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Journal Description

JMIR Preprints contains 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.

With the exception of selected submissions to the JMIR family of journals (where the submitting author opted in for open peer-review, and which are displayed here as well for open peer-review), there is no editor assigning peer-reviewers.

Submissions are open for anybody to peer-review. Once two peer-review reports of reasonable quality have been received, we will send these peer-review reports to the author, and may offer transfer to a partner journal, which has its own editor or editorial board.

The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal.

If authors want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc) after peer-review, please specify this in the cover letter. Simply rank the journals and we will offer the peer-reviewed manuscript to these editors in the order of your ranking.

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.

JMIR Preprints accepts manuscripts at no costs and without any formatting requirements (but if you intend the submission to be published eventually by a specific journal, it is of advantage to follow their instructions for authors). Authors may even take a WebCite snapshot of a blog post or "grey" online report. However, if the manuscript is already peer-reviewed and formally published elsewhere, please do NOT submit it here (this is a preprint server, not a postprint server!).

 

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    Peer-Review 2.0: Welcome to JMIR Preprints, an Open Peer-Review Marketplace for Scholarly Manuscripts

    Authors List:

    Abstract:

    JMIR Preprints is a preprint server and "manuscript marketplace" with manuscripts that are intended for community review. Great manuscripts may be snatched up by participating journals which will make offers for publication.There are two pathways for manuscripts to appear here: 1) a submission to a JMIR or partner journal, where the author has checked the "open peer-review" checkbox, 2) Direct submissions to the preprint server. For the latter, there is no editor assigning peer-reviewers, so authors are encouraged to nominate as many reviewers as possible, and set the setting to "open peer-review". Nominated peer-reviewers should be arms-length. It will also help to tweet about your submission or posting it on your homepage. For pathway 2, once a sufficient number of reviews has been received (and they are reasonably positive), the manuscript and peer-review reports may be transferred to a partner journal (e.g. JMIR, i-JMR, JMIR Res Protoc, or other journals from participating publishers), whose editor may offer formal publication if the peer-review reports are addressed. The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal. 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.

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  • Effectiveness of Targeted Secure Messages to Facilitate Access to Tobacco Treatment Counseling for Veterans

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 21, 2017 - Sep 30, 2017

    Background: Studies show that combining nicotine replacement therapy (NRT) with tobacco treatment counseling (TTC) is most effective for smoking cessation. However, TTC has been underutilized across t...

    Background: Studies show that combining nicotine replacement therapy (NRT) with tobacco treatment counseling (TTC) is most effective for smoking cessation. However, TTC has been underutilized across the nation. A secure e-mail message sent to patients already taking NRT was hypothesized to increase the utilization of TTC among Veterans in NJ. Objective: The main objective of this project was to determine if there was a significant increase in adoption of TTC among Veterans who received a secure message describing the options for TTC available to them. Secondary objectives were to demographically characterize Veterans who were and were not enrolled in secure messaging, as well as those who opened or did not open a message. Finally, because the language and content of the messages were changed across project phases, this project also sought to determine (by analysis of response rates) the type of language that was most effective at eliciting a response. Methods: Over two phases, messages were sent to two samples of Veterans prescribed NRT within the prior 90 days of each phase. In Phase 1, one message was sent in December 2015. In Phase 2, one message was sent in July 2016, plus an identical follow-up message in August 2016 to persons who did not open the July message. The July/August 2016 message was more directive than the December message. Response rates to the December message vs. the July message were compared. A logistic regression analysis determined effect of age and gender on enrollment in secure messaging across both phases. The effectiveness of each phase at increasing TTC was analyzed using a McNemar test. Results: The message with more directive language, sent to 423 Veterans in July 2016, had a significantly higher response rate than the December 2015 message, sent to 348 Veterans (18.3% vs 7.7%, P=.04). The July/August 2016 messages significantly increased utilization of TTC (net increase of 6 TTC adopters, P=.04) while the December 2015 message did not (net increase of 2 TTC adopters, P=.5). Women (OR 1.6; 95% CI: 1.1, 2.3), and those aged 30-49 (compared to other age groups) were more likely to be enrolled in secure messaging. Neither gender nor age were significant predictors of opening or replying to either message. Conclusions: While the effect was small, secure messaging was a useful modality to increase TTC. Directive content with a follow-up message appeared useful. Female Veterans and/or Veterans between 30 and 49 years old are more likely to use secure messaging.

  • Evaluation of a smartphone-based intervention to increase parents’ knowledge about the MMR vaccination and their psychological empowerment: A mixed method approach.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Nov 16, 2017

    Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most interventions is that they lack a rigorous evaluative assessment which is part...

    Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most interventions is that they lack a rigorous evaluative assessment which is partly due to the fact that, over the last two decades, randomized controlled trials have been increasingly considered as the only proof of the effectiveness of an intervention and, consequently, as the most important instrument in deciding whether to adopt an intervention or not. Objective: The aim of this study is to evaluate two smartphone-based interventions aimed at increasing parents’ knowledge of the MMR vaccination (through elements of gamification) and their psychological empowerment (through the use of narratives), respectively. The two interventions were part of a randomized controlled trial. Methods: We conducted two studies with the RCT participants: an online survey aimed at assessing their rating of the tool regarding a number of qualities, such as usability and usefulness, and qualitative telephone interviews to explore participants’ experiences with the application. Results: The results of the survey showed that participants receiving the knowledge intervention (alone or together with the empowerment one) liked the app significantly better compared to the group that only received the empowerment intervention. Parents receiving the empowerment intervention complained that they did not receive useful information but were only invited to make an informed, autonomous MMR vaccination decision. Conclusions: The results suggest that empowering efforts should always be accompanied by the provision of factual information. Using a narrative format that promotes parents’ identification can be an appropriate strategy, but it should be employed together with the presentation of more points of views and notions regarding, for instance, the risks and benefits of the vaccination at the same time.

  • Case Study: Implementing an Open Source Electronic Health Record (EHR) System in Secondary Care in Kenya

    From: Journal of Medical Internet Research

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 17, 2017 - Oct 12, 2017

    Background: The Kenyan government, working with international partners and local organisations, has developed an e-Health strategy, specified standards and guidelines for EHR adoption in public hospit...

    Background: The Kenyan government, working with international partners and local organisations, has developed an e-Health strategy, specified standards and guidelines for EHR adoption in public hospitals, and implemented two major health IT projects: DHIS2, for collating national healthcare indicators, and HMIS (using KenyaEHR and IQCare), for managing 600 HIV clinics across the country. Following these projects, a modified version of the OpenMRS EHR system was specified and developed to fulfil the clinical and administrative requirements of primary and secondary healthcare facilities operated by devolved counties and to automate the process of collating healthcare indicators and entering them into the DHIS2 system. Objective: To present a case study of the implementation of an open source Electronic Health Record (EHR) system in secondary care facilities in Kenya. Methods: We conducted a landscape review of existing literature concerning e-Health policies and EHR development in Kenya. Following initial discussions with the Ministry of Health, WHO and implementing partners, we conducted a series of visits to implementing sites to conduct semi-structured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results: This case report describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital IT infrastructure, training users and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of socio-technical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions: Implementing EHR systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. We hope this case study will provide some lessons and guidance for other challenging implementations of EHR systems as they continue across Africa.

  • What is the feasibility of patients using an online forum for reporting progress when engaging with a six-week exercise programme for knee rehabilitation?

    From: JMIR Rehabilitation and Assistive Technologies

    Date Submitted: Jul 30, 2017

    Open Peer Review Period: Jul 31, 2017 - Sep 25, 2017

    Background: The use of e-health and web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual ‘sticky n...

    Background: The use of e-health and web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual ‘sticky notes'. Objective: The primary aim of this study was to determine feasibility of patients on a six-week, knee-exercise programme using Padlet as an online forum for self-reporting on outcome progression. Methods: Undergraduate manual therapy students were recruited as part of a six week study into knee rehabilitation. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analysed for association between engagement, entry frequency and participant characteristics. Individual data facilitated single subject, multiple baseline analysis using statistical process control. Experiential narrative was analysed thematically. Results: Nineteen participants were recruited (47% female); ages ranged from 19 to 53. Twelve individuals (63%) opted to engage with the forum (range: 4 - 40 entries), with 5 (42%) reporting across all six weeks. Gender did not influence reporting (OR 0.761, CI 0.06-6.93). No significant difference manifested between BMI and engagement (P=.46); age and entry frequency did not correlate (r2=0.054, CI -0.42 to 0.51, P=.83). Statistically significant conditioning profiles arose in single subjects. Themes of pain, mitigation and response were inducted from the experiences posted. Conclusions: Patients will engage with an online forum for reporting progress when undertaking exercise programmes. In contrast to related literature, no significant association was found with reporting and gender, age or BMI. Individual posted data allowed multiple baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualised visual data to patients and the role of forums in monitoring patients’ progress in symptomatic knee-pain populations need further consideration.

  • Evaluation of a website supporting sensitive religious and cultural advance care planning: ACPTalk

    From: Journal of Medical Internet Research

    Date Submitted: Jul 27, 2017

    Open Peer Review Period: Jul 29, 2017 - Sep 23, 2017

    Background: Advance care planning (ACP), encourages consideration of future health care decision making and fosters collaborative, informed end-of life-care. To meet the needs of multicultural and mul...

    Background: Advance care planning (ACP), encourages consideration of future health care decision making and fosters collaborative, informed end-of life-care. To meet the needs of multicultural and multi-faith populations in Australia, an ACP website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific ACP content and complement existing resources. Objective: The purpose of this paper was to utilise the Context Input Process Product (CIPP) framework to conduct a formative and summative evaluation of an ACP website, ACPTalk. Methods: Context: health professionals’ solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: to ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a web-based survey. Product: Website analytics were used to report utilisation and stakeholder perceptions were captured through interviews and a website survey. Results: Context: Sixteen health professionals (n=7 general practitioners, n=7 primary health nurses, n=2 palliative care nurses) participated in key stakeholder interviews. Website solutions included: religious and cultural information, communication ideas, education and role plays, legal information, downloadable content and web-based accessibility. Both Christian and non-Christian faiths were deemed important to be included in religion-specific content. Input: There were no project delays. Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: Thirty-seven content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5) and community organizations (n=3). The majority strongly agree/agree that the content used appropriate language and tone (92%), would support health professionals (89%) and was accurate (83%). Product: Resource usage within the first nine months was 12,957 page views in 4,260 sessions: majority (89%) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (78%), easy to understand (82%), useful (86%) and appropriate (86%). Twenty nurses (general practice n=10, palliative care n=10, both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design and increased knowledge of ACP. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. Conclusions: The CIPP framework was effectively applied to evaluate the development and end product of an ACP website. While overall findings were positive, further ACP website development should consider the recommendations derived from this study.

  • M-health tools for self-management of complex patients in primary care settings: Understanding the patient and provider experience

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 3, 2017

    Open Peer Review Period: Aug 4, 2017 - Sep 29, 2017

    Background: Given the complex and evolving needs of individuals with multi-morbidity, the use of m-health tools to support self-management efforts is increasingly being explored, particularly in prima...

    Background: Given the complex and evolving needs of individuals with multi-morbidity, the use of m-health tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The Electronic Patient Reported Outcomes (ePRO) tool was co-developed with patients and providers in an inter-disciplinary primary care team in Toronto, Canada to help facilitate self-management in community-dwelling adults diagnosed with multiple chronic conditions. Objective: Explore the experience and expectations of patients with multi-morbidity and their providers around the role of the ePRO tool in supporting self-management efforts to generate insights into how m-health applications targeted towards helping patients self-manage are perceived by patients and providers. Methods: A 4-week usability trial of the ePRO tool was conducted. Patient and provider experience and expectations were explored through focus groups that were conducted at the end of the usability trial. Thematic analyses were used to assess shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Results: Eleven patients and six providers were involved in the usability trial. Findings revealed that both patients and providers emphasized the need for greater personalization and customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Providers recognized the ePRO tool’s value in providing insights into broader patient context and emphasized alignment with existing processes, i.e., goal setting techniques and linkage with electronic medical records. Conclusions: In developing the ePRO tool, a nuanced disconnect emerged between patient and provider expectations around the role of the ePRO tool in enabling self-management, specifically that patients indicated they see the tool ePRO as a supplement to existing interaction rather than a replacement of in-person consults with their providers. In contrast, provider expectations were centered on the ePRO tool’s potential to monitor patient progress remotely. More in-depth inquiry is needed to better understand whether m-health technologies can resolve this gap around expectations between user groups. The adoption of a more patient-centered lens in content and question design, and greater adaptability to accommodate patient complexity and provider workflow were identified as next steps in refining the ePRO tool ahead of full-scale application in a randomized pragmatic trial.

  • WalkAlong: process evaluation of an online mental health portal using Google Analytics

    From: JMIR Mental Health

    Date Submitted: Sep 7, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: Despite the increasing amount of research on online mental health interventions with proven efficacy, high attrition rates decrease their effectiveness. Continued process evaluations shoul...

    Background: Despite the increasing amount of research on online mental health interventions with proven efficacy, high attrition rates decrease their effectiveness. Continued process evaluations should be performed to maximize the target population’s engagement. Google analytics has been used to evaluate various health-related web-based programs, and may also be useful for online mental health programs. WalkAlong.ca is a youth-oriented mental health web-portal that includes various tools including self-assessment and monitoring, mental health literacy pages, and links to additional resources and online programs (ie. MoodGYM – a free, interactive web program designed to prevent depression). Objective: This evaluation study is aimed to evaluate WalkAlong using Google Analytics to inform the improvement strategy for the platform, and to demonstrate the use of Google Analytics as a tool for process evaluation of e-mental health interventions. Methods: Google Analytics was used to monitor user activity during WalkAlong’s first year of operation (Nov. 13, 2013 – Nov. 13, 2014). User behaviour based on the device (desktop, mobile phones, and tablets) used, and channels (direct via URL (Uniform Resource Locator), organic search, referrals) used to access the website were observed. New and returning users, depth and length of average sessions, and visits to individual WalkAlong pages were also observed. These indicators were measured using descriptive statistics in terms of proportion of sessions (%), bounce rate (%), pages visited per session (N), mean session duration (minutes seconds), and goal conversion rate (%). Bounce rate measures the proportion of sessions that were ended after visiting only a single page. Goal conversion rate measures the proportion of sessions that achieved a goal out of the total sessions where goals are defined as creating an account. Results: The results cover data from the first year of operation, including data from 3076 unique users viewing 29,299 pages. The majority of visitors were desktop users (82.3%) with a lower bounce rate (39.6%) compared to tablets (48.7%) and smartphones (61.6%). Direct traffic (access via URL) accounted for the largest proportion with 45.5% among other channels with low bounce rate (36.6%). Returning users had lower bounce rate (31.0%) than new users (51.6%). Users spent longer average time on the screener tool (3m 04s) than the mindsteps (0m 35s) and self-help exercises (1m 08s). Conclusions: Future improvement for WalkAlong should improve mobile accessibility, engage new users, and engage users more with mindsteps and self-help exercises. The data provided by Google Analytics, though informative, can be supplemented by other evaluation methods (ie. qualitative methods) in order to better determine the modifications to improve user engagement. Google Analytics can play a vital role in highlighting the preference of those using e-mental health tools.

  • Healthcare Information Systems and Technology: A Systematic Review

    From: JMIR Medical Informatics

    Date Submitted: Jul 31, 2017

    Open Peer Review Period: Jul 31, 2017 - Sep 25, 2017

    The present article offers a systematic mapping of studies related to information systems and technology in the field of health care. Articles were selected and compiled from prestigious publications...

    The present article offers a systematic mapping of studies related to information systems and technology in the field of health care. Articles were selected and compiled from prestigious publications that combine knowledge related to information systems, science and health. This facilitates establishing a distribution of the available literature, obtaining as a result a map of knowledge that structures the different trends and main areas of research in this area. Finally, we project and propose future research for those trends that stand out because of their interest and the possibility of deepening them.

  • Applicability of a web-based, individualized exercise intervention in patients with liver disease, cystic fibrosis, esophageal cancer, and psychiatric disorders

    From: Journal of Medical Internet Research

    Date Submitted: Aug 2, 2017

    Open Peer Review Period: Aug 3, 2017 - Sep 28, 2017

    Background: Regular physical activity is recommended in different diseases to improve disease related symptoms, to delay the progression of the disease, to enhance postoperative outcomes, and to incre...

    Background: Regular physical activity is recommended in different diseases to improve disease related symptoms, to delay the progression of the disease, to enhance postoperative outcomes, and to increase the physical activity level. In the preoperative context, there has been a paradigm shift in favor of using preconditioning concepts prior to surgery. Web-based interventions seem an innovative and effective tool for delivering general information, tailored exercise recommendations, and peer support. Objective: Our first objective was to assess feasibility of our web-based interventional concept and to analyze similarities and differences in a sustained exercise implementation in different diseases. The second goal was to investigate the overall participants’ satisfaction with our web-based concept. Methods: Study participants were recruited by physicians in the cooperating centers. Four clinical trials are still being carried out, including patients with esophageal carcinoma scheduled for oncologic esophagectomy (iPEP study; internet-based perioperative exercise program), nonalcoholic fatty liver disease (HELP study; hepatic inflammation and physical performance in patients with NASH), depression (EXDEP study; exercise in depression) or cystic fibrosis (COMMED study; cystic fibrosis online mentoring for microbiome, exercise & diet). During the intervention period, the study population had access to the website with disease-specific contents and a disease-specific discussion forum. All participants received weekly individual tailored exercise recommendations from the sports therapist. Results: A total of 20 participants (5 of each trial) were analyzed. During the intervention period, a regular contact and a consequent implementation of exercise prescription were easily achieved in all substudies. Across the four studies, there was a significant decrease in login rates (P <.001) and login durations (P<.001) with time. A detailed view into the different studies shows a significant decrease in login rates and login durations in the HELP study (p=.004; p=.002) and iPEP study (P=.021; P=.001), whereas the EXDEP study (P=.583; P=.378) and COMMED study (P=.867; P=.558) showed no significant over the eight weeks intervention period. There was no significant change in physical activity within all studies (P=.311). Only in the HELP study, the physical activity level increased steadily over the period analyzed (P= .045). Overall, 85% (n=17) felt secure and were not scared of injury, with no major differences in the subtrials. Conclusions: The theoretical framework of the web-based intervention appears to be applicable across the heterogonous collectives of our study patients with regard to age and disease. Although the development of physical activity shows only moderate improvements, flexible communication and tailored support could be easily integrated into patients’ daily routine. Clinical Trial: iPEP study: ClinicalTrials.gov: NCT02478996; https://clinicaltrials.gov/ct2/show/NCT02478996 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL). HELP study ClinicalTrials.gov: NCT02526732; https://clinicaltrials.gov/ct2/show/NCT02526732 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL). EXDEP study: ClinicalTrials.gov: NCT02874833; https://clinicaltrials.gov/ct2/show/NCT02874833 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).

  • Primary care providers’ response to an online lifestyle modification intervention

    From: Journal of Medical Internet Research

    Date Submitted: Aug 1, 2017

    Open Peer Review Period: Aug 1, 2017 - Sep 26, 2017

    Background: Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct thei...

