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Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review (FAQ: What are Preprints?). For a list of all preprints under public review click here. The NIH and other organizations and societies encourage investigators to use interim research products, such as preprints, to speed the dissemination and enhance the rigor of their work. JMIR Publications facilitates this by allowing its' authors to expose submitted manuscripts on its' preprint server with a simple checkbox when submitting an article, and the preprint server is also open for non-JMIR authors.

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

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

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

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

If authors do NOT wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter.

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

 

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

    Authors List:

    Abstract:

    JMIR Preprints is a preprint server and "manuscript marketplace" with manuscripts that are intended for community review. Great manuscripts may be snatched up by participating journals which will make offers for publication.There are two pathways for manuscripts to appear here: 1) a submission to a JMIR or partner journal, where the author has checked the "open peer-review" checkbox, 2) Direct submissions to the preprint server. For the latter, there is no editor assigning peer-reviewers, so authors are encouraged to nominate as many reviewers as possible, and set the setting to "open peer-review". Nominated peer-reviewers should be arms-length. It will also help to tweet about your submission or posting it on your homepage. For pathway 2, once a sufficient number of reviews has been received (and they are reasonably positive), the manuscript and peer-review reports may be transferred to a partner journal (e.g. JMIR, i-JMR, JMIR Res Protoc, or other journals from participating publishers), whose editor may offer formal publication if the peer-review reports are addressed. The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal. For pathway 2, if authors do not wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter. Also, note if you want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc), please specify this in the cover letter. Manuscripts can be in any format. However, an abstract is required in all cases. We highly recommend to have the references in JMIR format (include a PMID) as then our system will automatically assign reviewers based on the references.

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Latest Submissions Open for Peer-Review:

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  • Feasibility and Acceptability of a Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: A Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Jun 28, 2017

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

    Background: Adolescent depression is a global mental health concern. Despite evidence on efficacious interventions, a huge proportion of depressed adolescents do not receive evidence-based treatment a...

    Background: Adolescent depression is a global mental health concern. Despite evidence on efficacious interventions, a huge proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective: To assess the feasibility and acceptability of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. Methods: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Prior to randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. The intervention group (RCDC, N=65) received a three-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records and phone patient monitoring. The control group (EUC, N=78) received enhanced usual care by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the shared electronic health records system were registered; in addition, patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up. Results: Adolescents (N=143; 13-19 years) with MDD were recruited. More than sixty percent of the original estimated sample size was recruited, and a response rate of 90.9% was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the shared electronic health records system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. Conclusions: The RCDC intervention implemented in this trial was shown to be feasible and well accepted by both patients and primary care clinicians. Recruitment strategies and feasible approaches to implementing an RCDC intervention are discussed. Clinical Trial: Clinicaltrials.gov NCT01860443.

  • Design and methods of Get Social: A non-inferiority trial comparing clinic- versus online social network-delivered lifestyle interventions

    From: JMIR Research Protocols

    Date Submitted: Jul 20, 2017

    Open Peer Review Period: Jul 21, 2017 - Aug 4, 2017

    Online social networks may be a promising modality to deliver lifestyle interventions by reducing cost and burden. Though online social networks have been integrated as one component of multi-modality...

    Online social networks may be a promising modality to deliver lifestyle interventions by reducing cost and burden. Though online social networks have been integrated as one component of multi-modality lifestyle interventions, no randomized trials to date have compared a lifestyle intervention delivered entirely via online social network to a traditional clinic-delivered intervention. This paper describes the design and methods of a non-inferiority randomized controlled trial testing whether a lifestyle intervention delivered entirely through an online social network will produce weight loss that is not appreciably worse than a traditional clinic-based lifestyle intervention among overweight and obese adults, but at lower cost. Adults with BMI between 27-45 kg/m2 (N=328) will be recruited from the communities in central Massachusetts. Measures will be obtained at baseline, 6-, and 12-months after randomization. The primary non-inferiority outcome is percent weight loss at 12 months. Secondary non-inferiority outcomes include dietary intake, and moderate intensity physical activity at 12 months. Our secondary aim is to compare the conditions on cost. Exploratory outcomes include treatment retention, acceptability, and burden. Finally, we will explore predictors of weight loss in the online social network condition. Findings will extend the literature by revealing whether delivering a lifestyle intervention via an online social network is an efficacious alternative to the traditional modality of clinic visits, given the former might be more scalable and feasible to implement in settings that cannot support clinic-based models.

  • Challenges during implementation of a patient-facing mobile app for surgical rehabilitation

    From: Journal of Medical Internet Research

    Date Submitted: Jun 6, 2017

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

    Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challe...

    Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in healthcare settings. Objective: To report challenges experienced when implementing mobile apps for patients to support their post-surgical rehabilitation in an orthopaedic setting. Methods: A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-minute usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results: Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, IT infrastructure at home, privacy concerns, time limitations, the role of carer, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care include competing demands among clinicians, IT infrastructure in healthcare settings, identifying the ‘right’ time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions: Three insights were identified for mobile app implementation in routine care: 1) apps for patients need to reflect their journey over time, and in particular post-operative apps ought to be introduced as part of pre-operative care with opportunities for patients to learn and adopt the app during their postoperative journey; 2) strategies to address digital literacy issues among patients and clinicians are essential; and that 3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored and reviewed. Ultimately, digital health interventions should supplement but not replace patient interaction with clinicians.

  • Web-based decision-aid to assist help-seeking choices for young people who self-harm: Outcomes from a randomised controlled feasibility trial

    From: Journal of Medical Internet Research

    Date Submitted: Jun 16, 2017

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

    Background: Adolescents who self-harm are often unsure how or where to get help. We developed a web-based personalised decision aid (DA), designed to support young people in decision-making about seek...

    Background: Adolescents who self-harm are often unsure how or where to get help. We developed a web-based personalised decision aid (DA), designed to support young people in decision-making about seeking help for their self-harm. Objective: Our aim was to evaluate the feasibility and acceptability of the DA intervention and the randomised controlled trial (RCT) in a school setting. Methods: We conducted a 2-group, single blind, randomised controlled feasibility trial in a school setting. Participants aged 12-18 years who reported self-harm in the past 12 months were randomised to either an web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomisation and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision-making and help-seeking behaviour. Qualitative interviews were conducted with young people, parents/carers and staff, and subjected to thematic analysis to explore their views of the DA and study processes. Results: Parental consent was a significant barrier to young people participating in the trial, with only 208 (18%) of the 1,164 parent/guardians contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 82% (n=170) of young people into the study. Of those young people screened, 14% (n=23) had self-harmed in the past year. Ten participants were randomised to receiving the DA and 13 were randomised to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety and self-harm may be more beneficial. Conclusions: A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and/or the intervention are needed before generalisable research about DAs can be successfully conducted in a school setting. Clinical Trial: ISRCTN11230559

  • Part of a system – the changing place of online activity within a sexual health economy

    From: Journal of Medical Internet Research

    Date Submitted: May 26, 2017

    Open Peer Review Period: May 29, 2017 - Jul 24, 2017

    Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits, ordered online and delivered to the user in the post may increase us...

    Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits, ordered online and delivered to the user in the post may increase user choice, convenience and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users towards online or face-to face services according to clinical need. Objective: This paper investigates the impact of two interventions on testing activity across a whole sexual health economy a) the introduction of open access online STI testing services and b) a clinic policy of ‘triage and signpost’ online where users without symptoms who attended clinics for STI testing were supported to access the online service instead. Methods: Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed and clinical activity provided including test results. Clinical activity was categorised as a simple STI test (could be done in clinic or online), a complex visit (requiring face-to-face consultation) or other. Results: Introduction of online services increased total testing activity across the whole sexual health economy by 17.5%, suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the online service with simple STI testing in the clinic decreasing from 17% to 12% of total activity and complex activity in the clinic increasing from 69% to75% of total activity. This intervention created a new population of online users who were different age, sex, presence of symptoms and positivity from those who use online services spontaneously. Some triage and signposted users (29%) did not complete the online testing process with the potential for missed diagnoses. Conclusions: This evaluation shows that users can effectively be transitioned from online to face-to-face services and that this introduces a new population to online service use and changes the focus of clinic based activity. Further development is underway to optimise the triage and signposting process to support test completion.

  • Thought Spot: Optimization of an eHealth solution through participatory action research with transition-aged youth in post-secondary settings

    From: Journal of Medical Internet Research

    Date Submitted: May 26, 2017

    Open Peer Review Period: May 29, 2017 - Jul 24, 2017

    Background: Seventy percent of lifetime cases of mental illness emerge prior to age 24, but many youth are unable to access the supports and services they require in a timely and appropriate way. With...

    Background: Seventy percent of lifetime cases of mental illness emerge prior to age 24, but many youth are unable to access the supports and services they require in a timely and appropriate way. With most youth using the Internet, eHealth interventions are promising tools for reaching this population. Through participatory action research (PAR) and participatory design research (PDR) engagement methods, Thought Spot, a web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth in post-secondary settings. Objective: To describe the process of engaging with transition-aged youth through PAR and PDR approaches with the ultimate goal of optimizing the Thought Spot platform. Methods: Consistent with PAR and PDR approaches, five student-led workshops, attended by 41 students, were facilitated to obtain student feedback regarding help-seeking behaviours, the platform’s usability and functionality and its potential value in a post-secondary setting. The workshops were co-designed and co-facilitated by students to increase ownership by youth over the research process. Various creative engagement activities were delivered to provide opportunities for youth to share their experiences, including semi-structured focus groups, questionnaires, personas, journey mapping and a world café. Results: Participants discussed the following issues related to help-seeking throughout the workshops: feelings of confusion and vulnerability when accessing health or mental health services; concerns about stigma, taboos and labelling; and overall health care costs and time constraints. Innovative technological features and refinements were also brainstormed during the workshops. By using PAR methods of engagement, participants felt confident that their ideas and recommendations were welcomed and appreciated. There was also an overall sense of respect and care integrated into each group, which facilitated a genuine exchange of ideas and opinions. Conclusions: The process of engaging with transition-aged youth to redesign the Thought Spot digital platform through PAR and PDR has been effective. Findings from these workshops will significantly inform new technological features within the app that enable positive help-seeking behaviours among transition-aged youth. These behaviors will be further explored in the second phase that involves a randomized controlled trial.

  • A Mixed-methods Evaluation of ‘Formulift’: a Wearable Sensor Based Exercise Biofeedback System

    From: JMIR mHealth and uHealth

    Date Submitted: May 30, 2017

    Open Peer Review Period: Jun 4, 2017 - Jul 30, 2017

    Background: ‘Formulift’ is a newly developed mHealth app which connects to a single inertial measurement unit (IMU), worn on the left thigh. The IMU captures users’ movements as they exercise an...

    Background: ‘Formulift’ is a newly developed mHealth app which connects to a single inertial measurement unit (IMU), worn on the left thigh. The IMU captures users’ movements as they exercise and the app analyses the data to count repetitions in real-time and classify users’ exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively. Objective: The aim of the study was to assess the ‘Formulift’ system, with 3 different and realistic types of potential users (beginner gym-goers, experienced gym-goers and qualified Strength & Conditioning coaches) under a number of categories: (a) Usability. (b) Functionality. (c) The perceived impact of the system. (d) The subjective quality of the system. It was also desired to discover suggestions for future improvements to the system. Methods: Fifteen healthy volunteers participated (12 males, 3 females, age: 23.8 +/- 1.8 years, height: 1.79 +/- 0.07 m, body mass: 78.4 +/- 9.6 kg). Five were beginner gym-goers, 5 were experienced gym goers and 5 were qualified and practising S&C coaches. IMU data was first collected from each participant in order to create individualised exercise classifiers for them. They then completed a number of non-exercise related tasks with the app. Following this a workout was completed using the system, involving squats, deadlifts, lunges and single leg squats. Participants were then interviewed about their user-experience and completed the System Usability Scale (SUS) and the user-Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts and survey results were analysed. Results: Qualitative and quantitative analysis found the system has ‘good’ to ‘excellent’ usability. The system achieved a mean ± S.D. SUS usability score of 79.2 ± 8.8. Functionality was also deemed to be good with many users reporting positively on the systems rep counting, technique classification and feedback. A number of bugs were found and other suggested changes to the system were also made. The overall subjective quality of the app was good with a median star rating of 4/5 (IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them and help them avoid injury. Conclusions: This study demonstrated an overall positive evaluation of ‘Formulift’ in the categories of usability, functionality, perceived impact and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor based exercise biofeedback systems.

  • Sleep Tracking and Exercise in Patients with Type 2 Diabetes Mellitus (STEP-D): A Pilot, Longitudinal Study to Determine Correlations between Fitbit Data and Patient Reported Outcomes Pertaining to Health Behaviors

    From: JMIR mHealth and uHealth

    Date Submitted: May 31, 2017

    Open Peer Review Period: Jun 4, 2017 - Jul 30, 2017

    Background: Background and Objective: Few studies assessing the correlation between patient related outcomes (PROs) and patient generated health data (PGHD) from wearable devices exist. We sought to d...

    Background: Background and Objective: Few studies assessing the correlation between patient related outcomes (PROs) and patient generated health data (PGHD) from wearable devices exist. We sought to determine the direction and magnitude of associations between PGHD (from the Fitbit Charge HR) and PROs for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). Objective: Background and Objective: Few studies assessing the correlation between patient related outcomes (PROs) and patient generated health data (PGHD) from wearable devices exist. We sought to determine the direction and magnitude of associations between PGHD (from the Fitbit Charge HR) and PROs for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). Methods: Methods: STEP-D was a longitudinal, pilot study conducted on adult participants diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at three time points: Day 1, Day 7, and Day 14. PGHD included minutes asleep and number of steps taken. Questionnaires assessed number of days of exercise and nights of sleep problems per week and gym membership status. Means and standard deviations were calculated for all data and Pearson correlations used to measure associations between PROs and PGHD. All respondents provided informed consent prior to participating. Results: Results: On an average, participants took 4,955.0 steps and slept 6.7 hours per day. Participants self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between PROs and PGHD for physical activity was strong (r=0.60; p<0.01) while the association for sleep variability was moderate (r=0.28, p=<0.05). Conclusions: Conclusions: Fitbit and patient reported data are positively associated for both, physical activity as well as sleep. Physical activity is more closely correlated than sleep-related information. This may indicate that wearable devices are more valid for measuring certain types of health behaviors and could increase the amount and quality of health related behavioral data collected from chronic illness populations.

  • MyMate&Me: A medication adherence app for children with sickle cell disease

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 21, 2017

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

    Background: Haemoglobinopathies are very complex disorders with severe complications that can be alleviated with very simple basic preventive and therapeutic interventions, such as daily medication....

    Background: Haemoglobinopathies are very complex disorders with severe complications that can be alleviated with very simple basic preventive and therapeutic interventions, such as daily medication. Yet young people with sickle cell disease (SCD) often demonstrate low medication adherence and low motivation for effectively self-managing their disorder. Additional support for this group of patients including encouraging them to adhere to their medication regime and doctors’ instructions, can be provided through the use of mobile health (mHealth) interventions such as smartphone apps. The popularity of smartphones among teenagers makes this approach highly promising, with gamification, or entertainment elements creating particular appeal. Objective: The aim of this study was to develop a theory and evidence-based, user-centered medication adherence app to support children and adolescents with sickle-cell disease. Methods: An existing mhealth development approach combining a theoretically-based intervention development framework (The Behaviour Change Wheel) a user-centred design (UCD) approach and collaboration with industry guided the development process. A Review of the literature, along with 10 interviews with children and adolescents with sickle-cell disease aged 12-18 years, and consultation with experts, informed app development. Thematic analysis of interviews provided relevant theoretical, user-centered and technological components to underpin the design and development of the app. Results: Inputs from patients helped to identify barriers and enablers to medication adherence in patients’ capability, motivation and opportunity and 10 associated theoretical domains Framework (TDF) domains. Findings suggested that some patients’ had: a limited knowledge of the disease as well as lapses in their memory for taking their medication (Capability); variation in beliefs towards the effectiveness of medication for treating their condition and confidence in self-managing their condition; variations in the perceived link between emotions and pain (Motivation); a limited time to take medication and; barriers and enablers within the changing context of social support during the transition into adulthood (Opportunity). User-centred findings revealed positive feedback to ideas for a quiz and a mood tracker and suggestions for inclusion of techniques and games to distract from pain episodes. Steps were taken to select the appropriate behaviour change techniques and translate them into engaging app features designed to overcome these barriers to medication adherence. Conclusions: Patients with SCD have complex barriers to medication adherence necessitating the need for comprehensive models of behaviours to analyse the problem. Children and adolescents require an app that goes beyond simple medication reminders: taking into account patient’s beliefs, emotions and environmental barriers to medication adherence. Considerations must also be afforded to their desires for techniques and games to manage and distract from their pain. Clinical Trial: N/A

  • Validity and reliability of central and peripheral augmentation index estimated by a novel wrist-worn tonometer

    From: Journal of Medical Internet Research

    Date Submitted: Jun 1, 2017

    Open Peer Review Period: Jun 2, 2017 - Jul 28, 2017

    Background: Incorporation in clinical practice of pulse wave analysis (PWA) still have difficulties mainly due to training requires and time spent. Objective: Analyze the reliability and validity of P...

