Interactive Journal of Medical Research最新文献

{"title":"Economic Evaluations and Equity in the Use of Artificial Intelligence in Imaging Examinations for Medical Diagnosis in People With Dermatological, Neurological, and Pulmonary Diseases: Systematic Review.","authors":"Giulia Osório Santana, Rodrigo de Macedo Couto, Rafael Maffei Loureiro, Brunna Carolinne Rocha Silva Furriel, Luis Gustavo Nascimento de Paula, Edna Terezinha Rother, Joselisa Péres Queiroz de Paiva, Lucas Reis Correia","doi":"10.2196/56240","DOIUrl":"10.2196/56240","url":null,"abstract":"<p><strong>Background: </strong>Health care systems around the world face numerous challenges. Recent advances in artificial intelligence (AI) have offered promising solutions, particularly in diagnostic imaging.</p><p><strong>Objective: </strong>This systematic review focused on evaluating the economic feasibility of AI in real-world diagnostic imaging scenarios, specifically for dermatological, neurological, and pulmonary diseases. The central question was whether the use of AI in these diagnostic assessments improves economic outcomes and promotes equity in health care systems.</p><p><strong>Methods: </strong>This systematic review has 2 main components, economic evaluation and equity assessment. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool to ensure adherence to best practices in systematic reviews. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews), and we followed the PRISMA-E (Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Equity Extension) guidelines for equity. Scientific articles reporting on economic evaluations or equity considerations related to the use of AI-based tools in diagnostic imaging in dermatology, neurology, or pulmonology were included in the study. The search was conducted in the PubMed, Embase, Scopus, and Web of Science databases. Methodological quality was assessed using the following checklists, CHEC (Consensus on Health Economic Criteria) for economic evaluations, EPHPP (Effective Public Health Practice Project) for equity evaluation studies, and Welte for transferability.</p><p><strong>Results: </strong>The systematic review identified 9 publications within the scope of the research question, with sample sizes ranging from 122 to over 1.3 million participants. The majority of studies addressed economic evaluation (88.9%), with most studies addressing pulmonary diseases (n=6; 66.6%), followed by neurological diseases (n=2; 22.3%), and only 1 (11.1%) study addressing dermatological diseases. These studies had an average quality access of 87.5% on the CHEC checklist. Only 2 studies were found to be transferable to Brazil and other countries with a similar health context. The economic evaluation revealed that 87.5% of studies highlighted the benefits of using AI in dermatology, neurology, and pulmonology, highlighting significant cost-effectiveness outcomes, with the most advantageous being a negative cost-effectiveness ratio of -US $27,580 per QALY (quality-adjusted life year) for melanoma diagnosis, indicating substantial cost savings in this scenario. The only study assessing equity, based on 129,819 radiographic images, identified AI-assisted underdiagnosis, particularly in certain subgroups defined by gender, ethnicity, and socioeconomic status.</p><p><strong>Conclusions: </strong>This review underscores the importance of transparency in the description of AI tools and the representativeness of p","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e56240"},"PeriodicalIF":1.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12349886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Interventions for Improving Body Dissatisfaction in Children and Emerging Adults: Systematic Review and Meta-Analysis.","authors":"Li Liu, Jianning Yang, Fengmei Tan, Xia Yang, Huan Luo, Yanhua Chen, Xiaolei Zhao","doi":"10.2196/72231","DOIUrl":"10.2196/72231","url":null,"abstract":"<p><strong>Background: </strong>Body dissatisfaction is a condition where individuals are dissatisfied with their physical appearance. It has become a global issue, especially among children and emerging adults. A growing number of digital interventions have been developed to address body dissatisfaction in children and emerging adults; however, controversies remain regarding their efficacy, underscoring the need for a comprehensive synthesis of current evidence.</p><p><strong>Objective: </strong>This systematic review aimed to explore the effectiveness of digital interventions in improving body image-related outcomes among children and emerging adults.</p><p><strong>Methods: </strong>From inception to April 24, 2024, a literature search was performed across 7 databases-PubMed, Web of Science, MEDLINE, EBSCO (Elton B Stephens Company), Cochrane Library, CNKI (China National Knowledge Infrastructure), and WANFANG-to identify randomized controlled trials (RCTs) with a predefined set of inclusion criteria. This systematic review was reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Study selection, data extraction, and risk of bias assessment using the Cochrane Risk-of-Bias Tool 2.0 were conducted independently by 2 researchers. Standardized mean differences (SMDs) and 95% CIs from the included RCTs were calculated for the meta-analysis. Heterogeneity was assessed with I² values. A fixed-effects model was used when I²≤50%, and a random-effects model was selected when I²>50%.