    Background: Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct their patients to the intervention during a primary care visit. However, little is known of physicians’ perspectives and utilization of the referral model for an online lifestyle modification intervention. Objective: To evaluate primary care providers’ (PCP) response to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. Methods: PCPs at six primary care clinics were asked to refer adult obese patients to a year-long online lifestyle intervention providing self-management support for weight loss. Following the one year intervention, all providers at the participating practices were surveyed regarding their views of the program. Respondents completed survey items assessing their attitudes regarding the one-year intensive weight loss intervention and identifying resources they would find helpful for assisting patients with weight loss. Referring physicians were asked about their level of satisfaction with implementing the counseling services using standard electronic health record (EHR) referral processes. Attitudes towards obesity counseling among referring and non-referring providers were compared. Impressions of how smoothly the referral model of obesity treatment integrated with the clinical workflow were also quantified. Results: Non-referring providers were more likely to prefer counseling themselves (P=.04) and to report having sufficient time to do so (P=.03). Non-referring providers were more likely to report that their patients lacked computer skills (77% versus 35%) or had less access to the internet (64% versus 33%). Conclusions: Understanding providers’ views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention.

  • Application of Machine Learning Algorithms to Depression Screening and Attempt at Pattern Extraction of Patient-Reported Outcomes that Negatively Affect Classification Accuracy

    From: Journal of Medical Internet Research

    Date Submitted: Aug 1, 2017

    Open Peer Review Period: Aug 3, 2017 - Sep 28, 2017

    Background: Smartphone applications have recently been used as a breakthrough technology for monitoring mental health conditions in cancer outpatient settings. However, the use of electronic patient-r...

    Background: Smartphone applications have recently been used as a breakthrough technology for monitoring mental health conditions in cancer outpatient settings. However, the use of electronic patient-reported outcomes (ePROs) on mental conditions through smartphone applications raises new concerns, which includes the question of the accuracy of depression screening. Thus, research is essential for improving the depression-screening performance. Objective: This study aims to (1) test whether deep-learning-based algorithms can overcome the limitations of traditional statistical methods in terms of depression screening accuracy. In addition, the study aims to (2) explore ePRO patterns that adversely affect depression screening accuracy. Methods: As a deep learning-based algorithm, a feedforward neural network algorithm was used. As a traditional statistical method, a random intercept logistic regression was employed. To explore the ePRO patterns that negatively impact model accuracy, mental fluctuations, missing data, and compounding effects between mental fluctuations and missing data were tested. The performances of the algorithms and the effects of the ePRO patterns were measured through the receiver operating characteristic comparison test. Results: The results of the study show that the performance of the deep-learning-based models was superior to that of the traditional statistical approach. The study found that mental fluctuations statistically reduced the accuracy of depression-screening models. A weak association between ePRO omissions and screening accuracy was found. Moreover, the compounding effects that had a negative effect on the depression screening accuracy were statistically significant. Conclusions: Although well-trained deep-learning-based models exhibit excellent performance, they still have some limitations. Thus, it is very important to focus on data quality to predict health outcomes when using data that is difficult to quantify, such as mental conditions.

  • Web-based interventions supporting adolescents and young people with depressive symptoms: a systematic review and meta-analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 2, 2017

    Open Peer Review Period: Aug 2, 2017 - Sep 27, 2017

    We conducted a systematic review and meta-analysis of trials to describe the effectiveness of web-based interventions to support adolescents with depression or depressive symptoms, anxiety and stress....

    We conducted a systematic review and meta-analysis of trials to describe the effectiveness of web-based interventions to support adolescents with depression or depressive symptoms, anxiety and stress. We also explored the content of the interventions, as there has previously been a lack of coherent understanding of the detailed content of the web-based interventions supporting adolescents’ mental wellbeing. We included parallel randomized control trials (RCT) targeted at adolescents, or young people between 10 and 24 years old, with symptoms or diagnoses of depression and/or anxi-ety. The interventions were from original studies aimed to support mental health among adolescents, and they were delivered by web-based information and communication technology (ICT). Out of 2,087 records identified, 27 articles (22 studies) met the inclusion criteria. Based on a narrative analysis of 22 studies, a variety of web-based interventions were found; the most commonly used intervention was based on cognitive behavioral therapy. Meta-analysis was further conducted with 15 studies (4,979 participants). At the end of the intervention, a statistically significant improvement was found in the intervention group (10 studies) regarding depressive symptoms (P<.02, median 1.68, 95% CI 3.11-0.25) and after 6 months (3 studies) (P<.01, median 1.78, 95% CI 3.20-0.37). Anxiety symptoms (8 studies) (P<.001, median 1.47, 95% CI 2.36-0.59) and moods and feelings (two studies) (P<.04, median 5.55, 95% CI 10.88-0.22) improved as well in the web-based in-tervention group. However, there was no difference in stress scores. On the other hand, adolescents in the intervention group left the study early more often, both in short-term (10 studies) (P<.01, median 1.33, 95% CI 1.06-1.66) and in mid-term (3 studies) (P<.02, median 1.65, 95% CI 1.09-2.49). We did not find any studies that had assessed the costs of the web-based interventions. Despite widely reported promises that information technology use is beneficial to adolescents with depression, the results of our review showed only short-term effects to adolescents’ mental wellbeing, while long-term effects can be questioned due to the limited number of studies reviewed. Information about the economic benefits of web-based interventions is still lacking. The quality of the studies, especially biases related to attrition rates and selective reporting, still needs serious attention.

  • Few Tweets After Flu Peak: Twitter-based Influenza Detection by Referring Indirect Information

    From: Journal of Medical Internet Research

    Date Submitted: Aug 2, 2017

    Open Peer Review Period: Aug 4, 2017 - Sep 29, 2017

    The recent rise in popularity and scale of social networking services (SNSs) has resulted in an increasing need for SNS-based information extraction systems. A popular application of SNS data is healt...

    The recent rise in popularity and scale of social networking services (SNSs) has resulted in an increasing need for SNS-based information extraction systems. A popular application of SNS data is health surveillance for predicting the outbreak of epidemics by detecting diseases from text messages posted on SNS platforms. Such applications share the same logic: they incorporate SNS users as social sensors. These social sensor approaches also share a common problem: SNS-based surveillance can be reliable if sufficient numbers of users are active, but small inactive populations produce inconsistent results. This paper proposes a novel approach that overcomes this problem using indirect information covering both urban areas and rural areas within the posts. Experiments were conducted using a collection of tweets spanning three years (seven million influenza-related tweets in Japanese). Both direct information and indirect information that mentions other places were used. As indirect information is less reliable (too noisy or too old) than direct information, the indirect information data were not utilized directly but were considered as inhibiting direct information. For example, when indirect information appeared often, it was considered as signifying that everyone already had a known disease, leading to a small amount of direct information. The proposed approach improved the detection performance not only in rural cities, but also in urban cities, thereby demonstrating that it is feasible.

  • A Scoping Study on mHealth Initiatives in Vietnam

    From: Journal of Medical Internet Research

    Date Submitted: Aug 6, 2017

    Open Peer Review Period: Aug 7, 2017 - Oct 2, 2017

    Background: MHealth offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity in published information on mHealth in Vietnam. Objective: Th...

    Background: MHealth offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity in published information on mHealth in Vietnam. Objective: The objectives of this scoping study are 1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and 2) to examine the strengths, weaknesses, opportunities and threats of mHealth utilization in the Vietnamese context. Methods: This scoping study systematically identified and extracted relevant information from 19 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources including published literature, gray literature (i.e., government reports and unpublished literature), conference presentations, online documents, and key informant interviews. Results: Our findings suggest the largest advantage of mHealth in Vietnam is its ability to reach hard-to-reach populations and vulnerable groups. On the other hand, mHealth implementation in Vietnam has been challenged by factors including features unique to the Vietnamese language, sociocultural factors, and technological infrastructure. Conclusions: The largest threats to mHealth moving forward are the absence of government policy, lack of government interest, and heavy dependence on foreign funding. Lastly, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, there have yet to be sustainable mHealth initiatives outside of those funded by external donors.

  • Challenges and Opportunities of Implementing a Patient-Reported Measure of Physical Function through an online Electronic Health Record Patient Portal in Routine Rheumatology Practice

    From: Journal of Medical Internet Research

    Date Submitted: Aug 15, 2017

    Open Peer Review Period: Aug 16, 2017 - Oct 11, 2017

    Background: Despite significant interest in the collection of patient-reported outcomes (PROs) to make care more patient-centered, few studies have evaluated implementation efforts to collect PROs fro...

    Background: Despite significant interest in the collection of patient-reported outcomes (PROs) to make care more patient-centered, few studies have evaluated implementation efforts to collect PROs from diverse patient populations. Objective: We assessed the collection of PROs from rheumatoid arthritis (RA) patients in an academic rheumatology clinic, using a paper and an online form through the electronic health record (EHR) patient portal. Methods: We identified patients seen between 2012- 2016 with ≥2 face-to-face encounters with a rheumatology provider and ICD codes for RA, ≥30 days apart. In 2013, our clinic implemented a paper version of the Patient Reported Outcome Measurement Information System (PROMIS) physical function (PF) form that was administered to patients upon their check-in at the clinic; in 2015, an online version of the form became available via the EHR patient portal to patients with active portal accounts. We compared the proportion of visits with documented PROMIS scores across age, race/ethnicity, and language, using chi-square, ANOVA tests, and logistic regression model and examined trends over time using a control chart. Results: We included 1,078 patients with RA with 7,049 in-person encounters at the rheumatology clinic over 4 years, with an average of 168 visits/month. 80.4% of patients (867/1078) were female; mean age was 55 (SD 16). Overall PROMIS PF score documentation increased from 60.4% (1081/1791) of visits in 2013 to 74.4% (905/1217) in 2016. Online score documentation increased from 10.0% (148/1473) in 2015 to 19.3% (235/1217) in 2016. African Americans were less likely to have a PROMIS PF recorded (62.5% (55/88) vs. 80.0% (792/990) for other racial/ethnic groups, P<0.001). Compared with Whites, both African American and Hispanics were less likely to have active online EHR portal accounts (50% (44/88) and 57.3% (90/157) respectively, vs. 83.9% (437/521) of Whites; P<0.001) and, once activated, less likely to use the online survey (13.6% (6/44) and 17.8% (16/90) respectively, vs. 30.9% (135/437) of Whites; P=0.02). There was no significant difference in the proportion of any PROMIS PF recorded between non-English vs. English speakers. No significant differences were found across age or gender. Conclusions: PROMIS PF form completion improved overall from 2012-2016, but lagged among racial/ethnic minorities and non-English speaking patients. Future studies should address issues of portal access, enrollment, satisfaction and persistence, and focus on developing PRO implementation strategies that accommodate the needs and preferences of diverse populations.

  • The impact of digital health interventions on health-related outcomes in the workplace: a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Aug 12, 2017

    Open Peer Review Period: Aug 12, 2017 - Oct 7, 2017

    Background: Background: The impact of employee health on productivity in the workplace is generally evidenced through absenteeism and presenteeism. Multicomponent health promotion programs delivered i...

    Background: Background: The impact of employee health on productivity in the workplace is generally evidenced through absenteeism and presenteeism. Multicomponent health promotion programs delivered in the workplace have been shown to effectively modify health risks, in turn impacting medical costs and supporting employees being more effective in their roles. Scalable, cost effective online programs have gained in popularity over the last two decades, due at least in part to their almost limitless scalability and lower cost of implementation. However, little is known about the impact of digital only interventions on health related outcomes in employee groups. Objective: Objective: To assess the impact of purely digital health interventions in the workplace on health-related outcomes. Methods: Methods: Using Scopus (i.e. search engine including databases such as MEDLINE, EMBASE, PubMed, PsycINFO, and CINAHL), literature was reviewed using PRISMA guidelines. Results: Results: Of the initial 1,345 records screened, the final number of eligible studies was 25. Most of these studies were RCTs (n=20) that included control or comparison groups and ran for an average of three months. The interventions within these studies targeted a broad range of health-related outcomes such as sleep, stress, mental health, sedentary behaviors, and physical activity levels, but did not always use standardized measures to quantify impact. All but one study found a significant improvement in at least one health-related outcome. Attrition rates ranged extensively, from 0 to 80%, suggesting program engagement was an issue. In addition, risk of bias assessment was generally unclear for the majority of the studies reviewed. Conclusions: Conclusions: Overall, the review found modest evidence that digital only interventions have a positive impact on health-related outcomes in the workplace. Due to a lack of robustly designed studies within the literature future research should include the evaluation of digital interventions with more RCTs and a focus on issues of engagement and the increased use of standardized measures.

  • Two Year Assessment of Nurses’ Experience of Health Information Technology: A Longitudinal Qualitative Study

    From: Journal of Medical Internet Research

    Date Submitted: Aug 11, 2017

    Open Peer Review Period: Aug 12, 2017 - Oct 7, 2017

    Background: Nurses are the largest group of HIT users. As such, nurses’ adaptation is critical for HIT implementation success. However, longitudinal approaches to understanding nurses’ perceptions...

    Background: Nurses are the largest group of HIT users. As such, nurses’ adaptation is critical for HIT implementation success. However, longitudinal approaches to understanding nurses’ perceptions of HIT are underexplored. Previous studies of nurses’ perceptions demonstrate that the progress and timing for acceptance and adaptation varies. Objective: the study aims to explore nurses’ experience regarding implementation of health information technology (HIT) over time. Methods: A phenomenological approach was used for this longitudinal qualitative study to explore nurse perceptions of HIT implementation over time, focusing on three time points (rounds) at 3, 9, and 18 months after the implementation of electronic health records (EHR) and bar code medication administration (BCMA). The purposive sample was comprised of clinical nurses who worked on a medical-surgical unit in an academic center. Results: Major findings were categorized into 7 main themes with 53 subthemes. Nurses reported personal-level and organizational-level factors that facilitated HIT adaptation. We also generated network graphs to illustrate the occurrence of themes. Thematic interconnectivity differed due to nurses’ concerns and satisfaction at different time points. Equipment and workflow were the most frequent themes across all three rounds. Nurses were the most dissatisfied about 9 months after HIT implementation. Eighteen months after HIT implementation, nurses’ perceptions appeared more balanced. Conclusions: It is recommended that organizations invest in equipment to improve HIT functionality, refine policies to reflect nursing practice, and improve systems to focus on patient safety. Future research is necessary to confirm patterns of nurses’ adaptation to HIT in other samples.

  • Views of indigenous young people about SPARX, a computerized e-mental health program

    From: JMIR Serious Games

    Date Submitted: Aug 16, 2017

    Open Peer Review Period: Aug 17, 2017 - Oct 12, 2017

    Background: Globally, depression is a major health issue. This is true for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological intervent...

    Background: Globally, depression is a major health issue. This is true for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological interventions for these populations. In New Zealand there is little known about taitamariki (Māori adolescent) opinions regarding the development and effectiveness of psychological interventions, let alone computerized cognitive behavioural therapy. SPARX is a computerized intervention developed in New Zealand to treat mild to moderate depression in young people. It was designed to appeal to all young people in New Zealand, and incorporates a number of images and concepts that are specifically Māori. Objective: To conduct an exploratory qualitative study of Māori adolescents’ opinions about the SPARX program. This is a follow-up to an earlier study where taitamariki opinions’ were gathered to inform the design of a computerized cognitive behaviour therapy (cCBT) program. Methods: Taitamariki were interviewed using a semi-structured interview once they had completed work the SPARX resource. Six participants agreed to complete the interview; these interviews ranged from 10 to 30 minutes. Results: Taitamariki participating in the interviews found SPARX to be helpful. The Māori designs were appropriate and useful, and the ability to customize the SPARX characters with Māori designs was beneficial and appeared to enhance cultural identity. These helped young people to feel engaged with SPARX which, in turn, assisted with the acquisition of relaxation and cognitive restructuring skills. Overall using SPARX led to improved mood and increased tlevels of hope for the participants. In some instances, SPARX was used by wider whānau (Māori word for family) members with reported good effect. Conclusions: Overall, this small group of taitamariki reported that cultural designs made it easier for them to engage with SPARX, which, in turn, led to an improvement in their mood and gave them hope. Further research is needed about how SPARX could be best used to support the families of taitamariki. Clinical Trial: Ethics approval was granted by the Northern Regional Y committee (NTY/09/01/003) of the New Zealand Ministry of Health.

  • mHealth applications impact in improving immunization coverage and maternal-child health in Africa

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 17, 2017 - Oct 12, 2017

    Background: Despite laudable efforts and achievement, maternal and child mortality remains high in Africa. The region accounts for 97% of maternal and 94% of children less than five mortality in 2015....

    Background: Despite laudable efforts and achievement, maternal and child mortality remains high in Africa. The region accounts for 97% of maternal and 94% of children less than five mortality in 2015. Limited resources, lack of infrastructures and shortage of healthcare workers have been identified as the main barriers towards healthcare outcomes improvement. Availability and use of mobile phones is increasing rapidly with 46% of African population having a mobile-cellular subscription in 2015. Mobile health (mHealth) interventions have proven to be beneficial in improving maternal and child health service delivery and outcomes in developed countries and elsewhere. In Africa, only few mhealth pilot research projects and small studies have been conducted, those limiting generalizability Objective: The objective of the project is to provide an overview about the current impact of mHealth applications and innovative strategies in improving large-scale (population-based) immunization coverage and maternal- child health service delivery in African countries Methods: Peer-reviewed papers were identified from Medline/PubMed, Google scholar and mHealthEvidence database via a combination of search terms Results: A total of 1217 articles were found of which only 17 met the inclusion criteria and were included in the project. Our findings indicates that there is some evidence on the potential of mHealth applications benefitsin increasing childhood immunization awareness, retention, coverage and effectiveness as well as maternal- child quality care delivery and outcomes Conclusions: Building robust and resilient government and stakeholders leadership, committed partnerships and platform is crucial in investing on large-scale and sustainable ownership of mhealth policies and programs, adequate infrastructure, building capacity and mHealth/eHealth management implementation in strengthening health systems. Moreover, addressing inherent issues of mhealth interoperatibility, patient data privacy. confidentiality and security is needed for socio-economic benefits, cost-effective digital landscape public health solutions and gains across African countries

  • Use of Patient Generated Health Data collected from consumer wearable devices in clinical care: a systematic review and meta-analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 19, 2017 - Oct 14, 2017

    Background: PGHD (Patient Generated Health Data) are health-related data created or recorded by patients to inform their self-care. The availability of low-cost easy-to-use consumer wearable technolog...

    Background: PGHD (Patient Generated Health Data) are health-related data created or recorded by patients to inform their self-care. The availability of low-cost easy-to-use consumer wearable technologies has facilitated patients’ engagement in their self-care and increased production of PGHD but the uptake of this data in clinical environments has been slow. Studies showing opportunities and challenges affecting PGHD adoption and use in clinical care have not investigated these factors in detail during all stages of the PGHD life cycle. Objective: This study aims to provide deeper insight into various issues influencing the use of PGHD at each stage of its life cycle from the perspectives of key stakeholders including patients, healthcare professionals, and the health IT managers. Methods: A systematic review was undertaken on the scholarly and industry literature published from 2012 to 2017. Thematic analysis of content was applied to uncover perspectives of the key PGHD stakeholders on opportunities and challenges related to all life cycle stages of PGHD from consumer wearables. Results: Thirty-six papers were identified for detailed analysis. Challenges were discussed more frequently than opportunities. Most studies done in real-world settings were limited to the collection stage of PGHD life cycle that captured through consumer wearables. Conclusions: There are many gaps in knowledge on opportunities and challenges affecting PGHD captured through consumer wearables in each stage of its life cycle. A conceptual framework involving all the stakeholders in overcoming various technical, clinical, cultural, and regulatory challenges affecting PGHD during its life cycle could help to advance the integration with and use of PGHD in clinical care.

  • Feasibility and Effectiveness of a Web-Based Portal for delivery of care to home dialysis patients.

