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Background. First-mile walking to mass rapid transit (MRT) has two methodological problems. Composite walkability scores blur which features drive walking. And because walking to transit is itself transport physical activity (PA), linking it to total PA is circular. Both issues are sharper in tropical Asian cities. Methods. We surveyed 378 adults within a 1 km network distance of 20 stations on Bangkok's Pink Line MRT. Walkability was measured with NEWS-A (aggregate and eight subscales); PA with the GPAQ. Binary logistic regression with station-cluster-robust standard errors tested which NEWS-A subscales predict first-mile walking and whether walkers meet the WHO PA guideline (≥150 min/week MVPA). A tautology sensitivity test removed transport PA from the outcome. Results. Walkers were 71.7% of the sample. Disaggregating NEWS-A improved fit; two subscales were the dominant predictors: pedestrian infrastructure and traffic safety. Walkers were 30.6 percentage points more likely to meet the overall PA guideline; with transport PA removed, the gap was 17.5 points and still significant. The pedestrian infrastructure effect was strongest 201-1000 m from a station, not at the immediate frontage. Conclusions. Perceived pedestrian infrastructure quality and perceived traffic safety drive first-mile walking in suburban Bangkok. The walking-PA link is not entirely a measurement artefact. The 201-1000 m ring is a plausible priority for pedestrian investment.

Pulmonary embolism (PE) in octogenarians (i.e., patients > 80 years) is associated with substantial morbidity and mortality, yet this population remains underrepresented in major studies. We compared the predictive performance of the Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), European Society of Cardiology (ESC) risk classes, and National Early Warning Score (NEWS) for mortality prediction in octogenarians versus younger emergency department (ED) patients. In this single-center retrospective cohort study, adults with confirmed PE presenting to an ED in Vienna, Austria, between January 2017 and December 2024 were included. Patients were categorized as octogenarians or ≤80 years. Clinical characteristics, treatment, and outcomes were compared. Predictive performance for 30-day mortality was assessed using receiver operating characteristic analyses and diagnostic accuracy measures. Sensitivity analyses and evaluation of 7-day mortality were also performed. Among 773 patients, 114 were octogenarians. Compared with younger patients, octogenarians had more cardiovascular comorbidities, higher cardiac biomarker levels, more right ventricular strain, and significantly higher 30-day mortality. PESI showed the most consistent overall prognostic performance but was less accurate in octogenarians. sPESI demonstrated limited specificity because most octogenarians were classified as high risk. ESC risk classes provided moderate discrimination. NEWS ≥ 7 showed prognostic value for short-term mortality among octogenarians, although the differences from PESI were not statistically significant. Established PE prognostic tools perform less well in octogenarians. PESI showed the most consistent overall performance, while NEWS demonstrated promising short-term prognostic value that warrants further investigation.

Background: Healthcare-associated bloodstream infections (HABSIs) are among the main categories of nosocomial infections. This analysis aims to identify the clinical characteristics of patients in the emergency department (ED) who will develop a HABSI during their hospital stay. Methods: Main outcome measures were HABSI and the cumulative survival rate at 30 days. The features tested in a logistic model were age, sex, vitals by the National Early Warning Score (NEWS), priority levels, main complaints, comorbidities by the Charlson Comorbidity Index (CCI), trauma-related disease, main diagnosis and ED length of stay. Results: In 414 (2.3%) out of 18,304 patients, aged 75 (16) years, mean (SD), a diagnosis of HABSI was recorded. HABSIs occurred in subjects with main diagnosis of diseases of the respiratory system (N = 116; 28.0%), digestive system (N = 72; 17.4%), and circulatory system (N = 68; 16.4%). The main key clinical features selected by the logistic model were: NEWS > 6, diagnosis of neoplasms, CCI > 4, and diagnosis of diseases of the digestive system. The ROC curve for the HABSI risk score was 0.703 &#xb1; 0.027 in predicting the outcome, (sensitivity 79%, specificity 51%, at optimal cut-off score). The overall hazard mortality risk was twofold higher in patients with HABSIs (hazard ratio: 2.319; 95% confidence interval: 1.871-2.875; p-value: <0.001). The overall 30-day survival rate was lower among patients with HABSIs (33%) vs. non-HABSI patients (62%). Conclusions: A group of main clinical features in subjects without suspect of infectious disease in the ED are associated with HABSIs. These features negatively impact survival rate during hospital stays.

