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Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review. For a list of all preprints under public review click here. 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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  • Pleural Effusion resembling a lung tumor: Phantom Tumor of the Lung.

    From: JMIR Preprints

    Date Submitted: Jul 3, 2016

    Open Peer Review Period: Oct 3, 2016 - Sep 18, 2017

    Background: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo...

    Background: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo are coined, for this unusual finding, because it resembles to a tumor on radiograph and vanishes after initiating diuretic therapy. Objective: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo are coined, for this unusual finding, because it resembles to a tumor on radiograph and vanishes after initiating diuretic therapy. Methods: Case report Results: We suggest that, Phantom tumor be always kept in differentials of mass-like finding on chest radiograph in patients with congestive heart failure; if there has been an increase in symptoms and signs of congestive heart failure. And treatment with diuretics be provided, before going for any other expensive and unnecessary investigations or procedures. Conclusions: We suggest that, Phantom tumor be always kept in differentials of mass-like finding on chest radiograph in patients with congestive heart failure; if there has been an increase in symptoms and signs of congestive heart failure. And treatment with diuretics be provided, before going for any other expensive and unnecessary investigations or procedures.

  • Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control.

    From: Journal of Medical Internet Research

    Date Submitted: Feb 9, 2017

    Open Peer Review Period: Feb 21, 2017 - Apr 18, 2017

    Background: Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or dev...

    Background: Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. Objective: We describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We describe the developed intervention in line with reporting guidelines for a structured and systematic description. Methods: We used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions. Results: We reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components. Conclusions: Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process. Clinical Trial: The trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386); Pan Africa Trial Register (PACTR201411000724141); ClinicalTrials.gov (NCT02019823).

  • The use of Facebook in recruiting participants for research purposes – a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Feb 4, 2017

    Open Peer Review Period: Feb 4, 2017 - Apr 1, 2017

    Background: Social media is a popular online tool that allows users to communicate and exchange information. It allows digital content such as pictures, videos and websites to be shared, discussed, re...

    Background: Social media is a popular online tool that allows users to communicate and exchange information. It allows digital content such as pictures, videos and websites to be shared, discussed, republished and endorsed by its users, their friends and businesses. Recruiting for research purposes is complex with strict requirement criteria imposed on the participants. Traditional research recruitment relies on flyers, newspaper adverts, radio and television broadcasts, letters, emails, website listings, and word of mouth. These methods are potentially poor at recruiting hard to reach demographics, can be slow and expensive. Recruitment via social media, in particular Facebook, may be faster and cheaper. Objective: Objective: To systematically review the literature regarding the current use and success of Facebook to recruit participants for research purposes. Methods: Method: A literature review was completed in November 2015 in the English language using Medline, Embase, Web of Science, PubMed, PsycInfo, Google Scholar and a hand search of article references. Papers from the past 10 years were included and number of participants, recruitment period, number of impressions, cost per click/participant and conversion rate extracted. Results: Results: Twenty-four studies were identified and appraised using the CASP checklist from the USA (n=15), Australia (n=6) Canada (n=1), Japan (n=1) and Germany (n=1). All focused on the feasibility of recruitment via Facebook with some also testing interventions such as smoking cessation and depression reduction. Most recruited young age groups (16-24 years) with the remaining targeting specific demographics, for example military veterans. All available information from the 24 studies was analyses with median data showing 254 recruited participants, a 3-month recruitment period, 4.8 million impressions, cost per click of $0.48, conversion rate of 4.4%, eligibility of 69.5% and cost per participant of $9.82. The studies showed success in penetrating hard to reach populations and found the results representative of their control or comparison demographic except for an over representation of young white women. Conclusions: Conclusion: There is growing evidence to suggest that Facebook is a useful recruitment tool and its use, therefore, should be considered when implementing future research. Benefits include; reduced costs, shorter recruitment periods, better representation and improved participant selection in young and hard to reach demographics. It remains limited by internet access and the over representation of young white women. Future studies should recruit across all ages and explore recruitment via other forms of social media.

  • The Impact of Crowdfunding on Knowledge of Science and Rare Genet-ic Diseases Research

    From: Journal of Medical Internet Research

    Date Submitted: Dec 24, 2016

    Open Peer Review Period: Jan 2, 2017 - Feb 27, 2017

    Background: Although the cost to sequence a genome has been substantially reduced, it is still unaffordable for many patients because it is rarely covered by health insurance. Financial strain is all...

    Background: Although the cost to sequence a genome has been substantially reduced, it is still unaffordable for many patients because it is rarely covered by health insurance. Financial strain is all too familiar to many Americans today. Nearly half of respondents to a 2011 poll from the National Bureau of Economic Research stated that if they were given a 30-day timeframe, they would be unable to produce an extra $2,000. Beyond overtaxed household budgets, families dealing with undiagnosed or rare diseases incur countless unexpected healthcare costs that create tremendous financial burdens. These families shoulder these staggering health care expenses accumulated over years of seeking treatment. Crowdfunding may help support patients in need of DNA sequencing by providing access to a test that might uncover the cause of their disease and potentially lead to viable clinical treatment. Objective: The goal of Amplify Hope was to test the effectiveness of strategies for raising the necessary funding for trio exome sequencing through crowdfunding campaigns. More generally, we sought to understand the strategies that are the most successful for crowdfunding campaigns for medical expenses. Methods: Our research sought to 1) provide demographic information on the donor population; 2) identify common factors among successful medical crowdfunding campaigns; 3) identify factors that influenced people to donate, as reported by donors; and 4) describe the im-pact crowdfunding campaigns had on donors’ knowledge of genomics. We conducted the study in several phases, including a needs assessment, participant recruitment, a 30-day crowdfunding training period, a 30-day online crowdfunding period, and follow-up surveys given to participants and donors. Results: We found that social media played an important role in all campaigns. Specifically, a strong social media network, an active outreach process, and a high degree of comfort with networking all correlated with a higher success rate. Amplify Hope donors were more likely to support projects that were near their fundraising goals, and found video far more effective for learning about genomics than any other medium. Conclusions: The campaigns that achieved complete funding during the 30-day online crowdfunding campaign study period shared several characteristics. Individual campaign organizers who reached their campaign goals engaged more during the training program prior to the start of the crowdfunding campaign, as compared to those that did not achieve their campaign goals. These organizers read our shared Amplify Hope study materials, followed recommended guidelines, and perhaps most importantly initiated communication via phone calls and emails to their networks prior to the campaign launch. In other words, the successful campaigners frontloaded their campaigns. They also actively engaged their network and donors by providing updates throughout the campaigns rather than trailing off.

  • Development and Testing of an Intelligent Pain Management System (IPMS) on smart phone by a Randomized Trial among Chinese Cancer Patients: a New Approach in Cancer Pain Management

    From: Journal of Medical Internet Research

    Date Submitted: Jan 18, 2017

    Open Peer Review Period: Jan 19, 2017 - Mar 16, 2017

    Background: Cancer has become increasingly prevalent in China over the past few decades. Among symptoms related to the quality of life of cancer patients, pain has commonly been recognized as a most c...

    Background: Cancer has become increasingly prevalent in China over the past few decades. Among symptoms related to the quality of life of cancer patients, pain has commonly been recognized as a most critical one that may also result in ineffective treatment of cancer. More than one-third of cancer patients in China have experienced cancer pain. Driven by the need for better pain management for cancer patients, our research team developed a mobile-based Intelligent Pain Management System (IPMS) in the hope of providing a low-cost approach to prompt pain response and effective care for cancer patients. Objective: Our objective was to design, develop, and test the IPMS to facilitate real-time pain recording and timely intervention among cancer patients with pain. The system’s usability, feasibility, compliance, and satisfaction were also assessed. Methods: A sample of 46 patients with cancer pain symptoms were recruited at the Oncology Center of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch (hereinafter referred to as “the Oncology Center”). In a pre-test, participants completed a pain management knowledge questionnaire and were evaluated with the baseline cancer pain assessment and Karnofsky Performance Status (KPS) evaluation. The participants were then randomly assigned into two groups (the trial group and the control group). After a 14 days’ trial period, another round of cancer pain assessment was conducted. In the trial group, the data was fully automated collected by the IPMS. In the control group, the data was collected using conventional methods, such as phone interviews or door-to-door visits by physician. The pain management knowledge questionnaire and KPS evaluation were repeated in both groups at the end of the trial. The participants were also asked to complete a satisfaction questionnaire on the use of the IPMS. Results: All participants completed the trial successfully. The primary end point was to assess the feasibility of IPMS by observing the number of daily pain assessments recorded among patients. The usage of IPMS was very favorable with a mean of 2.37±0.53 pain assessment times per day. The secondary end point was to evaluate the users’ satisfaction, effectiveness of pain management and changes in the quality of their lives. All the participants gave high satisfaction score after they used IMPS. Both groups (IMPS=25 vs control=21) reported similar pain scores (3.28±0.68 of the trial group vs. 2.90±0.62 of the control group, P = 0.06) as well as the KPS scores (50.80±7.02 of the trial group vs. 50.95±7.40 of the control group, P = 0.94) at the baseline. During the trial period, the mean pain score of the trial group was 2.53±0.42, compared to a significantly higher score 2.81±0.47 of the control group (P < 0.001). At the end of the trial, the mean pain score of the trial group was 2.20±0.50, compared to a significantly higher score 2.95±0.59 of control group (P < 0.001). The ending KPS score was significantly higher of the trial group than of the control group (68.80±7.23 vs. 56.2±7.40, P < 0.001). As to the pain management knowledge score, there was a 2.96±0.61 increase in the trial group, compared to a 0.81±0.67 increase (P < 0.001) in the control group after using the IPMS for 14 days. At the same time, all the participants gave high satisfaction score after they used IMPS. Conclusions: The result demonstrated that IPMS was a feasible, effective, and low cost pain management tool for cancer patients. This study provided preliminary data to support the potentials of using IPMS in cancer pain communication between patients and doctors, and to provide real-time supportive intervention at a convenient basis in a low cost. Overall, the IPMS can serve as a reliable and effective approach to the control of cancer pain and improved quality of life for patients with cancer pain. Clinical Trial: Name: Intelligent Pain Management System for Assessing Pain in Cancer Patients Registration number: NCT02765269 URL: https://www.clinicaltrials.gov/ct2/archive/NCT02765269

