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JMIR Preprints
A preprint server for pre-publication/pre-peer-review preprints intended for community review as well as ahead-of-print (accepted) manuscripts
Background: Given the health benefits of Internet use among older adults, inadequate use of the Internet is an urgent public health issue in many countries. Objective: We aimed to determine whether visual impairment is associated with Internet use in a population-based sample of older adults. Methods: This cross-sectional study sourced data for the year 2016 from the Japan Gerontological Evaluation Study (JAGES). It included community-dwelling individuals aged ≥ 65 years (n =19,452 ) in Japan. We used multivariate logistic regression with multiple imputations to analyze visual status, daily Internet use, and any correlations between them. Results: We observed that 4,599 (23.6%) of respondents used the Internet almost daily. Even after adjusting for several covariates, significant associations persisted between visual status and daily Internet usage. The odds ratios (ORs) tended to increase as visual status improved (P for trend < .001). The adjusted ORs for individuals with excellent and very good visual status who used the Internet almost daily were 1.36 (95% confidence interval [CI]: 1.20‒1.54) and 1.24 (95% CI: 1.14‒1.35), respectively. Conversely, the adjusted OR for those with fair/poor visual status was 0.75 (95% CI: 0.63‒0.88). Conclusions: Visual impairment negatively impacted the daily use of the Internet by older adults. This highlights the need to address visual impairments to promote Internet use as healthcare services become more easily accessed online.
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Background: Given the health benefits of Internet use among older adults, inadequate use of the Internet is an urgent public health issue in many countries. Objective: We aimed to determine whether vi...
Background: Given the health benefits of Internet use among older adults, inadequate use of the Internet is an urgent public health issue in many countries. Objective: We aimed to determine whether visual impairment is associated with Internet use in a population-based sample of older adults. Methods: This cross-sectional study sourced data for the year 2016 from the Japan Gerontological Evaluation Study (JAGES). It included community-dwelling individuals aged ≥ 65 years (n =19,452 ) in Japan. We used multivariate logistic regression with multiple imputations to analyze visual status, daily Internet use, and any correlations between them. Results: We observed that 4,599 (23.6%) of respondents used the Internet almost daily. Even after adjusting for several covariates, significant associations persisted between visual status and daily Internet usage. The odds ratios (ORs) tended to increase as visual status improved (P for trend < .001). The adjusted ORs for individuals with excellent and very good visual status who used the Internet almost daily were 1.36 (95% confidence interval [CI]: 1.20‒1.54) and 1.24 (95% CI: 1.14‒1.35), respectively. Conversely, the adjusted OR for those with fair/poor visual status was 0.75 (95% CI: 0.63‒0.88). Conclusions: Visual impairment negatively impacted the daily use of the Internet by older adults. This highlights the need to address visual impairments to promote Internet use as healthcare services become more easily accessed online.
Background: Cerebral hemorrhage is a critical medical condition which necessitates a rapid and precise diagnosis for timely medical intervention including emergency operation. Computed Tomography (CT)...
Background: Cerebral hemorrhage is a critical medical condition which necessitates a rapid and precise diagnosis for timely medical intervention including emergency operation. Computed Tomography (CT) is essential for identifying cerebral hemorrhage, while its effectiveness is limited by the availability of experienced radiologists, especially in resource-constrained regions or when shorthanded during holidays or night. Despite advancements in artificial intelligence (AI)-driven diagnostic tools, most of which require technical expertise, posing a challenge for widespread adoption in radiological imaging. The introduction of advanced natural language processing (NLP) models such as GPT-4, which can annotate and analyze images without extensive algorithmic training, offers a potential solution. This study investigates GPT-4's capability to identify and annotate cerebral hemorrhage in cranial CT scans, a novel application of NLP models in radiological imaging. Objective: CT scans with six types of cerebral hemorrhage collected at Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine between January and September in 2023. Methods: In this retrospective analysis, we collected 208 CT scans with six types of cerebral hemorrhage at Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine between January and September in 2023. All CT images were randomly fed into GPT-4 for the analysis and annotation of cerebral hemorrhage. The outputs were subsequently examined using Photoshop and evaluated by experienced radiologists on a 4-point scale to assess the identification completeness, accuracy and success. Results: The overall identification completeness percentage for six types of cerebral hemorrhage was 72.59 ± 18.62%. Specifically, GPT-4 achieved higher identification completeness percentages in epidural and intraparenchymal hemorrhages (89.02 ± 19.01%, 86.86 ± 17.69%, repectively), yet its identification completeness percentage in chronic subdural hemorrhages was very low (37.35 ± 37.50%). The misidentification percentages for complex hemorrhage, epidural hemorrhage and subarachnoid hemorrhage were relatively high (54.00 ± 28.04%, 50.25 ± 22.65%, 50.54 ± 29.18%, respectively), whereas they were relatively low for acute subdural hemorrhage, chronic subdural hemorrhage and intraparenchymal hemorrhage (32.61 ± 26.27%, 40.34 ± 27.19%, 26.24 ± 23.85%, respectively). The identification completeness percentages in both massive and minor bleeding showed no significant difference. However, the misidentification percentage in recognizing massive bleeding was significantly lower than that for minor bleeding. The identification completeness percentage and misidentification percentage for cerebral hemorrhage at different locations showed no significant differences. At last, radiologists showed relative acceptance regarding the identification completeness, accuracy and success (3.60 ± 0.54, 3.30 ± 0.65, 3.38 ± 0.64, respectively). Conclusions: GPT-4, a standout among NLP models, exhibits both promising capabilities and certain limitations in the realm of radiological imaging, particularly when it comes to identifying cerebral hemorrhages in CT scans. This opens up new directions and insights for the future development of NLP models in radiology. Clinical Trial: This retrospective study was registered at ClinicalTrials.gov (NCT06230419) and approved by the Ethics Committee of Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine.
Background: Providing incentives for doctors' knowledge contributions in online medical communities is crucial for both doctors and patients. For doctors, offering channels to monetize their knowledge...
Background: Providing incentives for doctors' knowledge contributions in online medical communities is crucial for both doctors and patients. For doctors, offering channels to monetize their knowledge enhances their earnings from online contributions, increasing their willingness and efficiency in sharing knowledge. For patients, the existence of paid knowledge complements their access to information, providing higher-quality and more specialized medical knowledge. Objective: This article examines how the introduction of monetary incentives in online medical communities affects doctors’ unpaid knowledge activities in the community. Methods: This article uses the website of Haodf online platform as the data source, that introduces paid scenarios for its science popularizing function which can bring economic benefits to doctors. A total of 7453 doctors who participated in the knowledge contribution of the website were collected including their paid and unpaid knowledge activities. Then this article studies the impact of participation in paid knowledge activities on doctors' free knowledge contributions, including knowledge quantity, quality, and diversity dimensions. Considering the inconsistent participation time of doctors in paid knowledge activities, this article combines the propensity score matching method and the multi-period difference-in-differences method. Results: This study found that participation in paid knowledge activities has a positive spillover effect on doctors' free knowledge contributions, which is manifested in the increase of post quantity, article length, function word frequency, causal word frequency, and content information entropy. The paid function leads to a decrease in the consistency of title content. Conclusions: The research conclusions of this article complement the relevant literature on the role of economic incentives in the medical context. The findings of this article help the platform understand the important role of monetary incentives on doctors' content contributions, thus promoting the long-term development of content.
Background: Primary hypertension (PH) poses significant risks to children and adolescents. Few prediction models for the risk of PH in children and adolescents currently exist, posing a challenge for...
Background: Primary hypertension (PH) poses significant risks to children and adolescents. Few prediction models for the risk of PH in children and adolescents currently exist, posing a challenge for doctors in making informed clinical decisions. Objective: This study aimed to investigate the incidence and risk factors of PH in Chinese children and adolescents. It also aimed to establish and validate a nomogram-based model for predicting the next year PH risk. Methods: A retrospective cohort (N=3,938, between January 1, 2008 and December 31, 2020) and prospective (N=1,269, between January 1, 2021 and July 1, 2023) cohort were established for model training and validation. An independent cohort of 190 individuals was established for external validation of the model. The result of the least absolute shrinkage and selection operator (LASSO) regression technique was employed to select the optimal predictive features, and multivariate logistic regression to construct the nomogram. The performance of the nomogram underwent assessment and validation through the area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration curves, decision curve analysis (DCA), clinical impact curves, and sensitivity analysis. Results: The PH risk factors that we have ultimately identified include gender, age, family history of hypertension, fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL-C), and uric acid (UA), while factor breastfeeding has been identified as a protective factor. Subsequently, a nomogram has been constructed incorporating these factors. AUCs of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.849 in the external validation cohort. C-index of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.849 in the external validation cohort. The nomogram has been proven to have good clinical benefits and stability in calibration curves, DCA, clinical impact curves, and sensitivity analysis. Finally, we observed noteworthy differences in UA levels and family history of hypertension among various subgroups, demonstrating a high correlation with PH. Moreover, the web-based calculator of the nomogram was built online. Conclusions: We have developed and validated a stable and reliable nomogram that can accurately predict PH risk within the next year among children and adolescents in primary care and offer effective and cost-efficient support for clinical decision support for the risk prediction of PH.
Background: The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems in order to safeguard a globally connected society, especially those in low-to-middle inco...
Background: The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems in order to safeguard a globally connected society, especially those in low-to-middle income countries. Africa’s rapid adoption of digital technological interventions created a new frontier of digital advancement during crises or epidemics. The use of digital tools for disease surveillance can assist with rapid outbreak identification and response, handling duties such as diagnosis, testing, contact tracing, and risk communication. Malawi was one of the first countries in the region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Objective: The aim of this study is to seek expert consensus using the Delphi methodology to examine Malawi's COVID-19 digital surveillance response strategy and to assess the digital tools using the World Health Organization mHealth Assessment and Planning for Scale Toolkit. Methods: This protocol follows the Guidance on Conducting and REporting DElphi Studies. Participants must meet the following requirements: must have first-hand experience on the design, implementation and maintenance with COVID-19 digital surveillance systems. There will be no restrictions on the level of expertise or years of experience. The panel will consist of approximately 40 participants. We will use a modified Delphi process whereby rounds one and two will be hosted online via Qualtrics and round three will encompass a face-to-face workshop held in Malawi. Consensus will be defined as ≥70% of participants strongly disagree, disagree, somewhat disagree or strongly agree, agree, somewhat agree. During round three, the face-to-face workshop, participants will be asked to complete, the mHealth Assessment and Planning for Scale Toolkit assessment on the digital tool on which they are experts. The MAPS toolkit, will enable the panel members to assess the digital tools from a sustainable perspective from six distinct, yet complementary axes i.e. 1) Groundwork, 2) Partnerships, 3) Financial Health, 4) Technology & Architecture, 5) Operations and 6) Monitoring and Evaluation. Results: The ability of a country to collate, diagnose, monitor, and analyze data forms the cornerstone of an efficient surveillance system, allowing countries to plan and implement appropriate control actions. Malawi was one of the first countries in the African region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Conclusions: We anticipate findings from this Delphi study will provide insights into how and why Malawi was successful in deploying digital surveillance systems. In addition, findings should produce recommendations and guidance for the rapid development, implementation, maintenance and impact of digital surveillance tools during a health crisis.
Background: Background: Urbanization & industrialization is contributing to the change in the lifestyle and food preferences especially in children. Childhood obesity is mainly a lifestyle-oriented di...
Background: Background: Urbanization & industrialization is contributing to the change in the lifestyle and food preferences especially in children. Childhood obesity is mainly a lifestyle-oriented disorder. It is a rising global burden with its lifelong implications. If not treated in childhood period, it may land up in adulthood with serious complications. In Ayurveda, Sthaulya is the condition which can be referred to obesity. Being over-obese is termed as Atisthula which is a santarpanottha (overnutrition) vyadhi (disorder) and is counted under eight censurable physiques. Treatment of Sthaulya is Karshana (Therapeutic Scrapping). Navak guggulu’s efficacy is already proven for treatment of Obesity. Vachaharidradi gana is a group of Karshana herbs mentionaed in Ashtang Hriday. So, in this study the efficacy of Vachahardidradi gana vati will be compared with Navak guggulu to treat overweight children. Objective: Evaluation of the efficacy of Navak Guggulu along with diet restriction and Suryanamaskara versus Vachaharidradi Gana Vati along with diet restriction and Suryanamaskara in children (10 – 16 years) with Sthaulya (Overweight). Methods: After doing the drug analysis, a total of 86 overweight children fitting into inclusion criteria from 10 to 16 years of the age group will be selected and will be distributed in 2 groups having 43 each. One group will be trial group and other group will be control group. Control group will be given Navak Guggulu and trial group will be given Vachahardiradi gana vati tablet. The medicines will be provided to subjects in double blinding manner. Both the groups will receive medicines for 90 days along with diet restriction and Suryanamaskara and they will be followed up every 15 days and their assessment during each visit will be recorded in the case record form. Final follow-up will on 180th day. Results: Results will be drawn from the observations of subjective and objective parameters. Conclusions: Conclusion of the study will be drawn based on statistical data calculated from the collected data and overall improvement. Clinical Trial: CTRI No. - CTRI/2023/03/051135 (clinical trial registry India)
Dated –28/03/2023
Background: Over 1.9 billion people are diagnosed as being obese or overweight. Digital technologies have varying effects in affecting weight loss in participants. Precision health exploits the benefi...
Background: Over 1.9 billion people are diagnosed as being obese or overweight. Digital technologies have varying effects in affecting weight loss in participants. Precision health exploits the benefits of digital health and data by being able to provide highly tailored, or personalised, pathways to service users. Obesity is a multi-morbid condition caused in part by lifestyle risk factors including dietary choices, sleep hygiene, exercise and mental health. Objective: The objective was to assess the effect of participants choosing their health “focus” on joining the NHS-certified Gro Health app to support holistic remote weight management. Methods: Participants were invited to engage with a precision behavioural change tool that addresses the four pillars of health; mental health/wellbeing, nutrition, sleep and exercise “Gro Health” by their primary care team or local authority and invited to use the tool’s education programmes, access MDT health coaching and track their health. Gro Health onboards users to self-select where they would like to place their health “Focus” on either; Sleep, Exercise, Nutrition or Wellbeing which tailors their experience of the digital tool. Outcome variables; weight, HbA1c, PHQ8, Karolinska Sleepiness Scale, and Patient Activation Measure (PAM) compared users across “focus” groups. Results: 438 participants downloaded the Gro Health app. Mean age 41.9 (± 13 years) and body weight on sign up was 95.59kg (SD 5.6). The majority of participants identified as female (51.1%) with mostly users of white ethnicity (71.2%). 72% of participants chose nutrition as their focus, with the greatest weight loss between baseline and 12-month recordings (MD=7.01, ±2.83) observed for these individuals, compared to those who selected exercise, sleep or wellbeing as their focus. The largest improvement in sleepiness and depression was for individuals who chose sleep as their focus. Conclusions: Allowing a participant to self-select their focus influences their health outcomes and can support multiple therapeutic benefits. A precision behavioural change tool can support holistic health management and the continuum of obesity management and is an effective way to deliver scalable and engaging precision behavioural change.
Background: In Saudi Arabia, the use of digital media and technology, such as the Internet and smartphones, has experienced significant growth. This has contributed to concerns about problematic digit...
Background: In Saudi Arabia, the use of digital media and technology, such as the Internet and smartphones, has experienced significant growth. This has contributed to concerns about problematic digital media use and its negative impacts on wellbeing, especially among young people. However, there is a paucity of research on stakeholder perspectives regarding intervention strategies to address these issues. Objective: The goal of the study was to gather insights from a range of societal stakeholders, including young people, parents, policy makers, industry leaders, clinicians, educators, and digital media users and non-users, to inform the development of culturally tailored interventions to improve digital wellbeing in Saudi Arabia. Methods: One hundred participants, sampled purposefully, completed an survey online. Participants answered questions regarding their experiences and perspectives on digital media use and digital well-being. We examined distributions of categorical variables for questions related to participant digital media use time, reasons for use, impacts of use, strategies to self-regulate use, and perceived likelihood of success of different interventions to improve digital wellbeing in Saudi Arabia (e.g., education programs, media campaigns, Internet use restrictions). Results: Among participants, 64% were male, and 51% were under 25 years old (range from 15 to 64). Participants were primarily identified as regular digital media users (25 %), persons with problematic Internet use (19%), or clinicians/healthcare professionals (17%). Most participants reported extensive daily screen time use, with 50% reporting four or more hours of digital media use for recreation on weekdays, and 59% on weekends. Participants reported differential impacts of their digital media/technology use ranging from positive (e.g., contact with family and friends, performance at school/work) to negative (e.g., disrupted sleep, reduced physical activity). Of all participants, 77% reported attempts at regulating their digital media use by using various strategies such as deleting apps from their phones or taking periodic digital detox breaks. Participants thought it was likely (endorsed by 50% of participants or more) that all potential intervention approaches presented to them would be effective to improve digital wellbeing in Saudi Arabia. Educational programs for parents, school programs for children, and apps designed to regulate digital media use were endorsed by at least 75% of respondents. Children and adolescents were perceived as the primary target population for these interventions. Conclusions: Our findings, based on perspectives of a diverse group of stakeholders, suggest that interventions to enhance digital wellbeing in Saudi Arabia should prioritize young people and focus on education-based interventions and apps designed to regulate digital media use. By incorporating stakeholder perspectives, culturally tailored interventions can be developed to address specific needs and challenges associated with digital media use in the Saudi context.
Background: Cycling is known to be beneficial for human health. Studies have suggested significant associations of physical activity with macroscale built environment and microscale streetscapes. Howe...
Background: Cycling is known to be beneficial for human health. Studies have suggested significant associations of physical activity with macroscale built environment and microscale streetscapes. However, it remains unknown whether good streetscapes can amplify the benefits of favourable built environment.
Methods: This study examines the moderation roles of streetscape perceptions on the effects of land use mix and accessibility on cycling, using data from18,019,266 bike-sharing orders during weekends in Shanghai, China. Street-view images and a human–machine adversarial scoring system, was combined to evaluate lively, safety and wealthy perceptions.
Results: Negative Binomial Regression results showed that there were significant interactions of the land use Herfindahl–Hirschman index with each of the lively and safety streetscape perceptions, while lively perception also positively moderated the effect of road intersection density on the number of bike-sharing. Moreover, lively perception emerged as the most influential moderator among the three perceptual indicators, which is different from the findings of Western studies. The findings are robust in the three sensitivity analyses.
Conclusions: A safer and livelier streetscape can enhance the benefits of land use mix in promoting cycling, with the former also intensifying the effect of accessibility. The findings have dual implications. To better promote cycling, it is key to conduct interventions on streetscape perceptions, which can indirectly affect physical activity by enhancing the benefits of accessibility and land use mix. As a complement of built environment at macroscale, streetscape interventions are usually more timely and feasible than interventions targeting urban form.
Background: Older caregivers have suffered from a high risk of geriatric depression due to low resilience to public health concerns during a critical period during the pandemic confronted with economi...
Background: Older caregivers have suffered from a high risk of geriatric depression due to low resilience to public health concerns during a critical period during the pandemic confronted with economic crisis and social issues at the same time. Past efforts mainly assessed the impacts of individual and household factors on depressive severity, yet failed to indicate whether the neighborhood environment could reduce depressive severity among older caregivers due to an ambiguous understanding of how environmental factors and any potential mediator together contribute to depression. Empirical evidence suggests that a critical potential mediator in this mechanism can be the standard of living encapsulating the perceived living standard determined by the caregiver’s willingness to achieve a better living and awareness of community resources. In addition, the perceived severity of depression even with the influence of environmental and relational factors can vary by gender groups and their living arrangement. Objective: This study aims to investigate a proposed mechanism in which how older caregivers’ depressive severity can be influenced by the impact factors on the level of individual, household, and environment. In addition, these impacts can be further influenced by the moderators of gender groups and living arrangements being alone or with family members. Methods: In this cross-sectional study, a total of 916 older caregivers across the representative districts in Hong Kong were recruited in 2021. The critical components of depressive severity, neighborhood environment, and standard of living as the critical indices were measured. A mediational model and a moderated mediation model were performed based on the ecological health resilience model to examine the mutual contribution of neighborhood environment and perceived standard of living on the depressive severity moderated by the gender role and relationship closeness. Results: The sampled older caregivers on average aged 73 years old with mild depressive symptoms. Our results indicated that a better quality of neighborhood environment was positively associated with the perceived living standards of older caregivers, and better-perceived living standards were associated with lower depressive severity. Additionally, the mediating effect of perceived standards of living was stronger among female caregivers, especially those without living alone. In contrast, the mediating effect of perceived standards of living was insignificant among male caregivers. Conclusions: In a region of high population density, the adequate allocation of neighborhood environment buffers the mental deterioration of older caregivers and reduces the burden in support their family members with chronic diseases, depending on relevant factors: (1) social mobility and housing arrangement, (2) willingness to relocate for better living condition, and (3) available community resources that can be aware of. This study further reveals the intermediating roles of subjective social status and gender preferences as the critical pathways between the impact of neighborhood environment on depressive severity. Additionally, maintaining a living condition with a basic relationship closeness and awareness of gender preferences are needed, especially among male caregivers who more often suffer from issues due to social isolation.
Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot and Happify, have shown promise in alleviati...
Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot and Happify, have shown promise in alleviating these symptoms. Objective: This study aims to investigate the effectiveness and acceptability of Woebot and Happify in reducing loneliness and depression among college students after the COVID-19 pandemic. Methods: A mixed-methods approach was employed over four months. Sixty-three participants aged 18-27 from Sungkyunkwan University in Seoul, South Korea, were initially recruited, with inclusion criteria of elevated loneliness (UCLA Loneliness Scale score ≥ 34-40) and depression (PHQ-9 score ≥ 6). Attrition resulted in a final sample of 27 participants. Participants were randomly assigned to Woebot (n=22), Happify (n=21), or a control group using Bondee, a metaverse social network messenger app (n=10). Quantitative measures (UCLA Loneliness Scale, PHQ-9) and qualitative assessments (user feedback, focused interviews) were used. Results: Modest decreases in loneliness and depression post-intervention were observed, although not statistically significant (likely due to small sample size). Welch's ANOVA found no significant differences between intervention groups (UCLA Loneliness: P=.5917; PHQ-9: P=.5058). Qualitative data indicated user satisfaction, with suggestions for improved app effectiveness and personalization. Conclusions: Despite limitations, the study suggests the potential of well-designed digital interventions in alleviating college students' loneliness and depression. Findings underscore the importance of accessible digital tools, mental health literacy education, and comprehensive support systems. Further research with larger samples is needed.
Background: Individuals identifying as Black, Indigenous, and People of Color (BIPOC) lack access to culturally appropriate accurate information and are the target of disinformation campaigns, which c...
Background: Individuals identifying as Black, Indigenous, and People of Color (BIPOC) lack access to culturally appropriate accurate information and are the target of disinformation campaigns, which create doubt in science/healthcare providers and might play a role in sustaining health disparities related to COVID-19. Objective: To create and disseminate culturally- and medically-appropriate messages for Black, Latino, and Native American communities in WI and evaluate their reach to address the need for information responsive to BIPOC communities. Methods: Our team identified relevant COVID-19 topics based on feedback from their respective community, developed lay format materials, and translated materials into culturally appropriate social media messages that community advocates delivered. Social media metrics (Reach, Engagement, Impressions) were collected using Sprout Social and Facebook Analytics. We hosted nine focus groups with community members to learn about their social media usage. These data were analyzed using an inductive approach, using NVivo to code content (Release 1.7). Results: Between August 2020 and January 2023, we created 980 unique social media posts that reached 88,790 individuals and gathered over 6,700 engagements. Average reach per post was similar across the three communities, despite differences in the number of posts and followers on each page: 119.46 (Latino), 111.74 (Black), and 113.11 (Oneida Nation). The type of posts that had higher engagement per reach rates (ERR) varied across communities and platforms, with Live videos being highest for Latino – Facebook (ERR: 9.40%), Videos for the Black Community on Facebook (ERR: 19.53%), and Text for the Oneida Nation page (ERR: 59.01%). Conclusions: Our project presents a unique and effective model for health messages and highlights the need for tailoring messages and approaches for minoritized audiences (e.g., age, gender, race, ethnicity). Further research studies explore how specific types of information affect the dissemination of information and the implications for health communications.
Background: The progression of hypertension is highly heterogeneous among populations and cost-effective biomarkers assessing the prognosis of hypertension have been rarely investigated. Recent studie...
Background: The progression of hypertension is highly heterogeneous among populations and cost-effective biomarkers assessing the prognosis of hypertension have been rarely investigated. Recent studies have highlighted the diagnostic and prognostic potential of red cell distribution width (RDW) beyond hematologic disorders. The relationship between RDW and the prognosis of hypertension has been rarely investigated. Objective: This study aimed to clarify the association of RDW with all-cause and cardiovascular disease (CVD) mortality in hypertensive adults. Methods: This prospective cohort study included 20968 adults with hypertension from the National Health and Nutritional Examination Surveys (NHANES) 1999-2018 with mortality follow-up through December 31, 2019. The participants were grouped based on the RDW quartiles as follows: Q1(≤12.5%), Q2(12.6%–13.1%), Q3(13.2%–13.9%), and Q4(≥14.0%). Kaplan-Meier curves and Cox regressions were performed to assess the relationship between RDW and mortality risk due to all-cause and CVD. The restricted cubic spline regressions were used to profile the dose-response relationship between RDW and mortality risk. The receiver operating characteristic curves were used to examine the predictive performance of RDW for mortality risk. Results: During a median follow-up of 96 months, 5475 deaths were documented including 1890 due to CVD. Multivariate analysis revealed that mortality risk increased step-wise by RDW quartiles, in which the HRs (95% CIs) from Q1 to Q4 were 1.00 (reference), 1.18 (1.06-1.31), 1.41 (1.27-1.56), and 2.19 (1.94-2.48) for all-cause mortality (P for trend <.001), and those were 1.00 (reference), 1.12 (0.94-1.33), 1.35 (1.12-1.63), and 2.20 (1.75-2.75) for CVD mortality (P for trend <.001). The RCS analysis revealed S-shaped associations between RDW and all-cause and CVD mortality risk. The ROC curves demonstrated acceptable predictive performance of RDW for all-cause and CVD mortality in hypertensive adults. Conclusions: In American adults with hypertension, higher RDW was significantly associated with higher risks of all-cause and CVD mortality. RDW might be a promising cost-effective prognostic biomarker in the management of hypertension. Further studies are warranted to explore the potential pathophysiological mechanisms underlying the association between RDW and mortality.
Background: Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of the elderly who suffer from sarcopenia may be improved...
