https://www.i-jmr.org/issue/feed 2024-01-18T09:15:04-05:00 JMIR Publications editor@jmir.org Open Journal Systems Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in the interactive Journal of Medical Research...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://www.i-jmr.org/, as well as this copyright and license information must be included. A new general medical journal for the 21st century, focusing on innovation in health and medical research. https://www.i-jmr.org/2026/1/e86211 2026-08-10T13:00:21-04:00 Peng Li Jiawei Wang Hongyi Wang Shuo Li Lei Wang Shan Gao Chunxiao Hu Guangjian Zhang

Background: Lung transplantation (LTx) is an established treatment for patients with end-stage lung diseases and can substantially improve survival. However, posttransplant recovery involves complex physical, psychological, and functional challenges, making quality of life (QoL) an important outcome beyond survival alone. Evidence on early longitudinal QoL changes after LTx remains limited, particularly in Chinese recipients and when assessed using disease-specific patient-reported outcome instruments. Objective: This study aimed to assess QoL and track its longitudinal changes in patients who underwent LTx using a disease-specific patient-reported outcome instrument. Methods: This single-center prospective cohort study screened 66 patients for enrollment who underwent LTx at the Xi’an Jiaotong University Lung Transplantation Center in China from June 2023 to December 2025. QoL was assessed using the Chinese version of the Lung Transplant Quality of Life questionnaire at baseline (preoperative) and serially at 1, 2, 3, 4, 5, and 6 months after surgery. The Lung Transplant Quality of Life questionnaire comprises 40 items across 7 domains, and each domain score was calculated as the item mean (range 0‐4). Random-intercept linear mixed models (LMMs) with both categorical and linear time specifications were fitted separately for each domain to evaluate longitudinal changes, accounting for repeated measures and incomplete follow-up under the missing at random assumption. Results: A total of 203 interviews from 51 eligible patients were included in this study, with a median of 5 (IQR 2-6) interviews for each patient. LMM analysis revealed significant overall time effects in 6 of 7 domains (likelihood ratio test: <.01 in all cases). Health perceptions showed the earliest and largest improvement (LMM-adjusted mean difference [MD] −1.58 at month 6; β=−0.23 points per month; <.001), followed by respiratory symptoms (MD −0.95 at month 6; β=−0.15 per month), anxiety and depression (MD −0.82 at month 6; β=−0.13 per month), digestive symptoms (MD −0.50 at month 6; β=−0.10 per month), and cognitive limitations (MD −0.51 at month 6; β=−0.09 per month; <.001 in all cases). Global well-being was the only domain with a positive trajectory (MD 1.18 at month 6; β=0.13 per month; =.002), with significant improvement already evident at month 1 (MD 0.71; =.23). Conclusions: LTx significantly improved QoL in patients with end-stage lung diseases, with the most substantial gains in health perceptions and respiratory symptoms. Patient-reported outcome–based monitoring can capture clinically meaningful QoL changes and should be integrated into routine posttransplant care to identify critical intervention time points and optimize long-term recovery.

2026-08-10T13:00:21-04:00 https://www.i-jmr.org/2026/1/e103310 2026-07-31T17:30:13-04:00 Dongsu Lee Wonseuk Jang

The proliferation of wearable devices and advances in data analytics are accelerating the adoption of personalized digital health care, relying heavily on patient-generated health data (PGHD). However, the sensitive nature of this data creates significant privacy boundaries. While previous research has focused on rational cost-benefit trade-offs, there is a limited understanding of how social and cognitive factors—specifically interpersonal trust and digital literacy (DL)—shape the data-sharing decisions of the general public. This study aims to identify the factors predicting individuals’ willingness to share health data (WS) by integrating privacy calculus and communication privacy management theories. It specifically examines the comparative influence of DL, interpersonal trust, and moral motivation on data-sharing decisions. We analyzed data from the 2023 Korea Panel Survey on the Digital Society (n=4518), a nationwide representative sample of internet users. Survey-weighted structural equation modeling with weighted least squares mean and variance adjusted estimation was used to examine the relationships among perceived risk (PR), perceived benefit (PB), DL, interpersonal trust, and WS. PR was the strongest negative predictor of WS (standardized coefficient [std β]=−0.189, P<.001), whereas PB was the strongest positive predictor (std β=0.076, P=.009), followed by moral motivation (std β=0.062, P=.03) and interpersonal trust. DL showed a significant negative direct association with willingness to share (std β = −0.060, P<.001). However, subdimension analysis revealed heterogeneous mechanisms: the “understanding” dimension was associated with lower PR and indirectly promoted sharing, whereas use and engagement were associated with higher PR. Age-stratified analyses suggested potential heterogeneity in these relationships, although the overall interaction was not statistically significant. PBs and risks were the strongest determinants of PGHD sharing, with benefits increasing and risks decreasing willingness to share. Beyond this risk-benefit balance, DL (particularly understanding) and interpersonal trust also played important roles, highlighting the need for trust-based and user-centric strategies to promote PGHD sharing and support the expansion of digital health care.