    From: Journal of Medical Internet Research

    Date Submitted: Aug 18, 2017

    Open Peer Review Period: Aug 19, 2017 - Oct 14, 2017

    Background: Background: Quality of life in home dialysis patients is low compared to the general population. Improvement in patient satisfaction through shared decision-making and handling of patient...

    Background: Background: Quality of life in home dialysis patients is low compared to the general population. Improvement in patient satisfaction through shared decision-making and handling of patient requests through an online interface has been shown to be beneficial in some studies in other disease populations. Such a system may improve patient satisfaction, reduce health service utilization and potentially improve health outcomes. Objective: Objective: To determine the acceptability, practicality, and implementation of an eHealth patient portal in home dialysis patients. Methods: Methods: Prospective feasibility cohort study among patients receiving either home hemodialysis or peritoneal dialysis over a four-month period. Web-based application allowing patients and healthcare workers to communicate through a secure, password protected online portal and permits visualization of the messaging history by patient and provider. Patients and the home dialysis healthcare team had the ability to send messages related to patient care at any time. Messages could be sent between the healthcare team and patient including proposed changes to medication, instructions after a clinic visit, times of new appointments, upcoming investigations or questions about care. Consumer Quality Index (CQI), Quality of Life using the EuroQol Five Dimensions Questionnaire, acceptability and satisfaction using online Acceptability E-scale and Satisfaction questionnaires. Patients were assessed at baseline and at 6 and 12 months of followup. Results: Results: Of the 41 patients who consented to join the web-based portal, 27 (66%) created an online account. Mean CQI for the Nephrology domain was 3.50 (95%CI: 3.33,3.67) and this did not change significantly over the study period. Quality of life using the EQ-index score was 0.80 (IQR: 0.71-0.83) at baseline and this also did not significantly change over the study period. The web-based portal was easy to use with a median response of 4 (IQR: 4-5). Most were satisfied with a mean score of 6.5±0.6 in overall satisfaction. Conclusions: Conclusions: In this study of home dialysis patients, we identified that an online portal for care-delivery was feasible. We did not find a significant improvement in CQI or QOL, but the portal was felt to be beneficial at addressing some domains of patient care. Clinical Trial: Trial Registration: ClinicalTrials.gov number NCT02128347

  • Personal Healthcare Management: Assessing the Relationship With Chronic Disease Prevalence

    From: Journal of Medical Internet Research

    Date Submitted: Sep 19, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: The use of personal healthcare management (PHM) is increasing rapidly within the U.S. due to implementation of health technology across the healthcare continuum and increased regulatory re...

    Background: The use of personal healthcare management (PHM) is increasing rapidly within the U.S. due to implementation of health technology across the healthcare continuum and increased regulatory requirements for healthcare professionals and organizations promoting the use of PHM, particularly the use of messaging, online scheduling, and online requests for prescription renewals. Limited research has been conducted comparing PHM use across groups based upon chronic condition. Objective: The purpose of this research is to describe the overall utilization of PHM and compare individual characteristics associated with PHM in groups with no reported chronic conditions, with one chronic condition and with two or more such conditions. Methods: Datasets drawn from the National Health Interview Series were analyzed using multiple logistic regression to determine the level of PHM use in relation to demographic, socioeconomic, or health-related factors. Data from 47,814 individuals were analyzed using logistic regression. Results: Approximately 12 percent of respondents reported using PHM, but higher rates of use were reported by individuals with higher levels of education and income. The overall rate of PHM remained stable between 2009 and 2014, despite increased focus on the promotion of patient engagement initiatives. Demographic factors predictive of PHM use were younger, non-Hispanic, and people who lived in the western region of the United States were the most likely to use PHM. There were also differences in PHM use based upon socioeconomic factors. Respondents with college level education were over 2.5 times more likely to use PHM than respondents without college level education. Health related factors were also predictive of PHM use. Individuals with health insurance and a usual place for healthcare were more likely to use PHM than individuals with no health insurance and no usual place for healthcare. Individuals reporting a single chronic condition or multiple chronic conditions reported slightly higher levels of PHM use than individuals reporting no chronic condition. Individuals with no chronic conditions who did not experience barriers to accessing healthcare were more likely to use PHM than individuals with one or more chronic conditions. Conclusions: The findings of this study illustrated the disparities in PHM use based upon a number of chronic conditions, and that multiple factors influence the use of PHM, including economics and education. These findings provide evidence of the challenge associated with engaging patients through the use of electronic health information as the healthcare industry continues to evolve.

  • Quality of YouTube TM videos on dental implants

    From: Journal of Medical Internet Research

    Date Submitted: Aug 19, 2017

    Open Peer Review Period: Aug 20, 2017 - Oct 15, 2017

    Background: Patients search YouTube for health-care information Objective: To examine what YouTube offers patients seeking information on dental implants, and to evaluate the quality of provided infor...

    Background: Patients search YouTube for health-care information Objective: To examine what YouTube offers patients seeking information on dental implants, and to evaluate the quality of provided information Methods: A systematic search of YouTube for videos containing information on dental implants was performed. Video demographics and content’s usefulness were analyzed. “Information for patients” available from the American Academy of Implant Dentistry, European Association of Osseointegration, and British Society of Restorative Dentistry were used for benchmarking. Results: A total of 117 videos were analyzed. The most commonly discussed topics were related to procedures involved in dental implantology (76.1%, no=89), and to the indications for dental implants (58.1%, no=78). The mean usefulness score of videos was poor (6.02 ±4.7 [range 0-21]), and misleading content was common (30.1% of videos); mainly in topics related to prognosis and maintenance of dental implants. Most videos (83.1%, n=97) failed to mention the source of information presented in the video or where to find more about dental implants. Conclusions: Information about dental implants on YouTube is limited in quality and quantity. YouTube videos can have a potentially important role in modulating patients’ attitude and treatment decision regarding dental implants Clinical Trial: no

  • Authors' Reply: Response to "Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy"

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 20, 2017

    Open Peer Review Period: Aug 20, 2017 - Oct 15, 2017

    NA...

    NA

  • Feasibility, Acceptability and Effectiveness of a Remote Collaborative Care Program for Patients with Depression Living in Rural Areas

    From: Journal of Medical Internet Research

    Date Submitted: Aug 21, 2017

    Open Peer Review Period: Aug 21, 2017 - Oct 16, 2017

    Background: In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas,...

    Background: In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. Objective: To test the feasibility, acceptability and effectiveness of a remote collaborative care program for patients with depression living in rural areas. Methods: Physicians from fifteen community hospitals located in rural areas recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to a remote collaborative care program (Telepsiquiatría; n=111) or to usual care (UC; n=139). Telepsiquiatría introduced a shared electronic clinical record between primary care teams and a specialized mental health team, telephone monitoring of patients, and remote supervision by a psychiatrist through electronic platform and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after assignment based on a blinded telephone assessment. Results: Two hundred and twelve patients (84.8%) completed the assessments to six months. Telepsiquiatría was feasible and acceptable; achieving higher user satisfaction (OR 1.94, 95% CI 1.25 to 3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02 to 3.19) at 6 months, as compared to UC. There were no statically significant differences in depressive symptoms between Telepsiquiatría and UC, although a favorable trend was observed in the intervention arm. Significant differences between groups in favour of Telepsiquiatría were observed at 3 months for mental health-related quality of life (β 3.11, 95% CI 0.19 to 6.02). Conclusions: Telepsiquiatría may help reduce depression treatment gap in rural areas, providing an acceptable and highly satisfactory intervention for depressed adults. Future studies must evaluate treatment process outcomes in a more detailed manner. Clinical Trial: Clinicaltrials.gov NCT02200367.

  • Privacy-preserving logistic regression based on homomorphic encryption

    From: Journal of Medical Internet Research

    Date Submitted: Aug 22, 2017

    Open Peer Review Period: Aug 22, 2017 - Oct 17, 2017

    Background: Learning a model without accessing raw data has been an intriguing idea to security and machine learning researchers for years. In an ideal setting, we want to encrypt sensitive data to st...

    Background: Learning a model without accessing raw data has been an intriguing idea to security and machine learning researchers for years. In an ideal setting, we want to encrypt sensitive data to store them on a commercial cloud and run analysis without ever decrypting the data to preserve the privacy. Homomorphic encryption technique is a perfect match for secure data outsourcing but it is a very challenging task to support real-world machine learning tasks. Existing framework can only handle simplified cases with low-degree polynomials such as linear means classifier and linear discriminative analysis. Objective: The aim of this study is to give a practical support to the mainstream learning models (e.g., logistic regression). Methods: We innovated on: (1) a novel homomorphic encryption scheme optimized for real numbers computation, (2) the least squares approximation of the logistic function for accuracy and efficiency (i.e., reduce computation cost), and (3) new packing and parallelization techniques. Results: Using real world datasets, we evaluated the performance of our model and demonstrated its feasibility in speed and memory consumption. For example, it took about 114 minutes to obtain the model parameter from homomorphically encrypted training model of Edinburgh dataset. In addition, it could give quite correct predictions on the testing dataset. Conclusions: We present the first homomorphically encrypted logistic regression model based on the critical observation that a precision loss of classification models is sufficiently small so that the decision plan stays still.

  • Usage of a Digital Health Workplace Intervention based on Socioeconomic Environment and Race: Is there a Digital Divide?

    From: Journal of Medical Internet Research

    Date Submitted: Aug 28, 2017

    Open Peer Review Period: Aug 29, 2017 - Oct 24, 2017

    Background: Digital health tools have been associated with improvement of cardiovascular (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and e...

    Background: Digital health tools have been associated with improvement of cardiovascular (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes in not well known. Objective: To identify the effect of socioeconomic environment of usage of a digital health intervention. Methods: We analyzed usage of a previously-validated workplace digital health tool in association with a change in intermediate markers of CVD over the course of one year in 26,188 participants of a work health program across 81 organizations in 42 states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and HbA1c which was then obtained in 90 day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. DHI usage was analyzed based on socioeconomic status as well as age, gender, and race. Results: The cohort was found to represent a wide sample of socioeconomic environments from a median income of $11,000 to $171,000. As a whole, doubling of income was associated with 7.6% increase in log-in frequency. However, there were marked differences between races. Blacks showed a 40.5% increase and Hispanics showed a 57.8% increase in use with a doubling of income, compared to 3% for Caucasians. Conclusions: The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and DHI usage for Whites. However, a strong relationship is present for Black and Hispanic cohorts. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for cardiovascular disease. This identifies a need for digital health applications that are effective in these high risk groups. Clinical Trial: Retrospective analysis, no trial number

  • Needs and perspectives of patients with asthma and chronic obstructive pulmonary disease on patient web portals: a focus group study

    From: Journal of Medical Internet Research

    Date Submitted: Aug 24, 2017

    Open Peer Review Period: Aug 24, 2017 - Oct 19, 2017

    Background: As accessibility to the internet has increased in society, many healthcare organizations have developed patient web portals. These portals can provide a range of self-management options to...

    Background: As accessibility to the internet has increased in society, many healthcare organizations have developed patient web portals. These portals can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and that they do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. Objective: We aimed to obtain and present an overview of patients’ perspectives of patient web portals to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. Methods: We performed a focus group study using semi-structured interviews in three patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met three times for two hours each, with one week between meetings. Data were analyzed with coding software and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. Results: We included 29 patients (55% male, mean age 65 years) with large variation in internet experience: some patients hardly used the internet, whereas others were daily uses. In general, patients were positive about having access to a patient web portal, considering access to personal medical records to be the most important option, though only after discussion with their physician. A medication overview was also considered a useful option. It was expressed that communication between healthcare professionals could be improved if patients could use the patient web portal to share information with their healthcare professionals. However, participants were worried about the language and usability of portals, so it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through online questionnaire use would only be useful if the results were discussed with healthcare professionals. Conclusions: Participants were positive about patient web portals and considered them a logical step. Today, most patients tend to be better educated and to have internet access, while also being more assertive and better informed about their disease. A patient web portal could support these patients. Our participants also provided practical suggestions for implementation in current and future patient web portal developments. The next step will be to develop a portal based on these recommendations and to assess whether it meets the needs of patients and healthcare providers. Clinical Trial: According to the medical ethics committee of the University Medical Center Groningen, this study did not fall under the Medical Research Involving Human Subjects Act.

  • Digital blind-spots: the role of symptom severity and user experience in digital intervention adherence.

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 25, 2017

    Open Peer Review Period: Aug 30, 2017 - Oct 25, 2017

    A recent systematic review by Killikelly and colleagues suggested a number of factors which may affect adherence to digital interventions for individuals with psychosis. While the review outlined some...

    A recent systematic review by Killikelly and colleagues suggested a number of factors which may affect adherence to digital interventions for individuals with psychosis. While the review outlined some crucial points from the research it drew early conclusions into the role that symptom severity may play in study drop-outs, and didn't discuss the potential role user experience may play in keeping user attention. This commentary discusses these points and suggests the necessity for research into the visual design of apps.

  • My Doctor Sister, My Nutrition Sister: Feasibility, acceptability and compliance with an integrated package of nutrition counselling and unconditional cash transfers on a mobile platform to improve maternal and child nutrition

    From: Journal of Medical Internet Research

    Date Submitted: Aug 25, 2017

    Open Peer Review Period: Aug 27, 2017 - Oct 22, 2017

    Background: Inappropriate feeding practices, inadequate nutrition knowledge and insufficient access to food are major risk factors for maternal and child under nutrition. There is evidence to suggest...

    Background: Inappropriate feeding practices, inadequate nutrition knowledge and insufficient access to food are major risk factors for maternal and child under nutrition. There is evidence to suggest that the combination of cash transfer and nutrition education improves child growth. However, it will require cost effective delivery platform to achieve the complete coverage of these interventions in the population Objective: This study aims to assess feasibility, acceptability and the compliance of an intervention package of voice messaging, direct counselling, and un-conditional cash transfers all on a mobile platform for changing perceptions on nutrition during pregnancy and the first year of the child’s life. Methods: We conducted a mixed method pilot study. We recruited 340 women. The women were either pregnant or lactating. The intervention consisted of an unconditional cash transfer combined with nutrition counselling both delivered on a mobile platform. The participants received BDT 787 per month and were given a mobile phone. The nutrition message and counselling were delivered by voice message and conversations with a counsellor from a call centre. We carried out cross sectional surveys at base line and end line, focus group discussion and in-depth interviews with participants and their family members. Results: The poor rural women were interested both in voice messages and direct counselling. Most women reported that they had no problem in operating the mobile phones and listen to the voice messages. There were also able to interact freely with the counsellor. Charging of the mobile handsets posed some challenges. Less than 50% households had electricity at home. However almost all families, which did not have electricity at home were able to find a solution. They either charged their mobiles at their neighbour’s house or at a market place. No major barriers were identified with the use of mobile banking for cash transfers. Regarding the use of cash, our study reported that one of the highest priorities for poor families was purchasing food. Conclusions: The use of mobile platform for cash transfer and nutrition counselling is a feasible and acceptable strategy and has the potential to be used in large-scale programs to improve maternal and child nutrition.

  • Using Reddit to recruit hard-to-reach study populations

    From: Journal of Medical Internet Research

    Date Submitted: Aug 29, 2017

    Open Peer Review Period: Aug 30, 2017 - Oct 25, 2017

    Background: Social media websites (e.g., Facebook and Twitter) have been used to recruit hard-to-reach populations for research. One hard-to-reach population is women who are refused reproductive heal...

    Background: Social media websites (e.g., Facebook and Twitter) have been used to recruit hard-to-reach populations for research. One hard-to-reach population is women who are refused reproductive health care due to a provider’s moral or ethical beliefs. Objective: To test methods for recruiting a hard-to-reach population into qualitative research via Reddit, a social news aggregation and discussion site. Methods: We employed two recruitment methods: 1) recruitment posts on applicable subreddits (pages dedicated to specific topics) and 2) private messaging Reddit users who had previously posted about being denied this care. Results: For the first approach, we posted recruitment messages 13 times on 6 subreddits at various times during a five-month interval. This method yielded no interviews. For the second approach, we used key words in Reddit’s search function, which revealed posts from 13 potentially-eligible women. After messaging the women, three completed the interview. Conclusions: Social media websites (e.g., Facebook and Twitter) have been used to recruit hard-to-reach populations for research. One hard-to-reach population is women who are refused reproductive health care due to a provider’s moral or ethical beliefs.

  • Preferences for online information material for low back pain – a semi-structured interview study of people consulting general practice (Part of the ADVIN Back Trial)

    From: Journal of Medical Internet Research

    Date Submitted: Aug 25, 2017

    Open Peer Review Period: Aug 27, 2017 - Oct 22, 2017

    Background: Information on self-management, including addressing people’s fears and concerns, are core aspects of managing patients with low back pain (LBP). Web applications with patient informatio...

    Background: Information on self-management, including addressing people’s fears and concerns, are core aspects of managing patients with low back pain (LBP). Web applications with patient information may be used to extend the consultation and encourage self-management outside of the consultation room. It is, however, important to identify the end users’ needs and preferences in order to maximise acceptance. Objective: The aim of this study was to identify preferences for the content, design, and functionality of a web application with evidence-based information and advice for people with LBP. Methods: This is a phenomenological qualitative study. Adults who had consulted their general practitioner because of LBP within the past 14 days were included. Each participated in a semi-structured interview, which was audiotaped and transcribed for text condensation. Interviews were conducted at the participant’s home by two interviewers. Participants also completed a questionnaire with information about age, gender, Internet usage, interest in searching new knowledge, LBP-related function, and pain. Results: We conducted fifteen 45-minute interviews. Participants had a median age of 40 (range, 22-68) years and reported a median disability of 7 points (range, 0-18) using the 23-item Roland Morris Disability Questionnaire. Participants reported that online information should be easy to find and easy to read, should not be overloaded with information, and should be easily overviewed. They found existing online information confusing, often difficult to comprehend, and not relevant for them, and they questioned the motives driving most hosting companies/organisations. The Patient Handbook, a Danish government-funded website that provides information to Danes about health, was mentioned as a trustworthy site and a preferred site when searching online for information and advice regarding LBP. Conclusions: This study identified important issues to consider when developing and supplementing existing general practice treatment with online information and advice to patients with LBP. Development of a web application should consider patient input, and developers should carefully address the following domains: readability, customisation, design, credibility, and usability.

  • SAMUV: the development of a digital app for teaching about Multiple-Victim Accidents

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 1, 2017

    Open Peer Review Period: Sep 2, 2017 - Oct 28, 2017

    Background: Multiple-Victim Accidents involve accidents with more than five seriously-ill victims and which are attended by SAMU service in Brazil. So, continuing education for team that works in thi...

    Background: Multiple-Victim Accidents involve accidents with more than five seriously-ill victims and which are attended by SAMU service in Brazil. So, continuing education for team that works in this service is important. Objective: To develop a mobile educational app focusing on decision-making in relation to multiple-victim accidents, for use in continuing education with professionals of the Urgent Medical Aid Service (SAMU, in Portuguese). Methods: An applied methodological study on technological production, undertaken between July and December 2016, following the stages of specification of requirements with the SAMU emergency care providers of a city in the Brazilian state of Paraná bordering Paraguay and Argentina, and the project and implementation based on the software development life cycle theory. The app was designed for the android platform and was written in the HTML 5 markup language. The study complied with ethical requirements. Results: The requirements specifications phase made it possible to carry out the paper prototyping with 17 SAMU professionals, thus allowing these staff members to participate in the app’s planning. The project and implementation phase realized the projections developed in the previous phase, with the construction of pages addressing theoretical topics on definitions of the various terms used in attending multiple-victim accidents, how the attendance functions, signs used to warn people of hazards, methods for triaging victims, each professional’s role during the attendance, frequently-asked questions, an interactive quiz, and a tab providing information on the app’s technical characteristics and the sources referenced in the texts. Conclusions: The theory used guided all the stages of the app’s development. It is necessary for other interactive and innovative strategies to be adopted in teaching urgent and emergency care, to encourage learning in the process of continuing education.

