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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: Organ and tissue donation practices in Brazil is low compared to other countries, the primary cause is due to family refusal. Adolescents are considered important targets in educational campaigns because they are involved in an intense process of biopsychosocial and indirect family involvement. Educational technologies aim to harness technological potential to engage individuals in the empowerment process. Educational games with content and purpose, also known as serious games (SG), play a prominent role. Conceptually, they represent games that go beyond entertainment, aiming to promote health, contribute to the discussion of sensitive topics, educate, guide, and encourage healthy habits and behaviors. To achieve this, they must undergo content and predictive validation, aiming to ensure their effectiveness as a health education tool as part of the learning process of the target audience. Objective: This study aimed to document the process of designing, developing and validating the gamification of an experimental board game about organ and tissue donation and transplantation targeting adolescents and adults. Methods: This was a methodological study of content and appearance validation organized in four stages: situational analysis, board game prototype development, content validation, and production of the final game board version. The game prototype underwent a content validation process following criteria established by Pasquali. The Delphi technique was used, which involves evaluating a specific theme through expert judgment. Na academic panel of professionals were selected and divided into 3 groups: educational professionals with experience in playful-pedagogical activities, health professionals with experience in organ donation and transplantation and design and advertising professionals with experience in playful games. One on-line data collection form was created for each panel of judges, using a 4-point Likert-type agreement scale for each item. After two Delphi rounds, the Content Validation Index (CVI) was obtained. Results: The final game version consists of a game board with 48 squares, six pawns, a six-sided die, a set of 20 green cards, 20 yellow cards, and 15 red cards containing easy, moderate and difficult level questions, respectively. Additionally, the game includes a manual of rules and instructions to be used by the teacher to guide participants before and during the game. Out of the 86 items evaluated by the judge panel during the first Delphi round, 80 scored above a 0.78 CVI, considered valid. In the second round, after excluding one item, validation was achieved for the remaining five items. Conclusions: It is expected that the game board will contribute to the learning of participants about the aspects involving organ donation and transplantation, as well as the importance and encouragement to become an organ-donor contributing to improving the health of others. Efficacy studies are needed to study game play involving participants.
Journal Description
JMIR Preprintscontains pre-publication/pre-peer-review preprints intended for community review (FAQ: What are Preprints?). For a list of all preprints under public review click here. The NIH and other organizations and societies encourage investigators to use interim research products, such as preprints, to speed the dissemination and enhance the rigor of their work. JMIR Publications facilitates this by allowing its authors to expose submitted manuscripts on its preprint server with a simple checkbox when submitting an article, and the preprint server is also open for non-JMIR authors.
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For pathway 2, if authors do not wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter. Also, note if you want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc), please specify this in the cover letter.
Manuscripts can be in any format. However, an abstract is required in all cases. We highly recommend to have the references in JMIR format (include a PMID) as then our system will automatically assign reviewers based on the references.
Background: Organ and tissue donation practices in Brazil is low compared to other countries, the primary cause is due to family refusal. Adolescents are considered important targets in educational ca...
Background: Organ and tissue donation practices in Brazil is low compared to other countries, the primary cause is due to family refusal. Adolescents are considered important targets in educational campaigns because they are involved in an intense process of biopsychosocial and indirect family involvement. Educational technologies aim to harness technological potential to engage individuals in the empowerment process. Educational games with content and purpose, also known as serious games (SG), play a prominent role. Conceptually, they represent games that go beyond entertainment, aiming to promote health, contribute to the discussion of sensitive topics, educate, guide, and encourage healthy habits and behaviors. To achieve this, they must undergo content and predictive validation, aiming to ensure their effectiveness as a health education tool as part of the learning process of the target audience. Objective: This study aimed to document the process of designing, developing and validating the gamification of an experimental board game about organ and tissue donation and transplantation targeting adolescents and adults. Methods: This was a methodological study of content and appearance validation organized in four stages: situational analysis, board game prototype development, content validation, and production of the final game board version. The game prototype underwent a content validation process following criteria established by Pasquali. The Delphi technique was used, which involves evaluating a specific theme through expert judgment. Na academic panel of professionals were selected and divided into 3 groups: educational professionals with experience in playful-pedagogical activities, health professionals with experience in organ donation and transplantation and design and advertising professionals with experience in playful games. One on-line data collection form was created for each panel of judges, using a 4-point Likert-type agreement scale for each item. After two Delphi rounds, the Content Validation Index (CVI) was obtained. Results: The final game version consists of a game board with 48 squares, six pawns, a six-sided die, a set of 20 green cards, 20 yellow cards, and 15 red cards containing easy, moderate and difficult level questions, respectively. Additionally, the game includes a manual of rules and instructions to be used by the teacher to guide participants before and during the game. Out of the 86 items evaluated by the judge panel during the first Delphi round, 80 scored above a 0.78 CVI, considered valid. In the second round, after excluding one item, validation was achieved for the remaining five items. Conclusions: It is expected that the game board will contribute to the learning of participants about the aspects involving organ donation and transplantation, as well as the importance and encouragement to become an organ-donor contributing to improving the health of others. Efficacy studies are needed to study game play involving participants.
Background: Adolescents and young adults (AYA) are key population for HIV infection. Effective intervention could reduce the transmission of HIV among AYA and improve the quality of life of AYA living...
Background: Adolescents and young adults (AYA) are key population for HIV infection. Effective intervention could reduce the transmission of HIV among AYA and improve the quality of life of AYA living with HIV. Some studies have shown effectiveness of serious games on HIV prevention and control for AYA. However, there are limited reviews on serious gaming to prevent and control HIV for AYA. Objective: To review and analyze the effectiveness of serious games on HIV prevention and control for AYA, and to provide references for studies related to serious games and their clinical promotion and application. Methods: Nine databases were searched from January 1986 to December 2023, including CNKI,VIP, Wan Fang, SinoMed, the Cochrane Library, Embase, Medline, Wed of Science, and PubMed. Studies related to the serious games on HIV prevention and control for AYA were collected. Results: A total of 1660 studies were searched and 11 studies met the inclusion criteria. The studies were mainly related to the game mechanism, application content, application scenarios, theoretical frameworks, and effectiveness of serious games on HIV prevention and control for AYA. It shows positive effects in promoting AIDS knowledge, reducing risky sexual behaviors, improving antiretroviral therapy (ART) adherence, and other aspects of HIV prevention and control for AYA. Conclusions: Serious games have become a novel and effective intervention on HIV prevention and control among AYA. However, larger-scale and higher-quality studies are needed to explore and verify the effectiveness of serious games on HIV prevention and control for AYA from different areas and cultures.
The increase in opioid-related overdoses has caused a decrease in average life expectancy, highlighting the need for effective interventions to reduce overdose risk. Peer Support Specialists (PSS) off...
The increase in opioid-related overdoses has caused a decrease in average life expectancy, highlighting the need for effective interventions to reduce overdose risk. Peer Support Specialists (PSS) offer an appealing strategy to engage overdose survivors and reduce subsequent overdose risk, but randomized controlled trials are needed to evaluate effectiveness. This National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) study is a multi-site, prospective, randomized (1:1) controlled pilot trial (CTN-0107) that aims to evaluate the effectiveness of an Emergency Department (ED)-initiated peer-delivered intervention tailored for opioid overdose survivors (Peer Intervention to Link Overdose survivors to Treatment [PILOT]), compared to treatment as usual (TAU). This study evaluates the effectiveness of the 6-month PILOT intervention compared to TAU on the primary outcome of reducing overdose risk behavior at 6 months post-enrollment. Adults (ages 18+; N=150) with a recent opioid-related overdose are approached in the ED, screened, enrolled and then are asked to complete study visits at months 1, 3, 6 (end of intervention), and 7 (follow-up). Participants randomized to the PILOT intervention receive a 6-month PSS-led intervention that is tailored to each participant’s goals to reduce their overdose risk behavior (e.g., overdose harm reduction, housing, medical, and substance use treatment or recovery goals). This paper describes the study protocol and procedures, design and inclusion decisions, and the peer-led PILOT intervention, as well as current study status. Results from this trial will inform ED-initiated PSS-led overdose risk reduction interventions including implementation of PSS services and research in medical settings.
Background: Fueled by innovations in technology and health interventions to promote, restore, and maintain health, and safeguard well-being, the field of eHealth yielded significant scholarly output....
Background: Fueled by innovations in technology and health interventions to promote, restore, and maintain health, and safeguard well-being, the field of eHealth yielded significant scholarly output. Objective: To understand eHealth research trends and multidisciplinary contributions to eHealth, we obtained evidence from three corpora: 10,022 OpenAlex documents with eHealth in title, 5,000 most relevant eHealth articles according to the Web of Science (WoS) algorithm, and all available (n=1,885) WoS eHealth reviews. Methods: In VOSviewer, we built keyword and concept co-occurrence networks. The scholarship on eHealth was synthesized by analyzing clusters and adding custom overlays that linked technologies to stakeholders and their needs. A co-citation map of sources referenced in WoS reviews demonstrated scientific fields supporting eHealth. Multidisciplinary contributions were also analyzed as co-occurring hierarchical concepts used by OpenAlex to tag eHealth articles. Results: Common research directions included eHealth studies on 1) self-management and interventions; 2) telemedicine, telehealth and technology acceptance; 3) privacy, security, and design; 4) health information consumers’ literacy; 5) health promotion and prevention of disease through active lifestyle choices; 6) mHealth and digital health; 7) HIV prevention. Researchers studied mental health and health literacy of young people; physical activity and lifestyle changes to prevent obesity, hypertension, cardiovascular disease and diabetes in adults and older adults; chronic disease, dementia, and pain management and medication adherence in older adults; cancer survivors and caregivers’ needs; as well as providers and health leaders. Echoing chronological developments in eHealth research, keywords internet (2017 mean publication year), telemedicine (2018), telehealth (2018), mHealth (2019), mobile health (2020), and digital health (2021) were strongly linked to literatures indexed with eHealth (2019) and e-Health (2017) keywords. Mean publication year was 2018.77 for eHealth articles and 2019.80 for eHealth reviews, a time lag of about 12 months. Given the volume of articles, review authors were more likely to focus on interventions and less likely to systematize research on eHealth and health literacy. Review authors cited a wide range of medical journals and journals specific to eHealth technologies, as well as journals in psychology, psychiatry, public health, epidemiology, health services, policy, education, health communication, and other fields. The Journal of Medical Internet Research stood out as the most cited source in eHealth reviews. An OpenAlex concept map confirmed these findings while also displaying a prominent role of political science and law, economics, nursing, business, and knowledge management. Conclusions: Drawing upon contributions from many disciplines, the field of eHealth has evolved from studies of internet-enabled communication, telemedicine, and telehealth to research on mobile health and emerging digital health technologies.
Background: Health information technology has revolutionized health care in the United States. Interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and electro...
Background: Health information technology has revolutionized health care in the United States. Interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and electronic patient access to health information have improved care and outcomes. Objective: This objective of this analysis is to examine progress and the Office of the National Coordinator for Health IT’s (ONC’s) mission to enhance health care through data access and exchange. Methods: This analysis leverages data on end-users of health IT to capture trends in engagement in interoperable clinical care data exchange (ability to find, send, receive, and integrate information from outside organizations), e-prescribing, electronic public health reporting, and capabilities to enable patient access to electronic health information. Data were primarily sourced from the American Hospital Association Annual Survey Information Technology Supplement (2008 to 2023), Surescripts e-prescribing utilization data (2008 to 2023), the National Cancer Institute's Health Information National Trends Survey (2014 to 2022), and the National Center for Health Statistics' National Electronic Health Records Survey (2009 to 2023). Results: Since 2009, there has been a remarkable 10-fold increase in EHR use among hospitals and 5-fold increase among physicians. This rapid digitization enabled the interoperable exchange of electronic health information, electronic prescribing, electronic public health data exchange, and the means for patients and their caregivers to access crucial personal health information digitally. Now, 70% of hospitals are interoperable, with many providers seamlessly integrated within EHR systems. Notably, nearly all pharmacies and 92% of prescribers possess e-prescribing capabilities, marking an 85-percentage point increase since 2008. In 2013, 40% of hospitals and a third of physicians allowed patients to view their online medical records. Patient empowerment has increased, with 97% of hospitals and 65% of physicians possessing EHRs that enable patients to access their online medical records. As of 2022, three-quarters of individuals report being offered online access to portals, and over half (57%) report actively engaging with their health information through their patient portal. Electronic public health reporting has also had an uptick, with most hospitals and physicians actively engaged in key reporting types. Conclusions: Federal incentives have served as catalysts for the widespread adoption of electronic health records (EHRs) and the rapid digitization in health care. We found tremendous growth in health IT capabilities. Interoperability initiatives have gained considerable momentum and have fostered collaboration across health care entities. However, challenges persist in achieving nationwide interoperability, stemming from technical, organizational, and policy challenges and optimizing the benefits of these technologies. Enhanced data standardization, governance structures, and the establishment of robust health information exchange networks are crucial steps forward. Interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and patient access to health information have grown substantially over the past quarter-century and have been shown to improve health care outcomes. However, interoperability hurdles, usability issues, data security, and equitable patient access persist. Addressing these demands will require collaborative efforts among stakeholders, refining standards, and enhancing policy frameworks.
Background: Botswana has made significant investments in its healthcare information infrastructure, including vertical programs for child health and nutrition, HIV care, and Tuberculosis (TB). However...
Background: Botswana has made significant investments in its healthcare information infrastructure, including vertical programs for child health and nutrition, HIV care, and Tuberculosis (TB). However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that “there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level,” seconded by the Botswana National eLearning strategy (2020) stating that “there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating.” Objective: 1. Create a visual representation of how data is processed and the inputs and outputs through each healthcare system level. 2. Understand how front-line workers perceive healthcare data sharing across existing platforms and the impact of data on healthcare service delivery. Methods: A mixed-methods approach was adopted, combining quantitative surveys with semi-structured interviews among healthcare professionals across Botswana. This comprehensive strategy aimed to unearth both statistical trends and nuanced personal perceptions regarding the adoption and use of technology in healthcare data management. Results: Despite a prevalent reliance on paper-based records, a broadly positive attitude towards digital technology was observed among healthcare workers. Notable challenges were identified, including disparities in data sharing, access, and the variability in the adoption and comfort level with technological devices. These issues underscore the critical need for enhanced infrastructure and digital literacy among healthcare providers. Conclusions: The findings highlight the transformative potential of digital technology in Botswana's healthcare sector, conditioned on addressing existing barriers. Specifically, the study calls for focused educational initiatives tailored to mitigate disparities in technology usage and to foster a cohesive understanding of data sharing practices among healthcare professionals. "Project Kamogano" underscores the opportunity for significant improvements in healthcare data management in Botswana, leveraging healthcare professionals' optimistic attitudes towards digital innovations. The study advocates for targeted interventions aimed at bridging the digital literacy gap and infrastructure enhancements, thereby facilitating effective patient care and informed public health strategies through strategic system upgrades and interoperability enhancements.
Background: Oral health is a critical component of overall well-being, influencing an individual's ability to eat, speak, and maintain social connections. However, vulnerable populations, including lo...
Background: Oral health is a critical component of overall well-being, influencing an individual's ability to eat, speak, and maintain social connections. However, vulnerable populations, including low-income individuals, marginalized communities, and those with limited access to healthcare, often experience disparities in oral health that significantly impact their quality of life. Prevalence of Oral Health Disparities: Limited Access to Dental Care: Vulnerable populations often face barriers to accessing regular dental care, leading to unmet oral health needs. Higher Burden of Oral Diseases: Factors such as lower socio-economic status contributes to a higher prevalence of dental caries, periodontal diseases, and other oral health issues. Impact on Quality of Life: Pain and Discomfort: Untreated oral health conditions can result in pain, discomfort, and difficulty in performing daily activities. [1] Psychosocial Implications: Poor oral health may affect self-esteem and social interactions, leading to psychosocial challenges within vulnerable communities. Barriers to Oral Health Access: Financial Constraints: Limited financial resources often prevent vulnerable individuals from seeking preventive and timely dental care. Lack of Education: Insufficient awareness and education about oral health contribute to neglect and delayed treatment. Interconnected Health and Social Factors: Systemic Health Implications: Oral health is interconnected with overall health, with poor oral hygiene linked to systemic conditions such as cardiovascular diseases and diabetes. Social Determinants: Social determinants such as education, employment, and housing influence oral health outcomes, further exacerbating disparities. Existing Interventions and Challenges: Community Programs: Some initiatives aim to provide dental care to vulnerable populations through community clinics and outreach programs. Challenges in Implementation: However, challenges such as limited resources, infrastructure, and awareness persist, hindering the effectiveness of interventions. Need for Research and Interventions: Evidence Gap: Despite the evident impact of oral health on quality of life, there is a need for comprehensive research to understand the specific challenges faced by 3 vulnerable populations. Tailored Interventions: Research findings can inform targeted interventions, including community-based education, mobile dental clinics, and policy changes to address systemic issues. [2,3] In addition, addressing oral health disparities in vulnerable populations requires a nuanced understanding of the challenges they face. Research focused on this intersection between oral health and quality of life can pave the way for effective interventions, ultimately improving the overall well-being of vulnerable communities. The current study aims to investigate and assess the relationship between oral health and these groups' quality of life in order to pinpoint obstacles and create focused interventions and strategies that will enhance oral health outcomes and quality of life. [4] Objective: Examine the oral health status of vulnerable populations through comprehensive dental assessments.
Evaluate the impact of oral health on the quality of life in these populations.
Identify barriers to accessing dental care and oral health education within vulnerable communities.
Develop targeted interventions and strategies to improve oral health outcomes and quality of life. Methods: 1. Study Design:
This research employs a mixed-methods approach to comprehensively evaluate the effectiveness of interventions aimed at enhancing oral health and quality of life among vulnerable populations. The study design incorporates both quantitative assessments of oral health indicators and qualitative exploration of the lived experiences of participants.
2. Population Selection:
Age Ranges: The age ranges of the target population are not specified in the description provided.
Vulnerability Indicators: Vulnerability indicators may include socioeconomic status, access to healthcare, housing stability, employment status, and educational attainment, among others.
Exclusion Criteria: Excluding individuals with severe cognitive impairments or communication barriers ensures data accuracy and participant comprehension, thereby enhancing the validity of the study results.
3. Sampling Strategy:
Probability Sampling: Random sampling techniques are utilized to ensure representativeness of
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the target population.
Stratified Sampling: Stratification based on demographic variables such as age, gender, socioeconomic status, and geographical location enhances the diversity of the sample.
4. Intervention Implementation:
Oral Health Education: Structured educational programs are developed to enhance participants' knowledge of oral hygiene practices, including proper brushing techniques, dietary habits, and the importance of regular dental visits.
Access to Dental Care: Collaborations with local dental clinics and professionals are established to provide affordable or free dental services, including preventive measures and treatment of dental conditions.
Community Engagement: Community-based initiatives are implemented to foster sustainable oral health practices and promote peer support networks.
5. Data Collection Instruments:
Quantitative Methods: In quantitative research, numerical data is collected and analyzed to quantify relationships, behaviors, and outcomes. In the context of this study, quantitative methods involve the use of standardized tools such as surveys and clinical examinations to measure oral health indicators and quality of life metrics among participants.
Qualitative Methods: Qualitative research involves the collection and analysis of non-numerical data such as interviews, focus groups, and observations to explore subjective experiences, perspectives, and behaviors. In this study, qualitative methods entail conducting interviews and focus group discussions to gain insight into participants' experiences, perceptions, and barriers related to oral health and quality of life.
6. Data Collection Procedure:
Baseline Assessment: Prior to the intervention, baseline data on oral health indicators and quality of life are collected through surveys, clinical examinations, and interviews.
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Intervention Implementation: The intervention is implemented over a specified period, with regular follow-up sessions to monitor participants' progress and address any emerging issues.
Post-Intervention Evaluation: Post-intervention data collection is conducted using the same instruments employed at baseline to measure changes in oral health outcomes and quality of life.
Oral Health Assessment Procedure: The complete procedure of oral health assessment involves standardized dental examination tools and trained dental professionals to evaluate oral health parameters such as dental caries, periodontal health, and oral hygiene practices.
Survey Instruments: The survey instruments used in the study should be culturally sensitive and accessible to ensure participant engagement and data quality. Validated surveys focusing on oral health-related quality of life should be administered to capture the broader impact of oral health disparities.
7. Data Analysis:
Quantitative Analysis: Statistical methods such as paired t-tests, ANOVA, and regression analysis are employed to analyze quantitative data and determine the effectiveness of the intervention.
Qualitative Analysis: Thematic analysis is used to identify recurring patterns, themes, and narratives within qualitative data obtained from interviews, providing insight into participants' experiences and perceptions.
8. Ethical Considerations:
For the kind information you may need, the Sapporo Dental College and Hospital's research ethics committee has examined and approved the research protocol titled Improving Oral Health and Quality of Life in Vulnerable Populations, which will be carried out in accordance with the further study protocol (Ref: SDC/CBl2024/l0l2), with Dr. Ashek Elahi Noor serving as the principal investigator and main author.
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Informed Consent: Participants are provided with detailed information about the study objectives, procedures, risks, and benefits, and their voluntary consent is obtained prior to participation.
Confidentiality: Measures are taken to ensure the anonymity and confidentiality of participants' data, with all information stored securely and accessible only to authorized personnel.
Beneficence and Non-maleficence: The study prioritizes the well-being of participants, minimizing any potential harm and maximizing the benefits derived from participation in the intervention. Results: 1. Participant Demographics: A total of 300 participants would be recruited for the study, with a mean age of 42 years (SD = 12.5). The gender distribution was relatively balanced, with 52% female and 48% male participants. Participants were predominantly from low socioeconomic backgrounds, with 65% reporting household incomes below the poverty line. Geographically, participants were from urban and rural areas across three regions.
2. Baseline Oral Health Assessment: Baseline assessments revealed a high prevalence of oral health problems among participants. The mean DMFT score at baseline was 8.3 (SD = 2.1), indicating a significant burden of dental caries. CPI scores indicated that 72% of participants had moderate to severe periodontal disease. OHRQoL questionnaires demonstrated impaired quality of life related to oral health, with mean scores below the established norms.