Background: Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of the elderly who suffer from sarcopenia may be improved via the practice of strength training and Tai Chi. However, it remains unclear if the hybridization of strength exercise training (SET) and traditional Chinese exercise (TCE) will have a better effect. Objective: Therefore, we designed a strength training and Tai Chi exercise hybrid program to improve sarcopenia in the elderly. Moreover, Explainable Artificial Intelligence was utilized to predict post-intervention sarcopenic status and quantify the feature contribution. Methods: To assess the influence of sarcopenia in the elder group, ninety-three participated as experimental subjects in 24-week randomized controlled trial and were randomized into three intervention groups, namely the Tai Chi exercise and strength training hybrid group (TCSG, n = 33), the strength training group (STG, n = 30), and the control group (CG, n = 30). Abdominal computed tomography (CT) was employed to evaluate the skeletal muscle mass at the third lumbar (L3) vertebra. Analysis of demographic characteristics of participants at baseline used one-way ANOVA and chi-square test and repeated measures ANOVA to analyze experimental data. In addition, ten machine-learning classification models were resorted to calculate if these participants could reverse the degree of sarcopenia after the intervention. Results: A significant interaction effect was found in skeletal muscle density at L3 (L3 SMD), skeletal muscle area at L3 (L3 SMA), grip strength, muscle fat infiltration (MFI), and relative skeletal muscle mass index (RSMI). Grip strength, RMSI, and L3 SMA were significantly improved after the intervention for subjects in the TCSG and STG. After post hoc tests, we found that participants in the TCSG had a better effect on L3 SMA than those in the STG and participants in the CG. The LightGBM classification model had the greatest performance in accuracy (88.4%), recall score (74.0%) and F1 score (76.1%). Conclusions: Skeletal muscle area of sarcopenic older adults may be improved by a hybrid exercise program composing of strength training and Tai Chi. In addition, we identified that the LightGBM classification model had the best performance to predict the reversion of sarcopenia.
Background: In recent years, with the continuous development of mobile communication technology, the large-scale popularization of intelligent mobile devices such as cell phones and tablet computers h...
Background: In recent years, with the continuous development of mobile communication technology, the large-scale popularization of intelligent mobile devices such as cell phones and tablet computers has prompted the emergence of mobile medical service platforms.With the aging trend of chronic diseases in China becoming more and more obvious, the public's demand for health information and the degree of portability is getting higher and higher, making it a certain requirement for the development and updating of mobile medical service platforms.Therefore, it is crucial to analyze the advantages and shortcomings of the current Chinese mobile medical and provide constructive suggestions. Objective: To comprehend the development of mobile medical service platforms in domestic general hospitals, study and compare the characteristics of various platforms, and make constructive recommendations for enhancing the quality of mobile medical services. Methods: Taking the mobile medical service platforms such as the latest version of mobile APP or hospital WeChat public number currently applied by the top 50 hospitals in the Fudan University 2022 Comprehensive Ranking of Chinese Hospitals as the object of study. Adopting the network survey method and literature analysis method, we construct a preliminary evaluation indicator system of the user interface containing three first-level indicators, 13 second-level indicators, and 19 third-level indicators of visual design, interaction design, and technological development, as well as a service function evaluation index system consisting of four modules, namely, service items, information content, health education, and evaluation system, to evaluate the current status of the functions of the mHealth service platform. Results: China's general hospital mobile medical service platform meets the requirements for a basic user interface design and offers a basic booking function in its service function. At the same time, the majority of hospitals focus on expanding their basic services and implementing relevant innovation. Since China's smart hospital is still in its early stages of development, construction took comparatively little time, homogenization between platforms is more evident, and platform construction innovation still needs to be further enhanced. Conclusions: The construction of mobile medical service platform in domestic hospitals is still in the initial stage, and the key to the development of mobile medical service is to improve the user experience, perfect the functional modules, take into account the users of different age levels and focus on privacy protection.
Background: Despite significant advancements in medical knowledge and medical diagnosis techniques, misdiagnosis remains a significant public health issue, contributing to mortality and morbidity worl...
Background: Despite significant advancements in medical knowledge and medical diagnosis techniques, misdiagnosis remains a significant public health issue, contributing to mortality and morbidity worldwide. Artificial intelligence (AI), especially models such as the Generative Pre-trained Transformer (GPT), has shown promise in enhancing diagnostic accuracy. However, the effectiveness of these AI models in diagnosing atypical presentations of common diseases has not been extensively explored. Objective: This study aimed to assess the diagnostic accuracy of the AI model ChatGPT-4 in generating differential diagnoses for atypical presentations of common diseases, and to understand its reliance on patient history during the diagnostic process. Methods: We utilized 25 clinical vignettes from the Journal of Generalist Medicine that presented atypical manifestations of common diseases. Two general medicine physicians categorized the cases based on atypicality. ChatGPT-4 was then employed to generate differential diagnoses, based on the clinical information provided. The concordance between AI-generated and final diagnoses was measured, with a focus on the top-ranked disease (top 1) and the top five differential diagnoses (top 5). Results: ChatGPT-4’s diagnostic accuracy decreased with an increase in atypical presentation. For Category 1 (C1) cases, the concordance rates were 17% for the top 1 and 67% for the top 5. Categories 3 (C3) and 4 (C4) showed a 0% concordance for top 1, and markedly lower rates for the top 5, indicating difficulties in handling highly atypical cases. Conclusions: ChatGPT-4 demonstrates potential as an auxiliary tool for diagnosing typical and mildly atypical presentations of common diseases. However, its performance declines with greater atypicality. The findings of study underscores the need for AI systems to encompass a broader range of linguistic capabilities, cultural understanding, and diverse clinical scenarios to improve diagnostic utility in real-world settings. Clinical Trial: NA
Background: In today’s digital society, the acquisition of parenting information through online platforms such as social networking sites (SNS) has become widespread. Amid the mix of online and offl...
Background: In today’s digital society, the acquisition of parenting information through online platforms such as social networking sites (SNS) has become widespread. Amid the mix of online and offline information sources, there is a need to discover effective information-seeking methods for solving parenting problems. Objective: This study aimed to identify patterns of information use among parents of young children in the digital age and elucidate the characteristics of these patterns through a comparative analysis of social support and parental self-efficacy. Methods: An online survey was administered with fathers and mothers of children aged 03 years. Convenience sampling, facilitated by an online survey company, was adopted, and data from 227 fathers and 206 mothers were analyzed. The survey included questions on personal characteristics; frequency of use of different sources of parenting information (websites, SNSs, parenting apps, family, friends, and professionals); perceived social support; and parental self-efficacy. K-means cluster analysis was used to extract the patterns of parenting information use, followed by covariance analysis. Results: Eight clusters were identified. Three clusters presented patterns with a combination of online and face-to-face information sources. Results from the analysis of covariance constructed with clusters and covariates revealed significant explanatory models for family support (F(17, 380)=5.98, P<.001), friend support (F(17, 380)=6.49, P<.001), and parenting self-efficacy (F(17, 379)=6.14, P<.001). Compared to Hybrid / Multichannel clusters, clusters with patterns with a relatively greater reliance on online information compared to face-to-face sources, a bias toward information from family sources, and a low frequency of information use across all sources were characterized by lower levels of social support and parental self-efficacy. Conclusions: This study adds to the evidence that online information can effectively supplement offline information in addressing parenting challenges, albeit with limited functionality as a substitute. These findings suggest the importance for parenting support professionals to simultaneously enhance information literacy and strengthen social relationships among parents, tailored to their information use patterns.
Background: We Can Do This was a web-based application (web-app) developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use. Objective: This paper...
Background: We Can Do This was a web-based application (web-app) developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use. Objective: This paper reports on a process evaluation of the web-app’s acceptability and feasibility when used by clients and clinicians in residential rehabilitation services and primary care. Methods: Clinicians and clients who had used the web-app were recruited via Aboriginal Community Controlled Health Services and Aboriginal residential rehabilitation services in urban and regional Victoria and South Australia. Non-identified usage data was collected from all participants. After using the web-app, those who indicated a willingness to be interviewed were contacted and interviewed by phone or in person and asked about the feasibility and acceptability of the web-app. Results: Interviews with ten clients and eleven clinicians highlighted that both clients and clinicians found the content coherent, relatable, empowering and culturally safe. Barriers to using the web-app for clients included a lack of internet connectivity and personal issues such as scheduling. Conclusions: Process evaluation is often under-valued. However, as We Can Do This was new, innovative and targeted a hard-to-reach population, understanding its feasibility and acceptability as a clinical tool was essential to understanding its potential. We Can Do This is unique as the only evidence-based, culturally appropriate online therapeutic program specifically designed for Aboriginal and Torres Strait Islander people who use methamphetamine. Findings suggest it was both acceptable and feasible as a low-cost adjunct to usual care in residential rehabilitation and primary care settings.
Background: The rapid growth of online medical services has highlighted the significance of smart triage systems in helping patients find the most appropriate doctors. However, traditional triage meth...
Background: The rapid growth of online medical services has highlighted the significance of smart triage systems in helping patients find the most appropriate doctors. However, traditional triage methods often rely on department recommendations, and are insufficient to accurately match patients’ textual questions with doctors' specialties. There is an urgent need to develop algorithms for recommending doctors. Objective: To develop and validate a patient-doctor hybrid recommendation model with response metrics (PDHR model) for better triage performance. Methods: A total of 646,383 online medical consultation records from the Internet Hospital of the First Affiliated Hospital of Xiamen University were collected. Semantic features representing patients and doctors were developed to identify the set of most similar questions and to semantically expand the pool of recommended doctor candidates, respectively. The doctors’ response rate was designed to improve candidate rankings. These three characteristics combine to create the PDHR model. Five doctors participated to evaluate the efficiency of the PDHR model through multiple metrics and questionnaires, as well as the performance of SBERT and Doc2Vec in text embedding. Results: The PDHR model reaches the best recommendation performance when the number of recommended doctors is 14. At this point, the model has an F1-score of 76.25%, a proportion of high-quality services of 41.05%, and a rating of 3.90. After removing doctors’ characteristics and response rates from PDHR model, the F1-score decreased by 12.05%, the proportion of high-quality services fell by 10.87%, the average hit ratio dropped by 1.06%, and the rating declined by 11.43%. According to whether those five doctors were hit by PDHR model, SBERT achieved an average hit ratio of 88.60%, while Doc2Vec achieved an average hit ratio of 53.40%. Conclusions: The PDHR model uses semantic features and response metrics to enable patients to accurately find the doctor that best suits their needs.
Background: Pregnant radiographers work in potentially hazardous environments of ionizing radiation and therefore require more stringent monitoring of fetal radiation dose. PregiDose, a mobile applica...
Background: Pregnant radiographers work in potentially hazardous environments of ionizing radiation and therefore require more stringent monitoring of fetal radiation dose. PregiDose, a mobile application, was the proposed technological intervention to address occupational health and safety needs of pregnant radiographers. Objective: The main objective of this paper is therefore to present a technical report of the implementation of a mobile application development life-cycle (MADL) towards the development of PregiDose. Methods: The MADL model comprised of seven steps namely 1) Identification, 2) Design, 3) Development, 4) Prototyping, 5) Testing, 6) Deployment, and 7) Maintenance. The team consisted of a project manager, a user experience (UX) designer, a user interface (UI) designer, two Flutter developers, and a test analyst. The entire development process was executed over a five-month period (August to January 2024). Results: The development process involved several team engagements and testing sessions. This emanated in the final mobile application which comprised of three core functional areas, namely Home (Dose Tracker), Journal, and Explore, each aimed at addressing the clients needs. Conclusions: PregiDose was developed through a rigorous MADL process model aimed at ensuring high quality, usability and usefulness of the app. The application of the model serves as a valuable framework that can be used to guide other mHealth apps.
Background: Intimate partner violence (IPV) and violence against children (VAC) are global issues with severe consequences. Intersections shared by the two forms of violence have led to calls for join...
Background: Intimate partner violence (IPV) and violence against children (VAC) are global issues with severe consequences. Intersections shared by the two forms of violence have led to calls for joint programming efforts that prevent both IPV and VAC. Parenting programmes have been identified as a key entry point for addressing multiple forms of family violence. Building on the IPV prevention material that has been integrated into the parenting programme ParentText, a digital parenting chatbot, this pilot study seeks to explore parents’ engagement with the IPV prevention content in ParentText, and explore preliminary impacts on IPV. Objective: This study aimed to assess parents’ and caregivers’ level of engagement with the IPV prevention material in the ParentText chatbot and explore preliminary indications of the chatbot’s impact on experiences and perpetration of IPV, attitudes toward IPV, and gender-equitable behaviours following the intervention. Methods: Caregivers of children 0-18 years were recruited through convenience sampling by research assistants in Cape Town in South Africa and by UNICEF Jamaica staff in three parishes in Jamaica. Quantitative data from women (N=47) and, in South Africa, men (N=21) caregivers were collected electronically via weblinks sent to users’ phones using Open Data Kit. The primary outcome was IPV experience (women) and perpetration (men), with secondary outcomes including gender-equitable behaviours and attitudes toward IPV. Descriptive statistics were used to report sociodemographic characteristics and engagement outcomes. Linear, Poisson, and logistic regression models were used to investigate potential changes in IPV outcomes between pre- and post-test. Results: The average daily interaction rate with the programme was 0.57 and 0.59 interactions per day for women and men in South Africa, and 0.21 for women in Jamaica. The rate of completion of at least one IPV prevention topic was 25% (5/20) for women and 5% (1/20) for men in South Africa, and 21% (6/28) for women in Jamaica. Exploratory analyses detected significant pre-post reductions in overall IPV experience among women and in men’s overall harmful IPV attitudes. Conclusions: This pilot study is the first to our knowledge that investigates user engagement with and indicative outcomes of a digital parenting intervention with integrated IPV prevention content. Study findings provide valuable insights into user interactions with the chatbot and shed light on challenges related to low levels of chatbot engagement. Indicative results which suggest reductions in IPV and improvements in attitudes after the programme are promising, yet, modest. Further research using a randomized controlled trial is warranted to establish causality. Clinical Trial: The trial is embedded within a larger study registered with ClinicalTrials.gov (NCT05003518) on 12/08/2021.
Background: Pulmonary tuberculosis (PTB) poses a global health challenge as obtaining results from traditional smear and culture tests require a few hours to weeks. Objective: We aimed to assess infec...
Background: Pulmonary tuberculosis (PTB) poses a global health challenge as obtaining results from traditional smear and culture tests require a few hours to weeks. Objective: We aimed to assess infectivity using AI-based chest radiography (CXR) alone with comparable performance to traditional tests for PTB. Methods: By employing DenseNet121 and visualisation techniques such as gradient-weighted class activation mapping (Grad-CAM++) and local interpretable model-agnostic explanations (LIME) to illustrate model's decision-making process, we analysed 36,142 CXR images of 4,492 patients with PTB obtained from Severance Hospital, focusing specifically on the lung region through segmentation and cropping with TransUNet. We used data from 2004–2021 to build the model, and data from 2022–2023 for internal validation. Additionally, we used 1,978 CXR images of 299 patients with PTB obtained from Yongin Severance Hospital for external validation. Results: : In the internal validation, the model achieved an accuracy of 73.27%, AUROC of 0.7917, and AUPRC of 0.7716. In the external validation, it demonstrated an accuracy of 70.29%, AUROC of 0.7686, and AUPRC of 0.7970. Additionally, Grad-CAM++ and LIME provide insights into the decision-making process of the AI model. Conclusions: This proposed AI tool can evaluate PTB infectivity from CXR images and potentially offer more accurate and faster screening and results than traditional smear and culture tests.
Background: The ability to passively and continuously monitor coughing would significantly improve cough management and research. To date there is no automated clinically validated cough monitor that...
Background: The ability to passively and continuously monitor coughing would significantly improve cough management and research. To date there is no automated clinically validated cough monitor that can be routinely used in clinical care and research. Here we describe the validation of such an automated cough monitor. Objective: To assess the overall performance of the Hyfe Cough Monitoring System when used by individuals with problematic cough, under common living conditions Methods: This multicenter observational study compared the results of the Hyfe CoughMonitor wrist-worn device with manually counted coughs in subjects with a variety of etiologies as they went about their usual daily activities. We collected 24 hours of continuous sounds from subjects while they simultaneously wore a CoughMonitor and an audio recorder. Coughs were labelled by multiple trained annotators who listened to the continuous audio recordings using validated methodology. The time stamps of these human-detected coughs were compared to those of the CoughMonitor to determine the system’s overall performance using event-to-event and hourly rate correlation analyses. Results: Over the 546 hours monitored, 4454 cough events were recorded; The overall sensitivity was 90.4% (95% CI of 88.3% to 92.2%). The overall false positive rate was 1.03 false positives per hour (95% CI of 0.84 to 1.24). The overall correlation between manual and CoughMonitor measured hourly coughing was high (Pearson correlation coefficient of 0.99 with OLS slope 0.94 and OLS intercept 0.68). Conclusions: The present analysis of cough events demonstrated that the Hyfe CoughMonitor accurately reflects them with a high sensitivity and a low false positive rate. Future studies should confirm its potential role in the management of patients with cough in clinical practice. Clinical Trial: Clinicaltrials.gov: NCT05723159
Background: Data models play a crucial role in facilitating clinical research and taking full advantage of clinical data stored in medical systems; data, as well as the clear relationships between the...
Background: Data models play a crucial role in facilitating clinical research and taking full advantage of clinical data stored in medical systems; data, as well as the clear relationships between them, are expected to be in a standardized format to establish reproducible research. Using the Fast Healthcare Interoperability Resources (FHIR) standard for clinical data representation would be a practical methodology to enhance and accelerate interoperability and data availability for research. Objective: To investigate data models utilizing the FHIR standard, to offer a comprehensive overview of the best practices for developing and implementing these data models as well as presenting a summary of tools, mappings, limitations and other important details in the selected models. Methods: To ensure the extraction of reliable results, we followed the instructions of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We analyzed the indexed articles in PubMed, Scopus, Web of Science, IEEE Xplore, ACM digital library, and Google Scholar using Boolean operators to merge relevant keywords and their related terms. Results: Based on the reviewed articles, we categorized them into two main groups; pipeline-based data models and non-linear data models. We summarized each included article and extracted information about the FHIR resources, technologies and standards, and mappings. We additionally aimed to extract and summarize the limitations of each research to provide a comprehensive view of the potential challenges and limitations that future researchers may face. Conclusions: Based on the results of our review, FHIR can be a very promising standard in developing interoperable data models and infrastructures, despite presenting some challenges in the development phase. Policymakers and healthcare specialists can utilize this standard in any field such as healthcare, research, administration, finance, and so on. Additionally, when developing data models, this standard can also be integrated with other health-related standards to propose more interoperable solutions.
The economic trend and the healthcare landscape are rapidly evolving across Asia. Effective Real-World Data (RWD) for regulatory and clinical decision-making is a crucial milestone associated with thi...
The economic trend and the healthcare landscape are rapidly evolving across Asia. Effective Real-World Data (RWD) for regulatory and clinical decision-making is a crucial milestone associated with this evolution. This necessitates a critical evaluation of Real-World Data (RWD) generation within distinct nations for utilization of various RWD warehouses in the generation of Real-World Evidence (RWE). In this article, we outline the RWD generation trends for two contrasting nation archetypes, ‘Solo Scholars’—nations with relatively self-sufficient RWD research systems—and ‘Global Collaborators’—countries largely reliant on international infrastructures for RWD generation. The key trends and patterns in RWD generation, country-specific insights into the predominant databases used in each country to produce RWE, and insights into the broader landscape of RWD database utilization across these countries are discussed.
Conclusively, the data points out the heterogeneous nature of RWD generation practices across 10 different Asian nations and advocates for strategic enhancements in data harmonization. The evidence highlights the imperative for improved database integration and the establishment of standardized protocols and infrastructure for leveraging Electronic Medical Records (EMR) in streamlining RWD acquisition. The Clinical Data Analysis and Reporting System (CDARS) of Hong Kong is an excellent example of a successful EMR system that showcases the capacity of integrated robust EMR platforms to consolidate and produce diverse RWE. This, in turn, can potentially reduce the necessity for reliance on numerous condition-specific local and global registries or limited and largely unavailable medical insurance or claims databases in most Asian nations. Linking Health Technology Assessment (HTA) processes with open data initiatives like the Observational Medical Outcomes Partnership Common Data Model and the Observational Health Data Sciences and Informatics could enable the leveraging of global data resources to inform local decision-making. Advancing such initiatives is crucial for reinforcing healthcare frameworks in resource-limited settings and advancing towards cohesive, evidence-driven healthcare policy and improved patient outcomes in the region.
International Registered Report Identifier (IRRID): RR2-10.2196/43741
Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnorm...
Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. These disorders are associated with diminished quality of life, school absence, increased health care use, and co-morbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of the mechanisms underlying the effect and the identification of additional treatment targets could contribute to the refinement of the treatment. Objective: This protocol paper describes a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms. Methods: First, the timing of the onset of the effect is examined through a single-case design study involving six children and six adolescents (sub-study 1). Following this, a pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (sub-study 2). Finally, spanning across these two sub-studies, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (sub-study 3). Results: Recruitment of participants began in June 2022 and is currently ongoing. The study is expected to be completed by January 2025. Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. Clinical Trial: Clinicaltrials.gov (NCT05237882 and NCT05486585) and OSF: https://osf.io/c49k7
Background: Measuring vital signs (VS) is important in potentially unwell children, as a change in VS may indicate a more serious infection than is clinically apparent or herald clinical deterioration...
Background: Measuring vital signs (VS) is important in potentially unwell children, as a change in VS may indicate a more serious infection than is clinically apparent or herald clinical deterioration. However, currently available methods are not suitable for regular measurement of VS in the home or community setting, and adherence can be poor. The COVID-19 pandemic highlighted a need for the contactless measurement of VS by non-clinical personnel, reinforced by the growing use of virtual medicine. Lifelight® is an app being developed as a medical device for the contactless measurement of VS using remote photoplethysmography via the camera on smart devices. The VISION-D (Measurement of Vital Signs by Lifelight® Software in Comparison to the Standard of Care – Development) and -V (Validation) studies demonstrated the accuracy of Lifelight compared with standard of care measurement of blood pressure, pulse rate, and respiratory rate in adults, supporting certification of Lifelight as a class I Conformité Européenne (CE) medical device. Objective: To support further development of the Lifelight app, the VISION-Junior study (clinicaltrials.gov identifier NCT05850013) is collecting high-quality data to enable the accurate measurement of VS (pulse rate, respiratory rate and oxygen saturation) in pediatric patients. Methods: The study is recruiting pediatric patients (age <18 years) attending the Sunderland Royal Hospital Paediatric Emergency Department of the South Tyneside and Sunderland NHS Foundation Trust. High-resolution videos of the face (and torso in children aged <5 years) and audio recordings (to explore the value of cry, wheeze, cough, and other sounds in predicting illness) are made using the Lifelight Data Collect app. VS are measured simultaneously using standard of care methods (finger clip sensor for pulse rate and oxygen saturation; manual counting of respiratory rate). Feedback from patients, parents/carers, and nurses who use Lifelight is collected via questionnaires. Anticipated recruitment is 500 participants, with sub-targets for age, sex, and skin tone distribution (Fitzpatrick six-point scale). Early data will be used to refine the Lifelight algorithms. A separate dataset will be retained to test the performance of Lifelight against predefined targets. Results: A total of 303 participants were recruited from June to December 2023; recruitment will continue until March 2024. Algorithm refinement is in progress. The performance of Lifelight compared with standard of care measurement of VS will then be tested. Recruitment will resume if further data are required. The analyses are expected to be completed by mid-April 2024. Conclusions: This study will collect data that enable development of Lifelight for the measurement of VS in pediatric patients. Clinical Trial: ClinicalTrials.gov NCT05850013
https://clinicaltrials.gov/study/NCT05850013
Background: There is an ongoing syndemic of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) in the United States, particularly among men who have sex with men (MSM). We h...
Background: There is an ongoing syndemic of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) in the United States, particularly among men who have sex with men (MSM). We have increasingly effective and diverse measures of prevention, including various types of pre-exposure prophylaxis (PrEP) for HIV prevention and doxycycline post-exposure prophylaxis (doxyPEP) for STI prevention. As options expand, we need to best understand how to use a combination of these strategies and other supports for MSM to best curb the syndemic. Objective: We designed a patient-preference trial to understand patient preferences of PrEP and doxyPEP, how preferences may change over time, and methods for preventing premature discontinuation of PrEP. Methods: We enrolled HIV-negative MSM in metropolitan Atlanta. Participants could elect to take PrEP (daily or on-demand), doxyPEP, both, or neither, along with app-based support to evaluate for risk factors of discontinuation or behavioral changes that might affect their choice of prevention methods. Participants were able to switch prevention methods at any time. Oral PrEP and doxyPEP users are offered quarterly in-person or at-home HIV, syphilis, gonorrhea, and chlamydia testing along with opportunities for motivational interviewing. Results: We enrolled individuals from 11/2021 to 9/2023. Among 240 participants, median age was 30 (interquartile range 25-35), 63% self-identified as non-Hispanic Black, and 69% were insured. Most participants (60%) elected to take daily PrEP plus doxyPEP, with a smaller proportion taking on-demand PrEP plus doxyPEP (14%) or daily PrEP without doxyPEP (14%). Conclusions: We designed an ongoing study to evaluate the preferences for PrEP and doxyPEP among MSM in metropolitan Atlanta. Enrollment was completed in 22 months and included a diverse cohort of MSM that will be followed longitudinally to evaluate prevention preferences over time. At baseline, most participants preferred to take a combination of daily PrEP and doxyPEP for HIV and STI prevention. Clinical Trial: Clinicaltrials.gov ID: NCT05072093
Background: A healthcare dashboard is a visual representation of vital healthcare data designed to emphasize key information for individuals and organizations, aiding them to make informed decisions....
Background: A healthcare dashboard is a visual representation of vital healthcare data designed to emphasize key information for individuals and organizations, aiding them to make informed decisions. [5] These dashboards are increasingly utilized worldwide to track and report emerging and widespread diseases, trends, and other information to allow the public to make better healthcare decisions. [6, 7] Some examples include the Johns Hopkins COVID-19 dashboard, the Centers for Disease Control and Prevention FluView Interactive dashboard, the World Health Organization Monkeypox dashboard, and the State of Pennsylvania’s Cancer Statistics dashboard. Objective: This study identifies the top 15 attributes of a healthcare dashboard. The objective of this research is to enhance healthcare dashboards worldwide to benefit the public by making better healthcare information available for more informed decisions by the public and to improve population-level healthcare outcomes. Methods: The authors evaluated 250 US government and commercial healthcare dashboards and conducted a survey of healthcare dashboards with 218 individuals identifying the best practices to consider when creating a public healthcare dashboard.
The dates of the survey and data collection were from June 2023 to August 2023.
