JMIRx med最新文献

{"title":"Large Language Models for Pediatric Differential Diagnoses in Rural Health Care: Multicenter Retrospective Cohort Study Comparing GPT-3 With Pediatrician Performance.","authors":"Masab Mansoor, Andrew F Ibrahim, David Grindem, Asad Baig","doi":"10.2196/65263","DOIUrl":"10.2196/65263","url":null,"abstract":"<p><strong>Background: </strong>Rural health care providers face unique challenges such as limited specialist access and high patient volumes, making accurate diagnostic support tools essential. Large language models like GPT-3 have demonstrated potential in clinical decision support but remain understudied in pediatric differential diagnosis.</p><p><strong>Objective: </strong>This study aims to evaluate the diagnostic accuracy and reliability of a fine-tuned GPT-3 model compared to board-certified pediatricians in rural health care settings.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study analyzed 500 pediatric encounters (ages 0-18 years; n=261, 52.2% female) from rural health care organizations in Central Louisiana between January 2020 and December 2021. The GPT-3 model (DaVinci version) was fine-tuned using the OpenAI application programming interface and trained on 350 encounters, with 150 reserved for testing. Five board-certified pediatricians (mean experience: 12, SD 5.8 years) provided reference standard diagnoses. Model performance was assessed using accuracy, sensitivity, specificity, and subgroup analyses.</p><p><strong>Results: </strong>The GPT-3 model achieved an accuracy of 87.3% (131/150 cases), sensitivity of 85% (95% CI 82%-88%), and specificity of 90% (95% CI 87%-93%), comparable to pediatricians' accuracy of 91.3% (137/150 cases; P=.47). Performance was consistent across age groups (0-5 years: 54/62, 87%; 6-12 years: 47/53, 89%; 13-18 years: 30/35, 86%) and common complaints (fever: 36/39, 92%; abdominal pain: 20/23, 87%). For rare diagnoses (n=20), accuracy was slightly lower (16/20, 80%) but comparable to pediatricians (17/20, 85%; P=.62).</p><p><strong>Conclusions: </strong>This study demonstrates that a fine-tuned GPT-3 model can provide diagnostic support comparable to pediatricians, particularly for common presentations, in rural health care. Further validation in diverse populations is necessary before clinical implementation.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e65263"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665557","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":"Data Obfuscation Through Latent Space Projection for Privacy-Preserving AI Governance: Case Studies in Medical Diagnosis and Finance Fraud Detection.","authors":"Mahesh Vaijainthymala Krishnamoorthy","doi":"10.2196/70100","DOIUrl":"10.2196/70100","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The increasing integration of artificial intelligence (AI) systems into critical societal sectors has created an urgent demand for robust privacy-preserving methods. Traditional approaches such as differential privacy and homomorphic encryption often struggle to maintain an effective balance between protecting sensitive information and preserving data utility for AI applications. This challenge has become particularly acute as organizations must comply with evolving AI governance frameworks while maintaining the effectiveness of their AI systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This paper aims to introduce and validate data obfuscation through latent space projection (LSP), a novel privacy-preserving technique designed to enhance AI governance and ensure responsible AI compliance. The primary goal is to develop a method that can effectively protect sensitive data while maintaining essential features necessary for AI model training and inference, thereby addressing the limitations of existing privacy-preserving approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We developed LSP using a combination of advanced machine learning techniques, specifically leveraging autoencoder architectures and adversarial training. The method projects sensitive data into a lower-dimensional latent space, where it separates sensitive from nonsensitive information. This separation enables precise control over privacy-utility trade-offs. We validated LSP through comprehensive experiments on benchmark datasets and implemented 2 real-world case studies: a health care application focusing on cancer diagnosis and a financial services application analyzing fraud detection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;LSP demonstrated superior performance across multiple evaluation metrics. In image classification tasks, the method achieved 98.7% accuracy while maintaining strong privacy protection, providing 97.3% effectiveness against sensitive attribute inference attacks. This performance significantly exceeded that of traditional anonymization and privacy-preserving methods. The real-world case studies further validated LSP's effectiveness, showing robust performance in both health care and financial applications. Additionally, LSP demonstrated strong alignment with global AI governance frameworks, including the General Data Protection Regulation, the California Consumer Privacy Act, and the Health Insurance Portability and Accountability Act.