Telemedicine adoption in cardiology: Determinants and predictors identified using Bayesian Model Averaging and Machine Learning Pascal Petit, Jonathan Nübel, Marie Josephine Walter, Christian Butter, Martin Heinze, et al. Plos Digital Health, 2026 In this secondary analysis of a German cross-sectional survey data, we investigated key determinants and predictors of telemedicine (TM) use among healthcare professionals (HCPs) treating cardiology patients. We applied Bayesian Model Averaging (BMA) for explanatory analysis and Machine Learning (ML) for predictive modeling. BMA identified TM determinants after excluding collinear variables and selecting variables based on LASSO regression. The extreme gradient boosting (XGBoost) ML algorithm predicted TM use and identified key predictors, using nested cross-validation to prevent overfitting. ML model performance was assessed via area under the receiver operating characteristic curve (AUROC), while predictor importance was evaluated using Shapley additive explanations. Among 112 HCPs, 64 (57%) used TM. BMA identified 12 determinants, including positive associations with TM knowledge, being a cardiologist, female gender, and perceiving TM as suitable for heart failure and for monitoring events. Negative associations included concerns about insufficient patient benefits, perceptions that TM is less suitable for acute events, and skepticism regarding its relevance for extending aftercare intervals. The XGBoost model showed strong predictive performance (AUROC: 0.88 [95% CI: 0.75; 1.00], accuracy: 0.79) for TM use. Key promoting factors included TM knowledge, being a cardiologist, female gender, number of average patients per quarter, and perceiving TM as suitable for arrhythmias, device follow-up, and heart failure. Limiting factors included older age, personal use of TM for one’s own health, and skepticism about TM’s relevance in acute situations. These findings emphasize the importance of knowledge and attitudes in shaping TM adoption and show that ML can accurately identify healthcare professionals most likely to use TM, supporting targeted interventions and safer implementation in cardiology.
The Digital Exposome: A Life Course Framework for Health in the Digital Age Pascal Petit, Nicolas Vuillerme Journal of Medical Internet Research, 2026 Digital technologies are reshaping human behavior, health care delivery, and population health; however, their cumulative effects across the lifespan remain underexplored. This viewpoint argues that exposures arising from interactions with digital technologies should be formally integrated into exposome science as a distinct, measurable component of the human environment. Our aims are to (1) redefine the digital component of the exposome (the digital exposome) within the broader exposome framework, (2) examine its life course implications for health and equity, and (3) outline a research and policy agenda to enable its systematic measurement and integration into clinical and public health practice. Digital technology–related exposures can confer benefits such as enhanced health monitoring, personalized interventions, improved access to care, and the promotion of healthy behaviors. However, they may also introduce potential risks, including mental health challenges, cognitive and circadian disruptions, sedentary lifestyles, exposure to misinformation, and widening inequities among vulnerable populations. Despite their ubiquity, digital technology–related exposures remain poorly integrated into clinical medicine, epidemiology, or public and global health policies. Drawing on interdisciplinary evidence from exposure science, epidemiology, and digital phenotyping research, we propose a refined conceptual definition of the digital exposome grounded in the classical exposome domains. We propose redefining the digital exposome as the full spectrum of exposures resulting from interactions or proximities with digital technologies and their combined influence on health across the lifespan. This framework conceptualizes digital technology–related exposures as a dynamic set of environmental influences operating through sociotechnical, behavioral, and biological pathways over the life course. To operationalize this framework, we discuss practical approaches using validated behavioral instruments, objective device use logs, ecological momentary assessments, smartphone-based digital phenotyping, and wearable sensing technologies. Systematic measurement, large-scale longitudinal studies, and harmonized exposure metrics are needed to characterize the cumulative health impacts of digital environments more accurately. Emerging tools such as digital markers or biomarkers and digital phenotypes offer promising opportunities to link real-world technology use with physiological and biological outcomes, thereby supporting precision medicine and population health strategies. Ethical governance, privacy safeguards, and equity considerations must be embedded from the start, drawing on emerging exposomethics frameworks. Recognizing the digital exposome as a modifiable determinant of health offers a foundation for evidence-based guidance, prevention strategies, and policy interventions suited to increasingly digital societies. By integrating digital technology–related exposures into exposome science, clinical practice, and public health research, this viewpoint seeks to foster interdisciplinary dialogue, guide future empirical work, and support the development of safer and more equitable digital environments across the lifespan.