2026-07-31T17:30:13-04:00 https://www.i-jmr.org/2026/1/e87909 2026-07-29T09:15:10-04:00 Hooi Swang Cheng Yi Wang Sharon Hui Xuan Tan Ian Yi Han Ang

Background: Waning immunity and recurring COVID-19 waves point to the importance of sustained booster vaccination strategies. With repeated boosters needed to sustain population-level immunity, evaluating public preferences for COVID-19 booster vaccination is important for informing future vaccination strategies, as changing perceptions of urgency, threat, and motivation may alter willingness to receive vaccine boosters compared with initial uptake. Objective: This study aimed to explore the public’s stated preferences and implicit willingness to pay for COVID-19 vaccine boosters in Singapore and to identify the sociodemographic factors and health-risk acceptance profiles associated with these outcomes. Methods: A discrete choice experiment survey was conducted among the general population in Singapore, recruited from an online panel in June 2022. Discrete choice experiment scenarios presented hypothetical scenarios varying by booster characteristics, including effectiveness, protection duration, and cost, and risks of COVID-19 infection, hospitalization, and death. A 2-stage discrete choice design was used: participants first selected between 2 hypothetical scenarios and then reported real-life booster acceptance of their chosen option. A mixed logit model was used for analyses. We also estimated implicit willingness to pay for vaccine boosters, as well as assessed the associations of sociodemographic factors and health-risk profiles with booster acceptance or hesitancy. Results: A total of 1567 participants were included in the analysis. Overall, respondents preferred boosters that offered a longer duration of protection, particularly under higher risks of COVID-19 infection and death. Respondents were willing to pay S$1.43 for every percentage-point increase in booster effectiveness, S$4.95 (S$1=US $0.77 as of July 10, 2026) per additional month of protection, and an additional S$55.23 for a vaccine booster under the hypothetical worst-case scenario of COVID-19. Younger adults, women, individuals of non-Chinese ethnicity, those without children, people with higher socioeconomic status, individuals who had received 2 or fewer COVID-19 vaccine doses, and those with chronic conditions or on chronic disease medication were more likely to receive a booster. On the other hand, older adults, individuals with lower education or socioeconomic status, those with prior COVID-19 infection, and those exhibiting higher health-risk acceptance were less likely to accept booster vaccination. Conclusions: Our findings demonstrate how vaccine attributes, sociodemographic factors, and health-risk attitudes influence booster acceptance. These insights can guide policymakers in tailoring strategies and communication efforts that address population needs and behavioral drivers to improve booster uptake, address hesitancy, and support sustainable long-term immunization coverage, contributing to adaptive vaccination planning in the ongoing management of COVID-19.

2026-07-29T09:15:10-04:00 https://www.i-jmr.org/2026/1/e80646 2026-07-28T13:15:08-04:00 Kátia M Avena Ana Paula A Brito Luiz F Quintanilha Mariana Araújo-Pereira Bruno B Andrade

Basic sciences remain a cornerstone of medical education, but the terms of the debate about their importance have changed. The central risk is no longer their formal exclusion from medical curricula but their curricular invisibility: the gradual dilution of mechanistic reasoning within integrated, technology-mediated, and institutionally unequal training environments. In this Viewpoint, we revisit the past, present, and future of basic science teaching to argue that reform must protect conceptual progression, curricular visibility, and clinical transfer. Active learning, curricular integration, digital tools, and AI may strengthen scientific literacy, but only when they are anchored in faculty development, institutional support, and explicit commitments to rigor and equity.

