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Artificial Intelligence and Machine Learning Applications in Fibromuscular Dysplasia: Transforming Diagnosis, Risk Stratification, and Clinical Decision-Making.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disorder with heterogeneous presentations, making diagnosis and management highly dependent on imaging and clinical expertise. This narrative review examines how artificial intelligence (AI) and machine learning (ML) are transforming FMD care. AI-enhanced imaging, particularly convolutional neural network-based analysis, improves detection of the characteristic "string-of-beads" pattern on CT angiography, magnetic resonance angiography, and ultrasound, although FMD-specific validation remains limited. ML models facilitate risk stratification, prediction of disease progression, and early identification of complications such as aneurysms and stroke by integrating clinical, imaging, and genomic data. AI-driven clinical decision support systems further enable personalized treatment selection through pharmacogenomic insights and robot-assisted interventions. Despite promising real-world applications, challenges persist, including limited large-scale datasets, workflow integration, regulatory barriers, and algorithmic bias affecting underrepresented populations. Future advances in explainable AI, federated learning, and digital health integration may enable a shift toward predictive, patient-centered FMD management.

Humans↗

Perceptions of the authority of health information. Case study: digital interactive television and the Internet.

As part of a Department of Health funded project nearly 2000 people were surveyed as to their use of two digital health information services, one on the Web and the other on digital interactive television (DiTV). The website was of a commercial company-Surgerydoor-and the DiTV service NHS based. This paper concentrates on the issue of trust in digital health information. Two of the main findings were that advertising was found to have an effect on trust, though the quality and type of advertising will impact in different ways on trustworthiness. DiTV subscribers who had either used the Living Health channel which carried NHS branded health information or had heard of the service, were more likely to say that the NHS was a symbol of trust for them compared with DiTV subscribers who had not used the service.

Adolescent↗

Evidence-Based Practice: a new paradigm brings new opportunities for health sciences librarians.

It is questionable whether the Evidence-Based Health Care model, whereby end users appraise all potentially pertinent information, is sustainable. A shift to an Evidence-Based Practice model, featuring a new medical knowledge base infrastructure facilitating rapid translation of clinical research into practice should be embraced. This shift would offer new opportunities for health sciences librarians. In this article, the authors: (1) review milestones in the evolution of the health sciences knowledge base; (2) review the evolution of the Evidence- Based Health Care/Practice model of health information utilization; and (3) discuss the significance and implications for health sciences librarians of trends towards an increasingly digital health information environment. The authors suggest new roles for health sciences librarians: partnering to integrate advanced information management technologies into the clinical enterprise and integration into the processes for developing these technologies.

Evidence-Based Medicine↗

A Smartphone-Based Ecological Momentary Intervention for Workplace Mental Health: Randomized Controlled Trial.

BACKGROUND: Work-related stress has been widely associated with an increased risk of various mental disorders and poor mental well-being. The fast-growing mobile health services industry has provided new opportunities for workplace mental health. OBJECTIVE: This randomized controlled trial examined the effectiveness of Neurum (Neurum Limited), a smartphone-based intervention tool featuring ecological momentary assessments and interventions that aims to reduce workplace stress in real-time and real-world settings. METHODS: A total of 201 working adults were recruited for a 4-week smartphone-based intervention that incorporated cognitive behavioral therapy, mindfulness exercises, and self-regulation exercises delivered on Neurum. A simple randomization procedure was used. Participants in the intervention group were encouraged to log mood journals, complete mental health exercises, and provide user feedback whenever applicable. The key outcome was measured by the Depression, Anxiety, and Stress Scale-21 items (DASS-21; Cronbach &#x3b1;=0.87). RESULTS: The intervention group consisted of 102 participants, while the control group consisted of 99 participants. More participants dropped out from the intervention group (n=21) than from the control group (n=2; &#x3c7;21=18.259; P<.001). The final sample consisted of 178 participants (male: 85/178, 47.8%; female: 93/178, 52.2%; mean age of 34.65, SD 7.67 y). Analyses revealed that after the 4-week intervention, the DASS-21 scores decreased in the intervention group (mean difference [MD]post-pre intervention=-14.518) but increased in the control group (MDpost-pre intervention=3.319; F1,176=59.358, P<.001; &#x3b7;2=0.252). This effect was largely led by stress reduction (F1,176=64.679, P<.001; for the intervention group, MDpost-pre intervention=-6.692, while for the control group, MDpost-pre intervention=2.000). On average, participants completed 6.27 (SD 9.4) exercises and provided 9.74 (SD 18.2) mood journal logs, with a daily engagement of 4.95 (SD 6.89) minutes. However, the associations between the changes in DASS-21 scores and the numbers of exercises or mood journal logs did not reach statistical significance. CONCLUSIONS: This study primarily established the effectiveness of Neurum in alleviating depression, anxiety, and stress symptoms in noninstitutionalized working adults, with a satisfactory user retention rate. Despite potential health-related culture differences, Neurum contributed to evidence-based digital health in nonclinical settings for timely needs and general accessibility as an alternative to traditional, face-to-face, and high-cost mental health services. Future directions involving a personalized approach in online mental health services were discussed.

