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Journal Description

The Interactive Journal of Medical Research (i-JMR, ISSN: 1929-073X, Journal Impact Factor of 2.2, Journal Citation Reports 2025 from Clarivate) is an interdisciplinary medical journal focusing on innovation in health, health care, and medicine. Interactive refers to the relationship between people, disciplines, organizations, systems, and/or technology (e.g. human-to-human, human-to-computer/systems, organization-to-organization, system-to-system, etc). The publications cover multiple areas of health sciences, including - but not limited to - cardiology, dermatology, dental sciences, kinesiology, neurology, nursing, nutrition, ophthalmology, and psychiatry. Innovation is evidenced through studies that: (1) present clinically relevant findings, (2) describe new medical techniques, (3) report unique medical cases, and (4) identify emerging trends in the current literature. All article types are considered for publication in i-JMR, including case reports, observational studies, interventional studies, viewpoints, bibliometric studies and literature reviews, as long as they present innovation. i-JMR is published by JMIR Publications (What is JMIR Publications?), the publisher of JMIR, the leading eHealth/mHealth journal.

i-JMR is indexed in PubMed, PubMed CentralDOAJ, Sherpa/Romeo, EBSCO, and Clarivate's Emerging Sources Citation Index (ESCI).

 

Recent Articles:

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/close-up-female-s-hand-using-smartphone_2593245.htm; License: Licensed by JMIR.

    Obesity Prevention and Reduction in China Using the Social Media Platform WeChat: Scoping Review

    Abstract:

    Background: Digital interventions for obesity have been shown to be effective in reducing and preventing obesity. The emergence of smart phones and popular applications such as WeChat represent potential modalities that might enhance the reach and sustainability of obesity interventions and reduce costs of implementation. By the end of first quarter in 2024, there were approximately 1.36 billion monthly active users of WeChat accounting for 96.5% of the whole Chinese population The potential of this widely used app for obesity interventions has been noted in multiple Chinese intervention trials, most of which have been published in Chinese language journals. Objective: We aim to summarize the existing evidence on obesity interventions delivered through WeChat to provide implications for intervention development in the future, and to reach an international audience. Methods: A scoping review of PubMed and China National Knowledge Infrastructure (CNKI) was conducted to identify research on WeChat-assisted obesity intervention. Results: We conducted a scoping literature review of PubMed and CNKI, which yielded 665 initial studies. Forty-three studies met eligibility criteria and underwent data extraction to provide intervention details. Most studies (86.0%) demonstrated the efficacy of obesity interventions via WeChat in short- and long-term weight loss using objective outcome measures such as body weight, body mass index, waist circumference, hip circumference, waist-to-hip ratio and body fat percentage. However, the studies lack sufficient formative research to inform intervention development. Other common study design flaws included: lack of randomization and/or blinding (97.7%), and no reporting of intervention compliance metrics (92.0%). Most interventions were limited to the “WeChat Groups”, and “Official Accounts” (i.e., public accounts that provide health education materials to followers, record daily diet and physical activity, and other functions) features for delivery. Conclusions: Overall, the WeChat platform could be a promising instrument in obesity interventions, but current applications do not take full advantages of the versatile features of this app (e.g., online payment, live streaming). Future research testing the effectiveness of using WeChat for obesity interventions should include a formative phase and employ a more rigorous study design, such as a randomized controlled trial, to understand the best way to format and deliver obesity interventions using this modality.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/person-having-hearing-issues_36233581.htm; License: Licensed by JMIR.

    Predicting Age-Related Hearing Loss in Community-Dwelling Older Adults: Multicenter Retrospective Cohort Study

    Abstract:

    Background: Age-related hearing loss (ARHL) is associated with severe negative outcomes, including social isolation, depression, and cognitive decline. Despite this, routine ARHL screening is often neglected in primary care due to low awareness, resource limitations, and inefficiencies. A practical risk assessment tool could effectively address this gap. Objective: This study aims to develop and validate a user-friendly nomogram for identifying older adults at high risk of ARHL in community settings, thereby facilitating targeted screening and timely interventions. Methods: This multicenter retrospective cohort study included 34,983 older adults from 3 primary health care centers in Beijing (January 2020 to October 2023). Data from center A (n=18,707) were used for model development, with external validation performed on cohorts from center B (n=11,008) and center C (n=5268). Least absolute shrinkage and selection operator and logistic regression identified the final predictors. Model performance was evaluated using discrimination, calibration, and decision curve analysis, leading to the development of an online nomogram. Results: In the training cohort (center A), 1177 participants (6.3%) had hearing loss. Six key predictors were identified: age, education, exercise frequency, physical function, dietary habits, and hypertension. The multivariate logistic regression model demonstrated good discrimination in internal validation (area under the curve [AUC] 0.806, 95% CI 0.782-0.831; sensitivity 0.774; specificity 0.820). External validation confirmed its generalizability (AUC 0.720, 95% CI 0.670-0.771 and AUC 0.747, 95% CI 0.712-0.782). Decision curve analysis highlighted a substantial clinical net benefit. A user-friendly online prediction web page was also developed. Conclusions: We successfully developed and validated a dynamic, online nomogram for predicting ARHL in older adults. Comprising 6 readily available predictors, this model shows potential as a practical, online tool for proactive risk identification in primary care. However, further validation in larger and more diverse populations is essential to confirm its generalizability and real-world clinical utility.