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;LSP represents a significant advancement in privacy-preserving AI, offering a promising approach to developing AI systems that respect individual privacy while delivering valuable insights. By embedding privacy protection directly within the machine learning pipeline, LSP contributes to key principles of fairness, transparency, and accountability. Future research directions include developing theoretical privacy guarantees, exploring integration with federated learning systems, and e","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e70100"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617963","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":"Predicting Escalation of Care for Childhood Pneumonia Using Machine Learning: Retrospective Analysis and Model Development.","authors":"Oguzhan Serin, Izzet Turkalp Akbasli, Sena Bocutcu Cetin, Busra Koseoglu, Ahmet Fatih Deveci, Muhsin Zahid Ugur, Yasemin Ozsurekci","doi":"10.2196/57719","DOIUrl":"10.2196/57719","url":null,"abstract":"<p><strong>Background: </strong>Pneumonia is a leading cause of mortality in children aged <5 years. While machine learning (ML) has been applied to pneumonia diagnostics, few studies have focused on predicting the need for escalation of care in pediatric cases. This study aims to develop an ML-based clinical decision support tool for predicting the need for escalation of care in community-acquired pneumonia cases.</p><p><strong>Objective: </strong>The primary objective was to develop a robust predictive tool to help primary care physicians determine where and how a case should be managed.</p><p><strong>Methods: </strong>Data from 437 children with community-acquired pneumonia, collected before the COVID-19 pandemic, were retrospectively analyzed. Pediatricians encoded key clinical features from unstructured medical records based on Integrated Management of Childhood Illness guidelines. After preprocessing with Synthetic Minority Oversampling Technique-Tomek to handle imbalanced data, feature selection was performed using Shapley additive explanations values. The model was optimized through hyperparameter tuning and ensembling. The primary outcome was the level of care severity, defined as the need for referral to a tertiary care unit for intensive care or respiratory support.</p><p><strong>Results: </strong>A total of 437 cases were analyzed, and the optimized models predicted the need for transfer to a higher level of care with an accuracy of 77% to 88%, achieving an area under the receiver operator characteristic curve of 0.88 and an area under the precision-recall curve of 0.96. Shapley additive explanations value analysis identified hypoxia, respiratory distress, age, weight-for-age z score, and complaint duration as the most important clinical predictors independent of laboratory diagnostics.</p><p><strong>Conclusions: </strong>This study demonstrates the feasibility of applying ML techniques to create a prognostic care decision tool for childhood pneumonia. It provides early identification of cases requiring escalation of care by combining foundational clinical skills with data science methods.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e57719"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558786","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 a Point-of-Care Ultrasound Training Program on the Management of Patients With Acute Respiratory or Circulatory Failure by In-Training Emergency Department Residents (IMPULSE): Before-and-After Implementation Study.","authors":"Sandra Bieler, Stephan von Düring, Damien Tagan, Olivier Grosgurin, Thierry Fumeaux","doi":"10.2196/53276","DOIUrl":"10.2196/53276","url":null,"abstract":"<p><strong>Background: </strong>Due to its diagnostic accuracy, point-of-care ultrasound (POCUS) is becoming more frequently used in the emergency department (ED), but the feasibility of its use by in-training residents and the potential clinical impact have not been assessed.</p><p><strong>Objective: </strong>This study aimed to assess the feasibility of implementing a structured POCUS training program for in-training ED residents, as well as the clinical impact of their use of POCUS in the management of patients in the ED.</p><p><strong>Methods: </strong>IMPULSE (Impact of a Point-of Care Ultrasound Examination) is a before-and-after implementation study evaluating the impact of a structured POCUS training program for ED residents on the management of patients admitted with acute respiratory failure (ARF) and/or circulatory failure (ACF) in a Swiss regional hospital. The training curriculum was organized into 3 steps and consisted of a web-based training course; an 8-hour, practical, hands-on session; and 10 supervised POCUS examinations. ED residents who successfully completed the curriculum participated in the postimplementation phase of the study. Outcomes were time to ED diagnosis, rate and time to correct diagnosis in the ED, time to prescribe appropriate treatment, and in-hospital mortality. Standard statistical analyses were performed using chi-square and Mann-Whitney U tests as appropriate, supplemented by Bayesian analysis, with a Bayes factor (BF)>3 considered significant.