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Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review. 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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Latest Submissions Open for Peer-Review:

  • A Pilates exercise program for improving core strength, balance and functional autonomy in aged women: study protocol for a randomised controlled trial

    From: JMIR Research Protocols

    Date Submitted: Jun 22, 2016

    Open Peer Review Period: Jun 26, 2016 - Jul 10, 2016

    Background: Spain is one of the oldest countries of the European Union with a major proportion of women in the older age group. Consequently, there is a need to identify and implement effective strate...

    Background: Spain is one of the oldest countries of the European Union with a major proportion of women in the older age group. Consequently, there is a need to identify and implement effective strategies to ensure their independence to achieve typical activities of daily living. Core training is becoming a novel approach for enhancing strength, balance, functional autonomy, and preventing falls among elderly. However, real life conditions require concurrent attention-demanding tasks, increasing the risk of falling and contributing to disability. Objective: Pilates-based exercise is proposed as a combined core and mental training program grounded on learning functionally effective postural sets and motor patterns, that will provide better results than a muscular exercise program in older women trunk strength and other complementary physical and mental functions such as balance or functional autonomy. Methods: This is a 34-week randomised controlled trial in which 80 independent older women will be allocated to a Pilates-based exercise program, a muscular exercise program, or a no-exercise control group. The intervention will be divided into 22 weeks of supervised exercise and a 12 weeks follow-up. The primary outcome will be isokinetic and isometric trunk and hip flexion-extension strength. The secondary outcome will include static and dynamic balance, the number of falls, functional autonomy, body composition, habitual physical activity and a standardized gerontological evaluation. Every item will be measured at baseline and after 22 and 34 weeks. Results: Recruitment process is currently accomplished. Pilates and Muscular exercise programs logistics are ready to begin their implementation. Results are expected in 2017. Conclusions: We expect that our results will guide other exercise-based strategies to implement combined core and mental training programs as a better way to enhance trunk strength, balance and functional autonomy, to diminish the risk of falling and preserve functionality in aged women. In addition, the follow-up period will provide new relevant information about the efficacy of the learning process included in Pilates-based exercise. Clinical Trial: NCT02506491

  • Rationale and design of Genetic study in Cardio-Metabolic risk factors: Tehran Cardio-Metabolic Genetic Study (TCGS)

    From: JMIR Research Protocols

    Date Submitted: Jun 4, 2016

    Open Peer Review Period: Jun 26, 2016 - Jul 10, 2016

    Background: Nowadays cardio-metabolic risk factors comprise cardiovascular diseases and/or diabetes and need to be evaluated in different fields. The primary aim of the Tehran Cardiometabolic Genetic...

    Background: Nowadays cardio-metabolic risk factors comprise cardiovascular diseases and/or diabetes and need to be evaluated in different fields. The primary aim of the Tehran Cardiometabolic Genetic Study (TCGS) is to create a comprehensive genome-wide database of at least 16 000 Tehranians, participants of the ongoing Tehran lipid and glucose study (TLGS) cohort. Objective: We aimed to undertake a genome wide association study evaluating and comparing genetic patterns in a Tehranian population to other reference genetic databases. This is one of the very first studies of its kind in the Middle East, and addresses the knowledge gap on the allele frequency, genetic association and the role of consanguineous marriage among Iranian families. Methods: TCGS was designed in collaboration with the Research Institute for Endocrine Sciences (RIES) and DeCode genetic company. Participants selected had already been followed for over a 16-years period for major incident cardio-metabolic related health events including; myocardial infarction, stroke, diabetes mellitus, hypertension, obesity, hyperlipidemia and familial hypercholesterolemia. Results: The TCGS cohort described here comprises 16,247 (76.58%) of the 21,216 TLGS participants who provided a baseline blood sample adequate for plasma and DNA analysis. 3937 families were collected and the mean pedigree size in population of study was 6.76 range 3 to 52. Finally 5201 males and 6296 females with the total genotyping rate of 0.9836 were genotyped with HumanOmniExpress-24-v1-0 bead chips (containing 715,871 SNP loci with an average mean distance of 4 kb). Conclusions: Investigations conducting within the TCGS will seek to identify relevant patterns of genetic polymorphism that could be related to cardio-metabolic risk factors in Tehran’s participants. By linking genome-wide data to the existing databank of TLGS participant, which includes comprehensive behavioral, biochemical and clinical data on each participant since cohort inception in 1999, the TCGS will also allow exploration of gene-gene and gene-environment interactions as they relate to disease status.

  • Validated smartphone based applications for ear and hearing assessment: a review

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 23, 2016

    Open Peer Review Period: Jun 26, 2016 - Aug 21, 2016

    Background: An estimated 360 million people have disabling hearing loss (DHL) globally. However, these figures are uncertain as few data are available from population-based surveys. This gap is largel...

    Background: An estimated 360 million people have disabling hearing loss (DHL) globally. However, these figures are uncertain as few data are available from population-based surveys. This gap is largely due to the significant logistical challenges that exist in performing these surveys in low and middle-income countries (LMIC) such as the requirement for skilled hearing healthcare professionals and specialist equipment to measure hearing. Objective: To explore the use of low-cost smartphone applications (apps) for audiological assessments and consider if they could be incorporated into population-based survey methodologies to enable scale-up of data collection in LMICs. Methods: Commercial appstores, Google Play and Apple Appstore, were searched to identify apps for tests of auditory function. A literature review was undertaken to assess which of the apps identified in the appstores review app had been validated in peer-reviewed literature. A comparison was made between validated apps. Results: Search queries returned 30 applications that could be used for audiological assessments, of which 5 were validated in peer-reviewed literature. One additional app was identified in the literature search that is not yet available commercially. uHear, an app for self-administered audiometry, was validated in the most number of peer reviewed studies against gold standard pure tone audiometry. However, the accuracy of uHear varied across these studies. Conclusions: Very few of the available apps have been validated in peer-reviewed studies identified in the literature. Of the apps that have been validated, further independent research is required in order to fully understand their accuracy at detecting hearing loss. With further validation, the use of smartphone apps has the potential to enhance data collection for hearing loss prevalence and allow planning of services accordingly.

  • A Multimedia Child Developmental Screening Checklist-Design and Validation

    From: Journal of Medical Internet Research

    Date Submitted: Jun 26, 2016

    Open Peer Review Period: Jun 26, 2016 - Aug 21, 2016

    Background: Identifying disability early in life confers long-term benefits for children. To detect those who need help early, judicious use of practical and reliable standardized screening tools is o...

    Background: Identifying disability early in life confers long-term benefits for children. To detect those who need help early, judicious use of practical and reliable standardized screening tools is of great importance. Objective: This study intended to construct the multimedia version child development checklists, and investigate the measurement equivalence of this multimedia version to the original text-based paper-and-pencil version. Methods: In order to develop the multimedia version of the Taipei City Child Development Screening tool, Second Version (Taipei II), a team of experts created illustrations, translations, and dubbing of the original checklists. The developmental process lasted approximately 10 months. The developmental screening test was administered to a total of 390 primary caregivers of children aged between 4 months and 6 years. Results: Psychometric testing revealed excellent agreement between the paper and multimedia versions. Good to excellent reliabilities were demonstrated for all age groups for both the cross-mode similarity (ICCmode range = 0.85-0.96) and test–retest reliability (r = 0.93). Regarding usability, 98% of the participants preferred the multimedia version because of its dynamic illustrations and explanatory dubbing. Conclusions: The multimedia tool produced essentially equivalent results to the paper-and-pencil tool, in addition to numerous advantages. It can facilitate active participation and promote early screening of target populations. Clinical Trial: NCT02359591

  • “Back on Track” – ACL Rupture Study: A Mobile App Observational Study Using Apple’s ResearchKit Framework

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 23, 2016

    Open Peer Review Period: Jun 26, 2016 - Aug 21, 2016

    Background: In March 2015 Apple, Inc. announced ResearchKit, a novel open-source framework intended to help medical researchers to easily create apps for medical studies. With the announcement of this...

    Background: In March 2015 Apple, Inc. announced ResearchKit, a novel open-source framework intended to help medical researchers to easily create apps for medical studies. With the announcement of this framework Apple presented five apps built in a beta-phase based on this framework. Objective: In this work the development of a study app based on ResearchKit is described. The objective of this study is the decision making in patients with acute anterior cruciate ligament (ACL) ruptures. Methods: A multi-language observatory study is conducted. At first a suitable research topic, target groups, participating territories and programming method are carefully identified. The ResearchKit framework is used to program the app. A secure server connection is realized via SSL. A data storage and security concept separating personal information and study data is proposed. Furthermore an efficient method to allow multi-language support and distribute the app in many territories is presented. Ethical implications are considered and taken into account regarding privacy policies. Results: An app study based on ResearchKit is developed without comprehensive iOS development experience. The Apple App Store is a major distribution channel causing significant download rates (> 1.200/y) without active recruitment. Preliminary data analysis shows moderate dropout rates and a good quality of data. 180 participants are currently enrolled with 107 actively participating and producing 424 completed surveys in 9 months. Conclusions: ResearchKit is an easy-to-use framework and powerful tool to create medical studies. Advantages are the modular built, the extensive reach of iOS devices and the convenient programming environment. Clinical Trial: Deutsches Register Klinischer Studien (DRKS) - https://www.germanctr.de: DRKS00009270

  • LGBT health-care disparities in Multiple Sclerosis: a cross-sectional web-based study in Italy

    From: Journal of Medical Internet Research

    Date Submitted: Jun 25, 2016

    Open Peer Review Period: Jun 25, 2016 - Aug 20, 2016

    Background: Lesbian, gay, bisexual and transgender (LGBT) patients might experience unique difficulties and barriers to treatment of chronic diseases related to their sexual orientation. Objective: To...

    Background: Lesbian, gay, bisexual and transgender (LGBT) patients might experience unique difficulties and barriers to treatment of chronic diseases related to their sexual orientation. Objective: To investigate health-care disparities experienced by LGBT patients with multiple sclerosis (MS). Methods: We conducted a survey on an Italian social-network (www.smsocialnetwork.com) for MS patients, by using standardized multiple-choice questions. The survey investigated: socio-demographic factors, lifestyle habits, MS-related health status and LGBT specific issues (e.g. friendliness to their sexual orientation or homophobic behaviors from the staff of their MS Center). Results: LGBT patients were associated with a smaller number of psychological consultations, compared to heterosexuals (Coeff.=-0.449; p<0.001; 95%CI=-0.682--0.217). LGBT patients were more likely to change MS Center, compared to heterosexuals (OR=2.064; p=0.046; 95%CI=1.011-4.212). The number of MS Center changes was associated with MS Center friendliness (p=0.037; rho=-0.229) and with the occurrence of homophobic behaviors (p=0.036; rho=0.234). Conclusions: LGBT MS patients more frequently changed MS Center and had a reduced use of psychological services, compared to heterosexuals. The attitude towards LGBT MS patients might affect resource utilizations and, possibly, LGBTs’ health status.

  • Protocol for a randomised controlled trial of proactive online versus telephone-based information and support: Can electronic platforms deliver effective care for lung cancer patients?

    From: JMIR Research Protocols

    Date Submitted: Jun 21, 2016

    Open Peer Review Period: Jun 23, 2016 - Jul 7, 2016

    Introduction: Community-based services such as telephone support lines can provide valuable informational, emotional and practical support for cancer patients via telephone-based or electronic platfor...

    Introduction: Community-based services such as telephone support lines can provide valuable informational, emotional and practical support for cancer patients via telephone-based or electronic platforms. However, very little rigorous research has been directed toward examining the efficacy of such services in improving patient outcomes. This study will determine whether: proactive telephone or online-delivered support produces outcomes superior to printed information; and proactive online-delivered support produces outcomes comparable to proactive telephone support. Methods and analysis: A consecutive sample of 501 lung cancer outpatients will be recruited from 50 Australian health services to participate in a multicentre, blinded, patient-randomized controlled trial. To be eligible, individuals must: be 18 years or older; have received a lung cancer diagnosis (including mesothelioma) within the previous four months; have an approximate life expectancy of at least six months; and have internet access. Participants will be randomly allocated to: (1) an information booklet; (2) proactive support delivered by telephone; or, (3) proactive support delivered on-line by chat or by email. The primary patient outcomes are general psychological distress and the efficacy and impact of health education; secondary outcomes include unmet supportive care needs. The acceptability of proactive recruitment strategies will also be assessed. All outcomes are reported using pen-and-paper surveys at baseline, 3, and 6 months post recruitment. Discussion: Community-based electronic approaches, if found effective, have the potential to greatly increase the accessibility and continuity of supportive cancer care. This evidence may also inform the redesigning of helpline-style services to be both effective and responsive to patient needs.