  • Perceptions of patients with chronic obstructive pulmonary disease and their physiotherapists regarding the use of an eHealth intervention

    From: JMIR Human Factors

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 13, 2017 - Feb 27, 2017

    Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. T...

    Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how users value an eHealth intervention following a period of use. Objective: Evaluation of perceptions of eHealth users. Methods: In this study, we examined physiotherapists (PTs) and patients with chronic obstructive pulmonary disease (COPD) as users of an eHealth intervention (website and smartphone application) aimed at stimulating physical activity (PA). Participants in a randomized controlled trial (RCT) were asked how they valued the eHealth intervention beginning 6 months after a period of use of 6 months. Interview requests were made to 33 PTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analysed in Excel (Microsoft, Redmond, WA, USA). The interviews with the PTs and text messages sent between patients and PTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH, Berlin, Germany). Results: Sixty patients with COPD filled out the questionnaire, and 24 PTs were interviewed. The smartphone application was used 89 ± 18.5% of the time by patients. Ten out of 19 physiotherapy practices reported spending little time on the intervention. Patients scored the ease of use of the smartphone and application as 5.7 ± 1.65 and 5.09 ± 1.14 (on a 7-point scale), respectively. They found the presentation of the PA information in the application to be clear, insightful, and stimulating. All PTs judged the website as explicit and user-friendly. Perceived usefulness of the intervention for the PTs was the objective measurement of PA, the ability to see PA patterns over time, and the ability to use the intervention as a tool to give their patients insight into their PA. Patients reported that the intervention supported them in increasing their PA and that it made them feel fitter. The messages were not perceived by the patients as supportive with respect to reaching the PA goal. Barriers to use of the intervention according to the PTs were time constraints and financial reasons. Devising a new PA goal for patients was considered difficult. Seventy-nine percent of the PTs and 58% of the patients mentioned they would be interested in using the intervention in the future. Conclusions: PTs and patients had positive feelings regarding the functionality and potential of the eHealth intervention. Use of the website and smartphone application was straightforward. This paper addresses a number of topics that may aid in the successful implementation of these types of eHealth interventions in the future. Clinical Trial: NA

  • Online smoking cessation interventions in the Netherlands: effects, cost-effectiveness, and theoretical underpinnings

    From: Journal of Medical Internet Research

    Date Submitted: Jan 13, 2017

    Open Peer Review Period: Jan 17, 2017 - Mar 14, 2017

    Background: Tobacco smoking is a worldwide public health problem. In 2015, 26.3% of the Dutch population of 18 years and older smoked, which of 74.4% were daily smoker. More and more people have acces...

    Background: Tobacco smoking is a worldwide public health problem. In 2015, 26.3% of the Dutch population of 18 years and older smoked, which of 74.4% were daily smoker. More and more people have access to the internet worldwide, with about 94% of the Dutch population having online access. Internet-based smoking cessation interventions (online cessation interventions) have opportunities to tackle the scourge of tobacco. Objective: The goal of this paper was to provide an overview of online cessation interventions in the Netherlands, while exploring its effectivity, cost-effectiveness, and theoretical underpinnings. Methods: A mixed-method approach was used to identify Dutch online cessation interventions, using: (1) scientific literature search; (2) grey literature search; (3) and Expert input. In search for Dutch interventions, two independent researchers screened titles, abstracts, and then full-text in scientific literature, and titles and first page of the grey literature. Including expert input, this resulted in six interventions identified in the scientific literature and 39 interventions via the grey literature. Extracted data included: effectiveness, cost-effectiveness, theoretical factors and behavior change techniques used. Results: Overall, many interventions were offered without providing data on the effectiveness, except six interventions that were included in trials. Four of them were shown to be effective and cost-effective. The most important theoretical techniques used were: changing attitudes, providing social support, increasing self-efficacy, motivating smokers to make concrete action plans to prepare quit attempts and to cope with challenges, supporting identity change, rewarding abstinence, advising on changing routines, advising on coping, and advising on medication use. Conclusions: While the internet may provide the opportunity to offer various smoking cessation programs, the user is left in bewilderment concerning its efficacy, as most of these data are not available nor offered to the smokers. If the internet wants to live up its promising perspective, clear regulations need to be made concerning the effectiveness of these interventions, in order to avoid disappointment and useless quit attempts. Policy regulations are thus clearly needed in order to regulate the outburst of these interventions and to foster quality.

  • Meeting Patients Where They Are: Development of a Novel Patient Engagement Platform Using Accessible Text Messages and Calls

    From: Journal of Medical Internet Research

    Date Submitted: Feb 8, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: Patient noncompliance with therapy, treatments, and appointments represents a significant barrier to improving health care delivery and reducing the cost of care. Objective: We created a n...

    Background: Patient noncompliance with therapy, treatments, and appointments represents a significant barrier to improving health care delivery and reducing the cost of care. Objective: We created a novel, digital health intervention, “Epharmix”, to engage all patients where they are, enabling health care to reach them regardless of their socioeconomic position. Epharmix utilizes existing SMS and phone infrastructure to help patients reach their clinical goals. Methods: The platform utilizes a series of condition-specific, automated text message or phone calls that are optimized for both clinical utility and patient engagement. The intervention algorithms generate provider alerts and triaged patient rosters so patients receive clinical assistance earlier in their disease process. Results: In total, 28,386 text messages and 24,017 calls were sent to 929 patients over nine months. Patients responded to 80-90% of messages allowing the system to detect 1,164 clinically significant events. Patients reported increased satisfaction and communication with their provider. Epharmix increased the number of patient-provider interactions from less than one to over 10 in any given month. Conclusions: Engaging high risk patients remains a difficult process that may be improved through novel, digital health interventions. The Epharmix platform enables increased patient engagement, with very low risk, to improve clinical outcomes. We demonstrated that engagement and adherence among high risk populations is possible when health care comes conveniently to where they are.

  • Critical Appraisal of E-Health Intervention for Anxiety Management in Youths

    From: Journal of Medical Internet Research

    Date Submitted: Jan 3, 2017

    Open Peer Review Period: Jan 11, 2017 - Mar 8, 2017

    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the deliver...

    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as Cognitive Behavioral Therapy (CBT), in the treatment of a number of psychological disorders in adults, including depression, anxiety, obsessive–compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone; self-help) and computer-assisted (in combination with face-to-face therapy; therapist guided) programs in youths. Objective: This article summarizes and critically reviews the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim is to improve the understanding of what would be critical for future development of effective technology-based interventions. Methods: A systematic literature search was conducted in three scientific electronic databases (including PsycINFO, Science Direct and PubMed). Keywords with various combinations were used: child/children, adolescent, pre-school children, anxiety, intervention or treatment or program, smartphone applications or apps, online or web-based tool, computer-based tool, serious games, cognitive behavioral therapy (CBT), biofeedback. Results: Available studies demonstrate promising results in reducing anxiety, especially relative to the application of CBT with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional intervention. Other approaches have been applied to technology-based interventions with inconclusive results. The majority of existing programs are developed to be used concurrently with traditional treatments and lack long term evaluation. Very little has been done in terms of prevention interventions. Conclusions: Future development of e-Health programs for the management of anxiety in children will have to address several unmet needs and overcome key challenges: although developmental stages may limit the applicability to preschool children, prevention should start in early ages; self-help format and personalization are highly relevant for large-scale dissemination; automated data collection should be built in for program evaluation and effectiveness assessment; a strategy to stimulate motivation to play and maintain high adherence should be carefully considered.

  • A health professional-led synchronous discussion in Facebook can provide personalized information and support but does not generate a peer-support network.

    From: Journal of Medical Internet Research

    Date Submitted: Jan 3, 2017

    Open Peer Review Period: Jan 6, 2017 - Mar 3, 2017

    Background: Arthritis is a major cause of pain and disability. Arthritis New Zealand is a non-government organization that provides advocacy, information, and advice and support services for people wi...