User Profiles and Engagement in a Hypertension Self-Management App: Cross-Sectional Survey Felix Muehlensiepen, Susann May, Frances Seifert, Eileen Wengemuth, Olen Johannsen, et al. Journal of Medical Internet Research, 2026 Background Mobile health (mHealth) technologies can improve hypertension self-management, yet real-world adoption remains limited and unequally distributed. Objective This study aimed to characterize the profiles, usage patterns, and engagement of active users of a hypertension self-management app ( Hypertension.APP ) in Germany, with a focus on user engagement and potential digital divides. Methods We conducted a cross-sectional online survey among adult users of Hypertension.APP in Germany between January and September 2023. An 88-item questionnaire assessed app usage patterns, perceived utility, integration into clinical care, sociodemographic and clinical data, and digital health literacy (eHealth Literacy Scale; scores 16‐40). Digital health literacy was categorized as low (16‐23.99), moderate (24‐31.99), or high (32-40). Descriptive statistics and univariable ordinal logistic regression were used to explore associations between sociodemographic and clinical variables and app usage frequency. Results Of 254 respondents, the mean age was 53.6 years, and 54.3% (138/254) were male. A total of 44.5% (113/254) had a university or technical college degree, and 44.5% (113/254) reported a monthly net income higher than €2500 (US $2950). Most participants (224/254, 88.2%) reported access to at least two digital devices. Overall, 88.2% (224/254) had moderate or high digital health literacy (eHealth Literacy Scale ≥24). App engagement was high: 80.7% (205/254) reported using the app at least weekly, and 52.4% (133/254) reported using the app to prepare for medical visits. However, only 20.1% (51/254) reported that the app was formally integrated into their medical care, and 11.8% (30/254) indicated that medication had been adjusted based on app data. In univariable ordinal logistic regression analyses, higher education, longer duration of hypertension, and living in a small town (5000‐20,000 inhabitants) were associated with more frequent app use, whereas systolic blood pressure of 140 mm Hg or higher was associated with less frequent use. Digital health literacy was not clearly associated with app usage frequency among current users. Conclusions Users of this hypertension self-management app were predominantly well-educated, digitally literate individuals with established hypertension, reinforcing concerns about a persistent digital divide. While app usability and engagement were high, formal clinical integration remained limited. Simply making an app available is insufficient; strategies to promote equitable access, strengthen clinical integration, and support patients with lower digital health literacy are needed for mHealth to contribute effectively to hypertension management.
Investigating Parkinson’s disease risk across farming activities using data mining and large-scale administrative health data Pascal Petit, François Berger, Vincent Bonneterre, Nicolas Vuillerme Npj Parkinson S Disease, 2025 The risk of Parkinson’s disease (PD) associated with farming has received considerable attention, in particular for pesticide exposure. However, data on PD risk associated with specific farming activities is lacking. We aimed to explore whether specific farming activities exhibited a higher risk of PD than others among the entire French farm manager (FM) population. A secondary analysis of real-world administrative insurance claim data and electronic health/medical records (TRACTOR project) was conducted to estimate PD risk for 26 farming activities using data mining. PD cases were identified through chronic disease declarations and antiparkinsonian drug claims. There were 8845 PD cases among 1,088,561 FMs. The highest-risk group included FMs engaged in pig farming, cattle farming, truck farming, fruit arboriculture, and crop farming, with mean hazard ratios (HRs) ranging from 1.22 to 1.67. The lowest-risk group included all activities involving horses and small animals, as well as gardening, landscaping and reforestation companies (mean HRs: 0.48–0.81). Our findings represent a preliminary work that suggests the potential involvement of occupational risk factors related to farming in PD onset and development. Future research focusing on farmers engaged in high-risk farming activities will allow to uncover potential occupational factors by better characterizing the farming exposome, which could improve PD surveillance among farmers.