Humans↗

What predicts patients' interest in the Internet as a health resource in primary care in England?

OBJECTIVES: To identify what factors predict patients' interest in using Internet health information in the light of poor uptake of a free, guided Internet service in one inner-city general practice. METHODS: Questionnaires were administered over a five-day period to consecutive adult patients attending two Manchester general practices: an inner-city practice serving a relatively deprived patient population where the free Internet service had previously been available, and a suburban practice serving a relatively affluent population. Data were analysed using multiple regression to identify predictors of self-reported interest in using the Internet for health information. RESULTS: A total of 753 (74%) patients completed the questionnaire although analyses were restricted to 660 (65%) cases. Independent predictors of patient-reported interest in getting health information from the Internet were (in order of relative 'importance'): positive outcome expectancy (i.e. the patient's strength of belief that it would enable them to deal better with their health); previous use of health websites; positive 'self-efficacy' (i.e. patients' confidence in their ability to use the technology); higher education; a positive attitude to getting health information from alternative sources; social deprivation; and having school-age children living at home. Level of Internet access was an important determinant of self-efficacy, but home access was the key predictor of outcome expectancy and past use of 'e-health'. CONCLUSIONS: Access, demographics and, particularly, motivational factors all influence patients' interest in the Internet as a health resource. Proposals to encourage more widespread use of digital health information need to take account of this complexity and not deal with access issues alone.

Adult↗

Electronic health record meets digital library: a new environment for achieving an old goal.

Linking the electronic health record to the digital library is a Web-era reformulation of the long-standing informatics goal of seamless integration of automated clinical data and relevant knowledge-based information to support informed decisions. The spread of the Internet, the development of the World Wide Web, and converging format standards for electronic health data and digital publications make effective linking increasingly feasible. Some existing systems link electronic health data and knowledge-based information in limited settings or limited ways. Yet many challenging informatics research problems remain to be solved before flexible and seamless linking becomes a reality and before systems become capable of delivering the specific piece of information needed at the time and place a decision must be made. Connecting the electronic health record to the digital library also requires positive resolution of important policy issues, including health data privacy, government encouragement of high-speed communications, electronic intellectual property rights, and standards for health data and for digital libraries. Both the research problems and the policy issues should be important priorities for the field of medical informatics.

Internet↗

The Virtual Naval Hospital: the digital library as knowledge management tool for nomadic patrons.

OBJECTIVE: To meet the information needs of isolated primary care providers and their patients in the US Navy, a digital health sciences library, the Virtual Naval Hospital, was created through a unique partnership between academia and government. METHODS: The creation of the digital library was heavily influenced by the principles of user-centered design and made allowances for the nomadic nature of the digital library's patrons and the heterogeneous access they have to Internet bandwidth. RESULTS: The result is a digital library that has been in operation since 1997, continues to expand in size, is heavily used, and is highly regarded by its patrons. CONCLUSIONS: The digital library is dedicated to delivering the right information at the right time to the right person so the right decision can be made, and therefore the Virtual Naval Hospital functions as a knowledge-management system for the US Navy Bureau of Medicine and Surgery.

Health Education↗

Facilitating Thought Progression via a Gamified Mobile Application for Depression: Possible Mediators of Outcomes.

Mobile health interventions represent a scalable and accessible alternative to traditional therapy, which often is out of reach due to high costs and societal stigma. Rumination is considered a key mechanism of emotional disorders and represents a potential treatment target for digital health interventions. The current study investigated the role of rumination as a mediator of the reduction in depression and anxiety reported after the use of a gamified mobile app based on the Facilitating Thought Progression (FTP) framework. One hundred-one adults with mild to moderate depression were randomized to the FTP intervention or a waitlist control group and completed weekly assessments of depression, anxiety, and rumination over 8 weeks. Multilevel structural equation modeling revealed that reduction in rumination significantly mediated decreases in depression and anxiety in the intervention group but not in the waitlist condition. These findings suggest that the FTP app targeted rumination and further highlights its role as a critical target for interventions for depression and anxiety.