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3. Intervention Implementation: Participants received a multifaceted intervention targeting oral health improvement and quality of life enhancement. The intervention included oral health education sessions, preventive dental care services, and access to subsidized dental treatments. Sessions were conducted bi-weekly over a period of six months, with a focus on promoting oral hygiene practices and dietary modifications. Dental treatments included scaling and root planning, fluoride applications, and restoration of decayed teeth.
4. Outcome Measures: Post-intervention assessments revealed significant improvements in oral health parameters. The mean DMFT score decreased to 4.1 (SD = 1.5), indicating a 50% reduction in dental caries prevalence. CPI scores showed a shift towards improved periodontal health, with 85% of participants exhibiting mild periodontal disease or better. OHRQoL scores demonstrated a substantial increase, surpassing the established norms for oral health-related quality of life.
5. Data Analysis: Statistical analysis was conducted using paired t-tests and chi-square tests to compare pre- and post-intervention outcomes. Subgroup analyses were performed to assess intervention effectiveness across different demographic and socioeconomic strata.
6. Primary Outcomes: The primary outcomes of the study included improvements in oral health status and enhancement in quality of life. The intervention achieved statistically significant reductions in dental caries prevalence and improvements in periodontal health. Participants reported a significant enhancement in their oral health-related quality of life post-intervention.
7. Secondary Outcomes: Secondary outcomes included changes in oral health behaviors and practices. Post-intervention surveys indicated a notable increase in tooth brushing frequency and adherence to recommended oral hygiene practices. Participants also reported greater satisfaction with their oral health and overall well-being.
8. Adverse Events: No serious adverse events would be reported during the study period. Minor adverse events, such as temporary tooth sensitivity following dental treatments, were promptly would be addressed by the dental team.
9. Subgroup Analysis: Subgroup analyses revealed consistent improvements in oral health
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outcomes across different demographic and socioeconomic groups. No significant disparities in intervention effectiveness were observed among subgroups based on age, gender, or income level. Conclusions: In conclusion, the intersection of oral health and quality of life within vulnerable populations underscores the urgent need for comprehensive and targeted interventions. The evidence presented throughout this discussion highlights the multifaceted challenges faced by individuals in vulnerable communities and emphasizes the far-reaching impact of poor oral health on their overall well-being. Clinical Trial: NA
Background: Patient portals are widely used for patient engagement in healthcare. However, patient perspectives on using portals for research purposes, health-related screenings, and patient-initiated...
Background: Patient portals are widely used for patient engagement in healthcare. However, patient perspectives on using portals for research purposes, health-related screenings, and patient-initiated self-testing is under studied. It is critical to understand patient perspectives on the use of portals to expand access to care. Objective: To understand patient perspectives on using portals for research purposes, health-related screenings, and patient-initiated self-testing. Methods: Patients (N=105) from the Patient Engaged Research Center at a large, urban midwestern health system completed a 23-question online survey on patient portal (MyChart) use, willingness to use the patient portal for research-purposes, risk assessments, and self-test kits. Binomial and multinomial regressions were run to determine whether demographic characteristics were associated with how and why patients access MyChart, likelihood of completing risk assessments on MyChart, and interest in receiving self-test kits. Results: Increasing age was negatively associated with MyChart use, interest in receiving self-test kits for alcohol and illicit drug use and willingness to complete risk assessments for alcohol and tobacco use, depression, stress, anxiety, sleep, and sexual history. Race and gender were not significantly associated with willingness to answer risk assessments in MyChart. Conclusions: The lack of significant findings based on race and gender suggests that patient portals may be an acceptable method of recruiting for and conducting research. Allowing patients to request self-test kits and complete risk assessments in portals may help patients to take agency over their healthcare. Future research should examine if patient portal recruitment may help to address persistent biases in clinical trial recruitment, to increase enrollment of women and racial minorities. Patient portals may be used for research recruitment, sending research-related information, and engaging patients to answer risk assessments, read about health information, and complete other clinical tasks.
Background: Smartphone apps and wearable activity trackers are expected to play an important role in promoting physical activity (PA). Although studies suggest that use of commercial mobile health too...
Background: Smartphone apps and wearable activity trackers are expected to play an important role in promoting physical activity (PA). Although studies suggest that use of commercial mobile health tools is associated with increased PA levels, most of the evidence is of a cross-sectional design, and thus longitudinal evidence is lacking. Objective: Therefore, we aimed to reveal the app-use patterns that are prospectively associated with increases in and maintenance of PA. We were specifically interested in (a) whether continued app use is associated with adherence to the recommended levels of PA (i.e., 23 METs-h/w for adults or 10 METs-h/w for people aged>65 years) during a follow-up assessment and (b) whether any functions and features of PA apps predict the changes in PA level. Methods: A two-wave longitudinal survey was conducted with the baseline and follow-up assessments separated by six months. A total of 20,573 Japanese-speaking online respondents participated in the baseline, among which 16,286 (8,289 women; mean age=54.7, standard deviation=16.8) completed the follow-up. On each assessment occasion, participants reported their current PA levels and whether they were using any PA apps and wearables. Each participant was then classified into following four categories: continued users (those who were using apps at both the baseline and follow-up; n=2,150, 13.2%), new users (those who started using apps before the follow-up; n=1,462, 9.0%), discontinued users (those who had been using apps at the baseline but not anymore at the follow-up; n=1,899, 11.7%), and continued nonusers (those who had never used apps; n=10,775, 66.2%). Results: Most continued users (n=1,538, 71.5%) improved or maintained their PA to the recommended levels over six months; however, discontinued users showed the largest reduction in PA (-7.95 METs-h/w on average), and most failed to meet the recommended levels at the follow-up. Analyses of individual app functions showed that energy analysis (e.g., app calculation of daily energy expenditure) and journaling (e.g., users manually entering notes and maintaining an exercise diary) were significantly associated with increases in PA (odds ratio [OR]=1.67, 95% confidence interval [CI] [1.05, 2.64] and OR=1.76, 95%CI [1.12, 2.76], respectively). On the other hand, those who maintained the recommended PA levels at the follow-up typically used the goal setting (OR=1.73, 95%CI [1.21, 2.48]), sleep information (OR=1.66, 95%CI [1.03, 2.68]), and blood-pressure recording (OR=2.05, 95%CI [1.10, 3.83]) functions. Conclusions: The results support the importance of continued app use in increasing and maintaining PA levels. Different app functions may be suited to increasing PA (e.g., goal setting and journaling) vs. maintaining high levels of PA (their health in general, covering sleep and blood pressure, not limited to PA).
Background: White spot lesions (WSLs) are white marks that can form on teeth during orthodontic treatment with fixed appliances (FA) and become apparent once they are removed. About half of people who...
Background: White spot lesions (WSLs) are white marks that can form on teeth during orthodontic treatment with fixed appliances (FA) and become apparent once they are removed. About half of people who have FA treatment get WSLs. They are usually caused by poor tooth-brushing around the brace.
Several studies explore the prevention and/or treatment of WSL. However, there remain uncertainties about what young people and their parents/guardians know or feel about WSL. A Cochrane review concluded that patient-reported outcomes have been overlooked in WSL prevention studies.
Methods: This protocol describes a mixed-methods study that aims to explore young people’s and their parents/ guardians’ perceptions, attitudes, and feelings towards WSLs. Participants will be recruited from children aged 11-15, undergoing orthodontic treatment at Liverpool University Dental Hospital and their parents/guardians. Part 1 (quantitative) will use a questionnaire and images of pre-treatment malocclusions and post-orthodontic WSLs of varying severity (mild, moderate, severe). Part 2 (qualitative) will involve one-to-one, semi-structured interviews, using open-ended questions with young people and their parents/ guardians.
A sample size of 200 survey respondents for Part 1 and 30 interviewees for Part 2 will be undertaken. The responses for the questionnaire use a Likert scale with the option of free text comments. The qualitative research will be analysed using a modified framework analysis approach; the outcomes will be presented as themes.
Discussion: WSLs can be highly visible when smiling or speaking. Aesthetic defects, caused by WSLs, may expose young people to oral health related stigma and discrimination e.g., bullying or teasing and impact on self-esteem. WSLs may also have cost consequences for patients and NHS dental services, for example, the costs of professionally applied fluoride, restorations, and their maintenance. This study is important for understanding the impact WSLs have on oral health-related quality of life and the decision making of young people and their parents/ guardians.
Background: The landscape of substance use behavior among young adults has observed rapid changes across time. Intensive longitudinal designs are ideal for examining and intervening on substance use b...
Background: The landscape of substance use behavior among young adults has observed rapid changes across time. Intensive longitudinal designs are ideal for examining and intervening on substance use behavior in real-time but rely on high participant compliance in study protocol, representing a significant challenge for researchers. Objective: The current study evaluated the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study. Methods: Participants (N=91; 67% female, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/day (EMA Group) or complete the same EMA protocol with one personalized message and a DD indicating multiple metrics of progress in the study, delivered at one randomly selected prompt/day (EMA+DD Group) via a micro-randomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups. Results: Levels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study. The EMA+DD Group was marginally more likely to perceive the compensation level to be adequate and the protocol as less burdensome. Qualitative findings revealed EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment-level did not significantly impact participants’ likelihood of completing the EMA or completion time at that particular prompt, with the exception of the first prompt of the day Conclusions: Providing a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants’ mobile devices.
Background: Cancer health disparities in Latina(o) populations stem from economic, cultural, linguistic, and systemic barriers, which simultaneously hinder effective screening and early detection, a...
Background: Cancer health disparities in Latina(o) populations stem from economic, cultural, linguistic, and systemic barriers, which simultaneously hinder effective screening and early detection, and directly contribute to lower screening rates. Fear, stigma, and challenges in navigating the healthcare system exacerbate this issue, underscoring the urgent need for initiatives aimed at increasing cancer screening rates in this population to enable earlier identification and treatment of cases. Digital behavior change interventions (DBCIs) offer accessible, cost-effective methods to increase screening and affect health outcomes in Latina(o) communities. Despite their potential, research on DBCIs' specific impacts on cancer prevention, education, and screening promotion among Hispanic/Latina(o) populations remains sparse . In our review, we use "Latina(o)" to reflect the community's preferences, as highlighted by recent studies, and "Hispanic" for broader Spanish-speaking groups, ensuring our language is inclusive and sensitive to diverse identities. Objective: This systematic review, spanning January 2000 – March 2023, aims to characterize the existing literature and findings on the impact of digital interventions on cancer prevention, screening, and education among Latina(o) populations. It critically evaluates the designs, participant demographics, intervention components, technological platforms, cultural tailoring, and measured outcomes of included studies. Methods: Adhering to PRISMA and PICOS , this review focused on English and Spanish articles that specifically address DBCIs for cancer screening, prevention, and education among Latina(o) populations aged 18-75 , excluding non-interventional and qualitative studies. We implemented a robust search strategy across databases: PubMed, Embase, ERIC, PsycINFO, Scopus, Web of Science, and CINAHL. Data were extracted, abstracted, and synthesized for a comprehensive analysis of present evidence. Results: The review analyzed 22 of 1,884 studies. Most, 95% (21/22) were US-centric with clinical settings common in 41% (9/22) of studies, alongside online and community settings. Study design were 68% (15/22) randomized controlled trials and 32% (7/22) quasi-experimental. About 55% (12/22) focused exclusively on Latina(o)s, with 72% (16/22) not specifying race, country of origin or subgroups. English and Spanish led in 68% (15/22) of the studies. In our analysis of cultural tailoring, linguistic adjustments encompassed 95% (21/22) of studies, yet only 40% (9/22) went beyond baseline surveys, literacy adaptations, or linguistics to integrate cultural values. In cancer screening studies, 45% (10/22) used smartphones to promote screenings. Of these studies, 70% (7/10) improving rates, notably in breast (75%, 3/4) and colorectal (100%, 3/3) cancers; and there was mixed results for cervical. Cancer education studies constituted 32% (7/22) of overall studies, all had a positive impact. A Majority of these, 71% (5/7), utilized smartphones for delivery, focused on breast cancer, 86% (6/7). A smaller portion addressed melanoma 14% (1/7), employing apps designed for symptom management and lifestyle advice. Cancer prevention studies comprised 23% (5/22) of overall studies; 40% (2/5) had positive outcomes. Specifically, 20% (1/5) utilized smartphone texting for HPV vaccine uptake, and 20% (1/5) employed a web platform for cervical cancer vaccine information-seeking. Conclusions: DBCIs present a significant opportunity for addressing cancer health disparities among U.S. Latina(o) communities, however, effectiveness requires more than linguistic changes; cultural adaptations are crucial. While 95% of studies adjusted language, only 40% incorporated culture, highlighting the need for culturally nuanced interventions. In cancer screening studies, smartphone strategies improved breast and CRCS rates, although cervical cancer screening and CRCS outcomes indicate potential for further research and improvement. Cancer education studies utilizing smartphones increased breast cancer awareness, highlighting mobile technology's effectiveness in health information dissemination. Yet, cancer education interventions should expand to cover CRC, using digital tools for symptom management and lifestyle guidance. Cancer prevention showed limited success in HPV vaccination and information-seeking for cervical cancer, underscoring the need for enhanced DBCI strategies for greater impact. The need for future research for deeper cultural tailoring, to align with the cultural values and beliefs of U.S. Latina(o) populations is evident. Focusing on accessible technology, especially smartphones and apps, is crucial to enhancing cancer prevention, screening, and education for equitable health outcomes across diverse communities.
Background: Humans have evolved to sit in a squatting position, whereas in the digitally integrated era epitomized by esports, prolonged sitting on a chair, namely seated position, is a widespread hab...
Background: Humans have evolved to sit in a squatting position, whereas in the digitally integrated era epitomized by esports, prolonged sitting on a chair, namely seated position, is a widespread habit linked to body and mind issues. Although standing position promotes health and cognitive performance, the postural influence on cognitive benefits and risks during esports play remains unknown. Objective: We aimed to test the hypothesis that a standing position enhances esports performance over short periods compared to a seated position, while prolonged standing can lead to cognitive fatigue. Furthermore, we examined whether the forward leaning seated position promotes cognitive dynamics as a possible alternative to the standing position during esports play. Methods: We recruited 25 collegiate casual esports players. They first performed a crossover session of virtual football gaming for a maximum of 3 hours while standing or seated positions (Experiment 1). During the playing, we measured their subjective sensations, mood, virtual football performance, executive function, heart rate, pupil diameter, and salivary cortisol and testosterone levels. Next, we tested the effect of leaning forward in a seated position during the same virtual football gaming condition through a crossover session with a backward seated position (Experiment 2). Results: In Experiment 1, standing increased vitality and pleasure, executive function assessed by Flanker interference, and shot performance during the initial 30 minutes. Heart rate, pupil size, and salivary cortisol and testosterone were higher in the standing condition. Beyond 60 minutes, standing slowed interference with increased conceded goals, and 50% of the participants retired during play. In Experiment 2, seated in a leaning forward position enhanced vitality and pleasure, interference, and shot and pass performance than seated in a reclining position during the initial 60 minutes, but led to lower interference and cognitive accuracy after 120 minutes. Reclining seated position slowed interference from the early phase, but accuracy remained unchanged throughout playing. Conclusions: Our findings provide evidence that standing position for moderate durations (≤60 minutes) improves mood, executive function, and esports performance, but standing for prolonged durations (>60 minutes) causes cognitive fatigue, leading to lowered esports performance. Furthermore, leaning forward seated position serves as an alternative active sitting mirroring the cognitive dynamics of standing esports play. Reclining seated position supports cognitive endurance with higher accuracy. Ultimately, adopting postures to match cognitive demands could encourage active and healthy lifestyles in today’s co-evolving computer-human society.
Background: Rapid systematic reviews are vital tools for providing timely evidence to inform healthcare decisions. Objective: The aim of this study was to assess the reporting quality of rapid review...
Background: Rapid systematic reviews are vital tools for providing timely evidence to inform healthcare decisions. Objective: The aim of this study was to assess the reporting quality of rapid review literature against established methodological guidelines to identify areas for improvement. Methods: A cross-sectional study design was used with thorough searches of PubMed, Cochrane Library, and Web of Science until February 28, 2023. An expert guided the search strategy, and the Cochrane RR Evidence-Based Methodology was used to evaluate the reporting quality of rapid reviews. Subgroup and comparative analyses were performed to explore influencing factors on quality. Results: Among 112 Rapid Reviews analyzed, less than 50% fully reported on four key items, while over 50% fully reported on four other items. Reports published after 2021 showed slightly higher overall quality than those published before 2020, with significant differences in specific reporting criteria(P<0.05).The included studies were divided into CRR and RR groups. CRR had 100% reporting rates in several items and higher reporting rates in others compared to RR. Overall reporting rates were low for several items, with significant differences between CRR and RR for some items(P<0.05).The included studies were divided into groups A (IF ≤ 5) and B (IF > 5). Literature with an impact factor greater than 5 demonstrated slightly higher report quality compared to lower impact factor literature. Statistically significant differences were observed in specific criteria(P<0.05), with certain items reaching high reporting rates in both subgroups. Conclusions: This study observes an improvement in report quality. Literature in the Cochrane Library shows better reporting quality. However, overall methodological and report quality still require enhancement.
Background: Visual impairment (VI) is a prevalent global health issue, affecting over 2.2 billion people worldwide, with nearly half of the Chinese population aged 60 and above being affected. Early d...
Background: Visual impairment (VI) is a prevalent global health issue, affecting over 2.2 billion people worldwide, with nearly half of the Chinese population aged 60 and above being affected. Early detection of high-risk VI is essential for preventing irreversible vision loss among Chinese middle-aged and elderly adults. While machine learning (ML) algorithms exhibit significant predictive advantages, their application in predicting VI risk among the general middle-aged and elderly population in China remains limited. Objective: We aimed to predict VI and identify its determinants using ML algorithms. Methods: We used 19,047 participants from four waves of the China Health and Retirement Longitudinal Study (CHARLS) that were conducted between 2011 and 2018. To envisage the prevalence of VI, we generated a geographical distribution map. Additionally, we constructed a model using indicators of self-reported questionnaire, physical examination, and blood biomarkers as predictors. Multiple ML algorithms, including gradient boosting machine (GBM), dynamic random forest (DRF), generalised linear model (GLM), deep learning (DL), and stacked ensemble, were used for prediction. We plotted receiver operating characteristics (ROC) and calibration curves to assess the predictive performance. Variable importance analysis was used to identify key predictors. Results: Among 19,047 participants, 33.9% suffered from VI. Qinghai, Chongqing, Anhui, and Sichuan showed the highest VI rates, while Beijing and Xinjiang had the lowest. GLM, GBM, and stacked ensemble achieved acceptable area under curve values of 0.706, 0.710, and 0.715, respectively, with the stacked ensemble performing best. Key predictors included hearing impairment, self-expectation of health status, pain, age, hand grip strength, depression, night sleep duration, haemoglobin, high-density lipoprotein cholesterol, and arthritis or rheumatism. Conclusions: Nearly one-third of middle-aged and elderly adults in China had VI. The prevalence of VI shows regional variations, but no distinct east-west or north-south distribution differences. ML algorithms demonstrate accurate predictive capabilities for VI. The combination of prediction models and variable importance analysis provides valuable insights for the early identification and intervention of VI among Chinese middle-aged and elderly adults.
Background: Since early 2021, monoclonal antibody (mAb) therapy has emerged as an efficacious intervention for patients with mild-to-moderate COVID-19 infections, particularly those at high risk of pr...
Background: Since early 2021, monoclonal antibody (mAb) therapy has emerged as an efficacious intervention for patients with mild-to-moderate COVID-19 infections, particularly those at high risk of progressing to more severe infections. With favorable results from clinical trials, the U.S. Food and Drug Administration (FDA) issued Emergency Use Authorizations for a series of mAb treatments. As these therapeutic agents became readily available, clinicians and researchers embarked on comprehensive investigations into their impact on hospitalization rates and mortality outcomes. Objective: This study delves deeper into the effectiveness of accessible mAb therapies and their synergistic interactions with COVID-19 vaccinations in mitigating rehospitalization and mortality over a span of 19 months, within the encompassing landscape of greater Seattle in western Washington. Methods: We conducted an IRB-approved retrospective chart review of non-hospitalized adult patients who presented to emergency departments (ED) in the greater Seattle area from March 2021 through October 2022, exhibiting with mild-to-moderate COVID-19 infections and met eligibility criteria for monoclonal antibody therapy, having at least one of the following active comorbidities: arrythmia, cancer, cardiovascular dysfunction, diabetes, immunosuppression, obesity, renal dysfunction, a respiratory disorder, and/or tobacco use. We compared outcomes of patients who were treated with monoclonal antibodies to eligible patients who were not treated. Primary outcomes were rates of 28-day rehospitalization and all-cause hospital mortality. Secondary outcomes were rates of hospital inpatient admission, intensive care unit admission, and necessity for mechanical ventilation. We used propensity score matching and logistic regression models to isolate the effect of monoclonal antibody treatment on the outcome variables controlling for demographic characteristics and comorbidities. All statistical analyses were done in R Studio, and the MatchIt package was used for propensity score matching. Results: A total of 21,139 patients were included in the analysis. In the matched cohorts (mAb treated: N = 1,349; untreated: N = 1,349), mAb treatment was associated with reduced significantly odds of 28-day rehospitalization (adjusted odds ratio [aOR] 0.66, [95% confidence interval (CI)] 0.49-0.87), P = 0.004), mortality (adjusted odds ratio [aOR] 0.32, [95% confidence interval (CI)] 0.19-0.51), P < 0.001), and inpatient admissions (adjusted odds ratio [aOR] 0.43, [95% confidence interval (CI)] 0.31-0.61), P < 0.001). Conclusions: From March 2021 through October 2022, monoclonal antibodies emerged as a pivotal factor in significantly reducing the incidence of rehospitalization, mortality, and inpatient admission amongst patients with mild-to-moderate COVID-19 infections in western Washington. Our study contributes real-world evidence to the medical literature, reaffirming the efficacy of monoclonal antibodies as a therapeutic option for outpatients with mild-to-moderate COVID-19 who are at an increased risk of developing severe infection. In light of the evolving landscape of the COVID-19 pandemic, marked by changing variants, the efficacy of individual mAb agents should continue to be vigilantly evaluated.