    Background: Arthritis is a major cause of pain and disability. Arthritis New Zealand is a non-government organization that provides advocacy, information, and advice and support services for people with arthritis in New Zealand. Since many people seek health information online Arthritis New Zealand has a webpage and a Facebook page. In addition to static content, Arthritis New Zealand provides synchronous discussions with an Arthritis Educator (AE) each week via Facebook. Objective: To determine how synchronous discussion with a health educator on a social media platform may provide information and support to people with arthritis and if such activity on social media can provide useful insights into consumers’ health care needs. Methods: Interpretive multi-methods were used. Facebook Analytics were used to describe the users of the Arthritis NZ Facebook page and provide descriptive summary statistics. Gephi and manual graphic analysis were used to summarise activity during a convenience sample of ten AE-led synchronous discussions. Principles of thematic analysis were employed to interpret transcripts of all comments from these ten weekly AE-led discussions. Results: Users of the Arthritis NZ Facebook page were predominately female (81%), aged 18-54 years. Three major activities occurred during AE-led synchronous discussions: (1) seeking or giving support; (2) information enquiry; and (3) information sharing across a broad range of topic areas, largely relating to symptoms and maintaining physical functioning. There was limited peer-to-peer interaction, with most threads consisting of two-comment exchanges between users and the AEs. Conclusions: The AE-led discussions provided a forum for informational and emotional support for users. The facilitated discussion forum for people with arthritis on Facebook could be enhanced by encouraging increased user participation and increasing peer-to-peer interactions, and further training of AEs in facilitation of online discussion. Future research should focus on addressing barriers to user participation and assessing the impact of AE facilitation training, with the latter leveraging the Action Research paradigm.

  • A Mobile Application to Streamline the Development of Wearable Sensor Based Exercise Biofeedback Systems: System Development and Evaluation

    From: Journal of Medical Internet Research

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 13, 2017 - Apr 10, 2017

    Background: Biofeedback systems which utilise inertial measurement units (IMUs) have been shown recently to have the ability to objectively assess exercise technique. However, there are a number of ch...

    Background: Biofeedback systems which utilise inertial measurement units (IMUs) have been shown recently to have the ability to objectively assess exercise technique. However, there are a number of challenges in developing such systems; vast amounts of IMU exercise datasets must be collected and manually labelled for each exercise variation and naturally-occurring technique deviations may not be well detected. One method of combatting these issues is through the development of personalised exercise technique classifiers. Objective: We aimed to create a tablet application for physiotherapists and personal trainers which would automate the development of personalised multiple and single IMU based exercise biofeedback systems for their clients. We also sought to complete a preliminary investigation of the accuracy of such individualised systems in a ‘real world’ evaluation. Methods: A tablet application was developed which automates the key steps in exercise technique classifier creation through synchronising video and IMU data collection, automatic signal processing, data segmentation, data labelling of segmented videos by an exercise professional, automatic feature computation and classifier creation. Fifteen volunteers (12 males, 3 females, age: 23.6 +/- 2 years, height: 1.79 +/- 0.07 m, body mass: 77.4 +/- 9.9 kg) then completed 4 lower-limb late stage rehabilitation exercises using a personalised single IMU based classification system. The real world accuracy of the systems was evaluated. Results: The tablet application successfully automated the process of creating individualised exercise biofeedback systems. The personalised systems achieved an average of 90% accuracy, with 90% sensitivity and 89% specificity for assessing aberrant and acceptable technique with a single IMU positioned on the left thigh. Conclusions: A tablet application was developed that automates the process required to create a personalised exercise technique classification system. This tool can be applied to any cyclical, repetitive exercise. The personalised classification model displayed excellent system accuracy even when assessing acute deviations in compound exercises with a single IMU. Clinical Trial: N/A.

  • Mental & Emotional Self-Help Technology Apps: Their Efficacy and Theoretical Mechanisms of Behavior Change

    From: JMIR Mental Health

    Date Submitted: Jan 5, 2017

    Open Peer Review Period: Jan 6, 2017 - Mar 3, 2017

    Background: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental hea...

    Background: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health-related behavior change has not been thoroughly examined. Objective: This study examines the theoretical mechanisms by which mental and emotional self-help apps change behavior. Methods: Cross-sectional survey of 150 users of mental or emotional health apps in the past six months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior, after controlling for potentially confounding variables. Results: In multivariate regression analyses, engagement (P < .001) was positively associated with the reported changes in the theory items. In the multivariate regression model with behavior change as the dependent variable, theory was positively associated (p < .001) as were engagement (P = .004), frequency of app(s) use (P = .013), and income (P = .049). Conclusions: Participants’ reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. These increases in perceptions, beliefs, and attitudes surrounding their mental and emotional health were significantly associated with perceived change in behavior. There was a positive association between the level of engagement with the app(s) and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field. Clinical Trial: N/A

  • Assess suicide risk and emotional distress in Chinese social media by natural language use

    From: Journal of Medical Internet Research

    Date Submitted: Jan 9, 2017

    Open Peer Review Period: Jan 13, 2017 - Mar 10, 2017

    Background: The mainstream assessment of individuals’ suicide risk or emotional distress relies on self-report scales or clinical assessments. Such assessment relies on individuals’ willingness an...

    Background: The mainstream assessment of individuals’ suicide risk or emotional distress relies on self-report scales or clinical assessments. Such assessment relies on individuals’ willingness and ability to seek help/treatment, which is often challenging for distressed or suicidal people. Objective: The present study explores how natural language can be utilized to proactively assess one’s suicide risk and emotional distress in Chinese social media. Methods: An online survey was conducted on Sina Weibo to assess the respondents’ suicide risk and emotional distress. With the respondents’ consent, we also downloaded all of their Weibo posts which were posted in the public domain during the 12 months prior to the survey by calling the Weibo API. Weibo posts were tokenized and language features were extracted by applying Simplified Chinese Linguistic Inquiry and Word Count (SC-LIWC). Logistic regression analysis were operated to examine the relationship between use of SC-LIWC categories and the respondents’ suicide risk with emotional distress. Support Vector Machines were trained to automatically classify whether a respondent was showing suicide risk or emotional distress. ROC curve analysis was operated for examining the diagnostic accuracy of the machine classifiers. Results: Weibo users with high suicide risk were marked by a higher usage of pronoun, prepend words, and multifunction words, a lower usage of verb, and a greater total word count. Severe depression was marked by more use of second-person plural and achievement-related words, but less use of work-related words. Anxiety was also marked by less use of work-related words. Stress was marked by more use of third-person and second-person plural, health-related words, and death-related word. and stress were marked by more use of second-person plural, and less use of work-related words. The machine classification on suicide risk and depression achieved satisfying results after adding a filter of Weibo suicide communication. However, the classification results for severe depression and stress were still not significant. Conclusions: The study demonstrates the utility of natural language as alternative assessment tool of suicide risk and emotional distress in Chinese social media. The current development can improve assessment coverage and efficiency but still requires experts’ inputs to increase accuracy. Clinical Trial: N/A

  • Towards understanding pain-monitoring electronic technologies for adults: a Systematic Literature Review

    From: Journal of Medical Internet Research

    Date Submitted: Jan 6, 2017

    Open Peer Review Period: Jan 9, 2017 - Mar 6, 2017

    Background: Remote monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, remote mon...

    Background: Remote monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, remote monitoring of patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain, however, no previous study has characterized a patient’s situation through all the relevant contextual information that a monitoring system may capture. Objective: The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adult patients with pain, and (2) construct a model of the context information relevant to pain monitoring that may be used to implement applications and devices aimed at monitoring patients with pain. Methods: A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore), using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. Results: 87 articles were included in the final analysis and 53 of them (61%) used technologies to collect contextual information. 49 types of context information were found and a five-dimension model of context information to monitor patients was proposed, expanding a previous model. Most technological interfaces for pain monitoring are wearable, possibly because they can be used in more realistic contexts. Few studies focus on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. Conclusions: The design of remote monitoring devices and interfaces for patients with pain must deal with the challenge of selecting relevant contextual information to understand the user’s situation, and not overburdening or inconveniencing users with information requests. A complete model of contextual information that a device can capture may be used by designers to review possible contextual information and choose which is relevant for a particular device.

  • A Review of Portable Digital Assistant (PDA) Implementation process in Low Resource Settings

    From: JMIR Medical Informatics

    Date Submitted: Jan 10, 2017

    Open Peer Review Period: Jan 20, 2017 - Mar 17, 2017

    This paper presents the Portable Digital Assistant Implementation in the Sene District of Ghana. The study sought to understand eHealth implementation in low resource settings through the lens of acto...

    This paper presents the Portable Digital Assistant Implementation in the Sene District of Ghana. The study sought to understand eHealth implementation in low resource settings through the lens of actor-network theory. Part of this theory is made up of the sociology of translations, which was employed as a crucial framework for exploring the Portable Digital Assistant Set-up. Data was collected between January 2011 – June 2014. Data collection has been through triangulation of qualitative methods: interviews, participant observation, and document analysis. A total of 20 human and non-human actors’ were identified and semi-structured interviews conducted with the human actors using Face to Face (10), Telephone (2). It was deduced from the case that the champion in the case was able to mobilise the various actors to ensure that the project succeeds. His ability to manage the various resources ensured that there were not any lapses.