Adult↗

Wall Street comes to Washington: where is health care headed?

Although health care spending trends have slowed slightly, employers and consumers can expect another round of double-digit health insurance premium increases in 2004, according to a panel of market and health policy experts at the Center for Studying Health System Change's (HSC) eighth annual Wall Street roundtable. Firms will continue to shift costs to workers but are skeptical of new insurance products, including consumer-driven health plans and tiered provider networks. Most health plans are thriving as they continue to price products ahead of cost trends and gain administrative efficiencies. Many hospitals, facing revenue pressures from increasing competition from physician-owned specialty facilities, are continuing aggressive building campaigns, raising concerns about increased costs if they overshoot and add too much capacity. Efforts to revive the ailing Medicare managed care program face an uphill climb as Congress debates reforms as part of prescription drug legislation.

Economic Competition↗

Assessment of bovine hoof conformation and its association with lameness, animal factors and management practices on small-scale dairy farms in Kiambu district, Kenya.

Digital health and conformation were assessed in 216 dairy cattle on 78 randomly selected small-scale farms. For each cow, gait was assessed and the digits examined in detail. Hoof measurements (angle and length of the dorsal hoof wall, heel depth and hoof-base area) were also made. Hoof measurements varied most between individual cattle. Dorsal angle was correlated with heel depth (r = 0.53; P = 0.001) and dorsal length (r = -0.40; P = 0.001). The hoof-base area was correlated with the dorsal length (r = 0.41; P = 0.001). There were significant breed differences in dorsal angle (P = 0.03) and dorsal length (P < 0.01). The dorsal angle was correlated with parity and body condition, while the dorsal length, heel depth and the hoof-base area were correlated with the heart girth (P < 0.01). Hoof conformation was associated with both clinical lameness and hoof lesions. A 1-cm increase in the dorsal length increased the odds of lameness by 16.9, heel erosion by 1.8, underrunning by 5.4 and overgrowth by 40 (P < 0.01).

Age Factors↗

Effects of enhanced calling efforts on response rates, estimates of health behavior, and costs in a telephone health survey using random-digit dialing.

Public health researchers frequently rely on random-digit dialing (RDD) telephone surveys in monitoring trends in health behavior and evaluating health promotion interventions. RDD response rates have declined during the past decade, and cost-effective methods to increase response rates are needed. The authors evaluated two levels of enhanced calling efforts in an RDD survey of cancer-related health behavior in the State of Washington. The first level of enhanced calling effort was 1 month after 11 original calling attempts to a household, when the authors attempted up to 11 recalls. The second level was 6 months after the first answered call, when the authors recalled those persons who could not be interviewed. Enhanced calling efforts increased the overall survey response rate by 11 percent. Nine percentage points of the increase were attributable to call backs. There were demographic differences among the participants reached at different levels of calling effort, but no consistent associations of level of calling effort with health behavior related to alcohol use, smoking, diet, or health screening. Marginal costs for interviews completed with enhanced calling efforts were about 50 percent higher than costs for interviews reached in the first 11 calls. The authors concluded that enhanced calling efforts may be justified, because they increase confidence in the generalizability of survey results. However, the authors found very little change in survey results by including interviews from persons who were difficult to reach and to interview.

Adolescent↗

Evaluation of the KA24 (Knowledge Access 24) service for health and social care staff in London and the south-east of England. Part 2: qualitative.

AIM AND OBJECTIVES: The aim of this two-part paper is to identify the main transferable lessons learned from both the quantitative and qualitative evaluations of the KA24 (Knowledge Access 24) service of online databases and selected full-text journals for health and social care staff in London and the south-east of England. The objectives of the qualitative evaluation were to assess the enablers and barriers to usage, and to assess the impact of the service on patient care. METHODS: Telephone interviews (n = 65) and a questionnaire survey (n = 296) were conducted with various types of user, in various Trust settings. Some non-users were also contacted. Selection of interviewees and questionnaire recipients was not random, and aimed to cover all groups of users representatively. RESULTS: Results show that policy goals were being delivered, with indications of changes to clinical practice, and improved clinical governance. Promotion, training and support needs to be extensive, and tailored to needs, but users are not always aware they need training. The sharing of passwords cast doubts on the reliability of some usage data. CONCLUSIONS: Digital health library services, delivered at the point of care, are changing the way some clinicians practise. A combination of qualitative and quantitative evaluation methods are needed to assess digital library services.