</p><p><strong>Results: </strong>Twenty RCTs with 5251 participants (2610 in intervention groups and 2641 in control groups) met the inclusion criteria. Digital interventions included web pages, mobile apps, computer-based videos, computer-based sessions, internet-based sessions, internet games, chatbots, podcasts, and social media. Our results indicate that digital interventions could significantly improve body dissatisfaction (SMD=0.38, 95% CI -0.63 to -0.13; I2=55%; P=.003), physical appearance comparison (SMD=-0.24, 95% CI -0.45 to -0.03; I2=0%; P=.003), thin-ideal internalization (SMD=-0.28, 95% CI -0.36 to -0.2; I2=41%; P<.001), self-esteem (SMD=0.14, 95% CI 0.07-0.21; I2=21%; P<.001), self-compassion (SMD=0.55, 95% CI 0.33-0.78; I2=35%; P<.001), and depression (SMD=-0.59, 95% CI -0.97 to -0.21; I2=0%; P=.002), with small to medium effect sizes.</p><p><strong>Conclusions: </strong>While digital interventions improved body dissatisfaction among children and emerging adults, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the effectiveness of digital interventions on body dissatisfaction.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e72231"},"PeriodicalIF":1.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-Based Digital Exercise Interventions for Reducing Body Weight and Fat and Promoting Physical Activity in Adults With Overweight and Obesity: Systematic Review and Meta-Analysis.","authors":"Mohamad Motevalli, Clemens Drenowatz, Derrick Tanous, Gerhard Ruedl, Werner Kirschner, Markus Schauer, Thomas Rosemann, Katharina Wirnitzer","doi":"10.2196/73656","DOIUrl":"10.2196/73656","url":null,"abstract":"<p><strong>Background: </strong>Digitally delivered physical exercise interventions are becoming increasingly popular in addressing the obesity epidemic. However, there remains uncertainty on their efficacy regarding the reduction of body weight (BW) and body fat, which may, at least partly, be due to variations in study designs and inconsistent adherence to international physical activity (PA) guidelines.</p><p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of digital exercise interventions based on PA guidelines in reducing BW and fat in adults with overweight or obesity, as well as their impact on PA-related factors.</p><p><strong>Methods: </strong>This review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Comprehensive searches were performed in October 2024 across PubMed, Cochrane Library, Web of Science, and Ovid MEDLINE databases. Eligible studies included adults (aged ≥18 years) with objectively confirmed overweight or obesity who used digital interventions aligned with international PA guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias (version 2) tool for randomized controlled trials and the Risk of Bias in Nonrandomized Studies of Interventions tool for nonrandomized studies. A random-effects meta-analysis with Hartung-Knapp adjustment was performed using R software.</p><p><strong>Results: </strong>Out of 4948 studies identified, 188 (3.8%) were screened in full and 30 (0.6%) met the eligibility criteria. Intervention durations ranged from 8 weeks to 24 months (average 6.4, SD 5.5 months). Meta-analysis showed that guideline-based digital exercise interventions significantly reduced BW compared to controls (mean difference [MD]=-1.17 kg; P=.003; I²=0.0%), with subgroup analysis revealing greater effects in active (nondigital) controls (MD=-1.23 kg; I²=7.5%) compared to passive (waitlist) controls (MD=-0.52 kg; I²=0.0%). A significant reduction in BMI was observed (MD=-0.50 kg/m²; P=.003), although with substantial heterogeneity (I²=70.0%), and subgroup analysis showed greater effects compared to passive controls (MD=-0.70 kg/m²; I²=43.1%) rather than to active controls (MD=-0.45 kg/m²; I²=74.5%). No significant effect was observed for body fat percentage overall (MD=-0.08%; P=.84; I²=7.4%). Qualitative analysis (including findings from noncomparative studies) showed that guideline-based digital exercise interventions led to significant reductions in BW (22/25, 88% studies; range -1.3 to -8.4 kg); BMI (19/23, 83% of studies; range -0.4 to -3.4 kg/m²); waist circumference (15/16, 94% of studies; range -2.1 to -9.2 cm), body fat percentage (9/9, 100% of studies; range -0.3% to -4.1%); and fat mass (7/7, 100% of studies; range -0.4 to -6.5 kg), while findings for waist-to-hip ratio and PA outcomes were inc","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e73656"},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Platform Availability of Smartphone Sensors for Depression Indication Systems: Mixed-Methods Umbrella Review.","authors":"Johannes Leimhofer, Milica Petrovic, Andreas Dominik, Dominik Heider, Ulrich Hegerl","doi":"10.2196/69686","DOIUrl":"10.2196/69686","url":null,"abstract":"<p><strong>Background: </strong>A popular trend in depression forecasting research is the development of machine learning models trained with various types of smartphone sensor data and periodic self-ratings to derive early indications of changes in depression severity. While most works focus on model performance, there is little concern about the universal usability and reliable operation of such systems across smartphone platforms. This review serves as foundational work for the MENTINA clinical trial, which investigates smartphone-based health self-management for depression. The usability and reliability of mobile apps for depression are commonly perceived through the lens of the approaches and interventions offered rather than the reliability of the built-in mobile phone functions to support effortless and exact delivery of intended interventions.</p><p><strong>Objective: </strong>This work aimed to synthesize existing systematic reviews to identify smartphone sensor modalities used in mental health monitoring and, building on this foundation, assess the cross-platform availability of these data streams using PhoneDB to inform the design and implementation of digital depression indication systems.</p><p><strong>Methods: </strong>To identify the already used hardware and software sensors and their purposes in mental health monitoring, an umbrella review was conducted. Three electronic databases, including PubMed, Web of Science Core Collection, and Scopus, were searched using smartphone, sensor data, and depression keyword combination to retrieve relevant literature reviews published within the last 5 years (2019-2024). Once the initial search was completed, the extracted hardware sensors were checked for availability on Android and iOS smartphones by analyzing device specifications in PhoneDB over the last 10 years.</p><p><strong>Results: </strong>The extracted data streams observed across the 9 included studies covered 16 hardware and 3 software data streams. Hardware data streams included accelerometers, barometers, battery levels, Bluetooth, cameras, cellular networks, GPSs, gyroscopes, humidity, light sensors, magnetometers, proximity sensors, sound sensors, step counters, temperature sensors, and Wi-Fi. Software data streams included app usage, call and message logs, and screen status. Hardware component availability on Android and iOS systems showed the changes in component trends from 2014 to 2024 as of September 2024, with the accelerometers, batteries, cameras, and GPSs remaining consistent on Android and iOS, while components such as gyroscopes, step counters, and barometers gradually increased over the years, particularly on Android.</p><p><strong>Conclusions: </strong>Multiple data streams identified in the literature review showed a consistent increase in availability over time, enabling improved use of these outputs for depression forecasting and the training of machine learning models with diverse smartphone data, including sen","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e69686"},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Chronic Cognitive-Motor Deficits in Adults With a History of Concussion Using Computerized Eye-Hand Coordination Tasks: Preliminary Experimental Design Study.","authors":"Qin Zhu, Shaochen Huang","doi":"10.2196/70867","DOIUrl":"10.2196/70867","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Concussion has been a major public health concern due to the substantial cognitive sequelae it results. Although the dysfunctions of the frontal lobe and corpus callosum owing to concussions have been documented, the existing concussion screening tools merely examine cognitive functions in isolation of motor functions and failed to detect the chronic cognitive-motor impairments following concussions. Yet, there has been no concussion screening test aimed specifically to assess the coupled cognitive-motor functions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to provide preliminary evidence for using computerized eye-hand coordination tasks to detect chronic cognitive-motor deficits associated with concussion history.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The computerized eye-hand coordination tasks were used to assess the coupled cognitive-motor functions of the participants with and with no history of concussion. In experiment 1, a total of 12 participants (6 young adults with a history of concussion and 6 healthy controls) completed longitudinal assessments of coordination profiles across a year. Experiment 2 examined a total of 20 participants (10 participants with a history of concussion and 10 healthy controls) using an iterated single-session protocol. Just noticeable difference (JND) and proportion of time-on-task (PTT) were used to assess cognitive-motor performance. Mixed-design ANOVAs were used to examine group differences, and the effect sizes were assessed using Cohen d test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In experiment 1, participants with a history of concussion exhibited more inconsistent ability to visually discriminate the in-phase coordination pattern (coefficient of variation of JND: participants with a history of concussion = mean 0.27, SD 0.04, and healthy controls = mean 0.17, SD 0.07; t10=2.93; P=.02). Similarly, their performance on unimanual and bimanual in-phase and anti-phase coordination patterns was significantly poorer (at in-phase: PTTConcussed=mean 0.63, SD 0.10, and PTTHealthy=mean 0.73, SD 0.08 [F1,10=8.49; P=.02]; at anti-phase: PTTConcussed=mean 0.46, SD 0.14, and PTTHealthy=mean 0.60, SD 0.10 [F1,10=10.67; P=.008]). In experiment, 2 where only the unimanual coordination tasks were implemented for screening, participants with a history of concussion showed impaired performance in both in-phase and anti-phase tasks (at in-phase: PTTConcussed=mean 0.62, SD 0.13, and PTTHealthy=mean 0.74, SD 0.07 [F1,54=4.20; P=.045]; at anti-phase: PTTConcussed=mean 0.37, SD 0.15, and PTTHealthy=mean 0.56, SD 0.14 [F1,54=10.26; P=.002]), and they also failed to show the differentiated performance between anti-phase and 90° coordination patterns (PTTAnti-phase=mean 0.37, SD 0.15, and PTT90° coordination=mean 0.37, SD 0.13).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Due to their ability to detect both impaired and undifferentiated performance in producing intrinsic and novel coordination patterns, the un","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e70867"},"PeriodicalIF":1.9,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Physicians' Referral Decision-Making for Rehabilitation Outpatient Services in the Health Care Landscape of China: Cross-Sectional Study.","authors":"Yawei Li, Ruixue Ye, Linlin Shan, Kun Wang, Kaiwen Xue, Zeyu Zhang, Yingzi Hao, Yucong Zou, Xiaoxuan Li, Yulong Wang","doi":"10.2196/64464","DOIUrl":"10.2196/64464","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Stratified health care systems are used globally to optimize medical resource allocation and enhance patient care experiences. Although successfully implemented in countries like the United Kingdom, Australia, and Canada, China's introduction of stratified health care in 2015 has achieved progress in disease management but still faces challenges due to the lack of a comprehensive referral evaluation system and patients' preference for higher-tier medical institutions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to investigate the factors influencing Chinese rehabilitation physicians' referral decisions for outpatient rehabilitation patients. The findings may provide empirical evidence for developing stratified rehabilitation triage tools and constructing a referral evaluation system in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study, conducted from September 2023 to January 2024, examined the patient factors (diagnosis, functional impairments, disease status, condition stability, duration of illness, and functional status measured via the Longshi Scale) impacting physicians' referral decisions for outpatient rehabilitation services in China. Data were collected through convenient stratified sampling from physicians and outpatient rehabilitation patients across 12 medical institutions in 5 cities in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 131 rehabilitation physicians conducted diversion assessments for 1984 outpatient rehabilitation patients in this study. In total, 45.5% (902/1984) of outpatient rehabilitation patients were considered by physicians to be referred to rehabilitation outpatient clinics, 19% (376/1984) to primary health care institutions, 20.4% (405/1984) to secondary institutions, and 15.2% (301/1984) to tertiary institutions. Single-factor analysis indicated that age, disease, functional impairment, disease control, disease stability, and Longshi Scale results were significantly associated with physicians' decisions regarding the referral institutions for outpatient rehabilitation patients. Logistic regression analysis showed that neurological disorders (odds ratio [OR] 1.88, 95% CI 1.02-3.43; P=.04), cardiopulmonary diseases (OR 2.91, 95% CI 1.07-7.93; P=.04), geriatric conditions (OR 0.40, 95% CI 0.23-0.68; P&lt;.001), disease control (OR 0.23, 95% CI 0.13-0.34; P&lt;.001), and Longshi Scale results for the bedridden (OR 0.10, 95% CI 0.14-0.34; P&lt;.001), and domestic groups (OR 0.24, 95% CI 0.14-0.34; P&lt;.001) as independent factors for referrals to tertiary versus primary institutions. Orthopedic diseases (OR 3.27, 95% CI 1.89-5.67; P&lt;.001), geriatric conditions (OR 0.58, 95% CI 0.33-1.87; P=.009), cognitive impairments (OR 1.98, 95% CI 1.17-3.36; P=.01), multiple impairments (OR 0.35, 95% CI 0.18-0.70; P=.002), and disease control (OR 0.26, 95% CI 0.15-0.37; P&lt;.001) were key factors for tertiary versus secondary referrals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In advancin","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e64464"},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lactation Consultant Access and Breastfeeding Outcomes in the United States: Cross-Sectional Analysis.","authors":"James F Dockins, Heather D Pahl, David J Lingerfelt","doi":"10.2196/70098","DOIUrl":"10.2196/70098","url":null,"abstract":"<p><strong>Background: </strong>Breastfeeding provides unmatched health, developmental, and economic benefits to both infants and mothers, yet breastfeeding continuation rates remain suboptimal in the United States, especially beyond the early postpartum period. Despite well-documented advantages, many mothers face challenges that lead to early cessation, including lack of access to skilled lactation support. International Board Certified Lactation Consultants (IBCLCs) are considered the clinical gold standard in lactation care, but their availability varies widely across states. Understanding how IBCLC access relates to breastfeeding outcomes at the population level is critical to informing equitable public health interventions.