Interactive Journal of Medical Research

Mapping Digital Nudges and Recommender Systems for Obesity Prevention: Scoping Review

2026-04-17T15:00:19-04:00

Background: Recommender systems are pivotal in organizing information to enhance noticeability, reduce overload, and streamline decision-making. They can be even more effective if combined with digital nudges. Digital nudging is a subtle approach that combines design, information, and interaction elements to create a choice architecture that can guide user behavior in digital environments. While promising in many fields, there is a notable gap in health promotion, particularly because digital nudges and recommender systems can encourage and support sustained healthier choices in nutrition, physical activity (PA), and sedentary behavior reduction to prevent overweight and obesity. Objective: This scoping review addresses these gaps by exploring how digital nudges and recommender systems are used in obesity prevention. Methods: We prospectively published the scoping review protocol and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligibility was defined using the PCC (Population, Concept, Context) framework. We searched 7 bibliographic databases (MEDLINE and PsycINFO via Ovid, Web of Science, CINAHL via EBSCO, Scopus, ACM Digital Library, and IEEE Xplore) up to October 2023. Following a 2-stage screening by independent reviewers, we selected 68 articles that included 94 user evaluations. Results: Most articles (36/68, 53%) report on recommender systems focused on nutrition, with fewer (16/68, 23%) aiming to promote PA. Most studies on digital nudges (11/68, 16%) targeted nutrition-related nudges for shopping and meal selection (8/68, 2%). Articles address PA and sedentary behavior less frequently (3/68, 4%). Three out of 68 (4%) articles report on recommender systems in combination with games, and 2 out of 68 (3%) articles report on recommender systems and digital nudges. Approaches to item retrieval vary widely, with 31 out of 68 (46%) articles failing to describe their methods. In the scoping review, we found a discrepancy between the target group for which the system was developed and the group with which the evaluation was conducted. Sixty-eight evaluations report positive results, while 26 studies report mixed, negative, or no-difference results. Conclusions: Integrating digital nudges and recommender systems might hold potential in overweight and obesity prevention by subtly encouraging healthier lifestyle choices. However, the heterogeneity in study designs, outcome measures, and reporting quality limits the comparability of findings and makes it difficult to draw robust conclusions about effectiveness. Future work should include detailed definitions, mechanism descriptions, broader geographic representation, and rigorous intervention testing and user evaluations to fully leverage these systems for improved health outcomes and to support sustainability and well-being objectives. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-080644

Effectiveness and Lessons Learned From an Occupational E-Mental Health Intervention for Enhancing Workplace Mental Health: The EMPOWER Cluster Randomized Controlled Trial

2026-04-14T15:00:18-04:00

Background: Occupational e-mental health (OeMH) interventions emerged as a promising solution to prevent common mental health problems and enhance well-being and work performance. However, they must be subject to robust and reliable assessments for effectiveness. Methods: A multimodal e-mental health intervention (EMPOWER [The European Platform to Promote Wellbeing and Health in the Workplace]) delivered over 7 weeks was developed and evaluated through a cluster randomized controlled trial conducted mainly in small to medium enterprises and public agencies from Spain (n=127), Finland (n=141), Poland (n=51), and the United Kingdom (n=389) between February 2022 and May 2024 (recruitment finalized in September 2023 and follow-up completed in May 2024). Inclusion criteria were being 18+ years, having a smartphone, sufficient language knowledge, and agreeing to participate. Clusters (companies or departments) were randomized to intervention or control conditions. The primary outcome was presenteeism, and secondary outcomes were depression and anxiety symptoms, etc, all measured at baseline, postintervention, and in 21 weeks after program completion. The analysis was performed as an intention-to-treat approach using adjusted linear mixed models and as per protocol analysis comparing outcomes by level of engagement. Results: A total of 347 participants were allocated to the intervention group and 361 to the control group. In the overall sample, the intention-to-treat analysis detected no statistically significant short-term (7 wk) or long-term (21 wk postintervention) effects of the EMPOWER intervention on presenteeism (postintervention =2.186; 95% CI −2.424 to 6.796, follow-up =1.294; 95% CI −3.608 to 6.396) and on other secondary outcomes such as depressive symptoms (postintervention =−0.052, 95% CI −1.02 to 0.905, follow-up =0.202, 95% CI −0.840 to 1.245), anxiety symptoms (postintervention =−0.328, 95% CI −1.168 to 0.512, follow-up =0.375, 95% CI −0.537 to 1.287), or general stress level (postintervention =0.385, 95% CI −0.195 to 0.965, follow-up =0.123, 95% CI −0.502 to 0.749). Subgroup analyses yielded several notable results, with significant differences between age groups, gender, and psychological symptoms at baseline. The per-protocol analysis showed no significant differences between participants who actively engaged with the intervention (119/347, 34%) and those who did not. Implementation challenges were related to technical problems, the complexity of this study’s design, external factors, co-design strategy, and organizational barriers, which led to a smaller sample size, high attrition rates, and low adherence. Conclusions: Our study provides evidence from a large cluster randomized controlled trial evaluating an OeMH intervention implemented in workplace settings, including small to medium enterprises and public agencies in Europe. Although no overall effectiveness was observed, this study contributes important methodological and implementation insights, highlighting the challenges of evaluating OeMH interventions. These findings suggest that future interventions should prioritize feasibility testing, organizational readiness, user engagement, and more targeted and pragmatic evaluation approaches to enhance real-world impact. Trial Registration: ClinicalTrial.gov NCT04907604; https://clinicaltrials.gov/study/NCT04907604 International Registered Report Identifier (IRRID): RR2-10.1177/20552076221131145