  • Costs and Cost-Effectiveness of a Web-Based Physical Activity Intervention for Spanish Speaking Latinas

    From: Journal of Medical Internet Research

    Date Submitted: Jun 22, 2016

    Open Peer Review Period: Jun 22, 2016 - Aug 17, 2016

    Background: Latinas report particularly low levels of physical activity (PA), and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that...

    Background: Latinas report particularly low levels of physical activity (PA), and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinos and the scalability of web-based programs. Objective: To examine the costs and cost-effectiveness of a web-based Spanish language PA intervention for Latinas compared to a contact control. Methods: Healthy adult Latinas (N=205) were recruited from the community and randomly assigned to receive a Spanish language web-based individually-tailored PA intervention (Intervention), or were given access to a website with content on wellness topics other than PA (Control). PA was measured by 7-Day Physical Activity Recall Interview and ActiGraph accelerometer at baseline, 6 months (post-intervention) and 12 months (maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (wage, benefits and overhead), materials, hardware, website hosting, and routine website maintenance. Results: At 6 months, the cost of the Intervention and Control groups were $17/month and $8/month, respectively. These fell to $12 and $6 at 12 months. Linear interpolation showed Intervention participants increased their PA by 1362 total minutes at six months (523 by accelerometer) compared to 715 minutes in Controls (186 by accelerometer). At six months, each minute increase in PA for the Intervention cost $0.08 ($0.20 by accelerometer), compared to $0.07 in Controls ($0.26 by accelerometer). Incremental costs per minute increase associated with the intervention were $0.08 at six months and $0.04 at 12 months ($0.16 and $0.08 by accelerometer, respectively). Sensitivity analyses showed variations in staffing costs or intervention effectiveness yielded only modest changes in incremental costs. Conclusions: While the web-based PA intervention was more expensive than the wellness control, both were quite low cost compared to face-to-face or mail-delivered interventions. Cost-effectiveness ranged markedly based on physical activity measure, and was similar between the two conditions. Overall, the web-based intervention was effective and low cost, suggesting a promising channel for increasing PA on a large scale in this at-risk population. Clinical Trial: NCT01834287

  • Addressing the Gaps in Diabetes Care in First Nations communities with the Reorganizing the Approach to Diabetes through the Application of Registries (RADAR): The Project Protocol

    From: JMIR Research Protocols

    Date Submitted: Jun 22, 2016

    Open Peer Review Period: Jun 22, 2016 - Jul 6, 2016

    Background: Type-2 diabetes rates in First Nations communities are 3-5 times higher than the general Canadian population, resulting in a high burden of disease, complications and comorbidity. Limited...

    Background: Type-2 diabetes rates in First Nations communities are 3-5 times higher than the general Canadian population, resulting in a high burden of disease, complications and comorbidity. Limited community nursing capacity, isolated environments and a lack of electronic health records (EHR)/registries lead to a reactive, disorganized approach to diabetes care for First Nations people. The Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) project was developed in alignments with federal calls for innovative, culturally relevant, community-specific programs for people with type-2 diabetes developed and delivered in partnership with target communities. Objective: To implement and assess the effectiveness of a system wide, scalable infrastructure – RADAR. RADAR applies both an integrated diabetes EHR/registry system (CARE platform) and centralized care coordinator (CC) service that will support local healthcare workers in transforming care for First Nations people with diabetes. Methods: The CC will work with local healthcare workers to support patient and community health needs (using the CARE platform) and build capacity in best practices for type-2 diabetes management. A modified stepped wedge controlled trial design will be used to evaluate the model. During the baseline phase, the CC will work with local healthcare workers to identify patients with type-2 diabetes and register them into the CARE platform, but not make any management recommendations. During the intervention phase, the CC will work with local healthcare workers to proactively manage patients with type-2 diabetes, including monitoring and recall of patients, relaying clinical information and coordinating care, facilitated through the shared use of the CARE platform. The RE-AIM framework will provide a comprehensive assessment of the model. Assessments of whether the intervention is Reaching the target population; has been Adopted by the community and staff; is being Implemented as intended in a cost-effective manner; the Effectiveness of the intervention (e.g. clinical changes over time – A1c, BP, cholesterol, foot and eye exams, etc.); and the Maintenance of the intervention will be extracted. Results: The primary outcome measure will be a 10% improvement in any one of A1c, BP, or cholesterol over the baseline values. Secondary endpoints will address other diabetes care indicators including: the proportion of clinical measures completed in accordance with guidelines (e.g., foot and eye examination, receipt of vaccinations, smoking cessation counseling); the number of patients registered in CARE; and the proportion of patients linked to a health services provider. The cost-effectiveness of RADAR specific to these communities will be assessed. Concurrent qualitative assessments will provide contextual information, such as the quality/usability of the CARE platform and the impact/satisfaction with the model. Conclusions: Through the application of health information systems and guidance from a CC, RADAR will systematically organize proactive diabetes care in First Nations communities to improve diabetes-related outcomes.

  • Happy, a Smartphone-based Intervention to Promote Cancer Prevention Behaviors: Usability and Feasibility Study

    From: Journal of Medical Internet Research

    Date Submitted: Jun 22, 2016

    Open Peer Review Period: Jun 22, 2016 - Aug 17, 2016

    Background: Estimates predict that more than half of all cancers are due to inadequate lifestyle choices. Smartphones can be successfully used to support the behavior change needed to prevent cancer....

    Background: Estimates predict that more than half of all cancers are due to inadequate lifestyle choices. Smartphones can be successfully used to support the behavior change needed to prevent cancer. Objective: The purpose of this study was to field-test Happy, a smartphone app designed to promote cancer prevention behaviors, based on tailored-messages deliver. Methods: Thirty-two participants downloaded and used the app for 28 consecutive days (4 weeks). At the end of this period, they all answered to an online questionnaire and ten of them were interviewed. Usability, feasibility, message receptivity, and perceived impact of the app were assessed. Results: Compliance with cancer prevention guidelines was lower than expected. Happy was considered simple, intuitive and easy to use. Messages sent by the app were considered easy to understand, providing good advices and meaningful information that grabbed reader’s attention. Participants also considered that Happy might be an effective way to promote cancer prevention. Behavioral data collected during the trial showed an increase in several cancer prevention behaviors and a significant increase in the overall cancer prevention level, 7 points in average (P=.031). Conclusions: This study showed the viability of designing and implementing smartphone-based interventions to promote cancer prevention behaviors. The results suggest that Happy is usable and might help users change their behavior, making healthier choices, thus reducing their personal risk of developing cancer.

  • Internet and adolescents: use and access, behavior, cyberbullying and grooming. Results of an investigative whole city survey.

    From: Journal of Medical Internet Research

    Date Submitted: Jun 21, 2016

    Open Peer Review Period: Jun 21, 2016 - Aug 16, 2016

    Background: According to the Digital Agenda for Europe, the way children use Internet and mobile technologies changed dramatically in the past years. Objective: This study aims to break down the modal...

    Background: According to the Digital Agenda for Europe, the way children use Internet and mobile technologies changed dramatically in the past years. Objective: This study aims to break down the modalities of access and use of the Internet by teenagers to assess risks and risky behaviours and to provide scientific data to evaluate and counsel safe use of the Internet and new technologies by teenagers. Methods: The study was conducted under the program “Strategies for a better internet for children” started in May 2012 by the European Commission. It represents the main result of the project launched by Telecom Italia “Anche io ho qualcosa da dire” (I too have something to say) thanks to which many of contributions were collected and used to develop a survey. The questionnaire was structured in 45 questions, covering three macro areas of interest and it was approved by the Department Board at UMG’s School of Medicine. After authorization from the regional high school authority, it was administered to all 1534 students (aged 13 to 19) in the city of Catanzaro, Italy. Results: The data has been broken down into three main groups: describing education and access to the Internet, methods of use and social networking and finally perception and evaluation of risk and risky behaviours. Among noteworthy results in the first group we can mention that the average age of first contact with information technologies was around 9 years old. Moreover, 79% of the interviewed students reported the access to a smartphone or a tablet. Among the results of the second group we find that the most used social networks were Facebook (85%), Youtube (61%), and Google+ (52%). 72% of the interviewed teenagers use their name and surname on social networks. 40% of them knew all their Facebook contacts personally. Among the results of the third group we find that 7,7% of the interviewed teenagers have uploaded pictures or movies that they feel ashamed of. 27% have received invitations from people they met on the Internet to meet in real life, and 8,4% have accepted such invitations. Conclusions: The results offer a breakdown of the teenagers’ use of the Internet, focusing on how teenagers learn to use and access it considering factors such as parental coaching, schooling or self-education. It describes how they approach and interact with social networks, and how they perceive risks and/or risky behaviours in a virtual environment. Information technology must be seen as an instrument and not as a hindrance. For this to happen parental guidance, schooling, and medical counseling are needed for a sound evolution of the child in this critical stage of development.

  • HIV care and viral suppression during the last year of life—a comparison of HIV-infected persons who died of HIV-attributable causes with persons who died of other causes in 2012, 13 jurisdictions, United States

    From: JMIR Public Health and Surveillance

    Date Submitted: Jun 15, 2016

    Open Peer Review Period: Jun 18, 2016 - Jul 2, 2016

    Background: Little information is available about care before death among HIV-infected persons who die of HIV infection, as compared with those who die of other causes. Objective: Determine, on a popu...

    Background: Little information is available about care before death among HIV-infected persons who die of HIV infection, as compared with those who die of other causes. Objective: Determine, on a population level, HIV care and outcome before death among persons with HIV who died of HIV-attributable or other causes. Methods: We used National HIV Surveillance System data to compare CD4 T-lymphocyte counts and viral loads within 12 months before death among persons who died of HIV-attributable causes with those among HIV-infected persons who died of other causes. Persons were classified as “in continuous care” if they had ≥2 CD4 or viral load test results at least 3 months apart in those 12 months, and as having “viral suppression” if their most recent viral load was <200 copies/mL. Deaths were classified as “HIV-attributable” if the underlying cause in death-certificate data was HIV infection itself, an AIDS-defining disease, or immunodeficiency. Results: Among persons who died of HIV-attributable or other causes, respectively, 65% and 31% had late stage disease (AIDS) in the last 12 months before death, and 34% and 51% had viral suppression. The percentage of persons who received ≥2 tests at least 3 months apart did not differ by cause of death. Prevalence of viral suppression for persons who ever had AIDS was lower among those who died of HIV, but did not differ by cause of death for persons who never had AIDS. Conclusions: The finding of a lower prevalence of viral suppression among HIV-infected persons who died of HIV than among those who died of other causes implies a need to improve strategies to achieve viral suppression to reduce mortality due to HIV.

  • WhatsApp Messenger as an Adjunctive Tool for Medical Internet: A Review

    From: Journal of Medical Internet Research

    Date Submitted: Jun 17, 2016

    Open Peer Review Period: Jun 17, 2016 - Aug 12, 2016

    Background: The advent of medical internet has allowed physicians to deliver medical treatment to patients from a distance. Mobile applications such as WhatsApp Messenger, an instant messaging service...

    Background: The advent of medical internet has allowed physicians to deliver medical treatment to patients from a distance. Mobile applications such as WhatsApp Messenger, an instant messaging service, came as a novel concept in all fields of medicine. The use of instant messaging services has been shown to improve communication within medical teams by providing means for quick teleconsultation, information sharing, and starting treatment as soon as possible. Objective: The aim of the current study was to perform a comprehensive systematic review of present literature on the use of the WhatsApp Messenger application as an adjunctive healthcare tool. Methods: Searches were performed in PubMed, Embase, and the Cochrane Library using the term whatsapp* in articles published before January 2016. A bibliography of all relevant original articles that used the WhatsApp Messenger application was created. The impact and the indications of WhatsApp Messenger are discussed in order to understand the extent to which this application currently functions an adjunctive tool for telemedicine. Results: The database search identified a total of 30 studies in which the term whatsapp* was used. Each article’s list of references was evaluated item by item. After review articles, letters to the editor, and low-quality studies were excluded, a total of 10 studies were found to be eligible for inclusion. Of these studies, nine had been published in the English language and one had been published in Spanish. Conclusions: The pooled data presents compelling evidence that the WhatsApp Messenger application is a promising system, whether used as a communication tool between healthcare professionals, as a means of communication between healthcare professionals and the general public, or as a learning tool for providing healthcare information to professionals or to the general population. However, high-quality and properly evaluated research is needed, as are improvements in descriptions of the methodology and the study processes. These improvements will allow WhatsApp Messenger to be categorically defined as an effective telemedicine tool in many different fields of healthcare.