</p><p><strong>Objective: </strong>The aim of this study is to determine whether state-level IBCLC density is associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months.</p><p><strong>Methods: </strong>This cross-sectional analysis used publicly available 2022 data from the Centers for Disease Control and Prevention, US Census Bureau, and the International Board of Lactation Consultant Examiners. IBCLC density per 100,000 women of childbearing age (15-49 years) was calculated for each of the 50 US states. Breastfeeding outcome data included initiation, exclusive breastfeeding at 3 months, and exclusive breastfeeding at 6 months. Simple and multiple linear regressions were conducted to evaluate the association between IBCLC density and breastfeeding outcomes, adjusting for income, education, and insurance coverage.</p><p><strong>Results: </strong>IBCLC density ranged from 14.4 to 60.7 per 100,000 women of childbearing age across US states, with a national average of 25.5. Pearson correlation analysis indicated significant positive associations between IBCLC density and breastfeeding outcomes, including initiation (r=0.38; P<.001), exclusive breastfeeding at 3 months (r=0.52; P<.001), and exclusive breastfeeding at 6 months (r=0.32; P<.001). In multiple linear regression models adjusting for income, education, and insurance status, IBCLC density remained significantly associated with all 3 outcomes. For breastfeeding initiation, the adjusted β was 0.26 (95% CI 0.08-0.44; P=.005); for exclusive breastfeeding at 3 months, β was 0.43 (95% CI 0.23-0.63; P<.001); and for exclusive breastfeeding at 6 months, β was 0.25 (95% CI 0.12-0.39; P<.001). Adjusted R² values for the models ranged from 0.42 to 0.44, indicating moderate explanatory power.</p><p><strong>Conclusions: </strong>Higher IBCLC density is significantly associated with improved breastfeeding outcomes at the state level, particularly exclusive breastfeeding at 3 months. These findings support initiatives to expand access to professional lactation support as part of public health strategies to improve breastfeeding rates.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e70098"},"PeriodicalIF":1.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"French Versions of 2 English Questionnaires on Problematic Digital Use Assessed by Adolescents and Their Parents: Cross-Cultural Linguistic Translation and Adaptation Study.","authors":"Islam El Boudi, Mathilde Riant, Alexandre Bellier, Nicolas Vuillerme","doi":"10.2196/55685","DOIUrl":"10.2196/55685","url":null,"abstract":"<p><strong>Background: </strong>The emergence of problematic digital use is increasingly alarming, affecting between 7% and 20% of the world's adolescent population. However, there is no validated questionnaire in French to measure this. Only a few questionnaires, either self-reported by adolescents or hetero-reported by parents, have been translated and validated in English.</p><p><strong>Objective: </strong>This study aims to translate into French the Digital Addiction Scale for Children (DASC), which is self-reported by adolescents, and the Problematic Media Use Measure (PMUM), which is hetero-reported by parents of adolescents.</p><p><strong>Methods: </strong>We used the \"forward and backward\" method to establish the translation and achieve cross-cultural adaptation with 8 parents and 8 adolescents aged between 12 and 17 years. There were three stages: (1) initial translation and synthesis or reconciliation of the translations phase; (2) back translation and expert committee phase; and (3) pretesting phase, during which 8 parents completed the PMUM questionnaire and 8 adolescents completed the DASC questionnaire.</p><p><strong>Results: </strong>Despite slight variations in translation for both questionnaires, the translators quickly reached a consensus during the translation phase. The expert committee did not propose any other conceptual changes. In the final phase, the parents made no comments to improve the questions or the wording. Although some adolescents mentioned repetition between certain questions, they did not suggest any improvements to the DASC questionnaire in French.</p><p><strong>Conclusions: </strong>Although the translated versions of the DASC and PMUM questionnaires provide a foundation for detecting problematic digital use, they require further validation studies to confirm their reliability and applicability in the French adolescent population.