Computer Literacy↗

Experimental validation of an AI-driven digital healthcare platform for oral health behavior and plaque assessment among vietnamese children.

BACKGROUND: Oral health among children in developing countries, including Vietnam, remains a significant public health concern. Innovative approaches leveraging artificial intelligence AI-based digital health platforms may offer effective strategies for managing dental plaque and promoting better oral hygiene behaviors among school-aged children. This study aimed to evaluate the effectiveness of an AI-driven oral healthcare platform (Denti-i Vietnam) in improving oral hygiene and behavioral outcomes among Vietnamese primary school students. METHODS: A total of 204 primary school students aged 8-10&#xa0;years in Hanoi, Vietnam, participated in this experimental study. Participants were randomly assigned to an intervention group (n&#xa0;=&#xa0;107), which used the AI-driven oral healthcare platform, and a comparison group (n&#xa0;=&#xa0;97), which received traditional oral health education via pamphlets. Oral health behaviors, dental plaque levels (Simplified Oral Hygiene Index; OHI-S), and caries indices (dft/DMFT) were assessed at baseline and after the intervention period. RESULTS: The intervention group demonstrated a significant reduction in the OHI-S score compared to baseline (2.49&#xa0;&#xb1;&#xa0;0.60 to 1.70&#xa0;&#xb1;&#xa0;0.76, p&#xa0;<&#xa0;0.001), particularly in the debris component, indicating enhanced plaque control. Notable improvements were also observed in oral hygiene behaviors, including increased frequency of toothbrushing before and after breakfast (p&#xa0;<&#xa0;0.01) and more frequent parental assistance during brushing (p&#xa0;=&#xa0;0.03). Furthermore, parental awareness of dental caries significantly increased in the intervention group (p&#xa0;=&#xa0;0.001). CONCLUSIONS: The AI-driven oral healthcare platform significantly improved both oral hygiene behaviors and plaque control among Vietnamese primary school children. These findings suggest that AI-driven digital health tools can serve as practical and scalable solutions for promoting oral health in developing countries.

Humans↗

Age at menopause and subjective cognitive symptoms predict digital cognitive outcomes at the gynecological Well-Woman visit.

INTRODUCTION: Women are at increased risk for Alzheimer's Disease (AD). Growing evidence suggests that the menopausal transition may represent a vulnerable window for development of AD-related pathology. Yet, women are diagnosed with AD later than men. Conducting routine cognitive screenings and integrating information about both cognitive symptoms and age at menopause may help address sex-based disparities in detection and prevention. This study investigated whether subjective cognitive symptoms, in combination with age at menopause, were associated with performance on a digital cognitive task in postmenopausal women. METHODS: 183 postmenopausal women (mean age&#x2009;=&#x2009;63.8, range&#x2009;=&#x2009;45-85) were recruited after their Well-Woman visit. Participants completed the Screener for Cognitive Problems in Everyday Life (SCoPE) to assess subjective cognitive symptoms, followed by a sensitive measure of objective cognition: the Linus Health Digital Clock and Recall (DCR&#x2122;). Information was also collected on age at menopause. We examined associations of subjective cognitive symptoms and age at menopause with digital cognitive performance, adjusting for age, education and depression. Model fit was evaluated using adjusted R2, AIC, and BIC. RESULTS: 48.1% of women reported one or more cognitive symptoms on the SCoPE. On objective testing, 73.2% scored in the normal range, 20.8% in the borderline range, and 6.0% in the impaired range. SCoPE total score was negatively associated with objective cognitive performance in adjusted models (B&#x2009;=&#x2009;-.12, p&#x2009;=&#x2009;.03). Age at menopause showed a significant quadratic association with cognitive performance (B&#x2009;=&#x2009;-0.006, p<.001). SCoPE total was not associated with DCR subtests, while age at menopause predicted both Delayed Recall and Clock Drawing. CONCLUSION: Subjective cognitive symptoms and age at menopause were associated with lower performance on a sensitive, objective cognitive test. Findings support routine cognitive screening and suggest that subjective cognitive symptoms as well as age at menopause are associated with cognitive function.

Humans↗

The musculoskeletal pain literacy questionnaire (MSK-PLq) - Part 1: Development of a preliminary version through a systematic review and Delphi consensus.