  • Using Text Messaging in Long-Term Arthroplasty Follow-Up

    From: Journal of Medical Internet Research

    Date Submitted: Jun 16, 2016

    Open Peer Review Period: Jun 17, 2016 - Aug 12, 2016

    Background: Patient Reported Outcome Measures (PROMs) and mobile technology have to potential to change the way patients are monitored following joint replacement surgery. Objective: The aim of this s...

    Background: Patient Reported Outcome Measures (PROMs) and mobile technology have to potential to change the way patients are monitored following joint replacement surgery. Objective: The aim of this study was to determine the feasibility of text-messaging to record PROMs in long-term follow-up of hip/knee arthroplasty. In this pilot study our participants were 17 patients two-years-plus post hip/knee arthroplasty attending clinic with a mobile telephone number on record. Methods: A simple PROM (Oswestry Very Short Form) was texted to the patient. Responses were compared to clinical, radiographic and existing PROM findings. Patients were interviewed to discover their opinions on this use of texting. Results: Eleven patients engaged with the text-messaging. The mean age was 67. Reasons for six not engaging included wrong numbers, physical barriers and lack of understanding. Eight attending clinic allowed comparison of text-messaging with clinic findings. Four patients’ text-messaging responses matched clinical and radiographic findings; three also matched PROM scores collected in clinic. The three patients with mixed responses had abnormal clinical, radiographic or PROM findings. One patient’s text responses conflicted with clinical outcome. Analysis of patients’ views showed a generally positive opinion: patients were happy to communicate with surgeons by text. Practical problems, PROM limitations and trustworthiness of texting were highlighted. Conclusions: Engaging with changing technology created challenges for patients and healthcare professionals. Our results suggest text-messaging is a promising way to communicate with arthroplasty patients. Earlier integration of technology throughout the patient pathway may be important and needs further research.

  • Effectiveness of Internet-based injury prevention program in enhancing mother’s knowledge on child safety

    From: JMIR Research Protocols

    Date Submitted: Jun 17, 2016

    Open Peer Review Period: Jun 17, 2016 - Jul 1, 2016

    Background: Provision of anticipatory guidance to parents is recommended as an effective strategy to prevent injuries among young children. Internet-based anticipatory guidance is suggested to reinfor...

    Background: Provision of anticipatory guidance to parents is recommended as an effective strategy to prevent injuries among young children. Internet-based anticipatory guidance is suggested to reinforce the effectiveness of injury prevention, and improve parents’ knowledge on child safety. Parents receiving the guidance can reduce their children’s exposure to injury risk by adopting better childcare practices and using appropriate child safety devices at home. Objective: This study will examine the effectiveness of Internet-based injury prevention program with parental anticipatory guidance in enhancing mothers’ knowledge on child safety. It aims at increasing mothers’ knowledge and motivation of learning about domestic injury prevention through a new Internet-based intervention model. It also targets to improve mothers’ attitude and their perceived behavioral control of domestic safety practice. Methods: The study would adopt a randomized controlled trial design and recruit 934 mothers from the antenatal clinics and postnatal wards of two major public hospitals in Hong Kong. Participating mothers will be randomized into the intervention or control group with equal likelihood. Mothers in intervention group will be provided with free access to an Internet-based injury prevention program with anticipatory guideline whereas those in the control group will receive relevant parenting booklet. Results: Mothers’ general and age-appropriate knowledge on child safety and motivation of learning about domestic injury prevention will be the primary outcome measures. Conclusions: The Internet is increasingly recognized as a practical and cost-effective platform for health education and safety information delivery. This study will examine the effectiveness of a new Internet-based intervention program for improving mothers’ knowledge and raising their awareness about the importance and consequences caused by domestic injuries.

  • Effects of informatics course and Virtual Reality games on elderly socialization: Study protocol for a quasi-experimental design

    From: JMIR Research Protocols

    Date Submitted: Jun 16, 2016

    Open Peer Review Period: Jun 17, 2016 - Jul 1, 2016

    Background: The use of new Technologies, such as the resources of augmentative and alternative communication (AAC), appears as a valuable tool to promote socialization in many groups of people. Seriou...

    Background: The use of new Technologies, such as the resources of augmentative and alternative communication (AAC), appears as a valuable tool to promote socialization in many groups of people. Serious games with virtual reality are an example of these resources and might bring benefits also to the elderly population, allowing an enjoyable and safe interaction that uses various sensorial stimuli. The purpose of this study protocol is to evaluate the effects of practicing virtual reality games on elderly socialization. Objective: To evaluate the effects of practicing virtual reality games on elderly socialization. Methods: It will be an experimental, prospective longitudinal study which will use serious games with virtual reality to improve the socialization of elderly people. A minimum of 46 people aged 60 years and older, of both sexes, enrolled spontaneously in an informatics course for beginners will participate in the study. Three moments data collection will be compared: T0 – at baseline; T1 – after 8 conventional informatics classes and; T2 – after 8 informatics classes which includes 15 minutes for practicing virtual reality games. Results: The evaluation will consist mainly in two validated questionnaires on socialization, the SELSA-S and ULS-6. Response time and performance will also be measured by three virtual reality games, namely Reaction Time, Random and Moviletrando. Conclusions: This study will determine whether the practice of virtual reality games in addition to the usual informatics classes contributes to elderly socialization. The evolution in socialization, the evolution of reaction time and performance in virtual reality games and the correlation of motor learning to socialization will also be investigated. Clinical Trial: NCT02798081

  • Mobile telephone technology use by people experiencing Multiple Sclerosis fatigue.

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 13, 2016

    Open Peer Review Period: Jun 16, 2016 - Aug 11, 2016

    Background: Fatigue is one of the most commonly reported symptoms of Multiple Sclerosis (MS). It has a profound aspect on all spheres of life, both for the person with MS and their relatives. It is on...

    Background: Fatigue is one of the most commonly reported symptoms of Multiple Sclerosis (MS). It has a profound aspect on all spheres of life, both for the person with MS and their relatives. It is one of the key precipitants of early retirement. Individual, group and internet cognitive behavioural therapy based approaches to supporting people with MS to manage their fatigue have been shown to be effective. Objective: The aim of this project was to: 1) survey the types of mobile devices people with MS use or would consider using for a health intervention, together with the level of internet access they have, and 2) characterise the levels of fatigue severity and its impact experienced by the people in our sample, to provide an estimate of fatigue severity of people with MS in New Zealand. The ultimate goal of this work was to support the future development of a mobile intervention for the management of fatigue for people with MS. Methods: People with MS were surveyed using an online questionnaire. Results: This survey has demonstrated that NZ respondents with MS experienced high levels of both fatigue severity and fatigue impact. The majority of participants have a mobile device and access to the internet. Conclusions: These factors, alongside limited access to face-to-face cognitive behavioural therapy based interventions, create an opportunity to develop a mobile technology platform for delivering a cognitive behavioural therapy based intervention to improve the severity and impact of fatigue in people with MS.

  • Development of a smartphone app to support self-monitoring of emotional well-being

    From: JMIR Mental Health

    Date Submitted: Jun 14, 2016

    Open Peer Review Period: Jun 15, 2016 - Aug 10, 2016

    Emotional wellbeing is a primary component of mental health and well-being. Monitoring changes in daily emotion state over extended periods is however difficult using traditional methodologies. Provi...

    Emotional wellbeing is a primary component of mental health and well-being. Monitoring changes in daily emotion state over extended periods is however difficult using traditional methodologies. Providing mental health support is also challenging when approximately only 1 in 2 people with mental health issues seek professional help. Smartphone technology offers a sustainable means of enhancing self-management of emotional wellbeing. In this paper, we report on the development of ‘MoodPrism’, an evidence-based smartphone application (‘app’) which monitors emotional mental health and well-being, and provides links to mental health organization websites and resources. The app obtains data via self-report psychometric questionnaires, experience sampling methodology, and automated behavioural data collection. Trial data on functionality and user experience are also reported, indicating MoodPrism is a viable research data collection tool. Recommendations for future researchers and developers of mental health research apps are also presented. The methodology reported in this paper provides a valuable standard against which development future mental health apps should be considered, and offers a rich tool for a range of potential mental health research studies.

  • Test-Enhanced Online Learning Strategies in Postgraduate Medical Education

    From: Journal of Medical Internet Research

    Date Submitted: Jun 14, 2016

    Open Peer Review Period: Jun 14, 2016 - Aug 9, 2016

    Background: The optimal design of pedagogical strategies for online learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with ini...

    Background: The optimal design of pedagogical strategies for online learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with initial research suggesting that taking short breaks while watching videos (independent of answering test questions) may improve learning by focusing attention. Interspersed test questions may also improve knowledge acquisition and retention. Objective: We undertook this study to examine the effect of interspersed test questions and periodic breaks on immediate knowledge acquisition and retention at six months by pediatric residents engaged in video-based online learning. Methods: First and second year pediatric residents were randomized to one of three groups: viewing the complete video uninterrupted (full video), viewing the video interrupted with unrelated logic puzzles (logic puzzles), or viewing the video interrupted with brief comprehension test questions (short answer questions). Residents answered pre- and post-tests before and after video viewing, followed by a retention test at six months. Primary outcome included comparison of the change in test scores between groups. Results: Forty-nine residents completed the initial testing session. All three learning groups had comparable mean increases in immediate knowledge gain, but with no significant differences between groups (F(2,46)=0.35, P=0.71). Thirty-five residents completed retention testing with comparable degrees of knowledge retention in the full video and short answer test questions groups (P<0.001) but no significant change in the logic puzzles group (F(1,32)=2.44, P=0.13). Conclusions: Neither answering interspersed questions nor completing an alternate mind-engaging activity during interrupted online video viewing improved the amount of knowledge gain as compared to traditional uninterrupted video viewing. Both uninterrupted video viewing and answering interspersed test questions during interrupted video viewing demonstrated significant knowledge retention at six months.

  • An exploratory clinical trial of a novel treatment for giant congenital melanocytic nevi combining inactivated autologous nevus tissue by high hydrostatic pressure and a cultured epidermal autograft: Study protocol

    From: JMIR Research Protocols

    Date Submitted: Jun 14, 2016

    Open Peer Review Period: Jun 14, 2016 - Jun 28, 2016

    Background: Giant congenital melanocytic nevi (GCMNs) are large brown to black skin lesions that appear at birth and which are associated with a risk of malignant transformation. It is often difficult...

    Background: Giant congenital melanocytic nevi (GCMNs) are large brown to black skin lesions that appear at birth and which are associated with a risk of malignant transformation. It is often difficult to reconstruct large full-thickness skin defects after the removal of GCMNs. Objective: To overcome this difficulty we developed a novel treatment to inactivate nevus tissue and reconstruct the skin defect using the nevus tissue itself. In the present study, we designed an exploratory clinical study to investigate the safety and efficacy of a novel treatment combining the engraftment of autologous nevus tissue inactivated by high hydrostatic pressurization (HHP) and a cultured epidermal autograft (CEA). Methods: Patients with congenital melanocytic nevi that were not expected to be closed by primary closure will be recruited for the present study. The target number of nevi is 10. The full-thickness nevus of the target is removed and pressurized at 200 MPa for 10 minutes. The pressurized and inactivated nevus is sutured to the original site. A small section of the patient’s normal skin is taken from around the nevus region and a CEA is prepared after a three-week culturing process. The CEA is then grafted onto the engrafted inactivated nevus at four weeks after its retransplantation. The primary endpoint is the engraftment of the CEA at 8 weeks after its transplantation and is defined as being engrafted when the engraftment area of the inactivated nevus is ≥60% of the pre-transplantation nevus area, and when ≥80% of the transplanted inactivated nevus is epithelialized. Results: The study protocol was approved by the Institutional Review Board of Kansai Medical University (No.1520-2, January 5, 2016: version1.3). The study opened for recruitment in February 2016. Conclusions: This protocol is designed to show feasibility in delivering a novel treatment combining the engraftment of inactivated autologous nevus tissue and CEA. This is the first-in-man clinical trial of this treatment anditt should be a promising treatment of patients suffering from GCMN. Clinical Trial: UMIN000020732

  • User-Centered Design of a Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits

    From: Journal of Medical Internet Research

    Date Submitted: Jun 13, 2016

    Open Peer Review Period: Jun 13, 2016 - Aug 8, 2016

    Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by t...

    Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Objective: To employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. Methods: We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by 3 design sessions with a 12-patient group. We audio-recorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work. Results: Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (such as the ability to raise private or sensitive concerns), and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match gender and race/ethnicity of the actors with patients. Conclusions: User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting visit discussion priorities.

  • Social Media in Public Health: an analysis of national health authorities and leading causes of death in Latin America and the Caribbean

    From: Journal of Medical Internet Research

    Date Submitted: Jun 12, 2016

    Open Peer Review Period: Jun 12, 2016 - Aug 7, 2016

    Background: In Latin America, there are 23 leading causes of death, some of which are preventable. The mortality rates of diabetes, HIV/AIDS, heart disease, and more of these preventable diseases can...

    Background: In Latin America, there are 23 leading causes of death, some of which are preventable. The mortality rates of diabetes, HIV/AIDS, heart disease, and more of these preventable diseases can be reduced dramatically if health care professionals, patients and their families have access to health information and proper medical advice that enables them to make informed decisions about their health. National health authorities can provide access to reliable and quality health information on social media. Objective: A study was conducted to analyze the availability of information about the leading causes of death on the social media channels of national health authorities in 18 Spanish-speaking Latin American countries. Methods: Quantitative methods were used to gather data on the institutional presence of national health authorities in social media. This quantitative approach was helpful in identifying which countries make information on the leading causes of death available for the general population through these platforms. The exploratory-descriptive research was useful for the analysis and interpretation of the data and information collected, including analysis by country and by the leading causes of death. An analysis was carried out for a period of six months, from April 1 to September 30, 2015. Results: Sixteen of the 18 countries studied have institutional presence on at least one of the six social media mentioned. National health authorities have a presence on an average of almost three social media platforms (2.88%). An average of 1% across the 18 countries in this study follows national health authorities on social media. On average, information on 3.2 of the 10 leading causes of death was posted on the national health authority Facebook page, and 2.93 of the 10 leading causes of death was posted on their Twitter profiles. YouTube plays a key role in providing content that is shared on Facebook and Twitter. Conclusions: Non-traditional communication channels, such as social media, can improve the quality of the health information available and shared online and can contribute to keeping the information up-to-date. The study provides a valuable perspective on which countries have the best opportunity to influence their communities based on the content shared on social media.

  • Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review

    From: JMIR Preprints

    Date Submitted: Jun 9, 2016

    Open Peer Review Period: Jun 10, 2016 - Aug 5, 2016

    Background: Anxiety and mood disorders are the most prevalent mental health problems, though, the supply with effective psychological treatments, such as Cognitive Behavior Therapy (CBT), is deficient...

    Background: Anxiety and mood disorders are the most prevalent mental health problems, though, the supply with effective psychological treatments, such as Cognitive Behavior Therapy (CBT), is deficient in primary care. In view of the enduring diffusion of new media technologies into everyday live, internet-based computerized, respectively electronic mental health (i.e. e-mental health) programs, have been suggested as opportunity to expand the access to mental healthcare by overcoming regional, temporal or individual barriers. Previous research has confirmed the effectiveness of several online therapy approaches; however, the internationally targeted implementation of e-mental health into healthcare systems is remaining slow and the role of public acceptability of e-mental health for the envisioned large-scale uptake of e-mental health is barely understood. Objective: This scoping review aims at identifying recent evidence from surveys investigating acceptability of e-mental health in the general population. In accordance with technology acceptance models, we defined both perceived helpfulness and intentions to use web-delivered psychological services as indicators for public acceptability. Methods: We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library) to identify studies investigating expectations, preferences and attitudes toward e-mental health in the respective general population. Studies published between January 2010 and December 2015 were considered. Exclusion criteria involved data collection in clinical trials. Results: Of 76 identified publications, four articles from Europe and Australia met the inclusion criteria. Sample sizes ranged from 217 to 2.411, participants aged between 14 and 95 years. Included studies used cross-sectional designs and self-developed surveys. Except for one randomized controlled trial (RCT), the others used correlational study designs. Findings of three studies included indicated that e-mental health treatment services were perceived as less helpful than face-to-face psychotherapy. The willingness to engage with e-mental health treatments was overall smaller in comparison to traditional services, especially for online therapy delivered via smartphone or without therapist-assistance. In the RCT, providing educational information about e-mental health yielded to mixed effects on attitudes. Nonetheless, some results indicated that e-preferences, e-awareness and familiarity with online self-help corresponded with improved assessments of e-mental health. Conclusions: Given the marginal amount and methodological limitations of the four studies identified in this review and vague theoretical foundation of self-developed surveys, further research is required to determine public acceptability of e-mental health. Future studies should combine evidence-based, theory-lead and collaborative approaches to determine the role of e-health literacy and e-awareness in the relationship between public acceptability of e-mental health and help-seeking behaviour.

  • Formative work to develop a tailored HIV testing smartphone application for diverse, at-risk HIV-negative men who have sex with men

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 7, 2016

    Open Peer Review Period: Jun 10, 2016 - Aug 5, 2016

    Background: Although gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV, few test for HIV at regular intervals. Smartphone applications (or “apps”) may...

    Background: Although gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV, few test for HIV at regular intervals. Smartphone applications (or “apps”) may be an ideal tool to increase regular testing among MSM. However, the success of apps to encourage regular testing among MSM will depend on how frequently they are downloaded, whether they are continued to be used over months or years, and the degree to which such apps are tailored to the needs of this population. Objective: The primary objectives of this study are to answer the following questions: 1) What features and functions of smartphone apps do MSM believe are associated with downloading apps to their mobile phones?; 2) What features and functions of smartphone apps are most likely to influence MSM’s sustained use of apps over time?; and 3) What features and functions do MSM prefer in a HIV testing smartphone app? Methods: Focus groups (n=7 with 34 participants) were conducted with a racially and ethnically diverse group of sexually active HIV-negative MSM (Mean age of 32; 42% tested for HIV ≥10 months ago in Miami, Florida and Minneapolis, Minnesota. Focus groups were digitally recorded, transcribed verbatim, 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 focus groups. Results: Men reported cost, security, and efficiency as their primary reasons influencing whether they download an app. Usefulness and perceived necessity, as well as peer and posted reviews, affected whether they downloaded and used the app over time. Factors that influenced whether they keep and continue to use an app over time included reliability, ease of use, and frequency of updates. Poor performance and functionality and lack of use were the primary reasons why men would delete an app from their phone. 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: Mobile apps for HIV prevention have proliferated, despite relatively little formative research to understand best practices for their development and implementation. The findings of this study suggest key design characteristics that should be used to guide development of a HIV testing app to promote regular HIV testing for MSM. The features and functions identified in this and prior research, as well as existing theories of behavior change, should be used to guide mobile app development in this critical area.

  • A Prospective Observational Trial: Testing the Feasibility of Remote Patient Monitoring in Prenatal Care using a Mobile App and Connected Devices

    From: interactive Journal of Medical Research

    Date Submitted: Jun 7, 2016

    Open Peer Review Period: Jun 10, 2016 - Aug 5, 2016

    Background: Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth and preeclampsia. More effectiv...

    Background: Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed. Objective: The aim of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a smartphone app and connected digital devices. Methods: In this prospective observational study, we recruited eight women with low risk pregnancy in the first trimester at an urban academic medical center. Participants received a smartphone app with connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to patient and provider. As measures of feasibility of the system, patients were studied for engagement with the app, accuracy of remote data, efficacy of alert system and patient satisfaction. Results: Patient engagement with the mobile app averaged 5.5 times per week over the six-month study period. Weight data collection averaged 1.5 times per week and blood pressure data collection averaged 1.1 times per week. At-home measurements of weight and blood pressure were highly accurate compared to in-office measurements. Automatic clinical alerts identified two episodes of abnormal weight gain with no false triggers. Patients demonstrated high satisfaction with the system. Conclusions: In this pilot study, we demonstrated that a system using a smartphone app coupled to remote monitoring devices is feasible for prenatal care. Clinical Trial: Approved by the GWU IRB. IRB# 051422.

  • mHealth or eHealth? A randomized controlled trial testing the efficacy, use, and appreciation of a web-based computer-tailored physical activity intervention for Dutch adults.

    From: Journal of Medical Internet Research

    Date Submitted: Jun 8, 2016

    Open Peer Review Period: Jun 8, 2016 - Aug 3, 2016

    Background: Until a few years ago, web-based computer-tailored interventions were almost exclusively delivered via the computer (eHealth). However, nowadays, interventions delivered via smartphones (m...

    Background: Until a few years ago, web-based computer-tailored interventions were almost exclusively delivered via the computer (eHealth). However, nowadays, interventions delivered via smartphones (mHealth) are an interesting alternative for health promotion as they may more easily reach people 24/7. Objective: The first aim of this study was to compare the efficacy of a mHealth and eHealth version of a web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. Methods: Data was collected among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks and after 6 months). Participants were recruited via a Dutch online research panel and randomly assigned to the eHealth (N= 138), the mHealth (N= 108), or the control condition (N= 127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. ANOVA and linear regression analyses were used to examine differences between the study groups with regards to efficacy, use, and appreciation. Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B = 8.48, P = .025, df= 2; Cohen’s d = 0.27). A small effect size was found favoring the eHealth condition over the control group (B = 6.13, df = 2; P =.091, Cohen’s d = 0.21). The eHealth condition had lower dropout rates (84.4%) than the mHealth condition (75.0%) and the control group (71.7 %). Furthermore, the eHealth condition was appreciated better in comparison to the mHealth condition with regard to receiving (t= 3.07; df= 182; P= .002) and reading the feedback messages (t = 2.34; df= 181; P = .02) as well as the clarity of the messages (t = 1.99; df = 181; P = .049). Conclusions: The overall effect was mainly caused by the more effective eHealth intervention. The mHealth application was less appreciated than the eHealth version. More research is needed to assess how both methods can complement each other. Clinical Trial: Dutch Trial Register: NTR4503

  • The issues associated with the use of Semantic Web Technology in Clinical Decision Support Systems: A Systematic Review of the Literature

    From: Journal of Medical Internet Research

    Date Submitted: Jun 6, 2016

    Open Peer Review Period: Jun 7, 2016 - Aug 2, 2016

    Background: Clinical Decision Support System (CDSS) is a particular form of intelligent system that helps practitioners to make a decision regarding diagnosis or treatment. Knowledge acquisition is on...

    Background: Clinical Decision Support System (CDSS) is a particular form of intelligent system that helps practitioners to make a decision regarding diagnosis or treatment. Knowledge acquisition is one of the well-known bottlenecks in CDSS, partly because of the enormous growth in health related knowledge and the difficulty in assessing the quality of this knowledge. The semantic web (SW) represents a set of technologies that may be able to assist in automatically discovering relevant and high-quality knowledge for CDSS along with discovering data that may be relevant for the decision-making process` Objective: The paper aims to define the role of Semantic Web technology in acquiring knowledge for CDSS and identifying issues with these approaches Methods: We conducted a systematic review of the recent related work using search key terms in different scientific databases Results: The retrieved papers were categorized based on four main issues addressed; format heterogeneity, lack of semantic definition, lack of automatic analysis system and data heterogeneity and lack of data integration. Most existing approaches will be discussed under these categories. 21 papers have been reviewed in this study. Conclusions: The potential for using Semantic Web technology in CDSS has only been considered to a minor extent so far despite its promise. The review shows the capability of using Semantic Web technology to supply knowledge for a CDSS. Clinical Trial: N/A

  • Efficacy of Internet-based self-monitoring interventions on maternal and neonatal outcomes in perinatal diabetic women: A systematic review and meta-analysis

    From: Journal of Medical Internet Research

    Date Submitted: Jun 5, 2016

    Open Peer Review Period: Jun 6, 2016 - Aug 1, 2016

    Background: Self-monitoring using internet offers new opportunities to engage perinatal diabetic women in self-management to reduce maternal and neonatal complications. Objective: This review aims to...