  • Semantic location from mobile phones: Going beyond GPS

    From: JMIR mHealth and uHealth

    Date Submitted: Jan 10, 2017

    Open Peer Review Period: Jan 16, 2017 - Mar 13, 2017

    Background: Is someone at home, at their friend’s place, at a restaurant, or enjoying the great outdoors? Knowing the semantic location matters for delivering medical interventions, recommendations,...

    Background: Is someone at home, at their friend’s place, at a restaurant, or enjoying the great outdoors? Knowing the semantic location matters for delivering medical interventions, recommendations, and other context-aware services. This knowledge is particularly useful in mental healthcare for monitoring the behavioral indicators of mood states and improving treatment delivery. Local search-and-discovery services such as Foursquare can be used to detect semantic locations based on GPS coordinates, but GPS alone is often inaccurate. Smartphones can also sense other signals, such as movement, light, and sound, and using these signals promises to lead to a better estimation of the semantic location. Objective: To examine the ability of smartphone sensors in estimating semantic locations, and to evaluate the relationship between semantic location visit patterns and mental health. Methods: 208 participants across the United States were asked to log the type of locations they visited daily, including home and work, for a period of 6 weeks, while their phone sensor data was recorded. Based on the sensor data and Foursquare queries, we trained models to predict these logged locations, and evaluated their prediction accuracy on participants not seen by the model. We also evaluated the relationship between the amount of time spent in each semantic location and depression and anxiety, assessed at the baseline, in the middle, and at the end of the study. Results: While Foursquare queries detected the true semantic locations with an average area under the curve (AUC) of 0.60, using phone sensor data increased the AUC to 0.72. When we used Foursquare and sensor data together, the AUC further increased to 0.78. We found a few significant relationships between the time spent in certain locations and depression and anxiety, although these relationships were not consistent. Conclusions: The accuracy of location services such as Foursquare can significantly benefit from using phone sensor data besides their location databases. Our results suggest that the nature of the places we go to explains only a small part of the variance of anxiety and depression.

  • ICT for health in the EU: the effect of multimorbidity

    From: Journal of Medical Internet Research

    Date Submitted: Feb 10, 2017

    Open Peer Review Period: Feb 18, 2017 - Apr 15, 2017

    Background: Multimorbidity is becoming increasingly common and is a key challenge that societies with ageing populations are now facing. The presence of multimorbidity entails the implication of patie...

    Background: Multimorbidity is becoming increasingly common and is a key challenge that societies with ageing populations are now facing. The presence of multimorbidity entails the implication of patients to coordinate, understand and use the information obtained from different health care professionals, in addition to striving to distinguish the symptoms of different diseases and self manage their sometimes conflicting health problems. Information and communications technology (ICT) tools are an opportunity for health information and education for both patients and health professionals, and hold promise for more efficient and cost-effective care processes. Objective: This study aims to analyze the use of ICT tools, particularly the Internet, for health purposes, taking into account the citizens’ socio-demographic and clinical characteristics, and above all, the presence of multimorbidity. Methods: Cross-sectional and exploratory research using online survey data from July-August 2011 was conducted, including a total of 14,000 citizens from 14 European countries between 16 and 74 years of age, and who had used the Internet in the previous three months. The variables of study were the questionnaire items related to how often the Internet was used for health purposes, the degree of morbidity and the ICT for health gradient. Chi-square tests were conducted to classify participants and examine the relationship between the sociodemographic and clinical variables of participants and the ICT user group. A one-way analysis of variance (Anova) made it possible to compare the ICT for health gradient average between different groups of individuals according to their morbidity level. A two-way between-groups Anova was performed to explore the effects of multimorbidity and age group on the ICT for health gradient. Results: According to the ICT for health gradient, most participants (68.1%; 9,541) were labelled as Rare Users, being the majority of them (55.1%) 25-54 years old, with upper secondary education (50.3%), employed (49.3%) and living in medium-sized cities (40.7%). Results of the one-way Anova showed that the number of health problems significantly affected the use of ICT for health purposes [F (2, 13996) = 11.584; p = .001]. A two-way ANOVA showed there was a statistically significant interaction between the effects of age and number of health problems on the ICT for health gradient, F (4, 11991) = 7.936, p = .001. Conclusions: Although multimorbidity patients can benefit from Internet use for health-related activities, there is a need to consider different strategies to make ICT for health tools more sensitive to the particularities of older people and to reduce digital disadvantages.

  • THE BENECA m-Health App: FEASIBILITY OF A MOBILE HEALTH APPLICATION FOR ASSESSING AND MONITORING DIET AND PHYSICAL ACTIVITY HABITS IN BREAST CANCER SURVIVORS

    From: Journal of Medical Internet Research

    Date Submitted: Feb 14, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: Despite the potential benefits described by international organizations, 68–80% of survivors do not meet the described guidelines in terms of diet and physical activity. This concern cou...

    Background: Despite the potential benefits described by international organizations, 68–80% of survivors do not meet the described guidelines in terms of diet and physical activity. This concern could be approached with a user-friendly mobile health (mHealth) application for assessing and monitoring healthy lifestyles in breast cancer survivors (BCS). Objective: The main aim is to investigate the test-retest reliability and concurrent validity against accelerometry and dietary records of a novel mHealth system called BENECA (ENErgy Balance on CAncer). Methods: We conducted a descriptive reliability study (N=20 BCS) who were recruited from the Virgen de las Nieves Hospital of the Andalusian Health Service in Granada (Spain) between December 2015 and April 2016. Test-retest reliability analysis used an overlap of approximately 2 hours between times. During an 8-day period tri-axial accelerometers (ActiGraphGT3X+, Pensacola, Fl., US) were worn by patients for concurrent validity analysis. Alike, at baseline 24-hour dietary recalls (also after 8-day period), sociodemographic questionnaire and daily dietary record questionnaires were recorded. For the inter-rater reliability trials, two-way random effect intra-class correlation coefficients (Rho) and their confidence intervals were calculated. Moreover, the agreement in diet between gold-standard and BENECA m-Health System was evaluated using a method described previously by Hillier. Finally, the accuracy of BENECA m-Health System was assessed using a linear regression analysis to determine the correlation coefficient and a Passing-Bablok regression to evaluate bias. Results: The compliance rates for all assessment methods were very high. All outcome measures showed reliability estimates (α)≥0.90; the lowest reliability was obtained for portions of the FV (α=0.94). The inter-rater reliability (gold standard method versus BENECA mHealth system) was very good (Rho≥0.90). The mean match rate between food items reported using BENECA and those registered by gold-standards was 93.51%, with a phantom rate of 3.35%. There were no substantial differences between the BENECA m-Health system and the gold standard assessment methods. There was no fised bias and mean differences between methods were -0.15 for FAT, -0.01 for fruits and vegetables and -8.89 for minutes of moderate-to-vigorous physical activity. There were not any adverse events. One breast cancer survivor could not use the BENECA m-Health System because she was using a previous version of the Android System with which BENECA was incompatible. Conclusions: The BENECA mHealth system is a simple, quick, reliable and low burden method to assess diet and physical activity in BCS. This novel option has potential implications in the cancer units to examine energy balance-related behaviours. Further research is now required to study the usage of both BENECA mHealth system and objective measurement of physical activity because it could suppose a major advance for a growing cancer population whose energy imbalance increases risk of some of the most prevalent cancer processes.

  • Social media use and access to digital technology in U.S. young adults, 2016

    From: Journal of Medical Internet Research

    Date Submitted: Jan 11, 2017

    Open Peer Review Period: Jan 17, 2017 - Mar 14, 2017

    Background: In 2015, 90% of U.S. young adults with internet access used social media. Digital and social media are highly prevalent modalities through which young adults explore identity formation, an...

    Background: In 2015, 90% of U.S. young adults with internet access used social media. Digital and social media are highly prevalent modalities through which young adults explore identity formation, and by extension, learn and transmit norms about health and risk behaviors during this developmental life stage. Objective: The purpose of this study was to provide updated estimates of social media use from 2014 to 2016 and correlates of social media use and access to digital technology in data collected from a national sample of U.S. young adults in 2016. Methods: Young adult participants aged 18-24 years in Wave 7 (October 2014; N = 1,259) and Wave 9 (February 2016; N = 989) of the Truth Initiative Young Adult Cohort Study were asked about use frequency for eleven social media sites and access to digital devices, in addition to sociodemographic characteristics. Regular use was defined as using a given social media site at least weekly. Weighted analyses estimated the prevalence of use of each social media site, overlap between regular use of specific sites and correlates of using a greater number of social media sites regularly. Bivariate analyses identified sociodemographic correlates of access to specific digital devices. Results: In 2014, 89.42% (weighted n, 1126/1298) reported regular use of at least one social media site. This increased to 97.5% (weighted n, 965/989) of young adults in 2016. Among regular users of social media sites in 2016, the top five sites were Tumblr (85.5%), Vine (84.7%), Snapchat (81.7%), Instagram (80.7%), and LinkedIn (78.9%). Respondents reported regularly using an average of 7.6 social media sites, with 85% using 6 or more sites regularly. Overall, 87% of young adults reported access or use of a smartphone with internet access, 74% a desktop or laptop computer with internet access, 41% a tablet with internet access, 29% a smart TV or video game console with internet access, 11% a cell phone without internet access, and 3% none of these. Access to all digital devices with internet was lower in those reporting a lower subjective financial situation; there were also significant differences in access to specific digital devices with internet by race/ethnicity and education. Conclusions: The high mean number of social media sites used regularly and the substantial overlap in use of multiple social media sites reflect the rapidly changing social media environment. Mobile devices are a primary channel for social media and our study highlights disparities in access to digital technologies with internet access among U.S. young adults by race/ethnicity, education, and subjective financial status. Findings from the current study may guide the development and implementation of future health interventions for young adults delivered via the internet or social media sites.