Impact of forward and backward walking on gait parameters across parkinson’s disease stages and severity: a prospective observational study Tracy Milane, Nicolas Vuillerme, Pascal Petit, Elke Warmerdam, Robbin Romijnders, et al. BMC Neurology, 2025 Background Parkinson’s disease (PD) is characterized by motor symptoms altering gait domains such as slow walking speed, reduced step and stride length, and increased double support time. Gait disturbances occur in the early, mild to moderate, and advanced stages of the disease in both backward walking (BW) and forward walking (FW), but are more pronounced in BW. At this point, however, no information is available about BW performance and disease stages specified using the Hoehn and Yahr (H&Y) scale. The objectives of this study were to examine the link between clinical scores and gait parameters in PD, and to assess gait parameters in both FW and BW among PD patients in early disease stages (H&Y: 1–2) and advanced disease stages (H&Y: 3–4), as well as among PD patients with mild and moderate disease severity as per the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III). Methods Spatiotemporal gait parameters were analyzed during FW and BW over a 5-meter walkway at a comfortable speed using 3D motion capture. Correlations and regressions between clinical scores and gait parameters were examined. Wilcoxon Mann-Whitney rank sum tests were used to compare PD patients in early and advanced disease stages and assess differences in gait parameters for both FW and BW conditions. Results The study included a total of 25 PD patients (aged 65 ± 9 years), among whom 10 were in the H&Y stages 1–2 and 15 in stages 3–4. All participants were evaluated with the MDS-UPDRS III, with 17 having a total score ≤ 32 (mild impairment and disability) and 8 having a total score > 32 (moderate impairment and disability). During BW, PD patients with H&Y stages 1–2 had significantly (p < 0.05) longer step lengths, stride lengths, and a higher walk ratio compared to those with H&Y stage 3–4. Regardless of the walking condition, no difference was found between PD patients with a MDS-UPDRS III total score ≤ 32 and patients with a MDS-UPDRS III total score > 32. Discussion The study demonstrates that individuals with PD in H&Y stages 3–4 exhibit compromised FW and BW abilities in comparison to those in stages 1–2. Notably, the disparities are more prominent in the realm of backward walking. These findings substantiate the existence of distinct gait patterns between the early and advanced stages of the disease, with the variations being particularly accentuated in the context of backward walking. Conclusions Taken together, our results suggest that backward walking may hold greater clinical utility in assessing and managing PD patients. Trial registration The research procedure was approved by the ethical committee of the Medical Faculty of Kiel University (D438/18). The study is registered in the German Clinical Trials Register on 20,200,904 (DRKS00022998).
Ambitions and main conclusions of the conference “Global health, local decisions” organized by the Digital Health Network Robert Picard, Vincent Augusto, Mathias Béjean, Antoine Bertrand, Dominique Bicout, et al. Geriatrie Et Psychologie Neuropsychiatrie Du Vieillissement, 2025 Health is "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity". Health must therefore be considered in its entirety. To begin with, however, it is vital to move swiftly from the concept of holistic health to its practical implementation. This is what the first Digital Health Network symposium proposed on May 30 and 31, 2024. The Digital Health Network was originally set up by a group of players from the healthcare sector, industry, research and elected representatives, with the aim of pooling feedback from experience as close as possible to local realities. The following points were addressed: i) rebalancing the curative approach with a greater emphasis on prevention and health promotion; ii) rebalancing the genetic approach with a greater emphasis on exposomics; iii) insufficient use of digital technology to improve the health of local populations; iv) governance and organizational challenges from the point of view of local decision-makers and observers, with a focus on research; and v) the ambitions of the Digital Health Network. The symposium provided an opportunity to share case studies of public health challenges in local areas, and possible responses in terms of infrastructure and stakeholder participation: citizens, patients, healthcare professionals, service providers, experts and other stakeholders. The challenges of ageing and geriatric frailty underline the importance of a global, preventive and multidisciplinary approach to promote successful, independent ageing.