    Background: Self-monitoring using internet offers new opportunities to engage perinatal diabetic women in self-management to reduce maternal and neonatal complications. Objective: This review aims to synthesize the best available evidence to evaluate the efficacy of Internet-based self-monitoring interventions in improving maternal and neonatal outcomes among perinatal diabetic women. Methods: The review was conducted using Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsyINFO, Scopus, and ProQuest Dissertations and Theses to search for English-language research studies without any year limitation. A “risk of bias” table was used to assess methodological quality. Meta-analysis was performed with RevMan software. Q test and I2 tests were used to assess heterogeneity. The overall effect was assessed using Z-statistics at P < 0.05. Of the 438 studies identified through electronic searches and reference lists, 9 experimental studies from 10 publications were selected. Results: Half of the selected studies had low risk of bias and comprised 852 perinatal diabetic women in six countries. Meta-analysis revealed that the Internet-based self-monitoring intervention significantly decreased maternal glycosylated hemoglobin A1c level (Z = 2.23, P = 0.03) among perinatal diabetic women and significantly decreased cesarean section rate (Z = 2.23, P = 0.03) among the mixed group. Conclusions: This review showed similar neonatal or other maternal outcomes between the Internet-based self-monitoring intervention and usual diabetes care among perinatal diabetic women. Future research is needed to employ randomized controlled trial designs with follow-up data to confirm long-term effects. Clinical Trial: No trial registration number.

  • A criteria-based evaluation of Internet sites of orthodontists in private practice

    From: interactive Journal of Medical Research

    Date Submitted: Jun 3, 2016

    Open Peer Review Period: Jun 6, 2016 - Aug 1, 2016

    Background: Health-related use of the Internet has increased markedly in recent years. The Internet offers patients not only information on diseases and therapy options, but also the possibility to se...

    Background: Health-related use of the Internet has increased markedly in recent years. The Internet offers patients not only information on diseases and therapy options, but also the possibility to search for dentists using physician directories or websites. For privately practicing dentists, having a website serves as an important tool for marketing and recruiting new patients. Objective: This study aimed to investigate existence, frequency, and quality of websites of privately practicing orthodontists. Methods: Internet sites of orthodontists listed with the association of statutory health insurance physicians in five German states were investigated. Websites were evaluated according to 68 operationalized criteria and data analyzed based to hypotheses. Results: The majority of orthodontists (368 of 619; 59.5%) had a website. The frequency of websites differed in terms of region (city states 66.8% vs. territorial states 55.2%; P=.005), and practice type (single physician practice 40.6% vs. multiple physician practice 59.2%), but not in terms of gender (P=.43). The mean overall score was 43.0% (29.2/68 points). More information was found on therapy options (74.7%) and extra services (61.7%) than on clinical pictures treated (30.8%) or corresponding diagnostics (25.7%). Legal requirements (publisher’s information 43.5%; data protection declaration 43.2%) were oftentimes not fully met. Conclusions: Orthodontists’ websites focused on marketing aspects, whereas a higher value should be placed on patient-oriented content. Since legal requirements were oftentimes only met with deficiencies, there is a clear need for optimization in this regard. Orthodontists did not make use of all available web functions, in particular those with advanced potential (e.g. social media integration). Recommendations are desirable from the competent professional associations regarding the content and form of websites for dental practices.

  • Point-of-sale tobacco advertising and display bans: results from a policy evaluation study using mobile data gathering methods in five Russian cities

    From: Journal of Medical Internet Research

    Date Submitted: Jun 6, 2016

    Open Peer Review Period: Jun 6, 2016 - Aug 1, 2016

    Background: Background: The tobacco industry uses point-of-sale (POS) advertising, promotion and product display to increase consumption of their products among current users, to attract new consumers...

    Background: Background: The tobacco industry uses point-of-sale (POS) advertising, promotion and product display to increase consumption of their products among current users, to attract new consumers, and to encourage former customers to resume tobacco use. As part of a comprehensive tobacco control effort, Russia – having one of the highest tobacco use prevalence rates in the world – enacted legislation that banned tobacco POS advertising in effect November 15, 2013, and banned the display of tobacco and the sale of cigarettes in kiosks, effective June 1, 2014. Objective: Objective: Evaluate the implementation of the national law by assessing the state of POS advertising and promotion and product display, and sales in kiosks across Russia. Methods: Methods: Two waves of observations were conducted to measure compliance with the POS restrictions: wave 1 took place April-May 2014 after the advertising ban was in effect, and again in August-September 2014 after the display ban and elimination of tobacco sales in kiosks came into effect. Observations were conducted by local trained staff who traveled to 5 populous cities in different regions of Russia (Moscow, St. Petersburg, Kazan, Ekaterinburg, and Novosibirsk). Staff followed a published POS evaluation protocol, and used smartphones to collect data. Observations were conducted in a roughly equal number of chain supermarkets, convenience stores, and kiosks. Observed items included advertising at POS, product displays, and cigarette sales in kiosks. Results: Results: Observations were made in 780 venues in wave 1, and 779 revisited venues in wave 2. In wave 1, approximately a third of supermarkets and convenience stores (34%) were advertising cigarettes using lightboxes, and over half of observed venues (54%) had signage such as banners or shelf liners that used colors or images related to cigarette brands. Product displays were common in wave 1. In Wave 2, compliance with advertising restrictions was very good: there were virtually no lightboxes (1%, n=5); banners or shelf liners were observed in 30% of supermarkets/convenience stores; approximately 7% of venues were still displaying products in a Powerwall. In wave 2, 41% (n=100) of kiosks continued to sell tobacco. Conclusions: Conclusion: Russia’s compliance with POS bans was excellent. Remaining compliance issues are largely with the use of cigarette brand colors or images used in banners or shelf liners; this type of infraction is more difficult to enforce as inspectors need to be deeply familiar with tobacco industry products and marketing. A sizeable proportion of kiosks continue to sell tobacco post restrictions. Clinical Trial: Not Applicable

  • Crafting health messages with knowledge translation to provoke interest, raise awareness, inspire change, impart knowledge and transform practice: Short Paper

    From: JMIR mHealth and uHealth

    Date Submitted: May 31, 2016

    Open Peer Review Period: Jun 3, 2016 - Jul 29, 2016

    Background: There is growing use of technology supported knowledge translation (KT) strategies like social media in health promotion and in Indigenous health. However, little is known about how indivi...

    Background: There is growing use of technology supported knowledge translation (KT) strategies like social media in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behaviour change is weak. Objective: We examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for purpose and achieve impact. Methods: Conducted a desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people. Results: Our audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people identified thirteen out of 21 eligible campaigns used Facebook. Facebook pages with the highest number of likes (greater than 5000) linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real life events (credible). Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well aligned to the campaigns’ goals, messages and target audiences. KT planning can also help to mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualisation of the KT process itself.

  • Development of the educational game to organization of the surgical instruments in the table: applied research into technology production

    From: JMIR Serious Games

    Date Submitted: May 30, 2016

    Open Peer Review Period: Jun 2, 2016 - Jul 28, 2016

    Background: Current research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nurse educators can use games to supplement curricula,...

    Background: Current research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nurse educators can use games to supplement curricula, orientation, and staff development programs, foster team collaboration; and support critical thinking in nursing practice because are complex enviromment. Objective: To describe the process of developing an educational game for organization of the surgical instruments in the table as a resource to assist the teacher in training of surgical instrumentation students and health profissionals of the nursing in the continuing education. Methods: The study is characterized by applied research into technology production. Includes the phases of analysis and design, development and evaluation. The objectives of the educational game were developed through the Bloom’s taxonomy. Parallel to the physical development of the educational game was used for the development of game content, a proposed model for the use of digital elements for educational games activities. Results: The construction of the game was performed in four phases/releases. The game was evaluated by 15 participants, between them post-high school students and professional experts in various areas of knowledge such as nursing, information technology and education. It has created environment with an initial screen; with menu buttons, containing the rules of the game and the virtual tour modes, learning and assessment. The game was called The Playing with tweezers. Conclusions: The "digital" nursing student needs engagement, stimulation, realism, and entertainment not more just readings. The Playing with tweezers is one example of educational gaming as an innovative teaching strategy in nursing. Therefore, it encourages the strategy of involving the use of educational game to support the theoretical / practical classroom teaching. As the teacher does not work only with one type of teaching methodology but with a combination. Also, we can not forget that the skills training in educational game does not replace the curricular practice, but helps.

  • An analysis of 2.3 million participations in the CME program of a general medical journal: suitability, user characteristics, and evaluation by readers

    From: JMIR Medical Education

    Date Submitted: May 31, 2016

    Open Peer Review Period: May 31, 2016 - Jul 26, 2016

    Background: Doctors frequently use continuing medical education (CME) in journals. Little is known, however, on the evaluation of journal CME by the readers and on user as well as participation charac...

    Background: Doctors frequently use continuing medical education (CME) in journals. Little is known, however, on the evaluation of journal CME by the readers and on user as well as participation characteristics. Deutsches Ärzteblatt (DÄ), the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. It therefore provides a unique opportunity to analyze a journal CME program directed at an entire population of doctors. Objective: To analyze key sociodemographic characteristics of participants, frequency and temporal distributions of participations, detection of distinct clusters of participants, how doctors rate the CME articles, how successful they were in answering simple multiple choice questions, and whether the articles are suitable to a general medical audience. Methods: Using obligatory online evaluation forms and multiple choice questions we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association. Results: 128.398 doctors (55% male, median age class 40 to 49 years) took part 2.339.802 times (mean: 16478 participations/article). Depending on the year between 12% and 16% of all doctors in the country participated at least once. The CME program was disproportionally popular with doctors in private practice, and many participations took place in the early mornings and evenings (45%) as well as over the weekend (28%). Participation by specialty ranked: internal medicine (18.3%) > family medicine (16.4%) > anaesthesiology (10%) > surgery (7.1%). Cluster analysis revealed three groups, one of which comprised of only women, with two thirds working in private practice. Participants rated the CME articles as intelligible to a wider medical audience, and filling clinically relevant knowledge gaps. Almost 80% of the sample gave the CME articles very good or good marks. Conclusions: The CME article series of Deutsches Ärzteblatt is used on a regular basis by a considerable proportion of all physicians in Germany; its multidisciplinary articles are suitable to a broad spectrum of medical specialties. The program seems to be particularly attractive for doctors in private practice and those who want to participate from their homes and on weekends. While many doctors emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts on professional performance and patient outcomes.

  • Which characteristics and use of online health discussion forums? A systematic review from 2005 to 2015

    From: Journal of Medical Internet Research

    Date Submitted: May 31, 2016

    Open Peer Review Period: May 31, 2016 - Jul 26, 2016

    Background: With the development of the social web, the use of health-Internet is a frequent and omnipresent practice. It become a usual mean for retrieving health-related information but also a mode...

    Background: With the development of the social web, the use of health-Internet is a frequent and omnipresent practice. It become a usual mean for retrieving health-related information but also a mode of expression for communicating and exchanging This is facilitated by the development of online community and social media tools such as wikis, blogs, chats, social networks and online health discussion forums. However, while those media are increasingly used by a diverse population and contain a lot of information on interaction and content, they are still insufficiently explored: there is no real description and the whole set of interaction processes poorly documented. Objective: Through a systematic review, this study has two objectives. First it aims at defining and characterizing the health discussion forum and its users in comparison with general discussion forums. The second objective is to characterize the usage of health discussion forums by Internet users. Methods: Scientific papers have been collected on nine bibliographic databases: SCOPUS, DIAL, Cochrane library, Embase, Pubmed, BDSP, CAIRN, ERIC, Science Direct have been consulted. We also gather gray literature manually with general Internet queries, and from our personal bibliographic database. The 22 selected references have been analyzed independently by two researchers according to three types of criteria which consider (a) definitions and characteristics of online health forums; (b) online health forum users, and (c) usages of online health forums. Results: We identify six definitions of health discussion forums through the analysis of the literature review and we propose an exhaustive description .We also characterize the health forum users according to a multidimensional classification: 1. Official forum regulatory function; 2. Communication role; 3. Forum assiduity; 4. Impact of the contribution. Finally, we describe the user behavior on health forums: they take advantage of this media to share information on medical topics and non-medical, but also to support each other and to acquire knowledge useful for managing their disease. Conclusions: This systematic review lead us to elaborate a definition of the online health forums by identifying or by refining its characteristics and those of these users. We also highlight the essential role of the learning process when healthy people, patients and their families use health forums. Indeed, their experience accumulated through daily practice is a knowledge base which can be shared with peers on health forums. Thus, these can be assimilated to an apomediation medium fostering informal learning, autonomy and self-efficacy, especially in chronic patients, to acquire skills to manage their disease. In that context, we argue it is important to characterize the circumstances and conditions of health forum use, but also the users’ learning strategies throughout their involvement in such forums.