    Background: Incorporation in clinical practice of pulse wave analysis (PWA) still have difficulties mainly due to training requires and time spent. Objective: Analyze the reliability and validity of Pulse Wave Analysis as reported by a novel wrist-worn device, easy and quick to use, comparing central and peripheral augmentation index (AIx) with the same measures from the SphygmoCor MM3. Additionally, we analyzed the association with other parameters of vascular structure and function, end-organ damage, and cardiovascular risk. Methods: Cross sectional study including 254 subjects. Mean age was 51.9±13.4 and the subject population was 53% women. Main measures reported are: Peripheral AIx (PAIx), Central AIx, (CAIx) by the wrist-worn device and SphygmoCor; carotid-femoral (cf) pulse wave velocity (PWV) by SphygmoCor MM3; cardio-ankle vascular index (CAVI), ankle-brachial index (ABI) y brachial-ankle (ba) PWV by the Vasera device; carotid intima media thickness (IMT) measured using ultrasound; other measures of cardiac and renal function and cardiovascular risk. Results: Intra-observer intra-class correlation coefficient (ICC) for PAIx was 0.886 (95%CI:0.803 to 0.934) and for CAIx was 0.943 (95%CI:0.901 to 0.968) with Bland Altman limits of agreement of -0.75 (-23.8 to 21.8) and 0.08 (-15.7 to 15.9) respectively. The inter-observer ICC for PAIx was 0.952 (95%CI 0.915 to 0.972) and CAIx was 0.893 (95%CI:0.811 to 0.939) with limits of agreement of -0.45 (-13.7 to 12.8) and 0.43 (-17.7 to 18.5) respectively. Comparing the wrist-worn device to SphygmoCor, we observed an ICC of 0.849 (95%CI:0.798 to 0.887) for PAIx, and 0.783 (95%CI:0.711 to 0.838) CAIx. In Bland Altman analysis, limits of agreement for PAIx were -1.03 (-22.73 to 20.67) and CAIx 2.14 (-20.50 to 24.79). PAIx, CAIx, and heart rate-adjusted CAIx (CAIx_HR75) correlated with age, CAVI, ABI, baPWV, cfPWV, IMT, glomerular filtration rate, and cardiovascular risk. Conclusions: The wrist-worn device shows a good intra-observer and inter-observer reliability and inter-device reliability when compared to the SphygmoCor MM3, and a good validity when compared with other clinical measures that evaluate arterial stiffness, end-organ damage and cardiovascular risk. Clinical Trial: Clinicaltrials.gov NCT02623894;https://clinicaltrials.gov/ct2/show/NCT02623894

  • Disparities in using information and communication technologies especially video call for family life information sharing with family well-being: A population-based survey

    From: Journal of Medical Internet Research

    Date Submitted: Jun 2, 2017

    Open Peer Review Period: Jun 2, 2017 - Jul 28, 2017

    Background: The use of information and communication technologies (ICTs) for information sharing in family members is increasing dramatically. However, little was known about the associated factors an...

    Background: The use of information and communication technologies (ICTs) for information sharing in family members is increasing dramatically. However, little was known about the associated factors and how it related to family well-being. Objective: We investigated the pattern and social determinants of family life information sharing with family and the associations of different methods of sharing with perceived family health, happiness and harmony (3Hs) in Hong Kong, where smartphone ownership and Internet access are among the most prevalent, easiest and fastest in the world. Methods: A territory-wide population-based telephone survey was conducted from January to August 2016 on different methods of family life information (information related to family communication, relationships with family members, emotion and stress management) sharing with family members, including face-to-face, phone, instant messaging (IM), social media sites, video call and email. Family well-being was assessed by three single items on perceived family health, happiness and harmony, with higher scores indicating better family well-being. Adjusted prevalence ratios were used to assess the associations of socio-demographic factors with family life information sharing, and adjusted beta coefficients (β) for family well-being. Results: Of 2017 respondents, face-to-face was the most common method to share family life information (74.45%, 1502/2017), followed by IM (40.86%, 824/2017), phone (28.10%, 567/2017), social media sites (11.91%, 240/2017), video call (5.89%, 119/2017) and email (5.48%, 111/2017). Younger age and higher education were associated with the use of any (at least one) method, face-to-face, IM, and social media sites for sharing family life information (all P for trend <.01). Higher education was most strongly associated with the use of video call (adjusted prevalence ratio =5.61, 95% CI 2.29-13.7). Higher household income was significantly associated with the use of any method, face-to-face and IM (all P for trend <.05). Sharing family life information was associated with a higher level of perceived family well-being (β=0.56, 95% CI 0.37-0.75), especially by face-to-face (β=0.62, 95% CI 0.45-0.80) and video call (β=0.34, 95% CI 0.04-0.65). The combination of face-to-face and video call was most strongly associated with a higher level of perceived family well-being (β=0.81, 95% CI 0.45-1.16). Conclusions: The differential use of ICT to share family life information supports the Inverse Information Law. The prevalence of video call was low but associated with much better family well-being. Intervention studies to promote the use of video call to communicate and share information with family, particularly in disadvantaged groups are warranted, and may reduce socioeconomic disparities.

  • Using WhatsApp to support quality improvement teams: Experiences from an Indian hospital

    From: Journal of Medical Internet Research

    Date Submitted: Jun 7, 2017

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

    Background: Quality improvement involves four steps: 1) forming a team to work on this specific aim, 2) analyzing the reasons for current poor performance, 3) developing changes that could improve car...

    Background: Quality improvement involves four steps: 1) forming a team to work on this specific aim, 2) analyzing the reasons for current poor performance, 3) developing changes that could improve care and testing these changes using plan-do-study-act (PDSA) cycles, and 4) putting place interventions to sustain the changes that work. Teamwork and group discussion are key for effective quality improvement, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: An exploratory qualitative study was performed to examine experiences with WhatsApp as a communication tool which improving adherence to aseptic protocol and how WhatsApp can be used as a coaching tool to strengthen quality improvement team functioning. Methods: Ten quality improvement team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guides on how to do quality improvement, clinical guidance, and performance indicator data. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (e.g., using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings.

  • Discovering Cohorts of Pregnant Women from Social Media for Safety Surveillance and Analysis

    From: Journal of Medical Internet Research

    Date Submitted: Jun 8, 2017

    Open Peer Review Period: Jun 10, 2017 - Aug 5, 2017

    Background: Pregnancy exposure registries are the primary sources of information about the safety of maternal usage of medications during pregnancy. Such registries enroll pregnant women in a voluntar...

    Background: Pregnancy exposure registries are the primary sources of information about the safety of maternal usage of medications during pregnancy. Such registries enroll pregnant women in a voluntary fashion early on in pregnancy, and follow them until the end of pregnancy or longer to systematically collect information regarding specific pregnancy outcomes. While the model of pregnancy registries has distinct advantages over other study designs, they are faced with numerous challenges and limitations, such as low enrollment rate, high cost and selection bias. Objective: The primary objectives of this study were to systematically assess if social media (Twitter) can be used to discover cohorts of pregnant women, and to develop and deploy a natural language processing and machine learning pipeline for automatic collection of cohort information. In addition, we also attempted to ascertain, in a preliminary fashion, what types of longitudinal information may potentially be mined from the collected cohort information. Methods: Our discovery of pregnant women relies on detecting pregnancy-indicating tweets (PITs)—which are statements posted by pregnant women regarding their pregnancies. We use a set of 14 patterns to first detect potential PITs. We manually annotated a sample of 14,156 of the retrieved user posts to distinguish real PITs from false positives, and trained a supervised classification system to detect real PITs. We optimize the classification system via cross validation with features and settings targeted towards optimizing precision for the positive class. For users identified to be posting real PITs via automatic classification, our pipeline collects all their available past and future posts, from which other information (e.g., medication usage and fetal outcomes) may be mined. Results: Our rule-based PIT detection approach retrieved over 200,000 posts over a period of 18 months. Manual annotation agreement for three annotators was very high at κ=0.79. On a blind test set, the implemented classifier obtained overall F1-score of 0.84 (0.88 for the pregnancy class; 0.68 for the non-pregnancy class). Precision for the pregnancy class was 0.93, and recall was 0.84. Feature analysis showed that the combination of dense and sparse vectors for classification achieved optimal performance. Employing the trained classifier resulted in the identification of 71,954 users from the collected posts. Over 200 million posts were retrieved for these users, which provided a multitude of longitudinal information about them. Conclusions: Social media sources such as Twitter can be used to identify large cohorts of pregnant women, and to gather longitudinal information via automated processing of their postings. Considering the many drawbacks and limitations of pregnancy registries, social media mining may provide beneficial complementary information. While the cohort sizes identified over social media are large, future research will have to assess the completeness of the information available through them.

  • Transforming literature on people’s health experience s into a co-design workshop card-tool to inspire interaction

    From: Journal of Medical Internet Research

    Date Submitted: Jun 22, 2017

    Open Peer Review Period: Jun 23, 2017 - Aug 18, 2017

    Background: Patient experiences are an essential focus when designing healthcare services, as they are linked to patient outcomes, safety, clinical effectiveness and more meaningful health interaction...

    Background: Patient experiences are an essential focus when designing healthcare services, as they are linked to patient outcomes, safety, clinical effectiveness and more meaningful health interactions. A wealth of peer-reviewed data exists in the current literature that can help with understanding peoples’ experiences of health and health care services. Yet, health improvement teams are unable to find practical ways to use it and may therefore overlook its value. Objective: This study explored how the existing healthcare experience literature can be utilised in healthcare design. A card-tool was developed that can be used in healthcare collaborative design (co-design) workshops to make existing literature accessible and thereby enable understanding of health experiences, trigger discussion and facilitate human-centered healthcare improvements. Methods: Qualitative research, exploring the experience of living with diabetes and preventing diabetic eye disease, was gathered through a review of the literature. The findings were analysed through a process of affinity diagramming to identify insights into the health experience. These insights were developed into a card-tool, the Health Experience Insight Cards: Living with Diabetes edition that was used in a co-design workshop with participants who had relevant professional experience to discuss the future prevention of diabetic eye-disease. Results: The review identified papers 13 papers that fit the selection criteria. These were analysed to develop the Health Experience Insight Cards, Living with Diabetes Edition. Six Participants used the cards, in a co-design workshop. Analysis of the workshop identified three types of interaction that resulted from playing the cards in the design-game: (a) applying the insight from the card to the character/story, (b) discussing real life and (c) discussing experiences. Conclusions: A method was developed to transform patient experience literature into Health Experience Insight Cards. The method aids understanding of experiences, facilitates discussion and enables groups to work towards improving healthcare from a human-centred perspective.

  • Mining the Posts with Unified Medical Language System Metathesaurus to Enhance Online Patients' Knowledge Support

    From: Journal of Medical Internet Research

    Date Submitted: Jun 13, 2017

    Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017

    Background: Online health communities (OHCs) provide patients effective social healthcare services and a channel where patients can discuss their health conditions and share their experiences with oth...

    Background: Online health communities (OHCs) provide patients effective social healthcare services and a channel where patients can discuss their health conditions and share their experiences with others. The posts contain a vast amount of biomedical information in natural language, including drugs, symptoms and conditions, but are hard for secondary use to provide better knowledge support to online patients in disease prevention and self-management due to the semantic complexity of the texts. Objective: The objective of this study is to propose a practical mining method to make the best use of explicit and implicit biomedical knowledge in the patient-reported posts to improve patients’ abilities of seeking knowledge support online. Methods: By integrating the biomedical knowledge sources including Unified Medical Language System (UMLS) Metathesaurus, Systematized Nomenclature of Medicine -- Clinical Terms (SNOMED CT), and MetaMap program, a new mining method is proposed. Furthermore, we collected 372,343 patient-reported posts from an OHC to test the proposed mining method in terms of information extraction and knowledge discovery. Three metrics, namely the Knowledge Richness Degree (KRD), the Potential Knowledge Conversion Rate (PKCR) and the Knowledge-Constrained Online Behavior Index (KC-OBI), are proposed to evaluate the performance of the proposed method to provide knowledge support. Results: The results of the experiment on 671 drug-related posts (0.18% of total 372,343 posts), show significant difference between our proposed mining method and traditional dictionary-based method according to the Mann-Whitney Test with α=.05 and P<.001. The distribution of the KRD falls in the range [0.20, 0.60] for the traditional method and in the range [0.03, 0.20] for our proposed method. According to the evaluation of the changes of PKCR , as the number of discovered biomedical concepts increases; however, the PKCR of the post reduces (Skewness=5.93, Kurtosis=40.47, P=.003<.05), which exponentially reduces. Conclusions: The results suggest that by integrating the biomedical domain knowledge into the process of mining online posts, the healthcare platforms are enhanced to implement the knowledge-based support for online patients in their disease prevention and continual self-management training. Therefore, the designers of the community should make use of the biomedical knowledge indicators to help the system to implement machine learning techniques to analyze the online health reports.

  • Using Social Media Content to Assess the Population Impact of a New Paediatric Influenza Vaccination Programme in England

    From: Journal of Medical Internet Research

    Date Submitted: Jun 15, 2017

    Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017

    Background: A new childhood live attenuated influenza vaccine (LAIV) programme was launched in England in 2013, which consisted of a national campaign for all 2 and 3 year olds and several pilot locat...

    Background: A new childhood live attenuated influenza vaccine (LAIV) programme was launched in England in 2013, which consisted of a national campaign for all 2 and 3 year olds and several pilot locations offering the vaccine to primary school (4-11 years) children during the influenza season. The 2014/15 influenza season saw the national programme extended and included additional pilot regions, some of which offered the vaccine to secondary school (11-13 years) children as well. Objective: We utilise social media content to obtain a complementary assessment of the programmes that were launched in England during the 2013/14 and 2014/15 flu seasons. The overall community-wide impact on transmission in pilot areas is estimated for the different age groups that were targeted for vaccination. Methods: A previously developed statistical framework is applied, which consists of a non-linear regression model that is learnt to infer influenza-like illness (ILI) rates from Twitter posts originating in pilot (vaccinated) and control areas. The control areas are then used to estimate ILI rates in pilot areas, had the intervention not taken place. These predictions are compared with their corresponding Twitter-based ILI estimates. Results: Results suggest a reduction in ILI rates of 14% (1%-25%) and 17% (2%-30%) across all ages in primary school age only vaccine pilot areas during the 2013/14 and 2014/15 influenza season, respectively. No significant impact is observed in areas where only two age cohorts of secondary school children were vaccinated. Conclusions: These findings corroborate independent assessments from traditional surveillance data, thereby informing on the most effective vaccination strategies for the campaign and providing evidence of the value of social media content as an additional syndromic surveillance tool.

  • Are SMS based maternal health information messages cost effective in improving utilization of maternal and child health services in Gauteng, South Africa?

    From: JMIR Medical Informatics

    Date Submitted: Jun 11, 2017

    Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017

    Background: Limited evidence exists on the value for money of SMS health information programs in low resource settings. Objective: Drawing from data collected as part of a retrospective study explorin...

    Background: Limited evidence exists on the value for money of SMS health information programs in low resource settings. Objective: Drawing from data collected as part of a retrospective study exploring the effectiveness of messaging exposure on utilization of maternal and child health services, we modelled the incremental cost effectiveness of gradually scaling up messaging services to pregnant women throughout Gauteng province, South Africa from 2012-2017. Methods: Stage based maternal health SMSs were sent to pregnant women twice per week in pregnancy and continued until the infant's first birthday. Program costs, incremental costs to users and the health system, were measured along with changes in utilization of antenatal care (ANC) visits and childhood immunizations, and compared against a control group of pregnant women who received no SMS messages. Incremental changes in utilization were inputted into the Lives Saved Tool and used to forecast lives saved and DALYs averted of gradually scaling up program activities to reach 60% of pregnant women across Gauteng province within 5 years. Uncertainty was characterized using one way and probabilistic uncertainty analyses. Results: Five-year program costs are estimated to be $1.2 million USD; 17% of which were incurred by costs on program development and 31% on SMS message delivery costs. Costs to users were $1.66 to attend clinic based services; nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register MAMA users ($0.08) and provide ANC 1-4 ($4.36) and PNC 1-5 ($3.08) services. Incremental costs per DALY averted from a societal perspective ranged from $1,985 USD in the first year of implementation to $200 USD in the 5th year. At a willingness to pay threshold of $2,000 USD, the project had a 40% probability of being cost effective in year 1 versus 100% in all years thereafter. Conclusions: Study findings suggest that SMS health information messages delivered to pregnant women may be a cost-effective strategy for bolstering ANC and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modelled results. Clinical Trial: Not applicable

  • Feasibility and acceptability of a mobile breast cancer survivorship care application: Pilot study

    From: JMIR Cancer

    Date Submitted: Jun 12, 2017

    Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017

    Background: Background: Survivors living in rural areas experience unique challenges due to additional burdens such as travel and limited access to specialists. Rural survivors of breast cancer have r...

    Background: Background: Survivors living in rural areas experience unique challenges due to additional burdens such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, mental health and physical functioning, as well as lower than average quality of life compared to urban survivors. Objective: Objective: To explore the feasibility and acceptability of developing a mobile health survivorship care application to facilitate care coordination, support medical, psychosocial, and practical needs, and improve survivors' long-term health outcomes. Methods: Methods: An interactive prototype application, SmartSurvivor, that included recommended survivorship care plan components was developed. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6) and health care providers (n=5). Results: Results: Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions: Conclusions: Our pilot indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research.

  • Towards developing consumer health vocabulary by mining health forum texts based on word vector space: a semi-automatic approach

    From: Journal of Medical Internet Research

    Date Submitted: Jun 15, 2017

    Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017

    Background: Vocabulary gap between consumers and professionals in medical domain hinders information seeking and communication. Objective: To explore the application of a distributed word vector space...

    Background: Vocabulary gap between consumers and professionals in medical domain hinders information seeking and communication. Objective: To explore the application of a distributed word vector space model to identify new words in certain semantic categories, to build up a Chinese consumer health vocabulary, and to fill the gap between professional medical terminology and consumer vocabulary. Methods: Textual content from one of the largest Chinese online community, the Tianya community, was crawled and extracted. Word2vec was employed to construct a word vector for each word in the corpus. Then we used small sets of terms from ICD-10 and other human-curated dictionaries as seed words, from which we expand the vocabularies by calculating word-word similarities and word-category similarities. We explored how these word vectors help find synonyms for each term, and help identify new terms that belong to certain semantic categories. Results: The best precision for finding new words via the category representative word vector was 90%, and the coverage of words belong to the categories expanded as much as 14.51 times. Experimental results demonstrate that the method is able to identify common misspellings and abbreviations frequently used by consumers which does not exist in original professional terminologies. Conclusions: This study demonstrates the effectiveness of using distributed word vector as semantic representations of health-related consumer words in Chinese, and its capability to identify new words in certain semantic categories via calculating word-word similarities and word-category similarities. We show that our method has the potential to be employed to develop a Chinese consumer health vocabulary to improve consumers’ experiences in searching health information. Clinical Trial: None

  • “Eating chicken feet with pickled peppers cause avian influenza”? An observational case study on a hot topic in the Chinese social media during the avian influenza A (H7N9) outbreak

    From: Journal of Medical Internet Research

    Date Submitted: Jun 13, 2017

    Open Peer Review Period: Jun 13, 2017 - Aug 8, 2017

    Background: A hot topic on the relationship between a popular avian-origin food and avian influenza occurred in the social media during the outbreak of the emerging avian influenza A (H7N9). The misin...