</p><p><strong>Results: </strong>A total of 69 and 54 patients were included before and after implementation of the training program, respectively. The median time to ED diagnosis was 25 (IQR 15-60) minutes after implementation versus 30 (IQR 10-66) minutes before implementation, a difference that was significant in the Bayesian analysis (BF=9.6). The rate of correct diagnosis was higher after implementation (51/54, 94% vs 36/69, 52%; P<.001), with a significantly shorter time to correct diagnosis after implementation (25, IQR 15-60 min vs 43, IQR 11-70 min; BF=5.0). The median time to prescribe the appropriate therapy was shorter after implementation (47, IQR 25-101 min vs 70, IQR 20-120 min; BF=2.0). Finally, there was a significant difference in hospital mortality (9/69, 13% vs 3/54, 6%; BF=15.7).</p><p><strong>Conclusions: </strong>The IMPULSE study shows that the implementation of a short, structured POCUS training program for ED residents is not only feasible but also has a significant impact on their initial evaluation of patients with ARF and/or ACF, improving diagnostic accuracy, time to correct diagnosis, and rate of prescribing the appropriate therapy and possibly decreasing hospital mortality. These results should be replicated in other settings to provide further evidence that implementation of a short, structured POCUS training curriculum could significantly impact ED management of patients with ARF and/or ACF.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e53276"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598431","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":"Checklist Approach to Developing and Implementing AI in Clinical Settings: Instrument Development Study.","authors":"Ayomide Owoyemi, Joanne Osuchukwu, Megan E Salwei, Andrew Boyd","doi":"10.2196/65565","DOIUrl":"10.2196/65565","url":null,"abstract":"<p><strong>Background: </strong>The integration of artificial intelligence (AI) in health care settings demands a nuanced approach that considers both technical performance and sociotechnical factors.</p><p><strong>Objective: </strong>This study aimed to develop a checklist that addresses the sociotechnical aspects of AI deployment in health care and provides a structured, holistic guide for teams involved in the life cycle of AI systems.</p><p><strong>Methods: </strong>A literature synthesis identified 20 relevant studies, forming the foundation for the Clinical AI Sociotechnical Framework checklist. A modified Delphi study was then conducted with 35 global health care professionals. Participants assessed the checklist's relevance across 4 stages: \"Planning,\" \"Design,\" \"Development,\" and \"Proposed Implementation.\" A consensus threshold of 80% was established for each item. IQRs and Cronbach α were calculated to assess agreement and reliability.</p><p><strong>Results: </strong>The initial checklist had 45 questions. Following participant feedback, the checklist was refined to 34 items, and a final round saw 100% consensus on all items (mean score >0.8, IQR 0). Based on the outcome of the Delphi study, a final checklist was outlined, with 1 more question added to make 35 questions in total.</p><p><strong>Conclusions: </strong>The Clinical AI Sociotechnical Framework checklist provides a comprehensive, structured approach to developing and implementing AI in clinical settings, addressing technical and social factors critical for adoption and success. This checklist is a practical tool that aligns AI development with real-world clinical needs, aiming to enhance patient outcomes and integrate smoothly into health care workflows.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e65565"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470088","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":"Determinants of Periodic Health Examination Uptake: Insights From a Jordanian Cross-Sectional Study.","authors":"Abdul Aziz Tayoun","doi":"10.2196/57597","DOIUrl":"10.2196/57597","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Routine periodic health examinations (PHEs) for adults who are asymptomatic are included in clinical preventive services. They aim to prevent morbidity and mortality by identifying modifiable risk factors and early signs of treatable diseases. PHEs are a standard procedure in primary health care worldwide, including in Jordan. The country is undergoing an epidemiological transition toward noncommunicable diseases, which are the leading causes of morbidity and mortality. The prevalence of smoking is among the highest in the world, with escalating rates of obesity and physical inactivity. Notably, hypertension and diabetes are the most prevalent diseases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to determine the extent to which individuals in Jordan participate in PHEs and to evaluate the various factors related to sociodemographics, health, knowledge, and behavior that influence this participation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study used a cross-sectional design and includes 362 participants 18 years or older residing in Jordan. A convenience sampling method was used, and data were collected through a hybrid web-based and face-to-face questionnaire. The analysis involved the application of logistic regression through SPSS to investigate the relationship between various influencing factors and the uptake of