  • Putting young people at the forefront of their mental health care through technology for holistic assessment and routine outcome tracking

    From: Iproceedings

    Date Submitted: May 31, 2016

    Open Peer Review Period: May 31, 2016 - Jul 26, 2016

    Background: Young people have the highest need for mental health support yet are least likely to seek it from professional services. Enabling access and engagement in mental health care is essential t...

    Background: Young people have the highest need for mental health support yet are least likely to seek it from professional services. Enabling access and engagement in mental health care is essential to intervening early to provide appropriate and effective care to prevent escalation of young people’s mental health problems. In response, Australia initiated headspace: the national youth mental health foundation, which provides f2f and online services to young people aged 12-25 with emerging mental health problems. Innovations in technology are being developed to better engage and put young people at the forefront of their mental health care. Objective: The aim was to investigate how technology could be used to facilitate holistic psychosocial assessments for young people entering mental health services, and routinely track meaningful outcomes across an episode of care. Objectives were to determine whether this use of technology would be engaging and acceptable to young people, and how it would affect appropriateness and effectiveness of the care received. Methods: An electronic holistic psychosocial assessment tool (EhHAT) and a brief routine mental health outcome measure (MyLifeTracker) were developed in collaboration with young people and their service providers. The EhHAT was piloted using a quasi-experimental two phase Treatment-as-Usual/Intervention design with 339 youth and 13 clinicians. Engagement and rates of disclosure and risk across the psychosocial domains were compared in a mixed methods approach. MyLifeTracker was implemented with all clients and quantitative data were available from 15,222 young people and used to compare MyLifeTracker with standardised mental health outcome measures. Qualitative data were collected from a small sub-sample to examine their experience of this routine monitoring approach. Results: The EhHAT was shown to be highly engaging and acceptable to young people and resulted in disclosure of psychosocial risks that were 2.8 through 10.4 times higher compared with the non-intervention group. MyLifeTracker was shown to have concurrent validity against well-validated measures of psychological distress, functioning, and life satisfaction. It was highly sensitive to change with excellent stability. Young people valued the opportunity to report and track their progress. For both applications, the use of technology improved the experience for young people, making them feel more in control, and providing better information for clinicians. Conclusions: The results show that technology is effective at engaging young people in their own mental health care. They are comfortable providing personal information via tablet applications and are more likely to disclose in this format. This yields better information for clinicians to provide more appropriate and tailored care. Young people appreciate the opportunity to routinely track their outcomes via technology and find this a helpful way to have conversations with their clinicians around the changes that are meaningful to them, leading to more appropriate and effective care. These holistic assessment and outcome tracking tools are essential ways forward harnessing technology to put young people at the forefront of their own mental health care.

  • Using technology to identify risk and meet demands: An innovative clinical pathway

    From: Iproceedings

    Date Submitted: May 29, 2016

    Open Peer Review Period: May 30, 2016 - Jul 25, 2016

    Background Over the past decade there has been a significant push by the Australian Government to fund youth friendly mental health services that are non-stigmatizing, low cost, and accessible. One s...

    Background Over the past decade there has been a significant push by the Australian Government to fund youth friendly mental health services that are non-stigmatizing, low cost, and accessible. One such organization is headspace: the National Youth Mental Health Foundation. This initiative has been highly successful; unfortunately, workforce and funding resources have not been able to keep up with the ever growing demand, resulting in increasingly lengthy wait times for young people. Objective The aim was to investigate how technology could be integrated into current pathways of care to reduce wait-times for young people accessing headspace centers and to help identify those young people at greatest risk. Objectives were to understand current clinical pathways, determine the technological requirements needed to ensure seamless integration, identify indicators of risk that highlight those young people in greatest need for immediate care, and to develop a new clinical pathway that seamlessly incorporates the new technology. Methods An electronic holistic psychosocial assessment tool (EhHAT) was developed in collaboration with young people and service providers, with service providers specifying ‘critical’ items they considered most indicative of risk. Centre managers were also interviewed to determine current and potential pathways of care and technological requirements. The EhHAT was then administered to 151 young people attending a headspace centre to determine the ‘critical items’ most likely to identify the top 10-20% of young people at greatest risk of harm. Results The critical items considered most indicative of risk included but were not limited to: a suicide screen score ≥10, current homelessness, self-harming behaviors in the previous month, psychotic experiences in the previous month, daily use of drugs, and an extreme K10 score. After administering the ehHAT to young people, it was found that the suicide screen would positively identify the top 11.9% of young people most at risk. In addition to those already identified via the suicide screen, a further 13.24% would be identified as ‘at risk’ by endorsing 3 or more ‘critical’ items or a further 5.29% identified by endorsing 4 or more items. Interestingly, while 23.07% of participants who endorsed 3 or more critical items also had a suicide screen of ≥10, 72.72% of those who endorsed 4 or more items also had a suicide screen of ≥10. In order to ensure seamless integration into clinical pathways, technological requirements included the ability to complete the assessment via mobile, tablet or computer, automated risk alerts to clinicians via text, clear highlighting of risks to clinicians via a summary, and the ability to integrate this assessment into current client data management tools. Conclusions With appropriate considerations and adaptations, technology can be integrated into clinical pathways to assess young people before they see a clinician. Such assessment ensures young people at the greatest risk of harm receive care quickly. Furthermore, the early identification of those with milder symptoms allows young people to be re-directed to alternative treatment options. Utilizing this stepped care approach will reduce wait times for those with more severe symptomology and those at greatest risk of harm.

  • An Evaluation of a Smartphone-Assisted Behavioral Weight Control Intervention for Adolescents: Pilot Study

    From: JMIR mHealth and uHealth

    Date Submitted: May 26, 2016

    Open Peer Review Period: May 29, 2016 - Jul 24, 2016

    Background: The efficacy of adolescent weight control treatments is modest and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering criti...

    Background: The efficacy of adolescent weight control treatments is modest and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment, including behavioral self-monitoring. Objective: This study examined the efficacy and acceptability of a smartphone-assisted adolescent behavioral weight control intervention. Methods: Sixteen overweight/obese adolescents (M age = 14.29, SD = 1.12) received 12 weeks of combined treatment consisting of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention. Results: On average participants attained modest but significant reductions in body mass index standard score (zBMI; .08 standard deviation units, t(13) = 2.22, P = .04, d = 0.63) over the in-person plus electronic intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20% of electronic-only intervention days. Conclusions: Smartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions. Clinical Trial: none

  • Appraising the Value of Digital Health Technologies From the Managed Care Perspective: Insights for Evidence Assessment and Reimbursement in the U.S.

    From: Iproceedings

    Date Submitted: May 26, 2016

    Open Peer Review Period: May 26, 2016 - Jul 21, 2016

    Background: Digital health technologies (DHTs) have accelerated in both number and utility in recent years, prompting managed care organizations (MCOs) to define the segment’s value and role in impr...

    Background: Digital health technologies (DHTs) have accelerated in both number and utility in recent years, prompting managed care organizations (MCOs) to define the segment’s value and role in improving the healthcare of their members. In this context, many technology manufacturers have initiated clinical trials to generate evidence supporting DHTs, however limited guidance remains on how MCOs formally evaluate these products. Objective: To understand how medical and pharmacy directors assess the value of DHTs in the U.S., and to identify best practices for supporting their reimbursement determinations. Methods: Medical and pharmacy directors within Xcenda’s Managed Care Network (MCN) were invited to complete a 10-part, web-based questionnaire. Respondents were asked to grade their organization’s current demand and coverage policy of 9 distinct categories of DHTs. 11 major disease classes were evaluated based on the potential impact DHTs can have for addressing unmet needs. Specific evidence requirements for reimbursement of DHTs were then proposed and rated. Finally, strategies for manufacturers to interface with MCO’s were examined. Results: 37 pharmacy directors (60.7%) and 24 medical directors (39.3%) completed the questionnaire. The respondents’ MCOs cover approximately 180 million lives in the U.S., with a mix of national (34.4%) and regional (65.6%) plans. Of the 9 technologies evaluated, mobile apps (80.3%), fitness trackers (60.7%), and medication adherence platforms (57.4%) scored the highest in demand for implementation as a covered benefit. Diabetes (88.5%) and cardiovascular disease (86.9%) were ranked highest in potential impact for DHTs to address unmet needs. Peer reviewed literature (96.7%) was rated as the most important evidence resource in evaluating the DHTs, followed by real world analysis (95.1%), and cost effectiveness models (78.7%). Clinical benefit (96.7%) was the top evidence criteria selected for coverage determination. Advisory board meetings (70.5%), continuing education sessions (57.4%), and dedicated peer reviewed journals for DHTs (55.7%) were identified as the preferred communication strategies between manufacturers and MCOs. Conclusions: MCOs are actively evaluating a wide range of DHTs in a variety of disease states. Traditional appraisal strategies used in the evaluation of medical devices and pharmaceutical products are seen to also apply in evaluating DHTs. Respondents indicated that more robust evidence communication strategies with technology manufacturers and MCOs are needed for coverage decision making.

  • Exploratory Study of funding and commercialization strategies for sustainable adoption and scale-up of mHealth initiatives in the LMICs.

    From: JMIR mHealth and uHealth

    Date Submitted: May 20, 2016

    Open Peer Review Period: May 25, 2016 - Jul 20, 2016

    Background: The new Sustainable Development Goals consist of 17 goals among which Universal Health Coverage (SDG3) and Partnerships for the Goals (SDG17) are two of the most relevant for our purposes....

    Background: The new Sustainable Development Goals consist of 17 goals among which Universal Health Coverage (SDG3) and Partnerships for the Goals (SDG17) are two of the most relevant for our purposes. (1) With rapid growth and daily innovations, Information and Communication Technology (ICT) has become the cornerstone of transforming global health care industry all around the world. Wide penetration of internet and mobile networks in many low and middle income countries (LMICs) has brought about new ideas and promises for better access, lower costs and higher quality of health services in remote areas. To make this promise come true, the ICT and global health industry along with a vast number of user and provider stakeholders have developed hundreds of transboundary mHealth ecosystems to leverage the provision and distribution of equitable health services operation, management and control through various mHealth initiatives. However, the lack of empirical evidence supporting the cost, performance and health outcomes of mHealth initiatives have impeded post pilot scale up, implementation and integration of mobile technologies in many health systems. On the same note, with limited financial and structural resources and without supporting empirical evidence the LMICs which are most likely to benefit from sustainable mHealth interventions, often do not manage to grab the attention of public and private partners to secure sustainable investments for scale up phase. Results of this study show that in agreement with the SDG17 and the comparative Net Utility equation, some elemental components for a successful business partnership, i.e.; “balance in value gain for the economic buyer and the funder”, “use of value capturing commercialization strategies with attention to stakeholders, Technology and contextual requirements, and “insurers’ contributions” need to get more concentrated attention before the sustainability of scale-up of mHealth projects can be achieved. Objective: This study is to show the necessity of ongoing market analyses to investigate the best practices for keeping mHealth initiatives sustainable for its adopters throughout its life cycle. Methods: The novel nature of our paper’s subject along with the authors’ concern to study a larger number of variables that could influence the paper’s suggested strategies, have encouraged us to use the Qualitative Exploratory Research method as the best way to address the new and undisclosed problems within the commercial scope of the mHealth industry. Results: The results of this exploratory review suggest that there are certain factors that may directly or indirectly contribute to an affordable and sustainable scale-up and adoption of mHealth initiatives especially within resource-poor contexts. Interestingly, some elemental components for a successful business partnership, i.e.; “balance in value gain for the economic buyer and the funder”, “use of value capturing commercialization strategies with attention to stakeholders, Technology and contextual requirements, and “insurers’ contributions” need to get more profound attention before the sustainability of scale-up mHealth projects could be achieved. Conclusions: Discussed as the “Technology, Context and Commercialization Triangle”, the study suggests that for mHealth projects to be sustainable, three main aspects need to be taken into consideration at the same time. The first two aspects, which have been more commonly discussed in the body of literature, are cultural norms and technical infrastructure. Designing systems that would strengthen and integrate with the pre-existing technologies would motivate LMICs’ health authorities to support new mHealth projects. Also for the LMICs to be receptive to mHealth technologies, the applications should agree with the community’s culture and believes. The third aspect however, is beyond the technical and contextual requirements and looks more carefully into mHealth projects financing and commercialization models. It seems that even in the LMICs, the era of one-way donor-receiver relationship in development projects is coming to its end and for the mHealth projects to experience sustainable scale-up phases, donor-receiver relationship should turn into more “gain” oriented business partnerships with variety of public and private investors. Choosing the right partner at different stages of the projects’ life cycle is one of the delicate moments of mHealth business which has failed to be thoroughly discussed in the context of academia and industry. This study shows that not all stages of mHealth projects’ life cycle would respond equally to a single donor-based financing model, but specific financing strategies and engagement with different types of investors, businesses and technical partners; i.e. “public, private, NGOs and foundations” at infancy, development and maturity stages of mHealth projects may increase the chances for more sustainable scale-up phases in resource-poor countries. Last but not least, similar to their movement in the developed countries, supportive financial systems such as health insurers should start to consider the LMICs’ population as a new segment. The authors suggest that further studies are needed to assess the relevance of these findings within the contextual realities that permeate the LMIC sphere.