Global research trends on the human exposome: a bibliometric analysis (2005–2024) Pascal Petit, Nicolas Vuillerme Environmental Science and Pollution Research, 2025 Exposome represents one of the most pressing issues in the environmental science research field. However, a comprehensive summary of worldwide human exposome research is lacking. We aimed to explore the bibliometric characteristics of scientific publications on the human exposome. A bibliometric analysis of human exposome publications from 2005 to December 2024 was conducted using the Web of Science in accordance with PRISMA guidelines. Trends/hotspots were investigated with keyword frequency, co-occurrence, and thematic map. Sex disparities in terms of publications and citations were examined. From 2005 to 2024, 931 publications were published in 363 journals and written by 4529 authors from 72 countries. The number of publications tripled during the last 5 years. Publications written by females (51% as first authors and 34% as last authors) were cited fewer times (13,674) than publications written by males (22,361). Human exposome studies mainly focused on air pollution, metabolomics, chemicals (e.g., per- and polyfluoroalkyl substances (PFAS), endocrine-disrupting chemicals, pesticides), early-life exposure, biomarkers, microbiome, omics, cancer, and reproductive disorders. Social and built environment factors, occupational exposure, multi-exposure, digital exposure (e.g., screen use), climate change, and late-life exposure received less attention. Our results uncovered high-impact countries, institutions, journals, references, authors, and key human exposome research trends/hotspots. The use of digital exposome technologies (e.g., sensors, and wearables) and data science (e.g., artificial intelligence) has blossomed to overcome challenges and could provide valuable knowledge toward precision prevention. Exposome risk scores represent a promising research avenue.
The global landscape of planetary health: A bibliometric analysis over the last decade (2015-2024) since emergence S Afrin, R Ara, KM Saif-Ur-Rahman, P Petit, N Neeher, T Tanin, ... Environmental and Sustainability Indicators 31, 101282 , 2026 2026
The Digital Exposome: A Life Course Framework for Health in the Digital Age P Petit, N Vuillerme Journal of Medical Internet Research 28, e90153 , 2026 2026
Telemedicine adoption in cardiology: Determinants and predictors identified using Bayesian Model Averaging and Machine Learning P Petit, J Nübel, MJ Walter, C Butter, M Heinze, Y Ignatyev, ... Plos Digital Health 5 (4), e0001359 , 2026 2026
User Profiles and Engagement in a Hypertension Self-Management App: Cross-Sectional Survey F Muehlensiepen, S May, F Seifert, E Wengemuth, O Johannsen, ... Journal of Medical Internet Research 28, e83075 , 2026 2026 Citations: 2
Factors associated with the levels of eHealth literacy skills among patients in cardiovascular care: secondary analysis of data from users of a hypertension management app S Spethmann, P Petit, S May, F Seifert, O Johannsen, M Middeke, ... European Heart Journal 46 (Suppl 1), ehaf784.4537 , 2025 2025
Datagraphy: toward a systematic approach to dataset discovery P Petit, N Vuillerme GigaScience, giaf134 , 2025 2025 Citations: 2
Impact of forward and backward walking on gait parameters across parkinson’s disease stages and severity: a prospective observational study T Milane, N Vuillerme, P Petit, E Warmerdam, R Romijnders, E Bianchini, ... BMC Neurology 29 (1), 379 , 2025 2025 Citations: 1
Exploring Trichomonas vaginalis infection risk factors with explainable machine learning and electronic health records M Abanda, P Petit, R Ngome, N Nga, A Tchana, N Vuillerme 3èmes Journées Camerounaises de Biologie Clinique , 2025 2025
Ambitions and main conclusions of the conference “Global health, local decisions” organized by the Digital Health Network R Picard, V Augusto, M Béjean, A Bertrand, D Bicout, V Bonneterre, ... Gériatrie et Psychologie Neuropsychiatrie du Vieillissement 23 (2), 141-152 , 2025 2025