These features ranked in descending order of importance are (1) easy navigation, (2) historical data, (3) simplicity of design, (4) high usability, (5) use of clear descriptions, (6) consistency of data, (7) use of diverse chart types, (8) compliance with Americans with Disabilities Act, (9) incorporated user feedback, (10) mobile compatibility, (11) comparison data with other entities, (12) storytelling, (13) predictive analytics with Artificial Intelligence (AI), (14) adjustable thresholds, and (15) charts with tabulated data. The prior study on COVID dashboards with 118 participants showed similar results.[3] Both studies validated top attributes of healthcare dashboards as easy navigation, simplicity of design, high usability, use of clear descriptions, and use of diverse chart types. Future studies can extend the research to other types of dashboards such as bioinformatics, financial, and managerial dashboards as well as confirm these top 15 best practices with further evidentiary support. Results: The authors conducted a survey of 218 (n=218) individuals above the age of 18. The survey consisted of 15 questions. Responses of “yes” counted as one point, while responses of “no” counted as 0 points. The authors calculated a total of 3,259 responses - 2,945 responses of “yes” and 314 responses of “no”. The Use of Charts with Tabulated Data had the lowest percent agreement of “yes” responses of 83%, whereas Easy Navigation had the highest percent agreement of “yes” responses of 96%, and the use of Predictive Analytics using Artificial Intelligence had “yes” responses of 87%, ranking at the 13th most popular attribute. Conclusions: As technology evolves, the availability of resources and data has become increasingly easier and better. With a click or a quick search, consumers have access to an abundance of healthcare data and data dashboards which aid in making informed healthcare decisions. However, healthcare dashboards may not be of the highest quality or as easily understood. Through our observational review and multiple surveys, we evaluated the effectiveness of healthcare dashboards in the United States to better understand and improve their design elements. From our analysis, we were able to develop and confirm the top 15 best practices of healthcare dashboard design from the ease of navigation to the use of predictive analytics. These 15 top best practices were assessed as the most important aspects of a healthcare dashboard’s effectiveness. The studies validated and concluded that the top five attributes of healthcare dashboards, such as easy navigation, simplicity of design, high usability, use of clear descriptions, and use of diverse chart types. As identified and analyzed, the best practices can be incorporated in order to design and disseminate effective healthcare dashboards making valuable healthcare information available to the public. Ultimately, the availability of better healthcare dashboards will help consumers make better and more informed healthcare decisions resulting in better healthcare outcomes.
Background: Elbow stiffness is a common disease that can seriously limit daily activities. Open elbow arthrolysis is the most effective treatment, but long-term postoperative rehabilitation is necessa...
Background: Elbow stiffness is a common disease that can seriously limit daily activities. Open elbow arthrolysis is the most effective treatment, but long-term postoperative rehabilitation is necessary. Traditional health education is unlikely to improve patient compliance and outcomes. Convenient and interesting tools and methods, such as WeChat and scene-based graphics, should be used to enhance elbow recovery. Objective: The aim of this study is to evaluate the effectiveness of WeChat plus Scene-based graphics health education after open elbow arthrolysis. Methods: This historical control study included patients who were 18 years or older, who underwent open elbow arthrolysis, who had normal communication skills and who were capable of using WeChat. Those who were eligible to participate were divided into two groups based on their admission time: the control group (56 patients enrolled from January to June 2021) and the WeChat group (56 patients enrolled from July to December 2021). The control group received traditional health education, while the WeChat group received WeChat plus scene-based graphics health education. Information was presented as comics and divided into 4 parts, which were then shared through a WeChat public account. The patients received the information and daily lessons through the WeChat public account during hospitalization. Patients received online instruction through a WeChat group after discharge until 12 weeks post operation. All outcome data were collected at 1 week, 6 weeks, and 12 weeks post operation. The primary outcome was elbow range of motion, while the secondary outcomes included elbow function, quality of life, and incidence of complications. Results: At 12 weeks post surgery, the WeChat group exhibited a significantly greater elbow range of motion than the control group (all P<.001). Moreover, the WeChat group had significantly better elbow function and quality of life (all P<.001). At 6 weeks post surgery, there were two elbow range of motion items that were significantly different between the WeChat group and the control group (forearm pronation: P=.014; forearm supination: P=.042). The incidence of complications was similar between the two groups (heterotopic ossification: P=.799; new onset or exacerbation of ulnar nerve symptoms: WeChat: P=1.00; repeat elbow stiffness: P=0.558). Conclusions: WeChat plus scene-based graphics health education has a marked effect on elbow range of motion, elbow function, and quality of life, as well as preventing complications. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2000036004; https://www.chictr.org.cn/showproj.
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Background: Obesity and mental health present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing healthcare...
Background: Obesity and mental health present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing healthcare communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood. Objective: This scoping review aims to identify and understand the different types of technologies that are used by health professionals in supporting obesity and mental health communication. Methods: A comprehensive scoping review, guided by Arksey & O’Malley’s (2005) methodology, analysed literature from 2013-2023 across eight databases. Data extraction focused on HPs' use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review question was: “What are the uses, benefits, and limitations of digital technology in supporting communication between HPs and persons living with obesity and mental health issues?”. Results: In total, eight studies met the inclusion criteria, featuring web-based platforms, social media, synchronous videos, telephone, automated SMS, and email. Technologies such as Virtual Learning Collaborative (VLC) dashboards and video conferencing, supported by automated SMS and social media Facebook and WhatsApp groups were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, one-to-one sessions, and hybrid models.
Benefits included enhanced access to care and engagement, personalised digital CBT, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, mental health improvements were not significantly achieved. Limitations included engagement difficulties due to conflicting personal family and work commitments, variable communication mode preferences with some preferring in-person sessions, and misunderstandings of SMS prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care. Conclusions: Digital technologies have diversified the approaches HPs can take in delivering education, counselling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalised care. While effective in obesity management, the review reveals a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to act as mediums for a deeper engagement with individuals’ complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital healthcare communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs.
Background: Diapers are commonly used in elderly patients with urination disorders. In this study, we want to verify how well we estimate the weight of urine measured in conventional diapers using a s...
Background: Diapers are commonly used in elderly patients with urination disorders. In this study, we want to verify how well we estimate the weight of urine measured in conventional diapers using a smart diaper system (SDS). Objective: The aim of the current research is to determine the degree of accuracy of technology which has been specifically designed for the management of urination routines and the use of incontinence pads in older adults. Methods: From January to December 2022, 97 participants from three senior nursing homes were tested on elderly patients with at least one chronic disease. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. Results: The average age of 97 participants was 86.48 years, with 10 males and 87 females. Seventy-three patients (75.3%) with hypertension and 86 patients (88.7%) with dementia, and 86 patients (88.7%) with two or more comorbidities accounted for the majority. Pearson's correlation coefficient and intraclass correlation coefficient was 0.971 and 0.985 (P <.001). In Bland-Altman's figure, the difference in the mean between the two tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight are very consistent. And the difference between the mean of the two tests is -0.045 of standardized mean difference, and all measurements are located within the 95% confidence interval, so this confirms that the two test methods are interchangeable. Conclusions: This study showed the possibility that heath care givers could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications.
Background: Lung disease is a severe problem in the United States. Despite the decreasing rates of cigarette smoking, COPD continues to be health burden in the United States. In this paper, we focus o...
Background: Lung disease is a severe problem in the United States. Despite the decreasing rates of cigarette smoking, COPD continues to be health burden in the United States. In this paper, we focus on Chronic Obstructive Pulmonary Disease in the United States from 2016 to 2019. Objective: We gather a diverse set of data sources to better understand and predict COPD rates at the level of Core-Based Statistical Area in the United States. The objective is to compare linear models with machine learning models to obtain the most accurate and interpretable model of COPD. Methods: We integrate data from multiple Centers for Disease Control sources and use them to analyze Chronic Obstructive Pulmonary Disease by using different types of methods. We include cigarette smoking, a well-known contributing factor, and race / ethnicity variables because health disparities among different races and ethnicities in the United States are also well-known. The models also include air quality index, education, employment, and economic variables. We fit models with both multiple linear regression and machine learning methods. Results: The most accurate multiple linear regression model has variance explained = 81.1% and Root Mean Squared Error = 0.73. The most accurate machine learning model has variance explained = 87.1% and Root Mean Squared Error = 0.53. Overall, cigarette smoking and household income are the strongest predictor variables. Hispanic percentage of CBSA, Education, and American Indian / Alaska Native percentage of CBSA are moderately strong predictors. Conclusions: This research highlights the importance of using diverse data sources as well as multiple methods to understand and predict COPD. The most accurate model is a Support Vector Machine, which captured non-linearities in a model whose accuracy is superior to the best multiple linear regression. Our interpretable models suggest ways that individual predictor variables can be used in interventions aimed at decreasing COPD rates. Gaps in understanding the health impacts of air pollution, particularly in relation to climate change, suggest a need for further research to design interventions and improve public health.
Background: As social media platforms gain popularity, their usage is increasingly associated with cyberbullying and body shaming, causing devastating effects. Objective: This study aims to investigat...
Background: As social media platforms gain popularity, their usage is increasingly associated with cyberbullying and body shaming, causing devastating effects. Objective: This study aims to investigate the impact of social media on Generation Z users’ body image satisfaction. More specifically, it examines the impact of TikTok on body image satisfaction among TikTok users between the ages of 17 and 26 in Indonesia. Methods: The methodology used mixed-method approaches. Quantitative data were obtained from 507 responses to a questionnaire and analyzed using covariance-based structural equation modeling. Qualitative data were obtained from the interviews of 32 respondents and analyzed through content analysis. Results: The study reveals that upward appearance comparison is influenced by video-based activity and appearance motivation. Conversely, thin-ideal internalization is influenced by appearance motivation and social media literacy. Upward appearance comparisons and thin-ideal internalization comparisons detrimentally impact users’ body image satisfaction. Conclusions: The results of this study are expected to provide valuable insights for social media providers, regulators, and educators in their endeavors to establish a positive and healthy social media environment for users.
Background: The management of Neurodegenerative Diseases (NDDs) in older population is usually demanding and involves care provision by various healthcare services, resulting in a greater burden to be...
Background: The management of Neurodegenerative Diseases (NDDs) in older population is usually demanding and involves care provision by various healthcare services, resulting in a greater burden to be placed on the healthcare systems in terms of both costs and resources. The convergence of various health services within the integrated healthcare models, enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative healthcare solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and healthcare professionals, with reported discrepancies in the needs and divergent preferences amongst these groups. Objective: Complementing a previous publication, that reported on the needs and requirements of end-users in the development of the EU funded project Personalized Integrated Care Solution for Elderly “PROCare4Life”, the current paper aims to report about the opinions of other key stakeholders in the fields of academia, media, market, and decision makers, for improving the acceptability and implementation of an integrated ICT-based healthcare platforms supporting the management of NDDs. Methods: The study included 30 individual semi-structured interviews, that took place between June and August 2020 in five European countries (Germany, Italy, Portugal, Romania, Spain). Almost all the interviews were done on the web, except for participants who asked to be interviewed in-person. In that cases the Covid-19 PROCare4Life safety procedures were applied. Results: Two themes and five sub-themes were identified. Users’ engagement, training and education, and the role played by the media were identified as strategic measures to ensure acceptability of the ICT healthcare platforms. Whereas sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The gradual transformation and responding to the various needs of the end-users in the ICT-based healthcare platforms requires a shared dialog between different experts such as: researchers, policy makers, technology developers, and media experts. Addressing typical barriers for ICT adoption among older population such as technology complexity and digital literacy among the potential users, need to be considered by providing a tailored system. Future projects are required to plan and budget training measures for end-users, ensuring that the time needed for training on the technology is planned for. Furthermore, overcoming costs of technology adoption can be facilitated by offering tailored pricing models. A comprehensive research on the users’ needs shall comprise four main aspects: Identifying the challenges associated with illness; researching the digital skills and preferences of the target groups; adjusting the ICT functionalities to the real unmet needs of end users; and the inclusion other key stakeholders in the research.
Background: Childhood obesity prevalence has remained high, especially in minority populations with low incomes. This epidemic has been attributed to various dietary behaviors including increased cons...
Background: Childhood obesity prevalence has remained high, especially in minority populations with low incomes. This epidemic has been attributed to various dietary behaviors including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. The purpose of this study was to assess the feasibility and acceptability of Intervention INC, a Web-based tool comprising a 6-chapter interactive nutrition comic. The tool’s preliminary effectiveness on diet-related psycho-social variables and behaviors was also explored. Objective: The purpose of this study was to assess the feasibility and acceptability of Intervention INC, a Web-based tool comprising a 6-chapter interactive nutrition comic. The tool’s preliminary effectiveness on diet-related psycho-social variables and behaviors was also explored. Methods: 89 Black/African American and Hispanic pre-adolescents (mean age=10.4±1.0 years, 61% female, 62% Black, 42% Hispanic, 53% overweight/obese, and 34% annual household income <$20,000) from New York City participated in a pilot two-group randomized study, comprising a 6-week intervention and a 3-month follow-up period. Participants were randomly assigned to the experimental (E) (n=45) group, who received the web-based comic tool, or the comparison (C) (n=44) group, who received online nutrition newsletters. Primary measures included feasibility (measured by tool usage) and usability (measured by a 30-item questionnaire) at intervention mid-point (T2) and intervention end (T3). Semi-structured interviews were also conducted at the same time to assess participant acceptability and satisfaction. Secondary measures included attitudes, beliefs, and behaviors related to fruit, vegetable, water, sugar and junk food intake, which were collected at baseline (T1), T2, T3 and at 3-month follow-up (T4). Descriptive analyses were conducted for usage and usability data. Interviews were systematically analyzed to facilitate identification of patterns/themes. Secondary data were analyzed using mixed models with repeated assessments (T1-T3), condition (E-C), and time by condition interaction. Within- and between-group effect sizes were reported. Results: During the intervention, 72.3% and 60.3% of the E and C groups, respectively, accessed their tool on a weekly basis. Mean total usability score was moderately high for both groups (on 5-point Likert scale), however, the E group score was higher (4.01 ± 0.37 and 3.81 ± 0.51, respectively; p=0.048). Overall, children in both groups found their tool to be acceptable and very few reported any difficulties logging in or accessing content. Within-group effect sizes for dietary beliefs and attitudes were generally larger in the E group at T3, however, improvements were largely diminished by T4. The E group reported a statistically significant (p<.05) increase in fruit, vegetable and water intake, which were maintained at T4. Conclusions: This pilot and feasibility study suggests an interactive comic tool may be an appealing and useful format to promote positive dietary behaviors in minority preadolescents. However, further research, including a full-scale RCT with a longer follow-up period, is warranted to determine the effectiveness of Intervention INC. Clinical Trial: NCT03165474
Background: The aging population and increased disability prevalence in Spain have heightened the demand for long-term care. Informal caregiving, primarily performed by women, plays a crucial role in...
Background: The aging population and increased disability prevalence in Spain have heightened the demand for long-term care. Informal caregiving, primarily performed by women, plays a crucial role in this scenario. This protocol outlines the CUIDAR-SE study, focusing on the gender-specific impact of informal caregiving on health and quality of life among caregivers in Andalusia and the Basque Country from 2013 to 2024. Objective: Analyze the gender differences in health and quality of life indicators of informal caregivers residing in two Spanish autonomous communities (Granada, Andalusia and Gipuzkoa, Basque Country) and its evolution over time, in relation with the characteristics of caregivers, the caregiving situation, and support received. Methods: The CUIDAR-SE study employs a longitudinal, multicenter design across three phases, tracking health and quality of life indicators among informal caregivers. Utilizing a questionnaire adapted to the Spanish context that employs validated scales and multilevel analysis, the research captures changes in caregivers’ experiences amid societal crises, notably the 2008 economic crisis and the COVID-19 pandemic. A multistage randomized cluster sampling technique is used to minimize study design effects. Results: Funding for the CUIDAR-SE study was in three phases starting in January 2013, 2017, and 2021, spanning a 10-year period. Data collection commenced in 2013 and continued annually, except for 2016 and 2020 due to financial and pandemic-related challenges. As of March 2024, 1,294 participants have been enrolled, with data collection ongoing for 2023. Initial data analysis focused on gender disparities in caregiver health, quality of life, burden, perceived needs, and received support, with results from phase I published. Currently, analysis is ongoing for phases II and III, as well as longitudinal analysis across all phases. Conclusions: This protocol aims to provide comprehensive insights into caregiving dynamics and caregivers’ experiences over time, as well as understand the role of caregiving on gender inequality in health, considering regional variations. Despite limitations in participant recruitment, focusing on registered caregivers, the study offers a detailed exploration of health impacts of caregiving in Spain. The incorporation of gender perspective and the examination of diverse contextual factors enrich the study’s depth, contributing significantly to the discourse on caregiving health complexities in Spain.
Background: Real-world walking speed is being proposed as the sixth vital sign to track functional health; this requires consideration of how the context of activity affects the individual. For examp...
Background: Real-world walking speed is being proposed as the sixth vital sign to track functional health; this requires consideration of how the context of activity affects the individual. For example, as it gets colder outside healthy adults walk faster and increase their cadence (steps/min). Environmental factors (weather conditions, time of year, time of day) and the individual (disease-group, gender, height, BMI) may have a varied impact on walking speed across disease cohorts. Objective: The aim of the paper is to examine the relationship between temperature and wind speed with measures of outdoor walking speed (cadence) across disease groups and healthy adult controls. Expected differences between disease groups and healthy controls were expected to be found. Methods: As a part of a technical validation study assessing worn mobility trackers (Mobilise-D), participants were asked to carry a smartphone with an installed tracking app recording GPS location, step activity and local temperature and wind speed, of walking bouts for seven consecutive days. A total of 57 participants were assessed included: 16 healthy adults, 12 patients with Multiple Sclerosis, 17 patients with Chronic Obstructive Pulmonary disease and 12 with Parkinson’s disease. Results: Pearson and Spearman Rank correlation coefficients were obtained for associations between hourly temperature and wind speed against hourly measurements of cadence and physical activity. Temperature and wind speed were found to be positively correlated with cadence (CI: -.437, -.228). Fisher’s r groupwise comparison established significant differences for associations of weather and mobility between health adults and COPD (p <.001), MS (p =.032), and PD (p = .007). The opposite effect of temperature on physical activity was observed in MS compared against COPD, PD and HA groups. Conclusions: Mobility impaired disease groups are affected by the weather in a dissimilar pattern to that of healthy adults. This should be accounted for when measuring digital mobility outcomes of various patient groups. Smartphone apps for real world cadence appear to be very similar to those recorded by wearable sensors for both healthy adults and disease groups
Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership...
Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and the sense of agency (SA), attention to SA in trauma has been lacking. This perspective article explores the loss of SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of SA, leading to a freeze response and dissociation, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an "enactive" perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies like gesture sonification (GS), which translates body movements into sounds to enhance the SA. GS offers a screen-free, non-invasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD.
Traditional Chinese medicine (TCM) is a holistic medical system with more than 2,000 years of empirical backing, with unique diagnostic methods, including inspection, auscultation and olfaction, inqui...
Traditional Chinese medicine (TCM) is a holistic medical system with more than 2,000 years of empirical backing, with unique diagnostic methods, including inspection, auscultation and olfaction, inquiry, and palpation. Despite TCM's holistic and subjective diagnostic approach, Artificial intelligence (AI) promises to enhance diagnostic accuracy, treatment efficacy, and prognosis by leveraging advanced data analysis and machine learning techniques. This review provides an overview the potential applications of AI across TCM's four main diagnostic methods, highlighting recent advancements, challenges, and future directions. AI-powered Tuina massage robots and AI-directed acupuncture manipulation, underscoring the potential for personalized treatment and improved clinical outcomes. However, successful AI integration faces challenges including data quality, interdisciplinary collaboration, computational interpretation of TCM theories, ethical considerations, and regulatory frameworks. Addressing these challenges is crucial for realizing AI's full potential in TCM and advancing patient care in modern healthcare systems.
As digital phenotyping, the capture of active and passive data from consumer devices like smartphones, becomes more common the need to properly process the data and derive replicable features from it...
As digital phenotyping, the capture of active and passive data from consumer devices like smartphones, becomes more common the need to properly process the data and derive replicable features from it has become paramount. Cortex is an open-source data processing pipeline for digital phenotyping data, optimized for use with the mindLAMP apps which is used by nearly 100 research teams across the world. Cortex is designed to help teams 1) assess digital phenotyping data quality in real time, 2) derive replicable clinical features from the data, 3) and enable easy to share data visualizations.
Cortex offers many options to work with digital phenotyping data, although some common approaches are likely of value to all teams using it. This paper highlights the reasoning, code, and example steps necessary to fully work with digital phenotyping data in an streamlined manner. Covering how to work with the data, assess its quality, derives features, and visualize findings, this paper is designed to offer the reader the knowledge and skills to apply towards analyzing any digital phenotyping dataset. Towards highlighting clinical applications, this paper also provides three easy to implement examples of Cortex use in real world settings. Through understanding how to work with digital phenotyping data and providing ready to deploy code with Cortex, the paper aims to show the new field of digital phenotyping can be both accessible to all yet still rigorous in methodology.
Background: While the benefits of fathers’ engagement in pregnancy are well researched, little is known about first-time expectant fathers’ information-seeking practices in Southeast Asia regardin...
Background: While the benefits of fathers’ engagement in pregnancy are well researched, little is known about first-time expectant fathers’ information-seeking practices in Southeast Asia regarding pregnancy-related. Additionally, there is a notable gap in understanding their information-sharing behaviours during the pregnancy journey. Considering the cultural norms prevalent in Southeast Asia, these might influence their information-sharing behaviour, particularly related to information about pregnancy. Objective: This research study aims to explore and analyse the health information-sharing behaviour of first-time expectant fathers in Southeast Asia. Specifically, it investigates whether fathers share pregnancy information, with whom, through what means, and reasons behind the decisions to share or not to share. Furthermore, we aim to understand if there are any behavioural differences between fathers in Southeast Asia and other countries Methods: We conducted semi-structured interviews with first-time Southeast Asian fathers in Indonesia, a sample country in the Southeast Asian region. We analysed the data using quantitative descriptive analysis and qualitative content theme analysis. A total of 40 first-time expectant fathers were interviewed Results: The results reveal distinct patterns in health information-sharing behaviour among first-time expectant fathers in Indonesia. Factors such as cultural norms and the nature of relationships play crucial roles in shaping these behaviours. The majority of Indonesian fathers limit their information-sharing to a limited audience circle. Furthermore, they also tailor their approaches within this circle based on the specific relationships with the audience. Additionally, the data highlights how fathers’ decisions to share or not share information are influenced by local cultural norms Conclusions: This study provides valuable insights into the nuanced health information-sharing behaviours of first-time fathers in Southeast Asia. In contrast to fathers in developed countries, the information-sharing behaviour of Southeast Asian fathers resembles that of fathers in developing countries, where culture plays a crucial role in their daily decision-making processes. Therefore, this emphasises the importance of cultural considerations in future discussions and the development of intervention programs related to pregnancy for Southeast Asian fathers
Background: The growing healthcare challenges from a rapidly expanding aging population necessitates examination of effective rehabilitation techniques that mitigate age-related comorbidity and improv...
Background: The growing healthcare challenges from a rapidly expanding aging population necessitates examination of effective rehabilitation techniques that mitigate age-related comorbidity and improve quality of life. To date, exercise is one of a few proven interventions known to attenuate age-related declines in cognitive and sensorimotor functions critical to sustained independence. This work aims to implement a multi-modal imaging approach to better understand the mechanistic underpinnings of the beneficial exercise induced adaptations to brain and behavior in sedentary older adults. Due to the complex cerebral and vascular dynamics that encompass neuroplastic change with aging and exercise, we propose an imaging protocol that will model exercise induced changes to cerebral perfusion, cerebral vascular reactivity (CVR) and cognitive & sensorimotor task-dependent fMRI after prescribed exercise. Objective: Our hypothesis is that the 12-week aerobic exercise intervention will increase basal perfusion and improve CVR as measure by increased magnitude of reactivity in areas susceptible to neural and vascular decline (inferior frontal and motor cortices) in previously sedentary older adults. To better understand the neural versus vascular adaptations in the motor and inferior frontal cortices, we will map changes in basal perfusion and CVR over target regions of interest (inferior frontal and the motor cortices) that we have demonstrated to be beneficially altered during fMRI BOLD (verbal fluency and motor tapping) by increased cardiovascular fitness. Methods: Sedentary adults (aged 65-80) will be randomly assigned to either a 12-week aerobic-based, interval-based cycling intervention or a 12-week balance and stretching intervention. Assessments of cardiovascular fitness using the YMCA submaximal VO2 test, basal cerebral perfusion using arterial spin labeling (ASL), CVR using hypercapnic fMRI, cortical activation using fMRI during verbal fluency and motor tapping tasks, and a battery of cognitive-executive and motor function tasks outside of the scanning environment will be performed before and after the interventions. Results: Our own studies and others show that improved cardiovascular fitness in older adults’ results in improved outcomes related to both physical and cognitive health as well as quality of life. A consistent but unexplained finding in many of these studies is a change in cortical activation patterns during task-based fMRI that corresponds with improved task performance (cognitive-executive and motor). Conclusions: To date, exercise is one of the most impactful interventions aimed to improve physical and cognitive health in aging. This study aims to better understand the mechanistic underpinnings of improved health and function of the cerebrovascular system. If our hypothesis of improved perfusion and cerebrovascular reactivity following a 12-week aerobic exercise intervention are supported, it would add critically important insight about the potential of exercise to improve brain health in aging and could inform exercise prescription for older adults at risk for neurodegenerative disease brought on by cerebrovascular dysfunction.
This paper reports on the growing issues experienced when conducting internet-based research. Non-genuine participants, repeat responders, and misrepresentation are common issues in health research po...
This paper reports on the growing issues experienced when conducting internet-based research. Non-genuine participants, repeat responders, and misrepresentation are common issues in health research posing significant challenges to data integrity. A summary of existing data on the topic and the different impacts on studies is presented. Seven case studies experienced by different teams within our institutions are then reported, primarily focused on mental health research. Finally, strategies to combat these challenges are presented, including protocol development, transparent recruitment practices, and continuous data monitoring. These strategies and challenges impact the entire research cycle and need to be considered prior to, during and post data collection. With a lack of current clear guidelines on this topic, this report attempts to highlight considerations to be taken to minimise the impact of such challenges on researchers, studies and wider research. Researchers conducting online research must put mitigating strategies in place, and reporting on mitigation efforts should be mandatory in grant applications and publications to uphold the credibility of online research.
Background: The application of artificial intelligence to health and healthcare is rapidly increasing. Several studies have assessed the attitudes of health professionals but far fewer have explored p...
Background: The application of artificial intelligence to health and healthcare is rapidly increasing. Several studies have assessed the attitudes of health professionals but far fewer have explored perspectives of patients or the general public. Studies investigating patient perspectives have focused on somatic issues including radiology, perinatal health, and general applications. Patient feedback has been elicited in the development of specific mental health solutions, but broader perspectives towards AI for mental health have been under-explored. Objective: To understand public perceptions regarding potential benefits of AI, concerns, comfort with AI accomplishing various tasks, and values related to AI, all pertaining to mental health. Methods: We conducted a one-time cross-section survey with a nationally representative sample of 500 United States-based adults. Participants provided structured responses on their perceived benefits, concerns, comfortability, and values on AI related to mental health. They could also add free text responses to elaborate on their concerns and values. Results: A plurality of participants (49.3%) believed AI may be beneficial for mental healthcare, but this perspective differed based on socio-demographic variables (p<0.05). Specifically, Black participants (OR = 1.76) and those with lower health literacy (OR=2.16), perceived AI to be more beneficial, and females (OR=0.68) perceived AI to be less beneficial. Participants endorsed concerns related to the use of AI for mental health regarding its accuracy, possible unintended consequences such as misdiagnosis, confidentiality of their information, and loss of connection with their health professional. Over 80% of participants also valued being able to understand individual factors driving their risk, confidentiality, and autonomy as it pertained to the use of AI for their mental health. When asked about who was responsible for misdiagnosis of mental health conditions using AI, 81.6% of participants found the health professional to be responsible. Qualitative results revealed similar concerns related to the accuracy of AI and how its use may impact the confidentiality of their information. Conclusions: Future work involving the use of AI for mental health should investigate strategies for conveying the level of AI's accuracy, factors that drive risk, and how data are used confidentially so that patients may work with their health professionals to determine when AI may be beneficial. It will also be important in a mental health context to ensure the patient-health professional relationship is preserved when AI is utilized. Clinical Trial: Not applicable
Background: Tracking technologies are frequently employed to gather and examine data regarding user interactions with websites or mobile applications of regulated health-related entities. These techno...