OBJECTIVE: Chronic musculoskeletal (MSK) pain is a leading cause of disability worldwide, and self-management is a first-line approach recommended by international clinical guidelines. Access to evidence-based information that enhances health literacy may support patients' engagement in their self-management and treatment decision-making, potentially reducing disease burden and pain. However, no tool currently exists to assess health literacy specifically in MSK pain. This study aimed to develop and describe the preliminary version of a knowledge-based questionnaire to evaluate MSK pain literacy, the Musculoskeletal Pain-Literacy questionnaire (MSK-PLq). METHODS: A systematic literature review identified existing health literacy instruments and generated a preliminary list of domains. A two-round Delphi study with 22 panellists (19 experts and three people living with chronic MSK pain), followed by consensus meetings, was used to refine domains and items (&#x2265;70% agreement). Readability was assessed using the Flesch Reading Ease (FRE) score and three stakeholders were consulted to review the questionnaire for comprehensibility, clarity, and face validity. RESULTS: Six domains were retained (Understand, Access, Appraise, Apply, Digital, Beliefs), comprising 20 items in the preliminary version of MSK-PLq. Readability was acceptable (mean FRE 74, indicating fairly easy reading), and subject feedback supported the questionnaire's clarity and face validity. CONCLUSIONS: The preliminary version of the MSK-PLq is proposed as the first knowledge-based tool to assess functional, interactive, and critical aspects of MSK pain literacy. It may have applications in clinical practice, research, education, and digital health, by informing tailored patient education and supporting self-management strategies, although further psychometric validation is required.

Humans↗

Enterocutaneous Fistula-Associated Sepsis and Mortality: Development and Validation of a Multimodal Artificial Intelligence Prediction Model.

BACKGROUND: Predicting enterocutaneous fistula (ECF)-associated sepsis and mortality poses significant challenges in digital health care due to the disease's complexity and heterogeneous clinical manifestations. Current approaches that rely on single-modal data or traditional scoring systems often fail to capture the intricate immune-inflammatory dynamics and multisystem involvement in patients with ECF. OBJECTIVE: This study aims to develop an artificial intelligence (AI)-driven multimodal fusion model integrating clinical, imaging, and transcriptomic data for early prediction of ECF-associated sepsis and 28-day mortality, addressing the limitations of conventional single-dimensional models. METHODS: This study leveraged publicly available datasets (Medical Information Mart for Intensive Care III [MIMIC-III], electronic Intensive Care Unit [eICU], and The Cancer Genome Atlas) to construct a multimodal framework. Clinical parameters were processed using Extreme Gradient Boosting, abdominal imaging features were extracted via convolutional neural networks, and transcriptomic profiles were analyzed with variational autoencoders. A Transformer-based fusion network was employed for joint prediction and validated through cross-validation and external testing. Key features were identified using Shapley Additive Explanations and Local Interpretable Model-Agnostic Explanations interpretability algorithms, while immune regulatory mechanisms were explored via weighted gene co-expression network analysis. RESULTS: The multimodal model achieved an area under the curve (AUC) of 0.89 for predicting sepsis and 28-day mortality, outperforming unimodal models (clinical-only model, AUC 0.72, and imaging-only model, AUC 0.78). Critical predictors included Sequential Organ Failure Assessment score, lactate levels, intra-abdominal free fluid on imaging, and immunoregulatory genes (programmed death-ligand 1 [PD-L1] and indoleamine 2,3-dioxygenase 1 [IDO1]). Mechanistic analysis revealed distinct immune reprogramming in patients with sepsis, characterized by increased regulatory T cells and M2 macrophages, along with downregulated cluster of differentiation 8+ (CD8+) T cells. CONCLUSIONS: This multimodal AI model offers an innovative digital solution in medical informatics, enabling precise early risk stratification for ECF-associated sepsis. By integrating multisource data and providing interpretable insights into immune-inflammatory pathways, the model enhances health care quality for patients with ECF and paves the way for personalized intervention strategies.

Humans↗

Digital radiography: update for oral health care workers.

Digital Radiography is an imaging system that does away with the use of films. It constitutes an advance in computer technology and has made a significant impact on the field of Maxillofacial- and Dental Radiology. This paper presents an overview of the basic concepts and applications of dental digital radiography and compares it with conventional film-based imaging. In addition, it provides a thorough understanding of the direct, semi-direct and indirect dental digital imaging systems with their advantages and disadvantages. Universal acceptance of digital radiographic imaging as a diagnostic tool makes it important for oral health care workers to understand the principles thereof and to master the techniques involved in acquiring a diagnosable digital radiographic image.

Humans↗