    Background: A hot topic on the relationship between a popular avian-origin food and avian influenza occurred in the social media during the outbreak of the emerging avian influenza A (H7N9). The misinformation generated from this topic had caused great confusion and public concern. Objective: Our goals were to explore the trend and contents of the relevant posts with the hot topic. We also aimed to understand the characteristics of the misinformation and to provide suggestion to reduce public misconception in the social media during the emerging disease outbreak. Methods: The original microblog posts were collected from China’s Sina Weibo and Tencent Weibo using a combination of key words between April 1, 2013 and June 2, 2013. We analyzed the weekly and daily trend of the relevant posts. Content analysis were applied to categorize the posts into four kinds with a unified sorting criteria. The posts’ characteristics and geographic locations were also analyzed in each category. We conducted further analysis on the top 5 most popular misleading posts. Results: A total of 1680 original microblog posts on the topic were retrieved and 341 (20.3%) of them were categorized as “misleading messages”. The number of relevant posts had not increased a lot during the first 2 weeks but rose to a high level in the next 2 weeks after the suddenly rising number of reported cases at the beginning of week 3. The posts under “misleading messages” also occurred and increased from the beginning of week 3, but their daily posting number decreased when the daily number of posts under “correcting messages” outnumbered them. The bloggers of the misleading posts had the lowest mean rank of followers and previous posts, but their posts had a higher mean rank of the replies or number of retweets. The proportion of “misleading messages” in the places with no reported cases was significantly higher than that in the epidemic areas (25.8%>16.4%). The most popular misleading posts appeared to be narrative and attractive. Conclusions: Our findings suggested the importance to respond to common questions and misconception in the social media from the beginning of disease outbreaks. Authorities need to release clear and reliable information related to the popular topics early. The bloggers posting correct information should be empowered and their posts could be promoted to clarify false information. Equal importance should be attached to clarify misinformation in both the outbreak and non-outbreak areas.

  • Fall Detection in Individuals with Lower-limb Amputation using Mobile Phones: Machine Learning Enhances Robustness for Real-World Applications

    From: Journal of Medical Internet Research

    Date Submitted: Jun 13, 2017

    Open Peer Review Period: Jun 14, 2017 - Aug 9, 2017

    Background: Automatically detecting falls with smartphones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is benef...

    Background: Automatically detecting falls with smartphones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is beneficial for populations that are prone to falling, such as people with lower limb amputations. Many prior studies have focused on fall detection in able-bodied individuals and using data from a lab-setting only. Such approaches may provide a limited ability to detect falls in amputees and in real-world scenarios. Objective: We sought to develop a classifier which uses data from able-bodied subjects to detect falls in individuals with a lower-limb amputation, as they freely carry the smartphone in different locations both in lab and at home. Methods: We obtained 861 simulated indoor and outdoor falls from 10 young able-bodied subjects and 6 individuals with a lower limb amputation. In addition, we recorded a broad database of activities of daily living (ADL), including data from 3 subjects’ free-living routine. Sensor readings (accelerometer and gyroscope) from a smartphone were recorded, as subjects freely carried it in three common locations – on the waist, in a pocket, and in the hand. A set of 40 features were computed from the sensors data and 4 classifiers were trained and combined through stacking to detect falls. We compared the performance of 2 population-specific models, trained and tested on either healthy or amputee subjects, with that of a model trained on healthy subjects and tested on amputees. A simple threshold-based classifier was used to benchmark our machine learning classifier. Results: The accuracy of fall detection in amputees for a model trained on able-bodied (Sens: 0.98 ± 0.02, Spec: 0.97 ± 0.03) was not statistically different (P = 0.69) from that of a model trained on the amputee population (Sens: 0.98 ± 0.02, Spec: 0.97 ± 0.02). Detection of falls in able-bodied yielded similar results (Sens: 0.98 ± 0.02, Spec: 0.99 ± 0.01). An average number of 2.2 ± 1.69 false alarms per day were obtained when evaluating the model (vs 122 ± 166 based on thresholds) on data recorded as subjects carried the phone during their daily routine for 2 or more days. Machine learning classifiers outperformed the threshold-based one (P < 0.002). Conclusions: A smartphone-based fall detection model can use data from able-bodied to detect falls in individuals walking with a prosthesis. We successfully detected falls when the mobile phone is carried across multiple locations and without a predetermined orientation. Furthermore, the number of false alarms yielded by the model over a longer period of time was reasonably low, considering that users carried and used the phone freely and without any specific instruction. This moves the application of smartphone-based fall detection systems closer to a real-world use case scenario.

  • Development and Pretest of a Computer-assisted Personal Interview in REDCapTM to Administer Time Trade-off Surveys

    From: Journal of Medical Internet Research

    Date Submitted: Jun 13, 2017

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

    Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represe...

    Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality-of-life (HRQoL). Software applications exist to administer the TTO task; however, most of these applications are poorly documented and unavailable to researchers. Objective: To fill the void, we developed an online application to administer the TTO task for a research study that is examining general public proxy HRQoL estimates for persons with Alzheimer’s disease (AD). This manuscript describes the development and pretest of the application. Methods: We used Research Electronic Data Capture (REDCap™) to build the TTO application. The application’s modular structure and REDCap™’s object-oriented environment facilitated development. After the TTO application was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease-of-use. Results: Feedback from the pretest group was positive. Minor modifications included clarity enhancements, i.e., re-arranging some paragraph text into bullet points, labelling the application to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease (AD). Conclusions: We developed an online application to administer the TTO task. Other researchers may access and customize the application for their own research purposes.

  • Association between Online Health Information Use and Health Service Use

    From: Journal of Medical Internet Research

    Date Submitted: Jul 3, 2017

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

    Background: The use of online health information among older population is receiving increasing attention, but few studies explored its association with chronic health conditions and health service us...

    Background: The use of online health information among older population is receiving increasing attention, but few studies explored its association with chronic health conditions and health service use using a nationally representative data. Objective: To determine whether the use of online health information is associated with health service utilization and if the association is affected by specific health conditions. Methods: The study used the technology module from a nationally representative sample of community-dwelling older Americans from the 2012 Health and Retirement Study (HRS) (N=990). Negative binomial regression models were used to examine the association between use of online health information and the reported use of health services in both 2012 and 2014, adjusting for predisposing, enabling, and need factors. The interactions of use of online health information with chronic health conditions were also tested. Results: 48% of older adults reported using online health information. The use of online health information was associated with reports of more concurrent doctor visits, but not use over the next two years. Users of online health information with diabetes had significantly fewer doctor visits compared to non-users with diabetes at both times. Conclusions: The users of online health information were more likely to visit doctors concurrently, but the effect did not remain significant in a subsequent interval. Because the interaction effect of using online health information and having diabetes was significant at both measurement points, health-related internet use may be associated with fewer doctor visits for certain chronic health conditions.

  • Clinical decision support systems for drug allergy checking: a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Jun 15, 2017

    Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017

    Background: Worldwide the burden of allergies, and in particular drug allergies, is growing. In the process of prescribing, dispensing or administering a drug, a medication error can occur, which can...

    Background: Worldwide the burden of allergies, and in particular drug allergies, is growing. In the process of prescribing, dispensing or administering a drug, a medication error can occur, which can have adverse consequences, for example when a drug is given to a patient with a documented allergy to this particular drug. Computerized physician order entry systems (CPOE) with built-in clinical decision support systems (CDSS) have the potential to prevent these medication errors and consequent adverse events. Objective: In this systematic review, we provide a comprehensive overview regarding all aspects of CDSS for drug allergies including development, implementation, coding terminologies, and outcome evaluation. Methods: PRISMA guidelines were followed and searches were conducted in five databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Results: Of the 3,160 articles considered, 60 met the inclusion criteria. Nine additional articles were added based on expert opinion, resulting in a total of 69 articles. Large heterogeneity across study objectives, study designs, study populations and reported results was found. Several key findings were identified. Evidence of the usefulness of CDS for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of drug allergy information in the electronic health record is difficult, as it is often not clear for healthcare providers how and where to document drug allergies. Besides underreporting of drug allergies, outdated or inaccurate drug allergy information in the electronic health record poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is a lack of use of a generally accepted standard terminology for the structured documentation of allergy information. A last key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90% leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We only found one study specifically reporting on outcome related to CDSS for drug allergies. It showed that ADEs resulting from overridden drug allergy alerts do not occur frequently. Conclusions: Accurate and comprehensive recording of drug allergies is required for the good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergies are recorded in the EHR. It remains difficult to reduce drug allergy alert overload while keeping patient safety as highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Also the effect on patient outcome and the cost-effectiveness should be evaluated.

  • Replacing Alumni Surveys with Extant Internet Data plus a Single-Question Survey

    From: Journal of Medical Internet Research

    Date Submitted: Jun 16, 2017

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

    Background: A standardized alumni survey that is short, provides program-specific feedback, and could allow programs to compare their performance to each other is not available. Objective: To test if...

    Background: A standardized alumni survey that is short, provides program-specific feedback, and could allow programs to compare their performance to each other is not available. Objective: To test if a single-question survey, along with additional information readily available on the web, can be used to create a standardized alumni survey for academic programs. Methods: Alumni surveys were conducted for two programs: Master of Health Administration (MHA) and Master of Science in Health Informatics (MSHI). Most of the information collected through alumni surveys (demographic, emails, career information, industry, location of work, and estimated salary) were obtained by examining information available on the alumni on the web. Additional information (review of program content and courses) was obtained by emailing the alumni and asking them “Regarding your recent degree, what worked well and what needed improvement?” The available data and alumni responses were weighted to be representative of all alumni and not just the group whose information were on the web. Results: Among 41 MHA and 50 MSHI alumni 1-2 years out of the program, email information was available 43% and 55% of time respectively. Other information, including demographic (100%, 100%), current employer (89%, 82%), and estimated salary (78%, 74%) were also widely available. When available, the average estimated salary for MHA graduates 1-2 years out was $92,957 and for MSHI graduates was $72,904. In addition, among the MHA and MSHI who were contacted by email, 75% of MHA and 34% of MSHI alumni completed the free-text program review. Their comments were detailed and program specific. Independent reviewers classified comments into Curriculum, Program Organization, Capstone Related, Job Placement, External Relationships, Student Body, Personal Growth, and Value/Cost categories. Most comments (80% for MHA and 74% for MSHI) were positive and focused on program organization and program curriculum. Conclusions: The proposed alumni survey can be applied to different programs. Items in this survey had a high response/availability rate. The survey identified the impact of the program on employment and salary. Furthermore, the program review component of the survey provided useful insight on how programs could be improved in the future. Additionally, these procedures can be used to benchmark different programs against each other.

  • User acceptance of smart wrist bands among community dwelling older adults: A mixed method study

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 14, 2017

    Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017

    Background: Smart wrist bands are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer grade smart wrist bands are increasingly ubiquitous in the mark...

    Background: Smart wrist bands are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer grade smart wrist bands are increasingly ubiquitous in the market but the acceptance, attitudes, and voluntary use among older adults are poorly understood. Objective: To assess acceptance and usage of smart wrist bands in Canadian community dwelling older adults using the potentially influential factors as identified in literature and technology acceptance model. Methods: A mixed methods design was used. Twenty older adults aged 55 and older were recruited from the Southwestern Ontario. Participants used two different smart wrist bands (Xiaomi Mi Band and Microsoft Band) separately for each segment in the cross-over design study for 21 days (i.e. 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing two different devices. Semi-structured interviews were conducted with 4 participants and a content analysis was performed. Results: Participants ranged in age from 55-84 (mean 64). The Mi Band gained higher levels of acceptance (80%) compared to the Microsoft Band (50%). Equipment characteristics dimension scored significantly higher for the Mi Band (p<0.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (p<0.05). Multivariate logistic regression with three covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of four main themes: 1) smartphones as facilitators of smart wrist bands, 2) privacy is less of a concern for smart wrist bands, 3) value proposition: self-awareness and motivation, 4) subjective norm, social support, and sense of independence, and 5) equipment characteristics matter: display, battery, comfort and aesthetics. Conclusions: Older adults were mostly accepting of smart wrist bands and they had a clear understanding of its value for their lives. Smart wrist bands were uniquely considered more personal than other types of technologies, thereby its equipment characteristics including comfort, aesthetics, and price had significant impact on the acceptance. Results indicated that privacy was less of concern for older adults but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of smart wrist bands among older adults.

  • French validation of the Work Addiction Risk Test questionnaire

    From: JMIR Mental Health

    Date Submitted: Jun 30, 2017

    Open Peer Review Period: Jul 10, 2017 - Sep 4, 2017

    Background: Work addiction is a significant public health problem with a growing prevalence. The Work Addiction Risk Test (WART) is the gold standard questionnaire to detect “Workaholism”. Objecti...

    Background: Work addiction is a significant public health problem with a growing prevalence. The Work Addiction Risk Test (WART) is the gold standard questionnaire to detect “Workaholism”. Objective: The main objective was to validate the French version of the WART. Methods: Questionnaires were proposed to voluntary French workers using the Wittyfit software. There were no exclusions criteria. The questionnaire was administered anonymously for initial validity testing and readministered one week later for test-retest reliability. We also assessed the workers’ socio-demographic characteristics, as well as other measurements, for external validity such as stress, well-being, and co-addictions for tobacco, alcohol and cannabis. Several psychometric properties of the French-WART were explored: acceptability, reliability (internal consistency – Cronbach’s alpha coefficient, and reproducibility – Lin concordance coefficient), construct validity (correlation coefficients and principal component analysis) and external validity (correlation coefficients). Results: Among the 1580 workers using WittyFit, 187 (11.8%) agreed to complete the WART questionnaire. Of those, 128 completed the test-retest survey (68.5%). Acceptability found that all respondents had fully completed the questionnaire, with few floor or ceiling effects. Reliability was very good with a Cronbach’s alpha coefficient at 0.90 (internal consistency) and Lin concordance coefficient at 0.903 (95% CI 0.871–0.935) with a difference on the retest of 0.039±4.92 (95% CI -9.61–9.69) (reproducibility). We identified three main dimensions (construct validity). Relationships between the WART and stress and well-being confirmed its external validity. Conclusions: The French version of the WART is a valid and reliable instrument to assess work addiction, with satisfactory psychometric properties. Used in occupational medicine, this tool would allow the diagnosis of work addiction, and may be easily implemented in current practice. Clinical Trial: Clinicaltrials.gov: NCT02596737; https://www.clinicaltrials.gov/ct2/show/NCT02596737.

  • Mining Online Author’s Publication to Report the Core Research Domain with PubMed MeSH Terms: A Systematic Review for a Journal

    From: Journal of Medical Internet Research

    Date Submitted: Jun 15, 2017

    Open Peer Review Period: Jun 15, 2017 - Aug 10, 2017

    Background: Identifying an author’s research domain (RD) using MeSH (Medical Subject Headings) terms is important for a journal’s development and for its readership, but no journal uses mining onl...

    Background: Identifying an author’s research domain (RD) using MeSH (Medical Subject Headings) terms is important for a journal’s development and for its readership, but no journal uses mining online methods or social network analysis (SNA) to extract journal publication information to report an author’s contributions. Objective: To select prestigious authors and papers that have contributed most to a journal, we retrospectively (1) calculated an SCI (Science Citation Index) journal’s most recent impact factors (IF) and (2) used graphical representations that include MeSH terms of RDs for authors and journals. Methods: We collected 2053 papers published between July 1, 1999, and April 3, 2017, in the Journal of Medical Internet Research (JMIR) and cited by 673 journals, for which we also collected annual IFs for 394 SCI journals, including the JMIR. The prestigious authors and JMIR papers based on the weight of the 5-year SCI IFs from 394 cited-by papers in 2015. The JMIR core aims and scope are presented using major MeSH terms based on their corresponding average weighted scores. Social network analysis was used to create a graphical RD pattern for JMIR, and its prestigious papers and authors. Results: All JMIR 5-year IFs have not been less than 2.9 for the past 14 years. The authors who contributed most to JMIR in number of publications and in weighted citations are Gunther Eysenbach and My Hua. Their cohesion measures (ranging from 0 to 1.0) to JMIR are 34% and 5.7%, respectively. The highest prestige weighted contribution among papers published in JMIR is the one (PMID: 23567935 /DOI: 10.2196/jmir.2324 ) with a cohesion measure of 4.5%. Conclusions: An author’s research domain is required with an essential and graphical presentation along with the author’s submission to the target journal. Journal editors also look forward to evaluating an author’s research domain and the submitted paper’s cohesion measure for the journal.

  • Time-Series Analysis of Newspaper Articles about HPV Vaccines

    From: Journal of Medical Internet Research

    Date Submitted: Jun 19, 2017

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

    Background: Media coverage and reports are also major factors in influencing individual vaccination and other health-related activities. People use the media to seek information and knowledge on healt...