  • Development and Usability Evaluation of an Art and Narrative-Based Knowledge Translation tool for Parents with a Child with Pediatric Chronic Pain: A multi-method research project

    From: Journal of Medical Internet Research

    Date Submitted: Sep 1, 2017

    Open Peer Review Period: Sep 5, 2017 - Oct 31, 2017

    Background: Chronic pain in childhood is increasingly being recognized as a significant clinical problem, affecting between 15-39% of children and their families. Previous research has identified that...

    Background: Chronic pain in childhood is increasingly being recognized as a significant clinical problem, affecting between 15-39% of children and their families. Previous research has identified that families want information about the causes of their child’s chronic pain and the various treatment options, as well as effective strategies to help their child cope with the pain. Unfortunately, parents have reported that finding this information can be challenging. Objective: To actively work together with children attending the Pediatric Chronic Pain Clinic and their parents to develop, refine and evaluate the usability of an art and narrative-based electronic book (e-Book) for pediatric chronic pain. Methods: A multiphase, multi-method research design employing patient engagement techniques was used to develop, refine and evaluate the usability of an art and narrative based e-Book for pediatric chronic pain management to facilitate knowledge translation for parents with a child with chronic pain. The multi-phases included: 1) qualitative interviews to compile parents’ narratives using qualitative interviews, 2) qualitative data analysis, 3) development of an e-Book prototype, 4) expert clinician feedback, 5) parent usability evaluation, knowledge change, and confidence in knowledge responses using an electronic survey, 6) e-Book refinement and 7) dissemination of the e-Book. Results: A 48-page e-Book was developed to characterize the experiences of a family living with a child with chronic pain. The e-Book was a composite narrative of the parent interviews and encompassed descriptions of the effects the condition has on each member of the family, including the mother, father, siblings, and the child living with chronic pain. This was merged with the best available research evidence on the day-to-day management of pediatric chronic pain. The story highlighted the difficulties and struggles of finding resources to improve the quality of life of a child with chronic pain. The e-Book was vetted for clinical accuracy by expert pediatric pain clinicians. All parents that participated in the usability evaluation (n=14) agreed or strongly agreed the content of the e-Book was easy to understand and similarly all parents stated that they would recommend the e-Book to other families who have children with chronic pain. Paired t-tests did not demonstrate a statistically significant difference in knowledge; however, they demonstrated a statistically significant difference in confidence in answering two of the five knowledge questions (chronic pain is a disease involving changes in the nervous system; the use of ibuprofen is usually effective at controlling chronic pain), t=0.165, P=0.001 and t=0.336, P=0.002, respectively, after being exposed to the e-Book. Conclusions: Our results demonstrate that parents positively rated an e-Book developed for parents with a child with chronic pain. Our results also identify that parents’ confidence in their knowledge about chronic pain and its management increased in two aspects after e-Book exposure. These results suggest that art and narrative-based knowledge translation interventions may be useful in transferring complex health information to parents.

  • Combining fitness trackers with motivational interviewing and mutual support to increase physical activity in adolescent/parent dyads

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 5, 2017

    Open Peer Review Period: Sep 7, 2017 - Nov 2, 2017

    Background: An essential component of any effective adolescent weight management program is physical activity (PA). The growing field of health technology provides potential solutions for addressing c...

    Background: An essential component of any effective adolescent weight management program is physical activity (PA). The growing field of health technology provides potential solutions for addressing chronic health issues and lifestyle change, such as adolescent obesity. Activity trackers, used in conjunction with smart phone apps, can engage, motivate, and foster support, among users while simultaneously providing feedback on their PA progress. Objective: To evaluate the effect of a 10 week pilot study utilizing smartphone-enabled activity tracker data to tailor motivation, goal setting on physical activity (PA) for overweight/obese adolescents and their parents. Methods: Eligible adolescents, ages 13-16 with BMI >85th percentile, and one of their parents were queried as to behaviors, barriers to change, perceptions about exercise and health pre- and post-intervention. We captured daily step count and active minutes via fitness trackers. Staff made phone calls to dyads at weeks 1, 2, 4, 8 post enrollment to set daily personalized step count/active minutes goals based upon their prior data, age specific Center for Disease Control and Prevention (CDC) goals. Dyad correlations were evaluated using the non-parametric Spearman rank order correlations. Results: 9 parent adolescent dyads were enrolled. Mean adolescent age was 15 years (range 14-16) (4 female/5 male); mean parent age was 47 years (range 36-66). On average, adolescents met their personalized daily step count goals 35% (11-62%) of the days they wore their trackers; parents did so 40% (3-68%) of the days they wore their tracker. Adolescents met their active minute goals 56% (27-85%) of the days they wore their tracker; parents did 83% (52-97%) of the days. Parent and adolescent success was strongly correlated: step count r=0.36, P=.001, active minutes r=0.30, P=.007. Parental age was inversely correlated with step count success (r=-0.78, P=.01). Conclusions: Our findings that parent-adolescent dyads have highly correlated physical activity success rates suggest that further investment in family-centered weight management strategies merit consideration by policy makers, insurers, and health care providers.

  • Psychosocial assessment using telehealth in adolescent and young adults with cancer: A randomised pilot study

    From: JMIR Mental Health

    Date Submitted: Sep 1, 2017

    Open Peer Review Period: Sep 3, 2017 - Oct 29, 2017

    Background: Adolescent and young adults (AYAs) with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of in-patient face-to-face psychosocial ca...

    Background: Adolescent and young adults (AYAs) with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of in-patient face-to-face psychosocial care, whilst essential, may limit the capacity for clinicians to provide timely and personalised assessment and intervention to AYAs who are unable to attend due to barriers such as time, logistics, distance to travel and stigma. Telehealth offers a promising alternative towards increasing access to the provision of evidence-based psychosocial assessment and treatment for AYAs with cancer. Objective: This partially-randomised patient-preference pilot study aimed to examine the feasibility and acceptability of providing psychosocial assessment via telehealth to AYAs currently receiving treatment for cancer, relative to face-to-face delivery. Methods: Patients were eligible if they were: between the ages of 15-25; currently receiving treatment; had sufficient English; and were medically stable. Patients were recruited from oncology clinics/wards, and allocated to receive a psychosocial assessment (AYA Oncology Psychosocial Assessment Measure) with a clinical psychologist or social worker via face-to-face or telehealth modalities using a partially-randomised patient preference model. Patients completed a pre- and post-assessment questionnaire including validated and purposely designed feasibility and acceptability indices (YSQ, Treatment Credibility and Expectations Questionnaire, WAI) and measures of psychosocial wellbeing (K10, Peds-QL-AYA, AYA Oncology Screening Tool). Clinicians also completed a post-assessment questionnaire rating their impressions of the acceptability and feasibility of the intervention delivery via each modality. Results: Patients were recruited from three hospitals in Australia. Of 29 patients approached, 23 consented to participate (response rate = 79%). Participants were randomised to either the telehealth (n=8; 35%; mean age=16.50 years [range=15-23]; females=4 [50%]) or face-to-face (n=11; 62%; mean age=17 years [range=15-22]; females=8 [72.70%]) conditions. Four participants were withdrawn due to logistical/medical complications (attrition rate = 17.4%). The majority 6/8 (75%) of participants in the telehealth group used their own computer/iPad with minor technical difficulties occurring in 3/8 (37.5%) of assessments. Participants from both groups rated high working alliance (WAI: median patient response in the telehealth group = 74 [range: 59-84] and face to face group = 63 [range: 51-84]) and reported positive beliefs regarding the credibility and expectations of their treatment group. Post-assessment preferences between face-to-face or online modalities varied. The majority of patients in the telehealth group (5/8, 63%) reported no preference, whilst 6/11 (55%) in the face-to-face group reported a preference for the face-to-face modality. Conclusions: This study demonstrated that telehealth was acceptable, patient comfort was comparable across modalities, and no significant technological barriers were experienced. Despite this, patients varied in their preferred interview modality, highlighting the need to tailor treatment to patient preference and circumstance. Clinical Trial: ACTRN12614001142628, http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614001142628&isBasic=True

  • Associations of eHealth Literacy with Health Services Utilization among College Students

    From: Journal of Medical Internet Research

    Date Submitted: Sep 7, 2017

    Open Peer Review Period: Sep 9, 2017 - Nov 4, 2017

    Background: eHealth literacy has become an important topic in the health field and related fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive ca...

    Background: eHealth literacy has become an important topic in the health field and related fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive care services and to have effective interactions with their physician. In addition, previous studies have shown that there is a gender difference in the utilization of physician access and outpatient services. Nevertheless, few studies have explored the associations among gender, eHealth literacy, and various determinants of health services utilization among college students. Moreover, there is a lack of studies that focus on the three levels of eHealth literacy as predictors of health services utilization. Objective: To investigate the associations among gender, eHealth literacy, and health services utilization. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Health Services Utilization Scale is a 10-item instrument developed to measure four dimensions of health services utilization by college students. A nationally representative sample of 489 valid college students in Taiwan was surveyed. We then conducted a multiple regression analysis to examine the associations among gender, eHealth literacy, and health services utilization. Results: The study found that being female negatively predicted the purpose dimension of health services utilization (t484=-2.85, P<0.01). Moreover, critical (t484=2.98-4.23, P<0.01) and interactive eHealth literacy (t484=2.43-2.89, P<0.05) predicted 3 of the health services utilization dimensions, and functional eHealth literacy predicted only the purpose dimension (t484=-2.63, P<0.01). Conclusions: This study found that participants with high interactive and critical eHealth literacy are more likely to utilize various determinants of health services. Moreover, it found that participants with low functional or high interactive eHealth literacy might have a short time interval for visiting a doctor and that females are less likely to seek preventive, illness-related and custodial care

  • Using Mobile Health Gamification to Facilitate Cognitive-Behavioral Therapy Skills Practice in Child Anxiety Treatment

    From: Journal of Medical Internet Research

    Date Submitted: Sep 5, 2017

    Open Peer Review Period: Sep 6, 2017 - Nov 1, 2017

    Background: Cognitive Behavioral Therapy (CBT) is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40-50%) do not show a significant reduction in symptoms and...

    Background: Cognitive Behavioral Therapy (CBT) is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40-50%) do not show a significant reduction in symptoms and/or full recovery from primary anxiety diagnoses. Children may fail to improve because they do not fully understand or apply the skills learned in the clinic to their daily lives. Homework is routinely assigned in CBT with the goal of generalizing skills beyond the therapy session in clinic. Many children however, are likely to struggle with homework completion. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of CBT skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve CBT efficacy by delivering more engaging and interactive strategies to facilitate CBT skills practice in everyday lives (in vivo). Objective: The goal of this project was to redesign an existing mHealth system called SmartCAT so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project sought to evaluate the utility of SmartCAT in open clinical trial, and also to assess the effectiveness of gamification in improving user engagement and retention throughout post-treatment. Methods: We redesigned our existing SmartCAT system consisting of a smartphone app and an integrated clinician portal. The app contains: (1) a series of interactive activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use CBT skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure techniques, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used the portal connected to the app to setup required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to Brief CBT (BCBT) in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at post-treatment with the existing version of SmartCAT without gamification. Results: Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 minutes on the app (SD=64.18) completing 13.00 activities between each therapy session (SD=12.61). At the .10 significance level, the app usage of the gamified system (Median=68.00) was higher than that of the existing version (Median=37.00), U=76.00, P<.01. The amount of time spent on the gamified system (Median=173.15) was significantly different from that of the existing version (Median=120.73), U=173.00, P=.06. Conclusions: The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving BCBT treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment, and thus has the potential to increase involvement in full-length treatment.

  • The effects of a guided computer-based health information search on hypertensive seniors’ decision self-efficacy levels: a quasi-experimental design.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 6, 2017

    Open Peer Review Period: Sep 8, 2017 - Nov 3, 2017

    Background: Patients’ engagement in healthcare decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research rep...

    Background: Patients’ engagement in healthcare decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of health information preference and consultation on seniors’ perceived confidence in making an informed choice (i.e., decision self-efficacy). Objective: The goal of this study was to contribute to a better understanding of the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of information consultation. Additionally, the study allowed insights into the sources senior patients prefer to consult. Methods: A sample of 101 senior citizens (aged 60 or older) with a high blood pressure condition in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of co-variance were conducted to detect differences between and within who desired additional hypertensive related contents (intervention group) and ‘information avoidant’ profiles (control group). Results: Healthcare professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the Internet. However, among the total sample the Internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred to seniors consulting further information compared to avoidant profiles (F(1,93) = 28.25; P<.001). Conclusions: Engaging in a guided computer-based health information consultation is a helpful activity to ultimately increase hypertensive senior patients’ perceived confidence in making treatment decisions.

  • Patient Access to Provider Notes: A Comparison of Resident and Attending Perceptions Prior to Pilot Implementation

    From: JMIR Medical Education

    Date Submitted: Sep 5, 2017

    Open Peer Review Period: Sep 7, 2017 - Nov 2, 2017

    Background: As the Electronic Health Record (EHR) becomes a more integral part of a physician’s daily life, new EHR tools will continue to be rolled out to trainees. Patient access to provider notes...

    Background: As the Electronic Health Record (EHR) becomes a more integral part of a physician’s daily life, new EHR tools will continue to be rolled out to trainees. Patient access to provider notes is becoming a more widespread practice since several studies have shown that it is a tool to increase patient empowerment. Objective: In this analysis, we compared differences between resident and attending physicians’ perceptions prior to implementation of patient access to provider notes to facilitate optimal use of EHR features and potential for patient empowerment. Methods: Prior to implementation of patient access to provider notes we surveyed residents and attendings to assess differences in perceptions of this new EHR tool using an open access survey provided by OpenNotes. Results: Survey response rates were 37% (n=20/54 total) for resident physicians and 72% (n=31/44 total) for attending physicians. Similarities between the groups included concerns around litigation and documenting sensitive topics. Residents were more concerned about litigation, discussing weight, offending patients, and overall communicated with patients less through the EHR compared to attendings. Conclusions: Patient access to provider notes has potential to empower patients but resident concerns need to be validated and addressed prior to being comfortable utilizing this tool.

  • Development of Just-in-time Adaptive Intervention for Insomnia: Usability Study

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 5, 2017

    Open Peer Review Period: Sep 7, 2017 - Nov 2, 2017

    Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, d...

    Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this “Just in Time Adaptive Intervention” (JITAI) for insomnia—an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools—can significantly improve patient access and clinician delivery of evidence-based insomnia treatments. Objective: This study aims to develop and assess the usability of a JITAI application platform called iREST (“interactive Resilience Enhancing Sleep Tactics”) for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians. Methods: The development of iREST was based on the interactive and incremental (IID) software development model. Requirement analysis was based on the case study’s description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the JITAI architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns. Results: The iREST app was developed from the mobile logical architecture of JITAI. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members (ADSM) and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean=12.23, SD=8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as “highly usable”, achieving a mean System Usability Score (SUS) score of 85.74 (SD =12.37), which translates to an adjective rating of “Excellent”. The participants also gave high scores on “ease of use and learnability” with an average score of 4.33 (SD=0.65) on a scale of 1 to 5. Conclusions: iREST provides a feasible platform for the implementation of JITAI in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based JITAI is not only feasible, but also works effectively.

  • Mobile Diabetes Health Intervention: Impact on Diabetes Distress and Depression Among Adults

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 6, 2017

    Open Peer Review Period: Sep 8, 2017 - Nov 3, 2017

    Background: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activit...

    Background: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients’ emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes. Objective: To determine impact of a one-year mobile phone diabetes intervention (MDIS) cluster randomized clinical trial (RCT) on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D). Methods: 163 adults with less than well-controlled T2D were enrolled from community primary care practices. Primary care practices were cluster-randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a web-portal to communicate with physicians/diabetes educators. A priori established secondary outcomes included distress measured by Diabetes Distress (DD) Scale (DDS); subscales measuring emotional burden (EB), interpersonal distress (ID), physician-related distress (PD), and regimen-related distress (RD); and depression, measured by Patient Health Questionnaire-9 (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time both overall and separately by sex, and to determine if the intervention affected total DD, DD subscales, or depression. The impact of total DDS on changes in HbA1c was also studied. Results: There were no significant treatment group effects for DDS total (baseline P = .07, differences over time P = .38) or for depression (P = .06 over time). Significant declines in total DD were observed over the 12-month intervention period (P = .01). Regimen-related distress significantly decreased for all study participants (P < .001) but no significant change over time was observed for EB (P = .83), ID (P = .64), or PD (P = .73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, EB, PD, and RD, but not ID. Women also reported higher baseline depression compared to men (P = .006). Overall, depression decreased over the treatment period (P =.007), but remained unaffected by group assignment (P =.06) or by sex (P = .97). Diabetes distress had no effect on the change in HbA1c (P = .91) over the treatment period. Conclusions: We found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression; this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Mobile technology provides an opportunity to personalize, contextualize and intervene in the emotional well-being of persons with diabetes.

  • Understanding barriers to physicians adopting clinical decision support systems: A Systematic Review

    From: JMIR Medical Informatics

    Date Submitted: Sep 6, 2017

    Open Peer Review Period: Sep 8, 2017 - Nov 3, 2017

    Background: The purpose of this paper was to conduct an analytical review and task analysis of CDSS re-search, and to develop a new framework for CDSS design in order to achieve user acceptance. Objec...

    Background: The purpose of this paper was to conduct an analytical review and task analysis of CDSS re-search, and to develop a new framework for CDSS design in order to achieve user acceptance. Objective: This paper tackles a critical issue modern healthcare systems namely, the adoption of Health Informatics Technologies (HIT). The paper provides a comprehensive literature review of the current status quo of Clinical Decision Support Systems adoption, the barriers to adoption from users stand point, and proposes novel solutions to current gaps in order to the enhancement of healthcare delivery and execution. Methods: A literature review of CDSS papers was conducted with a focus on user acceptance. In order to gain a greater understanding of the problems associated with CDSS, we conducted a task analysis to identify and describe the goals, user input, system output, knowledge requirements, and constraints from two different perspectives. Results: Based on the literature review, findings are characterized by whether user acceptance was favorable and unfavorable for clinical guidelines, reminders, and diagnostic CDSS. We propose two models: 1) the User Acceptance and System Adaptation Design (UASAD) model which includes optimizing CDSS design based on user needs/expectations and 2) the Input-Process-Output-Engage (IPOE) model which reveals to users the processes the govern CDSS outputs. Conclusions: CDSS have the capacity to decrease medical errors and improve patient outcomes. However, current CDSS designs do not consistently show such improvements. We hypothesized that the incorporation of the proposed models will improve user acceptance to support beneficial impacts of CDSS adoption. Ultimately, if a user does not accept technology this not only poses a threat to the use of the technology but can also pose a threat to the health and wellbeing of patients.

  • Gut Hormone and Anti-Inflammatory Pathways Underlying Probiotic-effects on Glycaemic Control, Gut Microbiota and Quality of Life among Type 2 Diabetes Mellitus Patients: A Study Protocol

    From: JMIR Research Protocols

    Date Submitted: Sep 7, 2017

    Open Peer Review Period: Sep 9, 2017 - Sep 23, 2017

    Type 2 diabetes mellitus (T2DM) is a hyperglycaemic condition characterised with systemic inflammation and high oxidation level. Recently, imbalanced gut microbiota has been identified as one of the c...