2026-07-28T13:15:08-04:00 https://www.i-jmr.org/2026/1/e98428 2026-07-27T16:30:13-04:00 Akiko Hashiguchi Satoru Takahashi

Background: Acquiring external funding for academic research is a crucial element of researcher performance assessment. However, funding opportunities are often concentrated among a limited number of researchers, reinforcing existing structural inequalities. Under these conditions, it is important to clarify how individual researchers can improve their ability to secure external funding through their own actions and thereby build sustainable academic careers. In addition, fair faculty evaluation requires recognizing disciplinary differences in funding acquisition without assuming a normative research environment. Objective: This study aimed to examine whether research-related behaviors at different career stages contribute to variations in funding acquisition capability across research fields. Methods: We used funding data from Grant-in-Aid for Scientific Research, Japan’s largest competitive research funding program, and classified 1152 professors according to their lifetime patterns of research funding acquisition. We also collected data on individual research-related behavioral characteristics, including supervisor prestige, authorship position, publication quality, collaborative research structure, and funding acquisition strategies, from publication records and administrative data, constructing a dataset of 804 researchers. By integrating these datasets, we conducted univariate and multivariate regression analyses to examine the factors associated with research funding acquisition. Results: Field-specific differences were observed in the upper range of funding levels and individual behaviors. High-funding recipients were found only in the field of basic and internal medicine. Univariate logistic regression analyses showed that early-career publication success (basic medicine: odds ratio [OR] 1.48, 95% CI 1.22‐1.79; internal medicine: OR 1.34, 95% CI 1.06‐1.69; and surgery: OR 1.70, 95% CI 1.28‐2.27) and midcareer senior authorship were significantly associated with funding acquisition (basic medicine: OR 5.99, 95% CI 2.63‐13.65; internal medicine: OR 3.17, 95% CI 1.16‐8.70; and surgery: OR 9.79, 95% CI 3.26‐29.43). In addition, supporting specific collaborators (surgery: OR 2.09, 95% CI 1.10‐3.97) and the quality of publications during the first 12 years of a researcher’s career were major determinants of success (surgery: OR 2.22, 95% CI 1.18‐4.17). In multiple linear regression analyses with total funding as the outcome, the adjusted ² values were 0.576 for surgery, 0.890 for social medicine, and 0.738 for dentistry, indicating that the models accounted for many behavioral factors associated with funding acquisition. However, the model fit suggests that additional relevant factors may influence funding acquisition in basic medicine, internal medicine, and nursing. Conclusions: This study identified individual behaviors that influence Grant-in-Aid for Scientific Research funding acquisition across research fields. While organizational and academic structures have a significant impact, personal initiative during researchers’ transition from peripheral to core roles becomes important, emphasizing strong relationship-building skills and outstanding publication records. As effective actions and their timing vary by field, individuals must consider their field characteristics and implement appropriate measures at suitable times.

2026-07-27T16:30:13-04:00 https://www.i-jmr.org/2026/1/e96883 2026-07-23T14:30:14-04:00 Yuvraj Pathak David Muhlestein

Our study uses the latest Transparency in Coverage data to show that there is wide variation in health care prices for some of the most commonly utilized services in the United States. The findings demonstrate that there is an opportunity for employers, policymakers, and other stakeholders to curb health care spending by choosing cost-efficient health care networks and providers.

2026-07-23T14:30:14-04:00 https://www.i-jmr.org/2026/1/e94073 2026-07-21T14:00:20-04:00 Kazuki Ohashi Masaya Watanabe Yasuhiro Morii Hisashi Yokoshiki Kengo Kusano Katsuhiko Imai Masahiko Takagi Teiichi Yamane Hiroshi Tada Katsuhiko Ogasawara