Background: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (e.g., timing of intervention prompts) is an evidence gap in...
Background: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (e.g., timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions. Objective: The study examined the feasibility, acceptability, technical/functional reliability of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents’ moderate-to-vigorous physical activity (MVPA) levels. Consistent with the ORBIT model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials. Methods: Ten adolescents completed a seven-day baseline monitoring period and TAGS (Temporally Augmented Goal Setting), a digital physical activity intervention that included a mid-day self-monitoring message that occurred when adolescents typically start to exercise (3pm). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from pre-intervention to intervention. Additionally, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention (NUDGE: Network Underwritten Dynamic Goals Engine), without the mid-day self-monitoring message, to explore differences in MVPA between interventions. Results: The TAGS intervention was mostly feasible, acceptable, and technically/functionally reliable. Adolescents showed adequate levels of engagement. Pre-intervention to intervention changes in MVPA were small (approximately a two-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared to NUDGE. Conclusions: TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical/functional reliability, participants’ rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3pm decision point. Further optimization of TAGS will inform the design of a just-in-time adaptive intervention for adolescent physical activity and prepare the intervention for more rigorous testing.
Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization (WHO) developed the Dig...
Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization (WHO) developed the Digital Adaptation Kits (DAKs) within the SMART Guidelines framework to reinforce standards and recommendations through digital systems, however, a systematic process is needed for implementing and ensuring impact of DAKs in country contexts. Objective: The paper details the structured process and stepwise approach used to customize the DAKs to the national program and digital context in five countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe All these countries have existing digital systems, which have potential to be updated with the DAKs. Methods: A DAK assessment tool was developed and employed to assess guideline digitization readiness and opportunities for system uptake in each country. Multi-stakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Results: Country adaptation processes identified requirements for national level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into sexual and reproductive health (SRH) national guidelines and strategic documents. Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services, and ultimately how this process can continuously be refined and sustained for country impact. Clinical Trial: N/A
Background: In 2017, Uganda implemented an electronic Integrated Disease Surveillance and Response System (eIDSR) to improve data completeness and reporting timelines. However, the eIDSR system had li...
Background: In 2017, Uganda implemented an electronic Integrated Disease Surveillance and Response System (eIDSR) to improve data completeness and reporting timelines. However, the eIDSR system had limited functionality and was implemented on a small scale. The Ministry of Health (MOH), with support from the Infectious Disease Institute (IDI) and Health Information Systems Program Uganda (HISP-Uganda), upgraded the system functionality and scaled up its implementation. Objective: We describe the upgrade of the eIDSR system, its rollout, and its effect on disease surveillance in Uganda. Methods: We used the human-centered iterative process to upgrade eIDSR. The eIDSR rollout followed a consultative workshop to create awareness of the system among stakeholders. A curriculum was developed, and a national training of trainers (TOT) was conducted. These trainers cascaded the training to the District Health Teams (DHTs), who later cascaded the training to health workers. The training adopted an on-site training approach, where a group of national or district trainers would train new users at their desks. Results: The eIDSR system was upgraded to the DHIS2 2.35 platform, featuring faster reading and writing tracker data, handling over 100 concurrent users, and enhanced case-based surveillance features on Android and web platforms. From October 2020 to September 2022, eIDSR was rolled out in 68% (100/146) districts. Additionally, the system permitted prompt reporting of signals of epidemic-prone diseases. Conclusions: Improving the functionality and the expanded geographical scope of the eIDSR system enhanced disease surveillance. Stakeholder commitment and leveraging existing structures will be needed to scale up eIDSR.
Background: The role of M&Ms are multifold as they serve as an essential tool for quality improvement programs aimed to optimize patient care, reduce medical error, and serves as an educational forum...
Background: The role of M&Ms are multifold as they serve as an essential tool for quality improvement programs aimed to optimize patient care, reduce medical error, and serves as an educational forum in a protected environment. Objective: To investigate the impact of virtual meeting platforms on faculty attendance during surgical Mortality and Morbidity conferences (M&Ms) as a result of changes made during the COVID-19 pandemic. Methods: A mixed methods approach was utilized combining a quantitative retrospective observational study with a qualitative faculty survey. A total of 84 M&M dates were studied for physician attendance in surgery M&Ms at St. Joseph’s University Medical Center, New Jersey and divided into three groups, n=28 each: Pre-COVID (during COVID without teleconferencing), COVID-T (during COVID with teleconferencing), and Post-COVID-T (after COVID with teleconferencing). A survey of 24 physicians was employed to further explore the impression of virtual platforms on physicians. Statistical analysis using the T-test, Pearson’s correlation (r), and regression analysis were performed, with a P-value of 0.05 indicating statistical significance. Results: Mean attendance-18, 22, 20 in Pre-COVID, COVID-T, POST-COVID-T respectively. There was significant (P = 0.03) increase in COVID-T vs PRE-COVID; no significant difference in POST-COVID-T vs PRE-COVID. PRE-COVID, attendance trends were declining by a weak negative correlation of r= -0.428. The attendance trends improved (r=-0.211), and in POST-COVID-T, continued to remain stable with weak correlation (r= -0.073). Physician survey responses- 83% M&Ms are extremely important, 8.3% somewhat important, 8.3% not important. 83% reported increased ability to attend M&Ms w/ teleconferencing. In terms of satisfaction with the option of utilizing virtual platforms to attend M&Ms vs in person, 41% somewhat satisfied, 29% extremely satisfied. 95% agreed that teleconferencing should be continued. Conclusions: Virtual platforms can play a vital role in encouraging the faculty participation in M&Ms, and should be continued.
Background: In Canada, the healthcare system has been estimated to generate 33 million tonnes of greenhouse gas emissions annually. Healthcare systems, specifically operating rooms (ORs), are signific...
Background: In Canada, the healthcare system has been estimated to generate 33 million tonnes of greenhouse gas emissions annually. Healthcare systems, specifically operating rooms (ORs), are significant contributors of greenhouse gas emissions, using three to six times more energy than the hospital’s average unit. Objective: This quality improvement study aimed to investigate the knowledge, attitudes, and perceptions of staff and patients on sustainability in the OR, as well as identify opportunities for initiatives and barriers to implementation. Methods: Two surveys were developed, consisting of 27 questions for staff and 22 questions for patients/caregivers. Topics included demographics, knowledge, and attitudes regarding environmental sustainability, opportunities for initiatives, and perceived barriers. Multiple choice, Likert-scale, and open-ended questions were used. Results: A total of 174 staff and 37 patients participated. The majority (88%) of staff had received no/minimal training on sustainability, while 93% cited practicing sustainability at work as important. Among patients/caregivers, 54% often/always noticed when a hospital is being eco-friendly. Both staff and patients agreed that improving sustainability would boost satisfaction (71.8%;59.4%) and hospital reputation (89.5%;69.5%). The staff’s highest rated environmental initiatives included transitioning to reusables, education, and improved energy consumption, while patients prioritized increased nature, improved food sourcing, and education. Perceived barriers to these initiatives included cost, lack of education, and lack of incentive. Conclusions: Staff and patients/caregivers in a large academic healthcare center acknowledge the significance of environmental sustainability in the OR. While they do not perceive a direct impact on patient care, they anticipate positive effects on satisfaction and hospital reputation. Aligning initiatives with staff and patient/caregiver preferences can help drive meaningful change within the OR and beyond.
The rapid integration of Artificial Intelligence (AI) in healthcare emphasizes the transformative potential it holds for improving patient outcomes through data-driven decision-making. There is a driv...
The rapid integration of Artificial Intelligence (AI) in healthcare emphasizes the transformative potential it holds for improving patient outcomes through data-driven decision-making. There is a drive toward implementing more complex predictive algorithms for disease diagnosis and prognosis. However, there are unique implications of AI that limit its clinical applicability and validity. To address these challenges, the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) group released an extension and update of its 2015 reporting guideline, the TRIPOD+AI, to enhance transparency and methodological rigor in regression and AI prediction model studies. The TRIPOD+AI framework encompasses an expanded scope, incorporating new domains such as fairness, open scientific practices, and patient and public engagement. It is anticipated that these augmented guidelines will facilitate the rigorous evaluation and subsequent adoption of artificial intelligence tools across diverse healthcare settings.
Background: Technology-mediated medication adherence interventions have proven useful, yet implementation in clinical practice is low. The ENABLE COST Action (CA19132) online repository of medication...
Background: Technology-mediated medication adherence interventions have proven useful, yet implementation in clinical practice is low. The ENABLE COST Action (CA19132) online repository of medication adherence technologies (MATech) aims to provide an open access, searchable knowledge management platform to facilitate innovation and support medication adherence management across health systems. To provide a solid foundation for optimal use and collaboration, the repository requires a shared interdisciplinary terminology. Objective: We consulted stakeholders on their views and level of agreement on the terminology proposed to inform the ENABLE repository structure. Methods: A real-time online Delphi study was conducted with stakeholders from 39 countries, active in research, clinical practice, patient representation, policy making, and technology development. Participants rated terms and definitions of MATech and of 21 attribute clusters on product and provider information, medication adherence descriptors, and evaluation and implementation. Criteria of relevance, clarity and completeness were rated on 9-point scales, and free-text comments provided interactively. Participants had the possibility to reconsider their ratings based on real-time aggregated feedback and revisit the survey throughout the study period. We quantified agreement and process indicators for the complete sample and per stakeholder group, and performed content analysis on comments. Consensus was considered reached for ratings with disagreement index (DI) below 1. Median ratings guided decisions on whether attributes were considered mandatory, optional or not relevant. We used results to improve the terminology and repository structure. Results: Of 250 stakeholders invited, 117 rated the MATech definition, of which 83 rated all attributes. Consensus was reached for all items. The definition was considered appropriate and clear (median ratings 7.02 and 7.26, respectively). Most attributes were considered relevant and mandatory, and sufficiently clear to remain unchanged, except ISO certification (considered optional, median relevance rating 6.34), and medication adherence phase, medication adherence measurement, and medication adherence intervention (candidates for optional changes, median clarity ratings 6.07, 6.37, and 5.67, respectively). Subgroup analyses found several attribute clusters considered moderately clear by some stakeholder groups. Results were consistent across stakeholder groups and across time, yet response variation was found within some stakeholder groups for selected clusters, suggesting targets for further discussion. Comments highlighted issues for further debate and provided suggestions which informed modifications to improve comprehensiveness, relevance, and clarity. Conclusions: By reaching agreement on a comprehensive MATech terminology developed following state-of-the-art methodology, this study represents a key step in the ENABLE initiative to develop an information architecture that has the potential to structure and facilitate the development and implementation of MATech in health systems across Europe. The debates and challenges highlighted in stakeholders’ comments outline a potential roadmap for further development of the terminology and the ENABLE repository.
Background: Digital health interventions (DHIs) aim to support health-related knowledge transfer e.g., through websites or mobile applications (apps). They have the potential to either increase health...
Background: Digital health interventions (DHIs) aim to support health-related knowledge transfer e.g., through websites or mobile applications (apps). They have the potential to either increase health inequalities due to the digital divide or to reduce health inequalities by making healthcare available to those who might not otherwise be able to access it, such as geographically remote populations. They can also overcome language barriers though translated content and enable people to access support and advocacy from family members or friends. However, public health programmes and patient-level healthcare delivered digitally need to consider ways to mitigate the digital divide through DHI design, deployment, and engagement mechanisms, to reach digitally excluded populations. Objective: The objective of this systematic scoping review was to identify the features of DHI design and deployment conducive to improving access to, and engagement with, DHIs by people from demographic groups likely to be affected by the digital divide. The review was conducted during the evolving Covid-19 pandemic, and its findings informed the rapid design, deployment, and evaluation of a post-Covid-19 rehabilitation DHI called ‘Living With Covid Recovery’ (LWCR). LWCR needed to be engaging and usable for patients with a wide range of demographic characteristics, to avoid exacerbating existing health inequalities as far as possible. LWCR was introduced as a service in 33 participating NHS hospital clinics from August 2020, was used by 7,679 patients, and the study ran until 20th December 2022. Methods: This systematic scoping review followed the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidance. The following databases were searched for primary research studies published in English from 1 October 2011 to 1 October 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC) and Trip. In addition, we used OpenGrey and Google Scholar to search for grey literature. We selected publications that met the following inclusion criteria: primary research papers that explored and/or evaluated features of DHI design and deployment intended to enable access to and engagement by adults from demographic groups likely to be affected by the digital divide (e.g., older age; minority ethnic groups; lower income/education level). The data from studies that met the review inclusion criteria were extracted, narratively synthesised, and thematically analyzed. Results: A total of 22 papers were included in the review. Inclusion criteria were met for 19 papers of 1245 hits retrieved by the search and three further papers were added from a search of publications included in relevant reviews. DHIs evaluated in the studies included:
telehealth, virtual assistants, text message interventions, decision aids and e-health learning programs. The main themes resulting from analysis of extracted data relating to design considerations included: co-development with end-users and user testing for iterative design cycles to produce DHIs that help improve digital skills and digital health literacy through use; tailoring for low literacy levels through animations, pictures, videos and writing for a low reading age; use of virtual assistants to collect information from patients and guide use of a DHI. For deployment, themes revealed included: provide devices and data, if possible, otherwise use text messages or signpost to sources of cheap/free devices and free WiFi; provide ‘human support’ for implementation / onboarding and troubleshooting; provide tailored digital skills education as part of the intervention; and incorporate peer/family support. Conclusions: Taking these “universal precaution”’ can help reduce the digital divide. The results helped guide the iterative design and successful deployment of the LWCR DHI. They also have wider implications for practitioners, policy makers, and researchers, and will inform best practices in the design and delivery of DHIs for equitable health improvement
Background: Digitalization of medical practices is an integral part of clinician’s daily life making it vital for medical practitioners to understand and effectively utilize digital tools in hospita...
Background: Digitalization of medical practices is an integral part of clinician’s daily life making it vital for medical practitioners to understand and effectively utilize digital tools in hospital settings. However, often clinicians express a lack of preparedness for their digital work environments. Especially new clinical end users, encompassing medical and nursing students, seasoned professionals transitioning to new healthcare environments, and experienced practitioners encountering new healthcare technologies, face critically intense learning periods with often lack of adequate time for learning digital tools, resulting in difficulties in integrating and adopting these into clinical practice. Objective: The goal of this study was to comprehensively collect advice from experienced healthcare professionals to guide new clinical end users on how to initiate their engagement with health information technologies within hospital settings. Methods: We conducted qualitative interviews with 52 healthcare professionals across Switzerland, representing 24 medical specialties from 14 hospitals, and performed inductive thematic analysis. Results: Ten themes emerged from the interview data, including 1) digital tool understanding, 2) peer-based learning strategies, 3) experimental learning approaches, 4) knowledge exchange and support, 5) training approaches, 6) innovative thinking, 7) the personal attitude towards technology, 8) critical thinking approaches, 9) dealing with emotions, and 10) the human focus. Subsequent ten recommendations with specific advice to new clinical end users on how to approach new healthcare technologies include 1) taking time to get to know and understand the tools you are working with, 2) proactively ask experienced colleagues, 3) simply try it out and practice, 4) know where to get help and information, 5) take sufficient training, 6) stay curious and think outside the box, 7) stay open-minded, 8) remain critically thinking and use your knowledge base, 9) overcome your fears, 10) never lose the human focus. Conclusions: Our study emphasized the importance of comprehensive training and learning approaches for healthcare technologies based on the advice and recommendations of experienced healthcare professionals. Moreover, these recommendations have implications for medical educators and clinical instructors, advising on effective methods to instruct and support new end users, enabling them to proficiently utilize novel technologies. Therefore, we advocate for new clinical end users as well as medical educators to prioritize effective training and cultivating technological readiness to optimize information technology use in healthcare.
Background: Shared decision making (SDM) is a model of patient-centered care that encourages patients and clinicians to work together to reach medical decisions by weighing the risks and benefits of v...
Background: Shared decision making (SDM) is a model of patient-centered care that encourages patients and clinicians to work together to reach medical decisions by weighing the risks and benefits of various options within the context of the values and goals of the patient. Despite the interest in incorporating SDM into routine care, current research studies identify various obstacles that limit SDM adoption. These obstacles include technical integration issues, logistical and workflow challenges, and psychological impediments such as uncertainty and legacy belief systems, which continue to impede progress. Integrating SDM tools and processes into EHR systems is often a complex and challenging problem. Objective: We aimed to understand the integration and implementation characteristics of reported Shared Decision Making (SDM) interventions integrated into an electronic health record (EHR) system. Methods: We conducted a scoping review using Arksey and O’Malleys' methodologic framework with guidance from the Joanna Briggs Institute. Results: A total of 19 studies of 2153 were included in the final review. There is a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that target established healthcare processes promoted use. Integrating SDM templates and tools into an EHR appeared to improve the outcomes for most studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were not included in several studies. The two most common study outcome measures were patient satisfaction and SDM tool use. Conclusions: Understanding the approaches for presenting SDM tools directly into a clinician’s workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes is needed for consistency across SDM studies. Targeting accepted clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized control trials are needed to expand the quality of the evidence base. Keeping the goals and values of the patient at the center of shared decision making interactions is a key area for future studies.
On March 13, 2024, the Parliament sanctioned the inaugural comprehensive artificial intelligence (AI) statute globally. The European Union deems the governance of this technology as crucial, in light...
On March 13, 2024, the Parliament sanctioned the inaugural comprehensive artificial intelligence (AI) statute globally. The European Union deems the governance of this technology as crucial, in light of potential infringements upon fundamental rights and public freedoms, detrimental impacts on the environment, and the integrity of democratic frameworks. Conversely, the undeniable advances in the medical domain necessitate the regulation of such technology to bolster investments and research, thereby providing the requisite legal certainty for users/patients, professionals, enterprises, and investors. The Regulation acknowledges the potential perils certain AI applications pose to fundamental rights, enacting prohibitions on practices such as biometric categorization, emotion recognition, and social scoring, among others. Nevertheless, the Regulation does not neglect the significance of medical research and, recognizing the imperative for support of new technologies and innovation, permits research with fewer constraints compared to the commercial use of AI algorithms in healthcare.
Background: In 2004, the Office of the National Coordinator for Health Information Technology (ONC) was established to facilitate the nationwide adoption and use of health information technology (heal...
Background: In 2004, the Office of the National Coordinator for Health Information Technology (ONC) was established to facilitate the nationwide adoption and use of health information technology (health IT). Since its inception, the health IT landscape has evolved with a diverse array of federal investments, programs, and policies to advance its use. Previous systematic reviews of literature related to health IT focused on assessing the adoption and use of technology. As health IT has evolved, research has pivoted from tracking adoption of specific health IT features to assessing the impact of these technologies and tools. Objective: This paper provides a comprehensive review of peer-reviewed publications published over the past decade to closely examine the impacts of health IT including the impact of federal policies, changing priorities, and how the expanded use of EHR features, and effect of health IT on people, processes, and outcomes. Methods: All health IT-related peer-reviewed published between January 2013 and June 2023 were evaluated to identify articles that focused on the impact of health IT. Articles and studies were extracted through a review of PubMed. A stepwise process was used to identify articles that met the inclusion criteria, focused on the impact of health IT, and demonstrated sufficient scientific rigor. Results: The resulting 408 articles were coded based on their primary focus (provider-facing or patient-facing technology), or based on topics that pertained to the systemwide use of health IT. Within each of these categories, articles were organized around key themes. Overwhelmingly, research studies reported that health IT generated a positive impact. More than half of all articles focused on provider-facing technology with a focus on measurable outcomes including quality, safety, and costs. A number of studies evaluated the increased use of patient portals and other tools to support engagement. Studies on interoperability highlighted the value of increased health information exchange. An emerging area of study included a focus on the role of health IT in advancing public and population health.
Over three-quarters of the published literature concluded that health IT generated a positive, mixed, or neutral impact. These effects were consistent across the different categories of health IT that were examined whether provider-facing, patient-facing, or systemwide impact of health IT. Conclusions: Over the past decade, the focus of studies on the impact of health IT has evolved, transitioning from a concentration on health IT adoption to optimizing its potential. This includes assessing the effectiveness of EHR functions as well as increasing information exchange. As the landscape evolved with broader acceptance of health IT, the focus shifted with greater interest in technology’s impact on patient engagement, and opportunities to use data to advance health care including population and public health. Clinical Trial: N/A
Background: There is growing interest in the real-time assessment of physical activity and physiological variables. Acceleration, particularly those collected through wearable sensors, has been increa...
Background: There is growing interest in the real-time assessment of physical activity and physiological variables. Acceleration, particularly those collected through wearable sensors, has been increasingly adopted as an objective measure of physical activity. However, sensor-based measures often pose challenges for large-scale studies due to their associated costs, inability to capture contextual information, and restricted user populations. Smartphone-delivered Ecological Momentary Assessment (EMA) offers an unobtrusive and undemanding means to measure physical activity to address these limitations.
Objective: To evaluate the usability of EMA by comparing its measurement outcomes with two self-report assessments of physical activity: Global Physical Activity Questionnaire (GPAQ) and a modified version of Bouchard’s Physical Activity Record (BAR).
Methods: 235 participants (137 females, 98 males, 94 repeated) participated in one or more 7-day study. Waist-worn sensors provided by Actigraph™ captured accelerometer data while participants completed three self-report measures of physical activity. The multilevel modeling method was used with EMA, GPAQ, and BAR as separate measures, with eight sub-domains of physiological activity (overall physical activity; overall excluding occupational; move; moderate and vigorous exercise; moderate and vigorous occupational; sedentary) to model accelerometer data.
Results: Among the three measurement outcomes, EMA (β = .185, p = .005) and BAR (β = .270, p < .001) exhibited higher overall performance over GPAQ (β = .140, p = .019). EMA also showed a more balanced performance, compared to other measurement tools, in modeling various physical activity domains, including occupational, leisure, and sedentary behaviour.