  • The impact of participation in online cancer communities on patient reported outcomes. A systematic review.

    From: JMIR Cancer

    Date Submitted: Jan 12, 2017

    Open Peer Review Period: Jan 18, 2017 - Mar 15, 2017

    Background: The concept of ‘online community’ has developed in recent years as a result of improved technical possibilities. By participating, people gain insight into their illness and as members...

    Background: The concept of ‘online community’ has developed in recent years as a result of improved technical possibilities. By participating, people gain insight into their illness and as members they usually search for others in comparable circumstances. The effect of participating in online communities on different outcomes of interest, has increasingly been investigated. Objective: The objective of this study was to systematically review all available literature concerning changes in patient reported outcomes (PROs) when cancer patients participate in online communities and the characteristics of patients who report positive effects. Methods: A computerized search of the literature via PubMed and Science Direct was performed. Last search was april 2016. Articles were included with the the following terms: cancer, patients, support group, health communities, internet. Twentyone articles were selected and were subjected to a 11-item quality checklist independently by two investigators. Results: The methodological quality of the selected studies varied; 12 were of high quality, 8 adequate and only 1 of low quality. Respondents were mostly women with breast cancer with a mean age of 50. Patients who are active online were mostly younger and higher educated than the non-users. The investigated PROs ranged from screening for general wellbeing (i.e. mood or health) through depression, anxiety, quality of life and post-traumatic growth, to cancer-related concerns. The effects found - i.e. PRO improvements - were overall marginal, in most cases insignificant and sometimes contradictory. Conclusions: Discussion: The big problem for this kind of studies is the lack of methodological instruments for reliable measuring. Conclusion: Some patients need online communities or online interaction, but do not expect to measure effects in PROs. If cancer survivors want to meet other survivors and share information or get support, online communities are a trustful possibility to make this happen.

  • Mental health mobile apps for children and young people: A systematic review and synthesis

    From: Journal of Medical Internet Research

    Date Submitted: Jan 23, 2017

    Open Peer Review Period: Jan 23, 2017 - Mar 20, 2017

    Background: There are an increasing number of mobile applications (apps) available for children and young people (CYP) with mental health problems and an increasing interest in assimilating mHealth in...

    Background: There are an increasing number of mobile applications (apps) available for children and young people (CYP) with mental health problems and an increasing interest in assimilating mHealth into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear. Objective: This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in CYP under the age of 18. Methods: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform – Children, Embase, Google Scholar, Pubmed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking and OpenGrey were systematically searched for relevant publications between January 2008 and July 2016. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self – harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis and insomnia) for mobile devices and for use by children and young people under the age of 18 years. Results: Thirty-two publications met the inclusion criteria. These described 19 apps, 3 of which were available to download. Two small randomised controlled trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Reviews which analysed the content of seven apps for CYP that are available to download established that none have undergone any research evaluation. Feasibility outcomes suggest acceptability of apps is good and app usage is moderate. Conclusions: Overall there is currently insufficient research evidence to support the effectiveness of apps for children and young people with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy and effectiveness is promptly needed.

  • Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks

    From: JMIR mHealth and uHealth

    Date Submitted: Jan 20, 2017

    Open Peer Review Period: Jan 21, 2017 - Mar 18, 2017

    Background: Goal setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to design a basic goa...

    Background: Goal setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to design a basic goal setting module within a mobile health system and to determine what functionality could be added to this goal setting module to support the complex goal setting routines desired by patients. Methods: A total of 750 goals were analyzed from patients with spina bifida and spinal cord injury enrolled in a wellness program. Results: A goal setting module was successfully developed. Checklists, data tracking and fact finding tools were identified as three functionalities that could be added to existing mobile health systems to support goal setting and achievement. Additional lessons learned provide a detailed list of recommendations for software development. Conclusions: Goals commonly set by individuals with disabilities can be supported by innovative mobile health tools.

  • A Web-Based Tailored Intervention to Support Illness Management in Patients Hospitalized for an Acute Coronary Syndrome: A Pilot Study

    From: Journal of Medical Internet Research

    Date Submitted: Jan 17, 2017

    Open Peer Review Period: Jan 18, 2017 - Mar 15, 2017

    Background: Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, foster participation in a cardiac rehabilitation program and optimize recovery. Web-b...

    Background: Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, foster participation in a cardiac rehabilitation program and optimize recovery. Web-based tailored interventions have the potential to provide individualized information and counselling to optimize patient’s illness management after hospital discharge. Objective: The primary objective of this pilot study was to develop and assess the feasibility, acceptability and preliminary effect of a Web-based tailored intervention (TAVIE@COEUR) designed to improve illness management related to self-care, medication adherence, anxiety management and cardiac risk factors reduction in patients hospitalized for an ACS. Methods: This pre-post pilot study was conducted with one group (N=30) of patients hospitalized for an ACS on the coronary care unit of a tertiary cardiology center. TAVIE@COEUR consists of three Web-based sessions with a duration ranging from 10 to 45 minutes and is structured around an algorithm to allow the tailoring of the intervention to different pathways according to patients’ responses to questions. TAVIE@COEUR includes 90 pages, 85 videos and 47 PDF documents divided across session 1 (S1), session 2 (S2) and session 3 (S3). These sessions concern self-care and self-observation skills related to medication-taking (S1), emotional control and problem-solving skills (S2) and social skills and interacting with health professionals (S3). Patients completed S1 before hospital discharge, and were asked to complete S2 and S3 within two weeks after discharge. Feasibility indicators were extracted from the TAVIE@COEUR Web-based platform. Data regarding acceptability and preliminary effect were assessed through telephone questionnaires at baseline and one month following discharge. Results: Twenty out of 30 participants (67%) completed S1, 10 (33%) completed S2 and 5 (17%) completed S3. High acceptability scores were observed for ease of navigation (mean 3.58, Standard Deviation [SD] 0.70; scale 0–4), ease of understanding (mean 3.46, SD 0.63; scale 0–4) and applicability (mean 3.55, SD 0.74; scale 0–4). The lowest acceptability scores were observed for information tailoring (mean 2.93, SD 0.68; scale 0–4) and individual relevance (mean 2.56, SD 0.96; scale 0–4). With regard to preliminary effect, we observed an overall self-care at 1 month following discharge score higher than at baseline (mean at one month: 54.07, SD 3.99 vs mean at baseline: 49.09, SD 6.92; scale 0–60). Conclusions: Although participants reported general satisfaction and appreciation of TAVIE@COEUR, feasibility results show the need for further development of the Web-based intervention to enhance its’ tailoring before undertaking a full-fledged randomized controlled trial. This may be accomplished by optimizing the adaptability of TAVIE@COEUR to patients’ knowledge, needs, interests, individual capabilities and emotional and cognitive responses during session completion.

  • A techno-health approach to participatory community-based One Health disease surveillance in pastoral communities of East Africa

    From: JMIR Public Health and Surveillance

    Date Submitted: Jan 20, 2017

    Open Peer Review Period: Jan 20, 2017 - Mar 17, 2017

    We describe development and initial achievements of a participatory disease surveillance system that relies on mobile technology to promote community level One Health security in Africa. The objective...