Background: Cardiac resynchronization therapy with defibrillator (CRT-D) improves survival, reduces hospitalization, and enhances quality of life in patients with heart failure and reduced ejection fraction (HFrEF). As heart failure prevalence increases in aging societies such as Japan, the associated clinical and economic burden continues to rise. Previous cost-effectiveness analyses conducted in multiple countries indicate that CRT-D may be cost-effective in selected patients with HFrEF. However, its cost-effectiveness within the Japanese health care system remains uncertain. Objective: This study aimed to evaluate the cost-effectiveness of CRT-D in patients with HFrEF within the Japanese health care setting. Methods: A partitioned survival model was developed with 3 health states: after treatment (follow-up), hospitalization, and death. Survival for CRT-D was estimated by reconstructing individual patient-level data from the Kaplan-Meier curve of the RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study using the method proposed by Guyot et al followed by fitting multiple parametric models; the gamma distribution was selected for the base case analysis. Survival for optimal medical therapy (OMT), the comparator, was estimated by applying a hazard ratio from a published meta-analysis. Hospitalization rates and device longevity were derived from prior studies. Cost estimates were obtained from the JROAD-DPC (Japanese Registry Of All cardiac and vascular Disease-Diagnostic Procedure Combination) database and the Japanese medical fee schedule. Utility values were assigned according to New York Heart Association class assuming treatment-specific distributions. The analysis was conducted from the public health care payer perspective using a monthly cycle over a 20-year time horizon. Deterministic and probabilistic sensitivity analyses were performed. Additionally, scenario analyses were conducted by varying the duration of treatment effect. Results: In the base case analysis, per capita costs were ¥12,258,410 (¥1=US $0.006 as of July 7, 2026) for CRT-D and ¥640,056.90 for OMT, resulting in an incremental cost of ¥11,618,353. CRT-D generated 7.07 quality-adjusted life years (QALYs) compared with 4.75 QALYs for OMT, yielding an incremental gain of 2.32 QALYs. The incremental cost-effectiveness ratio (ICER) was ¥5,009,880 per QALY. Scenario analyses showed that, when treatment effect waned after 7.5 years, the ICER increased to ¥5,423,235 per QALY. When the time horizon was shortened to 10 years or extended to 30 years, the ICERs were ¥8,523,072 and ¥4,386,803 per QALY, respectively. Deterministic sensitivity analysis identified CRT-D efficacy (hazard ratio), discount rate, and initial treatment cost as primary ICER drivers. Probabilistic sensitivity analysis produced a median ICER of ¥5,022,618 (IQR ¥4,448,306–¥5,760,425) per QALY, with a 95% credible interval of ¥3,804,418 to ¥7,178,795. At a willingness-to-pay value of ¥5,000,000 per QALY, CRT-D had a 49.2% probability of being cost-effective. Conclusions: CRT-D demonstrated acceptable cost-effectiveness in patients with HFrEF in Japan. Treatment efficacy and initial cost were the primary determinants of economic value, emphasizing the importance of appropriate patient selection and strategies to reduce device costs.

2026-07-21T14:00:20-04:00 https://www.i-jmr.org/2026/1/e86572 2026-07-20T13:00:13-04:00 Till Baldenius Kathrin Jürchott Christine Haeger Susann Behrendt Stefan Blüher Susanne Schnitzer

Background: In recent years, German long-term care (LTC) insurance has experienced an unprecedented increase in the number of beneficiaries. This raises the question of the role of health care in preventing or delaying the need for LTC. At present, related findings are limited. Addressing this research gap could promote longevity and improve quality of life while reducing the financial strain on the social security system. Objective: This study aimed to investigate the associations between the utilization of health care services and first-time LTC need. Methods: This retrospective cohort study examined nationwide linked claims data from the German statutory health and LTC insurance fund, AOK. The dataset included all individuals aged ≥60 years. Using multiple logistic regression, we investigated the association between health care utilization during the 5-year exposure period from 2016 to 2020 and the occurrence of first-time LTC need during the first quarter of 2021. Physician care, pharmaceutical care, physiotherapy, and medical aids were analyzed while adjusting for age, sex, regional variables, and comorbidities. Metrically scaled variables were categorized using the Fisher-Jenks algorithm to explore possible nonlinearities. Individuals who needed LTC prior to 2021 were excluded. Results: The study population comprised 5.3 million individuals. A total of 54.3% (n=2.9 million) were women, and the mean age was 71.3 (SD 8.16) years. Receiving more than 2 of the 5 recommended screenings and vaccinations examined, compared with receiving none, was associated with a strong reduction in the odds of first-time LTC need (odds ratio [OR] 0.62, 95% CI 0.60‐0.64; <.001). Odds of first-time LTC need were also significantly lower with high numbers of specialist groups and low numbers of specialist days (more than 7 specialist groups consulted and fewer than 48 billing days) compared with no specialist utilization (any specialist utilization: OR 0.82, 95% CI 0.79‐0.85; <.001; more than 7 instead of fewer than 5 specialist groups: OR 0.94, 95% CI 0.92‐0.96; <.001). Likewise, a physiotherapy prescription in between 5 and 10 quarters of the 5-year period instead of none was related to lower odds of first-time LTC need (OR 0.81, 95% CI 0.79‐0.83; <.001). Generalist care, hospitalizations, polypharmacy, and potentially inadequate medication were concomitant with first-time LTC need. Among the disease management programs and medical aids examined, there were both positive and negative relationships with first-time LTC need. Conclusions: Utilization of recommended screenings, vaccinations, specialist physician care, and physiotherapy is substantially and significantly associated with the nonoccurrence of first-time LTC need in the older German population. Our study provides a foundation for future research on orienting health care toward preventing functional decline.