    Background: Media coverage and reports are also major factors in influencing individual vaccination and other health-related activities. People use the media to seek information and knowledge on health-related behaviors. people obtain health-related information from media such as television and newspapers, and they trust such information. While a number of studies have examined the relation between media coverage and individual health, there is a lack of studies that analyze media reports of health information. In particular, no analyses related to cervical cancer vaccine were found. Objective: This study aims to focus on reports pertaining to the Human Papillomavirus vaccine mentioned in Japan’s printed news media and reveal their characteristics. Methods: “Yomidasu Rekishikan,” which is Yomiuri Shinbun’s archival database, and “Kikuzo II Visual,” which is Asahi Shinbun’s archival database, were used for text mining. First, a database was created by extracting articles published between January 1, 2007, and December 31, 2014, which matched the terms “cervical cancer, vaccination” in a keyword search. Then, the extracted articles were tallied based on the month of publication, and number of characters to conduct a time-series analysis. Results: A total of 219 articles were extracted. Of these, 154 [70.3%] were positive, and 51 [23.3%] were negative. Of the 51 negative articles, 4 articles [8.0%] were published before June 2013, when routine vaccination was temporarily discontinued due to concerns regarding side effects, and 47 articles [92.0%] were published since then. The negative reports commonly cited side effects, although prior to June 2013, these issues were hardly mentioned. Although foreign media reports mentioned side effects before the routine vaccination was temporarily discontinued, fewer articles included side effects than articles recommending vaccinations. Furthermore, on June 13, 2013, WHO’s advisory body GACVS [Global Advisory Committee on Vaccine Safety] issued a statement regarding the safety of cervical cancer vaccine, but hardly any articles reported this statement. Rather, several articles were written about the side effects after June 2013. Conclusions: As we consider media coverage as a factor that affects human health behavior, the media should extensively report on the cost of not receiving cervical cancer vaccination, global trends concerning cervical cancer vaccination, and statements released by various agencies on the subject.

  • Applying Social Network Analysis to Understand the Percentages of Keywords within Abstracts of Journals: A System Review of Three Journals

    From: Journal of Medical Internet Research

    Date Submitted: Jun 20, 2017

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

    Background: Academic literature suggests keywords that are retrieved from a paper’s title and abstract represent important concepts in that study. The percentage of keywords within an abstract (PKWA...

    Background: Academic literature suggests keywords that are retrieved from a paper’s title and abstract represent important concepts in that study. The percentage of keywords within an abstract (PKWA) is required to investigate. Objective: To compare the PKWA in journals of medical informatics and the keyword network relationship in order to develop a self-examining policy for the journal. Methods: Selecting 5,985 abstracts and their corresponding keywords in three journals (JMIR, JAMIA, and BMC Med Inform Decis Mak.) published between 1995 to 2017(April) on the US National Library of Medicine National Institutes of Health (Pubmed.org), we computed the PKWA for each journal by using MS Excel modules and compared the percentage differences across journals and years via a two-way ANOVA. Social network analysis (SNA) was performed to explore the relations of keywords in journals. Results: The PKWA are 48.81, 41.59, and 56.84 for the three journals, respectively. A statistically significant difference (p < 0.05) is found in the percentages among journals selected. In contrast, no differences (p> 0.05) are found (1) between years (2016 and 2017) and (2) in interaction effects between journals and years. Three journals display significantly different patterns in network keywords and major cohesion measures. Conclusions: It is required to apply the computer module when inspecting whether keywords are within abstracts. The cohesion measure provides journal editors with a method of examining keywords within an abstract for a paper under review.

  • User-centered design of a mobile app for weight and health management in adolescents with complex health needs: A qualitative needs assessment

    From: Journal of Medical Internet Research

    Date Submitted: Jun 23, 2017

    Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017

    Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted towa...

    Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted towards the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level healthcare. Objective: The aim of the present study was to conduct a user-centered needs assessment of adolescents with complex health needs requiring specialized healthcare services and interested in weight management, their parents and healthcare providers, to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from 2 tertiary healthcare centres. Separate audio-taped focus group interviews were conducted with adolescents, parents and healthcare providers. Interviews were transcribed and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVIVO 10.0. Results: 19 adolescents, 16 parents, and 21 healthcare providers were interviewed. Qualitative analysis revealed 7 major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with healthcare professionals, supporting mental health, gamification and incentives, and user interface design. Adolescents provided several ideas related to each feature, while parents’ views focused on assistance with meal planning and greater access to healthcare professionals. Healthcare providers viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with a healthcare professional. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized healthcare services towards the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to healthcare professionals, features to support mental health, and an attractive and engaging user interface. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs.

  • The Significance of “Witness Sensors”

    From: Journal of Medical Internet Research

    Date Submitted: Jul 4, 2017

    Open Peer Review Period: Jul 6, 2017 - Aug 31, 2017

    Due to the increasing number of natural and man-made disasters, mass casualty incident (MCI) events occur more often than ever before. As a result, the health providers need to adapt in order to cope...

    Due to the increasing number of natural and man-made disasters, mass casualty incident (MCI) events occur more often than ever before. As a result, the health providers need to adapt in order to cope with the overwhelming patient surge. On the quality and safety aspects of the health issues, the accurate information of pandemic disease control, death reduction, and health quality promotion should be further highlighted. Nevertheless, obtaining precise information in real-time is a hydra-headed challenge to all the researchers of the field. In this article, innovative strategies are presented, so to develop a sound information network by using the concept of “Witness Sensors” (WSs). In order to overcome the reliability and quality limitations of the information obtained by social media, researchers pay great attention to develop solutions that secure the authenticity of the messages, especially for matters related to health. In this research, we introduce a pioneering concept that is based on the two potential elements of “witness” and “sensor” to face the aforementioned matters. It is now more accepted than ever before, that the social media and any kind of information exchange through the internet is being transformed to a major communication tool for health providers and receivers. In this article, the WSs are designed to alleviate possible limitations and to distinguish fact from fiction in critical information matters. In order to enhance the health communication practices and deliver valid information to end users, the education and management of WSs should be further investigated, especially for the implementation of MCIs and epidemic outbreaks.

  • Comparison of the Effects of Exercise Therapy between Digital Video Disc and Web-site-based Interventions in Patients with Hip Osteoarthritis

    From: Journal of Medical Internet Research

    Date Submitted: Jun 23, 2017

    Open Peer Review Period: Jun 23, 2017 - Aug 18, 2017

    Background: Prevalence of developmental hip dysplasia is high in Japan, and morbidity associated with hip osteoarthritis has been reported as 1.0-4.3%. It is estimated that this figure will rise as th...

    Background: Prevalence of developmental hip dysplasia is high in Japan, and morbidity associated with hip osteoarthritis has been reported as 1.0-4.3%. It is estimated that this figure will rise as the aging population grows. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via DVDs and web sites, allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders thus far. Objective: This study aimed to compare the effectiveness of exercise therapy administered via DVDs and that administered via web sites. Methods: We developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of Open-Kinetic-Chain and Closed-Kinetic-Chain exercises. The exercise menu was designed such that patients could reach Step 6 in 3 months by advancing to a new step every 2 weeks, with 30 to 40 min of exercise daily. Once the program was developed, exercise DVDs were produced using easily comprehendible pictures, videos and relaxing music. The DVD users were shown the number of times each exercise should be performed, in order to promote exercise continuity. In addition to the six-step exercise program, our web site was enabled to count the number of exercises performed by each patient and was accessible via the internet at any time. We instructed the patients to start at an appropriate level and step up every two weeks unless they experienced pain, when they were asked to stop temporarily. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed pre-intervention and after 6 months. Results: At 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3 [SD=16.1] years), and 18 web-site users (2 male, 16 female; mean age 52.3 [SD=10.4] years) were reachable. Small effect was observed for JHEQ-pain, SF-8 physical component summary (PCS) and SF-8 mental component summary in the DVD group, and for OHS, SF-8 (PCS) and GSES in the web-site group. Although we could not confirm a significant improvement, most parameters tended to improve over the 6 months. Conclusions: When comparing the effectiveness of exercise therapy between our DVD and web site, we found that, while both groups tended to improve in physical function, only the web-site group showed enhanced self-efficacy.

  • Evaluation of the effectiveness of mhealth applications in self-care management of chronic lower back pain

    From: Journal of Medical Internet Research

    Date Submitted: Jun 21, 2017

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

    Background: Reviews of patient-targeted smartphone applications for pain management [22] showed that despite the large availability of applications for pain tracking, self-management, and exercise tra...

    Background: Reviews of patient-targeted smartphone applications for pain management [22] showed that despite the large availability of applications for pain tracking, self-management, and exercise training, the science of implementation of mHealth technologies and self-management of chronic conditions are important areas for further research [2, 23]. There has been little research regarding methods associated with continued user engagement, or the effectiveness of adherence to certain health platforms [6,14,24] for improving health outcomes among those living with chronic diseases. Objective: This study investigated the interaction of patients with various features of Limbr, a modular mHealth compliance enhancement intervention for self-management of Chronic Lower Back Pain (CLBP). Limbr is comprised of self-directed rehabilitation tutorial videos, personalizable, visual self-report tools, health coach support, and sensor-assisted passive tracking of activity levels. The Limbr program aims to promote adherence to the BackRx exercise rehabilitation regimen [21], increase engagement in self-directed management of pain (including pain, medication and exercise tracking) and improve self-reported outcomes of pain. Methods: We assessed CLBP patients’ adherence to (1) a 3-month, self-directed, rehabilitation program, and (2) user engagement in both self-reporting Activities of Daily Living (ADLs), medication, affect, and pain function, and frequency of messages to and from the health care coach. In addition, we tested the association between scores derived from our visual self-report method, YADL (an image based tool for tracking patient reported ADLs), and the well established Oswestry Disability Index (ODI) obtained from the Oswestry Low Back Pain Questionnaire. Participants were a convenience sample recruited through their clinician in New York, NY. 98 patients agreed to participate, of which, 35 patients completed the full 3 month intervention. In aggregate over 202 data points per patient were collected and analyzed. Results: Study results indicate that the Limbr mHealth intervention promoted engagement in patient self-monitoring and management of pain through use of the mobile applications. The 35 participants who completed the full three months of engagement demonstrated a sustained intensity of use of the Limbr system, with 65% of participants interacting at least once a week. Roughly 50% of participants perceived the visual self-reports as helpful in tracking pain-related ADLs, medication, and affect. In particular, about 60% of participants found YADL helpful in keeping track of ADLs. About two-thirds (71% and 67%) of the participants agreed that the daily notifications were beneficial in reminding them to complete the daily surveys and exercises respectively. 50% of the participants perceived the engagement features as highly motivating and very useful. It was also found that the Limbr self-assessment, YADL, is correlated to the ODI Index (P < .001). Conclusions: These results indicate that mHealth interventions that consist of visual self-reporting, personalized health coach messaging, weekly user updates and sensor-assisted reminders, can be very effective in promoting adherence to the self-management of chronic LBP and to a self-directed rehabilitation regimen. Clinical Trial: NCT03040310

  • Behavioral and medical mechanisms that link diabetes to disability depend on the intersection of place and gender

    From: JMIR Diabetes

    Date Submitted: Jun 23, 2017

    Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017

    Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind...

    Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind the link between diabetes (DM) and disability in eight countries. Methods: We borrowed data from Research on Early Life and Aging Trends and Effects (RELATE). This analysis included adults from eight countries including Barbados, Brazil, Costa Rica, Chile, Cuba, Puerto Rico, Mexico, and Uruguay. Diabetes was the independent variable, disability (activities of daily living) was the dependent variable, socioeconomics, obesity, health behaviors, and comorbidities were covariates, and gender was the moderator. We used country by gender specific- logistic regressions to test the effect of DM on disability after adjusting for socioeconomics (Model 1), socioeconomics, health behaviors, and obesity (Model 2), and socioeconomics, obesity, health behaviors, and medical comorbid conditions (Model 3). Results: Gender by country specific patterns of association between DM and disability were observed in Puerto Rico, Mexico, Brazil, Chile, and Cuba. In Puerto Rico, in men, DM – ADL could be explained by health behaviors and obesity, for women, however, the impact of DM on ADL was above all confounders for women. In Mexico, for men, DM was not associated with disability, however, for women, there was a link which could be explained by health behaviors and obesity. In Brazil, for men, DM – ADL limitation link could be fully explained by health behaviors and obesity, for women, however, DM was not associated with ADL at all. In Chile, for men, DM was not associated with ADL limitation, for women, however, there was an association between DM and ADL limitation which could not be explained by health behaviors, obesity, or comorbid medical conditions. In Cuba, for men, health behaviors and obesity fully mediated the effect of DM on ADL, for women, however, this link was mediated by comorbid medical conditions. Conclusions: Gender by place differences exist in the link between DM and disability, as well as behavioral and medical mechanisms behind such link. These findings advocate for the intersectionality approach in studying burden of illnesses such as DM.

  • Effects of mHealth and Wearable Activity Trackers to Promote Physical Activity among Healthy Children and Adolescents: A Systematic Review

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 27, 2017

    Open Peer Review Period: Jun 28, 2017 - Aug 23, 2017

    Background: A variety of children and adolescents are incapable to meet the current recommendations on physical activity (PA), with the result that health- related benefits of regular PA are not achie...

    Background: A variety of children and adolescents are incapable to meet the current recommendations on physical activity (PA), with the result that health- related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA. Objective: The present review systematically evaluated the effects of mobile health (mHealth) and wearable activity trackers on PA and related outcomes in this target group. Methods: Electronic databases CENTRAL, PubMed, Scopus, SPORTDiscus and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to December 2016. Included were articles that contained descriptions of interventions designed to promote PA among children (6-12 years old) and/or adolescents (13-18 years old), and that measured at least one PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets or mobile applications) or wearable activity trackers. Randomized controlled trials (RCTs) and non-randomized controlled trials, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with PA comparison between groups were assessed for methodological quality. Results: In total, 831 articles were identified. Finally, 7 studies (5 with tools of mHealth, 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used a RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone applications were used as tool(80%). Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as intervention and evaluation tool. No evidence was found for the effect of mHealth tools respectively wearable activity trackers on PA-related outcomes. Conclusions: Given the small number of studies, poor compliance with accelerometers as measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence.

  • Texting condolences: adapting mHealth programs after unexpected pregnancy and infant outcomes

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 26, 2017

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

    SMS messaging programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth and infant loss....

    SMS messaging programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth and infant loss.

  • Smartphone applications for mindfulness interventions with suicidality in Asian youths: Evidence is lacking

    From: Journal of Medical Internet Research

    Date Submitted: Jun 27, 2017

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

    Background: Background: The advent of mobile technology has ushered in an era where smartphone applications can be used for intervention for suicidality. Objective: Objective: Review recent research r...

    Background: Background: The advent of mobile technology has ushered in an era where smartphone applications can be used for intervention for suicidality. Objective: Objective: Review recent research relevant to smartphone application that can be used for mindfulness intervention for suicidality in Asian youths. Methods: Methods: The inclusion criteria for this review is papers published in peer reviewed journals from 2007 to 2017 with usage of search terms namely ‘smartphone application’, and ‘mindfulness’, assessed against the inclusion criteria and screened by an experienced Asian clinician to be of clinical utility for mindfulness intervention for suicidality with Asian youths. Results: Results: Initial search on databases yielded 375 results. 14 Full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. Conclusions: Conclusions: This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone applications that can be used for mindfulness interventions for suicidality with Asian youths. Clinical Trial: NA

  • Mobile Health (mHealth) Applications and Self HealthCare Management: Perspective of Iranian Female Patients

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 29, 2017

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

    Background: Mobile technologies are rapidly developing both in developed and developing country. Though, the main purpose of using smart phones, especially in developing countries, are for everyday co...

    Background: Mobile technologies are rapidly developing both in developed and developing country. Though, the main purpose of using smart phones, especially in developing countries, are for everyday communication, there are great potentials for using these devices for self-health care management notably in rural areas. Mhealth can be a major pathway for promoting telemedicine among rural woman who have restrictions such as time for their self-health care management. This paper analyzes the perspectives of women in rural areas of Iran to understand their perspectives regarding the best ways of employing a smart phone app for self-healthcare management. Objective: To assess the attitudes and preferences of rural Iranian female patients regarding various functionalities a mobile app should play on increasing their health literacy, adherence to medication and improving their self-care management. Methods: This is a descriptive, cross-sectional study collected data from 460 female patients visited " Health Houses" located in rural areas of Ardabil and Isfahan provinces. The respondents were selected randomly. The data collection tool is a questionnaire designed by the authors. Validity (content and form) and reliability (Spearman- Brown with r=0.83) includes two categories of questions: background and questions regarding the role of mobile information-communication apps. Data were analyzed by SPSS software. Results: This research shows the high willingness of Iranian female patients living in rural areas to use mobile apps for increasing their health literacy, to access and store their medical records, set appointments, and receive and pay their medical bills. The patients expressed little tendency to use mobile apps for accessing online reviews, and having virtual visits and consultation with their physicians. In general, they have medium trust to mobile apps, and they prefer to use mobile apps developed and run by a clinic or hospital and not a third party. In regard to methods a mobile app can increase their adherence to medication, the patients prefer receiving information on their diets and diseases over receiving alerts to take medication. Conclusions: This paper shows the tendency of female patients toward using mobile apps for establishing telemedicine systems in rural areas which access to medical and educational centers is hard. This paper will be a leading guideline for the development of mobile health apps in compatible with the needs of users and patients, specially vulnerable populations of developing countries.

  • Medication Adherence and Technology-based Interventions for Adolescents with Chronic Health Conditions: A Few Key Considerations

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 28, 2017

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

    Background: Not applicable Objective: Not applicable Methods: Not applicable Results: Not applicable Conclusions: Not applicable Clinical Trial: Not applicable...

    Background: Not applicable Objective: Not applicable Methods: Not applicable Results: Not applicable Conclusions: Not applicable Clinical Trial: Not applicable

  • A systematic literature review of models used in clinical decision support systems supporting healthcare professionals treating diabetic foot ulcers

    From: Journal of Medical Internet Research

    Date Submitted: Jun 30, 2017

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

    Background: Diabetic foot ulcer is one of the most devastating late diabetic complications. Many randomised controlled trials on the different wound care elements have been conducted and published in...