  • A feasibility study piloting a randomised controlled trial of computerised Cognitive Behavioural Therapy to treat emotional distress after stroke.

    From: Journal of Medical Internet Research

    Date Submitted: May 23, 2016

    Open Peer Review Period: May 24, 2016 - Jul 19, 2016

    Background: Depression and anxiety are common complications following stroke. Symptoms may be treatable with psychological therapy but there is little evidence-base. Aims: To investigate the accept...

    Background: Depression and anxiety are common complications following stroke. Symptoms may be treatable with psychological therapy but there is little evidence-base. Aims: To investigate the acceptability and feasibility of computerised Cognitive Behavioural Therapy (cCBT) to treat symptoms of depression and anxiety in the context of using Randomised Controlled Trial methodology as means of piloting assessment of efficacy. Method: Of 133 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomised in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator (n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of the interventions, alongside measuring levels of depression, anxiety and activities of daily living (ADLs) before, after and three-months post treatment. Results: Overall, our protocol design is reasonable; both interventions were considered appropriate, accessible and useful (ranging from 50-87.5%), and participants tolerated randomisation. Drop-out rates were in line with similar trials, with only a small proportion of participants (n=3) discontinuing due to potential adverse effects. Adaptations were required to the protocol for recruiting people who are further post-stroke, and future studies may wish to control for those receiving medical interventions for mood. Descriptive statistics of the proposed outcome measures are reported and qualitative feedback about the cCBT intervention is discussed. Conclusions: A pragmatic approach is required to deliver online interventions to accommodate individual needs. We report on a protocol that should inform the development of a full RCT for testing the efficacy of cCBT for people with long-term neurological conditions; a potentially promising way of improving accessibility of psychological support.

  • The Effectiveness of an On-line Training Program for Improving Fire Knowledge of Healthcare Workers: A Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: May 22, 2016

    Open Peer Review Period: May 24, 2016 - Jul 19, 2016

    Background: Fire disaster in hospitals can cause serious consequences. However, due to the busy schedule of healthcare workers, fire drills in hospitals are often difficult to achieve high attendance...

    Background: Fire disaster in hospitals can cause serious consequences. However, due to the busy schedule of healthcare workers, fire drills in hospitals are often difficult to achieve high attendance rate. Objective: We carried out and examined the effectiveness of an on-line fire knowledge training for healthcare workers in China. Methods: 128 participants were recruited between December 2014 to March 2015 by convenient sampling from five public hospitals in Chengdu, Kunming, Jingzhou, and Fuzhou in China. We built a webpage which includes the informed consent, pre-test questionnaire, video training, and post-test questionnaire. After completing the pre-test questionnaire, participants will be randomly assigned in 1:1 ratio by the webpage to watch one of the two videos. Those in the intervention group were watching a 14-min video showing the basic response to a hospital fire and patient evacuation methods, while those in the control group were watching a 6-min video introducing volcanic disasters. A questionnaire consisted of 45 items on fire knowledge was implemented before and after the video watching. The fire knowledge items can be further divided into two subscales, the first one consists of 25 items on generic knowledge of fire response, including prevention and disposal and the second one consists of 20 items on hospital-specific knowledge related to dealing with a hospital fire and selecting equipment under a fire emergency in a hospital. One point was awarded for each correct answer and no point was awarded for each wrong answer. Results: Half of the participants (n=64, 50%) was randomized into intervention group and the remaining 64 (50%) was randomized into control group. All of them complete the pre-test and pro-test questionnaire. For generic fire knowledge, those in the intervention group improved significantly (from 16.16 to 20.44, P < 0.001) while those in the control group decreased significantly (from 15.27 to 13.70, P = 0.03). For hospital-specific fire knowledge, those in the intervention group (from 10.75 to 11.33, P = 0.15) and the control group (from 10.38 to 10.16, P = 0.54) had insignificant change. For total score, those in the intervention group improved significantly (from 26.91 to 31.77, P < 0.001) while those in the control group decreased insignificantly (from 25.64 to 23.86, P = 0.07). After the intervention, the difference between intervention group and control group of all the three fire knowledge scores were significant (all Ps < 0.05). Conclusions: To conclude, on-line fire training program by watching educational video can effectively improve healthcare workers’ knowledge of fire prevention and evacuation. Clinical Trial: Clinicaltrials.gov NCT02438150; https://clinicaltrials.gov/ct2/show/NCT02438150

  • Young people, Adult worries: a randomised controlled feasibility study of the internet-based self-support method “Feel the ViBe” for adolescents and young adults exposed to family violence.

    From: Journal of Medical Internet Research

    Date Submitted: May 20, 2016

    Open Peer Review Period: May 20, 2016 - Jul 15, 2016

    Background: Children growing up in families where violence occurs are (almost) always exposed to this violence with severe consequences for physical, emotional and behavioural development. Peer suppor...

    Background: Children growing up in families where violence occurs are (almost) always exposed to this violence with severe consequences for physical, emotional and behavioural development. Peer support is recognized effective to change behaviour and the internet considered most suitable as mode of delivery. Objective: RCT and feasibility of the internet-based self-support method “Feel the ViBe (FtV)”, choosing efficacy, demand, acceptability, implementation, and practicality as focus. Feasibility studies aim to fully understand strengths and weaknesses of a new intervention, evaluating both efficacy and effectiveness. Methods: Adolescents and young adults aged 12-25 exposed to family violence, were randomized in an intervention group (access to FtV + usual care), and a control group (minimally enhanced usual care) after they self-registered themselves for participation. Between June 2012 and July 2014, participants completed the Impact of Event Scale and the Depression and Anxiety subscales of the Symptom CheckList-90R every 6 weeks. The Web Evaluation Questionnaire was completed after twelve weeks. All questionnaires were self-assessed, without face-to-face components. During the whole study period, quantitative usage data was collected using Google analytics and CMS logs and data files. UNIANOVA, Mixed Model analysis and Paired sample t-tests were used to compare groups. Feasibility measures were used to structurally address the findings. Results: 31 out of 46 participants in the Intervention group and 26 out of 47 participants in the Control group started FtV. After receiving full access 24 users used FtV for 24 weeks or longer, reporting a mean online time of 2.83 with a mean online session time of 36 minutes. Acceptability was good: FtV was rated a mean 7.47 (1-10 Likert scale) with a helpfulness score of 3.16 (1-5 Likert scale). All participants felt safe. 17 participants (I n=8, C n=9) completed all questionnaires. IES outcomes showed no significant differences between groups. Mixed model analysis showed significant differences between groups on the SCL-90 DEP (p=0.041) and ANX (p=0.049) subscales between six and twelve weeks after participation started. UNIANOVA showed no significant differences. Pre-post test paired sample t-tests for the SCL-90 DEP (p=0.034) and SCL-90 ANX (p=0.046) subscales showed significant improvements after twelve weeks. General knowledge of regular healthcare was low, but after twelve weeks, two thirds of the intervention participants started regular healthcare. Conclusions: FtV functions best as a first step for adolescents and young adults in an early stage of change and shows promising results. Preset goals for FtV have been met. No changes on the IES were found. SCL-90 DEP and ANX show promising results, however, the calculated sample size was not reached (n=18). FtV can be easily implemented without extensive resources. FtV should be implemented in the field of public healthcare or national governmental care. Clinical Trial: This randomized feasibility study is conducted in the Netherlands, registered in The Netherlands National Trial Register (NTR) and assigned the trial ID NTR3692.

  • Is Social Media a Threat to Patient Safety?

    From: Journal of Medical Internet Research

    Date Submitted: May 18, 2016

    Open Peer Review Period: May 19, 2016 - Jul 14, 2016

    Background: Many people are increasingly using social networking sites for health-related purposes. An increasing number of patients are using social networking sites to share their experiences with h...

    Background: Many people are increasingly using social networking sites for health-related purposes. An increasing number of patients are using social networking sites to share their experiences with health care providers or institutions. Patients also share their experiences with family members and friends via websites such as Facebook Objective: This study aims to describe the demographic characteristics of patients that demonstrate online health-seeking behavior. Second, we address how social networking affects health-seeking behavior. Third, we examine whether patients initiate or alter/discontinue their medications based on information derived from social media. Methods: We conducted a cross-sectional survey between April and June 2015 on patients attending King Abdulaziz University, Jeddah, Saudi Arabia. Patients who used social media (Facebook, WhatsApp, and Twitter) were included. A questionnaire was developed with closed-ended and multiple choice questions to assess the type of social media platforms patients used and whether information published on these websites influenced their healthcare decisions. A chi-square test was used to establish the relationship between categorical variables. An independent t-test was used to compare two group means. Results: The sample included 442 social media users aged 35.4 (11.5) years on average. The majority of respondents (89.8%) used WhatsApp, followed by Facebook (58.6%) and Twitter (42.3%). In most cases, respondents received health-related messages from WhatsApp and approximately 42.6% reported ever stopping treatment as advised on a social media platform. A significantly higher proportion of patients without heart disease (p = 0.001) and obese persons (p = 0.012) checked the authenticity of information disseminated through social medial channels. Decision-making by patients with heart disease was influenced by social media messages (p = 0.043). Respondents with heart disease (p = 0.001) and obese persons (p = 0.012) were more likely than those without these conditions to discuss health-related information published on social media channels with healthcare professional. A significant proportion of WhatsApp users reported that health-related information published on this platform influenced decisions regarding their family’s health care (p = 0.001). respondents’ decisions regarding family health care were more likely to be influenced when they used two or all three types of platforms (p = 0.003). Conclusions: Health education in the digital era needs to be accurate, evidence-based, and regulated. As technologies continue to evolve, we must be equipped to face the challenges it brings with it.

  • The appropriateness and presentation of commonly available cardiovascular web pages.

    From: Journal of Medical Internet Research

    Date Submitted: May 14, 2016

    Open Peer Review Period: May 17, 2016 - Jul 12, 2016

    Background: The Internet is becoming the primary source that people use to retrieve general and specific health information. Cardiovascular diseases are the number one cause of death globally and it c...