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/man-woman-wearing-face-mask-home_10163971.htm; License: Licensed by JMIR.

    Impact of the COVID-19 Pandemic on Contraceptive Services at Selected Primary Health Care Facilities in India, Nigeria, and Tanzania: Cross-Sectional Study

    Abstract:

    Background: The COVID-19 pandemic affected the provision of sexual and reproductive health services, including disruptions to family planning and contraceptive services. The World Health Organization conducted a multi-country study in India, Nigeria and Tanzania to determine the impact of the pandemic on the health system's capacity to provide contraception services. In this manuscript, we present findings of health facility assessment on availability and readiness to provide contraceptive services, and a comparison of trends in contraceptive uptake before and during the pandemic. Objective: The objectives of the health facility assessment were to (i) determine the status, availability and health facility readiness to provide contraceptive services in regions/localities most affected during the COVID-19 pandemic and (ii) assess the trends in the provision and uptake of contraceptive services in the facilities over the past 12 months. Methods: This mixed method study was conducted by the Indian Council of Medical Research-National Institute of Research in Reproductive and Child Health (India), the University of Ilorin Teaching Hospital (Nigeria), and the Ifakara Health Institute (Tanzania). Eleven primary health facilities in India, six in Nigeria and thirty-three in Tanzania were evaluated for the readiness of health facilities to provide contraceptive services using a facility assessment questionnaire. The most knowledgeable senior health care provider or administrator on contraceptive service provision in each health facility was selected to complete the questionnaire. Data was collected from May to August 2022. The study received ethical and scientific approval from the WHO Ethics Review Committee and Research Project Review Panel, and national regulatory bodies. In this paper, we compare the findings of the health facility assessment from the three countries. Results: Health facilities in all the three countries experienced shortages of various contraceptives. The disruptions in the use of essential health services, including sexual and reproductive health, contraceptive and abortion services, had a similar pattern in all countries but were most marked in Nigeria and least in Tanzania. There was a decline in clients visiting health facilities in India (30%) and Nigeria (11%) in 2020 compared to 2019, with a gradual recovery in the number of clients. Tanzania did not show a significant decline in number of clients, except for a slight dip (1%) in 2020. Readiness measures such as telemedicine, task shifting, community outreach, triaging, and patient redirection were implemented to minimize service disruption. Conclusions: This study offers crucial insights into the challenges posed by the COVID-19 pandemic on contraceptive services and the measures taken to alleviate them. The findings can help countries to better prepare to prevent the disruption of family planning and contraceptive services in future pandemics or emergencies.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/male-farmer-posing-fence-farm_21076616.htm; License: Licensed by JMIR.

    Digital Health for Australia: Bridging the Rural, Regional, and Remote Health Gap

    Abstract:

    In rural Australia, recent trends reveal an exponential increase in the rates of physical inactivity, central obesity, metabolic syndrome, and cancer in the population. The limited rural health workforce, which is struggling to meet this growing burden, is boosted by digital technologies such as My Health Record, Cardihab, Healthdirect, and MindSpot, all of which offer opportunities for improved diagnostics, monitoring, and management of chronic diseases. However, implementing proven digital health technologies in rural communities has been challenging on numerous fronts. This perspective aims to (1) highlight the rural health gap and propose a way forward in implementing evidence-based digital health technologies in the rural, regional, and remote communities of Australia and (2) guide future rural health policy.

  • Source: Freepik; Copyright: DC Studio; URL: https://www.freepik.com/free-photo/african-american-doctor-using-computer-plan-appointment-desk-medical-cabinet-health-specialist-with-white-coat-stethoscope-working-consultation-service-give-help-patient_23804009.htm; License: Licensed by JMIR.

    Streamlining Ophthalmic Documentation With Anonymized, Fine-Tuned Language Models: Feasibility Study

    Abstract:

    Background: The growing administrative burden on clinicians, particularly in medical documentation, contributes to burnout and may compromise patient safety. Recent advancements in generative artificial intelligence (AI) offer a promising solution to improve documentation processes and address these challenges. Objective: This study aims to evaluate the feasibility of using a fine-tuned OpenAI Curie model to automate the generation of medical report summaries (epicrises) in ophthalmology. By assessing the model’s performance through human and automated evaluations, this study seeks to determine its potential for reducing clinician workload while ensuring accuracy, usefulness, and compliance with regulatory requirements. Methods: A data set of around 60,000 anonymized medical letters was created using a custom algorithm to comply with General Data Protection Regulation guidelines. The Curie model was fine-tuned on this data set to generate epicrises from medical histories, diagnoses, and findings. The performance evaluation involved various human assessments and automated evaluations from 2 large language models (LLMs). Results: In the clinical context, 49.9% (384/769) of epicrises were evaluated as helpful or excellent, whereas only 25% (194/769) were considered disturbing. In a human (manual) evaluation, formal correctness was rated significantly higher than the neutral midpoint of 2.5 on the 4-point rating scale, as determined by a 1-sample Wilcoxon signed-rank test (mean 3.59, SD 0.85; W=1686; P<.001). Using paired t tests, we found a significant reduction in time, as correcting an AI epicrisis was faster than manually writing one (mean 109.52, SD 53.30 vs mean 54.25, SD 63.34 s; t68=3.39; P<.01). While medical accuracy and usefulness showed positive trends, these did not reach statistical significance when compared to the neutral midpoint (for medical accuracy, W= 7456; P=.08), for usefulness, W=7652.5; P=.18). Epicrises generated or corrected with AI were significantly shorter than manually written ones (mean 330.43, SD 115.42 vs mean 501.07, SD 243.50 characters; t68=–6.10; P<.001). Automated LLM assessments showed alignment with human ratings, with over 52% (356/679) and 66% (489/743) of responses in the top agreement categories, respectively. This supports overall consistency, though the comparison remains a proof of concept given methodological limitations. Conclusions: Our study demonstrates the technical and practical feasibility of introducing fine-tuned commercial LLMs into clinical practice. The AI-generated epicrises were formally and clinically correct in many cases and showed time-saving potential. While medical accuracy and usefulness varied across cases and should be focused on in further developments, a significant workload reduction is likely. Our anonymization process showed that regulatory challenges in the context of AI with patient data can effectively be dealt with. In summary, this study highlights the promise of transformer-based LLMs in reducing administrative tasks in health care. It outlines a pipeline for integrating LLMs into European Union clinical practice, emphasizing the need for careful implementation to ensure efficiency and patient safety.

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/two-young-sexy-hipster-girls-white-wigs-red-lips-beautiful-trendy-women-summer-clothes-summer-having-fun_7535599.htm; License: Licensed by JMIR.

    Enhancing Recruitment of Adolescents Aged 16-18 Years in a Web-Based Peer Network Study Through Financial Reimbursements: Randomized Controlled Trial

    Abstract:

    Background: Peers are known to influence the health behaviours and attitudes of adolescents, yet recruitment of these networks is challenging. Previous studies have used web-based respondent-driven sampling (WebRDS) methods to recruit this population, yet none have experimentally investigated the impact of financial reimbursements. Objective: This study aimed to (1) compare the effectiveness of two financial reimbursement strategies for recruiting adolescents and their peer networks, and (2) explore factors associated with successfully recruiting peers. Methods: A parallel design randomised controlled trial was conducted in which participants (seeds) were randomly allocated to a fixed cash reimbursement (control) or scaled reimbursement (experimental) group as a strategy to be recruited into a web-based peer network study. Seeds aged 16-18 were recruited online through social media advertisements and through an online student panel. They completed a web-based survey which assessed eligibility and included questions about their friends (peers). Allocation occurred through the survey platform using a simple randomisation method. In the fixed group, all participants in a peer network received AUD $5 (USD $3.29); in the scaled group, all participants in a peer network received an additional AUD $5 (USD $3.29) per peer who successfully completed the survey (to a maximum of AUD $30 each; USD $19.72). Participants and researchers were not blinded to intervention groups. The intervention was automated and did not require direct researcher contact. The primary outcome was recruitment of peers to complete the web-based survey (proportion of nominated peers). The number of peers recruited was a secondary outcome. In secondary analyses we identified peer- relationship- and seed-level variables associated with successfully recruiting peers. Results: Of 463 seeds allocated to an intervention (scaled n=221; fixed n=242), 319 (68.9%) had complete data for analysis (scaled n=157 (71.0%); fixed n=162 (67.0%)). A total of 11.9% of seeds successfully referred peers (18.5% scaled group; 5.6% fixed group). Those in the scaled reimbursement intervention were 3.80 times more likely to successfully recruit their peers than those in the fixed reimbursement intervention (proportion ratio (PR): 3.80, 95% CI 1.78–8.09). Similarly, the average number of peers recruited differed by 0.19 per seed between the scaled and fixed intervention groups (95% CI = 0.11–0.28). Peer recruitment success was similar regardless of the gender, age, education level, and network size of seeds, or the gender, age and closeness of peers. Seeds recruited through social media were more likely to successfully recruit their nominated peers then those recruited through a research panel (PR: 2.20, 95% CI = 1.06–4.55). Conclusions: Scaled reimbursements resulted in significantly greater recruitment of peers than fixed reimbursements, however, the total number of peers recruited was low. Other than recruitment site, no demographic or relational factors were found to impact on peer recruitment success. Despite the relative effectiveness of scaled reimbursements, recruiting peers through WebRDS remained challenging. Greater-value incentives and stronger initial recruitment through social media may be needed to recruit large numbers of friend networks. Clinical Trial: International Registered Report Identifier (IRRID): DERR1-10.2196/44813

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/elderly-woman-confronting-alzheimer-s-disease_16518431.htm; License: Licensed by JMIR.