Background: Tracking technologies are frequently employed to gather and examine data regarding user interactions with websites or mobile applications of regulated health-related entities. These technologies then illegally share user data with third parties that use it to target ads to patients across social media platforms. This collection and sharing constitutes a data leak of massive proportions. Specifically, some pharmacies, medical device companies, and hospitals utilize banned tracking or surveillance technologies on their websites in a way that exposes patients’ prescriptions, medical device information, doctor appointments and contact details to third parties. Objective: This study aimed to assess the use of prohibited tracking technologies on unauthenticated URL’s within three types of entities: pharmacies, medical companies, and health systems. Methods: We identified the largest-by-revenue medical device companies, pharmacies, and hospitals in the United States, using a scanning tool we developed based on existing open source software to detect the presence or absence of five banned tracking technologies on a sample of them. Results: In total, we included 341 URLs associated with three different types of HIPAA covered entities in our scan sample. Medical device company (n= 147) webpages comprised 43.1% of our overall sample. Pharmacy webpages (n=96) comprised 28.2% of our sample, and hospitals/health system URLs (n=98) comprised 28.7% of our sample. 63.9% of the medical device company URLs scanned contained at least one banned surveillance technology. 59.2% of pharmacy URLs scanned had at least one banned surveillance technology installed. 59.8% out of hospital URLs scanned contained at least one banned surveillance tracker.
The most common tracker found on medical device company sample was Google Audience (39.5%), followed closely by Facebook Pixel (36.1%)
There were a number of device companies, pharmacies, and hospitals scanned that had none of the banned trackers. n=53 URLs or 36.1% did not have any banned trackers identified. 40.8% (44) of pharmacies did not have any trackers. 67.0% of hospital URLs scanned did not have any trackers identified. Conclusions: This study demonstrates the presence of health trackers on many health-related sites despite the laws that prohibit them, and further examines the ways PHI may be shared with social media platforms or third parties via unauthenticated landing pages. Future studies are needed to assess the impact of leaking sensitive data belonging to millions of patients to third party vendors. Clinical Trial: n/a
Background: On February 28, 2023, the Facebook page of the United Nations Children's Fund (UNICEF) South Africa, announced the beginning of the HPV vaccination campaign for 2023. The announcement read...
Background: On February 28, 2023, the Facebook page of the United Nations Children's Fund (UNICEF) South Africa, announced the beginning of the HPV vaccination campaign for 2023. The announcement read: ‘‘Protect your daughter from cervical cancer and make sure she gets her HPV vaccine at school.” The post garnered several comments and reactions from Facebook users. Objective: The aim of this study was to examine the attitudes of Facebook users, who commented on the UNICEF South Africa post, towards HPV vaccination to inform the development and implementation of interventions that can increase HPV vaccine acceptance and uptake Methods: We used basic thematic analysis approach to analyse the content of the comments. Two authors (EJM and AJ) independently coded the responses through line-by-line readings as pro-vaccination, anti-vaccination or neutral. After labelling the data with the three main codes, we then used an inductive thematic analysis approach to extract emerging themes from the comments within each code. Results: Several comments were questions regarding the eligible criteria for vaccination, side effects, consent form, and vaccination strategies. Many Facebook users were hesitant towards HPV vaccination due to various reasons including concerns around side effects, religious beliefs, vaccine stock outs, and their distrust in the institutions or systems involved in vaccination programmes. Few users accepted HPV vaccination because they believed that it was a very important thing to do, beneficial for the children’s health, and they have vaccinated their children before. Conclusions: Our findings of the current study contribute to the promotion of acceptance and uptake of HPV vaccination by developing and implementing social media-based interventions tailored to address identified barriers that are associated with hesitant to HPV vaccination.
Background: Digital interventions can help to overcome barriers to care including stigma, geographical distance and a lack of culturally appropriate treatment options. We Can Do This was a web-app des...
Background: Digital interventions can help to overcome barriers to care including stigma, geographical distance and a lack of culturally appropriate treatment options. We Can Do This was a web-app designed with input from cultural advisors and end-users to support Aboriginal and Torres Strait Islander people seeking to stop or reduce their use of methamphetamine and increase psychosocial wellbeing. Objective: We sought to evaluate the effectiveness of the web-app via a wait-list control, randomised trial Methods: Aboriginal and Torres Strait Islander people aged 16 or over who self-identified as having used methamphetamine weekly for the past three months were invited to participate online. Following a baseline survey, participants were randomised to either the intervention group, who could access the web-app for six weeks, or the control group, who received harm-minimisation material. Participants repeated the survey at one, two and three months post-baseline. We hypothesized that the intervention group would have significantly reduced frequency of use at three-month follow-up. Secondary outcomes included help-seeking, psychosocial distress and days spent out of usual role due to methamphetamine use. Results: Participants at baseline were 210 Aboriginal and/or Torres Strait Islander men and women aged 16 or over. Methamphetamine use declined significantly in all participants who completed three-month follow-up, however there were no significant differences between intervention and control groups on the primary or secondary outcomes. Conclusions: Drop out and a lack of sustained engagement hindered our ability to evaluate the effectiveness of the web-app. Nonetheless, the trial gleaned some useful lessons relating to recruitment and engagement in web-apps. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376088&isReview=true
Background: Background: In Brazil, Men Who Have Sex with Men (MSM) are disproportionately affected by the HIV epidemic, mirroring global trends. Despite advancements in HIV prevention, such as Pre-Exp...
Background: Background: In Brazil, Men Who Have Sex with Men (MSM) are disproportionately affected by the HIV epidemic, mirroring global trends. Despite advancements in HIV prevention, such as Pre-Exposure Prophylaxis (PrEP), uptake among different MSM age groups remains uneven, influenced by diverse sexual behaviors, risk perceptions, and social stigmas. Objective: Objectives: To investigate factors associated with PrEP intentions among Brazilian MSM of different age groups. Methods: Method: A cross-sectional electronic survey involving Brazilian MSM aged 18 years and above. Results: Results: PrEP intentions were expressed by over half of the participants, 55.1%. Regarding protective knowledge and PrEP intentions, among those under 25 years, frequent barebacking was associated with a 25.4 times higher prevalence of PrEP intentions. Conversely, having one or more casual sexual partners in the last 30 days was associated with a 22% lower frequency of PrEP intentions. The practice of chemsex was also associated with a lower prevalence of PrEP intentions. In the age group of 25-49 years, it was observed that the practice of double penetration was associated with a higher prevalence of PrEP intentions, as well as being a receptive or versatile partner. Still within this age range, the prevalence of PrEP intentions was over 10% among those who exhibited some unique characteristics, such as a previous diagnosis of syphilis and non-use of condoms due to the intensity of sex or when sexual partners are known. However, being single, the partner's PrEP use, and gouinage, as an HIV/AIDS prevention practice, were exclusively associated with lower prevalences of PrEP intentions. Regarding MSMs aged ≥50 years, a higher prevalence of PrEP intentions was associated with the practice of double penetration, as well as being a receptive or versatile partner. On the other hand, chemsex practice was associated with a lower prevalence of PrEP intentions. Group sex practice was independently associated with a lower prevalence of PrEP intentions exclusively among MSMs aged ≥50 years. Conclusions: Conclusion: The study highlights significant generational differences in the factors influencing PrEP intentions among Brazilian MSM. It underscores the need for tailored HIV prevention strategies that consider the unique behaviors and perceptions of different age groups. By addressing these nuances, public health initiatives can better promote PrEP use, catering to the diverse needs of the MSM community and contributing effectively to the reduction of HIV infection rates.
Background: Orthopedic trauma care encounters challenges in follow-up treatment due to varying and often limited patient information provision, treatment variation, and the chaotic setting in which it...
Background: Orthopedic trauma care encounters challenges in follow-up treatment due to varying and often limited patient information provision, treatment variation, and the chaotic setting in which it is provided. Additionally, the pressure on healthcare resources is rising globally. To address these issues, digital follow-up treatment pathways were implemented for orthopedic trauma patients, aiming to optimize healthcare resource utilization and enhance patient experiences. Objective: To assess the feasibility of digital follow-up treatment pathways from the patient's perspective and their impact on healthcare resource utilization. Methods: A concurrent mixed-method study was conducted parallel to the implementation of the digital follow-up treatment pathways in an urban level-2 trauma center and teaching hospital between October 1, 2022 – April 1, 2023. Inclusion criteria were: 1) minimum age of 18 years, 2) active account for the study institution’s web-based patient portal ; 3) able to read and write in Dutch; and 4) no cognitive impairment or pre-existing motor impairment. Data were collected via electronic patient records and surveys at three time points: T0: within three days of the ED visit, T1: 4-6 weeks post-injury and T2: 10-12 weeks post-injury. Semi-structured interviews were performed at 10-12 weeks post-injury. Quantitative data were reported descriptively and the digital treatment pathway group was compared to a similar control group using anonymous data from a pre-existing institutional database to compare for healthcare resource utilization. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited effcacy. Results: In total, 66 patients were included for quantitative data collection. Survey response rates were 100% at T0, 92% at T1, and 79% at T2. Respondent groups per time point did not significantly differ from one another. For qualitative data collection, 15 semi-structured interviews were performed. Patients reported a median satisfaction score of 7 (IQR:6-8) with the digital treatment pathway and an 8 (IQR 7-9) for overall treatment, reflecting positive experiences regarding the functionality, actual and intended use, and safety of treatment. The digital treatment pathways reduced secondary healthcare utilization, with fewer follow-up appointments by phone in digital treatment pathway patients (median 0, IQR: 0-0) vs. the control group (median 1, IQR: 0-1). Qualitative data highlighted positive experiences with functionalities, intended use and safety, but also identified areas for improvement, such as managing patient expectations, platform usability, and protocol adherence. Conclusions: Utilization of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reduced healthcare resource utilization. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for involved healthcare professionals. These insights can guide clinicians and policymakers in effectively integrating similar digital tools into clinical practice Clinical Trial: Na
Background: Type 2 diabetes mellitus (T2D) is a common health issue, with heart failure (HF) being the common and lethal long-term complication. Although insulin is widely used for the treatment of T2...
Background: Type 2 diabetes mellitus (T2D) is a common health issue, with heart failure (HF) being the common and lethal long-term complication. Although insulin is widely used for the treatment of T2D, evidence regarding the efficacy of insulin compared to non-insulin therapies on incident heart failure risk is missing among randomized clinical trials. Real-world evidence on insulin’s effect on long-term heart failure may supplement existing guidelines on the management of T2D. Objective: This study compared the insulin therapy versus other medications on heart failure (HF) among T2D patients using real-world data (RWD) extracted from insurance claims. Methods: We employed doubly robust Augmented Inverse Probability Weighted estimation that extensively adjusted for high-dimensional confounding factors in both the propensity score and outcome regression models, using a data-driven approach for feature selection implemented through a LASSO sparsity penalty in each model. Results: After adjusting for broad list of confounders, insulin was found to be associated with 11.8% [95% CI: 11.0%-12.7%] higher 5-year HF rate compared to patients receiving GLP-1, 12.0% [95% CI: 11.5%-12.4%] higher 5-year HF rate compared to DPP-4, and 15.1% [95% CI: 14.3%-16.0%] higher 5-year HF rate compared to SGLT-2. Subgroup analysis shows the insulin effect with a higher HF rate is significant in subgroup with high baseline HF risk but not significant in subgroup with low baseline HF risk. Conclusions: This study generated real-world evidence on the association with higher 5-year heart failure rate of insulin therapy compared to GLP-1, DPP-4, and SGLT-2 based on claims data. These findings also demonstrated the value of real-world data for comparative effectiveness studies to complement established guidelines. On the other hand, the study shares the common limitation of observational studies. Even though high-dimensional confounders are adjusted, remaining confounding may exist and induce bias in analysis.
Background: AgeTech offers digital solutions for older adults, supporting aging in place, including digital health, assistive technology, internal of things, medical devices, robotics, wearables, and...
Background: AgeTech offers digital solutions for older adults, supporting aging in place, including digital health, assistive technology, internal of things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration. Objective: This scoping review investigates the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications. Methods: The literature review adhered to the PRISMA-ScR guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, utilizing a search string incorporating concepts like "older people," "technology," and "standards or guidelines". Alternative terms, Boolean operators, and truncation were employed for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods. Results: Initially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria, and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to "design and development," constituting 36.2% (n=21) of the literature, "usability and user experience" was the second most prevalent aspect with 19% (n=11). In contrast, “privacy and security" with 1.7% (n=1) and "data quality," (n=1) were the least addressed aspects 1.7%. Similarly, "ethics," "integration and interoperability," "accessibility," and "acceptance or adoption" each have 3.4% (n=2). Additionally, a thematic analysis identified qualitative themes that warrant further exploration of variables. Conclusions: This study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and Ambient Assisted Living (AAL) technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to prioritized areas for further development and research in the AgeTech domain.
Background: Preschoolers’ lifestyles have become physically inactive and sedentary, their eating habits unhealthy, and their sleep routines increasingly disturbed. Parent-based interventions have sh...
Background: Preschoolers’ lifestyles have become physically inactive and sedentary, their eating habits unhealthy, and their sleep routines increasingly disturbed. Parent-based interventions have shown promising to improve physical activity (PA), dietary behaviors (DB), and reducing sleep problems of preschoolers. However, because of the recognized obstacles of face-to-face approach (such as travel costs and time commitment), easy access and lower costs make electronic health (eHealth) interventions appealing. Previous studies that examined the effectiveness of parent-based eHealth on preschooler’s PA, DB, and sleep have either emphasized on one variable or failed to balance the dosage of PA, DB, and sleep modules or consider the intervention sequence during the intervention period and there is an acknowledged gap in parent-based eHealth interventions which target preschoolers raised in Chinese cultural contexts. Objective: To investigate the effectiveness of parent-based eHealth intervention on Chinese preschoolers’ PA, DB, and sleep problems. Methods: This two-arm parallel randomized controlled trial comprises a 12-week intervention with a 12-week follow-up. 206 parent-child dyads will be randomized to either eHealth intervention group or control group. Participants allocated to the eHealth intervention will receive 12 interactive modules on PA, DB, and sleep, with each module delivered on a weekly basis to reduce the sequence effect on variable outcomes. The intervention is grounded upon Social Cognitive Theory and will be delivered through social media, where parents can obtain valid and updated educational information, social rapport, and interact with other group members and facilitators. Participants in the control group will receive weekly brochures on PA, DB, and sleep recommendations from the kindergarten teachers, but they will not receive any interactive components. Data will be collected at baseline, 3 months, and 6 months. The primary outcome will be the preschooler’s physical activity. The secondary outcomes will be the preschooler’s dietary behaviors, preschooler’s sleep duration, and preschooler’s sleep problems, parent’s PA, parenting style, and parental feeding style. Results: The baseline and posttest data of this study were conducted from October 2023 to March 2024, and the follow-up data will be completed by August 2024. The project team has completed data collection on 238 preschoolers at the baseline and posttest. The results are expected to be published in 2025. Conclusions: The parent-based eHealth intervention has potential to overcome the aforementioned barriers of face-to-face interventions, which will offer a novel approach for promoting healthy lifestyle of preschoolers. If found to be efficacious, the prevalence of unhealthy lifestyles among preschoolers may be alleviated at a low cost, which not only has a positive influence on the health of the individual and the well-being of the family but also reduces the financial pressure on society to treat diseases caused by poor lifestyle habits. Clinical Trial: ClinicalTrial.gov Protocol Registration and Results System (PRS): NCT06025019
Background: Patient-reported outcome (PRO) measures comprise an emerging field in healthcare. In the Central Denmark Region, epilepsy outpatients can participate in remote PRO-based follow-up by compl...
Background: Patient-reported outcome (PRO) measures comprise an emerging field in healthcare. In the Central Denmark Region, epilepsy outpatients can participate in remote PRO-based follow-up by completing a questionnaire at home instead of attending a traditional outpatient appointment. This approach aims to encourage patient engagement and is used in approximately half of all epilepsy outpatient consultations. However, drop out in this type of follow-up can be a challenge. Objective: This study aimed to examine the association between potential self-reported determinants and dropout in remote PRO-based follow-up for patients with epilepsy. Methods: This prospective cohort study (N=2282) explored the association between dropout in remote PRO-based follow-up for patients with epilepsy and nine potential determinants covering three domains: health-related self-management, general and mental health status, and patient satisfaction. The associations were examined using multiple logistic regression analyses with adjustment for gender, age, education, and cohabitation. Results: A total of 770 patients (33.7%) dropped out of remote PRO-based follow-up over 5 years. A statistically significant association between all potential determinants and dropouts in PRO-based follow-up was identified. Patients with low social support had an OR of 2.02 (95%CI:1.38;3.50) for dropout. Patients rating health as poor had an OR of 2.17 (95% CI: 1.65; 2.85) for dropout. Similar estimates were identified for the remaining determinants in question. Conclusions: Patients with reduced self-management, poor health status, and low patient satisfaction had higher odds of dropout in remote PRO-based follow-up. Further research is needed to determine the reasons for drop out.
Background: Poor sleep (defined by short sleep duration or poor quality) is a common condition with potential serious health consequences. Exogeneous melatonin supplements have been found to effective...
Background: Poor sleep (defined by short sleep duration or poor quality) is a common condition with potential serious health consequences. Exogeneous melatonin supplements have been found to effectively improve poor sleep but have also been shown to have heterogeneity of treatment effects (HTEs) between individuals. Personalized N-of-1 trials, in which each participant is the unit of analysis, are ideal for identifying whether a treatment with high HTE is beneficial for each individual patient. Objective: This study aimed to identify the feasibility, acceptability, and effectiveness of a series of personalized N-of-1 trials of melatonin for poor sleep. Methods: This study consisted of 60 digital, personalized N-of-1 crossover trials comparing the effects of 3.0mg and 0.5mg of melatonin versus placebo for poor sleep with randomization to 1 of 2 orders. The trial was comprised of a 2-week baseline period and a 12-week intervention period. The primary outcomes were usability of the personalized trial system (measured using the System Usability Scale [SUS]) and participant satisfaction with the trial. Effectiveness outcomes included sleep duration (measured using a Fitbit activity tracker) and sleep quality (measured using the consensus sleep diary [CSD]). Results: Participants rated the usability of the personalized trial as acceptable (average SUS score=76.3 [standard deviation (SD)=17.1]), and 96% (55/57) of those who completed satisfaction surveys stated that they would recommend the trial to others. Importantly, indices of HTE were low for 3.0mg and 0.5mg doses of melatonin, indicating that the effect of these treatments on sleep duration and sleep quality did not substantially vary between participants and that averaged treatment responses are appropriate. Averaged participant sleep duration did not significantly differ between the 3.0mg (P=0.7) and 0.5mg (P=0.9) melatonin intervention periods and the baseline period. Additionally, regression models did not show differences between different levels of melatonin and placebo periods for sleep duration or quality. Conclusions: Participant ratings of the usability of and satisfaction with this series of personalized N-of-1 trials of melatonin for sleep suggest these trials are both feasible and acceptable. However, our results show that melatonin supplements did not significantly improve sleep duration or sleep quality. Further, the treatment effects’ lack of heterogeneity between participants suggests that future use of N-of-1 trials of melatonin for poor sleep is not needed.
Background: The promise of real-world evidence and the learning healthcare system primarily depends on access to high-quality data. Despite widespread awareness of the prevalence and potential impacts...
Background: The promise of real-world evidence and the learning healthcare system primarily depends on access to high-quality data. Despite widespread awareness of the prevalence and potential impacts of poor data quality (DQ), current best practices for its assessment and improvement are unknown. Objective: We sought to investigate how studies define, assess, and improve the quality of structured real-world healthcare data. Methods: A systematic literature search of studies in the English language was implemented in EMBASE and PubMed databases to select studies that specifically aimed to measure and improve the quality of structured real-world data within any clinical setting. The time frame for the analysis was from January 1945 to June 2023. We standardised DQ concepts according to the DAMA (Data Management Association) DQ framework to enable comparison between studies. After screening and filtering by two independent authors, we identified 39 relevant articles reporting DQ improvement initiatives. Results: Studies were characterised by considerable heterogeneity in settings and approaches to DQ assessment and improvement. Affiliated institutions were from 18 different countries and 18 different health domains, and most targeted data generated by multiple institutions. DQ assessment methods were largely manual and targeted only completeness and/or one other DQ dimension. Use of DQ frameworks (n = 6) and quality improvement methodologies (n = 5) were sorely lacking. Most studies reported improvements in DQ through the implementation of a combination of interventions, which included either DQ reporting and personalised feedback, implementation of new digital systems for electronic data capture, training on DQ or data standards, or improvements in clinical workflows. Reporting of changes in DQ varied significantly, making it difficult to conduct objective meta-analysis for determination of treatment effect. Conclusions: There is an urgent need for standardised guidelines in the context of DQ improvement research to enable comparison and effective synthesis of lessons learnt. Frameworks such as Plan-Do-Study-Act (PDSA) learning cycles and the DAMA DQ framework can facilitate this unmet need. However, DQ improvement studies also need to pay closer attention to root cause analysis of DQ issues to ensure the most appropriate intervention is implemented, thereby ensuring long term sustainable improvement.
Background: In response to the high patient admission rates during the SARS-CoV-2 (COVID) pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm sy...
Background: In response to the high patient admission rates during the SARS-CoV-2 (COVID) pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We aimed to find out whether the provisional ICU setting led to a greater alarm burden and more alarm fatigued staff. Objective: We aimed to compare the alarm situation between provisional COVID ICUs non-COVID ICUs during the second Corona wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by healthcare staff. Methods: Our approach involved a comparative analysis of alarm data from two provisional COVID-19 ICUs and two stationary non-COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the two ICU types. We analyzed alarm log data from the patient monitoring systems of all participating ICUs to inferentially check the differences. Additionally, we assessed staff’s alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on healthcare personnel. Results: COVID ICUs had significantly more alarms per bed per day than non-COVID ICUs and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-specific alarm type patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs were alarm fatigued. However, physicians and nurses in COVID ICUs showed a significantly higher level of alarm fatigue. Conclusions: Staff in COVID ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management as part of the preparations emphasizing the importance of alarm management training for future pandemics.
Background: Improving self-management approaches to healthcare is a promising strategy to empower patients with type 2 diabetes (T2D) to enhance self-care. Objective: To assess whether the use of the...
Background: Improving self-management approaches to healthcare is a promising strategy to empower patients with type 2 diabetes (T2D) to enhance self-care. Objective: To assess whether the use of the Greenhabit (mHealth) Behavioural Treatment can improve T2D outcomes compared to standard treatment. Methods: A randomized, parallel group, single-blind, controlled trial was conducted in 123 participants with T2D, who were face-to-face recruited and randomly assigned to one of two groups: 1. Intervention group, instructed to use the Greenhabit mobile application and following standard recommendations, and 2. Control group, following standard recommendations. Nutritional and anthropometric data and blood and urine samples were collected at baseline and after 6- and 12-weeks of follow-up. Quality of life, work-life, and social environment questionnaires were also collected at the baseline and final visits. The primary outcome was HbA1c. Repeated-measures ANOVA was used to compare changes (first baseline and 6-weeks and after baseline and 12-weeks) and the 2 intervention groups. Analysis of covariance was used to assess changes after 6- and 12-weeks adjusted for the baseline levels of each variable. The multiple contrasts were adjusted by a Bonferroni post hoc test. Results: Both intervention (n=50) and control (n=53) groups disclosed significant reductions in HbA1c concentrations after 6 and 12 weeks (mean change in intervention group -0.4%, P<.001 vs -0.3% in control group, P<.05). At 12 weeks participants in the intervention group also presented significant reductions in systolic and diastolic blood pressures (mean change -4.6 and -2.5 mmHg, respectively), body weight (mean change -0.8 kg), body mass index (mean change -0.3 kg/m2), waist perimeter (mean change -1.1 cm) and triglyceride concentration (mean change -18.7 mg/dL), as well as a significant increase in HDL-cholesterol concentrations (mean change 2 mg/dL), P<.05 all. Finally, participants allocated to the intervention group notably improved in 3 out of the 5 elements of balance: Positivity, Social environment, and Work life balance. Conclusions: A 12-week intervention with the Greenhabit Behavioral treatment mobile health application had beneficial effects on T2D outcomes, such as HbA1c, and reduced the burden of cardiovascular risk factors. Clinical Trial: ISRCTN 13456652
Background: Personal safety is a prevalent public health issue common to all demographics. There is growing interest in the use of mobile apps for enhancing personal safety, particularly for children...
Background: Personal safety is a prevalent public health issue common to all demographics. There is growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be “at risk”. Methods: A scoping review following published methodological guidelines was conducted. Four databases (Scopus, SocIndex, PsycInfo, and Engineering Village) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was also searched using Google and Google Scholar search engines. The results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR). For summarizing the features and users’ experience of the apps, a published framework for evaluating the quality of mHealth Apps for youths was employed. Results: 1,986 articles were identified, of which 41 were included in the review. Among the included articles, nine personal safety apps were captured, which were categorized into 4 groups based on the goals of the apps as follows: dating/sexual violence prevention (4 apps); bullying/school violence prevention app (2 apps), self-harm/suicide prevention (2 apps), and homeless youth support (1 app). Twenty-five articles provided data solely on app description and features, while the remaining 16 articles provided data on app evaluations. Outcomes, which were mostly self-reported, focused on app engagement, users’ experiences, and effectiveness of the apps. Four articles covering 3 app categories reported on apps use, 3 of which reported relatively high app engagement based on app download, use of features, and/or completion of modules. Data on users’ experience were obtained from 13 studies, which covered all 4 app categories. Across studies, the duration of app use ranged from 20 – 40 minutes to 12 months. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. While most of the views were positive, some were negative. Negative perceptions included redundancy of app features, limited context for use, and lack of usefulness. All 5 apps evaluated for effectiveness (2 dating/sexual violence prevention, 2 self-harm/suicide prevention, and 1 bullying/school violence prevention app) were associated with a statistically significant reduction in harm or risk to participants. Conclusions: The evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research to improve upon the current state of evidence and availability of effective personal safety apps for children and youth have been made.
Background: Depression is a significant global public health issue that affects the physical and mental well-being of hundreds of millions of people worldwide. However, a substantial number of individ...