    Type 2 diabetes mellitus (T2DM) is a hyperglycaemic condition characterised with systemic inflammation and high oxidation level. Recently, imbalanced gut microbiota has been identified as one of the contributing factors in the development of T2DM. Modulation of gut microbiota in favour of good bacteria is essential for the management of T2DM. Probiotics are being increasingly recognised for their ability in modulating microbiota shift. This beneficial effect could potentially increase secretion of gut hormones, reduce systemic inflammation and oxidative stress among T2DM patients. The present clinical trial aims to determine the effects of probiotics on glycaemic control in T2DM patients. This trial will also elucidate the role of probiotics on anti-inflammatory markers, anti-oxidants, gut hormone regulation as well as alteration of intestinal microbiota composition in T2DM patients. Furthermore, this study evaluates changes in quality of life of the T2DM patients upon probiotics intake. A double-centre, double-blinded, placebo-controlled, randomised trial will be conducted at the Primary Care Medicine (PCM) clinics of the Clinical Training Centre (CTC) Sungai Buloh and the CTC Selayang, Universiti Teknologi MARA (UiTM), Selangor Darul Ehsan, Malaysia. One hundred T2DM adult patients will be recruited and will be randomly assigned into two groups, receiving either one capsule of probiotics (Chr Hansen, Denmark) or one capsule of placebo twice daily for 24 weeks. Changes in glycaemic parameters [i.e. glycosylated haemoglobin (HbA1c) as the primary outcome], levels of anti-inflammatory markers, anti-oxidants, gut hormone, anthropometric parameters, gut microbiota composition and quality of life will be determined. Both blood (all patients) and stool (20 patients only) samples will be collected during baseline assessment (prior to commencement of the clinical trial), week 12 and week 24 follow-up. Assessment of compliance and adverse events will be conducted throughout the study. It is anticipated that probiotics may induce beneficial changes in the gut microbiota, reduce systemic inflammatory state and oxidative stress as well as increase secretion of gut hormone, all of which may lead to improved glycaemic control and quality of life in T2DM patients. 100 subjects were estimated to be enrolled for this study. This study was initiated in December 2015. Currently, it is now at the stage of data collection and expected to complete by May 2018. Australian New Zealand Clinical Trial Registry (ANZCTR) Identifier: (ACTRN12615001135505)

  • A smartphone app (BlueIce) for young people (aged 12-17) who self-harm: An Open Phase 1 Trial

    From: Journal of Medical Internet Research

    Date Submitted: Sep 8, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: Recent years have seen a significant increase in the availability of smart phone apps for mental health problems. Despite their proliferation few have been specifically developed for young...

    Background: Recent years have seen a significant increase in the availability of smart phone apps for mental health problems. Despite their proliferation few have been specifically developed for young people and almost none have been subject to any form of evaluation. Objective: Our aim was to undertake a preliminary evaluation of a mobile app (BlueIce), co-produced with young people, designed to help young people manage distress and urges to self-harm. We explored app acceptability and safety as well as changes in self-harm and pre-post changes on standardized measures of depression, anxiety and behaviour. Methods: We undertook an open trial where we recruited young people aged 12 to 17 attending specialist child and adolescent mental health services (CAMHS) who were currently, or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarisation) and again at 12 weeks (post-use). Standardised measures of depression, anxiety and general behaviour were completed alongside self-reports of self-harm, app helpfulness and safety. Results: Of the 54 young people assessed for eligibility, 44 began the study and completed baseline assessments. Post-familiarization interviews were conducted with 40 participants and 33 completed post-use assessments. BlueIce was highly acceptable to clinicians and young people. There were no adverse events during the course of the study and young people did not feel that BlueIce increased their urge to self-harm. Almost three-quarters of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a significant difference on symptoms of depression (P =.043) and on symptoms of anxiety (P =.001) at post-use compared to baseline. There was no statistically significant change in behaviour other than on the emotional sub-scale of the SDQ (P =.007). Conclusions: Although our study has limitations our findings are encouraging and suggest that BlueIce, used alongside a traditional CAMHS face to face intervention, can help young people manage their emotional distress and urges to self-harm. Clinical Trial: N/A

  • Just in time information and feedback (JITIF) on antibiotics use for village doctors in rural Anhui, China: A randomize controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: Sep 8, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: Excessive antibiotics use is very common worldwide especially in rural China and various measures have been used in curbing the problem but showed only marginal effects. Objective: This st...

    Background: Excessive antibiotics use is very common worldwide especially in rural China and various measures have been used in curbing the problem but showed only marginal effects. Objective: This study tested an innovative intervention which provided just in time information and feedback (JITIF) to village doctors on care of common infectious diseases. Methods: The “information” component of JITIF consisted of a set of theory or evidence- based ingredients including operation guideline, public commitment, and takeaway information; while the “feedback” component tells each participating doctor about his/her performance scores and percentages of antibiotic prescriptions. These ingredients were incorporated together in a synergetic way via a web-based aid (WBA). Evaluation of JITIF adopted a randomized controlled trial (RCT) design involving 24 village clinics randomized into equal control and intervention arms. Measures used included changes between baseline and endpoint (1 year after baseline) in terms of: percentages of patients with symptomatic respiratory or gastrointestinal tract infections (RTIs/GTIs) being prescribed antibiotics; delivery of essential service procedures; patients’ beliefs and knowledge about antibiotics and infection prevention. Two researchers worked as a group in collecting the data at each site clinic. One performed non-participative observation of the service process; while the other, structured exit interview about patients beliefs and knowledge. Data analysis consisted mainly: a) descriptive estimations of beliefs/knowledge, practice of indicative procedures and use of antibiotics at baseline and endpoint and for intervention and control groups; and b) Chi-square tests for the differences between these groups. Results: A total of 1048 patients completed the evaluation, including 532 at baseline (intervention=269, control=263) and 516 at endpoint (intervention=262, control=254). Patients diagnosed with RTIs and GTIs accounted for 407(76.5%) and 125(23.5%) respectively at baseline and 417(80.8%) and 99(19.2%) at endpoint. JITIF resulted in substantial improvement in delivery of essential service procedures (2.6% to 24.8% at baseline on both arms and at endpoint on the control arm versus 88.5% to 95.0% at endpoint on the intervention arm, P<0.05), beliefs favoring rational antibiotics use (11.5% to 39.8% at baseline on both arms and at endpoint on the control arm versus 19.8% to 62.6% at endpoint on the intervention arm, P<0.05) and knowledge about side-effects of antibiotics (35.7% on the control arm versus 73.7% on the intervention arm, p<0.05), measures for managing/preventing RTIs (39.1% versus 66.7%, p<0.05), and measures for managing/preventing GTIs (46.8% versus 69.2%, p<0.05). It also reduced antibiotics prescription (from 88.8% to 62.3%, p<0.05) and this decrease was consistent for RTIs (87.1% versus 64.3%, p<0.05) and GTIs (94.7% versus 52.4%, p<0.05). Conclusions: JITIF is effective in controlling antibiotics prescription at least in the short term, and may provide a low-cost and sustainable solution to the widespread excessive use of antibiotic in rural China. Clinical Trial: Not applicable

  • AllyQuest: engaging HIV+ young MSM in care and improving adherence through a social networking and gamified smartphone application.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 8, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among youn...

    Background: HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among young men who have sex with men (YMSM) is an urgent public health priority. Technology-based interventions – particularly mobile Health (mHealth) platforms – can provide tailored adherence interventions and allow YMSM to engage and connect with others. Objective: To describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM. Methods: AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two Youth Advisory Boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability. Results: Mean age of participants was 21.8 years (range 19-24), 95% were nonwhite. The mean time of app use was 158.4 minutes [SD 114.1], range 13 to 441 minutes. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (p<0.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications. Conclusions: AllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital given the urgency of the ongoing HIV epidemic among YMSM. Clinical Trial: ClinicalTrials.gov Identifier: NCT03090958

  • Response to Letter 'Digital blind-spots: the role of symptom severity and user experience in digital intervention adherence'

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 8, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: In their letter the authors state that a) our claim that there is little effect of symptom severity on drop-out was not clearly supported and b) our discussion of service user involvement...

    Background: In their letter the authors state that a) our claim that there is little effect of symptom severity on drop-out was not clearly supported and b) our discussion of service user involvement does not include ‘User Experience/User Interface (UXUI)’. We respond to each of these comments. Objective: NA Methods: NA Results: NA Conclusions: NA

  • Exploring the Use of Personal Technology in Type 2 Diabetes Management Among Minority Patients: the LIFT Diabetes Study

    From: JMIR Diabetes

    Date Submitted: Sep 9, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: Internet technology may afford a low-cost solution to chronic disease management. This study aims to assess use of information technology in a diverse sample. Objective: Here we seek to as...

    Background: Internet technology may afford a low-cost solution to chronic disease management. This study aims to assess use of information technology in a diverse sample. Objective: Here we seek to assess the feasibility of capitalizing on the pervasive use of technology as a secondary means of delivering diabetic counseling though an investigation of correlates to technology use within the context of an ongoing population health study. Methods: LIFT Diabetes randomized 260 overweight and obese adults with diabetes to two intervention arms. A survey evaluating access to and use of various technologies was administered at baseline and analyzed using descriptive statistics and logistic regression. Results: The sample had a mean age of 56, was 67% female and 54% non-white. Non-white participants had higher baseline mean BMI (p=0.0015) and HbA1c (p=.0034). Minority participants were less likely to have a home computer (75% vs. 93%, p<0.001) and less likely to have email access at home (p=0.032). Ownership of a home computer was correlated to higher income (p<0.001), education (p<0.001), full time employment (p=0.011), and ownership of a smartphone (p=0.001). Willingness to complete questionnaires online was correlated to higher income (p=0.001), education (p<0.001), full time employment (p=0.012), and home access to a computer, internet, and smartphone (p≤0.050). Racial disparities in having a home computer persisted after controlling for demographic variables and owning a smartphone (adjusted OR 0.26; 95%CI 0.10, 0.67; p=0.005). Willingness to complete questionnaires online was driven ownership of a home computer (adjusted OR 3.87; 95%CI 1.14, 13.2; p=0.030). Conclusions: Minority adults were more likely to report limited access to technology than white adults. As ownership of a home computer is central to a willingness to use online tools, racial disparities in access may limit the potential of web-based interventions to reach this population.

  • Academic leagues: a concept created on Brazilian medicals schools

    From: JMIR Medical Education

    Date Submitted: Sep 10, 2017

    Open Peer Review Period: Sep 13, 2017 - Nov 8, 2017

    Background: The Brazilian academic leagues are small groups of medical students that are growing on medical education. Objective: Present the concept of Brazilian academic leagues and synthesize the e...

    Background: The Brazilian academic leagues are small groups of medical students that are growing on medical education. Objective: Present the concept of Brazilian academic leagues and synthesize the experiences published in scientific journals. Methods: Was performed a survey bibliographic databases, with subsequent exclusion of items not related to the theme, repeated or without free access. It was included studies that contained reports of an individual experience of an academic league. Results: Was found 29 articles on total, and analyzed 15 experience reports. They have been described 7 reports of Medicine, 4 reports from other areas and 4 multidisciplinary reports. So, there is a gradual increase in the debate on the subject, although most of it is still in the form of experience reports. Conclusions: There is great variability in the reported academic leagues, although most of them have regular meetings with theoretical discussions, participate in scientific events, as listeners, speakers and leading academic papers. Many leagues have extension activities, with activities in the community in various segments.

  • Investigating the Impact of Hearing Aid Use and Auditory Training on Cognition, Mood and Social Interaction in Older Adults with Hearing Loss: the Study Protocol of a Crossover Trial

    From: JMIR Research Protocols

    Date Submitted: Sep 11, 2017

    Open Peer Review Period: Sep 15, 2017 - Sep 29, 2017

    Background: Sensorineural type of hearing loss is the most common sensory deficit among older adults. Some of the psychosocial consequences of this condition include difficulty in understanding speech...

    Background: Sensorineural type of hearing loss is the most common sensory deficit among older adults. Some of the psychosocial consequences of this condition include difficulty in understanding speech, depression and social isolation. Studies have shown that older adults with hearing loss show some age-related cognitive decline. There is no clinically proven method to predict the onset of this condition, as its occurrence is slow and progressive, affecting both ears equally. Although hearing aid use and auditory training have been proven as successful interventions to alleviate sensorineural hearing loss, no research has been designed to look at the effect of simultaneous hearing aid use and auditory training on cognitive performance in older adults. Objective: The objective of this research study is to investigate in a randomized crossover trial, the impact of hearing aid use coupled with auditory training on cognition, mood, and social interaction, for older adults with sensorineural hearing loss. The rationale for this study is based on the hypothesis that, in older adults with sensorineural hearing loss, hearing aids in combination with auditory training will be more effective for improving cognition, mood, and social interaction, than auditory training on its own. Methods: This is a crossover trial targeting elderly men and women between 50 and 90 years with either mild or moderate symmetric sensorineural hearing loss. Consented, willing participants will undergo a six month intensive auditory training program (active control), as a rigorous means of examining the impact of hearing aid use on cognition, mood and social interaction. Participants will be assigned in random order to receive hearing aid (intervention) for either the first three or last three months of the six month auditory training program. Each participant will be tested at baseline, three and six months on a battery of computer based cognitive assessments, together with mood, and social engagement measures. The primary outcome, cognitive performance, will be determined by a neuropsychological test battery. Secondary outcomes include mood and social interaction. The effectiveness of hearing aids and auditory training will be evaluated using an online speech perception test and the Abbreviated Profile of Hearing Aid Benefit (APHAB) Inventory. Results: This investigation is funded by the Australian Research Council and Blamey and Saunders Hearing Pty Ltd under the Industry Transformation Training Centre Scheme (ARC Project No. IC140100023) and it attained ethics approval on July 22, 2016 (Swinburne University Human Research Ethics Committee protocol number SHR Project 2016/159). Conclusions: This study will investigate whether using a hearing aid coupled with auditory training can improve a person’s cognition and learning abilities, relationships with family and friends, and quality of life. Results from the study will inform strategies for aural rehabilitation, hearing aid delivery and future hearing loss intervention trials. Clinical Trial: This trial is retrospectively registered at ClinicalTrials.gov, on April 13, 2017, identifier: NCT03112850.

  • Near-real-time surveillance using poison control data: the Alerting System for Illness Related to Consumption of Shellfish (ASIRCS)

    From: JMIR Public Health and Surveillance

    Date Submitted: Sep 11, 2017

    Open Peer Review Period: Sep 15, 2017 - Sep 29, 2017

    Background: Data from poison control centres have the potential to be valuable for public health surveillance of long-term trends, short-term aberrations from those trends, and poisonings occurring in...

    Background: Data from poison control centres have the potential to be valuable for public health surveillance of long-term trends, short-term aberrations from those trends, and poisonings occurring in near-real-time. This information can enable long-term prevention via programs and policies and short-term control via immediate public health response. Over the past decade there has been increasing use of poison control data for surveillance in the United States, Europe, and New Zealand, but this resource still remains widely underused. Objective: The British Columbia (BC) Drug and Poison Information Centre (DPIC) is one of five such services in Canada, and it is the only one nested within a public health agency. Here we aim to demonstrate how DPIC data are used for routine public health surveillance in near-real-time using the case study of its Alerting System for Illness Related to Consumption of Shellfish (ASIRCS). Methods: Every hour, a connection is opened between the DPIC Visual Dot Lab Enterprise (VDLE) database and the R, statistical computing environment. This platform is used to extract, clean and merge all necessary raw data tables into a single data file. ASIRCS automatically and retrospectively scans a 24-hour window within the data file for new cases related to illnesses from shellfish consumption. Detected cases are queried following a list of criteria that include: the caller location; exposure type; reasons for the exposure; and a list of keywords searched in the clinical notes. The alert generates a report that is tailored to the needs of food safety specialists, who then assess and respond to detected cases. Results: The ASIRCS system alerted on 79 cases between January 2015 and December 2016, and retrospective analysis found 11 cases that were missed. All cases were reviewed by food safety specialists and 46 (58.2 %) were referred to designated regional health authority contacts for follow-up. Of the 33 (41.8%) cases that were not referred to health authorities, some were missing follow-up information, some were triggered by allergies to shellfish, and some were triggered by shellfish-related keywords appearing in the case notes for non-shellfish-related cases. There was a 100% decrease in the number of cases with missing follow-up information from 2015 to 2016. Conclusions: The surveillance capacity is evident within poison control data as shown from the novel use of DPIC data for identifying illnesses related to shellfish consumption in BC. Further development of surveillance programs could improve and enhance response to public health emergencies related to acute illnesses, chronic diseases, and environmental exposures.

  • How healthcare professionals evaluate a digital intervention to improve medication adherence: a qualitative exploratory study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 12, 2017

    Open Peer Review Period: Sep 13, 2017 - Nov 8, 2017

    Background: For many chronic diseases, medication non-adherence poses a serious and hard-to-tackle problem. eHealth applications that foster patient engagement and shared decision making may be a nove...

    Background: For many chronic diseases, medication non-adherence poses a serious and hard-to-tackle problem. eHealth applications that foster patient engagement and shared decision making may be a novel approach to improve medication adherence. Objective: The aim of this study was to investigate the perspective of healthcare professionals regarding a new developed digital application, aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. Methods: A web-based prototype of the eHealth application (called ‘MIK’) was co-designed with patients and healthcare professionals. After user tests with patients we performed semi-structured interviews and user tests with 12 physicians from six different hospitals to examine how the functionalities offered by ‘MIK’ could assist physicians in their consultation and how they could be integrated in daily clinical practice. Qualitative thematic analysis was used to identify themes that covered physicians’ evaluations. Results: Three themes were identified based on the interview data; 1) Perceived impact on patient-physician collaboration; 2) Perceived impact on patient’s understanding and self-management regarding medication adherence; 3) Perceived impact on clinical decisions and workflow. Conclusions: The eHealth application ‘MIK’ seems to have the potential to improve the consultation between patient and physician in terms of collaboration and patient engagement. The impact of eHealth applications, based on the concept of shared decision making, on improving medication taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth applications aimed at improving self-management by means of patient engagement and shared decision making.

  • Team Resilience Training in the Workplace: An E-Learning Adaptation, Measurement Model, and Two Pilot Studies

    From: Journal of Medical Internet Research

    Date Submitted: Sep 13, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Two exploratory and quasi-experimental pilot studies were designed to address four shortcomings in the study of workplace resilience interventions. There is a need: to promote social or team resilienc...

    Two exploratory and quasi-experimental pilot studies were designed to address four shortcomings in the study of workplace resilience interventions. There is a need: to promote social or team resilience; to condense generally longer class-room training into a brief e-learning format; to use known guides for making e-learning programs effective, and for more theoretical precision in designing programs and assessing outcomes. The authors took an established evidence-based program (Team Resilience) and modified it based on these needs. A measurement model distinguishes outcomes that are more proximal (perceptions that the program improved resilience) and more distal (dispositional resilience). Seven hypotheses are advanced to test the model and program efficacy. Two samples (ns = 118, 181) of engineering firms received the online training and provided immediate reactions in a post-test only design. The second sample also included a control condition (n = 201). Findings generally support the model and program efficacy. For example, workplace resilience was greater in the intervention than control group. Other findings suggest social dissemination effects, equal outcomes for employees at different stress levels, and greater benefit for females.

  • Assessing Information Quality in Online Health Social Networks - An Exploratory Investigation of Diabetes-Related Threads

    From: Journal of Medical Internet Research

    Date Submitted: Sep 13, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Background: The number of people turning to online health social networks for health-related information continues to grow. While online support is an important benefit that patients derive from using...