OP0364-PARE Leveraging machine learning to identify predictors of digital health technologies among rheumatic patients using German nationwide survey data F Muehlensiepen, P Petit, S May, N Vuillerme Annals of the Rheumatic Diseases 84, 295 , 2025 2025
POS0872 IMPROVING HEALTH OUTCOMES AND REDUCING HEALTHCARE COSTS THROUGH DIGITAL MOVEMENT THERAPY: A RANDOMIZED TRIAL PP von Alten Blaskowitz, N Köhl, AM Liphardt, C Bouzas, B Coppers, ... Annals of the Rheumatic Diseases 84, 1009-1010 , 2025 2025
Using Machine Learning and Nationwide Population-Based Data to Unravel Predictors of Treated Depression in Farmers P Petit, V Bonneterre, N Vuillerme Mental Illness 2025, 13 , 2025 2025 Citations: 1
Global research trends on the human exposome: a bibliometric analysis (2005–2024) P Petit, N Vuillerme Environmental Science and Pollution Research , 2025 2025 Citations: 10
Environmental Pollution and the Risk of Congenital Hypothyroidism: Insights from a French Nationwide Retrospective Ecological Cohort Study S Chamot, P Petit, A Al-Salameh, V Bonneterre, C Cancé, G Decocq, ... Journal of Hazardous Materials Advances 17, 100560 , 2025 2025 Citations: 4
Exploring Supervised and Real-World Mobility in People with Parkinson's disease (PD) with and without Nocturnal Hypokinesia E Bianchini, D Rinaldi, S Galli, M Alborghetti, L De Carolis, P Petit, ... Movement Disorder 39 (suppl 1) , 2025 2025
Leveraging Administrative Health Databases to Address Health Challenges in Farming Populations: Scoping Review and Bibliometric Analysis (1975-2024) P Petit, N Vuillerme JMIR Public Health and Surveillance 11, e62939 , 2025 2025 Citations: 11
Investigating Parkinson’s disease risk across farming activities using data mining and large-scale administrative health data P Petit, F Berger, V Bonneterre, N Vuillerme npj Parkinson's disease 11, 13 , 2025 2025 Citations: 10
Digital Transformation of Rheumatology Care in Germany: Cross-Sectional National Survey S May, R Darkow, J Knitza, K Boy, P Klemm, M Heinze, N Vuillerme, ... Journal of Medical Internet Research 27, e52601 , 2025 2025 Citations: 1
Imprecise categorization of workstations for the risk assessment related to chemical mixtures L Calazans De Oliveira Costa, V Antoine, L De Oliveira Abrahao Reis, ... LFA 2025 - Rencontres francophones sur la Logique Floue et ses Applications 2224 , 2025 2025
Ambitions et principaux enseignements du colloque «Santé globale, décisions locales», organisé par la Filière Santé numérique R Picard, V Augusto, M Béjean, A Bertrand, D Bicout, V Bonneterre, ... Gériatrie et Psychologie Neuropsychiatrie du Vieillissement 23 (2), 141-152 , 2025 2025
MOST CITED SCHOLAR PUBLICATIONS
Lung cancer risk assessment for workers exposed to polycyclic aromatic hydrocarbons in various industries P Petit, A Maître, R Persoons, DJ Bicout Environment International 124, 109-120 , 2019 2019 Citations: 133
Air pollution and health impacts during the COVID-19 lockdowns in Grenoble, France ML Aix, P Petit, DJ Bicout Environmental Pollution 303, 119134 , 2022 2022 Citations: 32
Does prenatal exposure to multiple airborne and tap-water pollutants increase neonatal thyroid-stimulating hormone concentrations? Data from the Picardy region, France S Chamot, A Al-Salameh, P Petit, V Bonneterre, C Cancé, G Decocq, ... Science of The Total Environment 905, 167089 , 2023 2023 Citations: 22
Exporisq-HAP database: 20 years of monitoring French occupational exposure to polycyclic aromatic hydrocarbon mixtures and identification of exposure determinants A Maitre, P Petit, M Marques, C Hervé, S Montlevier, R Persoons, ... International journal of hygiene and environmental health 221 (2), 334-346 , 2018 2018 Citations: 21