    Background: Diabetic foot ulcer is one of the most devastating late diabetic complications. Many randomised controlled trials on the different wound care elements have been conducted and published in the Cochrane Library, all of which have only a low evidential basis. Thus, healthcare professionals are forced to rely on their own experience when making decisions regarding the treatment of diabetic foot ulcers. To progress from experience-based practice to evidence-based wound care practice, clinical decision support systems that help healthcare providers with decision-making in a clinical workflow have been developed. These systems have proven useful in many areas within the healthcare sector, partly because they have increased the quality of care, and partly because they have generated a solid basis for evidence-based practice. However, no systematic reviews focus on clinical decision support systems within the field of diabetic foot ulcer care. Objective: The aims of this systematic literature review are to identify models used in clinical decision support systems that specifically support healthcare professionals treating diabetic foot ulcers, to classify each clinical decision support model according to selected variables and to create an overview. Methods: A systematic review was conducted using six databases. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews. The following aspects were extracted from each article: authors, year, country, sample size of data and variables describing the type of clinical decision support models. The decision support models were described and classified according to the variables. Results: The final number of studies included in the systematic literature review was 10: the ten clinical decision support models included four quantitative decision support models and six qualitative decision support models. The earliest eligible article was published in 2007, and the most recent article was from 2015. Conclusions: The clinical decision support models were targeted at a variety of different types of chronic wounds. The degree of accessibility of the inference engines varied. Quantitative models served as the engine and were invisible to the healthcare professionals, while qualitative models required interaction with the user. None of the decision support models focused specifically on supporting healthcare professionals treating diabetic foot ulcers. Clinical Trial: The protocol for this systematic literature review was registered on PROSPERO with the registration no.: CRD42017068495 and is available in full on ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017068495).

  • Development of eHOME, a mobile instrument for reporting, monitoring and consulting drug-related problems in homecare: a human-centered design study.

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 29, 2017

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

    Background: Homecare patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, homecare could add to the multidisciplinary...

    Background: Homecare patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, homecare could add to the multidisciplinary expertise of general practitioners and pharmacists. The Homecare Observation of Medication-related problems by homecare Employees (HOME)-instrument is paper-based and assists homecare workers in reporting potential DRPs. To facilitate the multiprofessional consultation a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between homecare and general practices and/or pharmacies is desired. Objective: The objective of this study was to develop eHOME, a mobile version of the HOME-instrument including a monitoring and consulting system for primary care. Methods: The development phase of the Medical Research Council Framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi-round for context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by two series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving homecare workers, general practitioners and pharmacists throughout the process letting them hold the roles as informants, design partners and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report web page interface which includes adjusted content of the HOME-instrument and added homecare practice based problems, homecare workers can digitally report observed DRPs. Furthermore it was found that the monitoring and consulting web page interfaces enables digital consultation between homecare and general practices and/or pharmacies. The web pages were experienced as convenient, clear, easy and usable. Conclusions: By employing a HCD approach, the eHOME-instrument was found to be an easy to use system. The systematic approach promises a valuable contribution for future development of digital mobile systems of paper-based tools.

  • Association between a wider availability of health information and healthcare utilization in Vietnam.

    From: Journal of Medical Internet Research

    Date Submitted: Jul 16, 2017

    Open Peer Review Period: Jul 17, 2017 - Jul 25, 2017

    Background: The rapid and widespread development of mass-media sources including the Internet is occurring worldwide. The users are being confronted with a burst of health information through a wide a...

    Background: The rapid and widespread development of mass-media sources including the Internet is occurring worldwide. The users are being confronted with a burst of health information through a wide availability of sources. The studies on how the availability of health information has triggered the users’ interest in utilizing health care services remain limited on Vietnamese population. Objective: This study examined the associations between the wider availability of sources for health information and healthcare utilization in Vietnam after adjusting for potential confounding variables. Methods: The data for this study was drawn from a cross-sectional study conducted over a 6-month period in Hue, a city in central Vietnam. The subjects were 993 randomly selected adults between the ages of 18 and 60 years old. Information was collected through face-to-face interviews on the types of information sources that were consulted including traditional media (television), Internet, and health education courses, as well as the impact of such information on health care use (emergency visits, hospitalization, doctor visits). Univariate, bivariate and multivariate logistic regression analyses were performed at a 95% confidence level. Results: The prevalences of watching television, using the Internet and attending health education courses to obtain health information were 50.9%, 32.9%, and 8.7%, respectively. After further adjustments for the self-reported health status, the presence of health insurance, and monthly income, watching television and using the Internet to obtain health information were associated with doctor visit rates that were approximately 2 times higher than associated with non-use (AOR = 1.69, 95%CI; 1.29, 2.19; AOR = 1.64, 95%CI; 1.23, 2.18, respectively), and also significantly associated with inpatient hospitalization (P < .05). Conclusions: Our study elucidated that the use of widely available mass media sources (such as television and the Internet) to obtain health information was associated with higher healthcare utilization. However, the users’ abilities to analyze and assess these sources of health-related information were also closely correlated with their decision to use health care services. Thus, how interest in health - related information can be transmitted so that it will have a beneficial effect on care-seeking behavior should be a topic of concern for the further health promotion in developing countries.

  • Validation, in real conditions of use, of a sensor for Parkinson's Disease, which detects motor fluctuations and does not require previous calibration.

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 3, 2017

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

    Background: Using a single kinematic sensor worn on the waist, a new algorithm has been developed which combines information on gait bradykinesia and dyskinesia to detect motor fluctuations (On and Of...

    Background: Using a single kinematic sensor worn on the waist, a new algorithm has been developed which combines information on gait bradykinesia and dyskinesia to detect motor fluctuations (On and Off periods) without the need of being calibrated for each individual patient. Objective: The objective of the present study is to study the validity of this algorithm under real conditions of use. Methods: Validation study of the motor-fluctuations algorithm, on a sample of 23 patients with advanced Parkinson’s Disease. Patients were asked to wear the kinematic sensor for 1 to 3 days at home, while in parallel keeping a diary of their On and Off periods. Researchers were not present during the test period. Patients carried on their usual daily activities. The algorithm detections were compared with patient’s records, which were used as gold standard. Results: The algorithm produced 37% more results than patients’ records. The sensitivity of the algorithm to detect Off periods, compared with patients’ records, was 92% (IC95%: 87.33% - 97.3%) and the specificity was 94% (IC95%: 90.71% - 97.1%). Conclusions: The motor-fluctuation detecting algorithm is an accurate tool for outpatient monitoring of Parkinson patients with difficult-to-control motor fluctuations.

  • Usability and Usefulness Study of a Mobile Health App for Promoting Breastfeeding in Thailand

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 13, 2017 - Sep 7, 2017

    Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants, however, exclusive breastfeeding rate up to 6 months remains below 20% in Thailand. Although the numbe...

    Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants, however, exclusive breastfeeding rate up to 6 months remains below 20% in Thailand. Although the number of research and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae is developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: To evaluate the usability and usefulness of MoomMae, a smartphone app designed to support breastfeeding women. Methods: A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. Each participant was requested to attend a pre-use interview and given the app to use for 4 weeks. Following this period, a post-use interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audio-recorded for qualitative analysis. Results: The mean scores of usability and usefulness from the post-use survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral) and comments on usefulness were relatively positive (56 positives, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae is easy to use and offer great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system.

  • The Promise of Patient Portals for Adolescent Research

    From: Journal of Medical Internet Research

    Date Submitted: Jul 3, 2017

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

    Background: While adolescents can receive confidential health care without parental/guardian notification, they are rarely asked about their experiences and opinions regarding their care because parti...

    Background: While adolescents can receive confidential health care without parental/guardian notification, they are rarely asked about their experiences and opinions regarding their care because participation in research often requires parental consent. Anonymous research with adolescents via confidential patient portals may ameliorate this research gap. Objective: Because use of a confidential online adolescent patient portal is high at one academic institution, we hypothesized that adolescents would also respond to this portal for survey-based research. We sought to anonymously ask adolescents without parental consent about their knowledge, opinions and perceptions regarding their health and health care, including information on a long-acting reversible contraceptive (LARC). A secondary aim was to examine if and how adolescents use their patient portal to consider research participation. Methods: Upon receiving IRB approval, we sent two portal-based surveys about confidential services to two groups of females, ages 14-25 years, who had attended an adolescent clinic in the past three years. This clinic mostly serves Medicaid recipients (80%) and is racially and ethnically diverse with patients evenly divided between African-American and Caucasian, with roughly 10% Hispanic. The control group was a random sample of female patients who never received a LARC (n=150) and the intervention group included all female adolescents who had received a LARC from the same clinic (n=107). This second sample was manually cross-checked to confirm they had an office visit for this insertion. Consenting for themselves, the control group received an email through the patient portal with a link and a request to perform an assessment. The survey for the control group included items assessing health literacy and health communication preferences. The survey for the intervention group included health literacy items as well as items to assess their opinions and perceptions regarding their LARC. We tracked click-through rates and opened messages; each participant received four reminders. Results: While only three participants fully completed either survey, email ‘read rates’ (32.6% of LARC recipients and 37.5% of controls) were encouraging. Additionally, of those who opened the messages, almost twice as many of the LARC recipients (45.4%) read the entire survey as compared to those who received the survey asking about health literacy and health care preferences (22.2%). Conclusions: This study did not yield sufficient participation to understand these adolescents’ preferences. However, the methodology of using adolescent portals for online surveys was promising. Future studies need to test if a different survey topic would engage adolescents or if other methods like text-based reminders would improve participation.

  • Peer-based Social Media Features in Behaviour Change Interventions: A Systematic Review

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 3, 2017

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

    Background: Incorporating social media features into Digital Behaviour Change Interventions has the potential to contribute positively to their success. However, the lack of clear design principles to...

    Background: Incorporating social media features into Digital Behaviour Change Interventions has the potential to contribute positively to their success. However, the lack of clear design principles to describe and guide the use of these features in behavioural interventions limits cross-study comparisons of their use and effect. Objective: This work provides a systematic review of digital behaviour change interventions targeting modifiable behavioural risk factors which have incorporated social media features as part of their intervention infrastructure. A taxonomy of social media features is presented to inform the development, description and evaluation of behavioural interventions. Methods: Search terms were used in eight databases to identify digital behaviour change interventions that incorporated social media features and targeted tobacco smoking, diet & nutrition, physical activities or alcohol consumption. The screening and review process was performed by two independent researchers. Results: 5264 articles were screened and 143 articles describing a total of 134 studies were retained for full review. Most studies reported positive outcomes with regards to their respective objectives and hypothesis. Few studies reported on the association between the inclusions of social media features and intervention effect. A taxonomy of social media features used in behavioural interventions has been presented with thirty-six social media features organised under seven high level categories. The taxonomy has been used to guide the analysis of this review. Conclusions: Although social media features are commonly included in digital behaviour change interventions, there is an acute lack of information with respect to their effect on outcomes and a lack of clear guidance to inform the selection process based on features’ suitability for the different behaviours. The proposed taxonomy along with the set of recommendations included in this review will support future research aimed at isolating and reporting the effects of social media features in digital behaviour change interventions, cross-study comparisons and evaluations.

  • An Efficient Automated Classification Approach for Free-text Medical Narratives using Word Embedding and Convolutional Neural Networks

    From: Journal of Medical Internet Research

    Date Submitted: Jul 20, 2017

    Open Peer Review Period: Jul 21, 2017 - Sep 15, 2017

    Background: Automated disease code classification using free-text medical information is important for public health surveillance. However, traditional natural language processing (NLP) pipelines are...

    Background: Automated disease code classification using free-text medical information is important for public health surveillance. However, traditional natural language processing (NLP) pipelines are limited, so a method combining word embedding with a convolutional neural network (CNN) is proposed. Objective: We conducted a classification task identifying chapter-level ICD-10-CM diagnosis codes in discharge notes and compared the performance of traditional pipelines (NLP + supervised machine learning models) with that of word embedding combined with a CNN. Methods: Two classification methods are presented: (1) some features (terms, n-gram phrases, and SNOMED CT categories) are extracted from discharge notes and used to train a set of supervised machine learning models (support vector machine, random forests, and gradient boosting machine); (2) a feature matrix is built by a pre-trained word embedding model and used to train a CNN. These methods were used to identify the chapter-level ICD-10-CM diagnosis codes in a set of discharge notes. An evaluation was conducted using 103,390 discharge notes covering patients hospitalized from June 1, 2015 to January 31, 2017 in the Tri-Service General Hospital. The receiver operating characteristic curve was used as an evaluation measure, and the area under the curve (AUC) was taken as a global measure of effectiveness. Results: In five-fold cross-validation tests, our method had a higher testing accuracy (a mean AUC of 0.9696) than traditional NLP-based approaches (a mean AUC of 0.8183–0.9571). A real-world simulation that split the training sample and testing sample by date verified this result (a mean AUC of 0.9645 using the proposed method). Further analysis showed that the convolutional layers of the CNN effectively identified a large number of keywords and automatically extracted enough concepts to predict the diagnosis codes. Conclusions: Word embedding combined with a CNN shows outstanding performance compared with traditional methods, and it needs hardly any data pre-processing. This shows that future studies will not be limited by incomplete dictionaries. A large amount of unstructured information from free-text medical writing will be extracted by automated approaches in the future, and we believe that the healthcare field is about to enter the age of big data.

  • Development of e-Health Literacy Assessment (eHLA): a seven tool toolkit for assessesing the competencies needed to engage with digital health services

    From: Journal of Medical Internet Research

    Date Submitted: Jul 7, 2017

    Open Peer Review Period: Jul 7, 2017 - Sep 1, 2017

    Background: Digitalisation of health care systems has added a new dimension to health care services. To gain full potential of digitalization in healthcare, we need to better understand individuals’...

    Background: Digitalisation of health care systems has added a new dimension to health care services. To gain full potential of digitalization in healthcare, we need to better understand individuals’ e-health literacy. However, there is a lack of tools that provide a short and multi-facetted assessment of individuals engaging with digital health services. Objective: n response to this, the authors initiated the development and validation of the e-Health Literacy Assessment (eHLA) toolkit. eHLA consists of seven tools with four health-related (tool 1. “Functional Health Literacy”, tool 2. “Self-rated health literacy”, tool 3. “Familiarity with health and disease”, and tool 4. “Knowledge of health and disease”) and three digitally-related (tool 5. “Digital familiarity”, tool 6. “Digital confidence”, tool 7. “Digital motivation”) tools. The seven tools are a mix of existing, adapted, and original scales. Methods: eHLA was validated in a population sample of 475 respondents from the general community and an outpatient clinic north of Copenhagen, Denmark. Initial statistical analyses examined floor and ceiling effects, inter-item correlations, item-total correlations, calculation of Cronbach’s coefficient alpha (CCA), and further analyses examined fit of the data to the Rasch model (RM) and evaluated differential item functioning (DIF) with regards to age and sex. Each tool was reduced in items based on a combination of statistics results, face validity, and content validity. Results: Tool 1 was not reduced in items, and it consequently consists of 10 items. The overall fit to the RM was acceptable (Andersens CLR=10.8, df=9, p=0.2876), and CCA was 0.67. Tool 2 was reduced from 20 to nine items. The overall fit to a log linear RM was acceptable (Andersens CLR=78.4, df=45, p=0.0015) and CCA was 0.85. Tool 3 was reduced from 23 to five items. The final version of tool 3 consists of five items and showed excellent fit to a log linear RM (Andersens CLR=47.7, df=40, p = 0.1870). CCA was 0.90. Tool 4 was reduced from 12 to six items. The fit to a log linear RM was acceptable (Andersens CLR=42.1, df=18, p=0.0011) and CCA was 0.59. Tool 5 was reduced from 20 to six items. The fit to the RM was acceptable (Andersens CLR=30.3, df=17, p=0.0240) and CCA was 0.94. Tool 6 was reduced from five to four items. The fit to a log linear RM taking local dependency into account was acceptable (Andersens CLR=26.1, df=21, p=0.2031) and CCA was 0.91. Tool 7 was reduced from six to four items. The fit to a log linear RM taking LD and DIF into account was acceptable (Andersens CLR=23.0, df=29, p=0.7760) and CCA was 0.90. Conclusions: The eHealth Literacy Assessment toolkit is a validated set of tools to describe facets of individuals’ knowledge and skills in the engagement with digital health services.

  • Mobile Technology Use In Patients Eligible For Cardiac Rehabilitation: Does Age Matter?

    From: Journal of Medical Internet Research

    Date Submitted: Jul 5, 2017

    Open Peer Review Period: Jul 5, 2017 - Aug 30, 2017

    Background: Emerging evidence indicates mobile technology-based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardia...

    Background: Emerging evidence indicates mobile technology-based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardiac patients’ use of mobile technology, particularly for health reasons and whether usage varies across patient demographics. Objective: This study aims to describe cardiac patients’ use of mobile technology and to determine variations between age groups after adjusting for education, employment and confidence with using mobile technology. Methods: Cardiac patients eligible for/attending cardiac rehabilitation were recruited from nine hospital and community sites across metropolitan and rural settings in New South Wales, Australia. Participants completed a survey on use of mobile technology devices, features used, confidence with using mobile technology, willingness and interest in learning, and health-related use. Results: The sample (n = 282) had a mean age of 66.5 (SD 10.6) years, 72% (203/282) were male and 79% (223/282) lived in a metropolitan area. The most common diagnoses were percutaneous coronary intervention (33.3%, 94/282) and myocardial infarction (22.7%, 64/282). The majority (91.6%, 257/282) used at least one type of technology device, 70.9% (200/282) used mobile technology (smartphone/tablet) and 31.9% (90/282) used all types. Technology was used by 54.9% (154/282) for health purposes, most often to access information on health conditions (41.4%, 117/282) and medications (34.8%, 98/282). Age had an important independent association with mobile technology use after adjusting for education, employment and confidence. The youngest group (<56 years) was over four times more likely to use any mobile technology than the oldest (>69 years) age group (OR 4.45, 95% CI 1.46, 13.55), five times more likely to use mobile apps (OR 5.00, 95% CI 2.01, 12.44) and three times more likely to use technology for health-related reasons (OR 3.31, 95% CI 1.34, 8.18). In comparison to the older group, the middle age group (56-69 years) was more than twice as likely to use any mobile technology (OR 2.42, 95% CI 1.27, 4.59) and mobile technology for health-related purposes (OR 1.92, 95% CI 1.04, 3.53). Participants who had completed high school were twice as likely to use mobile technology (OR 2.62, 95% CI 1.45, 4.70) and mobile apps (OR 2.05, 95% CI 1.09, 3.84) and to use mobile technology for health-related reasons (OR 5.09, 95% CI 2.89, 8.95) than those who had not completed high school. Associations were also present for participants living in metropolitan areas and mobile technology use (OR 1.07, 95% CI 1.07, 4.24) and employment and mobile app use (OR 2.72, 95% CI 1.44, 5.140). Conclusions: Mobile technology offers an important opportunity to improve access to secondary prevention for cardiac patients, particularly when modified to suit subgroups. High levels of mobile technology use and health motivation need to be harnessed for secondary prevention. Clinical Trial: not applicable

  • ‘Wish you were here’: Examining assumptions about missing cases from psychotherapeutic trials

    From: JMIR Mental Health

    Date Submitted: Jul 6, 2017

    Open Peer Review Period: Jul 12, 2017 - Sep 6, 2017

    Background: Missing cases are common in clinical psychotherapeutic trials, and pose a challenge to the accuracy of measuring clinical outcomes [1]. However, little is known about the characteristics o...