Conclusions: Multilevel modeling on three self-report assessments of physical activity indicates that smartphone-delivered EMA is a valid and efficient method for assessing physical activity.telemedicine; smartphone; wearable electronic devices; physical activity
Background: Dementia presents a significant challenge for individuals affected by it, as well as their families, caregivers, and healthcare providers. Objective: This paper outlines the process of dev...
Background: Dementia presents a significant challenge for individuals affected by it, as well as their families, caregivers, and healthcare providers. Objective: This paper outlines the process of developing and assessing the feasibility of a tablet application aimed at addressing this challenge. It underscores the importance of incorporating input from general practitioners, stakeholders, and the needs of affected families to create a supportive healthcare app. Methods: A qualitative approach was chosen, consisting of three interviews and an expert workshop. Both were recorded, transcribed and the qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. During the development phases of the app, team meetings and discussions took place bi-weekly. Results: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive healthcare apps. General practitioners and relatives play pivotal roles in the treatment and care of Persons with Dementia, often expressing specific preferences and suggestions regarding supportive assistive technologies. Moreover, successful development of a useful tablet application requires robust scientific, multidisciplinary discussions, and teamwork within the healthcare community. Conclusions: The collaboration among medical disciplines, social and technical sciences, as well as supporting organizations is essential to integrate relevant knowledge and expertise into the design and development of practical products tailored to the daily needs for healthcare of end users. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. Clinical Trial: ISRCTN 36542
Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy, and has become an increasing major global public health concern because of its adverse implications...
Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy, and has become an increasing major global public health concern because of its adverse implications for the mother and fetal health. Objective: The objective of this study was to determine the prevalence and risk factors for GDM in rural areas of Vietnam. Methods: This cross-sectional study was conducted among 1003 pregnant women, aged ≥18 years in rural areas of Northern Vietnam. GDM was identified as an impaired oral glucose tolerance test based on the guidelines of the International Association of the Diabetes and Pregnancy Study Groups. Results: The prevalence of GDM was 26.2%. patients with GDM were more likely to be older than control group with odds ratio (OR) = 3.33, 95% Confidence Interval (CI)= [2.31 – 4.78]. Women with BMI ≥25 kg/m2 were twice as likely to develop gestational diabetes (OR = 2.15, 95%CI = [1.13 – 4.10]). The family history of diabetes increased threefold the risk of GDM (OR = 3.28, 95%CI = [1.18 – 9.12]). In addition, in vitro fertilization and use of endocrine medicine also increased twice the risk of GDM (OR = 2.71, 95%CI = [1.69 – 4.36] and OR = 2.11, 95%CI = [1.53 – 2.91], respectively). After adjusting for variables, multivariate analysis identified two significant risk factors of GDM, including aged over 35 years (aOR = 3.29, 95% CI = [2.28 – 4.73]), and pre-pregnancy BMI ≥ 25 (aOR = 2.01, 95% CI = [1.04-3.90]). Conclusions: We found a high prevalence of GDM among pregnant women in rural area of Vietnam. Interventions such as lifestyle changes, exercise and diet are needed to reduce the risk of GDM in older and obese pregnancy women.
Background: Labeling color fundus photos (CFP) is an important step in the development of artificial intelligence (AI) screening algorithms for the detection of diabetic retinopathy. The International...
Background: Labeling color fundus photos (CFP) is an important step in the development of artificial intelligence (AI) screening algorithms for the detection of diabetic retinopathy. The International Classification of Diabetic Retinopathy (ICDR) is used to assign labels to CFP, plus the presence or absence of macular edema. Images can be grouped as referrable or non-referrable for treatment. There is little guidance in the literature about how to collect and use clinical metadata as a part of the CFP labeling process. Objective: To improve the quality of the Multimodal Database of Retinal Images in Africa (MoDRIA) by determining whether the availability of clinical metadata during the image labeling process influences the accuracy, sensitivity, and specificity of image labels. Methods: This is a crossover assessment with 2 groups and 2 phases. Each group had 10 randomly assigned labelers who provided an ICDR score and presence or absence of macular edema for each of 50 CRF in a test image with and without metadata.
Specificity and sensitivity of referable retinopathy was based on ICDR scores, and macular edema calculated using 2-sided T-test. Comparison with and without metadata for each participant was calculated using the signed rank test. Statistical significance was set at P<0.05. Results: The sensitivity for identifying referrable diabetic retinopathy with metadata was 92.8% (95% CI: 87.6-98.0) compared with 93.3% (95% CI: 87.6-98.9) without metadata, and the specificity was 84.9% (95% CI: 75.1-94.6) with metadata compared with 88.2% (95% CI: 79.5-96.8) without metadata. The sensitivity for identifying the presence of macular edema was 64.3% (95% CI: 57.6-71.0) with metadata, compared with 63.1% (95% CI: 53.4-73.0) without metadata, and the specificity was 86.5% (95% CI: 81.4-91.5) with metadata compared with 87.7% (95% CI: 83.9-91.5) without metadata. Sensitivity and specificity of ICDR score and presence or absence of ME were also calculated for the 20 individual labelers with and without metadata. No findings were statistically significant. Conclusions: In this quality improvement project, clinical metadata availability did not influence labeling quality. Additional studies are needed to understand the potential implications of the process and components of labeling with and without metadata more thoroughly with regards to accuracy and bias. These issues have far reaching implications given the rapidly expanding use of AI with clinical images, including on the African continent.
Abstract
Objective: This investigation purposed to assess the effectiveness of an innovative digital therapy system in improving neck pain, quality of life, and function in patients outcomes among i...
Abstract
Objective: This investigation purposed to assess the effectiveness of an innovative digital therapy system in improving neck pain, quality of life, and function in patients outcomes among individuals post Anterior Cervical Discectomy and Fusion (ACDF) surgery.
Method: The system integrates computer vision exercise, cognitive-behavioral therapy, and sensor-based posture monitoring system to provide a comprehensive intervention program. A total of 105 post-ACDF patients were enrolled and randomly assigned to three treatment groups: Digital Therapy Group (DTG), Hospital Rehabilitation Group (HRG), and Conventional Treatment Group (CTG). A comprehensive evaluation was conducted before surgery, at 12 weeks, and 24 weeks post-surgery. The assessments included Cervical Spine Mobility, Muscle Endurance Testing, Visual Analog Scale (VAS), Neck Disability Index (NDI), SF-36 Mental Component Summary (SF-36 MCS), and Patient Satisfaction Questionnaire (PSQ).
Results: The study found that both the DTG and the HRG showed significant improvements in cervical mobility, muscle endurance, pain reduction, and mental health, with no significant differences between the two groups (p > 0.05).
Conclusion: The digital therapy system effectively improves neck pain, NDI score, cervical spine function, and mental health. Its efficacy is comparable to hospital rehabilitation and superior to conventional therapy methods.
Background: Rehabilitation aims to restore and optimize the functioning of impaired systems. It is an integral part of universal health coverage and access to it is a human right for people with disab...
Background: Rehabilitation aims to restore and optimize the functioning of impaired systems. It is an integral part of universal health coverage and access to it is a human right for people with disabilities. It is important to identify the key challenges to rehabilitation services in Sub-Saharan Africa (SSA) from a user, health system and service provider perspective Objective: To identify the key challenges to rehabilitation services in Sub-Saharan Africa (SSA) from a user, health system and service provider perspective Methods: This scoping review was conducted in accordance with the five steps framework proposed by Arksey and O'Malley and a comprehensive electronic search was run to identify published articles on rehabilitation services in Sub-Saharan Africa. Of all 131 articles retrieved in the searches, 83 articles were assessed for eligibility and 15 papers met the inclusion criteria were considered Results: The results showed that people with disabilities in Sub-Saharan Africa face multifactorial challenges to access rehabilitation services. Poor access to rehabilitation services is associated with less attention given to rehabilitation by governments which led to less funding, cultural and social beliefs, less and poorly equipped rehabilitation centers, failure of the health systems, lack of trainings to professionals, logistical and financial constraints.This review also revealed that digital rehabilitation reduced costs and improved access to services in hard-to-reach geographical areas. However, it faced connectivity issues, inaccessibility to technology and lack of technical knowledge, lack of privacy and ethical challenges Conclusions: This review concludes that people with disabilities face multifactorial challenges to access rehabilitation services in SSA. It is therefore critical to address these challenges to optimize patients’ health outcomes and offer better rehabilitation services.
Background: Personalized intelligent exercise prescriptions have shown significant effects in increasing individual physical activity and improving individual health levels. However, the health benefi...
Background: Personalized intelligent exercise prescriptions have shown significant effects in increasing individual physical activity and improving individual health levels. However, the health benefits of personalized intelligent exercise prescriptions rely on individuals' long-term adherence behaviors. Therefore, it is crucial to analyze the factors influencing individual adherence to personalized intelligent exercise prescriptions and further explore the intrinsic correlation between individual psychological motivation and adherence behaviors, aiming to enhance individual adherence to such prescriptions. Objective: This study aims to analyze the adherence behavior of community residents who received personalized intelligent exercise prescriptions from an electronic health promotion system, and to explore the relationship between their psychological motivations and adherence behaviors towards these prescriptions. Methods: This study employed purposive sampling to conduct individual, face-to-face semi-structured interviews with 12 community residents who had been prescribed personalized intelligent exercise for at least 8 months. The interviews utilized the trans-theoretical model and the multi-theory motivation model. Participants received detailed explanations and exercise guidance from staff after being provided with exercise health education materials. The interviews were recorded, transcribed verbatim, and analyzed using qualitative analysis software NVivo with three-level coding. The coding results were utilized to analyze the adherence status and influencing factors of personalized intelligent exercise prescriptions, and to further explore the relationship between community residents' psychological motivations and adherence behaviors towards exercise prescriptions. Results: Open coding yielded 21 initial categories, which were then organized into 8 main categories via axial coding: intrinsic motivation, extrinsic motivation, benefit motivation, pleasure motivation, achievement motivation, perceived barriers, self-regulation, and optimization strategies. Selective coding further condensed the 8 main categories into three core categories: "multi-theory motivation," "obstacle factors," and "solution strategies." Using the coding results, a model depicting factors influencing adherence behavior to personalized intelligent exercise prescriptions was developed. Subsequently, a pathway model for fostering adherence behavior to personalized intelligent exercise prescriptions was proposed by integrating it with the trans-theoretical model. Conclusions: While most community residents exhibit good adherence to personalized intelligent exercise prescriptions, such adherence behavior is influenced by both facilitating factors (multi-theory motivation, solution strategies) and hindering factors (perceived barriers). Furthermore, the development and sustenance of individual adherence to personalized intelligent exercise prescriptions is not instantaneous but rather entails a gradual progression across stages, influenced by diverse motivational and other factors. Hence, future endeavors aimed at enhancing adherence to exercise prescriptions from a multi-theory motivation perspective should also prioritize optimizing solution strategies and mitigating barriers to facilitate the attainment and perpetuation of adherence behavior to exercise prescriptions.
Introduction: With Americans spending over two hours daily on social media, platforms like TikTok have become prevalent sources for healthcare information. This study evaluates the quality and quantit...
Introduction: With Americans spending over two hours daily on social media, platforms like TikTok have become prevalent sources for healthcare information. This study evaluates the quality and quantity of dermatology-related content on TikTok.
Methods: In November 2022, TikTok was searched using dermatology-related keywords. Accounts with ≥50% dermatology content were selected. An engagement score was calculated for each account, and the top 10 were further analyzed using DISCERN criteria. The Kruskal-Wallis and Mann-Whitney U tests, along with a two-tailed independent t-test, were employed for statistical analysis.
Results: Out of 22,411 videos, 17,085 (76.3%) were informational. Dermatologists led in paid sponsorship videos (65% of 502 videos). Significant differences in engagement scores were found across different provider types, with medical clinics and aestheticians receiving the highest scores. Dermatologist-run accounts had higher views and comments but similar overall DISCERN scores to non-dermatologist accounts. However, dermatologists better referenced treatment uncertainty and explanations, while non-dermatologists more frequently discussed treatment risks.
Discussion: The substantial engagement with dermatology content on TikTok highlights its role as a significant information source, albeit with generally low educational quality. Given the high consumer trust in TikTok, dermatologists face an ethical obligation to improve the accuracy and quality of their online content to counteract potential misinformation.
Background: The rise of wearable sensors marks a pivotal development in the era of affective computing. These sensors, gaining increasing popularity, hold the potential to revolutionize our understand...
Background: The rise of wearable sensors marks a pivotal development in the era of affective computing. These sensors, gaining increasing popularity, hold the potential to revolutionize our understanding of human stress. A fundamental aspect within this domain is the ability to discern perceived stress through these unobtrusive devices. Objective: This study aims to enhance the performance of emotion recognition utilizing multi-task learning, a technique extensively explored across various machine learning tasks, including affective computing. By leveraging the shared information among related tasks, we seek to augment the accuracy of emotion recognition while confronting the privacy threats inherent in the physiological data captured by these sensors. Methods: To address the privacy concerns associated with the sensitive data collected by empathetic sensors, we propose a novel framework that integrates differential privacy and federated learning approaches with multi-task learning. This framework is designed to efficiently identify the user's mental stress while safeguarding their private identity information. Through this approach, we aim to enhance the performance of emotion recognition tasks while preserving user privacy. Results: Extensive evaluations of our framework are conducted using two prominent public datasets. The results demonstrate a significant improvement in emotion recognition accuracy, achieving an impressive rate of 90%. Furthermore, our approach effectively mitigates privacy risks, as evidenced by limiting re-identification accuracies to 47%. Conclusions: In conclusion, our study presents a promising approach to advancing emotion recognition capabilities while addressing privacy concerns in the context of empathetic sensors. By integrating multi-task learning with differential privacy and federated learning, we have demonstrated the potential to achieve high levels of accuracy in emotion recognition while ensuring the protection of user privacy. This research contributes to the ongoing efforts to harness the power of affective computing in a responsible and ethical manner.
Background: Background: Stroke is a leading cause of death and disability in the world. Rapid and accurate diagnosis is crucial for minimizing brain damage and optimize treatment plans. Objective: Obj...
Background: Background: Stroke is a leading cause of death and disability in the world. Rapid and accurate diagnosis is crucial for minimizing brain damage and optimize treatment plans. Objective: Objective: This review aims to summarize the methods of artificial intelligence (AI) assisted diagnosis of acute stroke and the assessment of stroke prognosis over the past 25 years, providing an overview of common performance metrics and the development trends of algorithms. It also delves into existing issues and future prospects, intending to provide a comprehensive reference for clinical practice. Methods: Method: A total of 33 representative articles published between 1999 and 2024 on utilizing AI technology for acute stroke diagnosis were systematically selected and analyzed in detail. Results: Results: The segmentation of acute stroke lesions from 1999 to 2024 can be divided into three stages. Prior to 2012, research mainly focused on brain white matter segmentation using thresholding techniques. From 2012 to 2016, the focus shifted to stroke lesion segmentation based on machine learning (ML). After 2016, the emphasis was on deep learning (DL) based stroke lesion segmentation, with a significant improvement in accuracy observed. For the classification and prognosis assessment of strokes, both ML and DL have their advantages, achieving a high level of accuracy. Conclusions: Conclusion: Over the past 25 years, AI technology has shown promising performance in segmenting, classifying, and assessing the prognosis of acute stroke lesion.
Background: Adolescent and young adult survivors of cancer (AYAs, aged 15-39) frequently engage in hazardous alcohol use, which can have multiple mental and physical health effects. Objective: The aim...
Background: Adolescent and young adult survivors of cancer (AYAs, aged 15-39) frequently engage in hazardous alcohol use, which can have multiple mental and physical health effects. Objective: The aim of this study was to adapt and refine an existing motivational interviewing-based mHealth alcohol reduction intervention, called Tracking and Reducing Alcohol Consumption (TRAC), for post-treatment AYAs. Methods: This was a two-phase, mixed methods study consisting of key informant interviews with post-treatment AYAs aged 18-39, oncology and psycho-oncology providers, and community advocates (n=15) to inform the adaptation of TRAC. After qualitative analysis of interview findings led to the development of the new TRAC-AYA intervention, 4 AYAs completed an open trial of the 4-week intervention and provided feedback on content and protocols through a qualitative exit interview. Descriptive statistics were used to provide data on intervention feasibility and adherence. Results: Key informant interviews revealed a need for the intervention to address cancer-specific alcohol use triggers such as scan-related anxiety, financial toxicity, and reproductive health concerns. TRAC-AYA was well-received by open trial participants—enrollment and retention were above target rates (67% and 75%, respectively) and 100% of participants completed at least 3/4 intervention sessions. Participants reported high satisfaction with TRAC-AYA content and its impact on their drinking. Conclusions: Post-treatment AYAs have unique triggers for alcohol use, which should be considered in the development of alcohol reduction interventions for this population. TRAC-AYA represents a potentially valuable tool in addressing high rates of hazardous alcohol use among this population and warrants further evaluation in larger randomized trials. Clinical Trial: ClinicalTrials.gov NCT05087875
Background: Many childhood cancer survivors (CCS) develop treatment-related late effects, including increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associa...
Background: Many childhood cancer survivors (CCS) develop treatment-related late effects, including increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associated comorbidities. Therefore, at-risk CCS could benefit from lifestyle counseling during regular long term follow up (LTFU). Objective: We implemented a new form of care to decrease the long-term morbidity among CCS and to gain new insights about the lifestyle of those patients. Methods: Over a one-year study period, lifestyle counseling was integrated into LTFU care. Metabolic disorders, including hypercholesterolemia, diabetes mellitus, over-/underweight, and low activity levels, were assessed as screening parameters for various risk groups. The perspectives of CCS, physicians, and sports scientists were compared to identify those with the highest needs. A follow-up appointment after one month was performed. Results: Of the 155 CCS aged 18 to 63 years (65% female, 35% male), 112 (72%) had an indication for lifestyle counseling, identified by physicians, sports scientists, or the CCS themselves. Metabolic disorders affected 45%, and 46% did not meet recommended activity levels. A total of 120 CCS (77%) received lifestyle counseling, including 8 initially uninterested individuals who became open to recommendations. Those with intensive cancer treatment history showed the greatest need. Follow-up revealed high adherence to recommendations and successful integration into daily lives, with 97% of survivors finding the provision of lifestyle counseling during LTFU beneficial. Conclusions: Incorporating specialized healthcare professionals into survivorship care enhances the multidisciplinary approach, promoting a healthy lifestyle and potentially reducing long-term morbidity among CCS.
Background: Family and unpaid caregivers play a crucial role in supporting people living with dementia (PLWD), yet they are not systematically identified and documented by health systems. Objective: T...
Background: Family and unpaid caregivers play a crucial role in supporting people living with dementia (PLWD), yet they are not systematically identified and documented by health systems. Objective: To determine the extent to which caregivers are currently identified and documented in the electronic health record (EHR), and to elicit the perspectives of caregivers and clinical staff on how to best identify, engage, and support caregivers of PLWD through the EHR. Methods: PLWD were identified based on ICD-10 codes or dementia medications in the EHR. Chart review of PLWD characterized how caregiver information was documented and whether caregivers had shared access to the patient portal. Caregivers of eligible PLWD were then recruited through mailed letters and follow up calls to the PLWD’s home. We conducted semi-structured interviews with caregivers, clinicians and staff involved in the care of PLWD within two health systems in Maryland and Colorado. Transcripts were analyzed using a mixed inductive and deductive approach. Results: Caregivers of PLWD were usually identified in the “contact information” or “patient contacts" tab (n = 20; 91%) by their name and relation to the PLWD; this tab did not specify the caregiver’s role. Caregivers were also mentioned and their roles described to a varying degree in clinical notes (n = 21; 96%). Of the 22 caregivers interviewed, the majority (n=17; 77%) reported that the PLWD had additional caregivers. The presence of multiple caregivers could be gleaned from most charts (n=16; 73%); however, this information was not captured systematically and caregivers’ individual contributions were not explicitly recorded. Interviews with 22 caregivers and 16 clinical staff revealed two major themes: 1) Caregiving arrangements are complex and not systematically captured or easy to locate in the EHR; 2) Health systems should develop standardized processes to obtain and document caregiver information in the EHR. Conclusions: This exploratory chart review and qualitative interview study found that PLWD frequently have multiple caregivers, whose roles and needs are captured inconsistently in the EHR. To address this concern, caregivers and clinical staff suggested that health systems should develop and test workflows to identify caregivers, assess their needs at multiple touchpoints, and record their information in extractable EHR fields.
Background: Online food delivery services (OFDS) enable individuals to conveniently access foods from any deliverable location. The increased accessibility to foods may have implications on the consum...
Background: Online food delivery services (OFDS) enable individuals to conveniently access foods from any deliverable location. The increased accessibility to foods may have implications on the consumption of healthful or unhealthful foods. Of concern, previous research suggests that OFDS offer an abundance of energy-dense and nutrient-poor foods, which are heavily promoted through deals or discounts. Objective: In this paper, we describe the development of the ‘DIGIFOOD’ dashboard to monitor the digitalisation of local food environments in New South Wales (NSW) Australia resulting from the proliferation of OFDS. Methods: Together with a team of data scientists, we designed a purpose-built dashboard using Microsoft PowerBI. The development process involved three main stages i) data acquisition of food outlets via web-scraping ii) data cleaning and processing iii) visualisation of food outlets on the dashboard. We also describe the categorisation process of food outlets to characterise the healthfulness of local, online and hybrid food environments. Results: To date, the DIGIFOOD dashboard has mapped 36,967 unique local food outlets (locally accessible, scraped from Google Maps) and 16,158 unique online food outlets (accessible online, scraped from UberEats) across NSW, Australia. In 2023, the market-leading OFDS operated in 1,061 unique suburb or localities in NSW. The Sydney – Parramatta region, a major urban area in NSW accounting for 28 postcodes, recorded the highest number of online food outlets (n=4,221). In contrast, the Far West and Orana region, a rural area in NSW with only two postcodes, recorded the lowest number of food outlets accessible online (n=7). Urban areas appeared to have the greatest increase in total food outlets accessible via online food delivery. Conclusions: The DIGIFOOD Dashboard leverages the current rich data landscape to display and contrast the availability and healthfulness of food outlets that are locally accessible versus accessible online. The DIGIFOOD Dashboard can be a useful monitoring tool for the evolving digital food environment at a regional scale and has potential to be scaled up at a national level. Future iterations of the dashboard including data from additional prominent OFDS, can be used by policymakers to identify high priority areas with limited access to healthful foods both online and locally.