Background: Depression is a significant global public health issue that affects the physical and mental well-being of hundreds of millions of people worldwide. However, a substantial number of individuals with depression on social media often go undiagnosed and struggle to access timely and effective treatment, increasingly becoming a major societal health concern. Objective: This paper aims to explore and develop an online depression risk detection method based on deep learning technology to identify individuals at risk of depression on the Chinese social media platform Sina Weibo. Methods: We initially collected approximately 527,333 posts publicly shared over one year from 1600 individuals with depression and 1600 individuals without depression on the Sina Weibo platform. Subsequently, we developed a hierarchical Transformer network to learn semantic features for each user. This network comprises two levels of Transformer structures, one at the word level and the other at the sentence level. These Transformers are employed to extract the textual semantic features of each post, and the aggregated features of all posts for each user generate user-level semantic features. A classifier is then applied to predict the risk of depression. Finally, we conducted statistical and linguistic analyses of the content of posts from individuals with and without depression using the Chinese LIWC. Results: We divided the original dataset into training, validation, and test sets. The training set consists of 1000 individuals with depression and 100 individuals without depression. The validation and test set each includes 600 users, with 300 individuals with depression and 300 without depression. Our method achieved an accuracy of 84.62%, precision of 84.43%, recall of 84.50%, and F1 score of 84.32% on the test set without applying sampling techniques. After applying our proposed retrieval-based sampling strategy, our method achieved an accuracy of 95.46%, precision of 95.30%, recall of 95.70%, and F1 score of 95.43%. These results strongly demonstrate the effectiveness and superiority of our proposed depression risk detection model and retrieval-based sampling technique. This provides new insights for large-scale depression detection through social media. Through language behavior analysis, it is observed that individuals with depression are more likely to use negation words (the value of "swear" is 0.001253). This may indicate the presence of negative emotions, rejection, doubt, disagreement, or aversion expressed by individuals with depression. Additionally, we also found that individuals with depression tend to use negative emotional vocabulary in their expressions (NegEmo: 0.022306, Anx: 0.003829, Anger: 0.004327, Sad: 0.005740), which may reflect their internal negative emotions and psychological state. This frequent use of negative vocabulary could be a way for individuals with depression to express negative feelings towards life, themselves, or their surrounding environment. Conclusions: The research results indicate the feasibility and effectiveness of deep learning methods in detecting the risk of depression. This provides insights into the potential for large-scale, automated, and non-invasive prediction of depression among users of online social media.
Background: Long term unobtrusive monitoring of breathing patterns can potentially give a more realistic insight into the respiratory health of people with asthma or chronic obstructive pulmonary dise...
Background: Long term unobtrusive monitoring of breathing patterns can potentially give a more realistic insight into the respiratory health of people with asthma or chronic obstructive pulmonary disease than brief tests performed in medical environments. However, it is uncertain whether users would be willing to wear these sensor garments long term. Objective: Our objective was to explore whether users would wear knitted garments with knitted-in breathing sensors long term to monitor their lung health and under what conditions. Methods: Multiple knitted breathing sensor garments, developed and fabricated by the research team, were presented during a demonstration. Participants were encouraged to touch and feel the garments and ask questions. This was followed by two semi-structured, independently led focus groups with a total of 16 participants of which 4 had asthma. The focus group conversations were recorded and transcribed. Thematic analysis was carried out by three independent researchers in three phases consisting of: familiarization with the data, independent coding and overarching theme definition. Participants also completed a web-based questionnaire to probe opinion about wearability and functionality of the garments. Quantitative analysis of the sensors’ performance was mapped to participants’ garment preference to support the feasibility of the technology for long term wear. Results: Key points extracted from the qualitative data were: 1) garments more likely to be worn if medically prescribed, 2) cotton vest as underwear was preferred, and 3) a breathing crisis warning system was seen as a promising application. The qualitative analysis showed a preference for loose short sleeved T-shirts with a 81% acceptability rate, a 69% acceptability rate for snug fitting garments and 0% for tight-fitting garments. 62% of the participants would wear the knit for the whole day and 81% only during the night if not too hot. The sensitivity demands on the knitted wearable sensors can be aligned with users’ garment preferences. Conclusions: There is an overall positive opinion about wearing a knitted sensor garment over a long period of time for monitoring of respiratory health. The knit cannot be tight but should be able to be worn as a vest as underwear in a breathable material. These requirements can be fulfilled with the proposed garments. Participants with asthma supported using it as a sensor garment connected to an asthma attack alert system.
Background: Suicide remains a leading cause of death among Veterans, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation and suicide attempts (SI/SA). mTBI worsens impulsivi...
Background: Suicide remains a leading cause of death among Veterans, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation and suicide attempts (SI/SA). mTBI worsens impulsivity and contributes to poor social and occupational functioning, which further increasing the risk of SI/SA. Repetitive transcranial magnetic stimulation (TMS) is a neuromodulation treatment approach designed to mimic endogenous brain rhythms. Intermittent theta burst stimulation (iTBS) is a "second-generation" form of TMS that is safe, shorter in duration, displays a minimal side effect profile, and is a promising treatment approach for impulsivity in mTBI. Our novel treatment uses frontal pole stimulation to target the ventromedial prefrontal cortex (VMPFC) and may reduce impulsivity by strengthening functional connectivity between the limbic system and frontal cortex, potentially saving lives. Objective: The objectives of this study are to (1) develop an iTBS intervention for individuals with mTBI and SI, (2) assess the feasibility and tolerability of the intervention, and (3) gather preliminary clinical outcome data on SI, impulsivity, and functioning that will guide future studies. Methods: This is a pilot, double-blinded, randomized controlled trial. In developing this protocol, we referenced SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials). We will enroll 50 subjects (25 active iTBS and 25 sham iTBS). The iTBS intervention will be performed daily, five days a week, for two weeks. We will collect quantitative outcome measures before and after the intervention. Measures included will assess functioning (Social and Occupational Functioning Assessment Scale (SOFAS), Veteran RAND-36), impulsivity (Urgency, Premeditation (lack of), Preservation (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale – Negative Urgency subscale (UPPS-P)), SI (Beck Suicide Scale (BSS), Columbia Suicide Severity Rating Scale (C-SSRS)), PTSD symptoms (PTSD Checklist for DSM-5 (CAPS-5) (PCL-5)), and depressive symptoms (Patient Health Questionnaire-9 (PHQ-9), Inventory for Depressive Symptoms – Self-Report (IDSSR)). We will collect qualitative data through semi-structured interviews to elicit feedback on the subject’s experience and symptoms. Results: This study protocol was approved by the Edward Hines Jr Veterans Administration Hospital Institutional Review Board (Hines IRB#14-003) and registered on ClinicalTrials.gov (NCT05647044). This novel treatment is a 5-year research project (04/01/2023 – 03/31/2028) funded by the VA Rehabilitation Research & Development (RR&D) service (CDA2 grant IK2 RX002938). Study results will be disseminated at or before the project’s end date in March 2028. Conclusions: We will provide preliminary evidence of the safety, feasibility, and acceptability of a novel frontal pole iTBS treatment for mTBI, impulsivity, SI/SA, and functional deficits. Clinical Trial: ClinicalTrials.gov (NCT05647044); https://clinicaltrials.gov/study/NCT05647044
Background: Rapid and flexible data collection efforts are necessary for effective monitoring and research on tobacco and nicotine product use in a constantly evolving marketplace. Objective: To docum...
Background: Rapid and flexible data collection efforts are necessary for effective monitoring and research on tobacco and nicotine product use in a constantly evolving marketplace. Objective: To document the first two years of the Rutgers Omnibus Study. Methods: Launched in February 2022 and fielded quarterly thereafter, we survey convenience samples of 2000 to 3000 US adults ages 18 to 45 years recruited through Amazon Mechanical Turk. The questionnaire includes core and rotating modules and is designed to take approximately 10 minutes to complete via Qualtrics. Fielding duration is approximately 10 days per wave. Each wave includes both unique and repeating participants, and responses can be linked across waves by an anonymous ID. Results: Sample sizes range from 2,082 (Wave 8) to 2,989 (Wave 1), and the 8-wave longitudinal dataset includes 10,334 participants, of whom 2,477 have three or more data points. Key demographics are consistent across waves and similar to that of the general population, while tobacco product trial and past-30-day use is generally higher. Conclusions: The Rutgers Omnibus Study is a quarterly survey that is effective for rapidly assessing the use of emerging tobacco and nicotine products and can also be leveraged to conduct survey experiments, generate pilot data, and address both cross-sectional and longitudinal research questions.
Background: Digital mental health tools designed to augment traditional mental health treatments are becoming increasingly important due to a wide range of barriers to access, including a growing shor...
Background: Digital mental health tools designed to augment traditional mental health treatments are becoming increasingly important due to a wide range of barriers to access, including a growing shortage of clinicians. Most existing tools use rule-based algorithms, often leading to unnatural-feeling interactions compared to human therapists. Large language models (LLMs) offer a solution for the development of more natural, engaging digital tools. In this manuscript, we detail the development of Socrates 2.0, which was designed to engage users in Socratic dialogue surrounding unrealistic or unhelpful beliefs, a core technique in cognitive behavioral therapies (CBTs). The multi-agent LLM-based tool features an AI therapist, 'Socrates', which receives automated feedback from an AI supervisor and an AI rater. The combination of multiple agents appeared to help address common LLM issues like looping and improved the overall dialogue experience. Initial user feedback from individuals with lived experiences of mental health problems as well as cognitive behavioral therapists has been positive. Moreover, tests in ~500 scenarios showed that Socrates 2.0 engaged in harmful responses in under 1% of cases, with the AI supervisor promptly correcting the dialogue each time. However, formal feasibility studies with potential end users are needed. Objective: This manuscript details a mixed method feasibility study of Socrates 2.0. Methods: Based on the initial data we devised a formal feasibility study of Socrates 2.0 to gather qualitative and quantitative data about users’ and clinicians’ experience of interacting with the tool. Using a mixed method approach, the goal is to gather feasibility and acceptability data from both 100 users and 50 clinicians to inform the eventual implementation of generative AI tools like Socrates 2.0 in mental health treatment. We designed this study to better understand how users and clinicians interact with the tool including the frequency, length and time of interactions, users’ satisfactions with the tool overall, as well as the quality of each dialogue and even individual responses, as well as ways in which the tool should be improved before it is used in efficacy trials. Descriptive and inferential analyses will be performed on data from validated usability measures. Thematic analysis will be performed on the qualitative data. Results: Recruitment will begin in February 2024 and is expected to conclude by February 2025. Conclusions: The development of Socrates 2.0 and outlined feasibility study are important first steps in applying generative AI to mental health treatment delivery and lays the foundation for formal feasibility studies. Clinical Trial: N/A
Background: At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during...
Background: At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during surgery is estimated visually by the surgeon. However, it is known that this type of method is very prone to error. Accordingly, better standardized methods are needed. Objective: We are planning to conduct a scoping review with the aim of presenting the currently available methods for measuring intraoperative blood loss. This should help to capture the current status and map and summarize the available evidence for measuring blood loss to identify any gaps. Methods: Our review will be based on the PRISMA guidelines. [1] We will search the Pubmed (Medline) and Cochrane Library databases. Studies published in the period from 2012 (01.01.2012) up to and including the end of 2023 (31.12.2023) will be included. Only publications in German and English will be considered. All clinical studies that define "blood loss" as a target criterion or as a primary or secondary endpoint will be included as study types. Results: The included studies will be listed in a database and the following basic data will be extracted: Title, year of publication, country, language, study type, surgical specialty, type of procedure. The number of participants will be listed and the distribution of the participants will be documented in terms of gender and age. The following outcomes will be extracted: measurement method, "blood loss" as primary or secondary outcome. Conclusions: Currently, there is no comparable review, resulting in ambiguous data regarding the prevailing measurement methods. The aim of this study is to provide a comprehensive overview - from methods of measurement to various formulas for calculating losses - and to establish a status quo. This could then serve as a foundation for further studies.
Background: The rapid evolution of SARS-CoV-2 imposed a huge challenge on disease control. Immune escape caused by genetic variations of SARS-CoV-2 S protein immunogenic epitopes affects the efficienc...
Background: The rapid evolution of SARS-CoV-2 imposed a huge challenge on disease control. Immune escape caused by genetic variations of SARS-CoV-2 S protein immunogenic epitopes affects the efficiency of monoclonal antibody-based therapy of COVID-19. Therefore, a rapid method is needed to evaluate the efficacy of the available monoclonal antibodies against the new emerging variants or potential novel variants. Objective: The aim of this study is to develop a rapid computational method to evaluate the neutralization power of SARS-Cov-2 monoclonal antibodies against new SARS-CoV-2 variants and other potential new mutations. Methods: The amino acid sequence of the extracellular domain of SARS-CoV (YP_009825051.1) and SARS-CoV-2 (YP_009724390.1) spike proteins were used to create computational 3D models for the native spike proteins. Specific mutations were introduced to the collected sequence to generate the different variant spike models. Neutralization potential of S309 against theses variants was evaluated based on the molecular interactions and binding energy (ΔG) in comparison to a reference model after molecular replacement of the reference RBD with the variant’s RBD. Results: The results showed a loss in binding affinity of the neutralizing antibody S309 with both SARS-CoV and - SARS-CoV-2. Comparing SARS-CoV-2 variants to the binding affinity of the first Wuhan strain showed an improvement of the binding affinity of S309 with variants Alpha, Beta, Gamma and Kappa. However, Delta and Omicron variants showed a substantial decrease in the binding affinity. Based on mutational profile of Omicron subvariants, our data describe the effect of G339H and G339D mutation and its role in escaping antibody neutralization which came in consistent with clinical published reports. Conclusions: This method is rapid, applicable and of interest to adapt the use of therapeutic antibodies to the treatment of emerging variants. It could be applied to antibody-based treatment of other viral infections. Clinical Trial: N/A
Background: Background: Stroke is an acute and focal neurological deficit syndrome. By definition, it can be interpreted as a clinical syndrome resulting from vascular injury (infarction, bleeding) in...
Background: Background: Stroke is an acute and focal neurological deficit syndrome. By definition, it can be interpreted as a clinical syndrome resulting from vascular injury (infarction, bleeding) in the central nervous system. Hypertension is the main risk factor of non-lobar intracerebral hemorrhage (ICH), in which around 85% of ICH patients are hypertensive. Hypertension is often found to damage the basement membrane of blood vessel walls. It can also induce tissue injury by increasing the inflammatory cytokines IL 17 and IFN-γ and reducing the expression of VE-Cadherin. Genetically, mutation of the genes Col4A1 and Col4A2 has been correlated with the incidence of non-lobar intracerebral hemorrhage. Objective: Objective: The aim is to investigate the correlation between the P352L, R538G Col4A1 gene, RS9521733 Col4A2 gene locus polymorphisms, levels of IFN-γ, IL-17, and VE-Cadherin with the event of non-lobar spontaneous intracerebral hemorrhage in hypertensive patients. Methods: Method: This is a research protocol. This research will be an observational study with a comparative cross-sectional approach where the dependent and independent variables will be examined at the same time. This research was designed to investigate the correlation between the P352L, R538G Col4A1 gene, RS9521733 Col4A2 gene locus polymorphisms, level of IFN-γ, IL-17, and VE-Cadherin with the incident of spontaneous non-lobar intracerebral hemorrhage in hypertensive patients. Blood samples will be collected from hypertensive patients with non-lobar intracerebral hemorrhage stroke patients with hypertension and hypertensive patients without intracerebral hemorrhage. The samples will be analyzed using ELISA and transcription polymerase chain reaction (PCR). Data analysis will involve statistical tests with descriptive analysis, univariate analysis, and bivariate analysis. Results: Results: This research is at the protocol development stage. A pilot study regarding its feasibility has been completed in January 2023. The results of the study are expected to be available by the end of 2024. Conclusions: Conclusion: A study of the relationship between Col4A1, Col4A2 gene polymorphisms, levels of IFN-γ, IL-17, and VE-Cadherin on the incidence of non-lobar intracerebral hemorrhage in hypertension patients is expected to increase understanding and expand knowledge of the pathophysiology of the risk of non-lobar intracerebral hemorrhage in hypertension patients.
Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviours and implementing interventions. Crisis helplines are...
Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviours and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located in within each of the UK’s four countries or regions. Objective: The aim of this study is to determine the impact of calls answered in the same region as the caller, compared to calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed In Samaritans, the telephony system sends the call to the next available volunteer, irrespective of location, therefore individuals may be routed to a branch within the same region as the caller’s current region (intra-regional calls) or routed to a branch that is in a different region from that of the caller’s current region (inter-regional calls). The origin of calls by region was identified using the landline prefix of the anonymised caller identifier, along with the region of the destination branch (as branch is recorded in the call details record). Results: A one-way analysis showed that there are significant differences in call durations between intraregional calls and interregional calls (p<0.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin, than if they were put through to a branch within a different region than the call origin. Conclusions: Possible interpretations and practical implications are discussed.
Background: The Corona Virus Disease of 2019 (COVID-19) pandemic motivates research efforts to address this catastrophe from the beginning of 2020 year up to the present. The year 2021 is coming to an...
Background: The Corona Virus Disease of 2019 (COVID-19) pandemic motivates research efforts to address this catastrophe from the beginning of 2020 year up to the present. The year 2021 is coming to an end, and there have been several developments in pharmacotherapy for COVID-19. In terms of antiviral therapy, monoclonal antibody combinations become one of COVID-19 immunotherapy. Remdesivir and Favipiravir are the two antiviral medications typically used to treat COVID-19. Objective: The purpose of this study compares the effects of a combination of antibodies (casirivimab and imdevimab), remdesivir, and favipiravir on COVID-19 swab results in COVID-19 hospitalized patients at discharge. Methods: In this study, 265 COVID-19 patients with polymerase chain reaction (PCR) confirmation and indications for antiviral medication were non-randomized into three groups with a ratio of (1:2:2): REGN3048-3051(group A); Remdesivir (group B); Favipiravir (group C). Non-Randomized Single-blind Controlled study was the study design. The study's medication is provided by Hospital of Mansoura University. Following ethical permission, the study was conducted for approximately 6 months. Results: Compared to Remdesivir and Favipiravir, casirivimab and imdevimab cause more negative swab results at discharge. The three antivirals also have no significant adverse effects. All three antivirals are considered safe with these findings. Casirivimab and imdevimab achieve more negative swab results than Remdesivir & Favipiravir. Conclusions: Casirivimab & imdevimab achieve more negative swab results than Remdesivir and Favipiravir. All three antivirals are safe with no significant toxicity. Clinical Trial: Clinical Trial Registration: Clinicaltrials.gov, NCT05502081
Background: Linguistic accommodation refers to the process of adjusting one's language, speech, or communication style to match or adapt to that of others in a social interaction. It is known to be vi...
Background: Linguistic accommodation refers to the process of adjusting one's language, speech, or communication style to match or adapt to that of others in a social interaction. It is known to be vital to effective health communication. Despite this evidence, there is little scientific guidance on how to design linguistically adapted health behavior interventions for diverse English-speaking populations. Objective: This paper aims to transparently document the strategies used to develop a culturally-grounded cancer prevention intervention with the capabilities to linguistically accommodate to speakers of African American English (AAE). Methods: We describe the iterative process of developing a cancer prevention intervention with contributions of racially and linguistically diverse colleagues representing various community and institutional perspectives, including communication scientists, linguists, a community advisory board, professional voice talents, and institutional representatives for scientific integrity. We offer a detailed description of the success and, in some cases, failures of strategies. Results: Social stereotypes associated with AAE were prevalent at both institutional and community levels, resulting in unanticipated challenges and delays during intervention development. The diversity of linguistic, racial, and role identities within the message development team was integral to successfully addressing and identifying opportunities for process improvement. Conclusions: Language is a vital, but often overlooked, aspect of intervention development. Message designers should consider implicit social stereotypes that unintentionally shape linguistic choices. The current manuscript provides a novel overview of how various types of expertise and iterative message development processes contribute to successfully navigating cultural grounding when sensitive or stigmatized issues are salient.
Background: Cardiovascular disease (CVD) and stroke are the leading causes of mortality and major contributors to disability worldwide. Consequently, evidence-based medicine highlights the significanc...
Background: Cardiovascular disease (CVD) and stroke are the leading causes of mortality and major contributors to disability worldwide. Consequently, evidence-based medicine highlights the significance of mitigating CVD and stroke risk factors to reduce the global health burden. The persistent and incurable nature of such chronic illnesses makes it crucial to continuously monitor signs and symptoms to reduce hospital readmissions and improve quality of life. As a result, mobile health technology has expanded rapidly to provide such continuous support. However, there is limited evidence about the utility of mHealth in MI and stroke patients and their long-term care. Objective: This scoping review aims to give an overview of the literature that highlights different mHealth interventions for post-hospitalization care of MI and stroke patients. Methods: We applied the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) methodology. A literature search was carried out across four databases—CINAHIL, PubMed, Scopus, and Cochrane— for studies between 26th July 2015 to 31st January 2023. All interventional trials were included if their primary intervention included mHealth for MI and stroke patients. All case reports, animal studies, or grey literature were excluded. Results: In total, 23 articles were selected with over 9471 people with MI and stroke using mHealth intervention with a mean age of 59.7 years and a total of 2738 women (28.91%). A total of four different mHealth interventions were identified including smartphone applications (n = 14, 60.9%), text messages (n = 4,17.4%), telephone calls (n = 3, 13.1%), and internet-based platforms (n = 2, 8.7%). Conclusions: This scoping review confirms that mHealth interventions have a positive impact on the long-term needs of MI and stroke patients. However, robust randomized trials are needed to further extend the applicability of these findings because of heterogeneous outcomes across all articles. Future high-quality research should focus on uniform outcome measures to investigate which mHealth intervention is superior for continuous healthcare management. Clinical Trial: N/A
Background: Health status at the macro level is influenced by many factors, including health system, risk factors and service coverage. Existing literature often overlooks the combined effect of these...
Background: Health status at the macro level is influenced by many factors, including health system, risk factors and service coverage. Existing literature often overlooks the combined effect of these factors. Quantification and comprehensive representation of the complex health domains and data availability on relevant health indicators are significant challenges to macro-level research. Understanding health outcomes at the macro-level is imperative as it facilitates policy and decision-makers in deciding upon viable, prioritised, and efficient mechanisms to improve the health status of a nation. Objective: The proposed study aims to assess the effect of health systems, risk factors and service coverage on the health status of selected countries through econometric analysis and examine the progress of these countries towards specific health-related sustainable development goals. Methods: The study utilises panel data comprising selected countries from 2015 to 2021. The study shall quantify the complex health constructs such as ‘Health status’, ‘Health System’, ‘Health Risk Factors’ and ‘Health Service Coverage’ using the underlying indicators as per the global reference list 2018 by the World Health Organisation. The annual data on the indicators shall be obtained from multiple authentic sources. We shall compute the composite index for the above health constructs by employing UNDP methodology for data normalisation, principal component analysis for weight determination and inverse normalised Euclidean distance formula for aggregation. Following that, we shall estimate the compound annual growth rate of the health indices from 2015 to 2021 to understand the trend growth and forecast values up to 2025. Analysis of variance and post-hoc analysis will assess differences in health indices across groups based on the human development index. Panel data regression modelling shall evaluate the effect of Health System, Health Risk Factors and Health Service Coverage on Health status. Furthermore, convergence and divergence in health-related sustainable development goal indicators will be examined using the approach developed by Phillips and Sul. Results: The research protocol was reviewed and approved in the Doctoral Committee meeting held on 6th July 2021, and ethical approval was obtained from the Institute Ethics Committee on 3rd January 2022. We shall undertake objective-wise statistical analysis using a panel dataset of 100 countries from 2015-21. Conclusions: Index construction for health domains like health system, risk factors, service coverage, and health status improves communication of vital health information, expediting monitoring of health programs and policy interventions. Analyzing predictors of health status is crucial for identifying significant indicators and formulating targeted improvement strategies, aiding cross-country collaboration and disease prevention efforts. The study contributes to global health equity and sustainable development.
Background: Large language models (LLMs) are increasingly used in the mental health field, with promising results in assessing mental disorders. However, correctness, dependability, and equity of LLM-...
Background: Large language models (LLMs) are increasingly used in the mental health field, with promising results in assessing mental disorders. However, correctness, dependability, and equity of LLM-generated information have been questioned. Amongst other, societal biases and research underrepresentation of certain population strata may affect LLMs. Because LLMs are already used for clinical practice, including decision support, it is important to investigate potential biases to ensure a responsible use of LLMs. Objective: We aimed to estimate the presence and size of bias related to gender and sexual orientation produced by a common LLM, exemplified in the context of ED symptomatology and health-related quality of life (HRQoL) of patients with AN or BN. Methods: We extracted 30 case vignettes (22 AN, 8 BN) from scientific articles. We adapted each vignette to create 4 versions, describing a female vs. male patient living with their female vs. male partner (2x2 design), yielding n=120 vignettes. We then fed each vignette into Chat Generative Pre-trained Transformer-4 (ChatGPT-4) thrice with the instruction to evaluate them by providing responses to two psychometric instruments, the RAND-36 questionnaire assessing HRQoL and the eating disorder examination questionnaire (EDE-Q). With the resulting LLM-generated scores, we calculated multilevel models (MLMs) with a random intercept for gender and sexual orientation (accounting for within-vignette variance), nested in vignettes (accounting for between-vignette variance). Results: The MLM with N=360 observations indicated for the RAND-36 mental composite summary, a significant association with gender (conditional means: 12.8 for male and 15.1 for female cases; 95% CI of the effect=[-6.15, -0.35]; p=.037) but neither with sexual orientation nor an interaction effect (ps>.370). We found no indications for main or interaction effects of gender or sexual orientation for the EDE-Q overall score (conditional means: 5.59-5.65; ps>.611). Conclusions: LLM-generated estimates of mental HRQoL in AN or BN case vignettes are at risk of being affected by cases’ gender, with male cases scoring lower. Given the lack of real-world epidemiological evidence for such a pattern, our study highlights relevant risk of bias when applying generative AI in the context of mental health. Better understanding and mitigation of risk of bias related to gender and other factors, such as ethnicity or socioeconomic status, are highly warranted to ensure responsible use of LLMs when conducting diagnostic assessments or providing treatment recommendations.
Background: Smartphones have become an indispensable part of people's lives, and the fear of being without them, what has been termed 'nomophobia', is a growing phenomenon. The connections among nomop...
Background: Smartphones have become an indispensable part of people's lives, and the fear of being without them, what has been termed 'nomophobia', is a growing phenomenon. The connections among nomophobia, mental health measures, smartphone usage, and daily activities remains largely unexplored. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone usage, potentially empowering them to manage and regulate their smartphone usage more effectively. Objective: This paper aims to explore the relationship between young depressive adults and smartphones, and investigate nomophobia by analysing data obtained from a pilot study of depression in a youth cohort. In addition to passive sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire (NMP-Q), which forms the basis of our investigation. Thus, we here examine associations between smartphone use, various clinical psychometric measures and nomophobia. Methods: During an 8-week period, data collected by smartphone sensors, self-reported Ecological Momentary Assessments, and psychometric evaluations were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. We explored statistical associations between smartphone-derived behavioral features, psychometric indicators, and nomophobia. Additionally, we utilized behavioral and psychometric data to develop a regression model demonstrating the prediction of nomophobia levels. Results: Our findings reveal that nomophobia is positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. We also have developed exploratory predictive linear regression models that demonstrates the feasibility of predicting an individual's NMP-Q score based on their smartphone sensing data. Conclusions: Our work is the first paper to explore the relationship between NMP-Q and smartphone sensor data. It provides valuable insights of the predictors of nomophobia level, contributing to how individuals behave and engage with their smartphones, and paving the way for future studies.