    Background: The number of people turning to online health social networks for health-related information continues to grow. While online support is an important benefit that patients derive from using such forums, patients also seek answers to questions relating to topics such as medication, treatment, and diagnosis. Many prior studies confirm that the health related information available on the Internet and in online health social networks is suspect. Incorrect responses to questions by patients could adversely impact patient safety if patients heed such advice. Objective: The goal of this exploratory study is to investigate the factors that are associated with information quality in online health social networks. These factors can then be used for predicting, monitoring, and warning patients about the extent of misinformation contained in threads in online healthcare social networks. Methods: This quantitative study is based on the analysis of 2,586 posts from 152 threads relating to diabetes mellitus. The data were extracted from a popular online health social network site (OHSNS), and three family medicine board certified physicians evaluated the clinical quality of responses for each thread. Partial least squares (PLS) regression was used to examine the factors. Only threads relating to questions seeking answers regarding medication, diagnosis, and treatment were included in the study. This study excludes threads purely seeking emotional support. Results: Our findings show that the clinical quality of the response is positively associated with the quality of the thread question (completeness P < .001, readability P = .09), the extent of user’s experience with the disease (P = .004), the sentiment within the thread (P = .001), and the proportion of responders with Type-1 diabetes (P < .001). Counter intuitively, the study also found that the quality of the response is negatively associated with the responder’s social network-related measures (likability (P= .001), tenure (P = .003), and activity (P = .047)). The findings suggest that traditional social media measures, such as responders’ “likes”, might mislead users. Conclusions: The results of this exploratory study help to identify factors (also referred to as cues) associated with the response quality of threads in OHSNS. The factors identified in this study could be utilized for developing indicators of information quality to improve patient safety.

  • Lessons learned from the use of a participatory design process to develop digital games addressing airway clearance therapy in children with cystic fibrosis

    From: JMIR Serious Games

    Date Submitted: Sep 14, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Worldwide, between 70,000 to 100,000 individuals are affected with cystic fibrosis. From early childhood, children affected do respiratory exercices to release the mucus stuck in their lungs. This ca...

    Worldwide, between 70,000 to 100,000 individuals are affected with cystic fibrosis. From early childhood, children affected do respiratory exercices to release the mucus stuck in their lungs. This can require many hours daily. Games for health and connected sensors that transform the breath into a signal offer promising avennues to make the treatment more fun. Since 2014, the collective Breathing Games has mobilized game designers, software developers, visual artists, sound composers, children affected and their parents, pulmonologists, and physiotherapists to collectively create prototypes of digital games about cystic fibrosis. These prototypes are released under copyfair licenses so that everyone can build upon them. We present the lessons learned from six game prototypes created through a participatory design process, emphasizing on their strengths and limits. We link this practical experience to a review of litterature about key elements to be included in the design of games for health. The article may benefit researchers and professionals interested in games for health by providing a case study that emerged from the practice, and built a posteriori on scientific methods.

  • The Development of a Mobile Social Networking-Based Relatedness Intervention Condition among Young, First-Time Blood Donors

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 15, 2017

    Open Peer Review Period: Sep 17, 2017 - Nov 12, 2017

    Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an assoc...

    Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an associated self-identity as a blood donor may be promoted by feelings of “relatedness” or connection to other donors, which may be enhanced through social relations and interaction. Objective: The purpose of this report it to describe the development and pilot testing of a social networking-based (Facebook) intervention condition designed to increase feelings of relatedness via virtual social interaction and support. Methods: To develop the intervention condition content, images, text, polls, and videos content was assembled. Ohio University college students (N = 127) rated the content (82 images/text) presented by computer in random order using a scale of one to five on various dimensions of relatedness. Mean ratings were calculated and ANOVA was conducted to assess associations among the dimensions. Based on these results, the relatedness intervention was adapted and evaluated for feasibility, acceptability, and preliminary efficacy among 24 first-time donors, aged 18 to 24, in a 30-day pilot. Paired t-tests were conducted to examine change over time in relatedness and connectedness. Results: The intervention condition developed was acceptable and feasible. Results of the uncontrolled, pre- and post-intervention evaluation revealed that feelings of individual-level relatedness increased significantly after the intervention. Conclusions: By promoting first-time donor relatedness our goal is to enhance internal motivation for donating and the integration of the blood donor identity, thus increasing the likelihood of future repeat donation. Clinical Trial: Clinical Trial Registration: NCT02717338

  • A Case Report of High-risk Multi-Vessel Percutaneous Coronary Intervention Using Impella CP with Severe Mitral Regurgitation

    From: JMIR Cardio

    Date Submitted: Sep 14, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Percutaneous Coronary Intervention (PCI) becomes a high-risk procedure when accompanied by several factors such as low ejection fraction, congestive heart failure, multi-vessel disease and severe mitr...

    Percutaneous Coronary Intervention (PCI) becomes a high-risk procedure when accompanied by several factors such as low ejection fraction, congestive heart failure, multi-vessel disease and severe mitral regurgitation. These factors cause a substantial increase in associated morbidity and mortality. Percutaneous Left Ventricular Assist Devices (pLVAD) assist in betterment of outcomes, in these patients. Here, we present a case documenting the utility of Impella CP, a pLVAD in high risk PCI. Our patient presented with myocardial infarction that was complicated by heart failure and mitral valve abnormality. Coronary angiography reported multi-vessel disease and was deemed unsuitable for surgery due to associated high-risk conditions. Thereafter, PCI was performed on this patient using Impella CP. The procedure was successful with no peri- and post-procedure complications even at 1-year follow-up. Impella CP is a micro-axial pump, which advances blood flow into the aorta from the left ventricle. It is advantageous for being minimally invasive and effective in decreasing end diastolic left ventricular volume. It should be attempted in unstable patients with severe coronary lesions and high-risk mortality with cardiac surgery.

  • Work Smarter or Harder in Healthcare? Investigating Taiwanese Technological Healthcare Innovation

    From: Journal of Medical Internet Research

    Date Submitted: Sep 14, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Background: Background: Technology-based healthcare has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users...

    Background: Background: Technology-based healthcare has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work. Objective: Objective: This study investigates how and why e-health has been applied in Taiwan and suggests implications that may inspire other countries facing similar challenges. Methods: Methods: A qualitative methodology was adopted to obtain insightful input from deeper probing. Taiwan was selected as a typical case study given its aging population, advanced technology, and comprehensive healthcare system. This study investigated 38 stakeholders in the healthcare ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion. Results: Results: First, respondents indicate that the use of technology can enable seamless patient care and clinical benefits, such as flexibility in time management. Second, the results suggest that a leader’s vision, authority, and management skills might influence success in healthcare innovation. Finally, the results imply that both internal and external organisational governance are highly relevant to implementing technology-based innovation in healthcare. Conclusions: Conclusions: This study provides Taiwanese perspectives on how to intelligently use technology to benefit healthcare and debates the perception that technology prevents human interaction between clinicians and patients.

  • Integrative analysis of the canonical TGFβ-Smad signaling pathway in breast cancer

    From: Journal of Medical Internet Research

    Date Submitted: Sep 15, 2017

    Open Peer Review Period: Sep 17, 2017 - Nov 12, 2017

    Background: Breast cancer deaths are mainly attributed to metastasis, while epithelial to mesenchymal transition (EMT) plays a pivotal role in promoting cancer cell metastasis. EMT is activated by var...

    Background: Breast cancer deaths are mainly attributed to metastasis, while epithelial to mesenchymal transition (EMT) plays a pivotal role in promoting cancer cell metastasis. EMT is activated by various stimuli, resulting in different therapeutic responses. The TGFβ signaling pathway is a canonical driver of EMT, and many molecular drugs are developed to target this pathway. However, the alternations of this pathway in BC remain elusive. Objective: The aim of this study was to investigate the relationship between the canonical TGFβ-Smad signaling pathway and breast cancer pathogenesis. Methods: Herein, we investigated the mutational, transcriptional, epigenetic and post-transcriptional alternations of 14 core members in this pathway through bioinformatics approach by analyses of 56,496 BC patients from various public databases, including COSMIC, Oncomine, DiseaseMeth and Starbase. A protein-protein interaction network was derived from Cytoscape software. Associations of these selected members with relapse free survival (RFS), overall survival (OS), distant metastases free survival (DMFS) and post progression survival (PPS) were performed using the Kaplan-Meier plotter online tool. Results: Our integrated analyses revealed that Smad4 was the most frequently mutated member of the TGFβ-Smad pathway in BC with a mutation frequency of 0.85% (30/3537). The expression levels of TGFβ1, TGFβ3, Smad1, Smad2 and Smad7 were significantly higher, whereas TGFβ2, ALK1, ALK2, ALK5, TGFβR2, Smad3, Smad4, Smad5 and Smad6 were downregulated in BC compared with normal subjects (P<0.001). Evaluation of epigenetic alteration identified that the promoters of ALK1 (P=0.000e+00), ALK2 (P=2.22e-16) and ALK5 (P=1.625e-12) were hypermethylated in 1,274 BC samples. In contrast, Smad2 (P=6.56e-04) was significantly hypomethylated in BC. Although all 14 members had potential diagnostic significances with different prediction power (AUC ranging from 0.788 to 1.00) in various subtypes of BC, only TGFβ3 could predict RFS (HR=0.69, 95% CI [0.62-0.77]), OS (HR=0.69, 95% CI [0.56-0.86]), DMFS (HR=0.8, 95% CI [0.66-0.97]) and PPS (HR=0.76, 95% CI [0.6-0.97]) for patients with BC in an independent manner. Additionally, 11 out of 14 members were associated with RFS in luminal A BC. Conclusions: Our results indicated that TGFβ-Smad pathway core members could serve as novel diagnostic and prognostic biomarkers in BC.

  • The Praise and Price of Pokémon GO -Exploring children’s and parents’ experiences playing Pokémon Go

    From: JMIR Serious Games

    Date Submitted: Sep 19, 2017

    Open Peer Review Period: Sep 19, 2017 - Nov 14, 2017

    Background: Physical activity has multiple health benefits, however, the majority of children around the world do not reach the recommended levels of daily physical activity. Research has shown that t...

    Background: Physical activity has multiple health benefits, however, the majority of children around the world do not reach the recommended levels of daily physical activity. Research has shown that the game Pokémon GO has increased the amount of physical activity and that the game has the potential to reach populations that traditionally have low levels of physical activity. Therefore, there is a need to understand which game components that can promote initial and sustained physical activity. By using a qualitative research approach, it is possible to achieve rich descriptions and enhance a deep understanding of the components promoting physical activity among children in a game like Pokémon GO Objective: Explore children’s and parents’ experiences playing Pokémon GO. Methods: Eight families comprising 13 children (aged 7-12 years) and 9 parents were selected using purposeful sampling. Data collected using focus groups were analyzed using qualitative latent content analysis. Results: Three themes were revealed: Exciting and enjoyable exploration, dangers and disadvantages, and cooperation conquers competition. The first centers around present and possible future aspects of Pokémon GO that promote physical activity. The second focuses on unwanted aspects and specific threats to safety when playing the game. The third shows that cooperation and togetherness is highly valued by the participants and that competition is fun but less important. Conclusions: Components from Pokémon GO might enhance the efficacy of physical activity interventions. Cooperation and exploration are aspects of the game that preferable could be transferred into interventions aiming at promoting children’s physical activity.

  • Comparative Analysis of Health Information Reporting Discrepancies Between Internet Media and Scientific Articles

    From: JMIR Preprints

    Date Submitted: Sep 15, 2017

    Open Peer Review Period: Sep 17, 2017 - Sep 2, 2018

    Background: Dietary supplements are the most used complementary and alternative health modality in the U.S., and omega-3 supplements continue to be the most popularly used non-vitamin/non-mineral supp...

    Background: Dietary supplements are the most used complementary and alternative health modality in the U.S., and omega-3 supplements continue to be the most popularly used non-vitamin/non-mineral supplements by adults. Supplement users report that they obtain health guidance from internet media resources, but there is question as to whether or not these resources provide the necessary evidence to guide health decisions. Current evidence suggests that there is a mistranslation occurring somewhere between researchers and the media. Objective: We conducted a comparative cross-sectional analysis to identify areas of discordance created when science is translated from the lab to online news media. Methods: A Google news search provided our convenience sample of 40 omega-3 supplement based media reports stratified by the years 2009-2012. Media reports (n = 17) were compared to the corresponding scientific article for content. Report and article content was extracted using commonly accepted reporting guideline domains, and domains were then compared to detect underlying omissions or mistranslations in reporting. Mean scores for all of the scientific articles and media reports were assessed for each domain. Results: Scientific articles generally maintained a mean close to complete (0.85) for each reporting domain. Media reports were far more likely to report potential caveats and warnings for consumers with a mean domain for Caveat reporting of 0.88, (95%CI[0.72, 1.0]). Conclusions: There are inherent differences in the intended audience, structure, and goals in scientific and media communications. These differences should be explored further, and consumers should be made aware of them. Additional considerations for balanced reporting and reader accessibility are also necessary to take into account, and are explored further in this analysis.

  • Multicenter Study on the Burden of Illness of Oral Side Effects from Conditioning Therapy Before Stem Cell Transplantation “Ora-Stem Study”

    From: JMIR Research Protocols

    Date Submitted: Sep 15, 2017

    Open Peer Review Period: Sep 17, 2017 - Oct 1, 2017

    Background: The oral cavity is a common site of complications related to the cytotoxic effect of high-dose chemotherapy and radiation therapy. Considering our limited understanding of the burden of i...

    Background: The oral cavity is a common site of complications related to the cytotoxic effect of high-dose chemotherapy and radiation therapy. Considering our limited understanding of the burden of illness in the oral cavity from various cytotoxic therapies, it is difficult to produce evidence-based, preventive and management protocols. A prospective multicenter study is necessary to collect data on the burden of illness from various cytotoxic regimens. Objective: The objectives of this prospective international observational multicenter study in hematopoi-etic stem cell transplant (HSCT) patients are to establish the nature, incidence and temporal re-lationship of oral complications related to conditioning regimens (chemotherapy with or with-out total body irradiation-TBI), stem cell transplantation and the immunologic reactions (main-ly GVHD) that may follow, and to determine what subjective and objective oral complica-tions related to treatment can predict negative clinical and economic outcomes and reduced quality of life (QoL). Methods: Adult patients at six study sites receiving full intensity conditioning (FIC), reduced intensity conditioning (RIC) or non-myeloablative conditioning (NMA), followed by autologous or al-logeneic hematopoietic stem cell infusion, are included. A pre-treatment assessment includes medical conditions, planned chemo- and radiation therapy regimen, medications, allergies, so-cial history, patient report of oral problems, dental history, subjective oral complaints, objec-tive measures of oral conditions, current laboratory values, dental treatment recommended and untreated dental disease. Starting 1-3 days after hematopoietic stem cell infusion, a bedside assessment is completed 3 days/week until resolution of neutropenia. A patient questionnaire is also completed during hospitalization. Beyond this time, patients with continued oral mu-cositis or other oral problems are followed 1 day/week in an inpatient or outpatient setting. Additional visits for urgent care for acute oral problems after hospitalization are documented. Autologous transplant patients are being followed up at 100 days ±30 days and at 1 year ±30 days post-transplantation to identify any long-term side effects. Patients treated with alloge-neic transplantation are being followed at 100 days ±30 days, 6 months ±30 days, and 12 months ±30 days. The follow-up assessments include cancer response to therapy, current med-ical conditions, medications, subjective and objective oral findings, QoL measures and labora-tory values. Results: A total of 211 participants have been enrolled. We anticipate enrollment of 109 additional par-ticipants to obtain the sample size of 320. Conclusions: The results of the ongoing prospective study will provide a unique dataset to understand the impact of oral complications on patients undergoing HSCT and provide needed information with forming more evidence-based guidelines regarding the management of this patient co-hort.

  • Standalone Effects of a Cognitive Behavioral Intervention Using a Smartphone Application on Psychological Distress and Alcohol Consumption among Japanese Workers: A Non-Randomized Controlled Trial

    From: JMIR Mental Health

    Date Submitted: Sep 18, 2017

    Open Peer Review Period: Sep 20, 2017 - Sep 27, 2017

    Background: Recent research shows computer-delivered interventions to be effective for treating psychological distress and drinking-related problems. Meanwhile, no studies have investigated standalone...

    Background: Recent research shows computer-delivered interventions to be effective for treating psychological distress and drinking-related problems. Meanwhile, no studies have investigated standalone effects of a smartphone-based cognitive behavior therapy (CBT) without any human contact. A smartphone application, called Self Record, that facilitates cognitive restructuring through self-monitoring of daily thoughts and activities was developed. Objective: The current study investigated the effectiveness of the Self Record application and the moderating effect of negative mood regulation expectancies (NMRE), which are beliefs about one's ability to control one's negative mood. Methods: A research marketing company recruited 723 Japanese full-time workers (age 20-59) with mild to moderate psychological distress and an interest in trying the self-monitoring application. Those who were willing to use the application used it for four weeks as an intervention group, while those who chose not to use the application were placed as a control group. Both groups completed pre-test and post-test measures of Negative Mood Regulation Scale (NMR-J), WHO-Five Well-being index (WHO-5), K6, Center for Epidemiological Studies Depression (CES-D), State-Trait Anxiety Scale (STAI), and Daily Drinking Questionnaire (DDQ). Results: Contrary to our hypothesis, results showed that participants in the intervention group had increases in anxiety, χ23 = 8.54, P = .04, typical drinking, χ23 = 13.99, P = .003, and heavy drinking, χ23 = 14.69, P = .002, compared to those in the control condition. NMRE moderated heavy drinking, F2,185 = 4.69, P = .01. For those with high NMRE, heavy drinking decreased among participants in the control condition but increased among those in the intervention condition; this difference was non-significant among participants with low NMRE. Effect sizes were small in all findings. Conclusions: Cognitive restructuring methods of standalone smartphone interventions may heighten individuals’ awareness of their pathological thought and behavior but may be insufficient to decrease psychological distress and drinking unless treated with a more intense or face-to-face intervention.

  • How Online Quality Ratings Influence Patients’ Choice of Medical Providers: A Controlled Experimental Survey Study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 16, 2017

    Open Peer Review Period: Sep 17, 2017 - Nov 12, 2017

    Background: In recent years, the information environment for patients to learn about physician quality is being rapidly changed by online ratings from both commercial and government efforts. However,...

    Background: In recent years, the information environment for patients to learn about physician quality is being rapidly changed by online ratings from both commercial and government efforts. However, little is known about how various types of online ratings affect individuals’ choice of physicians. Objective: The objective of this research is to measure the relative importance of online quality ratings from governmental and commercial agencies on individuals’ choice of primary care physicians. Methods: In a choice-based conjoint experiment conducted on a sample of 1000 Amazon Mechanical Turk users in October 2016, individuals were asked to choose their preferred primary care physician from pairs of physicians with different ratings in clinical and non-clinical aspects of care provided by governmental and commercial agencies. Results: The relative log odds of choosing a physician increases by 1.3147 (95% CI: 1.2620-1.3682; p<0.0001) and 1.3247 (95% CI: 1.2717-1.3784; p<0.0001) units when the government clinical ratings and commercial non-clinical ratings move from two to four stars, respectively. The relative log odds of choosing a physician increases by 1.1253 (95% CI: 1.0742-1.1770; p<0.0001) units when the commercial clinical ratings move from two to four stars. The relative log odds of selecting a physician with four stars in non-clinical ratings provided by the government is 1.0350 (95% CI: 0.9847-1.0860; p<0.0001) units higher than a physician with two stars in this rating. The log odds of selecting a physician with four stars in non-clinical government ratings relative to a physician with two stars, is 0.2340 (95% CI: 0.1322-0.3357; p<0.0001) units higher for females compared to males. Similar star increase in non-clinical commercial ratings increases the relative odd logs of selecting the physician by female respondents by 0.1504 (95% CI: 0.0435-0.2571; p=0.0058) units. Conclusions: Individuals perceive non-clinical ratings provided by commercial websites as important as clinical ratings provided by government websites when choosing a primary care physician. There are significant gender differences in how the ratings are used. More research is needed on whether patients are making the best use of different types of ratings, as well as the optimal allocation of resources in improving physician ratings from the government’s perspective.

  • Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: A Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Sep 16, 2017

    Open Peer Review Period: Sep 17, 2017 - Nov 12, 2017

    Background: E-learning through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cog...

    Background: E-learning through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes, satisfaction and learning experience in millennial medical students is unknown. Objective: The aim of our study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, satisfaction, and learning experience for emergent ORL-HNS disorders. Methods: This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the Group Embedded Figures Test. They were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional PowerPoint show (PPS) group matched by age, sex, and cognitive style. The participants were unblinded to use a fully automated courseware containing IM or PPS module on a 7-inch tablet for 100 minutes. Knowledge and competence were assessed using multiple choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction and learning experience using a AttrakDiff2 questionnaire. Results: All of the participants (median age 23 years, range 22‒26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, range -38–300%, P<.001) and competence (median 13%, range -50–150%, P=.006). There were no significant differences in knowledge gain (40% vs 60%, P=.42) and competence gain (0% vs 25%, P=.16) between the IM and PPS groups. However, the IM group had significantly higher satisfaction score (8 vs 6, P=.01), pragmatic quality score (1.7 vs 0.0, P=.003), hedonic stimulation score (1.5 vs -0.3, P<.001), and hedonic identification score (1.4 vs 0.3, P=.003) scores compared with the PPS group. Using Friedman’s two-way nonparametric analysis of variance, cognitive styles (either classical field-independent/field-dependent classification or modified field-independent/field-intermediate/field-dependent classification) and IM/PPS learning modules had significant effects on both knowledge gain and satisfaction (both P<.001). Conclusions: Mobile e-learning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with different cognitive styles. Clinical Trial: ClinicalTrials.gov NCT02971735, (http://clinicaltrials.gov/show/NCT02971735)

  • Barriers and facilitators to patient portal implementation from an organizational perspective: a qualitative study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Nov 16, 2017

    Background: Patient portals can contribute to patient-centered care and are defined as “an online gateway for patients to gather and share information mostly provided by one health institution”. T...

    Background: Patient portals can contribute to patient-centered care and are defined as “an online gateway for patients to gather and share information mostly provided by one health institution”. The number of patient portals is rising and while portals can have positive effects, its implementation has major impact on the providing health care institutions. Little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers and facilitators of different stakeholders may be useful for future implementations. Objective: The objective of this study is to identify the barriers and facilitators of patient portal implementation among different stakeholders within the hospital organization. Methods: Purposive sampling was used to select hospitals of different classes. Two university medical centers (UMCs), 3 mid-size hospitals and 2 general hospitals were included. Per hospital three stakeholders were interviewed: 1) medical professionals, 2) managers, and 3) IT employees. Semi-structured interviews were conducted using the model of Grol and Wensing, which describes barriers and facilitators of change in health care practice at six levels: 1) Innovation, 2) Individual professional, 3) Patient, 4) Social Context, 5) Organizational Context, 6) Economic Context. Two researchers independently selected and coded quotes by using this model. Additional factors related to technical and portal characteristics were added by using the model of McGinn et al developed for implementation of electronic health records. Results: In total, we identified 382 quotes and 34 factors. Twenty-five factors were common for all stakeholder groups including 16 barriers and 12 facilitators. Positive factors related to ‘advantage in practice’ were mentioned most frequently, followed by positive ‘attitude’ and ‘motivation to change’. The main barriers were ‘resources’ (eg lack of staff), ‘opinion of colleagues’ (eg negative beliefs) and ‘privacy and security’ (eg strict regulations). Similarities as well as differences were found between stakeholder groups and hospital classes. For example, medical professionals and IT employees considered 'resources' as an essential barrier. However, their perspectives differed regarding 'opinion of colleagues' as this was a major barrier for medical professionals (eg clinicians’ negative attitude), but a facilitator for IT employees (eg implementation can drive a positive change). Conclusions: The model of Grol and Wensing proved to be useful in elicitation and classification of barriers and facilitators to portal implementation. Nevertheless, technical and factors related to portal characteristics (eg 'privacy and security') were missing, and were added from the McGinn model. Barriers and facilitators occurred at various levels and differed between hospital classes and stakeholder groups on several factors (eg 'opinion of colleagues' and 'cost issues'). This underscores the added value of involving multiple stakeholders in portal implementations. The identified set of barriers and facilitators may be useful to make strategic and efficient implementation plans.

  • National Food, Nutrition and Physical Activity Survey of the Portuguese general population, 2015-2016: Design and methods

    From: JMIR Research Protocols

    Date Submitted: Sep 18, 2017

    Open Peer Review Period: Sep 20, 2017 - Oct 4, 2017

    The National Food, Nutrition and Physical Activity Survey, 2015-2016 aimed to collect national and regional data on dietary habits and physical activity, and to evaluate their relation with health det...

    The National Food, Nutrition and Physical Activity Survey, 2015-2016 aimed to collect national and regional data on dietary habits and physical activity, and to evaluate their relation with health determinants. Data were collected in a representative sample of the Portuguese general population (3 months to 84 years), by multistage sampling, and harmonized according to European guidelines/methodologies. An electronic platform was developed to manage the field work and to assist data collection by using Computer-assisted personal interviewing and includes the ‘eAT24’ module for dietary data collection by 24-hour recalls (two non-consecutive, 8-15 days apart) or food diaries in the case of children <10 years-old, synchronized with nutritional composition data and considering the FoodEx2 classification system; the ‘MOVE’ module for physical activity data (including the International Physical Activity Questionnaire, the Activity Choice Index, and 4-days physical activity diaries); and the ‘You’ module to collect sociodemographic and other health-related data. The results will assist policy planning and management of national health programs on the improvement of nutritional status and risk assessment related with food hazards, and the enhancement of physical activity. The infrastructures and data driven are a solid basis to the development of a future surveillance system reproducible over time.

  • Developing sustainable and impactful mobile phone HIV testing interventions for Spanish-speaking men who have sex with men in the United States (US): Lessons learned from informative interviews

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 18, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/...

    Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/Latino MSM, are needed. Many mHealth interventions in development and that include HIV testing have primarily focused on English-speaking white, Black and MSM of other races. To date, no studies have assessed app use, attitudes and motivations for downloading and sustaining use of mobile apps, and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the U.S. Objective: The primary objectives of this study were to answer the following questions: 1) What features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones?; 2) What features and functions of smartphone apps are most likely to influence men’s sustained use of apps over time?; and 3) What features and functions do the men prefer in a smartphone app aimed to promote regular testing for HIV? Methods: Interviews (n=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM (Mean age of 32; 40% tested for HIV 6 months ago) in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant comparison method (i.e., grounded theory coding) was employed to examine and re-examine the themes that emerged from the interviews. Results: Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were four reasons why participants chose to delete an app: dislike, lack of use, cost, and lack of memory/space. Participants’ also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. However, unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. As such, tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help appeal to their willingness to download a mobile app. Despite the growing number of HIV prevention apps in development, few are specifically tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research.

  • Implications of patient portal transparency in oncology: Experiences of patients, oncologists and medical informaticists

    From: Journal of Medical Internet Research

    Date Submitted: Sep 18, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients’ personal health knowledg...

    Background: Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients’ personal health knowledge. However, little is known about how patient portals are used in oncology. Objective: We aimed to understand attitudes of the portal’s adoption for oncology and to identify the advantages and disadvantages of using the portal to communicate and view medical information. Methods: In depth semi-structured interviews were conducted with 60 participants: 35 patients, 13 oncologists and 12 medical informaticists. Interviews were recorded, transcribed and thematically analyzed to identify critical incidents and general attitudes encountered by participants. Results: Two primary themes were discovered: 1) implementation practices influence attitudes, in which the decision-making and execution process of introducing portals throughout the hospital did not include the input of oncologists. Lack of oncologists’ involvement led to a lack of knowledge about portal functionality, such as not knowing the time period when test results would be disclosed to patients; 2) perceptions of portals as communication tools varies by user type, meaning that each participant group (patients, oncologists, and medical informaticists) had varied opinions about how the portal should be used to transmit and receive information. Oncologists and medical informaticists had difficulty understanding one another’s culture and communication processes in their fields, while patients had preferences for how they would like to receive communication, but it largely depended upon the type of test being disclosed. Conclusions: The majority of patients (54%) who participated in this study viewed lab results or scan reports via the portal before being contacted by a clinician. Most were relatively comfortable with this manner of disclosure, but still preferred face-to-face or telephone communication. Findings from this study indicate that portal education is needed for both patients and oncologists, especially when portals are implemented across entire health systems since highly specialized areas of medicine may have unique needs and uses. Patient portals in oncology can potentially alter the way diagnoses are delivered and how patients and oncologists communicate. Therefore, communication about the portal should be established during initial consultations so patients can decide whether they want to be informed in such a manner.

  • Burnout and workplace needs of physician mothers: A cross-sectional online survey of 5,782 physician mothers

    From: Journal of Medical Internet Research

    Date Submitted: Sep 19, 2017

    Open Peer Review Period: Sep 19, 2017 - Sep 28, 2017

    Background: Burnout among physicians has reached an all-time high, with serious consequences for patient care, physician safety, and the healthcare system. Objective: Our goal was to examine burnout a...

    Background: Burnout among physicians has reached an all-time high, with serious consequences for patient care, physician safety, and the healthcare system. Objective: Our goal was to examine burnout and career satisfaction in physician mothers. We were particularly interested in how burnout was associated with understudied factors relevant to mothers, including fertility, pregnancy, caregiving duties, and gender-based discrimination. Methods: This was a cross-sectional online survey of the members of the Physician Mothers Group (PMG) which is an online private Facebook group of over 60,000 female physicians who are mothers. This survey was distributed in June and July 2016. Measurements included self-reported burnout, career satisfaction, history of discrimination, reproductive and physical health, caregiver status, desired workplace changes. Results: Of the estimated 16,059 PMG members who viewed the survey post, 5,782 completed the survey (estimated participation rate 36%, or 16% of active members). Overall, 40%(N=2208) of respondents reported burnout, with 38.2% being mothers. Burnout was related to higher work hours, discrimination, history of depression or anxiety, medical mistakes, and being a caregiver for a severely ill friend or family member. Burnout was more common in those who work in emergency medicine or family medicine, or practice in military and public hospitals, with 45.2%, 46.9%, 52.4%, and 46.2% of physicians reporting burnout, respectively. The most highly valued workplace changes reported by physician mothers included flexibility in working schedules, option to not work on weekends or overnight, and higher pay. In addition, administrative support including scribes and protected time for charting were common workplace change suggestions. Conclusions: Burnout is common, especially among certain subgroups of physician mothers. Approaches to reducing burnout among physician mothers may include supporting more flexible workplace structures, addressing gender discrimination, and providing additional support for those with caregiver responsibilities. Clinical Trial: N/A

  • What do Persons with Multiple Sclerosis need from an mHealth app for Physical Activity? A qualitative exploratory study.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 19, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. The most common symptoms are overwhelming fatigue, visual disturbances, altered sensation, cognitive probl...

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. The most common symptoms are overwhelming fatigue, visual disturbances, altered sensation, cognitive problems and difficulties with mobility. Evidence suggests that physical activity (PA) helps people with MS stay active and reduces fatigue as well as improving quality of life. The use of mobile apps for health and wellbeing promotion has grown exponentially in recent years. There is currently a gap on mHealth applications for MS and to our knowledge no study has explored persons with MS perspectives to mHealth solutions for PA. Objective: The aim of this study was to: 1) generate insight as to persons with MS specific needs and characteristics for MS mHealth applications for Physical Activity; 2) detect perceived obstacles and facilitators for such mHealth solutions from persons with MS and healthcare professionals; and 3) provide validated MS personas to help further development of mHealth solutions for MS. Methods: A qualitative study was conducted in Kliniken Valens, Switzerland; a clinic specialized in neurological, musculoskeletal, and geriatric rehabilitation. Two series of focus groups, interviews and structured questionnaires took place. One with persons with MS and the other with healthcare professionals who work with MS. Demographic characteristics, satisfaction with life (SWLS), eHealth literacy (eHEALS), and technology use were assessed as well as user needs, barriers, facilitators and desired features for mHealth MS apps. Themes were identified during analysis such as: MS related barriers and facilitators; mHealth Design Considerations and General Motivational Aspects. Information and insights were used to create MS personas for design purposes. Results: A total of 12 persons with MS and 12 healthcare professionals participated in the study, median ages of 43.5 years and 40 respectively. Participants were well educated with an even distribution between genders. Desired features for mHealth applications for persons with MS were: a) activity tracking, b) incentives for completing tasks and objectives, c) customizable goal setting, d) optional sociability and e) game-like attitude among others. Potential barriers to mHealth apps adoption like a) rough on-boarding experiences, b) lack of clear use benefits and c) disruption of the healthcare provider-patient relationship. Potential facilitators were identified such as a) endorsements from experts, b) playfulness and c) tailored to specific persons with MS needs. Four MS personas were developed to provide designers and computer scientists means to help in the creation of future mHealth solutions for MS. Conclusions: The potential of mHealth apps for increasing physical activity in persons with MS holds promise. Allowing for realistic goal setting and positive feedback, while minimizing usability burdens seems to be critical for the adoption of such apps. Fatigue management is especially important in this population so more attention should be focused in that area.

  • Systematic review of studies on mHealth interventions for maternal and child health

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Nov 16, 2017

    Background: The application of mHealth technology in reproductive, maternal, newborn and child health (RMNCH) is increasing worldwide. However, best practice and the most effective mHealth interventio...

    Background: The application of mHealth technology in reproductive, maternal, newborn and child health (RMNCH) is increasing worldwide. However, best practice and the most effective mHealth interventions have not been reviewed systematically. Objective: A systematic review and meta-analysis on studies of mHealth interventions for RMNCH around the world were conducted to investigate their characteristics as well as features and effectiveness of mHealth interventions. Methods: Studies of mHealth interventions for RMNCH between January 2011 and December 2016 were retrieved from six databases (PubMed, EMBASE, Global Health, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang Data Knowledge Service Medium). Comparable studies were included in a random-effects meta-analysis for both exclusive breastfeeding (EBF) and antenatal checks (ANC). Descriptive analysis were conducted for mHealth studies with for a range of study design. Results: Analysis of 245 studies were included, including 51 RCTs. Results showed that there are increasing numbers of studies on mHealth interventions for RMNCH. Although two meta-analysis, one with two RCTs on EBF (OR 2.03, 95% CI 1.34–3.08, I2=25%) and the other with three RCTs on ANC (OR 1.43, 95% CI 1.13–1.79, I2=78%), showed that mHealth interventions are more effective than usual care, almost half (43.1%) of RCTs showed negative or unclear results on mHealth interventions. Functions described in mHealth interventions were diverse and the health stages covered were broad, but single function/single stage appeared to be dominant among mHealth interventions compared with multiple functions/stages. Conclusions: More rigorous evaluations are needed to draw consistent conclusions, and to analyse mHealth products with multiple functions, especially those popular in the Application markets.

  • Worker preferences for a mental health App in male-dominated industries: A Participatory Study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: Men are less likely to seek help for mental health problems possibly due to stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces s...

    Background: Men are less likely to seek help for mental health problems possibly due to stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services, or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of technologies men would be willing to engage with in their workplace, and no App can work if people do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces in order to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations, took part in participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged 26-65 years (92% male) from male-dominated workplaces in rural (27%), suburban (23%) and urban (50%) locations participated in one of six workshops resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment and “mood boost” tool were highly valued and App characteristics such as the brevity of interactions, minimal on-screen text and a solutions-oriented approach were considered essential by participants. Conclusions: Future mental health smartphone applications targeting workers in male-dominated workplaces need to balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights towards mental health technologies for men more generally, and for others in high-stigma environments.

  • Design of an mHealth tool for self-management and care engagement of cardiovascular disease patients: enhancing user experience through user study

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 20, 2017 - Sep 29, 2017

    Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and oth...

    Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, in order to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the application (app) can be used continuously. Objective: This study designed a user-friendly, personalized mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods: In order to drive the mobile functions and services that are needed to manage diseases in CVD patients, user research was conducted on CVD patients and doctors at a tertiary general hospital. Interviews and a survey were conducted on patients (35 subjects) and a focus group interview was conducted on doctors (5 subjects). A mock-up mobile app was developed based on the user survey results, and a usability test was conducted (8 subjects) to find the factors that need to be considered in order to improve usability. Results: The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Communication with doctors, self-risk assessment, exercise, tailored education, blood pressure (BP) management, health status recording, and other related functions had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were useful to patients. The medical staff requested a function that offers a comprehensive view of the patient’s daily health status by linking a regular health examination service with the hospital’s electronic medical records system. The results of the mock-up usability test showed that the ease of inputting and visualizing BP and other health conditions was required. Conclusions: Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel, would be helpful to improve patient engagement in care.

  • Incorporating an activity tracker into an office workplace sitting intervention: usage, acceptability and behavioural impact

    From: Interactive Journal of Medical Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: This study evaluated an activity tracker that targets sitting time, as part of a cluster-randomized workplace sitting intervention in office workers. Objective: To understand: 1) office wo...

    Background: This study evaluated an activity tracker that targets sitting time, as part of a cluster-randomized workplace sitting intervention in office workers. Objective: To understand: 1) office workers’ self-directed tracker use; 2) individual-level characteristics associated with tracker use; 3) the impact of tracker use on activity and sitting behaviours; and, 4) office workers’ perceived tracker acceptability. Methods: Sixty-six office workers were randomly assigned a belt-worn LUMOback tracker that provides real-time sitting feedback through an app. Usage data (n=62), online questionnaires (n=33), and telephone interviews (n=27) were used to evaluate study aims. Results: Tracker uptake was modest (71%, n=43/61), and among users, usage over the first three months was low (1-48 days, median=8). Usage was greatest among team leaders and those with low self-perceived scores for job control and supervisor relationships. Greater tracker use (≥5 days versus <5) was significantly (P=.046) associated only with changes in prolonged sitting (-48 min/16h awake; 95%CI: -95, -1). Qualitatively, participants valued the real-time app feedback. Non-uptake was attributed to being busy and set-up issues. Low usage was attributed to discomfort wearing the tracker. Conclusions: Activity trackers that target sitting might be effective at reducing prolonged sitting in office workers. Trackers should be easy to set-up and comfortable to wear. Clinical Trial: Australian New Zealand Clinical Trial Registry, ACTRN12614000252617

  • Prevalence, demographic correlates, and perceived impacts of use of mobile health applications: a cross-sectional questionnaire study​​

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The advent of mobile applications (apps) has changed the way people obtain health information and services and advance their understanding of and management strategies for their health. Al...