    We describe development and initial achievements of a participatory disease surveillance system that relies on mobile technology to promote community level One Health security in Africa. The objective of this system, Enhancing Community-Based Disease Outbreak Detection and Response in East and Southern Africa (DODRES), is to empower community-based human and animal health reporters with training and Information Communication and Technology (ICT)-based solutions to contribute to disease detection and response, thereby complementing strategies to improve the efficiency of infectious disease surveillance at national, regional and global levels. Formal discussions on the use of digital technology to develop a Southern African Centre for Infectious Disease surveillance (SACIDS) participatory surveillance system began at EpiHack™ Tanzania in 2014. This event was attended by human and animal health experts as well as ICT programmers who collaborated to identify major challenges facing early detection, timely reporting, and prompt response to disease events. This was followed by a project inception workshop in August 2015, which brought together key stakeholders, including policy makers and community representatives, to refine the objectives and implementation plan of the DODRES project. Supported by Skoll Global Threats Fund and building on previous initiatives, four prototype technical solutions were developed by a dedicated design and implementation team and, after testing, three functional versions of these prototypes-- packaged together as the “AfyaData” app were adopted by SACIDS to support One Health disease surveillance. Community Health Reporters (CHRs) and officials from animal and human health sectors in Morogoro and Ngorongoro districts in Tanzania were trained to use the AfyaData app and participate in DODRES. The AfyaData tools support near- to real-time data collection and submission at both community and health facility levels as well as the provision of feedback to reporters. A One Health Knowledge Repository application (OHKR) has also been integrated into the AfyaData app to provide health information on case definitions of disease syndromes of humans and animals and to synthesize advice that can be transmitted to CHRswith “next step” response activities or interventions. Additionally, a WhatsAppsocial platform was developed to sustain interactions between community members, local government officials and DODRES team members. Within the first five months (August-December 2016) of AfyaData tool deployment in the field, a total number of 1,915 clinical cases in livestock (1,816) and humans (99) were reported in Morogoro Urban (83) and Ngorongoro (1,832) districts. These initial results suggest that the DODRES community-level model creates an opportunity for One Health engagement of people in their own communities in the detection of infectious human and animal disease threats. Participatory approaches supported by digital and mobile technologies should be promoted for early disease detection, timely reporting, and prompt response at the community, national, regional, and global levels.

  • Foot Reflexology Therapy for Non-Specific Low Back Pain Condition: A Protocol for A Randomized Controlled Trial

    From: JMIR Research Protocols

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 19, 2017 - Mar 5, 2017

    Background: Non-specific low back pain (NSLBP) is one of the most common physical ailments affecting millions of people worldwide. This condition constitutes a significant public health problem and wa...

    Background: Non-specific low back pain (NSLBP) is one of the most common physical ailments affecting millions of people worldwide. This condition constitutes a significant public health problem and was listed as a prevalent health complaint in most societies. Even though there are many anecdotal claims for reflexology in the treatment of various conditions such as a migraine, arthritis and multiple sclerosis, but very little clinical evidence exist for reflexology on the management of low back pain per se. Objective: This study aim to evaluate the effects of foot reflexology therapy as an adjunctive treatment to the Malaysian low back pain standard care in relieving pain and promoting health related quality of life in people (HRQoL) with NSLBP. Methods: This is parallel randomized controlled trial in the reflexology therapy clinic, Kuala Terengganu, Malaysia; 100 people with non-specific low back pain will be allocated into one of two groups, using web-based application based on block randomisation. Outcome assessor and subjects will be blinded for group allocation. The control group will receive standard care, while the intervention group will receive standard care plus eight sessions, twice a week of foot reflexology therapy. The primary and secondary outcome variables are pain intensity and HRQoL respectively. Results: Outcome measures will be undertaken at pre-intervention (week 0), interim (week 1, week 2, week 3, week 4), post-intervention (week 6) and follow-up (week 10). Conclusions: This will be the first trail to compare the foot reflexology therapy with control group among people who medically diagnosed with NSPLB in Malaysia. The result of this study will contribute to better management of this population. Clinical Trial: This trail is registered in ClinicalTrials.gov, with the ID number of NCT02887430

  • Usability of a culturally informed mHealth intervention for anxiety and depression: Feedback from young sexual minority men

    From: JMIR mHealth and uHealth

    Date Submitted: Jan 24, 2017

    Open Peer Review Period: Jan 25, 2017 - Mar 22, 2017

    Background: To date, we are aware of no interventions for anxiety and depression developed as smartphone applications (apps) and tailored to young sexual minority men, a group especially at risk for a...

    Background: To date, we are aware of no interventions for anxiety and depression developed as smartphone applications (apps) and tailored to young sexual minority men, a group especially at risk for anxiety and depression. We developed TODAY!, a culturally informed smartphone intervention for young men who are attracted to men and who have clinically significant symptoms of anxiety and/or depression. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive-behavioral therapy and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (e.g. tips for current distress, visualizations of mood by context). Objective: We conducted usability testing to understand how young sexual minority men interact with the app, to inform later stages of intervention development. Methods: Participants (n = 9) were young sexual minority men aged 18-20 (M = 19.00, SD = 0.71; 44% Black, 44% White, 11.1% Latino), who endorsed at least mild depression and anxiety symptoms. Participants were recruited via flyers, emails to college LGBT organizations, online advertisements, another researcher’s database of sexual minority youth interested in research participation, and word of mouth. During recorded interviews, participants were asked to think out loud while interacting with the TODAY! app on a smartphone. Feedback identified from these recordings and from associated field notes were subjected to analysis. To aid interpretation of results, methods and results are reported according to the consolidated criteria for reporting qualitative research (COREQ). Results: Thematic analysis of usability feedback revealed six broad recurring themes: 1) Functionality (e.g., highlight new material when available); 2) Personalization (e.g., more tailored feedback); 3) Presentation (e.g., keep content brief); 4) Aesthetics, (e.g., use brighter colors); 5) LGBT/Youth Content (e.g., add content about coming out); and 6) Barriers to Use (e.g., perceiving psychoeducation as homework). Conclusions: Feedback from usability testing was vital to understanding what young sexual minority men desire from a smartphone intervention for anxiety and depression and was used to inform the ongoing development of such an intervention.

  • Is there Evidence of Cost and Benefits on Electronic Medical Records, Standards and Interoperability in Hospital Information Systems? An Overview of Systematic Reviews

    From: Journal of Medical Internet Research

    Date Submitted: Jan 24, 2017

    Open Peer Review Period: Jan 25, 2017 - Mar 22, 2017

    Background: eHealth interventions may improve the quality of care by providing timely, accessible information about one patient or an entire population. Electronic patient care information forms the n...

    Background: eHealth interventions may improve the quality of care by providing timely, accessible information about one patient or an entire population. Electronic patient care information forms the nucleus of computerized health information systems. However, data exchange among systems depends on the adoption of information standards. Additionally, investing in technology systems requires cost-effectiveness studies to ensure the sustainability of processes for stakeholders. Objective: To assess cost effectiveness in the use of electronically available inpatient data systems, information exchange, and standards to support interoperability among systems. Methods: An overview of systematic reviews was conducted, assessing the Medline, Cochrane Library, Lilacs and IEEE Library databases to identify relevant studies published through February 22nd 2016. The search was supplemented by citations from the selected articles. The direct outcome sought was cost effectiveness, and the indirect outcome was the impact on quality of care. Independent reviewers selected studies, and disagreement was resolved by consensus. The quality of the included studies was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR). Results: The primary search identified 286 papers, and two were manually included. Two hundred eleven were systematic reviews. From the 20 studies that were selected after screening the title and abstract, 14 were deemed ineligible, and six accepted to the reviewing process. The interventions did not show a direct, measurable effect on cost effectiveness. Despite the limited number of studies, the heterogeneity of electronic systems reported, and types of intervention on hospital routines, it was possible to identify some preliminary, indirect benefits on quality of care. Hospital information systems, along with information sharing, had the potential to improve clinical practice by reducing staff errors or incidents, improving automated harm detection, monitoring infection more effectively, and enhancing the continuity of care during physician handoffs. Conclusions: This review identified some indirect benefits on the quality of care but did not provide evidence that the implementation of eHealth interventions had a measurable impact on cost effectiveness or patient outcomes in hospital settings. However, further evidence is needed to infer the impact of interoperability on costs or benefits of health care; that requires further research.

  • Incorporation of a stress reducing mobile app in the care of patients with type 2 diabetes

    From: JMIR mHealth and uHealth

    Date Submitted: Jan 25, 2017

    Open Peer Review Period: Jan 25, 2017 - Mar 22, 2017

    Background: Emotional stress has been shown to contribute to the onset, progression and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to impro...

    Background: Emotional stress has been shown to contribute to the onset, progression and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to improve glycemic control. Use of a mobile app for stress management may enhance the scalability of such an approach. Objective: The study was designed to assess the effect of using a mobile app of biofeedback assisted relaxation on weight, blood pressure and glycemic measures of patients with T2D. Methods: Adult patients with type 2 diabetes and inadequate glycemic control (HbA1c>7.5%) were recruited from the outpatient diabetes clinic. Baseline weight, blood pressure, HbA1c, fasting plasma glucose, triglycerides and 7-point self-monitoring of blood glucose were measured. Patients were provided with a stress reducing, biofeedback mobile app and instructed to use it three times a day. The mobile app - Serenita© - is an interactive relaxation app based on acquiring a photoplethysmography signal from the Smartphone's camera lens, where the user places his finger. The app collects information regarding the user's blood flow, heart rate and heart rate variability and provides real-time feedback and individualized breathing instructions in order to modulate the stress level. All clinical and biochemical measures were repeated at 8 and 16 weeks of the study. The primary outcome was changes in measures at 8 weeks. Results: Seven patients completed 8 weeks of the study, and four completed 16 weeks. At week 8 weight dropped by an average of 4.0±4.3 kg; systolic blood pressure by 8.6±18.6 mmHg; HbA1c by 1.3±1.6%; fasting plasma glucose by 4.3±4.2 mmol/l and serum triglycerides were unchanged. Conclusions: Stress reduction using a mobile app based on biofeedback has the potential of improving glycemic control, weight and blood pressure. Clinical Trial: 02691273

  • Controlling Your "App"etite: How Diet and Nutrition-Related Mobile Applications Lead to Behavior Change

    From: JMIR mHealth and uHealth

    Date Submitted: Jan 26, 2017

    Open Peer Review Period: Jan 26, 2017 - Mar 23, 2017

    Background: In recent years, obesity in America has become a serious public health crisis. While the problem of obesity is being addressed through a variety of strategies, the use of mobile applicatio...