    Background: Missing cases are common in clinical psychotherapeutic trials, and pose a challenge to the accuracy of measuring clinical outcomes [1]. However, little is known about the characteristics of psychotherapy participants with missing values, their likely clinical outcomes, or suitability of different statistical assumptions that can characterise missing cases. Objective: Using a large sample, undergoing psychotherapy for depressive symptoms (n=820), this study aimed to explore the characteristics of missing cases (n=138), their likely treatment outcomes, and compare between statistical methods for replacing missing values. Methods: Initially, common participant and treatment features were tested through binary logistic regression, identifying variables that predict missing cases. Secondly, the same variables were screened for their ability to increase, or impede the rate of symptom remission. Third, using recontacted cases at three-month follow-up, to proximally measure treatment outcomes, simulated replacement scores and observed clinical outcomes were compared. Results: Missing cases were dominantly predicted by lower treatment adherence and increased symptoms at pre-treatment, and report symptom that are 30% higher than average at follow-up. Longitudinal statistical methods (GEE or MIXED models) that adjusted their estimates for missing values by treatment adherence rates and baseline symptoms severity (under the MAR assumption), predicted follow-up missing cases outcomes minimal measurement bias (<8%). Conclusions: Missing cases demonstrated characteristics, which can jointly be associated with likelihood of becoming missing and lesser clinical improvement. Under such circumstances, treatment effects can become concealed. Statistical methods that ignore these characteristics can overlook an important clinical phenomenon and generate inaccurate treatment outcome replacement estimates (-32% to 70% off the mark).

  • Training Working Memory in Adolescents using Serious Game Elements

    From: JMIR Serious Games

    Date Submitted: Jul 6, 2017

    Open Peer Review Period: Jul 6, 2017 - Aug 31, 2017

    Background: Working memory capacity (WMC) has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of WMC can lead to significant behavio...

    Background: Working memory capacity (WMC) has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of WMC can lead to significant behavioral improvements, but is usually long and tedious, taxing motivation. Objective: We evaluated whether adding game elements to the training could help improve adolescents’ motivation to train while improving cognition. Methods: Eighty-four high school students were allocated to a WMC-training, a gamified WMC-training or a placebo condition. WMC, motivation to train, and drinking habits were assessed before and after training. Results: Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified WMC-training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. WMC increased equally in all conditions, but did not lead to significantly lower drinking. Conclusions: We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time.

  • School counsellor perspectives on the factors influencing uptake of an online stepped care mental health service for schools: A cross-sectional online survey

    From: JMIR Mental Health

    Date Submitted: Jul 6, 2017

    Open Peer Review Period: Jul 11, 2017 - Sep 5, 2017

    Background: Mental health problems are common among high school aged youth and School Counsellors play a key role in the provision of school-based mental healthcare. However, school counsellors occupy...

    Background: Mental health problems are common among high school aged youth and School Counsellors play a key role in the provision of school-based mental healthcare. However, school counsellors occupy a multi-specialist role that makes it difficult for them to provide care to all of those who are in need in a timely manner. Internet-delivered (i.e. “online”) mental health services that offer screening, psychological therapy, and monitoring, may help counsellors manage time and yet still provide oversight. However, for such a model to be implemented successfully, school counsellors’ views about the value and potential implementation of services needs to be measured. Objective: The current study aimed to examine school counsellors’ acceptability of a proposed online mental health service, the feasibility of providing this type of service in the school context, and the barriers and facilitators of implementation. Methods: This study utilised a mixed-methods, online, cross sectional survey to evaluate school counsellors’ perspectives. Results: A total of 145 school counsellors completed the survey. Overall, a total of 82% (n=119) thought that the proposed service would be helpful to students. One third reported that they would recommend the proposed model, with the majority reporting potential concerns. Although background factors were not found to influence the levels of comfort, issues such as personal beliefs, knowledge and awareness, internet accessibility, privacy and confidentiality, were found to influence, both positively and negatively, the likelihood of school counsellors implementing a school-based online mental health service. Conclusions: This study confirms that greater support and resources are needed to facilitate what is already a challenging and emotionally demanding role for school counsellors. Mental health issues among students are dominant, and school counsellors are time poor. While the school counsellors in the current study were open to the proposed service model, the issues identified must be carefully addressed if implementation is to be successful.

  • Identifying Asbestos-Containing Materials in Homes: Design and Development of the ACM Check Mobile Phone App

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 12, 2017

    Open Peer Review Period: Jul 13, 2017 - Sep 7, 2017

    Background: Asbestos-containing materials (ACM) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-y...

    Background: Asbestos-containing materials (ACM) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-yourself home renovations. However, there remains a lack of knowledge and awareness amongst community members about asbestos identification and its safe management in residential settings. Objective: To describe the process of developing a mobile phone application (“app”), ACM Check, that incorporates a questionnaire designed to identify and assess asbestos-containing materials located in residential settings. Methods: A multidisciplinary team was involved in the formative development and creation of the mobile phone app. The formative development process included 6 steps: defining the scope of the app; comprehensive desktop review; drafting and revising the content, questionnaire, conditional branching rules and scoring algorithms; expert input; manual pre-testing of the questionnaire; and formulation of a final content document to be provided to the software development company. ACM Check was then constructed on the iOS platform for use in a validation study prior to being updated, replicated on Android, and released to the public. Results: The ACM Check app identifies potential ACMs, prioritises the materials based on their condition and likelihood of disturbance, and generates a summary report for each house assessed. Conclusions: ACM Check is an initiative to raise community members’ awareness of asbestos in the residential environment and also serves as a data collection tool for epidemiological research. It can potentially be modified for implementation in other countries or used as the basis for the assessment of other occupational or environmental hazards.

  • Cell phones and HIV linkage to care: Lessons from a randomised clinical trial

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 7, 2017

    Open Peer Review Period: Jul 9, 2017 - Sep 3, 2017

    The high availability of cell phones and the growing access to internet-enabled ‘’smart’’ phones in developing countries, has led to interest in using the technology to improve patient engagem...

    The high availability of cell phones and the growing access to internet-enabled ‘’smart’’ phones in developing countries, has led to interest in using the technology to improve patient engagement with health care. In HIV treatment programmes, the ‘’cascade of care’’, where patients are lost between diagnosis, laboratory evaluation, treatment initiation and then subsequent retention on antiretroviral therapy, is a well described challenge. We evaluated a smart phone application (“app”) in a randomised controlled trial, to evaluate whether giving patients their confidential laboratory results through the app and with attendance reminders, improved engagement with care after initial HIV diagnosis. The results are being prepared for publication, but here we describe in detail the significant operational and technological issues we experienced within the study, that severely hampered recruitment, despite a large majority of patients approached expressing interest in the study. We found that many of the issues around software installation, as well as data availability, meant that only 10% of newly diagnosed HIV patients could install the app on their phones. These issues may assist future programmes planning similar interventions to avoid some of the pitfalls we encountered, including having to take into account the large variety of cell phones, software platforms, and available memory being used by the patient population we drew from, as well as issues such as data cost. Ensuring sufficient expertise and understanding of the programmatic needs by the software developer, as well as in the implementation team, with adequate and rapid piloting within the target groups, may have ensured better recruitment. That said, the majority of newly diagnosed patients were interested in the study, and the app was installed successfully and used, in patients with sufficiently powerful cell phones, suggesting that this may be a way to engage patients with their health care data in future.

  • Internet- and mobile-based general practice: Who are the suitable consultants?

    From: Journal of Medical Internet Research

    Date Submitted: Jul 7, 2017

    Open Peer Review Period: Jul 9, 2017 - Sep 3, 2017

    Background: As a promising technology for the promotion of quality healthcare, mHealth is increasing in the world. To make full use of the advantages, an increase of internet hospitals established in...

    Background: As a promising technology for the promotion of quality healthcare, mHealth is increasing in the world. To make full use of the advantages, an increase of internet hospitals established in China. However, there is no study of the service scope and patient satisfaction of the internet hospital yet. Objective: The aim of the study was to explore the features of outpatients in general practice clinic of the internet hospital in order to provide the references for general practitioners (GPs) who will work for online clinic. Methods: Data were collected from the internet hospital of the first affiliated hospital, Zhejiang University between February 2016 and February 2017. Patients logon the internet hospital with the computer or mobile phone. The information included patients’ characteristics and the information of diseases. Results: There were totally 715 visits. According to the system classification, the former five ones were musculoskeletal system (12.73%), the digestive system (11.33%), the reproductive system (9.23%), urinary tract (7.69%) and the endocrine system (6.58%). According to the management, 451 patients (63.08%) should visit the offline clinic, 181 patients (25.31%) had received medication or test appointment, 9 people (1.26%) should use emergency department, and 74 people (10.35%) need supportive counseling. All patients received the corresponding health education. According to the diagnosis, 563 patients (78.74%) are diagnosed, while 152 individuals (21.26%) are medically unexplained physical symptoms (MUPS). Conclusions: Internet- and mobile-based online practice is feasible and convenient for patients with high satisfaction. Patients with chronic disease, health consultation and health education are suitable for internet hospital.

  • Use of social network services for communication among health professionals: a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Jul 20, 2017

    Open Peer Review Period: Jul 20, 2017 - Sep 14, 2017

    Background: Social network services (SNSs) are subject to tremendous exploitation in health communication. Although much research has been done investigating the roles of SNSs in linking patients and...

    Background: Social network services (SNSs) are subject to tremendous exploitation in health communication. Although much research has been done investigating the roles of SNSs in linking patients and health professionals, there is a lack of evidence on their uses, benefits and limitations in connecting health professionals. Objective: This review aimed to examine the utilization of SNSs for communication among health professionals in (1) frontline clinical practice, (2) professional networks and (3) education and training, so as to identify areas for future health communication research. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of the literature published in the last ten years (1 January 2007–1 March 2017) was performed in March 2017, using the following electronic databases: Medline via OvidSP, Embase, CINAHL Complete and InfoSci Journals. The searches were performed using the following defined search terms: ‘social media’ OR ‘social network’ OR ‘social network site’ OR ‘Facebook’ OR ‘Twitter’ OR ‘Linkedin’ OR ‘Instagram’ OR ‘Weibo’ OR ‘Whatsapp’ OR ‘Telegram’ OR ‘WeChat’ AND ‘health’ OR ‘health profession’. Results: A total of 32 studies were included in this review. They were exploratory in nature, and the majority utilized surveys, interviews and content analysis. The most reported SNSs were Twitter, Facebook, WhatsApp Messenger and LinkedIn. All retrieved studies stated that SNSs enhanced effective communication and information sharing. In clinical practice, SNSs were used for supporting operations, making referrals, and disseminating guidelines. They were beneficial in network building and professional collaboration. SNSs were novel tools to enhance educational interactions among peers, students, instructors and preceptors. Yet, the application of SNSs for professional communication came with restraints in technical knowledge and techniques. Concerns regarding data protection, privacy and liability should be addressed by proper institutional policy and training. Conclusions: SNSs create a new dimension in communication among health professionals. Expanding professional networks, disseminating multimedia information and producing positive learning experiences are the benefits observed. The evolving use of SNSs necessitates that health professionals match the pace of development. Further robust research such as randomized controlled trials is required to explore the full potential and relative effectiveness of SNSs in professional communication.

  • Feasibility of a Smart Phone Application Supporting Recovery from Addiction in China

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 10, 2017

    Open Peer Review Period: Jul 11, 2017 - Sep 5, 2017

    Background: Mobile health technologies have been shown to improve self-management of chronic diseases. However, there is limited research investigating its feasibility in supporting recovery from subs...

    Background: Mobile health technologies have been shown to improve self-management of chronic diseases. However, there is limited research investigating its feasibility in supporting recovery from substance use disorders (SUDs) in China. Objective: Mobile health technologies have been shown to improve self-management of chronic diseases. However, there is limited research investigating its feasibility in supporting recovery from substance use disorders (SUDs) in China. Methods: A total of 75 participants with SUDs in Shanghai were recruited to participate in the pilot study lasting 4 weeks, with 50 participants randomly assigned to the experimental group and 25 participants to the control group. The experimental group used m-health based ecological momentary assessment (EMA) technology to assess their daily drug use in natural environments, while the control group only received 2 short health messages each day from the app. Urine test and life experience timeline (LET) assessment were conducted at each week and a post-intervention survey was conducted for both groups. The correspondence between EMA and LET data were investigated. Results: The mean age of our participants was 41.6 years, and 70.7% were male. During 4 weeks of observation, 690 daily EMA survey data were recorded with the response rate being 49.3%. The percent agreement of drug use between EMA and LET was 66.7%, 79.2%, 72.4%, and 85.8% for each of the 4 weeks, and the correspondence between EMA and urine test was 51.2%, 65.1%, 61.9%, 71.5%. Post-intervention survey indicated that participants (45.7%) preferred to use face-to-face interview rather than m-health app. Conclusions: This study demonstrated a good concordance between EMA data and LET, but the acceptance of m-health among SUDs in China was not optimistic. Much more efforts are needed to improve its acceptance in China.

  • Investigating the Use of Smartphones for Learning Purposes by Iranian Dental Students

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 10, 2017

    Open Peer Review Period: Jul 10, 2017 - Sep 4, 2017

    Background: The use of smartphones for teaching and learning purposes is increasingly being developed in the field of dentistry. Objective: This study aims to investigating the use of smartphones for...

    Background: The use of smartphones for teaching and learning purposes is increasingly being developed in the field of dentistry. Objective: This study aims to investigating the use of smartphones for learning purposes by iranian dental students. Methods: This is a descriptive study. The population of study consists of the general students of The Faculty of Dentistry of Ahvaz Jundishapur University of Medical Sciences (AJUMS) located in south west of Iran. Sampling was practiced through census and by distributing questionnaires between all cases. Totally, 109 cases (64 females and 45 males) filled the questionnaire. Data was analyzed using SPSS 21. Results: Surfing course-related websites in the Internet and sharing notes with each other are the most frequent used items accounting for 96% and 94% of smartphone use, respectively. In addition, 91% of cases believe that smartphone improves their access to the content of courses. Moreover, 95% of cases have access to social media, especially Telegram, via their smartphone and acknowledge its usefulness in the education field. There was a positive correlation between the use of smartphones for general purposes and the use of them for learning purposes (0.483). In addition, the correlation between age and the use of smartphones for general purposes and between age and the use of smart phones for learning purposes is negative (-0.279). Conclusions: The use of smartphones for learning purposes or combining traditional educational approaches and e-teaching methods, including smartphones, can provide students with more diverse learning opportunities. Clinical Trial: The use of smartphones for learning purposes or combining traditional educational approaches and e-teaching methods, including smartphones, can provide students with more diverse learning opportunities.

  • Rationale and design of ‘Do Cardiac Health: Advanced new Generation Ecosystem (Do CHANGE)’ randomized, controlled trial: Enhancing lifestyle change in cardiac patients

    From: JMIR Research Protocols

    Date Submitted: Jul 11, 2017

    Open Peer Review Period: Jul 11, 2017 - Jul 25, 2017

    Background: Promoting a healthy lifestyle (e.g. physical inactivity, unhealthy diet) is crucial for primary and secondary prevention of non-communicable diseases (e.g. cardiac disease, diabetes). Obje...

    Background: Promoting a healthy lifestyle (e.g. physical inactivity, unhealthy diet) is crucial for primary and secondary prevention of non-communicable diseases (e.g. cardiac disease, diabetes). Objective: Current trial aims to evaluate the effectiveness of the Do CHANGE service which is developed to assist cardiac patients in adopting a healthy lifestyle and improving their quality of life. Methods: Cardiac patients (heart failure, coronary artery disease, hypertension) will be recruited at three pilot sites (Badalona Serveis Assistencials, Badalona, Spain (N=75); Buddhist Tzu Chi Dalin General Hospital, Dalin, Taiwan (N=100) and Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands (N=75)). Patients will be supported by the Do Something Different (DSD) programme to change their unhealthy habits / lifestyle. DSD had been developed to increase behavioral flexibility and subsequently adopt new (healthier) habits. In addition, patients’ progress will be monitor with a number of (newly developed) devices (e.g. Fitbit, Beddit, COOKiT, FLUiT) which will be integrated in one application. Results: Do CHANGE trial will provide us with new insight regarding the effectiveness of the proposed intervention. In addition, it will give insight in what work for whom and why. Conclusions: The Do CHANGE service integrates new technologies with behavioral intervention in order to change unhealthy lifestyle of cardiac patients. By changing unhealthy habits with the DSD programme, it is expected that the Do CHANGE service will produce long-term, sustainable behavior change. Clinical Trial: Clinicaltrials.gov NCT03178305

  • Raising awareness about cervical cancer using Twitter: a content analysis of the 2015 #SmearForSmear campaign

    From: Journal of Medical Internet Research

    Date Submitted: Jul 12, 2017

    Open Peer Review Period: Jul 13, 2017 - Sep 7, 2017

    Background: Cervical cancer is the 2nd cause of cancer among women under age 45. To deal with the decrease of smear test (ST) coverage in United Kingdom, a Twitter campaign called #SmearForSmear has b...