PHEs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our study indicated that only 98 of the 362 (27.1%, 95% CI 22.8%-31.9%) participants underwent PHEs within the last 2 years. Noteworthy predictors of PHE uptake among Jordanians included recent visits to a primary health care facility within the previous year (adjusted odds ratio [AOR] 4.32, 95% CI 2.40-7.76; P&lt;.001), monthly income (P=.02; individuals with a monthly income of 1500-2000 JD displayed more than five times the odds of undertaking PHEs than those with a monthly income &lt;500 JD; AOR 5.74, 95% CI 1.32-24.90; P=.02; those with a monthly income of more than 2000 JD exhibited even higher odds; AOR 9.81, 95% CI 1.73-55.55; P=.02; a currency exchange rate of 1 JD=US $1.43 is applicable), and knowledge levels regarding PHEs and preventive health measures (AOR 1.23, 95% CI 1.03-1.47; P=.007). These variables emerged as the strongest predictors in our analysis, shedding light on key factors influencing PHE uptake in the population. Contrary to other research, our study did not find any statistically significant association between gender (P=.33), smoking status (P=.76), marital status (P=.52), health status self-evaluation (P=.18), seasonal influenza vaccination (P=.07), combined health behavior factors (P=.34), and BMI (P=.76) and PHE uptake.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;PHE uptake is notably low in Jordan. Critical determinants of this uptake include recent visits to a primary health care facility within the previous year, monthly income, and knowledge levels regarding PHEs and preventive health services. To enhance PHE uptake, there is a critical n","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e57597"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257564","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":"Converting Organic Municipal Solid Waste Into Volatile Fatty Acids and Biogas: Experimental Pilot and Batch Studies With Statistical Analysis.","authors":"Hojjat Borhany","doi":"10.2196/50458","DOIUrl":"10.2196/50458","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Italy can augment its profit from biorefinery products by altering the operation of digesters or different designs to obtain more precious bioproducts like volatile fatty acids (VFAs) than biogas from organic municipal solid waste. In this context, recognizing the process stability and outputs through operational interventions and its technical and economic feasibility is a critical issue. Hence, this study involves an anaerobic digester in Treviso in northern Italy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This research compares a novel line, consisting of pretreatment, acidogenic fermentation, and anaerobic digestion, with single-step anaerobic digestion regarding financial profit and surplus energy. Therefore, a mass flow model was created and refined based on the outputs from the experimental and numerical studies. These studies examine the influence of hydraulic retention time (HRT), pretreatment, biochar addition, and fine-tuned feedstock/inoculum (FS/IN) ratio on bioproducts and operational parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;VFA concentration, VFA weight ratio distribution, and biogas yield were quantified by gas chromatography. A t test was then conducted to analyze the significance of dissimilar HRTs in changing the VFA content. Further, a feasible biochar dosage was identified for an assumed FS/IN ratio with an adequately long HRT using the first-order rate model. Accordingly, the parameters for a mass flow model were adopted for 70,000 population equivalents to determine the payback period and surplus energy for two scenarios. We also explored the effectiveness of amendments in improving the process kinetics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both HRTs were identical concerning the ratio of VFA/soluble chemical oxygen demand (0.88 kg/kg) and VFA weight ratio distribution: mainly, acetic acid (40%), butyric acid (24%), and caproic acid (17%). However, a significantly higher mean VFA content was confirmed for an HRT of 4.5 days than the quantity for an HRT of 3 days (30.77, SD 2.82 vs 27.66, SD 2.45 g-soluble chemical oxygen demand/L), using a t test (t8=-2.68; P=.03; CI=95%). In this research, 83% of the fermented volatile solids were converted into biogas to obtain a specific methane (CH4) production of 0.133 CH4-Nm3/kg-volatile solids. While biochar addition improved only the maximum methane content by 20% (86% volumetric basis [v/v]), the FS/IN ratio of 0.3 volatile solid basis with thermal plus fermentative pretreatment improved the hydrolysis rate substantially (0.57 vs 0.07, 1/d). Furthermore, the biochar dosage of 0.12 g-biochar/g-volatile solids with an HRT of 20 days was identified as a feasible solution. Principally, the payback period for our novel line would be almost 2 years with surplus energy of 2251 megajoules [MJ] per day compared to 45 years and 21,567 MJ per day for single-step anaerobic digestion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This research elaborates on the advantage of the refi","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e50458"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191413","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":"Mothers' Knowledge of and