obsessive-compulsive tendencies are correlated with independent measures of inattentive and biased responding. Taken together, we find substantial influence of inattentive and biased responding over both self-report psychiatric measures and confidence ratings. When not accounted for, these factors can produce a mirage of apparent metacognitive alterations in mental health. We discuss concrete precautionary measures that are needed to control for these biases.
Healthy aging has emerged as a global priority. However, older adults' participation in health promotion programs remains low, and traditional health promotion models have achieved limited success in fostering sustained engagement among this population. Mobile health (mHealth)-based gamification interventions offer a promising way to address these challenges. However, no published reviews support or oppose the use of mHealth-based gamification interventions as health promotion strategies in older adults. The study aimed to identify mHealth interventions using gamification to promote health among older adults. Our scoping review was conducted following the Joanna Briggs Institute recommendations for scoping reviews and Arksey and O'Malley's framework. The process followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklist. A comprehensive literature search was conducted across 8 databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, CINAHL, PsycARTICLES, and IEEE Xplore Digital Library, from their inception to December 10, 2025. Two reviewers independently screened titles, abstracts, and full texts via Rayyan, with disagreements resolved by a third reviewer. This scoping review identified 11 studies. Only 1 article was published before 2022. The interventions were found to improve enjoyment and motivation (n=5), cognitive function (n=3), physical activity (n=2), and digital literacy (n=2). Individual studies also reported improvements in mental health (n=1) and adherence (n=1), a reduction in suicidal ideation (n=1), improvements in physical function (n=1), the promotion of social engagement (n=1), and the identification of mild cognitive impairment (n=1). Game elements used were ranked by frequency as progress, challenges, goals, levels, reward, sensation, storytelling or narration, leaderboard, surprise, and avatar. No research was found to use the game element of "social sharing." mHealth types included augmented and virtual reality-based training systems, wearable devices, mobile phones, tablets, and Windows platforms and devices. Notably, only 4 studies applied theoretical frameworks, and 3 omitted the concrete approach to gamification. As the first scoping review to identify and map mHealth-based gamification interventions for older adults, this study highlights their potential as an innovative approach to health promotion. By systematically synthesizing evidence regarding intervention designs, gamification strategies, and preliminary health outcomes, it establishes a foundation for future inquiry. However, this review is limited by the small number of included studies, precluding broad generalizations. Future research should assess long-term impacts, integrate theoretical frameworks, establish reporting guidelines, design personalized social-interactive interventions, and expand to broader health domains. Ultimately, these insights provide targeted guidance for developing age-appropriate digital health solutions, contributing to the realization of active aging.