    Background: In recent years, obesity in America has become a serious public health crisis. While the problem of obesity is being addressed through a variety of strategies, the use of mobile applications (apps) is a relatively new development that could prove useful in helping people to develop healthy dietary habits. While such apps might lead to healthy behavior change, especially when relevant behavior change theory constructs are integrated into them, the mechanisms by which those apps facilitate behavior change are largely unknown. Objective: The purpose of this study is to identify which behavior change mechanisms are associated with use of diet- and nutrition-related health apps and whether the use of diet- and nutrition-related apps is associated with health behavior change. Methods: A cross-sectional survey was administered to a total of 217 participants. Participants responded to questions on demographics, use of diet/nutrition app(s) in the past 6 months, engagement and likeability of app(s), and changes in the participant’s dietary behaviors. Regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior, after controlling for potential confounding variables. Results: The majority of study participants agreed or strongly agreed with statements regarding app use increasing their motivation to eat a healthy diet, improving their self-efficacy, and increasing their desire to set and achieve health diet goals. The majority of participants strongly agreed that using diet/nutrition apps led to changes in their behavior, namely increases in actual goal setting to eat a healthy diet (58.5%), increases in their frequency of eating healthy foods (57.6%), and increases in their consistency of eating healthy foods (54.4%). Participants also responded favorably to questions related to engagement and likability of diet/nutrition apps. A number of predictors were also positively associated with diet-related behavior change. Theory (p<.001), app engagement (p<.001), app use (p<.003), and education (p<.010) were all positively associated with behavior change. Conclusions: Study findings indicate that the use of diet/nutrition apps is associated with diet-related behavior change. Hence, diet- and nutrition-related apps that focus on improving motivation, desire, self-efficacy, attitudes, knowledge, and goal setting may be particularly useful. As the number of diet- and nutrition-related apps continues to grow, developers should consider integrating appropriate theoretical constructs for health behavior change into newly developed mobile apps.

  • Access to electronic personal health records: The case of patients with multiple chronic conditions

    From: Journal of Medical Internet Research

    Date Submitted: Feb 1, 2017

    Open Peer Review Period: Feb 2, 2017 - Mar 30, 2017

    Background: National incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of pat...

    Background: National incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). Little is known, however, about the current availability and use of ePHRs and patient portals among those managing MCC. Objective: To determine the associations between number of chronic conditions and sociodemographic characteristics, and usage of ePHRs; and to assess how the public’s use of ePHRs varies across subpopulations, including those with MCC. Methods: Using data collected in 2014 from the Health Information National Trends Survey (HINTS), we assessed differences in use of ePHRs between those with and without MCC (total n = 3497) using multiple logistic regression techniques. We included variables associated with healthcare systems (insurance status, having a regular provider) and patient-reported self-efficacy in our models. Results: While those with MCC had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (OR = 2.46, 95% CI = 1.37 to 4.45); the overall percentage of those with MCC using ePHRs remained low (25.6%). Conclusions: We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients but especially those with MCC. Clinical Trial: Not applicable.

  • Testing the effectiveness of a primary care intervention to improve uptake of colorectal cancer screening: A randomised controlled trial protocol.

    From: JMIR Research Protocols

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 19, 2017 - Mar 5, 2017

    Background: Screening for colorectal cancer (CRC) significantly reduces mortality associated with this disease. In Australia, the National Bowel Cancer Screening Program provides regular faecal occult...

    Background: Screening for colorectal cancer (CRC) significantly reduces mortality associated with this disease. In Australia, the National Bowel Cancer Screening Program provides regular faecal occult blood tests (FOBT) for those aged 50-74, however, participation rates in the program have plateaued at 36%. Considering low uptake in the National Bowel Cancer Screening Program it is necessary to explore alternate methods to increase CRC screening rates. Primary care is a promising adjunct setting to test methods to increase CRC screening participation. Primary care guidelines support the recommendation and provision of CRC screening in primary care patients. Those in the National Bowel Cancer Screening Program target age range frequently present to their primary care provider. Objective: This study tests the effect that printed advice on screening, provision of a free point-of-care FOBT and face-to-face primary care provider endorsement of screening delivered in an Australian primary care has on CRC screening uptake. Methods: Primary care patients presenting for an appointment with their primary care provider complete a touchscreen survey to determine eligibility for the trial. Those aged 50-74, at average risk of CRC, who have not have had a FOBT in the past two years or a colonoscopy in the past five years are eligible to participate in the trial. Trial participants are randomised to the intervention or usual care group by day of attendance at the practice. The intervention consists of provision of a FOBT, a printed information sheet and primary care provider endorsement to complete the FOBT. The usual care group receives no additional care. Results: The primary outcome is completion of CRC screening six weeks after recruitment. The proportion of patients completing CRC screening will be compared between trial groups using a logistic regression model. Conclusions: Protocol paper only Clinical Trial: This study was registered with the Australian New Zealand Clinical Trials Registry on 15th September 2016 (ACTRN12616001299493). The Universal Trial Number (UTN) for this trial is U1111-1185-6120.

  • Machine or Human? Evaluating the Quality of a Language Translation Mobile App for Diabetes Education Material

    From: JMIR Diabetes

    Date Submitted: Feb 3, 2017

    Open Peer Review Period: Feb 6, 2017 - Apr 3, 2017

    Background: Diabetes is a major health crisis for Hispanics and Asian Americans. Moreover, Spanish and Chinese speakers, in particular, are more likely to have limited English proficiency in the U.S....

    Background: Diabetes is a major health crisis for Hispanics and Asian Americans. Moreover, Spanish and Chinese speakers, in particular, are more likely to have limited English proficiency in the U.S. One potential tool for facilitating language communication between diabetes patients and providers is technology, specifically smartphones. Objective: With regard to the machine translation quality, previous studies only assessed the translation product using writing inputs. To bridge such research gap, we conducted a pilot study to evaluate the quality of a mobile language translation app (iTranslate) with the voice recognition feature when translating diabetes patient education material. Methods: The pamphlet, “You are the heart of your family…take care of it,” is a health education sheet for diabetes patients that outlines three recommended questions for patients to ask their clinicians. Two professional translators interpreted the original English sentences into Spanish and Chinese. We recruited six certified medical translators (three Spanish and three Chinese) to conduct blinded evaluations of the following versions: (1) sentences interpreted by iTranslate, and (2) sentences interpreted by a professional human translator. Evaluators rated the sentences provided on four scales: Fluency, Adequacy, Meaning, and Severity ranged from 1 to 5. We performed descriptive analyses to examine differences between these two versions. Results: Cronbach’s alpha values exhibited high degrees of agreement on the rating outcome of both evaluator groups: 0.920 for the Spanish raters and 0.971 for the Chinese raters. The readability scores generated using Microsoft Word’s Flesch-Kincaid Grade Level for these sentences were 0.0, 1.0, and 7.1. We found that iTranslate generally provided comparable translation accuracy as human translators on simple sentences. However, iTranslate made more errors when translating difficult sentences, which might cause delayed patient care. Conclusions: iTranslate could supplement, but not supplant, human translators. Mobile translation apps should be used with precaution.

  • Effectiveness of a Web-based tailored intervention with virtual assistants promoting the acceptability of HPV-vaccination among mothers of invited girls: Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 6, 2017 - Apr 3, 2017

    Background: In the Netherlands, in 2010, the HPV-vaccination was introduced in the National Immunization Program (NIP) for 12-year-old girls aiming to reduce the number of cervical cancer cases. HPV-v...