    Background: The advent of mobile applications (apps) has changed the way people obtain health information and services and advance their understanding of and management strategies for their health. Although many health apps are available, little is known about the prevalence of their use for various health purposes, whether the use is associated with demographic characteristics, and the impacts of the use on health knowledge and management. Objective: This study aimed to examine the prevalence and demographic correlates of use of health apps and the perceived impacts on health knowledge and management. Methods: A cross-sectional questionnaire survey of a random sample of 633 adults living in the community was conducted. Results: A total of 612 (96.7%) participants reported using mobile devices. Of them, 235 (38.4%) reported using multiple types of health apps. The most prevalent health app type was about healthy living information, 32.2%, followed by vital measurement or recording, 13.0%, health and medical reminders, 10.4%, recovery and rehabilitation information, 6.9%, assistance in diagnosis, 4.6%, emergency services, 2.6%, telehealth, 1.8%, and others, 3.1%. Multivariate logistic regression analysis found that those using health apps were more likely to be women and have a higher self-rated social class. Participants with education/culture/academic occupations, that worked in disciplinary forces, and with “others” occupations (e.g., health care, sports, media, social work, etc.) tended to agree that using health apps could increase their health knowledge or improve the effectiveness of health management. Conclusions: We found that the most prevalent types of health apps were ‘healthy living information apps’, ‘vital measurement and record apps’, and ‘health and medical reminders apps’. Results of the study showed that different demographic characteristics including gender, self-rated social class, education level, and occupation may be related to health app use. Since participants’ responses were diverse and they did not gather on a common idea, there were existing uncertainties in ‘whether using health apps could increase personal health knowledge and improve the effectiveness of personal health management’.

  • Making Friends with Doctors in Social Media: The Effect of Doctor-Consumer Interaction on Healthy Behaviors

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 22, 2017 - Nov 17, 2017

    Background: Background: Both doctors and consumers have engaged in using social media for health purpose. Social media change traditional one-to-one communication way between doctors and patients to m...

    Background: Background: Both doctors and consumers have engaged in using social media for health purpose. Social media change traditional one-to-one communication way between doctors and patients to many-to-many communication way between doctors and consumers. However, little is known about the effect of doctor-consumer interaction on consumers’ healthy behaviors. Objective: The purpose of this study is to investigate how doctor-consumer interaction in social media affects consumers’ healthy behaviors. Methods: Based on professional-client interaction theory and social cognitive theory, we propose that doctor-consumer interaction can be divided into instrumental interaction and affective interaction. These two types of interaction influence consumers’ healthy behaviors through declarative knowledge, self-efficacy and outcome expectancy. To validate our proposed research model, we employed the survey method and developed corresponding measurement instruments for constructs in our research model. 352 valid answers were collected and partial least square was performed to analyze the data. Results: Instrumental doctor-consumer interaction was found to influence consumers’ declarative knowledge (t=5.763, P <0.001), self-efficacy (t=4.891,P<0.001) and outcome expectancy (t=7.554, P <0.001) significantly, while affective doctor-consumer interaction also impacted consumers’ declarative knowledge (t=4.025, P <0.001), self-efficacy (t=4.775, P <0.001) and outcome expectancy (t=4.855, P <0.001). Meanwhile, consumers’ declarative knowledge (t=3.838, P <0.001), self-efficacy (t=3.824, P <0.001) and outcome expectancy (t=2.985, P <0.01) all significantly affected consumers’ healthy behaviors. Our mediation analysis showed that consumers’ declarative knowledge, self-efficacy and outcome expectancy partially mediated the effect of instrumental interaction on healthy behaviors, while the three mediators fully mediated the effect of affective interaction on healthy behaviors. Conclusions: Compared with many intentional intervention programs, doctor-consumer interaction can be treated as natural cost-effective intervention to promote consumers’ healthy behaviors. Meanwhile, both instrumental and affective interaction should be highlighted for the best interaction results. Declarative knowledge, self-efficacy and outcome expectancy are working mechanisms of doctor-consumer interaction.

  • Physical trauma patients with symptoms of an acute and post-traumatic stress disorder: an observational prospective cohort study

    From: JMIR Research Protocols

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 23, 2017 - Oct 7, 2017

    Background: Injury, medical treatment and rehabilitation can have a major impact on patients’ wellbeing. About 25-33% of the patients experience an acute (ASD) or post-traumatic stress disorder (PTS...

    Background: Injury, medical treatment and rehabilitation can have a major impact on patients’ wellbeing. About 25-33% of the patients experience an acute (ASD) or post-traumatic stress disorder (PTSD) after injury. ASD is a relatively new diagnosis. Therefore, knowledge about patients’ experiences, the course and who is at risk for developing ASD or PTSD is lacking. Objective: The aims of this multi-method study are to explore patients’ experiences with injury (care) using a focus group study. Then, in the observational study (possible) different courses of ASD, PTSD, and quality of life (QOL) will be examined. In addition, this study will examine if these courses could be characterized by socio-demographic, clinical, and psychological variables. Consequently, a risk profile will be developed to determine which patients are at risk for developing ASD and/or PTSD during 12 months after injury. Methods: Trauma patients treated in the shock room (2015) of the Elisabeth-TweeSteden Hospital will share their experiences with injury in the focus group study. Open, axial, and selective coding will be used to analyze the data. Concerning the observational study, patients treated in the shock room (during 2016 and 2017, Elisabeth-TweeSteden Hospital and Erasmus Medical Centre) will be asked to participate. The inclusion period is 12 months. Participants will complete the Impact of Event Scale-Revised, MINI-plus, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life-BREF after inclusion and at 3, 6, 9, and 12 months after injury. The NEO-Five Factor Inventory and the State-Trait Anxiety Inventory-Trait are completed after inclusion only. Repeated measures latent class analysis and linear mixed models repeated measures will be used to examine the research aims. Results: This project was funded in August 2015 by ZonMW. The results of the focus group study are expected in the first trimester of 2018. With regard to the observational study, recruitment is currently underway. Data collection will be completed in November 2018. Then, the first results will be expected in the first trimester of 2019. Conclusions: This is the first multi-method study in trauma patients that examines patients’ experiences (qualitative design) as well as psychological disorders (observational prospective). This study will contribute to the need for information on psychological consequences after injury. Moreover, it provides knowledge about which patients to include in future psychological intervention research. Finally, awareness in clinicians about the psychological consequences can be created, so they are able to act more effective to provide patient-oriented care. Clinical Trial: NTR6258

  • Is Social Media a Venue for Help-Seeking? Results from a Clinical Sample of Military Veterans with Depression

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Nov 16, 2017

    Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a...

    Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help, or how it compares to other sources of potential support for mental health problems. Objective: The objective was to evaluate the degree to which adults with depression use social media for help-seeking, in comparison to other more traditional sources of help. Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. Facebook users and non-users were compared via t-tests, chi-square, and mixed effects regression models. Associations between types of help-seeking were examined using mixed effects models. Results: The majority of participants were users of social media, primarily Facebook (n=162). Mean overall help-seeking intentions were similar between Facebook users and non-users, even after adjustment for potential confounders. Facebook users were very unlikely to turn to Facebook as a venue for support when experiencing either emotional problems or suicidal thoughts. Compared to help-seeking intentions for Facebook, help-seeking intentions for formal (e.g., psychologists), informal (e.g. friends), or phone help lines sources of support were significantly higher. Results did not substantially change when examining participants who were frequent or active users of Facebook. Conclusions: In its current form, a social media platform such as Facebook is not seen as a venue for seeking help for emotional problems or suicidality among people with major depression in the United States.

  • An mHealth Platform for Supporting Clinical Data Integration in Augmentative and Alternative Communication Service Delivery

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The recent trend of increasing healthcare costs in the United States is likely not sustainable. To make healthcare more economically sustainable, attention must be directed towards improvi...

    Background: The recent trend of increasing healthcare costs in the United States is likely not sustainable. To make healthcare more economically sustainable, attention must be directed towards improving the quality while simultaneously reducing the cost of healthcare. One of the recommended approaches to providing better care at a lower cost is to build high quality data collection and reporting systems, which support healthcare professionals in making optimal clinical decisions based on solid, extensive evidence. Objective: This project sought to develop an integrated mHealth Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a web-based clinician portal for supporting evidence-based clinical service delivery. Methods: A questionnaire and an interview study were used to collect clinicians’ ideas regarding what constitutes their desired “clinically relevant” data. In response, a web portal was designed by combining mobile and web technologies with AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with healthcare professionals. Results: A web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provides the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible web portal. Conclusions: The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

  • Development and Formative Evaluation of a Smartphone Application for Smoking Cessation: Crush the Crave

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: Emerging evidence supports the use of smartphone apps for smoking cessation. However, there remains a paucity of research describing the design and development processes of mobile health (...

    Background: Emerging evidence supports the use of smartphone apps for smoking cessation. However, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions, leaving unanswered questions about how to productively leverage apps for quitting smoking. Objective: This paper describes the process of developing the Crush the Crave (CTC) app for smoking cessation and the results of a formative evaluation of app usage behaviour, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods: The Spiral Technology Action Research (STAR) five-cycle model (listen, plan, do, act, and study) was employed to guide development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78), analysis of the content of existing apps, two sessions with content experts, and google analytics to assess user behaviour during a 12-month pilot. Results: LISTEN – focus groups revealed young adult smoker preferences of 1) Positive reinforcement, 2) Personalization, 3) Social support, 4) Quit support, 5) Tracking the behaviour, and 6) Tracking quit benefits. PLAN – Informed by evidence for smoking cessation, young adult preferences, and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO – Focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts, distractions from craving, and improvements to the organization of help information for quitting. ACT – CTC App refinements were made and app content was organized using the four key design components of credibility, task support, dialogue support and social support. CTC was launched April 2013 and piloted from the period July 2013 to June 2014 where 1,987 Android users had 18,567 sessions resulting in 59,384 page views and 89.6% of users returning within the same day to use CTC. STUDY – A pragmatic randomized controlled trial of CTC was launched August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. Conclusions: CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future.

  • Protocol for a systematic review of substance use prevention programs for Indigenous adolescents in the United States of America, Canada, Australia and New Zealand

    From: JMIR Research Protocols

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Oct 5, 2017

    Indigenous adolescents are at higher risk of experiencing harms related to substance use, compared to their non-Indigenous counterparts as a consequence of earlier onset and higher rates of substance...

    Indigenous adolescents are at higher risk of experiencing harms related to substance use, compared to their non-Indigenous counterparts as a consequence of earlier onset and higher rates of substance use. Early onset of substance use has been identified as a risk factor for future substance use problems and other health, social and family outcomes. Therefore, prevention of substance use among adolescents has been identified as a key area to improve Indigenous health. Evidence exists for the effectiveness of substance use prevention approaches for adolescents in mainstream populations and most recently, for the use of computer- and internet-delivered interventions to overcome barriers to implementation. However, there is currently no conclusive evidence about the effectiveness of these approaches for Indigenous adolescents. The purpose of this review is to synthesize the international evidence regarding the effectiveness of substance use prevention programs for Indigenous adolescents in the United States of America, Canada, Australia and New Zealand. Eight peer-reviewed databases will be searched, using search terms in line with the aims of this review and based on previous relevant reviews of substance use prevention. Studies will be included if they evaluate a substance use prevention program with Indigenous adolescents (aged 10 to 19) as the primary participant group and are published between 1 January 1990 and 31 August 2017. A narrative synthesis will be provided about the effectiveness of the programs, the type of program (whether cultural-based, adapted or unadapted), delivery of program (computer- and internet-delivered or traditional) and the setting in which the programs are delivered (community, school, family or a combination). The study will identify core elements of effective substance use prevention programs among Indigenous adolescents and appraise the methodological quality of the studies. This review will provide researchers, policy makers and program developers with evidence about the potential use of prevention approaches for Indigenous adolescents.

  • Web-Based Patient Education in Orthopaedics: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: Orthopaedic patients frequently use the Internet to find health information. Patient education that is distributed online may form an easy-accessible, time- and cost-effective alternative...

    Background: Orthopaedic patients frequently use the Internet to find health information. Patient education that is distributed online may form an easy-accessible, time- and cost-effective alternative to patient education delivered through traditional channels, such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of web-based educational interventions exists. Objective: The objective of this systematic review was to examine the effects of web-based patient education interventions for adult orthopaedic patients and to compare its effectiveness to generic health information websites and traditional forms of patient education. Methods: CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus and Web of Science were searched covering the period 1995-2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the Internet to the adult orthopaedic patient population, and assessed its effects in a controlled or observational trial. Results: A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients’ knowledge after web-based patient education. Seven trials reported increased satisfaction and good evaluations of web-based patient education. No compelling evidence exists for an effect of web-based patient education on anxiety, health attitudes and behaviour, or clinical outcomes. Conclusions: Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients’ knowledge and satisfaction. However, these findings may not be representative for the whole orthopaedic patient population as most reviewed trials included considerably younger, higher-educated, and internet-savvy participants only.

  • The effectiveness of healthcare information technologies: An empirical evaluation of trust, security beliefs, and privacy as determinants of healthcare outcomes.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The diffusion of health information technologies (HITs) within the healthcare sector continues to grow. However, there is no theory explaining how HITs success influences patient care outc...

    Background: The diffusion of health information technologies (HITs) within the healthcare sector continues to grow. However, there is no theory explaining how HITs success influences patient care outcomes. And the increase in data breaches, HITs success now hinges on the effectiveness of data protection solutions. Yet still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance. Objective: We study the effectiveness of HITs using the DeLone and McLean IS Success Model (DMISSM)1. We examine the role of information assurance constructs (i.e., information privacy and security beliefs, and trust in health information) as measures of HIT effectiveness. We also investigate the relationships between information assurance and three aspects of system success; electronic medical record (EMR) use, patients’ attitudes towards health information exchange (HIE), and patient care quality. Methods: Using structural equation modeling, we analyze data from a sample of 3,677 cancer patients. We used R software and the Lavaan package to test the hypothesized relationships. Results: Our extension of the DMISSM1 to healthcare was supported. We found that increased privacy concerns reduce the frequency of EMR use, positive attitudes towards HIE, and perceptions of patient care quality. Also, information security beliefs increase EMR use and the positive attitudes towards HIE. Trust in health information had a positive association with attitudes towards HIE, and patient care quality. Trust in health information had no direct effect on EMR use; however, it had an indirect relationship through information privacy concerns. Conclusions: Information trust and information security safeguards increase perceptions of patient care quality. Information privacy concerns reduce EMR use by patients, patients’ positive attitudes towards HIE exchange, and overall patient care quality. Healthcare organizations are encouraged to implement security safeguards for increasing trust and EMR use, reducing privacy concerns, and consequently increasing patient care quality.

  • Results of a systematic review of concepts and designs of 58 different mobile applications for the management of the West African Ebola outbreak 2014/15

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The use of mobile phone information technology in the health sector has received much attention especially during the Ebola Virus Disease (EVD) outbreak in 2014 until 2015. Mobile health (...

    Background: The use of mobile phone information technology in the health sector has received much attention especially during the Ebola Virus Disease (EVD) outbreak in 2014 until 2015. Mobile health (mHealth) promises to allow a major improvement, but there is a lack of an overview of what kinds of tools were available and used based on the functionalities they offer. Objective: We, therefore, conducted a systematic review of mHealth tools in the context of the recent EVD outbreak to support further mHealth developments for infectious disease control. Methods: We conducted a systematic review using the PRISMA systematic review methodology on mobile health tools developed in the context of the 2014-2015 Ebola-Virus-Disease (EVD) outbreak to identify the most promising approaches used. Using a 4-eye approach, we searched for publications in any language from 01.01.2014 until 31.12.2015 in MEDLINE and Google Scholar. Using the search strategy: ("outbreak" OR "epidemic") AND ("mobile phone" OR "smartphone" OR “smart phone” OR "mobile phone" OR "tablet" OR "mHealth") AND ("Ebola" OR "EVD” OR "VHF" OR "Ebola Virus Disease" OR "viral hemorrhagic fever"). We used a standardized form to extract information on the tools’ functionalities. Results: The automatic search generated 965 publications, of which 77 (8 %) reported on 58 different tools. Three tools offered functionalities for EVD case notification, case management and contact tracing and two adhered to the integrated disease surveillance and reporting system (IDSR). Conclusions: Among a large number of tools for EVD outbreak management in 2014 and 2015, only three appeared to contain the key functionalities for outbreak management and may be most promising for further development. We recommend focusing attention on the further development of those tools that contain comprehensive portfolios of outbreak management functionalities and reference to established standards in disease surveillance Clinical Trial: null

  • Effects of Drug Interventions with Combined Oral Contraceptives on the hypothalamic–pituitary–gonadal axis in patients with polycystic ovary syndrome: Protocol for systematic review and meta-analysis

    From: JMIR Research Protocols

    Date Submitted: Sep 22, 2017

    Open Peer Review Period: Sep 23, 2017 - Oct 4, 2017

    Background: Selection of combined oral contraceptives (COCs) with maximum antiandrogenic effects is one the most important issues in treatment of patients with polycystic ovary syndrome (PCOS). Object...

    Background: Selection of combined oral contraceptives (COCs) with maximum antiandrogenic effects is one the most important issues in treatment of patients with polycystic ovary syndrome (PCOS). Objective: This systematic review and meta-analysis protocol aimed to compare the effects of COCs containing progestins with low androgenic and antiandrogenic activities on the hypothalamic–pituitary–gonadal (HPG) axis in patients with PCOS. Methods: We searched PubMed, Scopus, Google Scholar, ScienceDirect, and Web of Science databases (1980–2017) to identify randomized clinical trials (RCTs) or non-randomized studies (NRS) investigating the effect of COCs containing progestins with low androgenic and antiandrogenic activities including products containing desogestrel (DSG), cyproterone acetate (CA) and drospirenone (DRSP) on the HPG axis in patients with PCOS. In this meta-analysis, fixed and random effect models were used. Outcomes interested were follicle stimulating hormone (FSH), luteinizing hormone (LH), LH to FSH ratio, estradiol (E2), total testosterone (TT) and sex hormone-binding globulin (SHBG). Potential sources of heterogeneity were investigated using meta-regression and subgroup analyses. Subgroup analyses were performed based on used progestin compound and treatment duration. We assessed quality of included studies and their risk of bias using Cochrane guidelines. Publication bias were assessed using Egger’s test and Funnel plot. Results: COC use was significantly associated with a decrease in gonadotropin levels including FSH and LH. Use of products containing CA was associated with a decrease in FSH after 3 months (WMD= -0.48; 95% CI: -0.81, -0.15), 6 months (WMD = -2.33; 95% CI: -3.48, -1.18) and 12 months (WMD = -4.70; 95% CI: -4.98, -4.42) and LH levels after 3 months (WMD = -3.57; 95% CI: -5.14, -1.99), after 6 months (WMD = -5.68; 95% CI: -9.57, -1.80), and after 12 months (WMD = -11.60; 95% CI: -17.60, -5.60). COCs containing DRSP for 6 months decreased FSH (WMD = -0.93; 95% CI: -1.79, -0.08) and LH (WMD = -4.59; 95% CI: -7.53, -1.66). Data for products containing desogestrel were few, but this compound generally had no influence on gonadotropin levels similar to that observed with COCs containing CA and DRSP. Use of COCs was not associated with any significant change in LH to FSH ratio. COCs containing CA showed maximum effect on gonadotropin suppression. COCs containing CA significantly decreased E2 concentrations, whereas those containing DRSP exhibited no such effect. All COCs demonstrated improvement in androgenic profile and had the same effects on TT and SHBG concentrations. Progestin compound and treatment duration had no important effects on changing TT and SHBG levels. Conclusions: COCs containing progestins with low androgenic and antiandrogenic activities can suppress gonadotropins, leading to a decrease in androgenic profiles in women with PCOS. All studied COCs showed the same effects on androgenic profile, whereas products containing CA had maximum effects in suppressing gonadotropin and E2 levels.

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