    Background: The Internet is becoming the primary source that people use to retrieve general and specific health information. Cardiovascular diseases are the number one cause of death globally and it can be expected that a large amount of patients will consult the Internet for advice. However, there is still little research on the quality of web pages that are online available for patients with cardiovascular diseases. Objective: To evaluate the quality and appropriateness of commonly available cardiovascular web page(s). Methods: A descriptive design with quantitative and qualitative data. The Suitability and Comprehensibility Assessment of Material was used to evaluate web pages. Open-ended questions were added to describe the evaluators’ opinion on positive and negative aspects. The qualitative data was analyzed with a modified summative content analysis with a manifest approach. Results: 27 web pages were evaluated. Six (22%) were ranked as superior, 10 (37%) as adequate, and 11 (41%) as not suitable. The content was not suitable in 15 (56%), the literacy demands not suitable in 3 (11%), the numeric literacy in 5 (19%), the graphics in 11 (41%), the layout/typography in 5 (19%), and learning simulation/motivation in 21 (78%). Conclusions: Commonly available cardiovascular web pages in the Swedish language need to improve their content and learning simulation and motivation, in order to be suitable for cardiac patients who visit those pages.

  • The associations among individual factors, eHealth literacy and health-promoting lifestyles among college students

    From: Journal of Medical Internet Research

    Date Submitted: May 15, 2016

    Open Peer Review Period: May 16, 2016 - Jul 11, 2016

    Background: eHealth literacy is becoming important in maintaining and promoting health. Studies have shown that individual factors are associated with eHealth literacy and health-promoting lifestyles....

    Background: eHealth literacy is becoming important in maintaining and promoting health. Studies have shown that individual factors are associated with eHealth literacy and health-promoting lifestyles. Nevertheless, few studies have explored the associations among individual factors, eHealth literacy and health-promoting lifestyles among college students. Moreover, there is a lack of studies that focus on various eHealth literacy aspects as predictors of six dimensions of health-promoting lifestyles. Objective: This study examines the associations among individual factors, eHealth literacy, and health-promoting lifestyle. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Health-promoting Lifestyle Scale is a 23-item instrument developed to measure college students’ self-actualization, health responsibility, interpersonal support, exercise, nutrition and stress management. A nationally representative sample of 556 valid college students in Taiwan was surveyed. A questionnaire was administered to gather the respondents’ background information, including information about the frequency of seeking information on health issues, the frequency of eating organic food, the degree of health concern and the students’ major. We then conducted a multiple regression analysis to examine the associations among individual factors, eHealth literacy, and health-promoting lifestyles. Results: The study found that medical majors (t552=2.46-7.57, P<.001-.01) and greater concern health (t552=2.11-9.01, P<.001-.04) predicted college students’ 4-6 health-promoting lifestyle dimensions and the 3 dimensions of eHealth literacy. Moreover, critical eHealth literacy positively predicted all 6 health-promoting lifestyle dimensions (t553=4.59-8.48, P<.001), interactive eHealth literacy positively predicted all dimensions except the exercise dimension (t553=2.10-4.88, P<.001-.04), whereas functional literacy only predicted the self-actualization and interpersonal support dimensions (t553=3.44-4.11, P<.001). Conclusions: This study found that participants who majored in medical fields, had greater concern for their health and frequently sought health information exhibited better eHealth literacy and had a positive health-promoting lifestyle. Moreover, this study showed that college students with higher interactive and critical eHealth literacy engage better in health-promoting activities than those with functional literacy do.

  • It's about me: Patients experiences of patient participation in multimodal rehabilitation in combination with the web Behaviour Change Program for Activity (web-BCPS)

    From: Journal of Medical Internet Research

    Date Submitted: May 12, 2016

    Open Peer Review Period: May 12, 2016 - Jul 7, 2016

    Background: Patients’ participation in their healthcare is recognized as a key component in high-quality healthcare. Patients with persistent pain are recommended treatments with a cognitive approac...

    Background: Patients’ participation in their healthcare is recognized as a key component in high-quality healthcare. Patients with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient’s active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling patients to play a more active role in rehabilitation. However, little is known about patients’ experiences of patient participation in web-based interventions. Objective: To explore patients’ experiences of patient participation in multimodal rehabilitation (MMR) in combination with a web Behaviour Change Program for Activity (the web-BCPA) among patients with persistent pain in primary healthcare. Methods: : Qualitative interviews were conducted with 14 women and 5 men, with a mean age of 45 years. Data was analyzed with qualitative content analysis. Results: One theme, “It’s about me”, and 4 categories, “Take part in a flexible framework of own priority”, “Acquire knowledge and insights”, “Ways towards change”, and “Personal and environmental conditions influencing participation”, were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of own choice. Being confirmed was fundamental to patient participation in interactions with healthcare professionals and with the web-BCPA, and included patients’ emotions and cognitions. To acquire knowledge and insights were experienced as patient participation, and included self-reflection, self-identification, and feedback. Patients experienced patient participation as structured ways to reach their goals of behaviour change, which included analyzing their resources and restrictions, problem solving and evaluation. Patients’ emotional and cognitive resources and restrictions, as well as the healthcare professionals’ attitudes and behaviour influenced patient participation. Situations of mistrust and disrespect with one healthcare professional were perceived as temporary restrained patient participation in the rehabilitation. Also, some patients experienced difficulties to choose area of interest in the web-BCPA content and that it became a burden to complete. Conclusions: There were satisfying patient participation in MMR in combination with the web-BCPA. The patients experienced themselves as being confirmed as a whole human being. The combined treatment MMR and the web-BCPA were experienced by the patients to increase patient participation in their rehabilitation. This study adds that also acquiring knowledge and insights was a component of patient participation. Clinical Trial: The study was approved by the Regional Ethical Review Board of Umeå University, Sweden (Umu dnr 2011-383-31M).

  • How do people suffering from psychosis use the Internet for getting information on their mental health? Literature review and recommendations

    From: Journal of Medical Internet Research

    Date Submitted: May 6, 2016

    Open Peer Review Period: May 6, 2016 - Jul 1, 2016

    Background: Studies show that the Internet has become an influential source of information for psychotic people, among which the rate of Internet users is growing, with rates ranging from 33,3% to 79,...

    Background: Studies show that the Internet has become an influential source of information for psychotic people, among which the rate of Internet users is growing, with rates ranging from 33,3% to 79,5% given the countries. Among people suffering from mental illness using the Internet on a regular basis, between 20,5% and 56,4% seek mental health information. Objective: Focusing on people suffering from psychosis’ navigation about their mental health, this paper examines what content they look for and what could be the benefits and disadvantages. Methods: We conducted a literature review through medical and psychological databases between 2000 and 2015, using the keywords “Internet”, “Web”, “Virtual”, “Health information”, “Psychosis”, “Schizophrenia”, “eMental health”, “eSupport”, “Telepsychiatry”. Results: People suffering from mental illness wish to find on the Internet trustful, non-stigmatizing information about their disease, flexibility, security standards, and positive peer-to-peer exchanges. E-mental health also appears to be desired by a substantial proportion of them. In this field, cost effectiveness and clinical efficiency have been demonstrated, and the existing developments for intervention and early prevention in the areas of depression, bipolar and anxiety disorders become also operational for schizophrenia. The many benefits of the Internet as a source of information and support, such as empowerment, enhancement of self-esteem, relief from peer information, better social interactions and more available care, seem to overcome the difficulties. Conclusions: In our paper, after having discussed the challenges related to the various aspects of the emergence of the Internet into the life of people suffering from psychosis, we propose areas of future research and practical recommendations for this major transition.

  • How do you #relax when you're #stressed? A content analysis and infodemiology study of stress-related tweets

    From: Journal of Medical Internet Research

    Date Submitted: May 5, 2016

    Open Peer Review Period: May 5, 2016 - Jun 30, 2016

    Background: Stress is a contributing factor to many major health problems in the United States, such as heart disease, depression and autoimmune diseases. Relaxation is often recommended in mental hea...

    Background: Stress is a contributing factor to many major health problems in the United States, such as heart disease, depression and autoimmune diseases. Relaxation is often recommended in mental health treatment as a frontline strategy to reduce stress, thereby improving health conditions. Twitter is a micro-blog platform that allows users to post their own personal messages (tweets), including their expressions about feelings and actions related to stress and stress management (e.g., relaxing). While Twitter is increasingly used as a source of data for understanding mental health from a population perspective, the specific issue of stress – as manifested on Twitter – has not yet been the focus of any systematic study. Objective: To understand how and in what way people express their feelings of stress and relaxation through Twitter messages. In addition, we investigate automated natural language processing (NLP) methods to (1) classify stress vs. non-stress and relaxation vs. non-relaxation tweets and (2) identify first-hand experience – i.e., who is the experiencer – in stress and relaxation tweets. Furthermore, we apply the automated classification methods we have developed to rank stress and relaxation levels at the city level, and compare the results to United States national stress surveys. Methods: We first performed a qualitative content analysis of 814 first-person tweets containing stress and relaxation related keywords, resulting in a manually annotated (coded) data set of 479 first-person stress-related tweets and 335 first-person relaxation-related tweets. We then investigated the use of machine learning algorithms – in particular naïve Bayes and Support Vector Machines (SVMs) – to automatically classify tweets as stress vs. non-stress and relaxation vs. non-relaxation. Finally, we applied these classifiers to sample data sets drawn from four cities (Los Angeles, New York, San Diego, and San Francisco) obtained from Twitter’s Streaming Application Programming Interface (API), with the goal of evaluating the extent of any correlation between our automatic classification of tweets and results from public stress surveys. Results: Content analysis showed that the most frequent topic of stress tweets was education (15%), followed by work (9%) and social relationships (8%). The most frequent topic of relaxation tweets was rest and vacation (36%), followed by nature (22%) and water (20%). Evaluations using 10-fold cross-validation showed that SVM outperformed naïve Bayes in classifying stress vs. non-stress and relaxation vs. non-relaxation tweets. However, naïve Bayes is better in identifying first-hand experience in both stress and relaxation tweets. When applied to the city dataset, we found that the proportion of stress tweets in New York and San Diego is substantially higher than in Los Angeles and San Francisco. In addition, we found that characteristic expressions of stress and relaxation vary for each city based on its geo-location. Conclusions: This content analysis and infodemiology study revealed that Twitter, when used in conjunction with NLP techniques, is a useful data source for understanding stress and stress management strategies, and can potentially serve as a supplement to infrequently collected survey-based stress data.

  • A national neighborhood dataset from geotagged Twitter data

    From: Journal of Medical Internet Research

    Date Submitted: May 1, 2016

    Open Peer Review Period: May 2, 2016 - Jun 27, 2016

    Background: Studies suggest that where people live, play and work can influence health and well-being. However, the dearth of neighborhood data, especially data that is timely and consistent across ge...

    Background: Studies suggest that where people live, play and work can influence health and well-being. However, the dearth of neighborhood data, especially data that is timely and consistent across geographies, hinders understanding of the effects of neighborhoods on health. Social media data represents a possible new data resource for neighborhood research. Objective: The aim of this study is to build, from geotagged Twitter data, a national neighborhood database with area-level indicators of well-being and health behaviors. Methods: We utilized Twitter’s Streaming Application Programming Interface (API) to continuously collect a random 1% subset of publicly available geo-located tweets over a period of 12 months (April 2015– March 2016). We collected 80 million geotagged tweets from 603,363 unique Twitter users across the contiguous United States. We validated our machine learning algorithms for constructing indicators of happiness, food, and physical activity by comparing predicted values to those generated by human coders. Geotagged tweets were spatially mapped to the 2010 census tract and zip code areas they fall within, which enabled further assessment of the associations between Twitter-derived neighborhood variables and neighborhood demographic, economic, and business characteristics. Results: Machine-labeled and manually-labeled tweets had a high level of agreement: 80% for happiness, 83% for food and 85% for physical activity. About 20% of tweets were classified as happy. Relatively few terms (less than 25) were necessary to characterize the majority of tweets on food and physical activity. Data from over 70,000 census tracts from the United States suggest that percent African American and economic disadvantage were associated with lower happiness levels. Urbanicity was related to higher frequency of fast food tweets. Greater numbers of fast food restaurants predicted higher frequency of fast food mentions. Surprisingly, fitness centers and nature parks were only modestly associated with higher frequency of physical activity tweets. Conclusions: Machine learning algorithms can be built with relatively high accuracy to characterize sentiment, food and physical activity mentions on social media. Such data can be utilized to construct neighborhood indicators consistently and cost-effectively for small areas across the United States. Access to neighborhood data, in turn, can be leveraged to better understand neighborhood effects and address social determinants of health. We find that neighborhoods with social and economic disadvantage, high urbanicity, as well as those with more fast food restaurants may exhibit lower happiness and fewer healthy behaviors.

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