2026-07-20T13:00:13-04:00 https://www.i-jmr.org/2026/1/e84818 2026-07-14T16:00:19-04:00 Wanqing Wang Xin Ma Matthew Ting Chi Liu Angela Chang

Background: Aging populations worldwide face increasing health care demands, particularly for chronic disease management. While telemedicine offers a viable solution to enhance health care access, significant trust-related barriers hinder its adoption among older adults, warranting a scoping synthesis of available evidence. Objective: This scoping review aims to map the available evidence on trust barriers experienced by older adults in telemedicine, identify underlying vulnerability domains, and chart the evidence base for design and policy recommendations. Methods: We conducted a scoping review in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, analyzing literature from PubMed, Web of Science, and Scopus. Thematic analysis was applied to synthesize findings from 30 included studies. Results: Four primary trust barriers were identified: technophobia and technical difficulties, privacy and data security concerns, negative emotional and social impacts, and a strong preference for in-person care. These barriers mapped onto 4 vulnerability domains: limited telemedicine literacy (particularly low eHealth self-efficacy), declining health status (including sensory and cognitive impairments), psychological and cognitive factors (such as anxiety about losing autonomy), and inadequate social support systems. The review also underscored how rapid technological change amplifies these challenges for older adults. Conclusions: Effective telemedicine implementation for older adults requires multipronged interventions, including age-appropriate interface design, targeted digital literacy training, robust privacy protections, and personalized support systems. These approaches address both technological and psychosocial barriers, potentially increasing engagement while mitigating vulnerabilities. Future research should assess the effectiveness of these interventions across diverse older populations.

2026-07-14T16:00:19-04:00 https://www.i-jmr.org/2026/1/e94317 2026-07-14T14:00:15-04:00 Mimi M Kim Amin M Shanaa Hossam Hammady Mohammad Aboelnour Robert Ayan

Deduplication across search results is one of the earliest and most critical steps in the systematic review methodological process; yet, existing solutions often lack the transparency, auditability, and reproducibility required by rigorous systematic review standards. Many automated deduplication tools introduce bias through opaque, nonconfigurable algorithmic decisions, while also potentially removing relevant references through false positive identification. We provide a tutorial on the Rayyan Method, including the Systematic Auto Resolver feature for the deduplication process. This method is defined by an enhanced deduplication approach that combines high-sensitivity duplicate detection with user-controlled resolution criteria. Systematic Auto Resolver enables research teams to define, apply, and document their own deduplication standards rather than relying on predetermined automated decisions. Users apply deduplication criteria, iteratively reviewing results after each pass, maintaining complete control over methodological decisions. The Rayyan Method addresses critical limitations in current deduplication approaches by supporting methodological rigor through user-controlled resolution while enhancing efficiency, transparency, and reproducibility. By empowering research teams to define their own deduplication criteria, this approach supports and aligns with the prescribed methodologically rigorous systematic review process. The method provides a citable framework for researchers to comprehensively document their deduplication methodology.

2026-07-14T14:00:15-04:00