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/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 https://www.i-jmr.org/2026/1/e92542 2026-07-06T11:45:15-04:00 Leyi Zhou Xinyi Zuo Joonyoung Cho Chuxuan Zheng Shengyi Jing Xiaoling Xiang

Background: Mental health conditions, including depression, anxiety, and psychological distress, are prevalent among the aging population and affect their health, functioning, and quality of life. Access to proper and high-quality mental health treatment is necessary; however, mental health treatment and care remain underused due to stigma, workforce shortages, cost, and mobility limitations. Digital mental health interventions (DMHIs) are emerging as a promising strategy to improve the accessibility and effectiveness of mental health services for older adults, but older adults have historically been underrepresented in DMHI development and evaluation. Additionally, the effectiveness of different types of DMHIs and how age-centered design approaches influence outcomes remain underexplored. Objective: This scoping review mapped and synthesized evidence on DMHIs focused on adults aged 50 years and older and identified gaps in the evidence base related to study design, age-related adaptations, and clinical outcomes. Specifically, we examined (1) the technologies and therapeutic approaches used, (2) the outcomes and effectiveness of DMHIs, and (3) age-centered adaptations and their outcomes. Methods: This scoping review searched for studies focusing on DMHIs for older adults across PubMed, PsycINFO, Scopus, Ageline, and Web of Science that were published from 2000 to February 2025. Eligible studies evaluated or described the design of DMHIs targeting mental health conditions among adults aged 50 years or older. Two rounds of independent screening and data extraction were conducted by multiple reviewers. Extracted data included study design, sample characteristics, intervention features, technologies used, age-related adaptations, and clinical outcomes. Results: Seventy-two studies met the inclusion criteria, of which 36 were randomized controlled trials and 54 reported clinical outcomes. Web-based cognitive behavioral therapy was the most commonly used approach, followed by games, virtual reality, mobile apps, chatbots, and robots. Fifty-four studies reported positive clinical outcomes, most commonly reductions in depression, anxiety, or psychological distress. However, only one-third of the studies incorporated age-centered design adaptations or co-design approaches, such as simplified interfaces, larger fonts, age-relevant content, or participatory development with older adults. Conclusions: Among studies reporting positive clinical outcomes, DMHIs can reduce depression, anxiety, and psychological distress. However, with only half of the included studies using randomized controlled trial designs, the overall evidence base remains moderate. In addition, age-adaptive design remains underdeveloped. Future research should strengthen trial designs and systematically examine how usability and age-centered adaptations influence DMHI effectiveness.

2026-07-06T11:45:15-04:00 https://www.i-jmr.org/2026/1/e85868 2026-06-22T15:00:29-04:00 Elizabeth R Boskey Jessica D Kant Ariel K Berman Frances W Grimstad

Background: Inclusive health education content has been shown to increase acceptability and accessibility for lesbian, gay, bisexual, transgender, queer, intersex, and asexual, as well as other sexual and gender minority (LGBTQ+) individuals. However, there has been some backlash among general audiences, with claims that such inclusive content is “woke” or otherwise problematic. Objective: The goal of this study was to test whether individuals across the political spectrum notice when sexual and reproductive health content is written with inclusive language in order to demonstrate the acceptability of inclusive content to a broader audience. Methods: This study included 454 adults assigned female at birth from the United States, one-third of whom identified as LGBTQ+, reviewed 2 sets of reproductive health educational handouts designed for adolescents, with 1 gender-inclusive and 1 gender-specific version in each set, randomized in order. Individuals were asked to rate each document and state a preference within each pair (implicit preference). They were then debriefed on the study’s purpose and asked if they had an explicit preference for gender-specific or gender-inclusive content. Results: Preferences for explicit content tended toward gender-specific content: always gender-specific (n=184, 40.5%), sometimes gender-specific (n=59, 13%), no preference (n=131, 28.8%), sometimes gender-inclusive (n=39, 8.6%), and always gender-inclusive (n=41, 9%). However, most people (n=273, 59%) did not notice differences between the first pair of documents they viewed or rate them differently (mean difference −0.19, SD 2.17, range −10 to 12). Furthermore, the majority of individuals who had a stated preference for gender-specific health education documents did choose the gender-specific document as their preferred version for either the first (n=45, 24%) or second pair of documents (n=69, 38%). Individuals who preferred content to always be gender-inclusive were significantly more likely to choose the concordant version of their document (n=20, 49% for the first pair; n=24, 58% for the second pair). A total of 58% (n=262) of the participants stated they did not notice the study design until the debrief. Conclusions: Most participants did not notice when sexual and reproductive health educational content had been made gender-inclusive—even when they had an explicit preference for gender-specific content. This suggests that when inclusive language is not directly called to readers’ attention, inclusive sexual and reproductive health content is broadly acceptable to individuals across a range of political beliefs. The use of inclusive language may therefore be a means of increasing the accessibility and applicability of educational materials to diverse recipients, including LGBTQ+ individuals. Trial Registration: ClinicalTrials.gov NCT07601581; https://clinicaltrials.gov/study/NCT07601581

2026-06-22T15:00:29-04:00 https://www.i-jmr.org/2026/1/e84933 2026-06-18T18:00:25-04:00 Bruno B Andrade

Generosity can function as a scientific method—a disciplined stance that aligns curiosity with openness, credit-sharing, and stewardship of data, specimens, and ideas. Rather than a soft add-on, generosity structures how questions are framed, teams are built, and results are disseminated, thereby improving rigor, reproducibility, and impact. This viewpoint article advances a conceptual and operational framework for “generosity in science,” aimed at researchers, institutions, and funders seeking alternatives to competition-driven models of knowledge production. I examine generosity as practice at the levels of people, collectives, and institutions and argue that persistent global challenges in health demand pro-collaborative architectures. Seen this way, generosity is not mere altruism; it is part of the epistemic engine that turns uncertainty into shared knowledge while distributing opportunity and recognition more fairly. I define core principles of generous research and organize them across three domains: research design, governance, and evaluation. The paper draws on illustrative examples and relevant literature to situate generosity within ongoing debates on open science, team science, and research assessment reform. I outline practical principles for embedding generosity into research design, governance, and evaluation and discuss how these principles can counter vanity metrics and short-term incentives. I conclude that embedding generosity in the infrastructure of science enables better questions, faster learning, and greater public value.

2026-06-18T18:00:25-04:00