Association Between Depressive Symptoms and Incidence of Stroke in a Population With Cardiovascular-Kidney-Metabolic Syndrome Stages 0 to 3: Nationwide Prospective Cohort Study

2026-04-01T17:00:20-04:00

Background: The association between depressive symptoms and cardiovascular diseases is well established. However, their impact on the incidence of stroke in individuals with cardiovascular-kidney-metabolic (CKM) syndrome remains unclear. Objective: This study aims to investigate the impact of depressive symptoms at different stages of CKM syndrome on the incidence of new-onset stroke. Methods: This study used data from the China Health and Retirement Longitudinal Study. Depressive symptoms at baseline were assessed using the Center for Epidemiologic Studies Depression Scale, with stroke incidence determined through standardized follow-up questionnaires. Cox regression and restricted cubic spline regression were used to evaluate the association between depressive symptoms and stroke risk. Results: The analysis included 9593 participants (n=5180, 54.92% male; mean age of 60.89, SD 9.39 y), classified into CKM stages 0 to 3. Fully adjusted Cox regression showed that each 1-point increase in depressive score was associated with a 3% higher stroke risk (hazard ratio 1.03, 95% CI 1.02‐1.04; <.001). Restricted cubic spline regression confirmed a significant positive linear relationship between depressive symptoms and stroke incidence (<.001). Conclusions: This cohort study demonstrates a positive linear association between depressive symptoms and increased stroke incidence in individuals with CKM syndrome (stages 0‐3). These findings highlight the importance of emotional health management, suggesting that effective depression treatment may help reduce stroke risk through inflammation reduction and lifestyle improvements.

An Introduction to AI for Clinicians: Tutorial

2026-03-30T14:45:09-04:00

Artificial intelligence (AI) is already fundamentally changing society, with medicine being no exception. AI will impact how we practice, how hospitals operate, and even the practice of medicine itself. The use of AI-based products has already begun, with examples including AI scribes and large language models such as ChatGPT. Work is ongoing to produce models that have specific functions within medicine, such as kidney injury prediction. However, transformative foundational work, such as AlphaFold (for protein structure prediction), also promises to completely change the way we approach medicine. Therefore, clinicians must develop a clear understanding of AI, not as an optional skill, but as a core competency of modern medical practice. This paper serves as a tutorial to guide medical professionals through the basic principles of AI. It will teach clinicians how to build a mental scaffold to understand and springboard into AI. The core parts of this paper are organized in steps, with additional relevant topics addressed in modules at the end of the paper. The core steps are meant to be read sequentially. To prepare the reader for the rest of the paper, this tutorial will first introduce what AI is and then cover some basic definitions needed to understand other concepts. The reader will then be ready to understand what deep learning is and the difference between supervised and unsupervised learning. Finally, the reader will go through how deep learning models learn. Separate modules on safety and clinical applications are also included. This tutorial is relevant to clinicians at all levels but may be particularly useful for practicing clinicians who are encountering AI tools integrated into their practices without previous formal education in the field. Users of this tutorial can refer to specific sections or read the entire paper.