Background: The patient-provider relationship in obstetrics and gynecology (OB/GYN) is uniquely complex due to the sensitive nature of exams and topics. Previous studies on desired OB/GYN provider tra...
Background: The patient-provider relationship in obstetrics and gynecology (OB/GYN) is uniquely complex due to the sensitive nature of exams and topics. Previous studies on desired OB/GYN provider traits lack evaluation of current relationships, barriers to care, and evolving patient preferences. Objective: To investigate if there are changes in patient preferences, patients’ concerns relating to current provider relationships, and prominent barriers to care post the #MeToo movement. Methods: A mixed-methods cross-sectional survey, utilizing a convergent parallel design, was conducted. OB/GYN patients from the US were recruited through social media from October to December 2019. Participants (n=1039) with experience with an OB/GYN provider, aged 18 and above, were included. Survey content included demographics, current relationships, provider traits, barriers to care, and qualities desired in providers. Quantitative data were analyzed to create descriptive statistics including means, standard deviations, and frequencies. Qualitative data from open-ended survey questions were reviewed for data-transformation and data-validation purposes. Results: Findings reveal that trust and comfort are paramount to patients, with listening skills ranked highest. The most significant shift in preferences is the increasing importance of provider gender, with 80.7% indicating same-gender preference. Barriers to care include daily commitments (67.5%). Participant demographics show a well-educated cohort (54.7% with higher degrees), with 83% emphasizing trust in provider relationships. Conclusions: The study highlights evolving patient preferences in OB/GYN provider characteristics, emphasizing gender identity as a significant factor. Trust and communication play pivotal roles in patient-provider relationships. The findings underscore the importance of patient-centered care, provider education, and quality improvement efforts in the OB/GYN setting to enhance patient experiences and outcomes. Further research involving diverse populations is necessary to ensure broad applicability.
Background: The development of technology and information systems have posed important changes to
the public health surveillance. Objective: This scoping review aimed to assess the available ev...
Background: The development of technology and information systems have posed important changes to
the public health surveillance. Objective: This scoping review aimed to assess the available evidence and
gather information about the use of digital tools for arboviruses (dengue, zika and
chikungunya) surveillance. Methods: The databases used in this scoping review were MEDLINE, SCIELO, LILACS, SCOPUS and
EMBASE. The results were evaluated according to the following steps: monitoring of outbreaks
and/or epidemics, tracking of cases, identification of rumors, dissemination of information,
decision-making and information for society. Results: Of the 2,227 studies retrieved based on screening
procedures by title, abstract and full text reading, 68 articles were included. The most frequent
digital tools used in arboviruses surveillance were Apps and Twitter. They were mostly used to
support the traditional surveillance system, strengthening aspects such as: information
timeliness, acceptability, flexibility, monitoring of outbreaks and/or epidemics, detection and
tracking of cases, and simplicity. Conclusions: However, methodological approaches for validating data
collected from unofficial sources remain as a challenge.
Background: Providing evidence-based, well-designed psychotherapy teaching for medical students and residents is urgently needed. Objective: The aim of this project is to measure the effectiveness of...
Background: Providing evidence-based, well-designed psychotherapy teaching for medical students and residents is urgently needed. Objective: The aim of this project is to measure the effectiveness of a new multimodal psychotherapy teaching program for medical students and residents in China. Methods: This study will be a two-arm randomized controlled trial (RCT). The intervention group will receive a two-day multimodal-based intensive educational intervention with 8 weeks follow-up (supervision-based online teaching). The wait-list control group will not receive the intervention until the end of the study. Both groups will be followed up for 8 weeks. This trial will be conducted at the Sir Run Run Shaw Hospital. This study aims to recruit about 160 medical students and residents, with approximately 80 in each group. Results: The primary outcome measure is the changes in the Facilitative Interpersonal Skills task (FIS) scores. Secondary outcome measures include: training program acceptability; trainees’ psychotherapy knowledge; utilization of psychotherapy; and self-reported self-efficacy and self-reported motivation for psychotherapy. Conclusions: If this CBT-based brief and short-term psychotherapy skill training program is proven effective, the mental health impact of its nationwide expansion could be enormous.
Background: Generalised Anxiety Disorder(GAD) is estimated to affect 1 in 8 people in the UK seeking help from their GP in primary care; where treatment options may either be unacceptable to patients...
Background: Generalised Anxiety Disorder(GAD) is estimated to affect 1 in 8 people in the UK seeking help from their GP in primary care; where treatment options may either be unacceptable to patients (e.g. medication), or may be delayed (e.g. psychotherapy delivered through NHS Talking Therapy services). These barriers leave an important treatment gap that may be filled by Digital Mental Health Interventions, offering immediate, evidence-based care. Objective: This study aimed to evaluate the efficacy and user acceptability and safety of the Resony Anxiety app, a digital therapeutic intervention for individuals with self-reported anxiety using a pre-post study design. Methods: A total of 86 UK-based participants were recruited and underwent a 6-week intervention using the Resony Anxiety app as a standalone unguided intervention. Primary and secondary outcome measures included the GAD-7 and DASS-21 questionnaires. Results: The participants reported a significant reduction in anxiety of 3.27 points on the GAD-7 after six weeks, with continued improvement during the follow-up period. The effect size was medium for GAD-7 and small for DASS-21 as measured using Hedge’s g. Qualitative feedback indicated that 95% of participants enjoyed using the app, and 64% found it effective in managing their anxiety. 77% of the participants would recommend the app to a friend or family member with anxiety. Conclusions: This study indicates that the Resony Anxiety app is effective and safe in reducing anxiety in adults. Future studies with larger samples and more robust experimental designs, such as randomised controlled trials, are needed to confirm these initial promising findings.
Background: Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper-limb (UL) movements needed for completing activities...
Background: Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper-limb (UL) movements needed for completing activities of daily living. Traditional laboratory and clinical motor assessments require extensive and stationary equipment, time-consuming in-person visits, and may not be fully engaging for children. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential alternative solution for UL motor assessment. Objective: This feasibility study examines whether MoEvGame can assess children’s whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to i) design and develop a novel mHealth gamified software tools to examine theory-driven features of UL movement, ii) analyze spatiotemporal game data with new algorithms and statistical techniques to quantify movement performance as a parameter of speed, accuracy, and precision, and iii) validate assessment methods with healthy participants from school. Methods: Elementary school children (N=31, median age=9.0 years, and IQR=5.0-14.0) participated by playing five games. The game tasks were focused on key features of skilled motor control: (i) whole limb reaching, (ii) fine motor control and manual dexterity, and (iii) bilateral coordination. Spatiotemporal game data were transferred and stored in a cloud-based data management server for further processing and analysis. We applied change point detection (i.e., PELT), signal processing techniques, and other algorithms to calculate movement speed and accuracy from spatiotemporal parameters. Different statistical methods (i.e., Pearson correlation, mean, standard deviation, p-value, 95% confidence interval) were used to compare speed-accuracy tradeoffs and evaluate the relationship between age and motor performance. Results: A negative correlation was identified between speed and accuracy in the whole limb movement (r= -0.30 to -0.42). Significant relationships between age and whole limb/manual dexterity performance were found: older participants exhibited lower errors with faster completion times compared to younger participants. Significant differences in bimanual coordination were found related to phase synchronization (In-phase Congruent, μ=28.85 σ=18.97 vs Anti-phase Congruent, μ=112.64 σ=25.82 and In-phase Mirrored, μ=23.78 σ=16.07 vs Anti-phase Mirrored μ=121.39 σ=28.19). Moreover, the average speed (RPS) and travel distance (m) of the in-phase mode were significantly higher than those of the anti-phase coordination. Conclusions: Results of this feasibility study show that spatiotemporal data captured from the mHealth application can quantify motor performance. Moving beyond traditional assessments, MoEvGame incorporates gamification into ubiquitous and accessible technology as a fast, flexible, and objective tool for UL motor assessment.
Background: Monitoring of various clinical outcomes and parameters such as lipid levels is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform th...
Background: Monitoring of various clinical outcomes and parameters such as lipid levels is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective: This systematic review and meta-analysis aim to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods: We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in and/or the development of abnormal lipid parameters. Secondary outcomes include body mass index, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to evaluate the overall certainty of evidence. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Conclusions: This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Clinical Trial: Prospero registration number: CRD42024483138
Background: In learning health systems (LHS), real-time evidence, informatics, patient-provider partnerships and experiences, and organizational culture are combined to conduct “learning cycles” t...
Background: In learning health systems (LHS), real-time evidence, informatics, patient-provider partnerships and experiences, and organizational culture are combined to conduct “learning cycles” that support improvements in care. Though the concept of LHS is fairly well established in the literature, evaluation methods, mechanisms, and indicators are less consistently described. Further, LHS often use “usual care” or “status quo” as a benchmark for comparing new approaches to care, but disentangling usual care from multifarious care modalities found across settings is challenging. There is a need to identify which evaluation methods are used within LHS, describe how LHS growth and maturity are conceptualized, and determine what tools and measures are being used to evaluate LHS at the system level. Objective: To 1) identify international examples of LHS and describe their evaluation approaches, frameworks, indicators and outcomes; and 2) describe common characteristics, emphases, assumptions, or challenges in establishing counterfactuals in LHS. Methods: A jurisdictional scan will be conducted according to modified PRISMA guidelines. LHS will be identified through a search of peer-reviewed and grey literature using Ovid Medline, Ebsco CINAHL, Ovid Embase, Clarivate Web of Science, PubMed Non-Medline databases, and the web. To gain a comprehensive understanding of each LHS, including details specific to evaluation, self-identified LHS will be included if they are described according to ≥4 of 11 pre-specified criteria (core functionalities, analytics, use of evidence, co-design/implementation, evaluation, change management/governance structures, data sharing, knowledge sharing, training/capacity building, equity, sustainability). Search results will be screened, extracted, and analyzed to inform two descriptive reviews pertaining to our two main objectives. Evaluation methods and approaches, both within learning cycles and at the system level, as well as frameworks, indicators, and target outcomes will be identified and summarized descriptively. Across evaluations, common challenges, assumptions, contextual factors, and mechanisms will be described. Results: NA Conclusions: This research will characterize the current landscape of LHS evaluation approaches and provide a foundation for developing consistent and scalable metrics of LHS growth, maturity, and success.
Background: Rheumatoid arthritis (RA) is an autoimmune disease that affects joints and can have extra-articular manifestations. The etiology of RA is unknown, and healthcare systems bear a considerabl...
Background: Rheumatoid arthritis (RA) is an autoimmune disease that affects joints and can have extra-articular manifestations. The etiology of RA is unknown, and healthcare systems bear a considerable burden due to its increasing prevalence. Ayurveda has taken the foremost place in managing the corresponding disease “Amavata” through a variety of interventions. The study is aimed to generate leads regarding the effectiveness of composite Ayurveda regimens in the management of RA. Objective: The clinical study is designed to evaluate the effectiveness and tolerability of a composite Ayurveda regimen in RA. Methods: The study will be an Open-label, Community-based interventional study with a black box design comprising a sample size of 200 participants of age between 18 and 65 years, diagnosed as per ACR Criteria (2010). Treatment will be classified based on major disease presentation patterns and customized based on the presence of associated symptoms. The outcome measures include change in Disease Activity Score (DAS)-28 with ESR and disease-specific biochemical & inflammatory markers, change in the participant's assessment of pain, Disability Index score, frequency of use of conventional analgesic/NSAIDs(Non-steroidal anti-inflammatory drugs). Tolerability will also be assessed through occurrence of adverse events. Results: The execution of the study has been initiated in April 2023 with the IEC approval followed by CTRI registration on 20th June 2023. The recruitment of participants has been initiated, as of 7th January 2024, 240 participants have been enrolled and 237 are continuing while 3 participants have dropped out due to incompliance. Conclusions: The present study will help to assess the effectiveness of composite Ayurveda interventions in various patterns of disease presentation and their tolerability in RA. Clinical Trial: The study is registered with the Clinical Trial Registry of India (CTRI/2023/06/054203) on 20th June 2023.
Background: Introduction:Glaucoma is a chronic progressive optic neuropathy that necessitates lifelong treatment to retard the decline of the optic nerve. Due to the extended and continuous treatmen...
Background: Introduction:Glaucoma is a chronic progressive optic neuropathy that necessitates lifelong treatment to retard the decline of the optic nerve. Due to the extended and continuous treatments required for patients, they may explore alternative or complementary therapies alongside conventional treatments to enhance the effectiveness in controlling disease progression. Acupuncture has displayed promise in the treatment of various ophthalmic disorders in clinical trials, and its potential to reduce intraocular pressure (IOP) makes it an intriguing candidate for managing glaucoma. Objective: The primary objective of this trial is to conduct a single-center clinical trial involving glaucoma patients, wherein acupuncture will be evaluated as an adjunctive therapy, aiming to explore its effectiveness for glaucoma. Methods: In this single-center, randomized, controlled trial, 50 patients diagnosed with primary open-angle glaucoma will be randomly allocated to two groups: the treatment group and the control group. Participants in the treatment group will undergo acupuncture targeting ophthalmology-related acupuncture points, aiming to elicit the 'De Qi' sensation. Conversely, the control group will receive minimum acupuncture stimulation targeting non-ophthalmic acupuncture points without the intention of achieving the 'De Qi' sensation. Both groups will undergo acupuncture therapy once a week for a total of six sessions and will be observed for twelve weeks. The primary outcome will be the variation in IOP before and after each acupuncture session. Secondary outcomes will encompass pre- and post-acupuncture measurements of heart rate and blood pressure. Additionally, assessments will be conducted for best-corrected visual acuity, visual field, optical coherence tomography (OCT), OCT-angiography, glaucoma symptom scale, and the glaucoma quality of life-15 questionnaire, with comparisons made against baseline measurements. Results: Ethics approval was obtained from the institutional review board of China Medical University Hospital (CMUH111-REC3-210), and was registered on clinicaltirl.gov (NCT05753137). Recruitment of participants for the trial commenced on June 28, 2023, and currently, only a limited number of participants have been enrolled to test the feasibility of the experiment. We anticipate that the preliminary data from this trial will be completed by 2025. Conclusions: This trial employs rigorous methodology and comprehensive outcome measurements to assess the clinical efficacy of acupuncture as an adjunctive therapy for glaucoma, providing valuable insights for future clinical treatment guidelines. Clinical Trial: ClinicalTrials.gov NCT05753137, registered on 2023/01/29
Background: Digital interventions typically involve using smartphones or personal computers to access online or downloadable self-help, and may offer a more accessible and convenient option than face-...
Background: Digital interventions typically involve using smartphones or personal computers to access online or downloadable self-help, and may offer a more accessible and convenient option than face-to-face for some people with mild to moderate eating disorders. They have been shown to reduce eating disorder symptoms significantly, but treatment dropout rates can be high. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centred digital interventions which are engaging and meet users’ needs.
Objective: To understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Objective: To understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Methods: We conducted a meta-synthesis of qualitative studies. We searched six databases for published and unpublished literature from 2013 to 2023. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. Results: Eight studies were included after screening 2,435 search results. Eight meta-themes were identified. Meta-themes include (1) Appeal of digital interventions, (2) Role of digital interventions in treatment, (3) Value of support in treatment, (4) Communication at the right level, (5) Importance of engagement, (6) Flexibility of digital interventions, (7) Shaping knowledge to improve eating disorder behaviours, and (8) Design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible to fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviours. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalised content and functions. Users preferred an intervention that offered diary functions to log their food, moods and binges as these supported engagement. Conclusions: Users found digital interventions for eating disorders to be a practical and effective method of intervention. However, users emphasised the importance of an intervention that recognises the range of eating disorder symptoms and severity and meets their language, lifestyle and engagement needs. An ideal intervention would allow users to tailor content, functions, appearance, and format of content. Increased personalisation may increase adherence to digital interventions for people with mild to moderate eating disorders. Future studies should investigate more diverse samples and include populations that are often overlooked in mental health research (for example, older adults and men). Future studies may also investigate the use of artificial intelligence and machine learning to further improve digital interventions. Clinical Trial: PROSPERO (CRD42023426932)
Background: Access to trustworthy, understandable and actionable health information is a determinant of health and an essential component of Universal Health Coverage and Primary Health Care. The Worl...
Background: Access to trustworthy, understandable and actionable health information is a determinant of health and an essential component of Universal Health Coverage and Primary Health Care. The World Health Organization (WHO) has developed a new digital resource for use with the general public to improve health and well-being at and across different life phases and to support people to care for themselves, their families and community. Objective: The aim of this manuscript is to describe the methodology used to develop the resource – ‘Your life, your health: Tips and information for health and well-being’ – in order to explore a potentially transferable approach to making trustworthy health information accessible, understandable and actionable for the general public in a digital format. Methods: A five-step process was used to develop Your life, your health. This included: a) a review and synthesis of existing WHO technical guidance, member state health and health literacy plans and international human rights frameworks to identify priority messages; b) the development of messages and graphics to be accessible, understandable and actionable for the public through the application of health literacy principles; c) engaging with experts and other stakeholders to refine messages and message delivery; d) presentation of priority content in an accessible digital format; and e) piloting with potential users to develop and adapt the resource based on feedback and new evidence. The ‘Your life, your health’ online resource adopts a life course approach to organize health information based on priority actions and rights that support people’s health and wellbeing at, and across, different life phases as well as on specific health topics. The resource supports users in developing health literacy skills through advice on how to ask questions of health workers, how to make good decisions about personal and family health, and how best to use digital media to obtain health information. It also reflects the ambitions of the Sustainable Development Goals, to provide “essential” information on the social determinants of health, and clarifies the different roles that individuals, frontline workers, governments and the media play in promoting and protecting health. Results: The ‘Your life, your health’ online resource adopts a life course approach to organize health information based on priority actions and rights that support people’s health and wellbeing at, and across, different life phases as well as on specific health topics. The resource supports users in developing health literacy skills through advice on how to ask questions of health workers, how to make good decisions about personal and family health, and how best to use digital media to obtain health information. It also reflects the ambitions of the Sustainable Development Goals, to provide “essential” information on the social determinants of health, and clarifies the different roles that individuals, frontline workers, governments and the media play in promoting and protecting health. Conclusions: Making health information available – including to the public – is an essential step in the global health information system. The development process for the ‘Your life, your health’ online resource outlined in this article offers a structured approach to public communication which can be adapted for use within and beyond the WHO to translate technical health guidelines into accessible, understandable, and actionable health information for the general public.
Background: Survivors of childhood cancer are at risk for medical, psychological, and social late effects. To screen for their risks, receipt of consistent, cancer-specific follow-up care is crucial....
Background: Survivors of childhood cancer are at risk for medical, psychological, and social late effects. To screen for their risks, receipt of consistent, cancer-specific follow-up care is crucial. Yet, less than 50% of survivors attend their aftercare and only 35% of them recognize that they could have a serious health problem. The use of mobile health (mHealth) is a promising form of intervention to educate, connect, and empower survivors of childhood cancer on the importance of follow-up care. Objective: Use co-design to identify the priority components to include in an mHealth intervention with young adult (18 to 39 years old) survivors of childhood cancer and healthcare providers. Methods: This study employed patient-oriented research methods and gathered qualitative descriptive from survivors of childhood cancer and healthcare providers. Data collected was analyzed using reflexive thematic analysis and verified through member checking techniques via a virtual community engagement event. Results: We co-facilitated with patient partners 5 virtual focus groups with 22 survivors of childhood cancer (mean age = 29.19 years, SD = 4.78). We conducted telephone interviews with 7 healthcare providers. Over 95% (n = 21) of the survivors identified as White (78% n = 35) and reported residing from 5 provinces across Canada with 79% indicating that they live in an urban community. Participants identified five priority areas to be included in an mHealth intervention: (1): Connections; (2); Education and information; (3); engagement; (4): Personalization; (5) Resources. Conclusions: Results from the current study has provided the necessary foundation to progress in intervention development. The next step of this multi-phased project is to build an innovative and accessible mHealth intervention prototype based on the core components identified and grounded in an established conceptual framework for co-design of mHealth. Clinical Trial: n/a
Background: The Tobacco Heating System (THS, commercialized as IQOS®) is a smoke-free heated tobacco product that was introduced in the United States (US) in 2019 and authorized by the US Food and Dr...
Background: The Tobacco Heating System (THS, commercialized as IQOS®) is a smoke-free heated tobacco product that was introduced in the United States (US) in 2019 and authorized by the US Food and Drug Administration as a modified risk tobacco product (MRTP) in 2020. THS consists of a holder and specially designed tobacco sticks that are heated instead of burned to produce a nicotine-containing aerosol. Objective: The aim of this study was to describe selected sociodemographic characteristics of adults who used IQOS (AUI), tobacco use patterns (e.g., tobacco use history, exclusive and dual-use, switching from cigarette smoking, etc.), risk perceptions of the product, and understanding of MRTP messages among AUI. Methods: The IQOS Cross-sectional Postmarket Adult Consumer Study was a study of AUI aged ≥21 years who were recruited from a consumer database via direct mail and emails. Participants completed the online survey between September and November 2021. Results: The survey was completed by 645 current and 43 former AUI who had used at least 100 tobacco sticks prior to the assessment. Of the 688 participants, 61% were male, 73% were non-Hispanic white, and the mean age was 45. The vast majority (99%) of AUI had ever smoked combusted cigarettes before first trying THS. At the time of assessment, 49% were still smoking after an average of 1 year of THS use. Among those, 83.6% smoked fewer cigarettes compared to before first trying THS. Among all AUI, over 80% had never used a cessation treatment or had not used it in the past 12 months. Approximately 80% of AUI demonstrated correct understanding of the MRTP message. Conclusions: This study is the first to provide evidence that THS can help adult smokers in the US completely switch away from cigarettes or reduce smoking.
Background: Osteoarthritis (OA) is more prevalent and severe among women compared to men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigra...
Background: Osteoarthritis (OA) is more prevalent and severe among women compared to men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigrant women. Prior research advocated for greater access to culturally-safe OA information for both diverse women and healthcare professionals. The Internet can reduce disparities by facilitating access to health information, but online materials can vary in quality. Objective: We aimed to assess the quality and cultural safety of online OA materials for persons affected by OA and healthcare professionals. Methods: We employed content analysis to describe publicly-available materials on OA first-line management developed by Canadian organizations for affected persons or healthcare professionals. Searching, screening and data extraction were done in triplicate. We identified materials by searching Google, MEDLINE and the references of OA-relevant guidelines and policies, and consulting our research team and collaborators. We assessed quality using DISCERN and a compiled framework for affected persons and healthcare professionals, respectively. We compiled frameworks to assess cultural safety. We derived an overall score, categorized as low (<50%), moderate (50% to 69%) or high (≥70%+) for criteria met. Results: After screening 176 items and eliminating 129, we included 47 OA materials published between 2013 and 2023. Of those, 43 were for persons with OA. Most were developed by charities (31, 72.1%), based on expert advice (16, 55.2%), and in the format of booklets (15, 34.9%) or text on web pages (10, 23.3%). Of those, 10 (23.3%), 20 (46.5%) and 13 (30.2%) scored low, moderate and high for quality; and 11 (25.6%), 21 (48.8%) and 11 (25.6%) were rated low, moderate and high cultural safety, respectively. Of the 47 included OA materials, 4 were for healthcare professionals. They were developed by a consortium (2, 50.0%), charity (1, 25.0%) and a professional society (1, 25.0%), and largely based on expert advice (3, 75.0%). Format included infographics (3, 75.0%) and text on web pages (1, 25.0%). Of those, 1 (25.0%), 1 (25.0%) and 2 (50.0%) were rated low, moderate and high quality, respectively; and all were rated low for cultural safety. Quality and cultural safety did not appear to be associated with OA material characteristics (e.g. type of developer, development method, format). Conclusions: Overall, included OA materials for persons affected by OA and healthcare professionals were low to moderate quality and cultural safety. These findings reveal the need for further efforts to improve existing or develop new OA materials for both affected persons, including ethno-culturally diverse immigrant women, and healthcare professionals. Further research is needed to assess the quality and cultural safety of OA materials developed by organizations outside of Canada, and to establish a framework or instrument to assess cultural safety in the OA context.
Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may...
Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities has not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE (via PubMed), Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies of adult populations, including caregivers, and studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on healthcare professional education were excluded. Articles were limited to those published in the English language. The review followed the Joanna Briggs Institute (JBI) guidelines for scoping reviews and is reported in line with the PRISMA-ScR guidelines. Titles and abstracts were screened by one reviewer. Full texts were screened by two reviewers. Data extraction was guided by the research question. Results: The search identified 8087 unique publications. Thirteen studies met the inclusion criteria. Telehealth training was commonly described as once-off pre-telehealth visit phone calls to service users, facilitated primarily by student volunteers, accompanied by written instructions. The training content included how to download and install software, troubleshooting, and adjusting device settings. Older adults were the most common target population for the training. All but one of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited evidence that training improved participants’ competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving broader digital skills of service users. There is a need for further studies to evaluate outcomes of telehealth training activities in geographically-diverse areas.
Background: Social media is an integral part of modern life in which people connect, learn, and share. The content shared on social media can drive behavior change as people, especially adolescents, s...
Background: Social media is an integral part of modern life in which people connect, learn, and share. The content shared on social media can drive behavior change as people, especially adolescents, seek to gain or maintain popularity. #Chronicillness is a rising trend on social media, yet the content and attention it garners remain poorly understood. Objective: This study aimed to analyze Instagram posts related to chronic illness by examining their content and assessing if posts with medical-related content received greater attention. Methods: To study individuals with chronic illness, publicly available Instagram posts were searched for hashtags related to chronic illness. We used a mixed-methods approach which included qualitative analysis of captions, hashtags, and photos for medical conditions, locations, and presence of medical equipment, alongside quantitative analysis to examine the relationship between medical content and attention. Multivariate analyses were performed to determine the odds of medical content Overperforming, a proxy measure for attention. Results: Content analysis of 279 posts revealed caption themes including Medical Experiences, Illness Journey, Connection, and Non-illness Experiences. Among the posts, 97 (35%) included medical content, 52 (19%) featured advertisements, and 10 (4%) depicted invasive medical equipment. Hashtags covered a wide range of 107 different conditions. Posts with medical content exhibited significantly higher odds of overperforming (OR 1.85; 95% CI: 1.01, 3.42), as did posts with photos containing invasive medical equipment (OR 6.19; 95% CI: 1.16, 32.99). Conclusions: Our findings underscore the potential reinforcing effect of sharing medical information on Instagram, the inadvertent promotion of invasive medical procedures as visible signs of illness, and the possibility of adolescents mimicking this attention-generating content. It is crucial to implement strategies for fostering positive and informed interactions within online communities, and to address the potential risks associated with overmedicalization, misinformation, and the commodification of health experiences.
Background: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. Objec...