    The Mediating Role of Depression in the Effect of Psychological Well-Being on the Self-Rated Health and Quality of Life of Older Adults: Cross-Sectional Study

    Abstract:

    Aim:Populations are rapidly aging all over the world. The concern for the nursing to general health of the older people was essential to constructing a positive aging society. Emotional experience plays an important role in predicting the general health of older people. To certify the mediating effect of depression on the association between emotional experience and general health to comprehensively understand the relationship between them. Design: Secondary analysis of data. Methods:A large sample of 8839 older adults from the 2017-2018 survey of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) was included. The emotional experience questionnaire, the 10-item CES-D scale (Center for Epidemiologic Studies Short Depression Scale) were applied to assess the older people’s emotional experience and depression respectively. Self-reported quality of life (QoL) and Self-reported health were used to evaluate the general health of the older people. IBM SPSS Statistics 25.0 and AMOS version 23.0 were adopted to analyze the data. Results:The average age of participants was 81.27±10.29 years. Among the older people, more positive affect was more pronounced among those with younger age, longer years of schooling, higher income of household, greater social security and social insurance, less depression level, higher self-rated health level. Depression had a partial mediation effect of emotional experience on general health, which explained 36% of variance totally (R2=0.36). In addition, emotional experience had a statistically significant direct effect on general health (β= 0.290, P<0.001). Furthermore, the indirect effect of emotional experience on general health was 0.228. Conclusions:Depression was an unignored mediator which regulated the effect of emotional experience on general health in the elderly. Nursing of emotion regulation may help prevent depression and promote the emotional well-being of the older people.

  • Source: freepik; Copyright: montypeter; URL: https://www.freepik.com/free-photo/hand-smoking-person_1234958.htm; License: Licensed by JMIR.

    Association of Modifiable Lifestyle and Metabolic Factors With the Risk of Developing Sepsis: 2-Sample Mendelian Randomized Study

    Abstract:

    Background: Sepsis is a life-threatening condition characterized by organ dysfunction resulting from a dysregulated host response to infections. Approximately 48.9 million people worldwide are diagnosed with sepsis annually, leading to 11 million deaths and representing 19.7% of all global deaths. No specific effective treatments are available for sepsis, which has a poor prognosis. Objective: We aimed to systematically explore the relationship between genetically predicted modifiable risk factors and sepsis. Methods: Univariable two-sample Mendelian randomization (MR) analysis was performed to explore the relationship between 30 modifiable risk factors (12 lifestyle, 3 educational and psychological, and 15 metabolic factors) and sepsis. Heterogeneity was evaluated using Cochran's Q analysis. Sensitivity analyses were conducted using the MR-Egger regression intercept tests and leave-one-out analyses. Additionally, multivariable MR analyses were performed to adjust for genetic associations between the instruments and obesity. Results: Genetically predicted smoking (odds ratio, OR, 1.20; 95% confidence interval, CI, 1.06–1.36), higher number of cigarettes smoked daily (OR, 1.70; 95% CI, 1.29–2.23), higher overall health rating (OR, 2.19; 95% CI, 1.61–2.98), body mass index (OR, 1.50; 95% CI, 1.38–1.63), waist circumference (OR, 1.70; 95% CI, 1.53–1.89), whole body fat mass (OR, 1.50; 95% CI, 1.37–1.64), trunk fat mass (OR, 1.48; 95% CI, 1.36–1.62), arm fat mass (OR, 1.57; 95 %CI, 1.43–1.71), and leg fat mass (OR, 1.69; 95 % CI, 1.51–1.90) were associated with increased sepsis risk (all with P < 0.05). However, light physical activity (OR, 0.26; 95% CI, 0.08–0.83), higher education attainment (OR, 0.52; 95% CI, 0.40–0.67) and high-density lipoprotein-cholesterol (OR, 0.91; 95% CI, 0.84–0.98) exhibited a protective effect against sepsis (all with P < 0.05). In multivariate analysis of obesity traits, the waist circumference (OR = 2.16, 95% CI = 1.18–3.96, P = 0.01) was an independent risk factor of sepsis. Conclusions: Genetic predictors of smoking initiation, smoking frequency, and waist circumference were associated with an increased risk of sepsis. By contrast, higher education, light physical activity, and high-density lipoprotein-cholesterol levels were associated with a reduced risk of sepsis. Our results can serve as a guide for reducing the risk of sepsis.

  • AI-generated image in response to the request "A man staring at his smartphone, overwhelmed by information overload" (Generator: Stable Diffusion; Requestor: Hiroko Okada;  2025.08.14). Source: Stable Diffusion; Copyright: N/A (AI-generated image); URL: https://www.i-jmr.org/2025/1/e67098/; License: Public Domain (CC0).