Background: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. Objective: This scoping review aims...
Background: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. Objective: This scoping review aims to examine and summarize the evidence from scientific literature concerning the impact of digitalization and the utilization of digital tools on the physical health of older workers. Methods: This scoping review will be conducted following recommendations outlined by Levac et al. and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews) guidelines for reporting. Peer-reviewed articles written in English will be searched in the following databases: MEDLINE, Cochrane, Proquest, Web of Science, Scopus, APA PsycInfo and ERIH PLUS. The web-based systematic review platform COVIDENCE will be used to create a data extraction template. It will cover the following items: study and participant characteristics, health measures, digital tool characteristics and usage, research findings, and policy implications. Following the Population, Concept, and Context (PCC) framework, our review will focus on studies involving older workers aged 50 years or above, any form of digitalization (including teleworking and the use of digital tools at work) and how digitalization affects physical health (such as vision loss, musculoskeletal disorders, migraine). Studies that focus only on mental health will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage) and data extraction (third stage) will be performed by a group of researchers, whereby each article will be revised by at least two people. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be solved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Results: A preliminary search of MEDLINE, Epistemonikos, Cochrane, Prospero and JBI Evidence Synthesis was conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. The results of the study are expected in April 2025. Conclusions: Our scoping review will seek to provide an overview of the available evidence and identification of research gaps regarding the effect of digitalization and the use of digital tools in the work environment on the physical health of older workers.
Background: Manually analyzing public health-related content from social media provides valuable insights into beliefs, attitudes, and behaviors of individuals, shedding light on trends and patterns t...
Background: Manually analyzing public health-related content from social media provides valuable insights into beliefs, attitudes, and behaviors of individuals, shedding light on trends and patterns that can inform public understanding, policy decisions, targeted interventions, and communication strategies. Unfortunately, the time and effort needed from well-trained human subject matter experts makes extensive manual social media listening unfeasible. Generative large language models (LLMs) have potential for not only summarizing but also interpreting large amounts of text. It is not clear to what extent LLMs can analyze a large set of social media posts at once to glean subtleties of health-related meaning and reasonably report on health-related themes. Objective: Assess feasibility of using LLMs for topic model selection or inductive thematic analysis of large contents of social media posts: Can LLMs conduct topic model selection and inductive thematic analysis as effectively as humans did in a prior manual study, or at least reasonably, as judged by subject matter experts? Methods: We asked the same research question and used the same set of social media content for both the LLM selection of relevant topics and the LLM analysis of themes, as was conducted manually in a prior published study about vaccine rhetoric. We compared the results from the prior manual human analyses to results from analyses by the LLMs GPT4-32K, Claude-instant-100K, and Claude-2-100K. We also assessed if multiple LLMs had equivalent ability and assessed consistency of repeated analysis from each single LLM. Results: Overall, all three LLMs could assess the large corpus of social media posts and summarize content. LLMs generally gave high rankings to the topics chosen previously by humans as most relevant. We reject a null hypothesis (P<0.001, overall comparison) and conclude that these LLMs are more likely to include the human-rated top 5 content areas in their own top rankings than would occur by chance. Regarding theme identification, LLMs identified several themes similar to those identified by humans, with very low hallucination rates. Variability occurred between LLMs and between test runs of an individual LLM. Despite not consistently matching the human-generated themes, subject matter experts found themes generated by the LLMs were still reasonable and relevant. Conclusions: LLMs can effectively and efficiently process large social media health-related datasets. LLMs can extract themes from such data that human subject matter experts deem reasonable. However, we were unable to show that the LLMs we tested can replicate the depth of analysis from human subject matter experts by consistently extracting the same themes from the same data. There is vast potential, once better validated, for automated LLM-based real-time social listening for common and rare health conditions, informing public health understanding of the public’s interests and concerns and determining the public’s ideas to address them. Clinical Trial: not applicable
Background: Public deliberation is a qualitative research method that has successfully been used to solicit lay people’s perspectives on health ethics topics, but questions remain as to whether this...
Background: Public deliberation is a qualitative research method that has successfully been used to solicit lay people’s perspectives on health ethics topics, but questions remain as to whether this traditionally in-person method translates into the online context. The MindKind Study conducted public deliberation sessions to gauge the concerns and aspirations of young people in India, South Africa, and the United Kingdom in regard to a prospective mental health databank. This paper details our adaptations to and evaluation of the public deliberation method in the online context, especially in the presence of a digital divide. Objective: The purpose of this paper is to assess the quality of online public deliberation and share emerging learnings in a remote disseminated qualitative research context. Methods: We convened participants for 2 hours of structured deliberation over an online video conferencing platform. We provided participants with multimedia informational materials describing different ways to manage mental health data. We analyzed the quality of online public deliberation in variable resource settings on the basis of (1) equal participation, (2) respect for the opinions of others, (3) adoption of a societal perspective, and (4) reasoned justification of ideas. In order to assess the depth of comprehension of informational materials, we used qualitative data pertaining directly to the material provided. Results: The sessions were broadly of high quality, although some sessions suffered from unstable internet connection and resulting multimodal participation, complicating our ability to perform a quality assessment. English-speaking participants displayed a deep understanding of complex informational materials. We found that participants were particularly sensitive to linguistic and semiotic choices in informational materials. A more fundamental barrier to understanding was encountered by participants who utilized materials translated from English. Conclusions: Although online public deliberation may produce similar quality outcomes to in-person public deliberation, researchers who utilize remote methods should plan for technological and linguistic barriers when working with a multinational population. Our recommendations to researchers include budgetary planning, logistical considerations, and ensuring participants’ psychological safety.
Background: The self-management of adolescents living with HIV (ALHIV) plays a pivotal role in enhancing their health quality of life. However, the current self-management practices within this popula...
Background: The self-management of adolescents living with HIV (ALHIV) plays a pivotal role in enhancing their health quality of life. However, the current self-management practices within this population are suboptimal. Therefore, it is imperative to reinforce HIV self-management education interventions. The advent of digital educational games presents an unparalleled opportunity for innovative educational methods. Objective: This study designed a digital educational game for self-management of ALHIV, offering an effective educational approach to enhance their self-management skills and facilitate comprehension of HIV self-management practices. Methods: The integrative framework for HIV self-management, empowerment theories, and the learning-game mechanics (LM-GM) model were used as theoretical framework to guide the design of the game system. Experts in diverse fields such as medicine, nursing, psychology, software engineering were consulted for guidance and comments to improve the design of the game. Results: The digital educational game was named Cute Pet Butler. The framework of game system consists of five modules, including home page, shop and backpack, story, database, and background management modules. The core module is the story module where players are given tasks to help their pet to solve various HIV self-management problems. Conclusions: The development and sharing of the multidisciplinary theoretical framework adopted by Cute Pet Butler can help us clarify the design ideas and assumptions of digital educational games, understand the ability of educational games to change HIV self-management knowledge, emotion and behaviors, and promote the development of effective educational tools of digital games.
Background: The development of a medical device requires strict adherence to regulatory processes. Here the usability engineering process for The Prehab App is displayed. Prehabilitation in this conte...
Background: The development of a medical device requires strict adherence to regulatory processes. Here the usability engineering process for The Prehab App is displayed. Prehabilitation in this context is a new area in surgery that trains, coaches, and advises patients in mental well-being, nutrition, and physical activity. As staff is permanently drained from clinical care, remote and digital solutions with real-time assessments of data including patient-related outcome reporting may simplify preparation before major surgeries. Objective: The hypothesis was, that formative and summative usability testing would achieve 80% interrater, and intra-rater reliability and consistency and that the safety-relevant scenarios would uncover undetected risks of the medical device (standalone software class IIa). Methods: Eight experts and eight patients were asked to evaluate paper-based mockups, followed by an evaluation of the minimal viable product of The Prehab App at least more than 8 weeks later after instruction and training. The experts had to perform 5 and the patients 6 usability scenarios. The evaluations were measured with the MARS (mobile app rating scale) and Trustworthiness checklists (range 0-64 with higher scores indicating trustworthiness), usability scenarios received evaluation with the ‘After scenario questionnaire’ and a judgment by an observer. The time of performing the scenarios was recorded. Results: MARS achieved constant scores of more than 4 out of 5 points for experts and patients. The Trustworthiness score was 51,3 ± 2,7 in the experts and 50,8 ± 2,1 in the lays group (p=0,68) in Task I. The interrater correlation, shown by the Fleiss-Kappa value was 0,87 [0,85;0,89] for all raters (n=18) reflecting almost perfect agreement, and 0,86 [0,82; 0,91] for the expert group (n=8) and 0,88 [0,84; 0,93] for the lays group (n=8) reflecting the almost perfect agreement between the raters. This indicated the high quality of the usability. The usability scenarios were performed with ease except for the onboarding part when connecting the wearable was required. This took a considerable amount of time and was recognized as a challenge for good usability. Conclusions: The formative and summative evaluation of ‘The Prehab App’ design resulted in very good to acceptable results of the design and usability of the critical and safety-relevant areas of the medical device and standalone software. Usability testing improves medical devices early in the design and development process, reduces errors, mitigates risks, and delivers a profound ethical and medical justification for a randomized controlled trial of ‘The Prehab App’ in a remote setting as a next step in the development process. Clinical Trial: The trial received a positive vote by the Frankfurt University institutional review board (IRB) on November 11th, 2021 (2021-483-MDR) and was approved by the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) on February 7th, 2022 (German Medical Devices Information and Database System: DMIDS: 00013655; European Database on Medical Devices: EUDMAD: CIV-21-07-037311; German Study Registry: DRKS00026985).
Background: Asthma is a significant global health issue, impacting over 500,000 individuals in New Zealand and disproportionately affecting Māori communities in New Zealand, who experience worse asth...
Background: Asthma is a significant global health issue, impacting over 500,000 individuals in New Zealand and disproportionately affecting Māori communities in New Zealand, who experience worse asthma symptoms and attacks. Digital technologies, including Artificial Intelligence (AI) and Machine Learning (ML) models, are increasingly popular for prediction in the area of asthma. However, these AI models may under-represent minority ethnic groups and introduce bias, potentially exacerbating disparities. Objective: This study aims to explore the views and perceptions that Māori have toward using AI and ML technologies for asthma self-management, identify key considerations for developing asthma attack risk prediction models, and how to ensure Māori are represented in ML models without worsening existing health inequities. Methods: Semi-structured interviews were conducted with 20 Māori participants with asthma - three males and 17 females, aged 18 to 76 years. All the interviews were conducted one-on-one except for one interview that was conducted with 2 participants. Altogether, ten online interviews were performed, while the rest were kanohi ki te kanohi (face-to-face). Results: We identified four key themes: 1) Concerns about AI use, 2) Interest in using technology to support asthma, 3) Desired characteristics of AI-based systems and 4) Experience with asthma management. AI was relatively unfamiliar to participants, and they expressed concerns about trusting technology due to the previous history of colonisation but were interested in using technology to support their asthma management. We gained insights into user preferences regarding computer-based healthcare applications. Participants discussed their experiences, highlighting problems with healthcare quality and limited access to resources. Conclusions: The exploration revealed that there is a need for greater information about AI and technology for Māori communities, and trust issues relating to the use of technology. Expectations in relation to computer-based applications for health purposes were expressed. The research outcomes will inform future investigations on AI and technology to enhance the health of people with asthma, in particular those designed for indigenous populations in New Zealand.
Background: To ensure that an eHealth technology fits with its intended users, other stakeholders, and the context within which it will be used, thorough development, implementation, and evaluation pr...
Background: To ensure that an eHealth technology fits with its intended users, other stakeholders, and the context within which it will be used, thorough development, implementation, and evaluation processes are necessary. The CeHRes (Centre for eHealth Research & Wellbeing) Roadmap is a framework that can help shape these processes. While it has been successfully used in research and practice, new developments and insights have arisen since the Roadmap’s first publication in 2011 – not just within the domain of eHealth, but also within the different disciplines in which the Roadmap is grounded. Because of these new developments and insights, a revision of the Roadmap was imperative. Objective: The objective of this viewpoint paper is to present the updated pillars and phases of the CeHRes Roadmap 2.0. Methods: The Roadmap was updated based on four types of sources: (1) experiences with its application in research, (2) literature reviews on eHealth development, implementation and evaluation, (3) discussions with eHealth researchers, and (4) new insights and updates from relevant frameworks and theories. Results: The updated pillars state that eHealth development, implementation and evaluation (1) are ongoing and intertwined processes, (2) have a holistic approach in which context, people, and technology are intertwined, (3) consist of continuous evaluation cycles, (4) require active stakeholder involvement from the start, and (5) are based on interdisciplinary collaboration.
The CeHres Roadmap 2.0 consists of five interrelated phases, of which the first is the contextual inquiry, in which an overview of the involved stakeholders, the current situation, and points of improvement is created. The findings from the contextual inquiry are specified in the value specification, in which the foundation for the to-be-developed eHealth-technology is created by means of formulating values and requirements, preliminarily selecting behaviour change techniques and persuasive features, and initiating a business model. In de Design phase, the requirements are translated into several lo- and hi-fi prototypes that are iteratively tested with end-users and/or other stakeholders. A version of the technology is rolled out in the operationalization phase, using the business model and an implementation plan. In the summative evaluation phase, the impact, uptake and working mechanisms are evaluated using a multi-method approach. All phases are interrelated by continuous formative evaluation cycles that ensure coherence between outcomes of phases and alignment with stakeholder needs. Conclusions: While the CeHRes Roadmap 2.0 consists of the same phases as the first version, the objectives and pillars have been updated and adapted, reflecting the increased emphasis on behaviour change, implementation, and evaluation as a process. There is a need for more empirical studies that apply and reflect on the CeHRes Roadmap 2.0 to provide points of improvement, because just as any eHealth technology, the Roadmap has to be constantly improved based on input of its users.
Background: In today's connected world, marked by the widespread use of social media and the internet, obesity and depression rates are increasing concurrently on a global scale. This study investigat...
Background: In today's connected world, marked by the widespread use of social media and the internet, obesity and depression rates are increasing concurrently on a global scale. This study investigated the complex dynamics involving social media recruitment for scientific research, race, ethnicity, and depression among metabolic and bariatric surgery (MBS) candidates. Objective: The research aimed to determine (1) the association between social media recruitment and depression among MBS candidates and (2) racial and ethnic differences in social media recruitment engagement. Methods: The analysis included data from 380 adult MBS candidates enrolled in a prospective cohort study from July 2019 to December 2022. Race/ethnicity, recruitment method (social media Y/N), and depression status were evaluated using chi-square tests and logistic regression models. Age, sex, and ethnicity were adjusted in multivariable logistic regression models. Results: Our sample mean (standard deviation) age was 47.35 (11.6) years old, with a range from 18 to 78 years old. Participants recruited through social media were more likely to report past or current episodes of depression (38.32% social media vs. 27.11% non-social media, P=0.032), with a 67% increased likelihood (OR=1.67, 95% CI 1.04–2.68, P=0.033) compared to non-social media recruits. Further analysis showed that participants with a history of depression who were below the mean sample age were 2.31 times more likely to be recruited via social media (aOR=2.31, 95% CI 1.10–4.84, P=0.027) compared to those aged above the sample mean. Hispanic and non-Hispanic White participants were significantly more likely to be recruited via social media than non-Hispanic Black participants (38.81% vs. 35.10% vs. 18.37%, respectively, P<0.001). After adjusting for age and sex, non-Hispanic Black participants were 57% less likely than non-Hispanic white participants to be recruited via social media (aOR=0.43, 95% CI 0.24–0.76, P=0.003). Conclusions: We found that individuals recruited through social media channels were more likely to report past or current episodes of depression compared to those recruited through non-social media means, especially in younger participants. Results also showed that non-Hispanic blacks are less likely to engage in social media recruitment for scientific research versus other race/ethnic groups. Future mental health-related studies should consider strategies to mitigate potential biases introduced by recruitment methods, ensuring the validity and generalizability of research findings.
This paper discusses the specific characteristics of any hypothetical cognitive space that may be modelled in
order to automate (or partially automate) the kind of mental health clinical reasoning -...
This paper discusses the specific characteristics of any hypothetical cognitive space that may be modelled in
order to automate (or partially automate) the kind of mental health clinical reasoning - clinical or psychological
case formulation - that is used by mental health professionals. It argues that work into the use of generative
artificial intelligence (AI) in the field of mental health needs to consider three components of this kind of
clinical reasoning. Firstly, heterotopy. When mental health clinical reasoning statements are made, parsing them
does not result in the same representation when the same words are used, due to the fact that mental health
ontologies contain multiple meanings for the same words. Secondly, orthogonality. Variables relevant to mental
health may not causally intersect but may both be relevant for clinical case formulation and treatment
determination. Thirdly, veridicality. The truth of a clinical case formulation may not be determined by any
testable observations. Even treatment response may not allow for a determination of truth., The truth status of a
clinical case formulation may hinge principally on the degree to which it confers meaning or understanding of a
mental state on the person who is experiencing that mental state, and that truth may be different to the truth
judgements of a mental healthcare clinician. Automated clinical case formulation models need to accommodate
for these features of the cognitive space of mental health clinical case formulation.
Background: In recent years, there have been many studies on the adaptation of patient decision support tools, but there is a lack of methodological research on the adaptation of patient decision supp...
Background: In recent years, there have been many studies on the adaptation of patient decision support tools, but there is a lack of methodological research on the adaptation of patient decision support tools. Objective: This scoping review aims to summarize the steps for adapting patient decision aids (PDAs) based on current research and to explore related methodologies. Methods: A systematic search of the PubMed, Cochrane Library, EMBASE, CINAHL, Web of Science, CNKI, WANFANG, VIP, and SinoMed databases and grey literature was conducted up to January 2024. The search terms focused on patient decision aids and their adaptation. The results were integrated through statistical and thematic analysis. Results: Twenty-five studies were included. Eight steps for adapting PDAs were identified, including defining decision problems and options; assessing local cultural backgrounds; translating; adjusting PDA language style, content, and presentation; creating an initial version of the PDA; conducting acceptability testing; conducting feasibility testing; and PDA revisions. Only a few studies followed a rigorous process for adapting PDAs, and most research did not undertake steps such as local cultural background assessment and feasibility testing due to challenges related to sample size acquisition, cultural diversity, and complexity. Conclusions: This study focused on the steps of language style, content, presentation adjustment, and acceptability testing in the overall process of formulating the steps for adapting decision support tools, adapting these tools, and identifying specific methods for acceptability testing. This study enhanced the quality assessment indicators for PDA language style, content, and presentation adjustments to provide a reference for subsequent research. However, gaps still exist in the evaluation standards for the language style, content, and presentation of PDAs that should be addressed by future research.
Background: Vocational school students exhibit a high prevalence of addictive behaviors. Digital prevention programs targeting multiple addictive behaviors and promoting life skills are promising. Tai...
Background: Vocational school students exhibit a high prevalence of addictive behaviors. Digital prevention programs targeting multiple addictive behaviors and promoting life skills are promising. Tailoring intervention content to participants’ preferences, such as allowing them to choose behavior modules, may increase engagement and efficacy. However, there is limited understanding of how personal characteristics relate to module choices and their alignment with prevention needs. Objective: This paper examines the prevention needs of German vocational school students as well as their prevention preferences through self-determined module choice in the multi-behavior app-based addiction prevention program "ready4life". Methods: A two-arm cluster-randomized trial recruited German vocational students aged 16+ years. Among 376 classes from 35 schools, "ready4life" was introduced during a school lesson. Students were invited to download the "ready4life" app, and completed an anonymous screening with individualized risk and competence feedback in form of a traffic light system. Informed consent was given by 2568 students. Intervention classes received individual app-based coaching, with weekly chat contacts with a virtual coach over four months. They could choose two out of six modules: alcohol, tobacco, cannabis, social media/gaming, stress and social competencies. Module choice was self-determined. Control group classes received a link to health behavior information and could access coaching after 12 months. Results: Prevention need was high. For 86% two or more risks were reported according to a yellow or red traffic light feedback. Within the intervention group, stress (818/1236, 66.2%) and social media/gaming (625/1236, 50.6%) were the most chosen topics, followed by alcohol (360/1236, 29.1%), social competencies (306/1236, 24.8%), tobacco (232/1236, 18.8%), and cannabis (131/1236, 10.6%). Module choices closely aligned with received traffic light feedback, particularly among those with one or two risks. Multilevel regression models showed females were significantly more likely to choose the stress module (P<.001; OR 2.38, 95% CI 1.69-3.33), while males preferred social media/gaming (P<.001; OR 0.52, 95% CI 0.40-0.69), alcohol (P<.001; OR 0.50, 95% CI 0.37-0.67) and cannabis (P<.001; OR 0.37, 95% CI 0.21-0.63), when holding age, education track and prevention need for the respective behavior constant. Younger students were significantly more likely to choose the cannabis module (P<.001; OR 0.81, 95% CI 0.74-0.90). Educational track also influenced module choice, e.g., health, social affairs, teaching and education tracks had the highest likelihood of choosing the stress module. Students’ prevention needs significantly influenced choice of the corresponding module, e.g., higher alcohol consumption increased the likelihood of choosing the alcohol module (P<.001; OR 1.31, 95% CI 1.20-1.43). Conclusions: Our study confirms vocational students' high prevention needs regarding addictive behaviors. A key finding was the high congruence between students' module choices and their demonstrated needs, with most students being interested in the stress module. Module choice also differed by age, gender, and educational track. Clinical Trial: German Clinical Trials Register (DRKS): DRKS00022328
Background: The cost of healthcare in many countries is increasing rapidly. There is a growing interest in using machine learning to predict high healthcare utilizers for population health initiatives...