Factors Associated With Telemedicine Use Among German General Practitioners and Rheumatologists: Secondary Analysis of Data From a Nationwide Survey F Mühlensiepen, P Petit, J Knitza, M Welcker, N Vuillerme Journal of Medical Internet Research 24 (11), e40304 , 2022 2022 Citations: 19
Towards a recommended biomonitoring strategy for assessing the occupational exposure of roofers to PAHs R Persoons, L Roseau, P Petit, C Hograindleur, S Montlevier, M Marques, ... Toxicology Letters , 2020 2020 Citations: 18
Agricultural activities and risk of treatment for depressive disorders among the entire French agricultural workforce: the TRACTOR project, a nationwide retrospective cohort study P Petit, G Gandon, M Dubuc, N Vuillerme, V Bonneterre The Lancet Regional Health - Europe 31, 100674 , 2023 2023 Citations: 17
Agricultural activities and risk of Alzheimer's disease: the TRACTOR project, a nationwide retrospective cohort study P Petit, E Gondard, G Gandon, O Moreaud, M Sauvée, V Bonneterre European Journal of Epidemiology , 2024 2024 Citations: 16
Constructing a database of similar exposure groups: the application of the Exporisq-HAP database from 1995 to 2015 P Petit, DJ Bicout, R Persoons, V Bonneterre, D Barbeau, A Maître Ann Work Expo Health 61 (4), 440-456 , 2017 2017 Citations: 15
The TRACTOR Project: TRACking and MoniToring Occupational Risks in Agriculture Using French Insurance Health Data (MSA) P Petit, D Bosson-Rieutort, C Maugard, E Gondard, D Ozenfant, N Joubert, ... Annals of Work Exposures and Health, 1-10 , 2021 2021 Citations: 14
Factors Associated With Telemedicine Use Among Patients With Rheumatic and Musculoskeletal Disease: Secondary Analysis of Data From a German Nationwide Survey F Mühlensiepen, P Petit, J Knitza, M Welcker, N Vuillerme Journal of Medical Internet Research 25, e40912 , 2023 2023 Citations: 13
Toxicological and Exposure Database Inventory: A review P Petit International Journal of Hygiene and Environmental Health 246, 114055 , 2022 2022 Citations: 12
Leveraging Administrative Health Databases to Address Health Challenges in Farming Populations: Scoping Review and Bibliometric Analysis (1975-2024) P Petit, N Vuillerme JMIR Public Health and Surveillance 11, e62939 , 2025 2025 Citations: 11
Prediction of the acceptance of telemedicine among rheumatic patients: a machine learning-powered secondary analysis of German survey data F Muehlensiepen, P Petit, J Knitza, M Welcker, N Vuillerme Rheumatology International , 2024 2024 Citations: 11
Global research trends on the human exposome: a bibliometric analysis (2005–2024) P Petit, N Vuillerme Environmental Science and Pollution Research , 2025 2025 Citations: 10
Investigating Parkinson’s disease risk across farming activities using data mining and large-scale administrative health data P Petit, F Berger, V Bonneterre, N Vuillerme npj Parkinson's disease 11, 13 , 2025 2025 Citations: 10
Impact of the digital health application ViViRA on spinal mobility, physical function, quality of life and pain perception in spondyloarthritides patients: a randomized … P Palm von Alten Blaskowitz, AM Liphardt, C Bouzas, B Coppers, P Petit, ... Arthritis Research & Therapy 26 , 2024 2024 Citations: 10
Consistency between air and biological monitoring for assessing polycyclic aromatic hydrocarbon exposure and cancer risk of workers M Valière, P Petit, R Persoons, C Demeilliers, A Maître Environmental Research, 112268 , 2021 2021 Citations: 10
Farming activity and risk of treated thyroid disorders: Insights from the TRACTOR project, a nationwide cohort study P Petit, S Chamot, A Al-Salameh, C Cancé, R Desailloud, V Bonneterre Environmental Research 118458 , 2024 2024 Citations: 9
Review of environmental airborne pyrene/benzo[a]pyrene levels from industrial emissions for the improvement of 1-hydroxypyrene biomonitoring interpretation A Clauzel, R Persoons, A Maître, F Balducci, P Petit Journal of Toxicology and Environmental Health, Part B , 2024 2024 Citations: 8