Background: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. Objective: To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. This study presents the usability results of a first-generation handheld wireless telestration platform. Methods: A prototype was developed with four core hand-held functions: 1) free-hand annotation, 2) cursor navigation, 3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, 4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality (AR) platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability, ergonomics, and educational value were evaluated with 5-point Likert scale surveys and a validated System Usability Scale (SUS). Results: Ten subjects (9 surgeons, 1 trainee; 5 male, 5 female) participated. Participants agreed or strongly agreed that it was easy to perform annotations (90%; neutral=0%), video feed navigation (85%; neutral=15%), and manipulation of ghost (avatar) instruments on the monitor (60%; neutral=33%). With regards to ergonomics, 40% of participants agreed or strongly agreed (neutral=40%) that the device was physically comfortable to use and hold. These results are consistent with open ended comments made on the device’s size and weight. The average SUS was 70 (median 75, interquartile range [63-84]) indicating an above average usability score. Participants responded favorably on the device’s potential educational value, particularly for postoperative coaching (agree=60%; strongly agree=40%). Conclusions: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and potential educational value were reported. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training.
Background: The burgeoning volume of scientific literature being generated today places a great burden on evidence reviewers. On average, only 2% to 8% of articles yielded by a search strategy are ult...
Background: The burgeoning volume of scientific literature being generated today places a great burden on evidence reviewers. On average, only 2% to 8% of articles yielded by a search strategy are ultimately included in a systematic review. Due to the burden of increasing information loads, there is a demand for methods that improve efficiency while maintaining accuracy in performing evidence reviews. Objective: This systematic review aims to determine the accuracy and efficiency of AI-assisted abstract selection compared to manual abstract selection, as assessed by diagnostic performance and workload saved over sampling (WSS). Methods: Two reviewers searched PubMed, Proquest, and Cochrane Library for studies evaluating the diagnostic performance and/or workload savings achieved by any AI tool, whether through full or semi-automation, in the title and abstract screening phase of literature review. Variance-weighted random effects meta-analysis was done to generate univariate measures of sensitivity, specificity, and WSS for the studies using RevMan verson 4.3 and the ‘meta’ and ‘mada’ packages on R version 4.3.1. Bivariate analysis was also performed for the measures of diagnostic accuracy and a hierarchal summary operating characteristics curve (HSROC) was generated. Results: Twenty-two studies were included in this review, where 13 reported diagnostic performance, 14 reported WSS, and five studies reported both outcomes. In fully automated workflows, AI tools had a sensitivity of 85.6% (95% CI: 60.8%-95.8%) and a specificity of 88.7% (95% CI: 58.7%-97.7%) with considerable heterogeneity, which likely stems from the differences in the SRs and AI techniques used. In semi-automated workflows, sensitivity was 87.6% (95% CI: 77.2%-93.6%) and specificity was 94.1% (95% CI: 60.0%-99.4%) also with considerable heterogeneity. Among studies on full automation, the median workload savings for 100% recall was 50.0% (IQR: 10.2), while for studies on semi-automation, the median workload savings was 55.6% (IQR: 16.4). Conclusions: Given the findings of this review, the diagnostic performance of AI tools appeared to be superior when used in semi-automated workflows rather than fully automated ones. This suggest that AI tools hold great potential in augmenting the accuracy and efficiency of human reviewers during study selection in literature review.
Background: There has been a surge in the development of applications that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a l...
Background: There has been a surge in the development of applications that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) based on passive sensing of the current user context (e.g., from smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions, such as encouraging messages, in a context-aware manner. However, based on a limited range of passive sensing capabilities, getting the timing and context right for delivering well accepted and effective interventions is often challenging. Ecological Momentary Assessment (EMA) can provide personal context by directly capturing user assessments e.g. moods and emotion. Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. Yet, extensive EMA schedules need to be scrutinized as they can increase user burden. Objective: Use machine learning (ML) to balance feature set size of EMA questions with prediction accuracy regarding likelihood of enacting PA. Methods: A total of 43 healthy participants (ages 19-67) completed four EMA surveys daily for three weeks. These surveys prospectively assessed different states including both motivational and volitional variables of PA preparation (e.g. intrinsic motivation, self-efficacy, perceived barriers) alongside stress and mood/emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable Results: The best performing ML models predicted PA engagement with an AUC score of 0.87 ± 0.02 SD in 5-fold cross validation and 0.87 on test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction. Conclusions: A small set of EMA based features like self-efficacy, stress, planning and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context aware support messages.
Background: Stroke is a public health problem, and the care of post-stroke people is a concern for families and their care. In this sense, psychoeducational intervention plays an important role in pro...
Background: Stroke is a public health problem, and the care of post-stroke people is a concern for families and their care. In this sense, psychoeducational intervention plays an important role in promoting health by empowering and guiding people with strokes and their carers. Objective: to evaluate the effectiveness of psychoeducational interventions in people after stroke and to synthesise the best evidence on the subject. Methods: systematic review with meta-analysis. The studies will be evaluated considering the descriptors and keywords (People after stroke, effectiveness studies, psychoeducational intervention, and improvement of quality of life) based on the following starting question: What is the effectiveness of psychoeducational interventions for the promotion of self-care of the person after stroke? The search strategy will use controlled terms MesH (Medical Subject Headings) and uncontrolled (Natural Language) and the selection of studies will be made talking into account the inclusion and exclusion criteria using the Cochrane methodology and the time limit the years 2017 to 2023 in the following databases: Medline, PubMed, Scopus, CINAHL Complete. Results: Some psychoeducational interventions in post-stroke people in the intervention group have been shown to be effective and significant compared to the control group. Many studies support the inclusion of training programmes. The expected results are the identification and evaluation of psychoeducational interventions with effectiveness in training the person after stroke. Conclusions: It is expected that studies of effectiveness with psychoeducational interventions, show results that can contribute to improve functional, motor, and cognitive performance as well as quality of life in people after stroke. Clinical Trial: CDR42023483087
Background: Chronic heart failure (HF) is a complex condition associated with high morbidity and mortality and increased healthcare utilisation. Key to improving outcomes is patient education - a crit...
Background: Chronic heart failure (HF) is a complex condition associated with high morbidity and mortality and increased healthcare utilisation. Key to improving outcomes is patient education - a critical step to promote self-management and optimise medical management. Newer digital tools, such as text-messaging and smart-phone applications provide novel approaches to educate patients. This study partnered with end-users (clinicians and consumers) to co-design a series of electronic health care tips (‘eTips’) to promote optimal HF self-management.
Methods and Results:
We conducted a series of three focus groups with cardiovascular clinicians, people living with HF and their caregivers which consisted of two stages: (i) an exploratory study to identify priority areas and unmet education needs of people living with HF (previously reported) and (ii) a co-design feedback session. This paper reports findings from the co-design feedback study.
We identified five key considerations in the delivery of eTips and six relevant HF education modules for their content. Key considerations in eTip delivery included: (i) Timing of the eTips; (ii) Clear and concise eTips; (iii) Embedding a feedback mechanism; (iv) Distinguishing actionable and non-actionable eTips; and (v) Frequency of eTip delivery. Relevant education modules included: (i) Smoking cessation; (ii) Medication adherence; (iii) Self-management; (iv) Food and nutrition; (v) Sleep hygiene; and (vi) Mental health.
Discussion and Conclusion:
Co-design study findings have informed the development of a bank of eTips, which will be evaluated for efficacy through the BANDAIDS clinical trial (ACTRN12623000644662).
Background: The prevalence of Type 2 Diabetes (T2D) is increasing at alarming rates in Low- and Middle-Income Countries (LMICs), including Kenya. Objective: The objective of this study is to optimize...
Background: The prevalence of Type 2 Diabetes (T2D) is increasing at alarming rates in Low- and Middle-Income Countries (LMICs), including Kenya. Objective: The objective of this study is to optimize glycaemic control in adults with T2D in Kenya using mHealth by improving food literacy Methods: We conducted an exploratory trial in adults with T2D in two rural hospitals in Kenya. Participants were randomly selected from two hospitals. Each hospital was assigned to the mHealth intervention or control group. Participants in the intervention group received mobile text messages through a bulk SMS API (Short Message Service Application Programming Interface). Participants in the control group received monthly appointment reminders (= attention control). Participants in both groups continued receiving routine standard of care. Baseline and endline data were collected through face-to-face sessions. The primary endpoint was glycated haemoglobin (HbA1c). Secondary outcomes were food literacy and Fasting blood glucose. Intention-to-treat analyses were performed using linear mixed models. Results: A total of 84 participants were recruited; 42 were assigned to the intervention group and 42 to the control group. A total of 57 (67.8%) participants (intervention: 29, control: 28) completed the study. After 12 weeks, univariate analysis showed that HbA1c remained stable in both groups. The difference with baseline measurement in the intervention group was 0.43% [from 10.02% (SD ±3.01) to 10.45% (SD ±3.22), P=.250] compared to 0.80% [from [10.62 (±3.35) to 11.42 (±3.25), P=.414]] in the control group. After multiple linear modelling, with age and education as random factors, the overall intervention effect for HbA1c was 0.19% (95% CI -0.82; 2.21) P=.846. For food literacy, the intervention group had a higher non-significant mean score after 12 weeks [53.5% (SD ±9.2) to 60.7% (±8.3), P=.012] compared to the control group [58.7% (±9.3) to 59.9% (±11.2), P=.767]. Fasting blood glucose did not significantly change. Conclusions: Although this study did not provide evidence on the effect of glycaemic control through food literacy for adults with Type 2 Diabetes, a focus on food literacy to improve dietary quality is still needed given its significant potential on dietary behaviour. Future research should pay attention to active patient involvement in the design and development of mHealth interventions, tracking behaviour and patient-centred outcomes, involving healthcare workers, and having a bi-directional approach. Clinical Trial: www.ClinicalTrials.gov (NCT05013294)
Background: Feverish illnesses are common among children, presenting a management challenge for caregivers. Despite evidence supporting beneficial immunological effects, the practical implementation...
Background: Feverish illnesses are common among children, presenting a management challenge for caregivers. Despite evidence supporting beneficial immunological effects, the practical implementation of this knowledge is lacking and a prevailing negative attitude towards fever persists. The overuse of antipyretics and antibiotics in general pediatric practice, along with the associated risk of antimicrobial resistance, underscores critical considerations in healthcare. Objective: The goal of this study was to evaluate the mHealth intervention FeverFriend, a personalized decision aid mobile phone application connected with a knowledge base. The aim was to enhance health literacy to improve health literacy among caregivers of children with feverish illnesses and to teach fever management adherent to the NICE (2021) guideline. It was hypothesized, that the users following the app usage would administer less antipyretics, antibiotics, and seek less frequent consultations with doctors compared to their practices before using the app. Methods: This study had a single-arm, prospective, pre-post evaluation design. Eligible participants were caregivers of healthy children under 18 residing in Hungary. Entering the study, participants provided demographic, anthropometric information and responded to premeasurements related to the use of 1) antibiotics, 2) antipyretics, and the 3) healthcare system (visiting a doctor) due to feverish illnesses.
The prospective intervention involved the use of the FeverFriend mHealth application, followed by post-measurements on the same three dimensions, among other feverish symptoms. We assessed sample coverage by examining basic caregiver-reported sociodemographic and anthropometric measures using chi-square test for independence. We captured within-patient change applying paired binary McNemar's tests for the three user-reported baseline and post-intervention outcome measures during the 35-month period analyzed. Results: Caregivers enrolled a total of 22.219 healthy children with average age 3 years 1 month (SD 3.28) demonstrating good coverage of the population on gender (female 48.22% (10.714/22.219; χ21=2.517, P=.64) and number of siblings (1.67, SD 0.88; χ24=11.45, P=.56). A total of 12.948 feverish illnesses were reported, of which 4.927 (38.05%, 4.927/12.948) were reviewed in detail providing post-measurements. The outcomes of the first illness reviews per each patient (n=1.934) were utilized to ensure consistent intervention exposure for all patients.
Our results support the hypotheses: after completing the mHealth intervention, caregivers administered significantly less antipyretics (McNemar χ21=13.79), antibiotics (McNemar χ21=8.17) and consult less often (McNemar χ21=128.84) with doctors (all P values <.005). Conclusions: This study provides preliminary evidence that the FeverFriend mHealth intervention has the potential to reduce administration of antipyretics, antibiotics among children with feverish illnesses and users exhibited a decreased frequency of doctor visits compared to their practices before using the app. Future research should incorporate randomized trials to confirm causality and the multivariate analysis of the secondary outcome measures of the app on symptoms and parental confidence. Clinical Trial: ClinicalTrials.gov NCT04633603; https://clinicaltrials.gov/study/NCT04633603
Background: Technology-based solutions to support the mental health needs of workers are on the rise, as evidenced by the growing body of research related to e-mental health applications (apps) implem...
Background: Technology-based solutions to support the mental health needs of workers are on the rise, as evidenced by the growing body of research related to e-mental health applications (apps) implemented with workers or within the context of workplaces. This expanding landscape of evidence related to mental health apps underscores the necessity to summarize and consolidate the different ways in which studies are evaluating real-world technology-based interventions in a complex setting such as a workplace. Objective: The aim of this scoping review is to summarize the body of evidence regarding evaluation of mental health apps with workers or at workplaces. Specifically, this review will outline the current trends and gaps across the outcomes commonly assessed in studies evaluating digital mobile mental health interventions with workers. Methods: The scoping review followed the five stages outlined in Arksey and O’Mally’s framework combined with Levac's recommendations. The search strategy was applied across seven databases to identify relevant studies from inception to August 2023. Results: From the 288 abstracts screened, 54 studies met the inclusion criteria for this review. The studies assessed apps in three ways: 1. Examining user engagement and utilization of the app 2. Investigating the effects of the app on users, and 3. Evaluating the implementation process. Most studies primarily evaluated the impact on individual mental health related outcomes as well as on workplace-related outcomes. A limited number of studies evaluated the implementation process and its relation to the overall effectiveness of the application for workers. Conclusions: This scoping review provides a comprehensive overview of the ways in which studies are currently evaluating workplace mental health apps. The review highlights notable trends and gaps in the existing studies where majority of the studies focused on assessing the effects of mental health apps on individual users with a gap in assessing the ways in which the implementation of a dynamic intervention such as a mobile app in a complex workplace setting could interact and influence the overall effectiveness of the app. Future research needs to delve deeper in understanding the implementation process and consider evaluation methods that are in congruence with the goals of the intervention.
A 6-month preliminary retrospective analysis of Australia's largest digital weight-loss service found that the company's clinicians commit prescribing errors in 2.2% of GLP-1 RA orders to weight-loss...
A 6-month preliminary retrospective analysis of Australia's largest digital weight-loss service found that the company's clinicians commit prescribing errors in 2.2% of GLP-1 RA orders to weight-loss patients.
Background: Real time access to guidance for physicians has been offered through Rapid Access to Consultative Expertise (RACE) in British Columbia (BC) for the past 12 years. In the context of the no...
Background: Real time access to guidance for physicians has been offered through Rapid Access to Consultative Expertise (RACE) in British Columbia (BC) for the past 12 years. In the context of the novel coronavirus (COVID-19), the service for RACE was expanded to include a Long-COVID RACE line. This is answered by a dedicated group of General Internal Medicine (GIM) Specialists with an interest and experience with acute and chronic COVID. The guidance provided by the Internal Medicine physicians includes diagnostic investigations, management, and navigation of these complex patients. Objective: We report here the types and frequencies of questions asked to GIM experts in Long-COVID, by general practitioners in BC. This analysis enables the identification of trends in patient presentations, primary care practitioner concerns, and related questions. This data informs on the development of education, tools, and care plans which improves the quality of care and long-term support for COVID-19 patients and their health care providers. Methods: 149 RACE line call medical notes, from its launch in August 2020 to June 2021, were reviewed to extract data regarding the variables of interest: patient demographics (age, sex, region) and types of queries related to COVID-19 (acute symptoms, subacute symptoms, chronic symptoms, vaccination inquiries, miscellaneous questions). This data was tabulated for analysis. Results: The data indicates the most common age group of RACE line patients as being between the ages 40-49 years old. Females made up 63.6% of patients, while males made up 36.4%. The most frequent geographic locations for the RACE line patient’s healthcare providers were in the Greater Vancouver and Fraser Valley region. The data demonstrates that subacute (2-12 weeks following diagnosis) symptoms (52) and vaccination queries (29) were the most common RACE line call matters. A larger frequency of RACE line calls to the COVID-GIM-Post-Infection division occurred between the January 2021 - March 2021 (60) and April 2021 – June 2021 (62) time periods, in comparison to the earlier August 2020 – December 2020 period (27) studied. Questions about specific symptoms varied by time post-infection, but the most frequent symptoms across time periods included shortness of breath, cough, and fatigue. Conclusions: This study investigated the COVID-GIM-Post-Infection Care RACE line calls between August 2020 and June 2021, revealing many trends in data. These calls mainly involved consults regarding the post-infection COVID-19 symptoms being experienced by PCPs’ patients. Respiratory symptoms were the leading type of symptoms reported, with shortness of breath, cough, fatigue, and fevers being the most common, respectively. This data will be used to inform future resource utilization and provide insights on the usage of the Long-COVID RACE line. Moving forward, RACE calls can be monitored in situations of emerging diseases to better inform and educate community physicians to common complaints that patients are presenting with.
Background: A core competency of integrative health (IH) education is applying evidence to clinical practice. Low rates of online health literacy put consumers at higher risk of misinformation. Practi...
Background: A core competency of integrative health (IH) education is applying evidence to clinical practice. Low rates of online health literacy put consumers at higher risk of misinformation. Practitioners may serve to reduce this risk. Integrative Health (IH) crosses multiple healthcare disciplines and is therefore well-suited to improve the health information ecosystem. IH practitioners must demonstrate evidence-based medicine (EBM) skills and electronic health information literacy (eHL) to make a positive impact. The Fresno Test of Evidence-Based Medicine (FEBM) is a validated, performance-based assessment used in medical education. However, the scenarios included in this assessment do not reflect IH practices. Objective: This study used a multi-phase pilot observational design to assess feasibility of incorporating eHL and EBM assessments into graduate coursework while adapting and validating the FEBM for an IH audience (FEBM-IH). Methods: Re-validation of the FEBM-IH began with a discipline-focused adaptation, which was reviewed by an expert panel. The FEBM-IH was then administered to IH students and faculty. Independently scored assessments determined inter-rater reliability, internal consistency, item discrimination, and item difficulty. Results: Outcome completion rates suggest the FEBM-IH and eHL assessment tools are feasible (>64% completion) to include in online courses, with 68.9% (102/148) eligible participants joining and 76.5% (78/102) completing all questions in all measures. The FEBM-IH demonstrated excellent assessor agreement (kappa = 0.97, p < 0.001), high internal consistency (α=0.799), and acceptable item discrimination (0.26-0.68). Conclusions: Self-perceived eHL scores showed a 3-point increase in median score by course’s end, suggesting improvements in eHL. Tools were feasible to integrate; FEBM-IH maintains acceptable validity; and further exploration of the relationship between EBM and eHL is warranted. Clinical Trial: NA- Not a Clinical Trial
Infrapubic penile implant surgery is a viable option for patients with severe penile curvature, shortening, and impaired penile rigidity due to fibrosis of the corpora cavernosa (Sadeghi-Nejad, 2007)....
Infrapubic penile implant surgery is a viable option for patients with severe penile curvature, shortening, and impaired penile rigidity due to fibrosis of the corpora cavernosa (Sadeghi-Nejad, 2007). Studies have shown that patients who undergo penile implant surgery, particularly the infrapubic approach, experience significantly better erectile function and treatment satisfaction compared to those receiving other treatments such as sildenafil citrate and intracavernous prostaglandin E1 (Rajpurkar & Dhabuwala, 2003). The infrapubic approach offers advantages such as ease of reservoir placement, rapid implantation, and direct vision during the procedure, as well as avoiding an extra incision on the scrotum, which can hinder rehabilitation (Montague & Angermeier, 2000; Vollstedt et al., 2017). Additionally, it has been noted that the infrapubic approach can be quickly learned by urologists who are already comfortable with the trans‐scrotal approach (Kramer & Chason, 2010). However, it is important to consider the drawbacks associated with the infrapubic approach, such as the higher risk of surgical errors during the placement of the device in the corpora (Kramer et al., 2010).
Background: This paper investigates the predictive capabilities of the Body Mass Index (BMI) formula over thousands of individuals and explores the potential enhancements achievable through integratin...
Background: This paper investigates the predictive capabilities of the Body Mass Index (BMI) formula over thousands of individuals and explores the potential enhancements achievable through integrating additional parameters using machine learning (ML) models. After exploring a wide variety of modern ML models (K-Nearest Neighbors, Neural Networks, Decision Trees, Support Vector Classification, Logistic Regression, and Ridge Classifiers. Ensemble models: voting Classifier, Random Forest, and Gradient Boosting), most models demonstrated a high precision capability, and, interestingly, some models were able to either equalize or even perform better than the reference model. Our results suggest that incorporating into the conventional BMI formula variables, such as age or gender, may lead to more accurate and personalized BMI measurements, helping health practitioners to provide more realistic weight management and health assessments, as well as early diagnoses, treatments, and enhanced healthcare. Objective: The Body Mass Index (BMI), a widely used metric for assessing an individual's body weight relative to their height, serves as a valuable tool in health assessments [1]. However, recent studies have questioned its accuracy, prompting an exploration into alternative approaches. For example, due to the variety of body types, muscle distribution, bone mass, etc, BMI is not appropriate as the only indication for diagnosis, which could lead to misclassification [2]. However, weight control is a key factor in the prevention of non-communicable diseases. Recent studies have shown the utility of Machine Learning (ML) in clinical settings. For example, a recent ML approach predicted weight changes over the years, which could be helpful for weight management approaches [3]. Thus, it will be interesting to evaluate the efficacy of the traditional BMI formula and investigate the potential improvements offered by modern ML classification models by incorporating additional parameters other than the traditional height and weight. For example, as a person ages, body fat mass naturally increases, and muscle mass declines. Numerous studies have shown that a higher BMI of 23.0–29.9 in older adults can be protective against early death and disease [4]. Other studies have indicated that the risk for heart disease and diabetes increases in women with a waist measurement greater than 35 inches (88.9 cm) and more than 40 inches (101.6 cm) in the case of men [5]. Furthermore, the BMI may not accurately reflect the health of certain racial and ethnic populations. For example, numerous studies have shown that people of Asian-Pacific descent have an increased risk of chronic disease at lower BMI cut-off points, which leads to specific BMI guidelines with alternative BMI cut-off points for this population [6].
This paper aims to investigate the potential of using modern ML classification models, by evaluating age, gender, and/or ethnicity as potential additional parameters to be considered in traditional BMI calculations. We employed a highly reliable and publicly available comprehensive and transparent dataset from the National Health and Nutrition Examination Survey (NHANES) [7]. NHANES is a program of studies designed to assess the health and nutritional status of adults and children in the United States, a subprogram of the Centers for Disease Control and Prevention (CDC) [7]. Survey data is intended to be used in epidemiological studies and health sciences research, which help develop sound public health policy, direct and design health programs and services, and expand the health knowledge for the Nation. These data were fundamental to conducting our comprehensive analysis aiming to provide potential new alternative measurements to the traditional BMI calculations. Methods: We downloaded data from 5663 individuals data obtained from surveys combining interviews and physical examinations from NHANES (years 1999 to 2022). Since 1999, the survey has examined about 5,000 people in 15 different counties across the country each year. Each participant makes an important contribution to the study, representing approximately 65,000 others in the country like them. The dataset comprises weight, height, age, gender, ethnicity, and BMI variables. Data Privacy was a priority for the NHANES dataset. Participation was confidential and bound by law, following strict privacy standards to protect every NHANES participant. Federal law, good statistical practice, and ethical obligations to the American people required that any personal information collected by this survey be treated with the utmost concern for the privacy of those who provide it.
Initially, we utilized Python language (version 3.11.3) within the JupyterLab environment [8], a highly extensible feature-rich notebook, part of the Jupyter project, to compute the standard BMI formula and compare different ML predictions against real BMI classification values (Underweight, BMI below 18.5; Normal, BMI 18.5 – 24.9; Overweight, BMI 25.0 – 29.9, and Obese BMI 30.0 and above). Subsequently, ML classification models were employed to discern whether incorporating additional parameters such as age, gender, and ethnicity could enhance predictive accuracy. ML models: K-Nearest Neighbors [9], Neural Networks [10], Decision Trees [11], Support Vector Classification [12], Logistic Regression [13], and Ridge Classifiers [14]. ML ensemble models: voting Classifier [15], Random Forest [16], and Gradient Boosting [17].
For statistical analyses, we computed two kinds of measurements: 1) MAE (Mean Absolute Error), the average absolute difference between the predicted and actual values); MSE (Mean Squared Error), the average of the squared differences between predicted and actual values; RMSE (Root Mean Squared Error), the square root of the MSE; and R-squared, the proportion of the variance in the dependent variable that is predictable from the independent variable(s). Lower MAE and MSE values indicate better predictive performance. RMSE is the square root of MSE, providing a measure of the spread of errors (Lower RMSE values are desirable). R-squared (R2 = 1 – (RSS/TSS), where RSS represents the sum of squares of residuals, and TSS represents the total sum of squares) measures the proportion of the variance in the dependent variable (Real BMI class) that is predictable from the independent variable (model predictions). R-squared values close to 1 indicate a good fit, but negative values suggest that the model is not suitable for prediction, i.e. the model's predicted values perform worse than using the average as a predicted value. 2) Accuracy, specifically calculated for each model as a measure of how well the model predicts the correct BMI class labels; Precision, the proportion of true-positive predictions among all positive predictions; Recall, the proportion of true-positive predictions among all actual positive instances; and F1-score, the harmonic mean of precision and recall.
Selection procedure: Step 1: we pre-selected those ML models that showed equal or lowest MAE, MSE, and RMSE values, compared to the reference models (considering height and weight parameters only). Step 2: we pre-selected those models showing equal or highest R-squared, Accuracy, Precision, Recall, and F1-score values, compared to the reference models. Finally, we selected as best models those with the best statistics in both steps 1 and 2. Results: Our findings indicate that the traditional BMI formula, based solely on weight and height, exhibits reasonable predictive power. However, some ML models trained on datasets enriched with age or gender information were able to outperform the model trained with the standard BMI parameters, height, and weight. Specifically, all models demonstrated a high precision, while models such as Decision Tree, Support Vector, and Ridge Classifiers, and ensembles such as Random Forest, Gradient Boosting, and Voting Classifier, can either equalize or even outperform the reference model (only trained with height and weight parameters) (Fig. 1, Tables 1 and 2). The results show that, in comparison to the traditional BMI parameters, training the datasets with additional age or gender parameters (HWA or HWG) can improve ML model prediction capabilities.
Figure 1. Accuracy, precision, recall, and F1-score of ML models.
Accuracy vs ML model's graphic. Abbreviations: HW: height and weight; HWG: height, weight, and gender; HWA: height, weight, and age; HWE: height, weight, and ethnicity; and HWAGE: height, weight, age, gender, and ethnicity.
Table 1. Accuracy, precision, recall, and F1-score of ML models table.