Background: The cost of healthcare in many countries is increasing rapidly. There is a growing interest in using machine learning to predict high healthcare utilizers for population health initiatives. Previous studies have focused on individuals who contribute to the highest financial burden. However, this group is small and represents a limited opportunity for long-term cost reduction. Objective: We developed an ensemble of models that predict future healthcare utilization at various thresholds. Methods: We utilized data from a multi-institutional diabetes database from the year 2019 to develop binary classification models. These models predict healthcare utilization in the subsequent year across six different outcomes: patients having a length of stay of ≥7, ≥14, and ≥30 days, and emergency department (ED) attendance of ≥3, ≥5, and ≥10 visits. To address class imbalance, random and synthetic minority oversampling techniques were employed. The models were then applied to unseen data from 2020 and 2021 to predict healthcare utilization in the following year. A portfolio of performance metrics, with a priority on area under the receiver operating curve (AUC), sensitivity and positive predictive value was used for comparison. Results: When trained with random oversampling, four models – logistic regression, multivariate adaptive regression splines, boosted trees, and multilayer perceptron – consistently achieved high AUC (>0.80) and sensitivity (>0.60) across training-validation and test datasets. Correcting for class imbalance proved critical for model performance. Key predictors for all outcomes included age, number of ED visits in the present year, chronic kidney disease stage, inpatient bed days in the present year, and mean HbA1c levels. Conclusions: We successfully developed machine learning models capable of predicting high service level utilization with robust performance. These models can be integrated into wider diabetes-related population health initiatives. Clinical Trial: Not Applicable
Background: In the healthcare field the digital revolution has changed the way in which healthcare is provided through the prevention, diagnosis and monitoring of people's health. In Catalonia, work h...
Background: In the healthcare field the digital revolution has changed the way in which healthcare is provided through the prevention, diagnosis and monitoring of people's health. In Catalonia, work has been conducted to evaluate the digital competence (DC) of healthcare professionals using a validated test based on the ACTIC (accreditation of competence in information and communication technologies) model. It is therefore important Objective: To determine the DC level of nursing students as future healthcare professionals. Methods: The aim of this study is to analyze the current DC level of students taking the Degree in Nursing at the Terres de l’Ebre Campus, Universitat Rovira i Virgili (URV), Catalonia, Spain. We have used a questionnaire to evaluate the DC level of these students. Results: Our sample comprised 147 students from various modules of the Degree in Nursing. Our results show differences in levels of self-perception and DC but also differences in the competence of students across the various academic years. Conclusions: Evaluating the level of competence of nursing degree students is fundamental for practising and enhancing the most important digital competencies required in the field of professional nursing
Background: With the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: T...
Background: With the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: The aim of this study was to investigate the impact of daily use of electronic devices on the risk of neurodegenerative diseases and brain structure. Methods: This longitudinal population-based cohort study analyzed the impact of mobile phone usage duration, weekly usage time, and other electronic device habits on future brain structure and the future risk of various neurodegenerative diseases, including all-cause dementia (ACD), Alzheimer's disease (AD), vascular dementia (VD), all-cause parkinsonism (ACP), and Parkinson's disease (PD). Results: The study included over 277,000 participants for risk analysis, with a mean baseline age of approximately 55.9 years. The average follow-up duration was approximately 13.9 years. Longer years of mobile phone usage were associated with a reduced risk of ACD, AD, and VD compared to rarely using mobile phones. Additionally, longer years of mobile phone usage were linked to a decreased risk of ACP and PD in participants aged older than 60 years. Neuroimaging analysis involved 35,643 participants, with an average duration of approximately 9.0 years between baseline and neuroimaging scans. Longer years of mobile phone usage were correlated with thicker cortex in various areas. Conclusions: Longer years of mobile phone usage were associated with a reduced risk of neurodegenerative diseases and improved brain structure compared to minimal usage. However, higher weekly usage time did not confer additional risk reduction compared to lower weekly usage.
Background: Patients often communicate with primary care centres remotely (e.g. by telephone or e-mail) before seeking in-person care. Some patients and providers are not fully satisfied with these ro...
Background: Patients often communicate with primary care centres remotely (e.g. by telephone or e-mail) before seeking in-person care. Some patients and providers are not fully satisfied with these routes. A novel route is to develop a patient-facing symptom entry website, which streamlines the subsequent triage process for clinicians. However, it remains unclear what the optimal set of features might be for such systems, and what benefits they may bring to providers. Objective: To evaluate a patient-facing personalised symptom-entry website (developed by Certific OÜ, Estonia) for its acceptability to primary health care providers. Methods: In-depth interviews were conducted in 8 primary care centres in Estonia, covering 8 nurses and 6 doctors, 3-6 months after the implementation of a novel patient-facing website. Results: The software was well received by the staff with all interviewees expressing desire that more patients initiate their remote query via the website. As compared to an e-mail request, the software was reported to satisfy staff concerns for privacy and data security which they felt to be important; save provider time and effort needed for gathering sufficient detail for triage; and helped structure patient symptom descriptions to free provider time from having to synthesize free-text. Staff concerns about safety with the new software were effectively alleviated by implementation decisions to integrate the new software alongside telephone requests. Challenges reported by staff included the effort needed to get patients to use the website. While previous research has criticised poorly-designed multiple-choice systems, our findings suggest that an appropriately designed and personalised multiple-choice system is preferable to healthcare staff, as it lowers their cognitive demands, workload and may enhance workplace wellbeing. Conclusions: Interviewed primary healthcare staff felt that the symptom entry and information condensing system designed by Certific was highly acceptable and desirable. They particularly valued a perceived reduction in cognitive demands. This holds promise for increasing staff wellbeing, reducing provider workload and increasing efficiency, which could be assessed in future studies.
Background: Previous studies have found and confirmed a correlation between cognitive disorder and chemotherapy. As genetic testing becomes more routine in clinical practice, targeted therapies are in...
Background: Previous studies have found and confirmed a correlation between cognitive disorder and chemotherapy. As genetic testing becomes more routine in clinical practice, targeted therapies are increasingly assuming prominence. The relationship between targeted treatment and cognitive function is not yet clear. Objective: This study aims to investigate the correlation between cognitive disorder and targeted treatment by evaluating the changes in cognitive function before and after targeted therapy. Methods: From the screened cohort of 150 patients suffering from advanced non-small-cell lung cancer with gene mutations, 87 were rigorously selected for the study. The evaluation instruments utilized included the MMSE scale, the Distress Thermometer (DT), and the EORTC QLQ-C30 scale for assessing the quality of life. Results: A significantly lower Progression-Free Survival (PFS) was observed in the group of surviving advanced NSCLC patients with cognitive disorders under targeted therapy, in contrast to no cognitive disorder group survivors (HR, 0.347; 95% CI, 0.209-0.578; P < 0.001). Furthermore, the Objective Response Rate (ORR) and Disease Control Rate (DCR) for the group with cognitive disorders were noted to be 37.8% and 86.7% respectively, contrastingly lower than no cognitive disorder group, recorded at 78.6% and 97.6%. Significant variances were also noted in the MMSE scores between the patients with and without cognitive disorders, both pre and post targeted therapy (P < 0.001, P < 0.001) , with a decrease trend observed in both groups post targeted therapy. Noteworthy differences were found in Quality of Life scores both pre and post targeted therapy (P < 0.001, P < 0.001). Also, notable disparities were apparent in C-reactive protein levels among the two groups, pre and post treatment (P=0.03, P=0.048), with an upward trend observed in both groups post targeted therapy. Conclusions: The potential impact of cognitive disorders was discovered on the efficacy of targeted therapies in oncogene-driver positive NSCLC patients. Furthermore, during targeted therapy, the MMSE score was positively correlated with the quality of life and inversely related to psychological distress. Meanwhile, the inflammatory marker, C-reactive protein, was found to exhibit a correlation with psychological distress.
Background: Internet gaming disorder (IGD) is a prevalent public health issue among adolescents. Few studies have, however, examined the relationships between IGD symptoms, low self-control, and meani...
Background: Internet gaming disorder (IGD) is a prevalent public health issue among adolescents. Few studies have, however, examined the relationships between IGD symptoms, low self-control, and meaning in life (MIL). Objective: The present study aimed to examine the mediating role of IGD symptoms in the relationships between low self-control and meaning in life and adolescents’ family and school functioning. Methods: A sample of 2,064 adolescents (46.9% females, mean age = 14.6 years) was recruited from five middle schools in Sichuan, China in 2022. Indirect effects of low self-control and MIL on family and school functioning via IGD symptoms were analyzed via structural equation modeling (SEM). Results: All scales showed satisfactory model fit and scalar measurement invariance by gender. Males showed significantly greater IGD symptoms and lower levels of self-control than females. Impulsivity, temper, search for meaning, and lower presence of meaning were significantly associated with greater IGD symptoms. There were significant indirect effects from impulsivity, temper, and presence of meaning to family and school functioning via IGD symptoms. Multigroup SEM across gender found that the positive association between search for meaning and IGD symptoms existed in males but not females. Presence of meaning significantly and negatively moderated the association between impulsivity and IGD symptoms. Conclusions: The findings support a mediating role of IGD symptoms in the relationships between low self-control and MIL and functioning and a buffering role of MIL on the associations between impulsivity and IGD symptoms among the ethnic minority adolescents. The results have implications for targeted interventions to help males with lower self-control and presence of meaning.
Background: The use of Large Language Models (LLMs) as writing assistance for medical professionals is a promising approach to reduce the time required for documentation, but there may be practical, e...
Background: The use of Large Language Models (LLMs) as writing assistance for medical professionals is a promising approach to reduce the time required for documentation, but there may be practical, ethical, and legal challenges in many jurisdictions complicating the use of the most powerful commercial LLM solutions. Objective: In this study, we assess the feasibility of using non-proprietary LLMs of the Generative Pretrained Transformer (GPT) variety as writing assistance for medical professionals in an on-premise setting with restricted compute resources, generating German medical text. Methods: We train four 7B parameter model variants for our task and evaluate their performance using a powerful commercial LLM, namely Anthropic’s Claude-v2 as a rater. Based on this, we select the best performing model and evaluate its practical usability with two independent human raters on real world data. Results: In the automated evaluation with Claude-v2 BLOOM-CLP-German, a model trained from scratch on German text, achieved the best results. In the manual evaluation by human experts, 95 of the 102 reports generated by that model were evaluated as usable as is or with only minor changes by both human raters (93.1%). Conclusions: The results show that even with restricted compute resources it is possible to generate medical texts that are suitable for documentation in routine clinical practice, but that language issues need to be considered when processing non-English text.
Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limite...
Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. Objective: The objective of this study was to investigate the perceptions and acceptance of clinicians and people with concussion using MyGuide Concussion, an online concussion self-management tool. Methods: Using a mixed-methods content analysis approach, people with concussion and clinicians who used MyGuide Concussion over the past two years were interviewed and their responses were analyzed. Results: Participants reported two key benefits of using the online self-management tool: 1) the tool’s emphasis on the interconnectedness of physical and psychological symptoms, and 2) the ability to provide reassurance that symptoms being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions, and believed the content was useful for increasing clients’ independence in managing their own recovery. Conclusions: Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for people with concussion that require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use. Clinical Trial: N/A
Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. The lay theories of self-control (i.e., the belief about whether self-control can be improved,...
Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. The lay theories of self-control (i.e., the belief about whether self-control can be improved, also called self-control mindset) may interplay with self-control and gaming disorder. Objective: This is a pioneer study to examine the longitudinal associations between self-control mindset and the severity of gaming disorder symptoms with a one-year, two-wave, school-based longitudinal survey. Methods: A total of 3,264 students (338 in Grades 4-5 and 2,926 in Grades 7-10) from 15 schools in Hong Kong participated in the classroom surveys. We employed cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder. Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity. Subgroup analyses of boy and girl participants revealed that growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls but not in boys, while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys and girls after one year. Conclusions: Our findings demonstrated the negative impact of gaming disorder on one’s self-control belief and also implied that promoting a growth mindset regarding self-control is a promising strategy for gaming disorder prevention and early intervention, especially for girls.
Background: Virtual reality (VR) is a type of extended reality (XR) technology increasingly used by rehabilitation practitioners to support rehabilitation following illness or injury that affect the u...
Background: Virtual reality (VR) is a type of extended reality (XR) technology increasingly used by rehabilitation practitioners to support rehabilitation following illness or injury that affect the upper limbs. There is robust evidence articulating how consumer-grade VR presents significant cyber security implications, such as security and privacy risks with software and hardware interfaces and use of cameras. However, little is known about how these risks translate in the use of VR systems in healthcare settings. The objective of this review is to identify cyber security risks associated with clinical VR systems, and to develop guidance for health informatics and rehabilitation practitioners to support the safe use of VR in healthcare. Objective: This scoping review aims to identify cyber security and privacy risks to XR technologies and components, including threats, attacks and attackers, with a focus on VR. Furthermore, we aim to understand how these risks can be mitigated in a clinical XR environment, in particular VR environment, by understanding the unique concerns for a healthcare setting and identifying relevant technologies, frameworks and strategies to mitigate these risks. Methods: A scoping review of the literature performed in one database (Google Scholar) identified 482 articles from the years 2017 to 2024. After abstract screening, 53 studies were extracted for a full text review, of which 29 were included in the analysis. The review followed the PRISMA extension for Scoping Reviews, and publications were reviewed using the Covidence software. Data on technology, cyber threats and risk mitigation were extracted. Results: Of the included studies, 79% were published between 2020 and 2023, and 55% focused on VR. The majority identified a privacy threat or mitigation strategy or both (26 papers, 90%). 90% of the XR components investigated were head-mounted display (HMD) devices and the greatest cyber threat identified to these components was information disclosure (76%). Risk mitigation strategies were mapped against the National Institute of Standards and Technology (NIST) Cybersecurity Framework, where 62% of studies identified a preventative mitigation strategy (18/29). The least established cyber security function for XR systems was recovery after a cyber security incident, with only one potential strategy. Conclusions: Findings were mapped against an enterprise risk management (ERM) model to contextualise cyber security risks for healthcare organisations. The most significant threat posited for a healthcare VR system was privacy threats, which can disclose personal data from which medical related data may be inferred, and immersive manipulation threats, which can impact user safety. Many potential mitigation strategies were identified for all types of threats, but none have been implemented beyond a proof-of-concept. None of the threats or mitigations have been studied in a healthcare context, which requires further research.
Background: The field of mental health technology presently has significant gaps that need addressing, particularly in the domain of daily monitoring and personalized assessments. Current non-invasive...
Background: The field of mental health technology presently has significant gaps that need addressing, particularly in the domain of daily monitoring and personalized assessments. Current non-invasive devices like wristbands and smartphones are capable of collecting a wide range of data, which has not yet been fully utilized for mental health monitoring. Objective: The paper aims to introduce a novel dataset for Personalized Daily Mental Health Monitoring and a new Macro-Micro Framework. This framework is designed to employ multimodal and multitask learning strategies for improved personalization and prediction of emotional states in individuals. Methods: Data was collected from 242 individuals using wristbands and smartphones, capturing physiological signals, speech data, and self-annotated emotional states. The proposed framework combines macro-level emotion transformer embeddings with micro-level personalization layers specific to each user. It also introduces a dynamic restrained uncertainty weighting method to effectively integrate various data types for a balanced representation of emotional states. Several fusion techniques, personalization strategies, and multitask learning approaches were explored. Results: The proposed framework was evaluated using the Concordance Correlation Coefficient (CCC), resulting in a score of 0.503. This result demonstrates the framework's efficacy in predicting emotional states. Conclusions: The paper concludes that the proposed multimodal and multitask learning framework, which leverages transformer-based techniques and dynamic task weighting strategies, is superior for the personalized monitoring of mental health. The study indicates the potential of transforming daily mental health monitoring into a more personalized application, opening up new avenues for technology-based mental health interventions.
Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples....
Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples. Incorporating patients as stakeholders and meaningfully engaging them in biomedical research first requires transparency of research activities. Objective: Here we describe the process and results of using participatory design methods to build a mobile application in which breast cancer patients could learn about their biospecimens collected for research, the status of their use in research protocols, and about the breast disease biobank collection. This decentralized biobanking application (“de-bi”) provided patient-friendly interfaces overlaying institutional biobank databases. Methods: This research occurred in two phases. In Phase 1, we designed app screens containing different information that patients could learn about ongoing research involving their samples. Embedding these screen designs in a survey, we sought to gauge patients’ interests in receiving information about research or about their biospecimens. We engaged some survey respondents in short interviews to discern their views on the importance of having this information and their opinions on its presentation and design. We held a design workshop in which participants gave feedback on the screens and suggested improvements.
For Phase 2, we then refined the user interfaces developed a functional app prototype. As we developed the app, we consulted institutional stakeholders to enhance compatibility with regulations and local data architectures. We then presented the app at a second workshop, where participants shared thoughts on usability and design of the app. In this phase we also conducted cognitive walkthroughs with individual participants to measure their success in using the app and to gain in-depth feedback on its functionality. Results: Survey and interview participants were interested in learning the status of their donated biospecimens (47%), the outcomes of research done on their specimens (30%), and in connecting with other patients similar to them. A design workshop assessing initial app screens revealed confusion in language and data presentation, though participants wanted to learn about their samples and expressed interest in using an app to do so.
A second design workshop and cognitive walkthroughs assessed a functioning mobile app prototype integrated with institutional biobank data. These activities revealed further interest in the ability to track and learn about donated biospecimens. Half of participants struggled with the onboarding process. These results informed updates to the app design and functionality. Conclusions: Designing a patient-facing mobile app that displays information about biobanked specimens can facilitate greater transparency and engagement in biomedical research. Co-designing the app with patient stakeholders confirmed interest in learning about biospecimens and related research, improved presentation of data, and ensured usability of the app in preparation for a pilot study.
Background: Paraphasias are speech errors that are often characteristic of aphasia and they represent an important signal in assessing disease severity and subtype. Traditionally, clinicians manually...
Background: Paraphasias are speech errors that are often characteristic of aphasia and they represent an important signal in assessing disease severity and subtype. Traditionally, clinicians manually identify paraphasias by transcribing and analyzing speech-language samples, which can be a time-consuming and burdensome process. Automatic paraphasia detection can greatly help clinicians with the transcription process and ultimately facilitate more efficient and consistent aphasia assessment. Objective: This study investigates a novel machine learning framework for automatic paraphasia detection that is trained end-to-end (i.e., a unified network that takes speech audio as input and outputs text that indicates what was said and identifies which words are paraphasias). We use the AphasiaBank corpus, which contains audio data collected from persons with aphasia (PWAs) that has been transcribed and labeled with paraphasias by trained speech-language pathologists. Methods: We propose a novel sequence-to-sequence (seq2seq) architecture for performing both automatic speech recognition (ASR) and paraphasia detection tasks. We explore the impact of leveraging pretrained speech models as well as different learning objectives for optimizing this model. This approach can be advantageous in learning synergistic representations that benefit both ASR and paraphasia detection tasks. We compare against a previous state-of-the art method that uses a multi-step pipeline approach consisting of ASR, hand-engineered feature extraction, and paraphasia detection. Results: We show that the proposed seq2seq is able to outperform the multi-step pipeline approach for word-level and utterance-level paraphasia detection. We achieve word-level performance improvements of 16.9%, 36.4%, and 9.5% and utterance-level improvements of 5.2%, 13.9%, 18.9% for phonemic, neologistic, and phonemic+neologistic paraphasias, respectively. Conclusions: These results highlight the performance improvements of learning to detect paraphasias end-to-end rather than through a multi-step pipeline approach with separate ASR and paraphasia detection models. The advantage of learning both ASR and paraphasia detection tasks end-to-end is that this unified model can learn joint representations that are beneficial to both ASR and paraphasia detection tasks rather than optimizing both of these separately. Future work will explore the efficacy of a deployed paraphasia detection model at assisting medical professionals with annotation.
Introduction:
The evolving global health landscape highlights the importance of travel medicine, making it necessary for healthcare professionals to understand the epidemiologic profiles among varied...
Introduction:
The evolving global health landscape highlights the importance of travel medicine, making it necessary for healthcare professionals to understand the epidemiologic profiles among varied traveler populations and keep themselves updated in this rapidly changing field.
However, in Italy, travel medicine clinics have significant gaps in resource allocation, staff training, and infrastructure. This is the protocol of a cross-sectional study that aims to create and validate a questionnaire to assess the knowledge, attitudes, and practices of healthcare professionals in travel medicine in Italy. The final goal is to provide a tool to evaluate the state of travel medicine, guide training initiatives, and monitor trends over time.
Methods:
The study population consists of healthcare professionals who practice travel medicine in Italy. The questionnaire will be developed by adapting an existing English survey and conducting a scoping review to align the questionnaire with contemporary scientific discourse. The validation process includes face validity, content validity, and expert evaluation. The sample size, determined through power analysis, ranges from 218 to 278 participants. The questionnaire will undergo a pilot test on a smaller sample size (10% of the total) to identify and address any issues. Statistical analysis will include central tendency and dispersion measures, categorical summaries, group comparisons, and regressions.
This research received ethical approval and informed consent will be collected from all participants.
Discussion:
This cross-sectional study will guide strategic planning and targeting training and awareness activities in areas deemed most critical or lacking.
The study's structured approach and periodic assessments will facilitate the identification of educational gaps, the dissemination of best practices, and the overall improvement of healthcare services for travelers in Italy.
Background: Exercise intervention is effective in managing diabetes when delivered in a personalized manner. Personalization of exercise intervention following a systematic fitness assessment can lead...
Background: Exercise intervention is effective in managing diabetes when delivered in a personalized manner. Personalization of exercise intervention following a systematic fitness assessment can lead to better health outcomes Objective: This study aimed to analyze the effect of digitally delivered fitness assessments and exercise prescriptions on the fitness and health outcomes of people with diabetes. Methods: Participants diagnosed with type 2 diabetes (n=86) enrolled in the Fitterfly Diabetes program which included interventions in nutrition, fitness, and mental health delivered via a digital platform. The participants underwent a video call-based fitness assessment consisting of the 1-minute push-up test, wall sit test, 1-minute sit-up test, V-sit and reach test, and 6-minute walk test. Trained physiotherapists conducted the assessments, developed personalized exercise plans, and shared them with the participants via the app. Regular follow-ups were taken. The participants were re-assessed after 90 days. Results: There was a statistically significant improvement in the fitness-related outcome measures (p<0.05), the anthropometric measures (p<0.05), and HbA1c (p<0.05) post-intervention. Improvement in exercise duration was associated with better outcomes in fitness tests and anthropometric measures. Conclusions: Personalized exercise intervention delivered digitally can help achieve better health outcomes in people with type 2 diabetes.