Practices Toward Oral Hygiene of Children Aged 5-9 Years in Bangladesh: Cross-Sectional Study.","authors":"Tahazid Tamannur, Sadhan Kumar Das, Arifatun Nesa, Foijun Nahar, Nadia Nowshin, Tasnim Haque Binty, Shafiul Azam Shakil, Shuvojit Kumar Kundu, Md Abu Bakkar Siddik, Shafkat Mahmud Rafsun, Umme Habiba, Zaki Farhana, Hafiza Sultana, Anton Abdulbasah Kamil, Mohammad Meshbahur Rahman","doi":"10.2196/59379","DOIUrl":"10.2196/59379","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Healthy oral hygiene is crucial for overall health and well-being. Parents' dental care knowledge and practices affect their children's oral health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study examined mothers' knowledge and practices regarding their children's oral hygiene through a cross-sectional survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional survey was conducted from January 1 to December 31, 2022, in Dhaka, Bangladesh. Mothers' knowledge and practices regarding their children's oral hygiene were assessed through a semistructured questionnaire. Statistical analyses, including the χ2 test and Pearson correlation test, were performed. The Mann-Whitney U and Kruskal-Wallis 1-way ANOVA tests were also used to show the average variations in knowledge and practices among different sociodemographic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 400 participants, the mean age of mothers was 30.94 (SD 5.15) years, and 388 (97%) were of the Muslim faith, 347 (86.8%) were housewives, and 272 (68%) came from nuclear families. A total of 165 (41.3%) participants showed good knowledge of their children's oral hygiene, followed by 86 (21.5%) showing moderately average knowledge, 75 (18.8%) showing average knowledge, and 74 (18.5%) showing poor knowledge. A total of 182 (45.5%) mothers had children with good oral hygiene practices, followed by mothers with children who had average (n=78, 19.5%), moderately average (n=75, 18.8%), and poor (n=65, 16.3%) oral hygiene practices. The mother's knowledge level was significantly associated with age (P=.01), education (P&lt;.001), family size (P=.03), and monthly income (P&lt;.001). On the other hand, educational status (P=.002) and income (P=.04) were significantly associated with the mother's practices regarding their children's oral hygiene. Nonparametric analysis revealed that mothers who were older (mean knowledge score: 12.13, 95% CI 10.73-13.54 vs 11.21, 95% CI 10.85-11.58; P=.01), with a bachelor's degree or higher (mean knowledge score: 12.93, 95% CI 12.55-13.31 vs 9.66, 95% CI 8.95-10.37; P&lt;.001), who were working mothers (mean knowledge score: 12.30, 95% CI 11.72-12.89 vs 11.45, 95% CI 11.17-11.73; P=.03), and who had a higher family income (mean knowledge score: 12.49, 95% CI 12.0-12.98 vs 10.92, 95% CI 10.48-11.36; P&lt;.001) demonstrated significantly higher levels of oral health knowledge. Conversely, good oral hygiene practices were significantly associated with higher maternal education (mean practice score: 6.88, 95% CI 6.54-7.22 vs 6.01, 95% CI 5.63-6.40; P&lt;.001) and family income (mean practice score: 6.77, 95% CI 6.40-7.14 vs 5.96, 95% CI 5.68-6.24; P=.002). The mother's knowledge was also significantly and positively correlated (Pearson correlation coefficient r=0.301; P&lt;.001) with their children's oral hygiene practices, shown by both the Pearson chi-square (χ2=25.2; P&lt;.001) test and correlation coefficient.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The mothers' know","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e59379"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257567","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":"Identifying Safeguards Disabled by Epstein-Barr Virus Infections in Genomes From Patients With Breast Cancer: Chromosomal Bioinformatics Analysis.","authors":"Bernard Friedenson","doi":"10.2196/50712","DOIUrl":"10.2196/50712","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The causes of breast cancer are poorly understood. A potential risk factor is Epstein-Barr virus (EBV), a lifelong infection nearly everyone acquires. EBV-transformed human mammary cells accelerate breast cancer when transplanted into immunosuppressed mice, but the virus can disappear as malignant cells reproduce. If this model applies to human breast cancers, then they should have genome damage characteristic of EBV infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study tests the hypothesis that EBV infection predisposes one to breast cancer by causing permanent genome damage that compromises cancer safeguards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Publicly available genome data from approximately 2100 breast cancers and 25 ovarian cancers were compared to cancers with proven associations to EBV, including 70 nasopharyngeal cancers, 90 Burkitt lymphomas, 88 diffuse large B-cell lymphomas, and 34 gastric cancers. Calculation algorithms to make these comparisons were developed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Chromosome breakpoints in breast and ovarian cancer clustered around breakpoints in EBV-associated cancers. Breakpoint distributions in breast and EBV-associated cancers on some chromosomes were not confidently distinguished (P&gt;.05), but differed from controls unrelated to EBV