    Factors Predicting Information Overload During the COVID-19 Pandemic in the Digital Age: Longitudinal Study

    Abstract:

    Background: The human capacity to process information is limited. During the COVID-19 pandemic, people were exposed to a large amount of uncertain and complex health information. This situation made some people experience perceived information overload, which made them unable to adopt appropriate preventive behaviors. Objective: This study aimed to examine the individual characteristics, abilities, and attention to informational media that predict the perception of information overload during a pandemic. Methods: We conducted a longitudinal study with 2 time points, August 2020 and August 2021, among residents of Japan under a COVID-19 emergency declaration. The sample had the same proportions for sex, age, and prefecture as the general Japanese population. We used a web-based survey to measure sociodemographic characteristics, health literacy (HL), attention to 6 different types of information channels, and participants’ perception of information overload. Hierarchical multiple regression analysis was conducted with information overload as the objective variable. Results: A total of 784 participants responded to the survey at both time points, with a follow-up rate of 78.4% (784/1000). Hierarchical multiple regression analysis showed that younger age (β=−0.084, 95% CI −0.142 to −0.013), male sex (β=−0.163, 95% CI −0.008 to −0.003), lower HL (β=−0.084, 95% CI −0.114 to −0.011), paying less attention to television news (β=−0.118, 95% CI −0.038 to −0.001), and paying greater attention to social media (β=0.089, 95% CI 0.000-0.027) significantly predicted information overload 1 year after exposure to information during the pandemic. Conclusions: Public health communicators should aim to provide concise and understandable information in consideration of a target population that is vulnerable to information overload during a pandemic. A high level of attention to social media may increase the perception of information overload. By contrast, HL may reduce the cognitive load in information processing. Providing an environment during normal periods that allows people to develop the skills to critically interpret health information will help them to prepare for future infodemics.

  • AI-generated image. An older African woman assisting a dementia patient at home, symbolizing culturally sensitive dementia care. The image was generated by Abiodun Adedeji on 31 July 2025 using ChatGPT (https://chat.openai.com). Source: Image created by the authors; Copyright: N/A - AI-generated image; URL: https://www.i-jmr.org/2025/1/e75168; License: Public Domain (CC0).

    Adoption of Telemedicine for Dementia Care in Nigeria: Scoping Review

    Abstract:

    Background: Dementia is a global health challenge, particularly in Nigeria, where limited healthcare infrastructure, cultural stigmas, and poor awareness hinder its care. Telemedicine can improve patient outcomes, increase healthcare access, and support caregivers. However, challenges like poor internet connectivity, digital literacy, and lack of integrated strategies hinder its adoption, particularly in rural areas Objective: This study evaluates the adoption of telemedicine for dementia care in Nigeria, examining effectiveness in improving patient outcomes, reducing caregiver burden, and enhancing accessibility. It also identifies infrastructural and cultural barriers, proposing strategies for a sustainable telemedicine framework tailored to Nigeria’s sociocultural context. Methods: A scoping review guided by the (PRISMA) framework used databases like PubMed, Scopus, CINAHL, PsycINFO, and Google Scholar. Search terms included “telemedicine”, "dementia care," “Nigeria”, “digital health”, “telehealth interventions”, “video consultations”, and “remote monitoring tools”. Out of 640 results, 23 articles were selected. Issues like poor digital literacy, internet access, and lack of a cohesive policy were identified. Results: Out of 23 studies, 10 (43.5%) focused on m(Health) applications, 8 (34.8%) on video consultations, and 5 (21.7%) on remote monitoring tools. These interventions improved caregiver support, medication adherence, and access to specialist care but faced challenges in rural settings. Conclusions: There is an urgent need for an all-inclusive policy in Nigeria that integrates technological solutions into existing dementia care frameworks. mHealth apps, video consultations, and remote monitoring tools show potential for enhancing healthcare access, improving outcomes, and reducing caregiver burden.

  • Source: Image created by Placeit and authors; Copyright: The Authors / Placeit; URL: https://www.i-jmr.org/2025/1/e77400; License: Licensed by JMIR.

    Mapping the Dynamics of Inhibitors and Facilitators of Exercise Behavior Within the Transtheoretical Model: Nationwide Cross-Sectional Study Using Text...

    Abstract:

    Background: The transtheoretical model (TTM) explains the behavioral changes through sequential stages influenced by the balance of perceived benefits and barriers. Although prior studies have identified the inhibitors and facilitators of exercise behavior, only few have elucidated how these factors vary across the stages of behavioral change. Objective: This study aimed to identify the inhibitors and facilitators of each stage of behavioral change using text mining. Methods: A survey was conducted among 1,500 Japanese adults aged 20–69 years, recruited through stratified sampling based on sex, age group, and geographical region. The participants self-assessed their stages of change. Two open-ended questions captured the perceptions of inhibitors and facilitators of exercise behavior. Text responses were analyzed in a four-step process: morphological analysis to extract frequently used words, correspondence analysis to visualize relationships between frequently used words and the five change stages, conceptual categorization with coding rules, and creation of heat maps to illustrate stage-specific categories in inhibitors and facilitators. Results: The respondents included 754 males and 355 individuals in the 50–59 age group. Among them, 356 and 388 were in the precontemplation and maintenance stages, respectively. The inhibitors and facilitators were described using 9,893 words and 8,372 words, respectively. The inhibitors were categorized into seven groups: motivation, health, weather, family, time, opportunity, and working. The facilitators were classified into eight categories: reward, subjectivity, opportunity, relationship, health, record, digital device, and time. The stage-specific inhibitors included motivation and health in precontemplation; family, time, and working in contemplation and preparation; opportunity in action; and weather and health in maintenance. Facilitators, such as reward, health, and record, increasingly contributed as individuals progressed from precontemplation to maintenance. Conclusions: The findings of this study provide quantitative insights into the dynamics of inhibitors and facilitators across TTM stages. The inhibitors were low motivation, health issues, lack of time due to poor work–life balance, limited opportunities, and adverse weather conditions, which need to be sequentially addressed to acquire exercise habits. Recording personal progress and providing rewards for health improvements and consistency gradually emerged as facilitators. Intervention strategies targeting these inhibitors and facilitators can serve as effective new approaches for sustainable exercise habits.