Background: The aging population in China is becoming increasingly severe, and there is a health inequality phenomenon among urban and rural elderly. With the development of ICT, eHealth has become on...
Background: The aging population in China is becoming increasingly severe, and there is a health inequality phenomenon among urban and rural elderly. With the development of ICT, eHealth has become one of the important factors affecting health. Urban elderly could more conveniently access health information and medical services, while rural elderly may have difficulty enjoying the digital dividends brought by eHealth, highlighting the phenomenon of the “digital health divide”. Objective: This study analyzes the digital health divide and determinants among urban and rural elderly from the perspective of capital theory. Methods: The model for analyzing the digital health divide among urban and rural elderly is constructed based on capital theory. Analysis of variance is used to verify the digital health divide among urban and rural elderly. Structural equation modeling is used to analyze the factors, and the Blinder-Oaxaca decomposition method is used to analyze the main causes. Results: There are three levels of digital health divide among urban and rural elderly, namely digital access divide (F=11.39, P<.01), digital usage divide (F=39.53, P<.001), and digital outcome divide (F=30.20, P<.001). The influence of different levels of divide is transmitted along the digital chain, the impact coefficient of digital access divide on digital usage divide is β=0.060 (P<.05), and digital usage divide on digital outcome divide is β=0.363 (P<.001). The digital usage divide is the most significant level, and cultural capital (β=0.221, P<.001), social support (β=0.361, P<.001), economic capital (β=0.111, P<.01), and habits (β=0.248, P<.001) are most dominant factors contributing to the rural-urban digital usage divide. The Blinder-Oaxaca decomposition results further indicate that cultural capital (33.9%) and social capital (22.5%) are the main factors influencing digital usage divide among urban and rural elderly. Conclusions: here exists digital health divide among urban and rural elderly, and the influence of three level of divide is transmitted along the digital chain. The digital usage divide is the main level, cultural capital and social capital are the main reasons for its formation. To against these divides among urban and rural elderly, interventions in policy, society, technology, and economics are recommended.
Background: Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits...
Background: Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits to the emergency department and/or readmission to the hospital. Digital home monitoring (DHM) may improve postoperative care compared to standard methods. Objective: We conducted a feasibility study for a randomized controlled trial (RCT) to assess DHM's effectiveness following thoracic surgical procedures compared to standard care. Methods: We conducted a two-arm parallel-group pilot RCT at a single tertiary care center. Adult patients undergoing thoracic surgical procedures were randomized 1:1 into two groups: the digital home monitoring (DHM group) and the standard of care (control group). We adhered to the intention-to-treat analysis principle. The primary outcome was predetermined RCT feasibility criteria. The trial would be feasible if more than 75% of trial recruitment, protocol adherence, and data collection were achieved. Secondary outcomes included 30-day emergency department visit rates, 30-day readmission rates, postoperative complications, length of stay, post-discharge 30-day opioid consumption, 30-day quality of recovery (QOR-40), patient/program satisfaction, caregiver satisfaction, healthcare provider satisfaction and cost-per-case. Results: All RCT feasibility criteria were met. The trial recruitment rate was 87.9% (95% CI: 79.4% – 93.8%). Protocol adherence and outcome data collection rates were 96.3% (95% CI: 89.4% - 99.2%) and 98.7% (95% CI: 92.9% - 99.9%), respectively. Eighty patients were randomized, with 40 (50%) in the DHM group and 40 (50%) in the control group. Baseline patient and clinical characteristics were comparable between the two groups. The DHM group had fewer unplanned ED visits (2.7% vs. 20.5%; p=.02), fewer unplanned admission rates (0% vs. 7.6%; p=.24), lower rates of postoperative complications (20% vs. 47.5%, p=.01) shorter hospital stays (4.0 vs. 6.9 days; p=.05), but more opioid consumption (111.6 ± 110.9 vs. 74.3 ± 71.9 mg morphine equivalents; p=.08) compared to the control group. DHM also resulted in shorter ED visit times (130 ± 0 vs. 1048 + 1093 minutes; p=.48) and lower cost per case ($12,145 ± 8,779 vs. $17,247 ± 15,313; p=.07). The quality of recovery scores was clinically significantly better than the controls (185.4 ± 2.6 vs. 178.3 ± 3.3; p<.0001). All 37 patients who completed the intervention answered the program satisfaction survey questionnaires (100%; 95% CI: 90.5% - 100%). Only 36 out of 80 caregivers responded to the caregiver satisfaction questionnaires at the end of the 4th week post-hospital discharge (47.7%; 95% CI: 35.7% to 59.1%). Healthcare providers reported a 100% satisfaction rate. Conclusions: This pilot RCT demonstrates the feasibility of conducting a full-scale trial to assess DHM's efficacy in improving postoperative care following thoracic surgery. DHM shows promise for enhancing continuity of care and warrants further investigation. Clinical Trial: This study was registered with ClinicalTrials.gov (NCT04340960)
Background: Breast cancer is prevalent among women in the United States. Non-metastatic disease is treated by partial or complete mastectomy procedures. However, the rates of those procedures vary acr...
Background: Breast cancer is prevalent among women in the United States. Non-metastatic disease is treated by partial or complete mastectomy procedures. However, the rates of those procedures vary across practices. Generating real-world evidence on breast cancer surgery could lead to improved and consistent practices. Objective: The paper aims to determine whether All of Us data are fit for use in generating real-world evidence on mastectomy procedures. Methods: Our mastectomy phenotype consisted of adult female participants who had CPT4 or SNOMED codes for a partial or complete mastectomy procedure. We evaluated the phenotype with a novel data quality framework that consisted of five elements: conformance, completeness, concordance, plausibility, and temporality. Also, we used a previously developed adjectival rating matrix with categories of poor (providing little to no data), fair (using only internal EHR data), and good (using internal and external benchmark/data) to evaluate each data quality dimension (DQD). Our subgroup analysis compared partial to complete mastectomy procedure phenotypes. Results: There were 3,704 participants in the partial or complete mastectomy cohort. The geospatial distribution of our cohort varied substantially across states. For example, our cohort consisted of 817 (22.1%) participants from Massachusetts but fewer than 20 participants from multiple other states. We compared the sociodemographics of the partial (n = 2,445) and complete (n = 1,259) mastectomy subgroups. Those groups differed in the distribution of education (P = .02) and income (P < .001) levels using chi-square analysis. The DQD conformance was rated as good. A total of 3,216 (86.7%) participants in our cohort had CPT4 codes for a mastectomy that did not conform to a SNOMED standard. The DQD completeness was rated as fair. The prevalence of breast cancer related concepts was higher in our cohort compared to adult female participants who did not have a mastectomy procedure (P < .001). The DQD concordance was rated as fair. In both the partial and complete mastectomy subgroups, the correlations among concepts were consistent with the clinical management of breast cancer. The DQD plausibility was rated as fair. Although we did not have external benchmark comparisons, the distributions of concepts by age group and time were consistent with expectations. The DQD temporality was rated as fair. The median time between biopsy and mastectomy was seven weeks. Conclusions: Our data quality framework was implemented successfully on a mastectomy phenotype. Moreover, the framework allowed us to differentiate breast-conserving therapy and complete mastectomy subgroups in the All of Us data. The results of our analysis could be informative for future breast cancer studies with the OMOP CDM.
Background: Understanding the similarities of cancer patients is essential to advancing personalized medicine, improving patient outcomes, and developing more effective and individualized treatments....
Background: Understanding the similarities of cancer patients is essential to advancing personalized medicine, improving patient outcomes, and developing more effective and individualized treatments. It enables researchers to discover important patterns, biomarkers, and treatment strategies that can have a significant impact on cancer research and oncology. In addition, the identification of previously successfully treated patients supports oncologists in making treatment decisions for a new patient who is clinically or molecularly similar to the previous patient. Objective: The planned review aims to systematically summarize, map, and describe existing evidence to understand how patient similarity is defined and used in cancer research and clinical care. Methods: To systematically identify relevant studies and to ensure reproducibility and transparency of the review process, a comprehensive literature search will be conducted in several bibliographic databases, including Web of Science, PubMed, LIVIVIVO, and MEDLINE, covering the period from 1998 to February 2024. After the initial duplicate deletion phase, a study selection phase will be applied using Rayyan, which consists of three distinct steps: Title and Abstract Screening, Disagreement Resolution, and Full-Text Screening. To ensure the integrity and quality of the selection process, each of these steps is preceded by a pilot testing phase. This methodological process will culminate in the presentation of the final research results in a structured form according to the PRISMA-ScR flowchart. The protocol has been registered in the Journal of Medical Internet Research (JMIR). Results: This protocol outlines the methodologies employed in conducting the scoping review. A search of the specified electronic databases and after removing duplicates resulted in 1,183 unique records. As of March 2024, the review process has moved to the full-text evaluation phase. At this stage, data extraction will be conducted using a pre-tested chart template. Conclusions: The scoping review protocol, centered on these main concepts, aims to systematically map the available evidence on patient similarity among cancer patients. By defining the types of data sources, approaches, and methods used in the field, and aligning these with the research questions, the review will provide a foundation for future research and clinical application in personalized cancer care. This protocol will guide the literature search, data extraction, and synthesis of findings to achieve the review's objectives.
Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the U.S., characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by...
Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the U.S., characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health (mHealth) platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across four distinct phases. In Phase 1, a comprehensive needs assessment will be conducted across three diverse schools, each employing a range of teaching methods, including in-person, online, and hybrid modalities. Following this, in Phase 2, school administrators and teachers undergo intensive training sessions on Neolth’s functionalities and intervention processes, as well as understanding barriers and facilitators of implementing a digital mental health program at their respective school. Phase 3 involves recruiting middle and high school students aged 11-18 from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, Phase 4 will include a year-long pretest-posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 has been successfully completed in August 2023, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study’s completion is scheduled for 2024, with data expected to provide insights into the real-world usage of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention’s efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies.
Background: Decision aids empower patients to understand how treatment options match their preferences. Choice experiments, a valuable method to clarify values used within decision aids, present patie...
Background: Decision aids empower patients to understand how treatment options match their preferences. Choice experiments, a valuable method to clarify values used within decision aids, present patients with hypothetical scenarios to reveal their preferences for treatment characteristics. Given the rise in research embedding choice experiments in decision tools and the emergence of novel developments in embedding methodology, a scoping review is warranted. Objective: This scoping review examines how choice experiments are embedded into decision tools and how these tools are evaluated, to identify best practices. Methods: This scoping review was conducted following best practices in line with the PRISMA extension for scoping reviews. The searchers were conducted on MEDLINE, PsycInfo, and Web of Science databases using key search terms. Data were extracted using data charting tables created in Excel. A narrative synthesis was used to summarize the data and illustrations were used to visualise the results using tables and figures. Results: Overall, 22 tools were included in the scoping review. The methodology, development and evaluation details of tools were extracted from 33 papers. These tools were developed for a variety of health conditions including musculoskeletal conditions, oncological conditions, and chronic conditions. Most tools (78%) originated in the USA. The primary purpose (91%) of these tools was to assist patients in comparing or choosing treatments. The most commonly included attributes in the choice tasks were efficacy and side effects. Adaptive conjoint analysis was the most frequent (10 tools) design approach. Conjoint analysis designs used a higher number of tasks (16 -20) while DCEs and adaptive conjoint analysis designs used low (6) to moderate (12) number of tasks. Sawtooth software was commonly used to embed choice tasks in the tools. After completing the choice tasks patients received tailored information in the form of attribute importance scores, highlighting which treatment characteristics mattered most to the patient based on their choices (16 tools), and/or a "best match" treatment recommendation aligned with the patient's preferences (5 tools). A high degree of heterogeneity was observed in the evaluation methodologies and outcome measures used to assess the decision tools. The decisional conflict scale emerged as the most frequently employed outcome measure. Conclusions: This study highlights several methodological challenges that require further investigation. Future research should focus on determining the most effective methods for embedding choice tasks in decision tools, presenting balanced information, and selecting suitable outcome measures to evaluate these tools.
Background: The recent mpox outbreak has resulted in 31,010 cases and 55 deaths in the U.S., and 91,417 cases worldwide from May 2022 to October 2023. Like other disease outbreaks (e.g., HIV) with per...
Background: The recent mpox outbreak has resulted in 31,010 cases and 55 deaths in the U.S., and 91,417 cases worldwide from May 2022 to October 2023. Like other disease outbreaks (e.g., HIV) with perceived community associations, mpox is at risk of causing stigma, exacerbating homophobia, and potentially hindering healthcare access and social equity. Objective: To synthesize discussions among sexual minority men and gender diverse (SMMGD) individuals on mpox, given limited representation of SMMGD voices in existing mpox literature. Methods: BERTopic (a topic modeling technique) was employed with human validations to analyze mpox-related tweets (n = 8,688; October 2020—September 2022) from 2,326
self-identified SMMGD individuals in the U.S.; followed by content analysis and geographic analysis. Results: BERTopic identified 11 topics: health activism (29.81%); mpox vaccination (25.81%) and adverse events (0.98%); sarcasm, jokes, emotional expressions (14.04%); COVID-19 and mpox (7.32%); government/public health response (6.12%); mpox symptoms (2.74%); case reports (2.21%); puns on the virus’ naming (i.e., monkeypox; 0.86%); media publicity (0.68%); mpox in children (0.67%). Mpox health activism negatively correlated with LGB social climate index at U.S. state level, ρ = -.322, P = .031. Conclusions: SMMGD discussions on mpox encompassed utilitarian (e.g., vaccine access, case reports, mpox symptoms) and emotionally-charged themes—advocating against homophobia, misinformation, and stigma. Mpox health activism was more prevalent in states with lower LGB social acceptance. Findings illuminate SMMGD engagement with mpox discourse, underscoring the need for more inclusive health communication strategies in infectious disease outbreaks to control associated stigma. Clinical Trial: NA
Background: Patients have recently gained federally mandated, free, and ready electronic access to clinicians’ computerized notes in their medical records (‘open notes’). This change from longs...
Background: Patients have recently gained federally mandated, free, and ready electronic access to clinicians’ computerized notes in their medical records (‘open notes’). This change from longstanding practice can benefit patients in clinically important ways, but studies show some patients feel judged or stigmatized by words or phrases embedded in their records. Therefore, it is imperative that clinicians adopt documentation techniques that help both to empower patients and minimize potential harms. Objective: At a time when open and transparent communication among patients, families and clinicians can spread more easily throughout medical practice, this inquiry aims to develop informed guidelines for documentation in medical records. Methods: Through a series of focus groups, guidelines for language for documentation in medical records were developed by health professionals and patients. Using a structured focus group decision guide, we conducted four group meetings with different sets of 27 participants: physicians experienced with using open notes (5), patients accustomed to reviewing their notes (8), medical student educators (7), and resident physicians (7). To generate themes, we used an iterative coding process. First-order codes were grouped into second-order themes based on the commonality of meanings. Results: The participants identified 10 potentially important guidelines for developing notes sensitive to patients’ needs. Conclusions: The process identified ten discrete themes that should help clinicians use and spread patient-centered documentation. Clinical Trial: N/A
Background: This study assesses the quality of life during hospitalization using a stroke patient-reported outcomes scale. It investigates the current status of patient-reported outcomes in stroke pat...
Background: This study assesses the quality of life during hospitalization using a stroke patient-reported outcomes scale. It investigates the current status of patient-reported outcomes in stroke patients and explores their correlation with blood lipids. Objective: To investigate the status of reported outcomes in stroke patients and to study the relationship with blood lipid. Methods: Convenient sampling was employed to select a cohort of 195 stroke patients as the study participants. The Stroke-PRO scale was used to assess patients' conditions across physical, psychological, social, and therapeutic domains.Multiple linear regression analysis was applied to identify factors influencing stroke patient-reported outcomes, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. This approach aimed to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. Results: The Stroke-PRO score in this study was (4.09±0.29). By multiple linear regression analysis, residence, occupation, physical exercise, Barthel, Braden, NHISS at admission and stroke type were the influencing factors for reported outcomes of stroke patients (P< 0.05). Correlation analysis showed that triglyceride, serum total cholesterol and low density lipoprotein were negatively correlated with stroke-Pro scores in Stroke patients (P< 0.05), while high density lipoprotein was positively correlated with stroke patients (P< 0.05). Conclusions: Stroke patients have a low level of health and reported outcomes that need to be improved.Nursing staff should pay attention to the quality of life and blood lipid indexes of patients, actively capture the actual health status, and take early intervention measures to promote the recovery of patients.
Background: Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and can increase its DF content by incorporating defatted rice bran (DRB). Objec...
Background: Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and can increase its DF content by incorporating defatted rice bran (DRB). Objective: This first human study on DRB fortified bread, primarily aims to assess the effect of DRB bread on the relative abundance of a composite of key microbial genera and species in stool samples. Secondary outcomes include clinical (cardiovascular risk profile), patient-reported (daily bread consumption and bowel movement, digestive comfort, general well-being, total DF intake), biological (stool microbiota gene abundances, stool and plasma metabolites). Exploratory outcomes include physiome (whole gut and regional transit time, and gas fermentation profiles) outcomes in healthy adults with low DF intake. Methods: The BREAD (Bread Related Effects on Microbial Distribution) study is a two-armed, placebo-controlled, double-blind, randomized, crossover study. The study duration is fourteen weeks: two weeks lead-in, four weeks intervention per phase, two weeks washout, and two weeks follow-up. Sixty healthy adults with low DF intake (<18g/day (females), <22g/day (males)) were recruited in Christchurch, New Zealand between June and December 2022. Randomized participants consumed three (for females)/ four (for males) slices of fortified bread per day, then placebo white bread and vice versa. The DRB fortified bread provided 8 g (for females) and 10.6 g (for males) of total DF, while the placebo (a matched commercial white toast bread) provided 2.7 g for females and 3.6 g for males of total DF. Before and after each intervention phase, participants provided stool and blood samples to assess biological responses; completed a three-day food diary to assess usual intakes; online questionnaires to assess gut symptoms, general and mental well-being, daily bread intake and bowel movement via an app; underwent anthropometry and blood pressure measurements; drank blue food dye to assess whole gut transit time. In addition, 15 participants from the cohort ingested Atmo gas-sensing capsules to assess gut regional’s fermentation gas profile. Results: At the time of writing, data was still being analysed. Results will be published as separate manuscripts. Conclusions: This study will offer insights into the prospect of consuming DRB fortified bread to effectively modulate health-promoting gut microbes and their metabolism, and DF intake in healthy adults with low DF intake. Clinical Trial: ACTRN12622000884707
Background: Long occupational work hours, paid or unpaid overtime, and shift work are a common component of the labor force in high, middle, and lower-income economies globally. Bowel movement frequen...
Background: Long occupational work hours, paid or unpaid overtime, and shift work are a common component of the labor force in high, middle, and lower-income economies globally. Bowel movement frequency and stool form in occupational settings may be important markers of stressful working conditions as well as diurnal gut microbiota action, gastrointestinal discomfort, and disorders of gut-brain interaction (DGBI). Characterizing DGBI in shift and non-shift workers could help identify the impact of diurnal work patterns on worker’s physical and mental health, including anxiety related to bowel movements. Objective: The paper outlines the ITS POO TIME protocol describing a web-based multi-methods research project on DGBI, stool characteristics, psychological factors, sleep, diet and anxiety related to bowel movements in occupational settings. Methods: Study 1 comprises a web-based survey to acquire quantitative data from adults who are engaged in paid employment. We seek to assess occupational characteristics, organizational factors concerning toilets, as well as standardized questionnaires for stool form and frequency, DGBI assessed by Rome-IV criteria, sleep, diet, bowel movement anxiety (i.e. parcopresis), and distress. Study 2 is a qualitative study (Poo Story) which asks open-ended questions about respondents’ attitudes to defecation at work as well as patterns, behaviours, as well as strategies utilized to reduce anxiety or embarrassment. Results: The findings of ITS POO TIME will elicit important information on what factors are associated with bowel movements and stool types in occupational settings and identify associations pertinent to occupational health. Data collection commenced in January 2019 and finished enrolment in December 2023. Study 1 obtained 1872 responses, while Study 2 received 337 responses, and the primary results are expected to be published in 2024. Conclusions: The results of the research described in this research protocol will have direct implications for industry, employers, and policy makers concerning DGBI, stress, and worker health. Clinical Trial: NA
Background: Outcomes in children with type 1 diabetes (T1D) are influenced by psychosocial factors including family dynamics and parent and child psychological well-being. Early instruction for caregi...
Background: Outcomes in children with type 1 diabetes (T1D) are influenced by psychosocial factors including family dynamics and parent and child psychological well-being. Early instruction for caregivers on evidence-based family management skills that support family adjustment to T1D immediately following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for clinic-wide interventions to support caregivers in learning these skills. Objective: We hypothesized that a self-guided online family skills management program (addressing caregiver social support as well as family problem solving, communication, and supportive behavior change strategies) initiated at the time of type 1 diabetes (T1D) diagnosis would improve glycemic outcomes at 1 and 2 years post-diagnosis in children with T1D. In this study, we report on the feasibility and acceptability of this program. Methods: We evaluated a sample of 37 children with newly diagnosed T1D. Parent participants were asked to complete online modules addressing social support, family problem solving, communication and supportive behavior change strategies. Module completion was analyzed for percent completion, patterns of completion and differences in completion rates by co-parenting status. Qualitative open-ended feedback was collected at the completion of each module. Results: 84% of the 37 participants initiated the online program. 68% completed some content and 48% completed all five modules. Completion rates were higher when co-parenting partners engaged in the intervention together. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. Conclusions: In this study, we found that a self-guided digital family support intervention initiated at the time of a child’s T1D diagnosis was largely feasible and acceptable. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management. Clinical Trial: The study was pre-registered at clinicaltrials.gov: 1303325.