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e55685"},"PeriodicalIF":1.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readmission After Ischemic Stroke in Ningxia, China, From 2017 to 2021: Retrospective Cohort Study.","authors":"Hua Meng, Xingtian Wang, Dongfeng Pan, Xinya Su, Wenwen Lu, Zhuo Liu, Yuhui Geng, Xiaojuan Ma, Ting Pan, Peifeng Liang","doi":"10.2196/67522","DOIUrl":"10.2196/67522","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a major cause of death and disability worldwide. Ischemic stroke is the most common type of stroke. Readmissions after hospitalization increase the patient burden and waste health resources.</p><p><strong>Objective: </strong>This study aimed to calculate rehospitalization rates and explore risk factors associated with rehospitalization in ischemic stroke.</p><p><strong>Methods: </strong>In this retrospective cohort study, we identified 12,782 patients admitted for ischemic stroke at People's Hospital of Ningxia Hui Autonomous Region between January 2017 and December 2021. Groups were determined based on the ID number. The most important factors were selected using the Least Absolute Shrinkage and Selection Operator regression model. Stabilized inverse probability of treatment weighting (SIPTW) was used to correct baseline imbalances between groups. The adjusted hazard ratios and Kaplan-Meier survival curves of significant factors after SIPTW were calculated using stepwise backward Cox regression.</p><p><strong>Results: </strong>A total of 10,727 patients were included in the study. Among them, 12.7% and 7.2% were readmitted within 5 years and 1 year, respectively. Stepwise backward Cox analysis of SIPTW showed that diabetes was the influencing factor for rehospitalization within 5 years (1.15, 1.02-1.30) and 1 year (1.21, 1.03-1.43). Additionally, the female gender was identified as a protective factor against readmission within 5 years (0.83, 0.74-0.93).</p><p><strong>Conclusions: </strong>Although the rate of rehospitalization varied among patients with ischemic stroke at different time points, the significant factors remained consistent. Therefore, early prevention and treatment methods may be consistent.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e67522"},"PeriodicalIF":1.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Fortified Malt-Based Food on Immunity Outcomes in School Children in India: Cluster Randomized Controlled Trial.","authors":"Anuradha Khadilkar, Vinay Rawat, Jaladhi Bhatt, Devyani Chaturvedi, Vivek Garg, Pankaj Verma","doi":"10.2196/54189","DOIUrl":"10.2196/54189","url":null,"abstract":"<p><strong>Background: </strong>Nutritional inadequacy and consequent diminished immunity among school-age children is a public health problem in India. Nutrition interventional studies using a cluster randomized controlled trial (RCT) design can avoid ethical issues inherent in double-blind individual RCTs in children involving daily administration of an empty-calorie placebo.</p><p><strong>Objective: </strong>We tested the hypothesis that daily administration of a fortified malt-based food (FMBF), a multinutrient supplement, would improve immunity outcomes against common infectious diseases, nutritional status, and gut health in Indian school-age children by using a cluster RCT design. This report presents the study design attributes and the baseline characteristics of the study population.</p><p><strong>Methods: </strong>This was an open-label, 2-arm, parallel-group, matched-pair cluster RCT, stratified by gender, in children aged ≥7 to ≤10 years old with height-for-age z scores (HAZ) of ≥-3 to ≤-1 and good general health. Four schools located in Pune city in India participated in the study. Each school was deemed as a cluster and was randomized to the test group (FMBF and dietary counseling) or control group (dietary counseling alone). A total of 924 participants from the 4 randomized schools were enrolled in the study.</p><p><strong>Results: </strong>Observed mean age (SD) was 8.0 (SD 0.81; range: 7-10) years. There was no significant difference in mean age (P=.06), gender (P=.55), race (P>.99), HAZ category (P=.051), HAZ (P=.17), and BMI (P=.03). A very large proportion of children had micronutrient inadequacies in terms of vitamin D (97.5%), folate (79.2%), zinc (66%), and vitamin A (34.3%) at baseline. The study design meant that administration of the study intervention at a cluster level was easy. Mean compliance with the test product was 99.99% and retention in the study was 98%.</p><p><strong>Conclusions: </strong>The findings highlight the extent of nutritional inadequacies in Indian school-age children, reaffirming the need for nutritional strategies to optimize the nutritional status among these children. A cluster RCT design can be effectively used in nutritional intervention trials with children by maintaining high compliance and retention.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"14 ","pages":"e54189"},"PeriodicalIF":1.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}