  • Source: Freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/women-holding-each-other-back-view_9921317.htm; License: Licensed by JMIR.

    Evaluating the Safety and Efficacy of a Non–Weight-Centric Approach to Obesity Prevention in Rural and Urban Female Adolescents: Quasi-Experimental Study

    Abstract:

    Background: Obesity rates among Saudi adolescents are on the rise, with regional variations underscoring the need for tailored interventions. Existing school-based health programs in Saudi Arabia are limited and often focus on weight and body size, which can inadvertently exacerbate body image dissatisfaction and disordered eating behaviors. To date, no known study has delivered an obesity prevention program specifically targeting Saudi rural students. Objective: This study aimed to evaluate the feasibility and impact of a low-intensity, non-weight-centric educational intervention – Green apple- designed to enhance knowledge of macronutrients, Metabolic Non communicable diseases (MNCDs), and sedentary behavior while assessing its safety regarding body image discrepancies and disordered eating symptoms. Methods: This quasi-experimental study included 105 participants from urban and rural schools in Saudi Arabia, were four classes assigned to an intervention group (macronutrients education + MNCDs education) or a control group (macronutrients education only). Assessments were conducted at three time points: baseline, post-intervention, and one-month follow-up. Linear mixed-effects models were utilized to evaluate the effects of intervention type and school type on knowledge, sedentary behavior, body image discrepancy, and disordered eating symptoms. Results: Intervention significantly improved MNCDs knowledge at both post-intervention (p < 0.001) and follow-up (p < 0.001) in urban schools, with delayed but significant improvements in rural schools at follow-up (p = 0.03). The intervention reduced sedentary behavior, particularly in rural schools (p = 0.017). Promising trends were observed in decreasing body image discrepancy and disordered eating symptoms, particularly in urban schools (p = 0.007). No significant adverse effects on body image or disordered eating symptoms were noted, underscoring the program's safety. Conclusions: The Green Apple program demonstrates the potential of weight-neutral, culturally tailored interventions in improving metabolic health literacy, reducing sedentary behavior, and supporting positive psychosocial outcomes among Saudi rural female adolescents. These findings highlight the need for scaling such programs to address adolescent health challenges in non-Western contexts.

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  • A Scoping Review of 24-H Movement Behaviours Research in Chinese Children and Adolescents

    Date Submitted: Nov 25, 2025

    Open Peer Review Period: Dec 9, 2025 - Feb 3, 2026

    Background: Physical activity, sleep, and sedentary behaviour are essential components within the 24-h time frame. A scientific understanding of 24-hour movement behaviours is a crucial prerequisite f...

    Background: Physical activity, sleep, and sedentary behaviour are essential components within the 24-h time frame. A scientific understanding of 24-hour movement behaviours is a crucial prerequisite for formulating targeted intervention guidelines and programs. Objective: The objective of this study was to map the current state of research and fill the gaps in 24-h movement behaviours among Chinese children and adolescents. Methods: Web of Science, PubMed, EBSCO, and CNKI (China National Knowledge Infrastructure) were systematically searched for relevant studies published between January 2019 and October 2025. The study followed the PRISMA guidelines, and the literature screening process involved three rounds: duplicate removal, title and abstract screening, and full-text screening. Inclusion criteria: Targeting Chinese children and/or adolescents aged 3–18 years; Focusing on 24-h movement behaviours; Published in Chinese or English; Published between January 2019 and November 2025. Data extraction included: title, author, year, country, study type, research design, adherence to guideline, sample characteristics, and research results. Results: 92 studies were included in this scoping review. All the included studies were published between 2019 and 2025, showing a generally increasing trend over the years. The review included 817,482 participants aged 3–18 years, predominantly from the general population. Geographically, Shanghai and Guangdong were core regions, while the underdeveloped central and western regions had extremely low representation. Most studies used a cross-sectional design (80), with few longitudinal or intervention ones. For monitoring, device-based tools dominated sedentary behaviours/screen time assessment (31), questionnaires were the primary tool for physical activity (40), and public data utilization was low. Research variables centered on mental health, covering physical fitness, social interaction, body composition, etc. 52 studies showed average compliance rates of 22.34% (Moderate-to-Vigorous Physical Activity, MVPA), 45.35% (screen time), 37.77% (sleep), and only 8.39% for all three. Conclusions: Research on 24-h movement behaviours among Chinese children and adolescents faces multiple challenges, including an uneven geographic distribution of samples, limited diversity in monitoring methods, and low compliance with relevant guidelines. Most studies adopt a cross-sectional design, with few prospective cohort studies and intervention experimental studies. Additionally, there is no guidelines for 24-h movement behaviours tailored to Chinese children and adolescents.