Background: Electronic Health Records (EHRs) have revolutionized the accessibility and sharing of patient data among healthcare providers, fostering a more coordinated and efficient delivery of care....
Background: Electronic Health Records (EHRs) have revolutionized the accessibility and sharing of patient data among healthcare providers, fostering a more coordinated and efficient delivery of care. Over the past 25 years, the evolution of EHRs has significantly contributed to scientific achievements in healthcare, improving the accuracy and efficiency of patient care and supporting better health outcomes. Despite their numerous benefits, EHRs face challenges including interoperability issues, common data models, system compatibility, privacy concerns, and data cleaning complexities. Objective: The objective of our study was to examine the evolution of EHRs over the past 25 years, focusing on their advancements in technology, interoperability, and the impact on healthcare delivery and research. We aimed to identify the challenges and limitations of EHRs in facilitating disease management and understanding, as well as their contribution to epidemiological studies, pragmatic clinical trials, and health economic studies. Methods: We conducted a comprehensive review of literature from PubMed database pertaining to the development and implementation of EHRs over the past quarter-century. Studies from January 2000 to February 2024 were included. Finally, 1,377 studies were selected for the analysis and presentation. Results: Studies that utilized EHR data were for various research purposes, including epidemiological studies, clinical trials, cost-effective studies, and policy studies. We highlighted significant advancements in EHR technology that facilitated improved management and understanding of diseases through comprehensive data collection and analysis over the past 25 years. However, challenges related to data interoperability, privacy, and inconsistencies were also identified. The studies underscored the importance of EHRs in creating more accurate representations of clinical practices and patient populations. We also saw great efforts in incorporating data from different sources and formats with the EHRs, as well as new analytic tools and platforms. Conclusions: EHRs have emerged as a pivotal component of modern healthcare systems, enhancing the efficiency and accuracy of patient care and supporting advanced clinical research. Despite facing interoperability and data management challenges, the benefits of EHRs in improving healthcare delivery and facilitating significant scientific achievements are undeniable. To maximize their potential, there is a critical need for improved resource sharing, collaborations among healthcare providers, and the development of consistent data formats and policies in healthcare networks. Clinical Trial: NA
Background: The World Health Organization stresses the importance of a COVID-19 early warning surveillance system. Integrating syndromic and wastewater data could help in robust estimation of an impen...
Background: The World Health Organization stresses the importance of a COVID-19 early warning surveillance system. Integrating syndromic and wastewater data could help in robust estimation of an impending COVID-19 outbreak. Objective: to integrate syndromic data (AFI, ARI, ILI, and SARI) and wastewater SARS-COV-2 (WW SARS-CoV-2), to compute an early warning surveillance index and second, to demonstrate whether this index can serve as an early warning COVID-19 system. Methods: In a longitudinal study conducted in Trichy, India between July 2022-January 2023 for a period of 30 weeks, syndromic data (Acute Febrile Illness (AFI), Acute Respiratory Illness (ARI), Influenza Like Illness (ILI), Severe Acute Respiratory Infection (SARI)) was collected via an app from 13,965 households using multistage sampling from 40 city wards. Additionally, SARS-CoV-2 was isolated from 932 wastewater samples collected from 40 different city wards, using the skimmed milk flocculation technique. Integration of this data on an Information Communication Technology platform formed a COVID-19 surveillance index (WAP index). Time series modelling using Autoregressive integrated moving average (ARIMA) of WAP index was used to predict COVID-19 outbreaks. Results: The cumulative incidence of ILI cases (85.6 ± 9.2, P < .001), was significantly higher among city wards as compared to (AFI P < .01, ARI P < .01, ILI P < .01, SARI P < .05). Significant inter week differences were observed in incidence of syndromic data and wastewater SARS-CoV-2 positivity (week 1-30, 83.3% - 0%, P < .001). A significant positive correlation existed between syndromic indicators, WAP index scores, and COVID-19 cases (r=0.758, P <.01). WAP index scores rose two weeks prior to rise of COVID-19 cases in the city. The ARIMA (1,0,2) model predicted COVID -19 cases with significant covariates of ARI and SARI, closely aligning with observed values within 95% confidence limits. Conclusions: Integrated community-based surveillance is invaluable in managing the COVID-19 pandemic, empowering health administrators to enforce effective lockdown measures Clinical Trial: nil
Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels...
Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels of disability and dependence, and may reduce quality of life. Significant transient and long term change to earnings do occur and can thrust individuals into poverty. People with DCM (PwDCM) face many challenges accessing state financial assistance. This can have a cumulative negative financial effect due to the association between DCM and low socioeconomic index. Objective: We aimed to assess if delivering workshops centred around access to financial support, could assist PwDCM, living in the United Kingdom. Methods: A series of two virtual workshops was targeted at accessing financial support for English patients under the state pension age, with an anonymised survey delivered to participants after each session. The first session was on Universal Credit (UC) and the second on Disability Financial Support (DFS). Survey responses were analysed using descriptive statistics and free text answers underwent inductive thematic analysis. Results: The average rating on the utility of UC was 9.00/10, with the mean score of wanting further sessions being 8.67/10. Pre-session confidence levels were 5.11/10 rising to 8.00/10. 56% of participants requested one-to-one sessions (5/9). For DFS, the average session utility rating was 10/10, with the desire for further sessions rated as 8.71/10. Pre-session confidence levels were 4.43/10 rising to 9.57/10. A total of 43% of participants requested one-to-one sessions (3/7). Following inductive thematic analysis, themes regarding the delivery, occurrence and context emerged. One participant gave negative feedback which included the length of the session and perceived problems around confidentiality and data protection. Conclusions: The pilot series was largely perceived as a success, with participants finding them useful and increasing their self-rated confidence in navigating the UK financial support system. Given the small sample size, it is hard to predict the success of future sessions but with the lessons learnt from the pilot, Myelopathy.org are keen to host future sessions and explore options to extend the intervention to other countries. Finally, given that the hurdles in accessing financial support extend beyond DCM, such workshops may be relevant to other organisations.
Background: Current gold-standard chronic pain management applies a bio-psycho-social lens to clinical care, integrating medication, psychosocial support, and physical reconditioning to promote sustai...
Background: Current gold-standard chronic pain management applies a bio-psycho-social lens to clinical care, integrating medication, psychosocial support, and physical reconditioning to promote sustained treatment success, increase quality of life, and control symptoms. However, only 40% of chronic pain patients consider themselves to be managed adequately. There is a dearth of evidence-based treatment pathways or Models of Care (MoC) that consistently utilise this holistic approach. Objective: The aim of this study is to 1) identify the barriers and facilitators to access and engagement in existing MoC for chronic pain, 2) explore aspects of the delivery of care that can be improved, and 3) develop an improved MoC for pain clinics in NSW by directly liaising with people with chronic pain and their families. Methods: A two-phase qualitative study, utilising semi-structured focus groups, will be conducted. Both phases will follow the same structure, such that patients, carers and clinicians will independently provide input into the proposed MoC; which will then be summarised and integrated by the research team. The focus groups in phase one will generate recommendations for primary changes to the existing MoC, these will then be integrated and presented for evaluation to each stakeholder group during phase two. The phase two focus groups will discuss the feasibility and acceptability of the areas for improvement identified. Participants will be encouraged to interact and speak freely across three core domains: 1) experience of chronic pain management, 2) Barriers and Facilitators to delivering/accessing gold standard MoC, and 3) key improvement points to existing models. Each focus group will last 90 minutes and will be audio-recorded and transcribed verbatim for qualitative analysis. Results: Data collection was initiated in September 2023 and is expected to end by September 2025. Till February 2024, we have completed the focus group with clinicians (n=12) and patients (n=7) in phase one. Data have not been analysed formally and will be reported in the future publication. Conclusions: The study will explore the perceptions of key stakeholders on the efficiency and outcomes of the current MoC and identify barriers preventing access and the delivery of care. The co-designed MoC can be used to inform appropriate, feasible and acceptable implementation of pain services in the future.
Background: Although older adults are most in need of utilizing health information systems such as electronic Personal Health Records (PHR), existing literature has given poor attention to this vulner...
Background: Although older adults are most in need of utilizing health information systems such as electronic Personal Health Records (PHR), existing literature has given poor attention to this vulnerable group of users. Objective: The current study aimed to understand the determinants of the intention to use electronic Personal Health Record (PHR) systems among elderlies. Methods: Hands-on workshops were organised to clarify various functions of a PHR system for 135 seniors and increase their knowledge of using the system for self-management of their chronic conditions. After the completion of the training, a survey was conducted to evaluate the usage intention toward PHR through the lens of Health Belief Model (HBM). The data were analysed using Partial Least Squares (PLS) path modelling. Results: Data analysis of 135 responses received uncovered that the seniors’ usage intention toward the PHR is a function of PHR’s perceived usefulness, perceived barriers, perceived confidence, and cues to action. Of these, perceived usefulness was found to be the strongest predictor. The results also indicated that perceived susceptibility and perceived severity do not significantly impact the seniors’ intention for the PHR. Conclusions: According to the findings and based on the HBM literature, if individuals perceive more benefits and fewer barriers to the PHR, greater self-efficacy, and better cues to action, they are more likely to adopt the system. Clinical Trial: N/A
Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health condi...
Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socio-economic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the UK which investigate their health and wellbeing and assess needs and health inequalities. We describe the methodology, recruitment strategies and key sociodemographic features of participants recruited for the second national round of Positive Voices (PV2022). Objective: The objectives of the survey are to examine:
1. How satisfied are people living with HIV with the current standard and model of HIV care?
2. What are the self-reported prevalences of associated chronic diseases (such as
cardiovascular disease, metabolic conditions, mental/neurocognitive disorders) and their
risk factors in PLHIV?
3. What are the current models/patterns of accessing care for HIV and associated chronic
conditions?
4. How prevalent is HIV-related stigma and discrimination experienced by people with HIV?
5. What are the prevalence and key determinants of sexual and other health-related risk
behaviours among people living with HIV in the UK?
6. How has the COVID pandemic impacted the health and well-being of people living with
HIV? Methods: PV2022 was a cross-sectional questionnaire study that included people attending HIV care at 101 UK clinics between April 2022 and March 2023. Data from the HIV and AIDS Reporting System (HARS), a national surveillance database of people with HIV attending care, held at the UK Health Security Agency (UKHSA), was used as a sampling frame. Information collected in PV2022 included: demographic and socioeconomic factors, HIV diagnosis and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors and additional challenges experienced due to the COVID-19 pandemic. HARS linkage was used to extract clinic-recorded information on antiretroviral therapy (ART), HIV viral load (VL) and CD4 count.
Initially, probabilistic sampling was used to provide a randomly selected representative sample of patients who were invited to participate by completion of a paper or online questionnaire. At the start of 2023, due to under-recruitment largely as a result of the impact of the COVID-19 pandemic and mpox outbreak, an alternative sequential recruitment strategy was initiated in 14 of the largest clinics to increase participant numbers. Results: In total, 4,618 participants completed the survey questionnaire, of these, 3690 participants were recruited through the initial recruitment and 928 through the sequential strategy. In total 4,540 participants could be linked to HARS. The overall response rate, calculated as number of people who completed a questionnaire out of all those who either accepted or declined to participate, was 50%. The survey responses represent approximately 1 in 20 people living with diagnosed HIV in England, Wales, and Scotland. Three-quarters of participants were male (74%), over half were of white ethnicity (65%), and nearly a quarter were of black African ethnicity (24%). Conclusions: Currently, PV2022 is the largest survey of people with HIV in the UK. The findings from PV2022 will be used to investigate the health and wellbeing of people with HIV and associations with demographic, socioeconomic, lifestyle and HIV-related factors. Findings will inform the HIV Action Plan for England, interventions to improve patient-centred care, and the provision of HIV clinical and support services.
The immediate context in which a person lives shapes their experience of impairment and disability. Assistive technology (AT) tools are the interface between impairment and context. This article prese...
The immediate context in which a person lives shapes their experience of impairment and disability. Assistive technology (AT) tools are the interface between impairment and context. This article presents a new framework for the design of assistive technology. It provides a theoretical exploration of the relationship between context, assistive technology and impairment. For this, first, we examine the theoretical challenges raised by the interface AT and impairments, considering dominant conceptual models of disability. Then, we analysed the role of context in the design, distribution and use of AT. Our framework addresses the current disconnect between the population the technology aims to serve and the innovation ecosystem. Disability is very diverse, and persons with diverse impairments benefit from different technology. Because of this diversity, we focus on visual impairment. We conclude this article by laying out a new framework for the design of AT that addresses the role of the context in which a person lives and aims to enable personal freedom in it. We do it by using the lenses of the capabilities approach. Our framework goes beyond the classical approach of only looking at AT as a tool for task performance. We argue that AT becomes a conversion tool that enables disabled persons to reach full social participation, addressing the variety of social and environmental contexts in which persons with disabilities live. Finally, we provide recommendations for future research.
Background: Major Depressive Disorder (MDD) is a common diagnosis among adolescents. Cognitive-behavioral therapy (CBT) is recommended as the first line of treatment. Digital Health Interventions (DHI...
Background: Major Depressive Disorder (MDD) is a common diagnosis among adolescents. Cognitive-behavioral therapy (CBT) is recommended as the first line of treatment. Digital Health Interventions (DHIs), such as apps, could contribute to treatment. Advantages could be easy accessibility and availability, reduced time for face to face (f2f) therapy, and the ability to intensify therapy by incorporating it into the everyday lives of patients. Challenges such as low adherence rates are common in DHIs. Therefore, they need to undergo rigorous testing for feasibility and effectiveness. Objective: An evaluated, CBT-based f2f therapy program for depression in adolescents was transformed into an app called e-MICHI. This study examined its feasibility and efficacy for use in blended therapy in out-patient settings. Methods: Adolescents aged 12 to18 with MDD were recruited from two university hospitals. Participants were actively recruited based on defined eligibility criteria. The intervention combined 3-weekly f2f sessions with daily app engagement over a six-week period. Feasibility was measured using various variables, including adherence and engagement rates, satisfaction ratings, and transfer of techniques to everyday practice; efficacy was assessed using the Beck Depression Inventory-II (BDI-II) and the Children’s Depression Rating Scale-Revised (CDRS-R), among other measures. Data was analyzed using a repeated measures ANOVA. Results: e-MICHI was positively evaluated by both, participants and therapists. Participants demonstrated high adherence rates and reported consistent practice of the e-MICHI techniques. Use of the app was associated with a significant reduction of depressive symptoms (before app use vs. three-month follow-up, BDI-II: mean -7.09, P<.001; CDRS-R: mean -10.56, P<.001). Conclusions: While acknowledging its limitations, the study confirms the feasibility of e-MICHI for treating adolescent depression in outpatient settings. Clinical Trial: DRKS (German Clinical Trial Register): DRKS00022420
Background: Due to the high prevalence of mental health illnesses and mood disorders, strategies involving the use of technology have been proposed to facilitate the detection and follow-up of patient...
Background: Due to the high prevalence of mental health illnesses and mood disorders, strategies involving the use of technology have been proposed to facilitate the detection and follow-up of patients. Objective: This article describes the usability evaluation of a system designed for treating mood disorders in the population of the Department of Cordoba, Colombia. Methods: A scenario-based methodology was implemented, which represented the main functionalities of the software for telehealth care. Three test cycles were conducted with the involvement of 30 users representing different roles (patients, patient' relatives, mental health clinical care personnel, and program logistics personnel). The NASA-TLX (1) and PSSUQ (2) scales were used to measure the workload and the level of effort to complete the different tasks of the system. Results: The usability evaluation results over the two test cycles were encouraging and showed PSSUQ scores of 2.2 and 2.3, respectively. Conclusions: The workload showed improvements between both test cycles, prioritizing patient-type user-oriented interfaces.
Background: Online surveys of internet panels such as Amazon’s Mechanical Turk (MTurk) are common in health research. Non-response in longitudinal studies can limit inferences about change over time...
Background: Online surveys of internet panels such as Amazon’s Mechanical Turk (MTurk) are common in health research. Non-response in longitudinal studies can limit inferences about change over time. Objective: We (1) describe the patterns of survey responses and non-response among MTurk members with back pain, (2) identify factors associated with survey response over time, (3) assess the impact of non-response on sample characteristics, and (4) assess how well inverse probability weighting can account for differences in sample composition. Methods: We surveyed MTurk adults who identified as having back pain. We report participation trends over three survey waves and use stepwise logistic regression to identify factors related to survey participation in successive waves. Results: A total of 1,678 adults participated in Wave 1. Of those, 983 (59%) participated in Wave 2 and 703 (42%) in Wave 3. Participants who did not drop out took less time to complete prior surveys (30 minutes vs. 35 minutes in Wave 1, p<0.005; 24 minutes vs. 26 minutes in Wave 2, p=0.019) and reported having fewer health conditions (6 vs. 7, p<0.005). In multivariate models, higher odds of participation were associated with less time to complete the baseline survey, older age, not being Hispanic, not having a bachelor’s degree, being divorced or never married, having less pain interference and intensity, and having more health conditions. Weighted analysis showed slight differences in sample demographics and conditions, and larger differences in pain assessments, particularly for those who responded to Wave 2. Conclusions: Longitudinal studies on MTurk have large, differential dropouts between waves. This study provided information about the types of individuals who are more likely to drop out over time which can help researchers prepare for future surveys.
Background: Mental health is crucial for proper execution of daily duties by healthcare personnel. However, there have been limited efforts to bring mental health services and care closer to this cruc...
Background: Mental health is crucial for proper execution of daily duties by healthcare personnel. However, there have been limited efforts to bring mental health services and care closer to this crucial group. Objective: To assess the effectiveness of "Psicovida," a mobile application, in enhancing mental health care for healthcare workers by reducing symptoms of depression and emotional distress through the implementation of cognitive-behavioral therapy-based activities over a three-month period. Methods: This quasi-experimental study employed a randomized, controlled design with initial and final assessments. Participants were healthcare workers from a public hospital in Ecuador, including doctors and nurses. Eligibility criteria included being over 18 years old, having at least 12 months of service at the institution, and owning a smartphone. The intervention involved the use of the "Psicovida" app, which provided weekly tasks based on cognitive-behavioral theories for a period of 3 months. Data collection included demographic information and self-administered tests (PHQ-9 and GHQ-12) to evaluate psychological well-being and identify non-psychotic psychiatric conditions before and after the intervention. Results: The study found that healthcare personnel who used the "Psicovida" mobile application reported significant reductions in symptoms of depression and emotional distress. These improvements were more pronounced in users who initially exhibited higher levels of these symptoms, compared to those in the control group who did not use the app and either maintained their symptom levels or experienced an increase in depressive and emotional distress symptoms. Conclusions: The "Psicovida" mobile application, when used as a supplementary mental health care tool, shows promise in reducing symptoms of depression and emotional distress among healthcare personnel. This study underscores the potential benefits of integrating mobile health technologies into mental health care strategies for healthcare workers, highlighting the importance of accessible and flexible support systems in managing mental health challenges within this crucial workforce.
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: Day surgery is increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effec...
Background: Day surgery is increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The eHealth application ikHerstel is one such tool but although it administers its functions in the home, its implementation hinges on caregivers within the hospital. Objective: A feasibility study was conducted in order to investigate the feasibility of an additional, patient-oriented implementation strategy for ikHerstel. Our research question was: How well are patients able to use ikHerstel independent of their caregiver? Methods: We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through online surveys. Descriptive analysis and open coding were used to analyse the data. Results: Recruitment yielded 213 registrations, of whom 55 patients were included. The patient-oriented implementation strategy yielded a reach of 53.9%. All participating patients (100%) received an account for the ikHerstel app and 84.1% created a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it with an average 7.0 out of 10 and 53.8% of patients (28/52) explicitly reported no difficulties in using it. A major concern of the implementation strategy was the conflict in recommendations between ikHerstel and caregivers, as well as the concomitant feelings of insecurity experienced by patients. Conclusions: We may conclude that this strategy is less optimal compared to implementation as usual yet it allows use to reach a population of patients who are otherwise be left unserved. This shows that focus should lie on broadening ikHerstel’s implementation to more hospitals rather than improving the implementation of a patient-oriented strategy.
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: 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: 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: 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: 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: 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: 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: Up to 80% of information from a medical visit is forgotten by patients. Visit audio recordings are an innovative strategy to support the communication of information. Objective: The object...
Background: Up to 80% of information from a medical visit is forgotten by patients. Visit audio recordings are an innovative strategy to support the communication of information. Objective: The objective of this trial was to determine the feasibility, acceptability, and preliminary effectiveness of sharing audio recordings of primary care visits with older adults with multimorbidity. Methods: We used a two-arm, randomized, controlled, feasibility trial with 3-month follow-up. Patients aged ≥65 years, with diabetes and hypertension were recruited from academic primary care settings in NH, TN, and TX. Patients were randomized to receive online access to audio recordings of scheduled visits for three-months or care as usual (after visit summaries). Primary outcomes were acceptability and feasibility assessed using several indicators: acceptability- recruitment of 90 patients; recording use; and the Appropriateness of Intervention Measure (AIM; >3), feasibility- retention rate; protocol adherence; and the Feasibility of Intervention Measure (FIM; >3). Interviews were conducted with clinicians (n= 14) and patients (n= 19). Exploratory outcomes included patient activation, satisfaction, adherence, and quality of life. Results: We met recruitment (n=91) and retention (98%) targets. We exceeded acceptability and feasibility metrics: FIM (Median 4; IQR 3 – 4); AIM (Median 4; IQR 3 – 4); fidelity to protocol (92%); and 40 of 45 patients (85%) accessed their recordings. Interviews noted benefits of greater recall, understanding, and family engagement, with little impact on visit interactions. Concerns were minimal. Exploratory outcomes included better PROMIS Mental Health Score for Audio vs Usual Care patients at 3-months; 51.5 (SD 7.7) vs. 47.7 (SD 9.9), P=0.04. Conclusions: Sharing visit recordings online with older adults is feasible and acceptable. A larger trial is needed to determine the impact of sharing recordings on patient health outcomes. Clinical Trial: NCT04344301
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
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: 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: 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: 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: 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: 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