To analyze the current research status and trends in the management of cancer-related muscle pain worldwide from 2015 to 2024 using bibliometric methods. In this study, a literature search was conducted in the Web of Science Core Collection for the period from January 1, 2015, to January 21, 2025. The inclusion criteria were restricted to English-language original articles and reviews. We excluded non-English publications and other document types, such as editorial materials, book chapters, proceeding papers, letters, and news items. Ultimately, 909 valid publications (671 articles and 238 reviews) were retrieved. Data analysis was carried out using CiteSpace, VOSviewer, and the bibliometrix package in R software, focusing on main bibliometric indicators including the number of publications, total citation counts, country and institutional contributions, author productivity, journal influence, and keyword co-occurrence clusters. China and the United States were the main contributors in this field. The number of published articles increased continuously, peaking at 148 publications in 2023. Most of the highly productive authors were from China, forming a close collaboration network. In terms of journal influence, Medicine (n&#x2005;=&#x2005;77) and Cancers (n&#x2005;=&#x2005;31) published the most articles, while The Lancet (1990 citations) and Pain (974 citations) received the highest total citation counts. Through keyword clustering analysis, 4 dominant clusters were identified: basic research and clinical management of cancer-related muscle pain, the psychological state and quality of life of patients, evaluation of the safety and effectiveness of treatment, and comprehensive management strategies. This study systematically summarizes the research progress in the management of cancer-related muscle pain from 2015 to 2024, and reveals the research hotspots and future trends in this field. Future research should further strengthen international cooperation and improve the research quality, especially in the research on pain mechanisms, comprehensive management, and the quality of life of patients.

As AI becomes more sophisticated, new risks are emerging. In this News and Perspectives article, JMIR Correspondent Shalini Kathuria Narang reports on the American Medical Association's response to the rising issue of physician deepfakes.

This Medical News article discusses the renaming of polycystic ovary syndrome to polyendocrine metabolic ovarian syndrome to better reflect current science and improve diagnosis.

This Medical News article discusses a US Department of Health and Human Services initiative to reduce the prescribing of medications to treat psychiatric disorders.

Conversational medical AI systems are increasingly blurring the lines between simply being digital tools and simulating medical practice. In this News and Perspectives article, MD-PhD candidate and JMIR Correspondent Tejas S Athni reports on recent health AI controversies and evolving regulatory challenges.

To systematically examine the impact of climate risks on China's financial system, this study employs the EGARCH-SGED model to precisely fit financial market volatility based on China's Climate Change News Index. It then combines the LASSO-CoVaR method to measure tail risk spillover effects within China's financial system under climate risk shocks, constructs a risk contagion network, and innovatively utilizes the RF-AdaBoost model to establish the risk early warning system. Findings reveal that climate risk is a key driver of dynamic correlation evolution within the financial system, with heterogeneous impacts across different markets. Physical climate risk events intensify short-term risk contagion while generating long-term effects; transition risks undergo a dynamic process, initially amplifying uncertainty before enhancing systemic stability over the long term. The RF-AdaBoost model outperforms traditional machine learning models in risk warning, demonstrating outstanding predictive accuracy and generalization capabilities, thereby providing effective intellectual support for climate risk prevention and financial stability management.

Fraudulent papers are on the rise in scientific publishing. In this News and Perspectives article, JMIR Correspondent Cliff Dominy reports on recent cases of false authorship and how they might be prevented to safeguard trust in science.

Prospective memory (i.e., remembering to complete future plans) and retrospective memory (i.e., memory for past events) are essential to daily functioning, but both are prone to everyday failures, such as forgetting to carry out an intended action (e.g., missing a medication dose) or inaccurately recalling past information (e.g., forgetting the details of a recent conversation). To mitigate these, individuals may rely on cognitive offloading, the use of physical actions or external tools to reduce retrieval effort (e.g., setting an alarm to avoid forgetting an important task). This study examined the impact of cognitive offloading on both prospective and retrospective memory, using two offloading strategies. In the first phase, 152 participants were instructed to send an email 48 h later at 7 p.m. and were randomly assigned to one of three conditions: a reminder (e.g., an alarm), a scheduled email for automatic delivery, or no reminder (internal memory). They also watched a news report. In the second phase, participants sent an email (prospective memory) and then completed a free recall question about the video (retrospective memory). Results show that both offloading conditions performed better in the prospective task. Notably, there were no significant differences in retrospective memory performance. Overall, cognitive offloading enhanced prospective memory and subjective confidence but did not influence retrospective recall, highlighting a dissociation between remembering when to act and remembering contextual information.

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