  • Exploring Location Data as a Predictor for Blood Glucose in Type 1 Diabetes: A Systematic Review

    Date Submitted: Nov 6, 2025

    Open Peer Review Period: Dec 9, 2025 - Feb 3, 2026

    Background: Managing Type 1 Diabetes (T1D) requires regular glucose monitoring and appropriate insulin dose adjustments. Although the use of continuous glucose monitoring (CGM) sensors has been benefi...

    Background: Managing Type 1 Diabetes (T1D) requires regular glucose monitoring and appropriate insulin dose adjustments. Although the use of continuous glucose monitoring (CGM) sensors has been beneficial, there are still inherent delays in CGM measurements and insulin onset of action, making accurate glucose prediction essential. Smartphones can collect Global Positioning System (GPS) data that can be converted into location categories (e.g., “gym,” “cafe,” “restaurant”), which provide information about a person’s location and offer insight into their behavior, and both location and behavior may influence blood glucose levels. Objective: This systematic review aims to evaluate existing research on the use of location category data as a predictor of blood glucose fluctuations in individuals with diabetes. It explores whether such data have been used to identify location categories where people with diabetes are more likely to be out of range, potentially supporting timely corrective actions. Methods: The systematic review was conducted following PRISMA guidelines, identifying studies examining the use of semantic or geographic location category data for blood glucose prediction in individuals with diabetes. Eligible studies were analyzed for the location category data used, predictive modeling approaches, and outcome measures. Results: 665 screened studies, only three met the inclusion criteria. All were from a single research project involving 40 individuals with Type 2 Diabetes (T2D), monitored over a period of 3 days. These studies utilized geographic and temporal data but did not classify places by location category. No studies investigated the use of the location category in the context of T1D. Conclusions: No studies have used location categories to predict blood glucose levels in individuals with T1D. Limited research in T2D has incorporated GPS data, but without identifying specific place types such as restaurants, gyms, or workplaces. In contrast, mental health research has effectively applied location-based methods to predict stress, anxiety, and depression, showing that the places people visit and the time they spend there reflect important behavioral patterns. Because diabetes management also relies on daily behaviors such as eating, physical activity, and routine, applying these methods from mental health research may provide new insights into how specific locations influence blood glucose variability and support more timely, personalized diabetes management strategies.

  • Depression and Poor Mental Health are Mediators of the Association Between Adverse Childhood Experiences and Asthma Control in U.S. Adults

    Date Submitted: Nov 27, 2025

    Open Peer Review Period: Nov 27, 2025 - Jan 22, 2026

    Background: This cross-sectional study examined whether the association between adverse childhood experiences (ACEs) and asthma control in U.S. adults is mediated by major depressive disorder (MDD) an...

    Background: This cross-sectional study examined whether the association between adverse childhood experiences (ACEs) and asthma control in U.S. adults is mediated by major depressive disorder (MDD) and poor mental health status. ACEs have long-term effects on physical and mental health, and prior research has linked them to asthma severity, but the mediating role of mental health in the ACE–asthma control relationship remains unclear. Objective: The aim of this study is examine the mediating role of depression and poor mental health status in the association between adverse childhood experiences and asthma control in a sample of non-institutionalized US adults. Methods: We analyzed data from 6,632 adults with asthma who participated in the 2019–2020 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-Back Survey. Measures included self-reported ACEs before age 18, current asthma control status, and self-reported MDD diagnosis and past-30-day mental health status. Weighted multivariable logistic regression assessed associations between ACEs and uncontrolled asthma, adjusting for confounders. Causal mediation analyses, using bootstrap resampling, estimated the direct and indirect effects of ACEs on asthma control through depression and poor mental health. Results: Overall, 37.3% of participants had uncontrolled asthma. After adjustment, adults with ≥1 ACE had 36% higher odds of uncontrolled asthma (adjusted OR = 1.36; 95% CI: 1.05–1.76; p = 0.02) compared with those with no ACEs. Individuals with ≥3 ACEs had significantly higher odds than those with none. Depression mediated 25% (95% CI: 12.59–63.67) of the total effect of ACEs on asthma control, and poor mental health mediated 38% (95% CI: 22.62–79.21). These effects remained significant in sensitivity analyses excluding smokers and those with chronic conditions. Conclusions: The association between ACEs and asthma control is partially mediated by depression and poor mental health. Integrating trauma-informed and mental health–focused interventions into asthma care may improve outcomes for adults with a history of early-life adversity. Clinical Trial: None

  • The content validity of the CHANT’s French translation and cultural adaptation: a modified e-Delphi study

    Date Submitted: Nov 18, 2025

    Open Peer Review Period: Nov 26, 2025 - Jan 21, 2026

    Background: Climate change is a critical global health emergency with direct consequences for public health. As frontline health promoters and agents of change, nurses must develop specific competenci...