The Lifetime Dance Exposure Questionnaire for Professional Training: Survey Development and Reliability Study

2026-03-27T14:00:13-04:00

Background: Dance is a complex mode of physical activity (PA) behavior and an art form, and one’s participation in dance may occur across discrete contexts throughout the lifespan. To further advance the study of lifetime participation in dance behavior, reliable questionnaires are needed. Objective: This study aimed to develop and test the reliability of a self-report, online questionnaire for surveilling lifetime participation in professionally led dance classes among adults. Methods: Community-dwelling adults (N=373) completed the Lifetime Dance Exposure Questionnaire for Professional Training (LDEQ-T) at baseline (T1), and 150 adults repeated the LDEQ-T after an 8-week delay (T2). Test-retest reliability for self-reported dance training frequency, duration, and PA intensity was analyzed for the LDEQ-T between T1 and T2. Reliability for the LDEQ-T item on total years of professional dance training was assessed using intraclass correlation coefficients (ICCs; 2-way, random effects); linearly weighted kappa (????) was used for ordinal variables on dance class duration, intensity, and frequency; an unweighted kappa (????) statistic was used to test the reliability of 3 dance training exposure groups (no or low, homogenous, or variable lifetime exposure to professional dance training). The significance level was set a priori with α=.05. Results: Adults reported having no or low (n=92), homogenous (n=196), or variable (n=85) lifetime exposures to professional dance classes at T1. Among adults who self-reported homogenous exposures to dance training throughout the lifespan, years of dance training were found to be reliable across all age periods (ICC range 0.83-0.94); as were weeks/month, months/year, and hours/week of dance training (???? range 0.35-0.61); but not any measure of PA intensity. Among adults who self-reported variable exposures to dance training, years of dance training across all age periods (ICC=0.70-0.96); classes/week, weeks/month, months/year, and hours/week (???? range 0.32-0.56); and some estimates of PA intensity (???? range 0.30-0.41) were found to be sufficiently reliable. Conclusions: The LDEQ-T appears to be a reliable instrument for quantifying lifetime participation in professional dance training among adults with self-reported low, homogenous, or variable exposures to professional dance classes throughout the lifespan. Among adults, researchers may surveil lifetime exposure to dance training in early childhood, childhood, adolescence, young adulthood, and middle or older adulthood using the LDEQ-T.

Mapping the Global Surge in Postoperative Sleep Research From 2014 to 2024: Bibliometric Analysis

2026-03-26T13:00:11-04:00

Background: Postoperative sleep is closely associated with recovery among patients undergoing surgery. Objective: This study aimed to analyze the research status and developmental trends in postoperative sleep between 2014 and 2024. Methods: Publications were retrieved from the Web of Science Core Collection. Microsoft Excel and VOSviewer were used to analyze the papers in terms of publication trends, countries, institutions, authors, journals, and keywords. Results: A total of 964 papers were obtained for the bibliometric analysis. The number of publications on this topic has increased gradually over the last 10 years. Zhu Junchao was the most prolific author in the field, and Chung Frances had the most citations. China had the most publications, followed by the United States. Scientific institutions in China, such as China Medical University and Capital Medical University, have led the way in terms of publication numbers. A total of 40 journals have published at least 5 papers. , with 19 publications, ranked first in publication count. The papers published in the , , , , and had higher citation counts on average. The high-frequency keywords were “sleep quality,” “postoperative pain,” “quality of life,” and “surgery,” while “lung cancer,” “enhanced recovery after surgery,” “breast cancer,” and “dexamethasone” emerged as new topics in this area. Conclusions: There has emerged a large body of literature on postoperative sleep over the past 10 years. Authors and organizations from China are leading contributors, followed by those from the United States. Anesthesiology is a critical discipline in this field. Postoperative pain is closely related to postoperative sleep and has become a major research focus. Recent studies have mainly focused on lung cancer and breast cancer surgeries. Enhanced recovery after surgery has become an emerging keyword.