Detailed statistical table for Fig. 1. Abbreviations: HW: height and weight; HWG: height, weight, and gender; HWA: height, weight, and age; HWE: height, weight, and ethnicity; and HWAGE: height, weight, age, gender, and ethnicity. Acc.:Accuracy; Pr.: precision; and F1: F1-score. Bold characters indicate the highest column values about the Accuracy, Precision, Recall, and F1-score. Red characters indicate zero values. Red background models indicate ML models outperforming the reference-trained HW model. Light gray cells stand for the predicted values of the reference dataset (HW); Sky blue cells indicate the same values as the reference dataset; and red cells indicate improved prediction values compared to the reference. Blue borders stand for best predictors (additional BMI parameters, other than height and weight, and ML models), combining information from Tables 1 and 2 (see methods).
Table 2. MAE, MSE, RMSE, and R-squared.
Abbreviations: Same as Figure 1, and MAE, Mean Absolute Error; MSE, Mean Squared Error; RMSE, Root Mean Squared Error; Rs, R-squared. Bold characters indicate the lowest column values about MAE, MSE, and RMSE calculations, and the highest column values about the R-square. Red characters indicate negative values (see methods). Red background models indicate ML models outperforming the reference-trained HW model. Light gray cells stand for the predicted values of the reference dataset (HW); Sky blue cells indicate the same values as the reference dataset; and red cells indicate improved prediction values compared to the reference. Blue borders stand for best predictors (additional BMI parameters, other than height and weight, and ML models), combining information from Tables 1 and 2 (see methods).
Specifically, using HWA (height, weight, and age) and HWG (height, weight, and gender) data with Decision Tree, Support Vector, and Ridge Classifiers as well as Random Forest, Gradient Boosting, and Voting Classifier's ensemble models can either equalize or perform even better than the same models using only height and weight parameters (Fig.1, Tables 1 and 2). However, R-squared values are negative in the case of the Ridge Classifier applied to the HWA dataset, suggesting that the model might not be suitable for prediction (see methods). In summary, these results suggest that the predictive capability of the traditional BMI formula could significantly be enhanced by incorporating age or gender parameters. Conclusions: Discussion
BMI is a standard health assessment tool in most healthcare facilities. Although, for decades, the BMI has been widely used as a standard measurement for health based on body size, it has been criticized for its oversimplification of the real meaning of being healthy. Many researchers have claimed that BMI is outdated and inaccurate, and, perhaps, it should not be used in medical and fitness settings. For example, in epidemiological studies, the BMI based on self-reported height and weight (self-reported BMI) is subjected to measurement error [18]. Other studies have suggested adjusting the Normal BMI values to avoid false positive/ negative assignments [19]. It is expected that medical professionals would take the BMI result and consider patients as unique individuals. However, some health professionals use only BMI to measure a person's health status before providing medical recommendations. This can lead to weight bias and poor quality healthcare [20, 21]. Moreover, serious medical issues might go unnoticed or incorrectly seen as weight-related problems [20]. Other studies have shown that the higher a person's BMI is, the less likely the person will attend regular health checkups due to fear of being judged, distrust of the healthcare professional, or a previous negative experience. This can lead to late diagnoses, treatment, and care [22]. However, because of the ease and efficiency of gathering height and weight information, it remains important to assess the extent of error present in self-reported BMI measures and to explore possible adjustment factors.
It is important to consider the potential limitations of this study. For example, regarding ethnicity data, some populations such as Asian-Pacific might be not included or be underrepresented in the NHANES dataset, which is reported to be formed by Mexican American, non-Hispanic White, non-Hispanic Black, Other Hispanic, and Multi-Racial ethnicities. This could explain why using ethnicity as an additional parameter for BMI class prediction did not show any significant improvement compared to the use of age or gender. Furthermore, R-squared values are negative in the case of the Ridge Classifier applied to the HWA dataset (see results), suggesting some potential limitations of the model or the nature of the age data may be due to underrepresentation of some age categories. Moreover, there is a possibility of other potential biases been introduced during the process of survey-data compilation.
Conclusions
Our results suggest that while the conventional BMI formula is widely used as a reliable metric, its predictive capabilities could significantly be enhanced by incorporating additional parameters such as age or gender. ML models, such as Decision Trees, Support Vector, and Ridge Classifiers, and ensembles, such as Random Forest, Gradient Boosting, and Voting Classifier, emerged as promising alternatives, showcasing the potential for a more nuanced and accurate approach to BMI measurement. These findings open avenues for further research into refining BMI calculations, to better reflect individual characteristics and health refinements. In summary, this study provides valuable insights into the predictive capabilities of ML models for classifying BMI values. Our results underscore the potential for improved BMI measurements by adapting traditional formulas with additional parameters, such as age or gender. Future research in this domain could contribute to developing more personalized and accurate health assessment tools. The BMI only considers weight and height as a measure of health status, rather than the person. Our results suggest that considering height, weight, age or gender, and potentially other factors that may affect an individual weight and health status, such as a more comprehensive ethnicity and age dataset, could complement traditional BMI calculations and provide more consistent health statements. For example, health practitioners could train and test their historical patient data with the above ML models and additional BMI parameters (age or gender, or both independently), and, either serve as a validation of the results, if there is no difference with the traditional BMI results, or, in case of discrepancy, study in more detail the potential causes behind the differences between the traditional BMI formula versus ML prediction. Furthermore, additional data, such as body composition [23], medical history [24], and demographic and socioeconomic information [25], could help health practitioners, researchers, and scientists to provide more realistic weight management and health assessments, as well as early diagnoses, treatments, better healthcare, as well as new opportunities for R&D and scientific discovery. We will take into account all the points described above in future analysis.
Background: The research reports the development of a behavioral satisfaction questionnaire (BSQ) for the use in cognitive-behavioral therapies (CBTs). Objective: It is purposed for semi-structured ps...
Background: The research reports the development of a behavioral satisfaction questionnaire (BSQ) for the use in cognitive-behavioral therapies (CBTs). Objective: It is purposed for semi-structured psychoanalytic interviews, but can also be used for self-report. The design of BSQ seeks to organize a referential scale with a psychodynamic perspective, in order to bridge the gaps among neurological / psychiatric therapies, psychological therapy, and patient / visitor autonomy. Methods: The psychometric evaluations are dissected into different dimensions in the questionnaire design, with a paradigmatic conceptual framework. Results: The test trial has demonstrated high affinity with other major psychometric methods. Conclusions: The BSQ design is valid in overall assessments on complicated psychological case. Clinical Trial: The test trial is registered on ClinicalTrials.gov with the identifier NCT05930912.
Background: Interoperability and electronic health records (EHR) standards in medicine Objective: What is the latest evidence related to EHR data interoperability, and standards in medicine? Methods:...
Background: Interoperability and electronic health records (EHR) standards in medicine Objective: What is the latest evidence related to EHR data interoperability, and standards in medicine? Methods: N/A Results: The need for interoperability is evident in every part of a typical health care organization, as many clinicians in a hospital setting need to communicate with their counterparts in the community and as such the EHRs should be able to share data automatically and seamlessly across institutions and display it in useful ways. Conclusions: Currently, a usable and reliable patient data at the point of care regardless of socioeconomic background is critical to the management of patients in medicine, especially the chronically ill.
Background: Due to the varying symptomology of Alzheimer’s disease (AD), primary care providers (PCPs) find it challenging to disentangle normal cognitive age-related dysfunction versus those indivi...
Background: Due to the varying symptomology of Alzheimer’s disease (AD), primary care providers (PCPs) find it challenging to disentangle normal cognitive age-related dysfunction versus those individuals on the clinical pathway of AD. Mobile health (mHealth) technology shows great potential in for improving health outcomes because of its mobility, instantaneous access for both the patient and PCP, and ease of use. Objective: This critical review aims to summarize findings from other reviews published recently on mHealth platforms used in remote cognitive screening or therapy for AD. Methods: Rapid scoping review techniques were still used to synthesize and create a broad understanding of mHealth platforms and it usage in AD screening or therapy. The PubMed data base was searched on November 8, 2023, for relevant reviews using the strategy mobile and cognitive impairment: “((mhealth) OR (mobile health)) AND (subjective cognitive decline OR mild cognitive impairment OR Alzheimer disease)”. Limits were placed in terms of article type (systematic review or review), and language (English). Results: The initial search identified 23 unique citations. The titles and abstracts were assessed based on the inclusion criteria, and of the 23 unique citations, 7 (30%) were excluded after title and abstract screening. Of those remaining, 5 (2%) were excluded as they were not relevant to the topic, 2 (9%) did not include mHealth components, 1 (4%) did not include AD-related outcome and 1 (4%) was a narrative review. Hence, of the 16 (70%) reviews included for full-text screening, 7 (30%) were included in the research synthesis. Conclusions: mHealth platforms have the potential to increase cognitive screening uptake and allow PCPs to remotely monitor their patients, provide support to caregivers and collect relevant health data. Yet, some important considerations are cognitive test features (i.e., characteristics, duration or frequency, psychometric properties), characteristics of patient (experience, knowledge and support with technology), usability of platform, and delivery method. Future interventions should consider incorporating social media platforms like WhatsApp or Facebook, to offer more customized, educational services to patients and their caregivers. Clinical Trial: N/A
The study systematically reviewed the literature to investigate the risk factors for wound-related complications after primary versus metastatic tumour surgery.
Screening of English-language publi...
The study systematically reviewed the literature to investigate the risk factors for wound-related complications after primary versus metastatic tumour surgery.
Screening of English-language publications between 2013-2023 on primary and metastatic spinal tumours surgery was conducted. The pooled analysis was done, which compared the risk factors identified in the studies for both metastatic and primary spine, which were defined as patient-related factors and surgery-related factors.
The search strategy identified 506, but only 20 studies were included after screening through inclusion and exclusion criteria. Out of the 20 studies, 17 studies were retrospective studies, 2 were systematic reviews, and 1 was an RCT study. Wound complications were associated with factors such as BMI, female sex, preoperative chemotherapy, smoking history, preoperative radiation, nutrition status, type of surgery, surgery duration, blood loss, preexisting conditions (like diabetes, hypertension) and medication. Holding these risk factors constant, the wound complications were higher for the metastatic spine than primary spine tumours, indicating that patients with metastatic spine tumours had a higher risk of developing wound complications after surgery than those with primary spine tumours.
The risk factors associated with wound complications in metastatic tumours included BMI, blood loss, medication, age, higher blood loss, neurological deterioration after surgery, venous thromboembolism (VTE), smoking, preexisting patient conditions such as diabetes, nutrition status of patients, American Society of Anesthesiologists risk classification (ASA) greater than 2, ambulatory presence, nutrition status of patients and ambulatory presence, history of previous radiation, type of surgery, surgery duration and type of tumour. Risk factors for primary tumours included sacral procedures and the use of equipment when conducting surgery. Given these factors, wound complications were higher for metastatic spine than primary spine tumours.
Background: The COVID-19 pandemic has resulted in changes in all aspects of life. The high number of cases, morbidity, and mortality caused by COVID-19 infection has resulted in the importance of carr...
Background: The COVID-19 pandemic has resulted in changes in all aspects of life. The high number of cases, morbidity, and mortality caused by COVID-19 infection has resulted in the importance of carrying out infectious disease surveillance to suppress the expansion of cases and obtain effective control. Objective: This study aims to evaluate the adequacy of attribute-based COVID-19 surveillance systems with a literature study approach. Methods: Qualitative descriptive research analyzes nine surveillance system attributes on articles that meet the inclusion and exclusion criteria in accordance with "Updated Guidelines for Evaluating Public Health Surveillance Systems". PubMed MesH term, Science Direct, Scopus, Web of Science, Europe PMC, and Google Scholar are some of the databases used for literature retrieval with the list of keywords are ‘Evaluation’; ‘Surveillance’; ‘Attribute’; ‘Nine attributes’; 'COVID-19' AND 'Corona Virus Disease-19' AND ‘SARS CoV-2’; ‘Epidemiological surveillance’. Descriptive data analysis was performed and presented in tables and narratives. Results: The study obtained six articles evaluating the spread of the COVID-19 surveillance system across six countries, including Ghana, Nigeria, Victoria, Indonesia, Ethiopia, and Pakistan. In the implementation method, four (67%) used sentinel surveillance, and two (33%) used epidemiological studies. Based on its activity, 5 (83%) used active and passive surveillance, while 1 (17%) used only passive surveillance. An attribute-based COVID-19 surveillance system adequacy assessment showed that three (50%) met the attribute of > 50%, namely, the surveillance systems in Nigeria, Indonesia, and Pakistan. In comparison, three (50%) did not meet the attributes of < 50%, namely, the surveillance systems in Ghana, Victoria, and Ethiopia. Conclusions: The COVID-19 surveillance system in each country is different in how well it works based on geography, the number of key informants and experts, the way stakeholders work together, and the health system policies in each country. Clinical Trial: Not Applicable
Background: In a bid to enhance eLearning at Mulungushi University School of Medicine and Health Sciences in Kabwe - Zambia, the Strengthening Health Professional Workforce Education Programs for Impr...
Background: In a bid to enhance eLearning at Mulungushi University School of Medicine and Health Sciences in Kabwe - Zambia, the Strengthening Health Professional Workforce Education Programs for Improved Quality Health Care in Zambia (SHEPIZ) project in 2020, conducted an evaluation of Mulungushi University's level of preparedness for eLearning as an initial step towards building the university’s capacity. Objective: This article provides a systematic description of the evaluation process, lessons learned, and implications for the future in enhancing eLearning programs at Mulungushi University School of Medicine and Health Sciences. Methods: The evaluation process took a two-phased approach. The first phase involved a desk review of literature on eLearning evaluation that informed the development of a framework to be used in the evaluation process. In the second phase, actual data was gathered through key informant interviews and a thorough physical assessment of ICT infrastructure. Results: Consequent to the desk review, a modified five (5) criteria evaluation framework was developed that considered key factors around organizational arrangements, Managerial approach, Technical and interface integration, Educational requirements, and Logistic support. An evaluation of the five critical factors demonstrated that Mulungushi University School of Medicine and Health Sciences had inadequate ICT infrastructure with low internet bandwidth and a lack of onsite technical support for the effective implementation of eLearning programs.
Lessons learned and recommendations: Some of the lessons learnt were that: The use of an evaluation framework to assess an institution's readiness for the adoption of eLearning was essential and that implementing eLearning programs might be difficult in the absence of on-site ICT technical staff and critical ICT infrastructure. Some of the recommendations made were that: Mulungushi University needed to conduct a self-assessment using the critical factors framework; have technical staff on site for system maintenance; give lecturers and students the necessary training and assistance to enable them to use eLearning resources effectively. Conclusions: Evaluation of Mulungushi University revealed that most of the critical factors for eLearning had not been fully addressed and the modified critical components framework could be a useful tool for institutional self-evaluation as an antecedent to effective delivery of the eLearning programs.
Background: In Community Medicine, students are made aware of real life situations and practical aspects through field visits. Visits are conducted without topic briefing assuming students will get or...
Background: In Community Medicine, students are made aware of real life situations and practical aspects through field visits. Visits are conducted without topic briefing assuming students will get orientation of the topic on site. Although utility of field visits is known, its cumulative effect with prior briefing is unexplored. Objective: To evaluate effectiveness of topic briefing followed by field visit in improvement of academic performance in the freshly inducted 1st batch of Indian medical graduates. Methods: In 48 freshly inducted MBBS students at our medical college. Two interventions were administered in sequence, Topic briefing session of 30 minutes followed by field visit to Anganwadi center lasting for an hour on the same day. We evaluated the academic performance through MCQ based Pre-test & Post-test and mean scores were compared. Results: Significant improvement was seen in mean total score out of 20 (theory-10 + practical-10) (from 9.14±2.46 at baseline to 14.46±2.01 post briefing to 16.21±1.57 after field visit) (RAMNOVA F-195.6, p<0.0001). Post-hoc Bonferronie’s test revealed significant improvement after both interventions. Mean theory score was significantly improved (from 4.14±1.70 at baseline to 7.81±1.36 post briefing to 8.31±0.77 post field visit) (RAMNOVA F-172.8, p<0.0001) However, post hoc analysis revealed significant improvement post briefing only & not post visit. Mean practical score was also significantly improved (from 5.00±1.81 at baseline to 6.64±1.49 post briefing to 7.91±1.18 after field visit) (RAMNOVA F-64.31, p<0.0001) & Post-hoc analysis also seconded this finding. Conclusions: The pre briefed field visit helped to significantly improve academic performance in both theoretical & practical aspects. Sequential application of topic briefing and field visit led to reinforcement of knowledge and improvement in precision. Clinical Trial: NIl
Background: The on-going interventional trial was conceived from the phenomena of COVID-19 post-vaccination adverse events. The accumulated evidence has proven the null hypothesis with significant res...
Background: The on-going interventional trial was conceived from the phenomena of COVID-19 post-vaccination adverse events. The accumulated evidence has proven the null hypothesis with significant results that falsify the predominant belief in the vaccination method. The alternative hypothesis is adjusted with proton equilibrium and sebaceous immunobiology’s correlations with immune reflex. Objective: The research purposes to locate the infection path. Methods: The sole-participant interventional trial compared the main medicines in myocarditis treatment from Nifedipine to angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor-neprilysin inhibitor (ANRI) with increasing power level. T values and Z statistics are calculated for statistical analysis, and the introduction of proton-pump inhibitor is uncertain with the case’s neurodivergent conditions. Results: Inter-ACEI comparison suggests the introduction of beta blockers regulated the immune reflex through heart rate with the blood-borne pathogen. ANRI superiority suggests S2 pathogens can be more severe without S1 constraints, and raises alerts on SARS-CoV-2 mutational directions from Omicron. Historic data from the participant after the second COVID-19 vaccine shot recorded the viral entry through low-density lipoprotein cholesterol (LDL-C). Conclusions: The study protocol with data refers to SARS-CoV-2’s S2 infection concentration and viral characteristics in LDL-C in human host. It is highly probable that S2 pathogen starts with LDL-C in vaccine poisoning. It is possible that HDL-C levels are responsible for the cytokine storms in neurologically infected cases. The placebo effect is maximized by the vaccine mandates, and the mass psychological biases need time to be narrowed down. Clinical Trial: The study protocol is retrospectively registered on ClinicalTrials.gov with the identifier number NCT05711810.
Background: Here we analyze a vast cohort comprising over 25 million COVID-19 patients collected by the Mexican Government between 2020 and 2023. The dataset contains valuable information on attribute...
Background: Here we analyze a vast cohort comprising over 25 million COVID-19 patients collected by the Mexican Government between 2020 and 2023. The dataset contains valuable information on attributes and comorbidities, enabling us to investigate clinically relevant associations. Objective: Our objective is to unravel the intricate network of relationships between variables within the entire cohort and specific patient subsets, with a particular focus on associations involving fatalities. Methods: We employ the Odds Ratio (OR), estimated from Fisher’s test on 2×2 contingency tables, as a measure of association between variable pairs. We compute a total of 3,899 such measures by examining all possible variable pairs within 25 patient groups. The results are ordered and presented as networks, where variables are depicted as nodes (vertices) and associations at a specific OR threshold are represented as links (edges). The recoded data, along with the results and data mining functions, are publicly accessible. Results: Our findings demonstrate that hospitalization, gender, and age significantly influence disease outcomes, as do comorbidities such as pneumonia, chronic renal problems, diabetes, and hypertension. Interestingly, we observe that the associations of comorbidities are diminished in pregnant women, suggesting a pro- tective effect of pregnancy against the detrimental impact of these comorbidities on COVID-19 patients. Conclusions: Our analysis of variables in Mexican COVID-19 patients reveals a complex network of associations. By visualizing these associations as networks, we provide a clear and accessible representation that enhances our understanding of the factors contributing to fatalities in this population.
Background: The lack of knowledge on stress self-regulation can significantly impact health and
overall well-being. Traditional stress management methods, such as mindfulness
meditation and progress...
Background: The lack of knowledge on stress self-regulation can significantly impact health and
overall well-being. Traditional stress management methods, such as mindfulness
meditation and progressive muscle relaxation, have limitations, including a lack of
interactivity. However, studies have shown that gamification can effectively address
these limitations by integrating stress management techniques into video games. Objective: This study aims to enhance stress self-regulation among younger adults by
evaluating the effectiveness of diaphragmatic breathing exercises embedded in
video games. Specifically, the focus is on Breeze 2, a mobile-based biofeedback game
emphasising a short diaphragmatic breathing exercise. Methods: The evaluation of Breeze 2 involved quantitative data analysis obtained from
questionnaires and physiological data measurements. Twenty student participants
took part in the experiment. Data collection included the administration of a
perceived stress scale questionnaire, a perceived effectiveness questionnaire, and
tracking heart rate variability and breathing rate. Results: The findings suggest that a short breathing session using Breeze 2 effectively
reduces stress, as the perceived effectiveness questionnaire indicates. However, the
reliability of the physiological data measurements is lower than anticipated, making
it challenging to establish relationships between questionnaire scores and
physiological data. Conclusions: It is recommended to conduct a longitudinal study to examine the sustained effects
of using Breeze 2 and to validate the methods of measuring physiological data in
future research. By doing so, a more comprehensive understanding of the
effectiveness of incorporating diaphragmatic breathing exercises in video games for
stress self-regulation can be obtained.
The commentary proposes the concept of bioenergy utilization in clinical technologies. It defines the bioenergy-signal utilization for energy efficacy in biomedical applications....
The commentary proposes the concept of bioenergy utilization in clinical technologies. It defines the bioenergy-signal utilization for energy efficacy in biomedical applications.
The review is summarative to the clinical trials numbered NCT05711810 and NCT05839236 on ClinicalTrials.gov, with the sole participant's recovery from autoimmune pathogens who was also diagnosed as ne...
The review is summarative to the clinical trials numbered NCT05711810 and NCT05839236 on ClinicalTrials.gov, with the sole participant's recovery from autoimmune pathogens who was also diagnosed as neurodivergent during the first interventional trial. The review seeks to bridge the literature gaps between psychiatry and the medical sciences on neurodiversity with the focus on immunobiology. It chooses the concept of adrenaline intolerance during the final phase of the recovery process to summarize the clinical evidences. The first part of the review synthesizes the key locations of autism spectrum disorder (ASD)'s neurological differences to neurotypical individuals. With the anatomic overview, the second part reviews the relevances to the immune system and implications in immune reflex. The third part reviews the neuroatypical hormonic paths based on the ASD participant's data, whereby the final recovery process with hypolipidemic agent intervention posed a contradiction between the neuronal needs and autoimmune needs of the participant's internal conditions. The review predicts that the contradiction offers a new window into the study of sebaceous immunobiology.
ALBI (Albumin-Bilirubin) score is routinely used in grading liver function of hepatocarcinoma and hepatitis patients. In this purposive review, the published values of serum albumin, bilirubin in Vira...
ALBI (Albumin-Bilirubin) score is routinely used in grading liver function of hepatocarcinoma and hepatitis patients. In this purposive review, the published values of serum albumin, bilirubin in Viral hepatitis, Tuberculosis, Scrub Typhus, Enteric fever has been compared with that of melioidosis. Since PubMed yielded zero searches with key words “albumin, bilirubin, melioidosis”, it was searched in Google Scholar, a better retrievable search engine. This yielded 46 relevant articles with 53 ALBI scores for Melioidosis. An equivalent search to retrieve 53 ALBI scores was made in Google Scholar for other confounding diseases of Melioidosis with search words “albumin, bilirubin, hepatitis” “albumin, bilirubin, tuberculosis”, “albumin, bilirubin, scrub typhus”, “albumin, bilirubin, enteric fever”. This raw data was deposited in Harvard dataverse (https://doi.org/10.7910/DVN/QEW20J) and subsequent analysis done is documented in this article. This placed Melioidosis patients and Scrub typhus patients to be on an average grade III ALBI and the patients of Viral Hepatitis, Tuberculosis, and Enteric fever in grade II ALBI.
Background: The research adopts an intercultural heuristics in discussing lust and desire in social structures. It draws a correlation between moral objectivism and legal philosophy. Objective: The re...
Background: The research adopts an intercultural heuristics in discussing lust and desire in social structures. It draws a correlation between moral objectivism and legal philosophy. Objective: The research aims to render a comparative anthropological psychology perspective between the Chinese culture and Western culture. Methods: The method takes an anthropological psychological approach to the linguistic arts and traditional Chinese culture. It uncovers the sex innuendo contents in the Chinese culture disguised in natural philosophy. Results: The research sheds light on the Chinese culture of censorship with the denial of the persons behind power in the Chinese way. Conclusions: Mass psychology is partially mass sexology. The diversity of desire by gender and sexuality is a positive sociological factor. The structural elements of the political problems are not without relevance to Gestalt psychology.
The article hypothesizes the cosmic origins of life forms that are currently known. The hypothesis is divided into two interrelated components of the matter form of life and the environmental conditio...
The article hypothesizes the cosmic origins of life forms that are currently known. The hypothesis is divided into two interrelated components of the matter form of life and the environmental conditions of the matter form. The two are interrelated by the thermonuclear dynamics of oscillation and resonance. The philosophical basis for the hypothesis is that a successful cosmological theory should, at least quantitatively, explain biology. Radiochemical separation on telomeres for unique signatures and spectroscopy development is proposed to test the hypothesis.
The article summarizes the neo-Nazist and fascist element of the "marriage law" construct of the PRC dictatorial regime with multilateralism and globalization. Albeit the politicization of sex, marria...
The article summarizes the neo-Nazist and fascist element of the "marriage law" construct of the PRC dictatorial regime with multilateralism and globalization. Albeit the politicization of sex, marriage, and family is non-gender-and-sexuality specific, its impact is asymmetric in gender & sexuality groups. Apart from some previous social surveys which has become experience, media psychology is the main method in the re-search with the cisgender homosexual psychoanalytic background in the shaping and constant reshaping of the self in the ego-centric dictatorial semantic environment. The purpose of the research was to change the governmental incentives but with the bio-physical dissections of dictatorial chains, sexism was used for human trafficker conversions and retributive justice was used for counter-measurement. Counter-transference on the neo-Nazist and fascist state of mind was conducted with quantum physics approach to cosmology, thermonuclear astrochemistry & astrophysics with the permeative cyber calculation environment. Queer theology was adapted for sexual and mental health in the marriage process combined with the cisgender homosexual solution to Freudian psychology. Cisgender resilience was aided by my husband John Pachankis with his clinical experience & practices. The research concludes that PRC seeks to establish a monolithic cisgender dominance in the United Nations Security Council.
Background: Happiness is a subjective feeling among the general population, but older adults in Nigeria might describe their happiness differently due to multiple factors, including health, family dyn...
Background: Happiness is a subjective feeling among the general population, but older adults in Nigeria might describe their happiness differently due to multiple factors, including health, family dynamics, spirituality, quality of life, nutrition, and frailty. Hence, it has a consequential impact on the promotion of quality living, clinical routine assessment and swift intervention of older adults with possible indices for a mood disorder. Although Nigeria is still lacking data on how the happiness of older adults is expressed, understood, and measured. Objective: Aim and Research Objectives
The study aims to explore determinants of happiness and health-related factors associated with happiness among ambulatory and non-ambulatory older adults in the Nigerian Geriatric Center. Methods: This will employ a case-control design involving older adults that attends a geriatric center in Nigeria, as the case group and non-ambulatory older adults residing in the community will be used as a control group Results: NA Conclusions: Therefore, this study protocol would be critical in creating a research landscape for understanding happiness among older adults in Nigerian geriatric centers. Clinical Trial: NA