    Background: Cervical cancer is the 2nd cause of cancer among women under age 45. To deal with the decrease of smear test (ST) coverage in United Kingdom, a Twitter campaign called #SmearForSmear has been launched in 2015 for the European Cervical Cancer Prevention Week. Its aim was to encourage women to take a selfie showing their lipstick going over the edge and post it on Twitter with a raising awareness message promoting cervical cancer screening. Estimated audience was 500 million of people. Other public health campaigns have been launched on social medias such as Movember to encourage participation and self-engagement. Their result was unsatisfactory as their aim had been diluted to become mainly a social buzz. Objective: Our objectives were to identify the tweets delivering a raising awareness message promoting cervical cancer screening (sensitizing tweets) and the characteristics of Twitter users posting about this campaign. Methods: 3-step content analysis of the English tweets tagged #SmearForSmear posted on Twitter for the 2015 European Cervical Cancer Prevention Week. Data were collected using Twitter API. Their extraction was based on an analysis grid generated by two independent researchers using a thematic analysis, validated by a strong Cohen’s kappa coefficient. 7 themes coded for sensitizing tweets and 13 for Twitter users’ status. Verbatims were thematically then statiscally analyzed. Results: 3018 tweets were collected, 1881 analysed. 70% of tweets had been posted by people living in United Kingdom. 57.4% of users were women, sex was unknown in 36% of cases. 54.4% of the users had posted at least one selfie with smeared lipstick. 32.2% of tweets were sensitizing. Independent factors associated with posting sensitizing tweets were: woman who experienced an abnormal ST (OR 13.456 [CI95% 3.101-58.378], p = 0.0005), female sex (OR 3.752 [CI95% 2.133-6.598], p < 0.0001) and live in the United-Kingdom (OR 2.097 [CI95% 1.447-3.038], p < 0.0001). Non-sensitizing tweets were statistically more posted by non-health or non-media company (OR 0.558 [CI95% 0.383-0.814], p = 0.0024). Conclusions: This study demonstrates that the success of a public health campaign using a social media depends on its ability to get its targets involved. It also suggests the need to use social marketing to help its dissemination. The clinical impact of this Twitter campaign to increase cervical cancer screening is yet to evaluate.

  • Digital health interventions in type 2 diabetes: a qualitative study of patient perspectives on digital diabetes self-management education and support

    From: Journal of Medical Internet Research

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    Background: The prevalence of type 2 diabetes is increasing globally and health services in many countries are struggling with the morbidity, mortality and costs associated with the complications of t...

    Background: The prevalence of type 2 diabetes is increasing globally and health services in many countries are struggling with the morbidity, mortality and costs associated with the complications of this long-term condition. Diabetes self-management education and behavioural support can reduce the risks of developing diabetes-related complications and improve glycaemic control. However, their uptake is low. Digital health interventions can provide sustained support and may overcome challenges with attendance at diabetes self-management sessions. They have the potential for delivery at multiple locations at convenient times, anonymity, and presentation of content in attractive and tailored formats. This study investigates the needs and wants of patients with type 2 diabetes to inform the development of digital self-management education and support. Objective: To explore patient perspectives on unmet needs for self-management and support and the role of digital health interventions in adults living with type 2 diabetes. Methods: Qualitative study based on data generated from four focus groups with 20 patients. Results: The data generated by the focus groups illustrated the significant burden that the diagnosis of diabetes places on many patients and the negative impacts on their emotional wellbeing, work, social life and physical health. Although patients’ experiences of the health care services varied, there was agreement that even the best services were unable to meet all users’ needs to support the emotional regulation and psychological adjustment needed for successful self-management. Conclusions: By focusing on medical management and information provision, existing healthcare services and education programmes may not be adequately meeting all the needs of patients with type 2 diabetes. Digital health interventions have the potential to improve access to diabetes self-management education and behavioural support and extend the range of content offered by health services to fit with a wider range of patient needs. Features that could help digital health interventions meet some of the unmet needs described by participants in this study included placing an emphasis on emotional and role management, being available at all times, having up-to-date evidence based guidance for patients and providing access to peer-generated and professional advice.

  • Public Health Echo Chambers in the Digital Media Ecosystem

    From: JMIR Public Health and Surveillance

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 17, 2017 - Jul 31, 2017

    Background: With the digitization and disintermediation of the information landscape, conflicting information online is pervasive. The World Economic Forum named digital misinformation as one of the m...

    Background: With the digitization and disintermediation of the information landscape, conflicting information online is pervasive. The World Economic Forum named digital misinformation as one of the main threats to society today. We’ve also witnessed a widespread decline in trust in major institutions. The breadth of information available online complicates the problem of mistrust. Given a broad selection of media, audiences tend to select information that conforms to their pre-existing beliefs, even when their chosen information is counter to fact. This complicates the process of disseminating evidence-based information, with particular consequences for the field of health. Objective: Homophily in social networks fosters an environment that reinforces pre-existing opinions, even when contrary to evidence. This creates sub-communities known as "echo chambers." Here, we analyze the digital media ecosystem to better understand information communities for public health topics. Methods: Using the open online platform Media Cloud, we developed the novel suite of tools to create a searchable archive of over 25,000 online media sources, including US and UK newspapers, broadcast media networks, and other influential publications. We analyzed hyperlink behavior and word frequency, investigating the phenomena of echo chambers for three case studies: Ebola, Zika and vaccines. Results: We identified information sub-communities for each case study, based on hyperlink citations between sources and similar framing of the topic. Information authorities existed in each sub-community, linking more frequently to sources in their own sub-community than to those in different sub-communities. Each information network studied contained a distinct, isolated public health sub-community. Conclusions: Echo chambers likely complicate the dissemination of evidence-based public health information. This illuminates the need for innovation in public health communications, and strategies for directly engaging with a variety of online communities.

  • Creating a Predictive Model for employee turnover utilizing behavioral risk factors extracted from an employer-based Happiness app

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    Background: In the past, significant research has been directed towards predicting churn of customers, particularly in the telecoms industry. However, few works have addressed the equally important qu...

    Background: In the past, significant research has been directed towards predicting churn of customers, particularly in the telecoms industry. However, few works have addressed the equally important question of employee turnover in companies and none have been able to create a predictive model to manage retention Objective: To identify turnover risk factors of employees. Methods: Using a smartphone Happiness application that tracks Happiness, we applied search-engine like classification methods (such as Google page ranking algorithm) to rank employees by risk of turnover. We set a risk cut-off to cluster employees in two groups: the ones that turn over and the ones that stay in the company. Then we used the top discriminant traits of each group to identify risk factors. The data source is the employee interaction with a mobile app that is used to track happiness. Sample size: 4k employees. Time length: 2 years. Participating companies: 34. Results: We developed a turnover prediction model that identifies employees that turnover with Sensitivity 34% and Specificity 99.4%. Predictive value of the positive test is 80%. Predictive value of the negative test= 96%. Test set contained 116 churns, test set sample size 1944 employees. Risk factors related to app usage are identified. Conclusions: The top three risk factors related to employee churn are low number of likes received in the anonymous company forum (low employee comment likeability), infrequent company posts (disengaged company), lower happiness than the company average (low relative happiness). Other factors such as absolute individual happiness, or likes given to other's anonymous post (positivity and engagement of the employee) was not found to be correlated with turnover. Clinical Trial: Does not apply

  • Reproducibility and Validation of the Qardioarm Application in the Assessment of Blood Pressure and Heart Rate: Reliability and ValidityStudy

    From: Journal of Medical Internet Research

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 17, 2017 - Sep 11, 2017

    Background: Self-measurement of blood pressure is a priority strategy for managing blood pressure. Objective: Following the European Society of Hypertension’s international validation protocol, we e...

    Background: Self-measurement of blood pressure is a priority strategy for managing blood pressure. Objective: Following the European Society of Hypertension’s international validation protocol, we evaluated the reliability and validity of blood pressure and heart rate as measured with the Qardioarm, a fully automatic, non-invasive wireless blood pressure monitor and mobile application. Methods: Test-retest validation study, with two measurement sessions separated by 2-5 days. A single study site with an evaluation room that was maintained at an appropriate temperature and kept free from noises and distractions. 100 healthy volunteers over age 25 from the general population of Ciudad Real, Spain. In each measurement session, 7 systolic blood pressure, diastolic blood pressure, and heart rate assessments were taken, alternating between two devices. The test device was the Qardioarm and the previously validated criterion device was the Omron M3. Results: The Qardioarm displayed very consistent readings both within and across sessions (intraclass correlation coefficients = .80-.95, standard errors of measurement = 2.5-5.4). The Qardioarm measurements corresponded closely to those from the criterion device (Pearson correlations > .96) and mean values for the two devices were nearly identical. The Qardioarm easily passed all validation standards set by the European Society of Hypertension international protocol. Conclusions: The Qardioarm can be recommended for clinical use in individuals with similar characteristics as those who participated in this study. Clinical Trial: IT IS NOT A CLINICAL TRIAL

  • Using a Web-based Transitions Intervention to Help Informal Caregivers of Older Adults with Dementia and Multiple Chronic Conditions: A Qualitative Study

    From: Journal of Medical Internet Research

    Date Submitted: Jul 14, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    Background: Informal caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of older persons with Alzheimer disease and related dementia (ADRD) in combination...

    Background: Informal caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of older persons with Alzheimer disease and related dementia (ADRD) in combination with multiple chronic conditions (MCC) who are living at home. However, they often do so to the detriment of their own physical, mental and emotional health. Caregivers often experience multiple, concurrent transitions (eg, changes to their roles and responsibilities). Recent evidence suggests that Web-based interventions have the potential to support informal caregivers by decreasing caregiver stress and burden. However, we know little about how Web-based supports help caregivers deal with the complex transitions they experience. Objective: The objectives of this paper were to describe: (a) how the use of a self-administered, psychosocial, supportive, Web-based Transition Toolkit, My Tools 4 Care (MT4C), helped informal caregivers of older adults with ADRD and MCC deal with the transitions they experienced as caregivers; (b) which features of MT4C caregivers found most and least beneficial; and (c) what changes would they would recommend making to MT4C. Methods: This study was part of a larger multi-site mixed methods pragmatic randomized controlled trial (RCT). The qualitative portion of the study and the focus of this article used a qualitative descriptive design. Data collectors conducted semi-structured, open-ended, telephone interviews with study participants who were randomly allocated to use MT4C for 3 months. All interviews were audio-taped and ranged from 20-40 minutes. Interviews were conducted at 1 and 3 months following a baseline interview. Qualitative content analysis was used to analyze collected data. Results: Fifty-six informal caregivers from Alberta and Ontario, Canada, participated in either 1 or both of the follow-up interviews (89 interviews in total). Five main themes, describing how MT4C helped caregivers deal with transitions in the context of caring for an older adult with ADRD and MCC, were identified: (1) using MT4C encouraged reflection; (2) using MT4C encouraged sharing of caregiving experiences; (3) using MT4C provided a source of information and education; (4) using MT4C provided affirmation; and (5) for some participants, using MT4C did not help with significant changes. Conclusions: Study results indicate that a self-administered psychosocial supportive Web-based resource helps caregivers of community-dwelling older adults with ADRD and MCC deal with the complex transitions they experience in their roles and responsibilities, identifying supports for caring, caring for self, and planning for future caregiving roles and responsibilities. Caregivers shared important recommendations for future development of Web-based supports.

  • Exploring the role of in-person components for online health behaviour change interventions: Can a digital person-to-person component suffice?

    From: Journal of Medical Internet Research

    Date Submitted: Jul 14, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    The growth of the digital environment provides tremendous opportunities to revolutionize health behaviour change efforts. This article explores the use of Web-based, mobile, and social media health be...

    The growth of the digital environment provides tremendous opportunities to revolutionize health behaviour change efforts. This article explores the use of Web-based, mobile, and social media health behaviour change interventions and determine if there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioural theories such as the Theory of Reasoned Action, and the Social Cognitive Theory, and further justified by the human support constructs of the Model of Supportive Accountability. Overall, face-to-face and online behaviour change interventions have their respective advantages and disadvantages and functions yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behaviour change interventions and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behaviour change. As the popularity of the online world grows, and the interest in using the digital environment for health behaviour change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored.

  • Reliability and Validity of the Telephone-Based eHealth Literacy Scale: Evidence from Data Collected among Older Adults

    From: Journal of Medical Internet Research

    Date Submitted: Jul 21, 2017

    Open Peer Review Period: Jul 21, 2017 - Sep 15, 2017

    Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally mo...

    Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. Objective: Examine the reliability and internal structure of eHEALS data collected from older adults over the age of 50 responding to items over the telephone. Methods: Respondents completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the Partial Credit Model (PCM) explored the internal structure of eHEALS data. Results: Compared to 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (RMSEA=0.07; CFI=1.0; TLI=1.0). Nonetheless, the 3 factors were highly correlated (r = 0.36 - 0.65). Item analyses revealed that eHEALS items 2 through 5 were over-fit to a minor degree (mean square infit/outfit values < 1.0; t-statistics < -2.0), but the internal structure of Likert scale response options functioned as expected. Over-fitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher-end of the latent continuum (i.e., those with high eHealth literacy), as compared to those at the lower end of the continuum (i.e., those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. Conclusions: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3-factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with three underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to modify the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations.

  • Proposed Taxonomy of Telemedicine

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 15, 2017

    Open Peer Review Period: Jul 16, 2017 - Sep 10, 2017

    Background: In the past 20 years, the use of telemedicine has increased, with telemedicine programs being conducted through the Internet and ISDN technologies. Objective: To validate a proposed taxono...

    Background: In the past 20 years, the use of telemedicine has increased, with telemedicine programs being conducted through the Internet and ISDN technologies. Objective: To validate a proposed taxonomy using keywords from a random sample Methods: I used three facets to search the Scopus database for telemedicine and drew a random sample from the results. I analyzed author and index keywords from the 327 random sample articles, along with taking into account the long literature review I conducted for my dissertation Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship to create my own taxonomy of telemedicine and to validate the three taxonomies of Tulu, Chatterjee and Maheshwari (2007), Bashshur, Shannon, Krupinski, Grigsby (2011), and Nepal, Li, Jang-Jaccard, and Alem (2014). Results: Results: The keywords collected from the random sample fit into the Proposed Taxonomy categories and so validated the Proposed Taxonomy. Conclusions: As is evident from the ontology rendered from the keywords found in the author and index keywords, telemedicine touches on several areas. Central to telemedicine are diagnosis and treatment of disease, including specific disease and specific telemedicine used.

  • The Effect of Using Mobile Phone on Medical Students’ Mental Focus in Respond to Knowledge Questions

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 18, 2017

    Open Peer Review Period: Jul 18, 2017 - Sep 12, 2017

    Background: BACKGROUND: Today, using the mobile phone has grown widely. This massive growth captures the attention of researchers on biological effects of mobile phone. Evidences have shown that exces...

    Background: BACKGROUND: Today, using the mobile phone has grown widely. This massive growth captures the attention of researchers on biological effects of mobile phone. Evidences have shown that excessive use of mobile phone has negative impact on physical and psychological health of mobile phone users. Objective: Aims: to evaluate the effect of using mobile phones on the students’ mental focus when they answer to general scientific questions, simultaneously in Ahvaz, Iran. Methods: METHOD: In this analytical study, a group of 60 students in the field of Health Information Technology (HIT) were participated. Participants were evaluated in order to verify the same level of information homogeneity and the ability of using a mobile phone. Therefore, the students were asked at the first step to respond to general information questions showed in computer monitor. Then, a message including 6-9 words by mobile phone was typed by the subjects while the typing time was registered. Next, they were asked to send a message while answering the questions showed on the monitor screen of the computers, simultaneously. Next, the difference between response accuracy to questions of graphical test in two phases was analyzed. Results: RESULTS: The results showed that the average scores of correct response to graphic test, as typing a text on the mobile phone, was (26.8000) and the average scores of correct respond to graphics test without typing a text on mobile phone was (30.2000). Moreover, the average scores when typing a text on mobile phone was (74.40) while the average scores for typing a text on mobile phone and responding to graphics test, simultaneously was (194.12). Conclusions: Conclusion: The results showed that using the mobile phone has a negative impact on the selected students’ performance to respond simultaneously to the general scientific questions.

  • Psychosocial distress of patients with psoriasis: Assessment of care needs and development of a supportive intervention: a study protocol

    From: JMIR Research Protocols

    Date Submitted: Jul 17, 2017

    Open Peer Review Period: Jul 18, 2017 - Aug 1, 2017

    Background: Psoriasis is a chronic inflammatory disease that is often associated with a number of somatic and mental comorbidity. Patients with psoriasis show an increased risk of depression and (soci...

    Background: Psoriasis is a chronic inflammatory disease that is often associated with a number of somatic and mental comorbidity. Patients with psoriasis show an increased risk of depression and (social) anxiety. Objective: The aims of this study are 1) to explore the psychosocial distress of patients with psoriasis and to assess their care needs; 2) to develop a supportive intervention based on the prior results. Methods: A multi-stage design with four phases combining quantitative and qualitative methodology will be used and conducted in two centers. 1) A scoping review and focus groups will be used to design a questionnaire to assess the psychosocial distress and care needs of the patients. 2) The questionnaire developed in phase 1 will be used in a cross-sectional survey to assess the extent of psychosocial distress and supportive care needs in patients with psoriasis. 3) A systematic review and meta-analysis will be conducted to identify psychosocial and psychoeducational interventions for patients with psoriasis and to describe their effectiveness. 4) Based on the results of the phases 2 and 3 a manualized supportive intervention will be developed and the feasibility and acceptance of the intervention will be assessed. Conclusions: The expected results of this study will show the extent of psychosocial distress of patients with psoriasis in Germany and supplement previous research with findings about the supportive care needs of this patient group. Moreover the developed intervention will help to address the psychosocial support needs of patients with psoriasis. Research shows that psychosocial support is strongly needed.

  • Partners in Parenting: A multi-level web-based approach to support parents in prevention and early intervention for adolescent depression and anxiety

    From: JMIR Mental Health

    Date Submitted: Jul 17, 2017

    Open Peer Review Period: Jul 18, 2017 - Sep 12, 2017

    Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important...

    Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a web-based parenting intervention, Partners in Parenting. We describe the components of the web-based intervention and how each component was developed. Development of the intervention was guided by principles of the Persuasive Systems Design model, to maximize parental engagement and adherence in the program. A co-design approach was used through consultations with parents and adolescents about the content and presentation of the intervention. The Partners in Parenting intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The Partners in Parenting web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents’ mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents’ needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes.