infection. Viral breakpoint clusters occurred in high-risk, sporadic, and other breast cancer subgroups. Breakpoint clusters disrupted gene functions essential for cancer protection, which remain compromised even if EBV infection disappears. As CRISPR (clustered regularly interspaced short palindromic repeats)-like reminders of past infection during evolution, EBV genome fragments were found regularly interspaced between Piwi-interacting RNA (piRNA) genes on chromosome 6. Both breast and EBV-associated cancers had inactivated genes that guard piRNA defenses and the major histocompatibility complex (MHC) locus. Breast and EBV-associated cancer breakpoints and other variations converged around the highly polymorphic MHC. Not everyone develops cancer because MHC differences produce differing responses to EBV infection. Chromosome shattering and mutation hot spots in breast cancers preferentially occurred at incorporated viral sequences. On chromosome 17, breast cancer breakpoints that clustered around those in EBV-mediated cancers were linked to estrogen effects. Other breast cancer breaks affected sites where EBV inhibits JAK-STAT and SWI-SNF signaling pathways. A characteristic EBV-cancer gene deletion that shifts metabolism to favor tumors was also found in breast cancers. These changes push breast cancer into metastasis and then favor survival of metastatic cells.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;EBV infection predisposes one to breast cancer and metastasis, even if the virus disappears. Identifying this pathogenic viral damage may improve screening, treatment, and prevention. Immunizing children against EBV may protect against breast, ova","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e50712"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070049","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":"The Impact of Rural Alimentation on the Motivation and Retention of Indigenous Community Health Workers in India: A Qualitative Study.","authors":"Ajit Kerketta, Raghavendra A N","doi":"10.2196/48346","DOIUrl":"10.2196/48346","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Rural health care delivery remains a global challenge and India is no exception, particularly in regions with Indigenous populations such as the state of Jharkhand. The Community Health Centres in Jharkhand, India, are staffed by Indigenous workers who play a crucial role in bridging the health care gap. However, their motivation and retention in these challenging areas are often influenced by a complex mix of sociocultural and environmental factors. One such significant but understudied influencing factor is alimentation, or nutrition, in rural settings. Previous studies have identified several motivators, including community ties, cultural alignment, job satisfaction, and financial incentives. However, the role of alimentation in their motivation and retention in rural areas has not been sufficiently explored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to explore how the strong bond with locally produced food products impacts the retention of Indigenous community health workers (CHWs) in Jharkhand, India, and shed light on a crucial aspect of rural health care workforce sustainability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study adopted a phenomenological research design to explore the lived experiences and perspectives of Indigenous CHWs in Jharkhand. A purposive sampling method was used to select CHWs who had worked in rural areas for at least five years. Data were collected through semistructured interviews, focusing on the participants' experiences of rural alimentation and how it influences their motivation and retention for rural health care. The interviews were audio recorded, transcribed, and analyzed using thematic analysis to identify common themes and patterns in their experiences related to nutrition and retention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study revealed that rural alimentation plays a significant role in both the motivation and retention of CHWs in Jharkhand. CHWs who experienced consistent access to local food reported higher job satisfaction, better physical well-being, and a stronger commitment to their roles. It has also been perceived that consuming nutrient-dense food products decreases the risk of chronic illness among rural populations. Additionally, community support systems related to alimentation were found to be crucial in maintaining motivation, with many CHWs emphasizing the importance of local food availability and cultural ties. The findings suggest that improving access to organic nutrition can positively influence the retention of CHWs in rural areas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Indigenous communities have unique food habits and preferences deeply rooted in agriculture and arboriculture. Their traditional eating practices are integral to their rich cultural heritage, with significant social, symbolic, and spiritual importance. This study highlights the critical role of rural alimentation in motivating and retaining CHWs in rural Community Health Centres in J","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e48346"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025926","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}