Prevalence and Associated Factors of Excessive Dietary Supplement Use Among Japanese Adults: Cross-Sectional Study

2026-03-19T16:15:10-04:00

Background: The use of dietary supplements (DSs) can lead to an excessive intake of certain nutrients, posing potential health risks. However, studies are scarce on whether DS users adhere to recommended doses provided by the manufacturer and what factors are associated with overconsumption of DS. Objective: By leveraging purchase history data to estimate DS use precisely, this study aimed to investigate the factors associated with DS consumption exceeding manufacturer-recommended doses and examine the prevalence of excess nutrient intake among DS users. Methods: An online survey was conducted from November to December 2024 among 2002 adults (aged 18‐74 years) with a history of buying one of the 25 major DS products and who had used it in the previous month or regularly. Self-reported daily DS consumption was assessed using a questionnaire and compared to the manufacturer-recommended doses indicated in the package. Using multivariate logistic regression analysis, the associations between DS consumption exceeding the manufacturer-recommended doses and sociodemographic factors were examined. Results: The prevalence of DS users exceeding tolerable upper intake levels (ULs), defined according to the Dietary Reference Intakes for Japanese, was calculated based on vitamin and mineral intake from DS only. Consequently, 371 (18.5%) of the 2002 participants consumed DS above the manufacturer-recommended dose. Consumption of DS above the recommended dose was associated with middle-aged, part-time or full-time employment, use of tablet-form DS, especially single water-soluble vitamin tablets, use of DS for 6 months or more, and intentional consumption above the recommended dose. For 1705 individuals consuming DS with UL nutrients, 17.4% (n=297) exceeded the manufacturer-recommended dose. Of these, 61.9% (184/297) surpassed UL by ≥1 nutrient. Conclusions: Middle-aged, part-time or full-time jobs, using tablet-form DS, and using DS for 6 months or more were associated with DS consumption exceeding the manufacturer-recommended dose, which may lead to excessive nutrient intake.

Information and Communication Technologies for Chronic Disease Self-Management in Adults Aged 65 Years and Older: Scoping Review

2026-03-19T16:15:10-04:00

Background: The increasing number of older adults living with chronic conditions has led to rapid growth in information and communication technologies (ICTs) designed to support chronic disease self-management. Although many technologies target behaviors such as medication adherence, physical activity, dietary management, and follow-up care, the breadth, characteristics, and design considerations of these tools for adults aged 65 years and older have not been comprehensively reported. Objective: This scoping review aims to systematically map the existing literature describing ICTs developed to support chronic disease self-management among adults aged 65 years and older. Specifically, the review seeks to (1) identify the types of ICTs available; (2) characterize the self-management behaviors they target; and (3) examine the extent of older adults’ involvement in the design, adaptation, or evaluation of these technologies. Methods: This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Seven databases (PubMed, CINAHL, Web of Science, Cochrane Library, Compendex, IEEE Xplore, and Computers & Applied Sciences Complete) were searched, with all searches completed on December 15, 2024. Inclusion criteria were peer-reviewed studies published in English between 2007 and 2025 that (1) included adults aged ≥65 years; (2) addressed one or more chronic diseases; and (3) evaluated, described, or tested an ICT intended to support at least 1 chronic disease self-management behavior. Two reviewers independently screened all titles and abstracts and full texts; disagreements were resolved by a third reviewer. Data were charted using a standardized extraction template and synthesized narratively by technology type and self-management domain. Results: Nineteen studies met the inclusion criteria. Technologies were grouped into 4 broad categories: mobile apps, online platforms, wearable or sensor-based tools, and smart home or device-integrated systems. Physical activity and medication management were the most targeted self-management behaviors, whereas follow-up appointment adherence and dietary behaviors were less frequently addressed. Only a small number of studies explicitly involved older adults in the design or development process, and such involvement was often limited to usability testing rather than participatory co-design. Conclusions: The current evidence base is fragmented, with substantial variability in technology types, targeted behaviors, and reported outcomes. Significant gaps remain regarding the participatory design of ICTs with older adults and the development of technologies that address multiple self-management needs simultaneously. Future ICT development should intentionally incorporate older adults and caregivers throughout the design cycle and expand beyond single-behavior interventions to reflect the multimorbidity common in this population.