  • Automatic Health Assessment of Smart Home Residents via Unsupervised Learning from Ambient Sensor Data: An Observational Study

    From: Journal of Medical Internet Research

    Date Submitted: Jul 18, 2017

    Open Peer Review Period: Jul 19, 2017 - Sep 13, 2017

    Background: Existing approaches to health assessment for smart home residents mostly rely on the activities recognized by supervised learning methods, which require well-annotated sensor data. Obtaini...

    Background: Existing approaches to health assessment for smart home residents mostly rely on the activities recognized by supervised learning methods, which require well-annotated sensor data. Obtaining such labeled data is not a feasible task, especially for senior adults. Objective: Developing an unsupervised learning method to health assessment for smart home residents without the need of labeled data. Methods: Ambient sensors are deployed in participants’ home to collect activity data. Home resident’s health is assessed via a two-step approach. In the first step, the clusters of sensor data are discovered using K-means or Gaussian Mixture Models (GMM). In the second step, the time spent on each data cluster is used to compute a health score that represents the physical health of the resident. As we could not obtain ground-truth labels, we conduct this project as an observational study. Results: We test the first step of our approach (sensor data clustering) on the Aruba dataset, which was acquired from a testbed occupied by a senior resident for more than a year. In this step, GMM achieves its best performance of 0.75 (𝐹1_score) and 0.79 (Rand_index) and outperforms K-means. Qualitative results obtained on our smart home dataset also demonstrate the correlation between the discovered sensor data clusters with resident’s daily routine. The health score derived in the second step of our approach is highly associated with the health events happened to one of our participants. Conclusions: The experimental results demonstrate that the sensor data clusters discovered by standard clustering methods are highly correlated with the ground-truth activities or daily routine. Between the two tested methods, GMM outperforms K-means in all metrics. The health score derived by our two-step unsupervised approach is highly related to the health events happened to the resident. Clinical Trial: The CSIRO Health and Medical Research Human Research Ethics Committee (#12/17).

  • Clinical Videoconferencing: A Systematic Review and Analysis of eHealth Enacted in User Patterns

    From: Journal of Medical Internet Research

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 19, 2017 - Sep 13, 2017

    Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted and used diffe...

    Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted and used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of “eHealth” identified 51 unique definitions and concluded that it had become an accepted neologism despite the lack of clear, precise, agreed-upon definitions. In 2015, the question “What Is eHealth: Time for an Update?” was posed. Objective: Considering videoconferencing as eHealth, the objective of the paper is twofold: to demonstrate and cluster (different) clinical videoconferencing practices and their situated implications and to explore and analyze whether—and how—common features and implications across clusters can contribute to an update of the eHealth concept. Methods: We performed a literature search via the National Center for Biotechnology Information (NCBI), encompassing PubMed and PubMedCentral, for quality reviews and primary studies. This paper reports results for primary studies. We used the terms “videoconferencing” and “clinical practices.” The selection process was based upon clearly defined criteria. We used an electronic proforma to extract data. The analysis was inspired by realist review and “the ten e’s of eHealth”. Results: The search returned 154 reviews and primary studies. This paper considers the primary studies, and eleven were included. We identified three broad clusters; 1) Videoconferencing as singular intstrument within existing organisational frameworks for expert advice, and effectiveness and quality improvement goals; 2) Videoconferencing as multifaceted with novel organisational arrangements, reaching out to homes and family caregivers with the purpose of co-creating improvement; 3) Videoconferencing as an operational instrument for improving administration of triage. The analysis of common features of videoconfeerencing across the clusters that might add to the understanding of eHealth resulted in a proposal to add four d’s to the existing ten e’s. The four d’s are: dynamic, differentiated along services and temporal lines, demanding of fresh resources and (inter) dependent of human and socio economic components. Conclusions: Videoconferencing for clinical work appear as a dynamic of differentiation and adaptation along service and temporal lines, made to work from an ongoing demand for fresh resources. Additionally, videoconferencing is an (inter)dependent assemblage of human, socio economic and technological constituent parts. The four d’s—dynamic, differentiated, demanding and (inter)dependent—can be added as an update of “the ten e’s of eHealth”.

  • Using a Refined Process Evaluation Model to Assess an Online Organ Donation Educational Intervention

    From: Journal of Medical Internet Research

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 19, 2017 - Sep 13, 2017

    Background: The lack of available organs is often considered to be the single greatest problem in transplantation today. Internet use is at an all-time high, creating an opportunity to increase public...

    Background: The lack of available organs is often considered to be the single greatest problem in transplantation today. Internet use is at an all-time high, creating an opportunity to increase public commitment to organ donation through the broad reach of web-based, behavioral interventions. Implementing Internet interventions, however, presents some challenges, including preventing fraudulent respondents and ensuring intervention uptake. While web-based organ donation interventions have increased in recent years, process evaluation models fit for web-based interventions are lacking. Objective: This study outlines a refined process evaluation model adapted for online settings and used to assess the implementation of an online intervention aimed to increase organ donation among African Americans. Methods: We used a randomized pretest-posttest control design to assess the effectiveness of the intervention website, which addressed barriers to organ donation through corresponding videos. Eligible participants were African American adult residents of Georgia who were not registered on the state donor registry. Drawing from previously developed process constructs, we adapted reach (the extent to which the target population was recruited into the study), recruitment (online mechanism used to recruit participants), dose received (intervention uptake) and context (how the online setting influenced study implementation) for Internet settings, and used the adapted model to assess the implementation of our online intervention. Results: Reach: 1,415 individuals completed the eligibility screener; 948 (67.0%) were determined eligible, of which 918 (96.8%) completed the study. After eliminating duplicate entries (n=17), those who did not initiate the post-test (n=21) and those with an invalid ZIP code (n=108), 772 valid entries remained. Per the IP address analysis, only 23 of the 772 valid entries (3.8%) respondents were within Georgia, and only 17 of those were considered unique entries and could be considered for analyses. Recruitment: 517 of the 772 valid entries (67.0%) of participants were recruited from an online recruiter. Dose received: No videos from the intervention website were watched in their entirety, and the average viewing duration was 17 seconds over the minimum. Context: Context analysis provided us with valuable insights into factors in the Internet environment that may have affected study implementation. Although only active for a brief period of time, the Craigslist.org advertisement may have contributed the largest volume of fraudulent responses. Conclusions: We determined fraud and low uptake to be serious threats to this study and further confirmed the importance of conducting a process evaluation to identify such threats. We suggest checking participants’ IP addresses prior to study initiation, selecting software that allows for automatic duplicate protection and tightening minimum requirements for intervention uptake. Further research is needed to understand how process evaluation models can be used to monitor implementation of online studies.

  • MyVoice National Text Message Survey of Youth 14-24yo: Study Protocol

    From: JMIR Research Protocols

    Date Submitted: Jul 18, 2017

    Open Peer Review Period: Jul 19, 2017 - Aug 2, 2017

    Background: Adolescent health in the US has not improved in decades. Researchers and youth-serving organizations struggle to accurately elicit youth voice and translate youth perspectives into health...

    Background: Adolescent health in the US has not improved in decades. Researchers and youth-serving organizations struggle to accurately elicit youth voice and translate youth perspectives into health care policy. Objective: Our aim is to describe the protocol of the MyVoice Project, a longitudinal mixed methods study designed to engage youth, particularly those not typically included in research. Text messaging surveys are collected, analyzed, and disseminated in real-time to leverage youth perspectives to impact policy. Methods: Youth age 14-24 are recruited to receive weekly text message surveys on a variety of policy and health topics. The research team, including academic researchers, methodologists, and youth, develop questions through an iterative writing and piloting process. Question topics are elicited from community organizations, researchers and policy makers to inform salient policies. A youth centered interactive platform has been developed that automatically sends confidential weekly surveys and incentives to participants. Parental consent is not required as the survey is of minimal risk to participants. Recruitment occurs online (e.g., Facebook, Instagram, UMHealthResearch.org), in person at community events, and through snowball sampling. Weekly surveys collect both quantitative and qualitative data. Quantitative data are analyzed using descriptive statistics. Qualitative data are quickly analyzed using natural language processing and traditional qualitative methods. Mixed methods integration and analysis supports a more in-depth understanding of the research questions. Results: We are currently recruiting and enrolling participants through in-person and online strategies. Question development, weekly data collection, data analysis, and dissemination are in progress. Conclusions: MyVoice quickly ascertains the thoughts and opinions of youth in real-time using a widespread, readily available technology– text messaging. Results are disseminated to policy makers and youth-serving organizations through a variety of methods. Policy makers and organizations then share their priority areas with the research team to develop additional question sets to inform important policy decisions. Youth-serving organizations can use results to make decisions to promote youth well being.

  • Security and Privacy Concerns Regarding Genetic Data in Mobile Health Record Systems: An Empirical Study from Turkey

    From: Journal of Medical Internet Research

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 19, 2017 - Sep 13, 2017

    Background: In today’s health services, it has become a necessity to keep patients’ health data in electronic format. There are many theories and considerable research on the design of electronic...

    Background: In today’s health services, it has become a necessity to keep patients’ health data in electronic format. There are many theories and considerable research on the design of electronic health record applications. As the use of genetic testing, and applications of bioinformatics is increasing in healthcare, genetic and genomic information needs to be included within these systems. Objective: In this study, we carried out a descriptive survey with 174 participants to acquire their views on the privacy and the security of mobile health record systems and inclusion of their genetic data in these systems. Methods: An online survey and an on-site survey in the two genetic diagnostic centers were conducted to reach patients or relatives of patients that had undergone genetic testing. Descriptive statistics is used to summarize the data. Results: Nearly half of the participants or their relatives (48.9%) had undergone genetic testing. Doctors are the only profession group that people trust for the privacy of their health and genetic information (61.2%); however, people chose to limit even their doctor’s access to their genetic/medical records (52.5%). Majority of the respondents (94%) prefer to keep full access right option only for themselves. The regulations and security measurements are suggested in the questionnaire are found to be acceptable by the majority of the respondents. A significant amount of participants had bad experiences and prejudices about electronic health records: 9.7 % of respondents’ medical records were used or released without their consents, 15.1 % stated that they had avoided being tested because of violation risks, and 3.5 % asked their doctors to enter a less embarrassing health status into their records. Also our analysis showed that participants attribute special importance to their genetic records, as significantly more participants stated that storing genetic records in a mobile system is more risky compared to other health records (P=.00). Conclusions: People have various negative experiences and there are plenty of information disclosure events in the media; hence people have concerns about the privacy and security of their health and genetic data. The results of our survey showed that people would like to see security measurements and regulations to protect their privacy, before they start to use any application to keep track of their health/genetic data. They also would like to have sole control on these applications. Personal Health Record (PHR) applications offers solutions to the data management problem as an electronic system, since they enable the users to have full control over their records.

  • A randomized controlled trial and process evaluation of a web-based therapy plus telephone support by a coach, compared with information about web-based resources, in depressed patients referred to secondary mental health care

    From: JMIR Mental Health

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 20, 2017 - Sep 14, 2017

    Background: The evidence for the effectiveness of web-based therapies comes mainly from non-clinical populations with a few studies in primary care. There is little evidence from patients referred to...

    Background: The evidence for the effectiveness of web-based therapies comes mainly from non-clinical populations with a few studies in primary care. There is little evidence from patients referred to secondary mental health care with depression. A problem with web-based therapies is that a high proportion of people fail to complete the courses. One way to address this is to create a new health service role – an e-coach – to guide people through the therapy which has been shown to increase adherence. Objective: The objective was to test in people referred to secondary care with depression if a web-based therapy (The Journal www.depression.org.nz) supported by an e-coach plus usual care would be more effective in reducing depression compared with usual care plus an information leaflet about on-line resources after twelve weeks. Methods: We conducted a randomized controlled trial with two parallel arms and a process evaluation. The e-coach had a background in occupational therapy. Participants were recruited face to face. Results: We recruited 63 people into the trial (intervention 35 control 28). There were no statistically significant differences in the change in PHQ-9 scores at 12 weeks comparing The Journal with usual care (mean change in PHQ-9 score 9.4 in the intervention group and 7.1 in the control group t-test 1.05 p=0.3; mean difference 2.3, 95% confidence interval -2.1 to 6.7). People who were offered The Journal attended on average about one less out-patient appointment compared with usual care although this difference was not statistically significant (intervention mean number of visits 2.8 (SD 5.5) compared with 4.1 (SD 6.7) in the control group t=- 0.80 p=0.43; mean difference 1.3 95% confidence interval -4.5 to 2.0). The process evaluation found that the mean number of lessons completed in the intervention group was 2.5 SD 1.9 (with a range of 0 to 6) and the number of contacts with the e-coach was a mean of 8.1 SD 4.4 (range 0 to 17). The qualitative interviews highlighted the problem of engaging clinicians in the research and their resistance to recruitment; technical difficulties with The Journal which prevented people logging in easily; difficulty accessing The Journal as it was not available at the time on smartphones or tablets; participants finding lesson three difficult; and participants saying they were too busy to complete the sessions. Conclusions: The study demonstrated that is feasible to use an e-coach in this setting, that people found it helpful and that it did not conflict with other care that participants were receiving. In the future trials need to engage clinicians at an early stage to articulate where web-based therapies fit into existing clinical pathways; web-based therapies should be available on mobile devices; and logging in should be easy. The role of the e-coach should be explored in larger trials. Clinical Trial: Australian and New Zealand Clinical Trials Registry ACTRN: ACTRN12613000015741

  • Uterine artery embolization versus hysterectomy in the treatment of symptomatic adenomyosis: design of the randomized QUESTA trial.

    From: JMIR Research Protocols

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 21, 2017 - Aug 4, 2017

    Background: Adenomyosis is a benign uterine disease characterized by invasion of endometrium into the myometrium resulting in heavy menstrual bleeding and pain (dysmenorrhea). Hysterectomy is establi...

    Background: Adenomyosis is a benign uterine disease characterized by invasion of endometrium into the myometrium resulting in heavy menstrual bleeding and pain (dysmenorrhea). Hysterectomy is established as the final treatment option when conservative treatment fails. Uterine artery embolization (UAE) in patients with symptomatic adenomyosis has demonstrated to reduce symptoms and improve quality of life, however randomized controlled trials are lacking. Objective: With this study we aim to evaluate the impact of UAE on Health Related Quality of life (HRQOL) in a randomized comparison to hysterectomy in patients with symptomatic adenomyosis. Methods: This is a multicenter non-blinded randomized controlled trial comparing UAE and hysterectomy. Eligible patients are symptomatic premenopausal women without the desire to conceive and who have symptomatic MRI confirmed pure adenomyosis or dominant adenomyosis accompanied by fibroids. After obtaining informed consent, patients will be randomly allocated to treatment in a 2:1 UAE versus hysterectomy ratio. The primary objective is HRQOL at 6 months following the assigned intervention. Secondary outcomes are technical results, pain management, clinical outcomes, HRQOL, and cost effectiveness during 2 years of follow-up. In addition, transvaginal ultrasound (TVUS) and MRI will be performed at regular intervals after UAE. Results: Patient enrollment started November 2015. The follow-up period will be completed two years after inclusion of the last patient. At time of submission of this article data cleaning and analyses have not yet started. Conclusions: This trial will provide insight for care takers and future patients about the effect of UAE compared to the gold standard hysterectomy in the treatment of symptomatic adenomyosis and is therefore expected to improve patients’ wellbeing and quality of life. Clinical Trial: NetherlandsTrial Register NTR5615. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5615

  • Title: The Tapering Practices of Strongman Athletes; A Test-Retest Reliability Study

    From: JMIR Research Protocols

    Date Submitted: Jul 21, 2017

    Open Peer Review Period: Jul 21, 2017 - Aug 4, 2017

    Background: Currently, little is known about the tapering practices of strongman athletes. We have developed an Internet comprehensive self-report questionnaire examining the training and tapering pra...

    Background: Currently, little is known about the tapering practices of strongman athletes. We have developed an Internet comprehensive self-report questionnaire examining the training and tapering practices of strongman athletes. Objective: The objective of this study was to document the test-retest reliability of questions associated with the Internet comprehensive self-report questionnaire on the tapering practices of strongman athletes. The information will provide insight on the reliability and usefulness of the online questionnaire for use with strongman athletes. Methods: Invitations to complete an Internet questionnaire were sent via ‘Facebook Messenger’ to identified strongman athletes. The survey consisted of four main areas of inquiry including; demographics and background information, training practices, tapering and tapering practices. Of the 454 athletes that completed the survey over the eight-week period, 130 athletes responded on ‘Facebook Messenger’ indicating that they were going to do or had completed the survey. These participants were asked if they could fill the online questionnaire in a second time for a test-retest reliability analysis. Sixty-four athletes (age, 33.3 ±7.7 y; height, 178.2 ±11.0 cm; body mass, 103.7 ±24.8 kg) accepted this invitation and completed the survey for the second time after a minimum 7-day period from the date of their first completion. Agreement between athlete responses was measured using ICC’s and kappa statistics. 95% Confidence intervals were reported for all measures and significance was set at p < 0.05. Results: Test-retest reliability for demographic and training practices items were significant (p < 0.001) and showed excellent (ICC range = .84 to .98) and fair to almost perfect (kappa range = .37 to .85) agreement. Moderate to excellent agreement (ICC range = .56 to .84; p < 0.01) were observed for all tapering practices measures except for the number of days’ athletes started their usual taper before a strongman competition (ICC = .30). When the number of days were categorized with additional analysis, moderate reliability was observed (kappa=.43; p <0.001). Fair to substantial agreement was observed for the majority of tapering practices measures (kappa range = .38 to .73; p <0.001) except for how training frequency (kappa=.26) and the percentage and type of resistance training performed changed in the taper (kappa=.20). Good to excellent agreement (ICC = .62 to .93; p < 0.05) was observed for items relating to strongman events and traditional exercises performed during the taper. Only the time at which the Farmers walk was last performed before competition showed poor reliability (ICC = .27). Conclusions: We have developed a low cost, self-reported, online retrospective questionnaire, which provided stable and reliable answers for most of the demographic, training and tapering practice questions. The results of this study support the inferences drawn from the tapering practices of strongman athletes study.

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