    Background: Climate change is a critical global health emergency with direct consequences for public health. As frontline health promoters and agents of change, nurses must develop specific competencies to implement sustainable practices and respond to climate-related health challenges. Objective: This overall work aimed to translate the Climate, Health, and Nursing Tool (CHANT) into French, culturally adapt it and conduct a content validation. The CHANT assesses nurses’ awareness, motivations, concerns and self-reported behaviours regarding climate change by evaluating both item-level content validity indices (I-CVI) and scale-level content validity indices (S-CVI). The secondary aim was to explore potential associations between the sociodemographic and professional characteristics of our expert panel members and their CVI ratings of the CHANT’s items. Methods: A descriptive, international study design was used, involving a three-round, modified e-Delphi technique to explore the relevance and comprehensiveness of each item and response option in the translated tool. The study was conducted between January and June 2025 in Switzerland’s French-speaking regions, France and Belgium. A panel of experts in nursing, planetary health and environmental science participated in the content validation process, contributing to an iterative refinement of the tool’s items. To ensure methodological transparency and rigour, this Delphi study was conducted and reported in accordance with the guidance on Conducting and REporting of DElphi Studies developed by Jünger et al. (2017). Results: Over three rounds, 57 experts evaluated the overall comprehensibility, relevance and response options of the CHANT’s 12 items. After Round 1, the comprehensibility I-CVI ranged from 0.786–1.0 across individual items, and the S-CVI for the full 12-item scale was 0.935. Complete consensus (100%) was achieved on every item. After Round 2, I-CVI ratings ranged from 0.71–1.0, and the S-CVI was 0.91, with 92% expert consensus. Item 2, suggested by the expert panel during Round 1, did not reach the predefined consensus threshold. In Round 3, I-CVI ratings ranged from 0.82–1.0, and the S-CVI remained at 0.935, confirming the expert panel’s continued consensus. The process concluded with a cognitive debriefing, during which the complete consensus on every item and response option was reaffirmed, as reflected by consistently high I-CVI and S-CVI ratings, thereby supporting the CHANT’s internal content validity. Conclusions: The rigorous validation of the CHANT’s French translation is a foundational step toward developing and strengthening climate-related competencies in nursing education and clinical practice. This validation supports the development and implementation of targeted strategies to strengthen eco-literacy in healthcare settings.

  • Diathermy risks and surgical smoke: a cross-sectional study of awareness, PPE use and teaching gaps in UK medical students

    Date Submitted: Nov 21, 2025

    Open Peer Review Period: Nov 24, 2025 - Jan 19, 2026

    A cross-sectional survey was answered by medical students to evaluate awareness of diathermy-related safety risks compared to that of surgeons, results highlighted educational gaps that could guide cu...

    A cross-sectional survey was answered by medical students to evaluate awareness of diathermy-related safety risks compared to that of surgeons, results highlighted educational gaps that could guide curriculum improvement in surgical safety training.

  • Prevalence of Comorbidities among United States Adults with Asthma and Their Association with Asthma Severity

    Date Submitted: Nov 22, 2025

    Open Peer Review Period: Nov 22, 2025 - Jan 17, 2026

    Background: The burden of comorbidities in asthma affects management and outcomes in asthma patients. Objective: This study aimed to analyze the prevalence and trends of comorbidities among adults wit...

    Background: The burden of comorbidities in asthma affects management and outcomes in asthma patients. Objective: This study aimed to analyze the prevalence and trends of comorbidities among adults with asthma and to investigate their association with persistent asthma. Methods: The study employed data from the Asthma Call-Back Survey (ACBS) to ascertain the prevalence and trends of comorbidities in adults with asthma. Comorbidities were self-reported binary responses. Asthma severity was categorized as intermittent or persistent based on established methodologies to derive asthma severity in the ACBS. Intermittent asthma includes those with current asthma who are well-controlled without being on long-term control medication (LTCM). Persistent asthma includes those on LTCM, regardless of asthma control status, and those not on LTCM whose asthma is not well controlled or is very poorly controlled. Weighted logistic regression controlling for confounders was used to determine the association of comorbidities and asthma severity. Results: Prevalence of comorbidities in adults with asthma were as follows: hypertension (38.4%), major depressive disorder (35.2%), diabetes (17.2%), MI (5.3%), Angina/CHD (6.0%), Stroke (5.0%), and Emphysema/Chronic bronchitis/COPD (19.0%). Prevalence of all comorbidities were higher among adults with persistent asthma compared to intermittent asthma. MI, Angina/CHD, obesity, depression, COPD/emphysema/chronic bronchitis, and hypertension were associated with increased odds of persistent asthma. No association was found between diabetes, stroke, and persistent asthma. Conclusions: Comorbidities are associated with persistent asthma. These findings suggest a need for healthcare providers in primary care settings to address comorbid conditions simultaneously as severity of asthma to improve health outcomes in this subset of patients.