Global Research Trends and Hotspots in Gene Editing and Stem Cell Therapies for Neurodegenerative Diseases: Bibliometric and Visualization Analysis

2026-03-09T15:45:14-04:00

Background: Neurodegenerative diseases are a major and growing global health burden. Their pathogenesis is complex, and effective therapies remain limited. Gene editing and stem cell–based strategies are reshaping the therapeutic landscape. However, the field has not been systematically examined through bibliometric analysis. Objective: We aimed to define the intellectual landscape of global research on gene editing and stem cell therapy for neurodegenerative diseases from 2005 to 2024, highlight evolving hotspots, track the field’s evolution, and identify major bottlenecks limiting clinical translation. Methods: We retrieved 1821 publications from the Web of Science Core Collection (2005-2024). We performed a multidimensional bibliometric analysis using CiteSpace and VOSviewer. We assessed publication output, country and institutional contributions, key authors and journals, co-cited references, and keyword networks. These analyses were used to track the field’s evolution and pinpoint emerging themes. Results: In total, 9978 researchers from 90 countries and 2515 institutions contributed to this literature. Annual publications increased from 28 in 2005 to 179 in 2024, with stepwise growth over time. The United States ranked first in output (n=780) and in citation impact (total local citation score=2784; total global citation score=40,009). China and India ranked second and fifth in output, respectively, but their average citation impact was lower than that of the leading countries. The University of California, San Francisco, and Johns Hopkins University remained consistently influential. Boulis NM, Bankiewicz KS, and Feldman EL were among the most prominent contributors. was the leading journal in this area. Keyword analyses pointed to a growing intersection between genetics and immunology. Major topics included nanotechnology-based delivery, adeno-associated virus vectors, small interfering RNA, intrathecal microsphere injection, autophagy, blood-brain barrier (BBB) targeting, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), and induced pluripotent stem cells. Burst detection highlighted “open label” as a recent hotspot. This likely reflects rising translational activity and early clinical testing. Conclusions: The field is moving from technology development toward clinical translation. Anglo-American countries currently drive both productivity and influence. China and India contribute heavily to volume but need a stronger impact. CRISPR/induced pluripotent stem cell platforms and BBB-focused delivery remain central frontiers. The rise of “open-label” studies suggests accelerating clinical momentum. Future progress will require safer and more efficient delivery, clearer standards, and larger global consortia to harmonize protocols and speed translation.

Frailty Screening and Management for Older Australians in General Practice: Mixed Methods Evaluation

2026-03-02T15:45:11-05:00

Background: Frailty increases with age and is associated with increased vulnerability to adverse health outcomes. International guidelines recommend screening for frailty in primary care; however, this is not routine practice in Australia. Once identified, frailty progression has the potential to be halted or reversed with early intervention. The FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) Scale Tool, a simple and validated screening and management tool, offers a feasible approach for integration into the Australian health assessment for those aged 75 years and older (75+HA), which can be performed annually by primary care providers. Objective: This study explores the rates of frailty, resources required to support management, and the determinants of implementing frailty screening and providing management for older Australians at the 75+HA. Methods: A mixed methods evaluation was conducted in 24 general practices across 2 Australian Primary Health Network regions, Sydney North and Brisbane South. The FRAIL Scale Tool was implemented during the 75+ health assessment, and data were collected on FRAIL Scale scores, hospitalization rates, recommended frailty interventions, and barriers to frailty management. Practice staff perceptions of the long-term sustainment of the FRAIL Scale Tool were assessed using the Provider Report of Sustainment Scale. Semistructured qualitative interviews were conducted with practice staff and patients, exploring barriers and enablers to implementing frailty screening and management. Guided by the Consolidated Framework for Implementation Research, transcripts were coded and themes developed. Results: Of the 1484 patients aged ≥75 years who were screened, 223 (15%) patients were frail, 616 (41.5%) patients were prefrail, and 645 (43.5%) patients were robust. People who were frail were more likely to be female, older, and have more prescribed medications. Of those screened as frail, 23 (11%) had a nonelective hospitalization in the 3 months prior to screening compared with 28 (5%) who screened as prefrail and 5 (1%) who screened as robust (=.012). Management recommendations commonly included medication reviews, aged care packages, assessment for depression, and exercise programs. Barriers identified to accessing interventions included health, transport, cost, and time. Survey and qualitative findings highlighted that the FRAIL Scale Tool was easy to use, integrated well into existing workflows as part of the 75+HA, and sustained use would be supported by software integration. Patients valued the assessment and tailored health support offered by trusted primary care providers. Conclusions: Incorporating the FRAIL Scale Tool into the annual health assessment for people aged 75 years and older provides a funded opportunity for addressing frailty in general practice. Patients and staff value the Tool’s simplicity and the opportunity to raise awareness and manage frailty proactively. Incorporating the Tool into practice software systems would enhance adoption. Broader implementation research in diverse settings and with Aboriginal and Torres Strait Islander populations is needed to improve frailty prevention and management.