    Background: In the Netherlands, in 2010, the HPV-vaccination was introduced in the National Immunization Program (NIP) for 12-year-old girls aiming to reduce the number of cervical cancer cases. HPV-vaccination uptake remains to be lower than expected (61% compared to 70%). Mothers were shown to play the most important role in the immunization decision of these girls. They expressed a need for interactive, personal information about the HPV-vaccination over and above the existing general information. To improve the existing communication about the HPV-vaccination and increase HPV-vaccination uptake, we systematically developed a Web-based tailored intervention with virtual assistants providing mothers of girls-to-be-invited with tailored feedback on the HPV-vaccination of their daughter. Objective: The aim of the study was to evaluate in a randomized controlled trial the effectiveness of the Web-based tailored intervention with virtual assistants to promote HPV vaccination acceptance. Methods: Mothers were recruited through the Dutch individual-based vaccination register (Praeventis) (n = 36,000) and through three online panels (n = 2,483). Those who gave informed consent (n = 8,062) were randomly assigned to: (1) a control (n = 4,067) or (2) the intervention condition (n = 3,995). HPV-vaccination uptake, as registered by Praeventis once the data on the HPV-vaccination round was complete, was used as the primary outcome measure. Secondary measures were differential scores across conditions between baseline (prior to the first vaccination) and follow-up (just before or during the first vaccination) regarding the mothers’ degree of informed decision-making, decisional conflict, and critical determinants of HPV-vaccination uptake among which intention, attitude, risk perception, and outcome beliefs. Results: Intention-to-treat analysis (N = 8,062) showed a significant positive effect of the intervention on informed decision-making, decisional conflict, and on nearly all determinants of HPV-vaccination uptake (P <.001). No effect was found on HPV-vaccination uptake (P = .60). This may be attributed to the overall high uptake rates in both conditions. Mothers evaluated the intervention as positive, specified by the high subjective evaluation of both the website and the virtual assistants that were used to deliver the tailored feedback. Conclusions: This computer-tailored intervention has the potential to improve HPV-vaccination acceptability and informed decision-making and decrease decisional conflict among mothers of invited girls. Implications for future research to better understand effects on vaccination uptake are discussed. Clinical Trial: Dutch Trial Register NTR4935; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4935

  • Ontology-based analysis of social media data related to adolescent depression

    From: Journal of Medical Internet Research

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 6, 2017 - Apr 3, 2017

    Background: Social network services (SNSs) contain abundant information about the feelings, thoughts, interests, and patterns of behavior of adolescents that can be obtained by analyzing SNS postings....

    Background: Social network services (SNSs) contain abundant information about the feelings, thoughts, interests, and patterns of behavior of adolescents that can be obtained by analyzing SNS postings. An ontology that expresses the shared concepts and their relationships in a specific field could be used as a semantic framework for social media data analytics. Objective: The aims of this study were to develop an ontology and terminology as a framework for analyzing social media data on adolescent depression and to evaluate a formal description of classes and relationships in the ontology and its applicability. Methods: The domain and scope of the ontology were defined using competency questions. Concepts constituting the ontology and terminology were collected from clinical practice guidelines, the literature, and social-media postings on adolescent depression. Class concepts, their hierarchy, and relationships among class concepts were defined. An internal structure of the ontology was designed using the entity-attribute-value (EAV) triplet data model, and superclasses of the ontology were aligned with the upper ontology. Description logics of the ontology were evaluated by competency questions using description logic queries. Applicability of the ontology was validated by examining the representability of 10 sentiment phrases using the ontology data model and conducting sentiment analyses of social media data using logistic regression, decision tree, and association rules. Results: The ontology consisted of five top-level classes with 438 subordinate classes arranged into three or four levels of hierarchy. In total, 443 classes with 1,682 synonyms had 19 different types of property relationships. All of the answers that were inferred from the ontology according to the queries were found to be correct. Regarding applicability, it was possible to represent the 10 sentiment phrases using the EAV triplet of the ontology class concepts. It was also found that ‘academic stresses’ and ‘suicide’ contributed negatively to the sentiment of adolescent depression. Conclusions: The ontology and terminology developed in this study provide a semantic foundation for analyzing social media data on adolescent depression. To be useful in social media data analysis, the ontology, especially the terminology, needs to be updated constantly to reflect rapidly changing terms used by adolescents in social media postings.

  • Computerised adaptive testing improves the reliability and efficiency of depression assessment using the CES-D scale

    From: Journal of Medical Internet Research

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 6, 2017 - Apr 3, 2017

    Background: The CES-D is a commonly-used measure of depression. We assess its performance as an item bank for measuring depression using a computer adaptive testing (CAT) administration protocol. Obje...

    Background: The CES-D is a commonly-used measure of depression. We assess its performance as an item bank for measuring depression using a computer adaptive testing (CAT) administration protocol. Objective: To provide evidence on the efficiency and accuracy of the CES-D when administer using CAT. Methods: We applied a battery of psychometric assessments to the legacy CES-D questionnaire. Dimensionality as assessed using confirmatory factor and Mokken analysis. Advanced psychometric properties were assessed using item response theory (IRT) including assessments of item and scale fit to the graded response model, local dependency and differential item functioning. Results: Confirmatory Factor analysis (CFA) was employed to investigate the unidimensionality of the CES-D scale. Initial CFA results indicate a poor fit to the model. Thus, Mokken analysis was employed to explore the dimensional structure of the CESD-D. Three items were eliminated to conform to a single dimension. The remaining 17 items to Samejima’s graded response model. Examination of the factor loadings revealed that all items loaded significantly on the single factor. Evaluation of local dependency resulted in no correlated residuals greater than 0.2. Significant differential item functioning was not found between age and gender groups. Estimates of the level of CES-D trait score provided by the simulated CAT algorithm and the original CES-D trait score derived from original scale were correlated highly. The CAT simulation conducted using real data found a downward trend in the length of items given to individuals, indicating higher precision at the extreme (higher) levels of the depression spectrum. Conclusions: In summary, the CES-D CAT is a precise and efficient measurement of a highly relevant psychological construct. Even in its current form, the CES-D CAT shows the immediate advantages which can be employed to measure depression that is more accurate, interpretable, and efficient than using a paper-based test.

  • Mutual Involvement in Families with Type 2-Diabetes through Internet-based Healthcare Solutions.

    From: JMIR Diabetes

    Date Submitted: Feb 6, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: Type 2-diabetes (T2D) is a prevalent chronic disease that affects not just the patient but the entire family. Both the patient and the rest of the family may benefit from gaining knowledge...

    Background: Type 2-diabetes (T2D) is a prevalent chronic disease that affects not just the patient but the entire family. Both the patient and the rest of the family may benefit from gaining knowledge about the disease and from supportive interfamilial interaction. Since the Internet is becoming a widely-used resource for health information, an Internet-based solution could potentially promote awareness and knowledge on how to manage T2D as a family, while also providing support for the family. Objective: To assess patients’ with T2D and their relatives’ usage of online information on diabetes and explore the families’ needs and preferences in regards to online information on diabetes. Objective: To assess patients’ with T2D and their relatives’ usage of online information on diabetes and explore the families’ needs and preferences in regards to online information on diabetes. Methods: A quantitative questionnaire survey was performed with families where at least one family member was diagnosed with T2D. The survey consisted of 36 closed questions on demographics, usage of the Internet, preferences in the source of information, interest in online information on six problem domains within family life related to T2D, preferences towards the delivery format of online information and peer-to-peer communication. Two open-ended questions were also included to elicit any additional comments or suggestions on improving online information on T2D regarding family life. Results: 50 participants corresponding to 22 families with T2D answered the questionnaire individually. 89% of the relatives and 100% of the patients indicated that information on T2D is relevant for them and 89-95% indicated that the Internet is the first or second preferred source when in need of information on T2D. Still, only 32-46% indicated to have searched the Internet to gain knowledge on T2D regarding family life. In regards to the six problem domains, 73-95% of the participants indicated interest in the domains Support, Knowledge and Everyday Life while 46-73% were interested in the domains ‘Communication, Worries and Roles. 72-84% of the participants indicated a preference for watching videos or reading about experiences derived from health care professionals (HCPs) or other families, while 20-32% were interested in peer-to-peer communication. Conclusions: Despite an interest for online information on T2D, there appears to be an unsatisfied need for more supportive online information on T2D aimed at Danish families with T2D. Based on family preferences, online information should focus on the six problem domains and be presented through text and videos by HCPs and peers. Peer-to-peer communication elements may be beneficial but are only expected to be used by a very limited number of families.

  • Ignoring an important sub-population: Measuring HIV prevalence and risk among adolescent key populations at higher risk of HIV exposure in Asia-Pacific

    From: JMIR Public Health and Surveillance

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 10, 2017 - Feb 24, 2017

    Ending the AIDS epidemic depends on greater efforts to reduce new HIV infections and prevent AIDS-related deaths among key populations at highest HIV risk, including men who have sex with men (MSM), s...

    Ending the AIDS epidemic depends on greater efforts to reduce new HIV infections and prevent AIDS-related deaths among key populations at highest HIV risk, including men who have sex with men (MSM), sex workers and people who inject drugs (PWID). One component of this strategy is to gather actionable strategic data through surveillance activities, especially HIV biological behavioral surveillance surveys (BBSS). HIV BBSS, conducted every few years worldwide among adult key populations, provide information on the prevalence of HIV and other infections, HIV testing, risk behaviors, program coverage and, when at least three of these surveys are conducted, trend data with which to evaluate progress. Three global meetings (2004 in Addis Ababa, Ethiopia; 2009 and 2015 in Bangkok, Thailand) have convened technical experts from around the world to share lessons learned, improvements and innovations, and outputs from international HIV surveillance activities. This third meeting was the first time substantial attention was given to adolescent (15 to 19 years) and young (20-24 years) key populations. Although adolescent key populations (AKP) are disproportionately affected by HIV, they have been largely ignored in HIV BBBS activities to-date. Barriers to their inclusion in HIV BBSS include limited effective sampling methods, and difficulties obtaining ethical approval for their inclusion. This paper reviews current ethical and sampling challenges and provides suggestions to overcome these, with the aim to ensure evidence-informed, strategic and targeted allocations and programmes towards ending the HIV epidemic among adolescent key populations.

  • Content Analysis of Smartphone Apps for Smoking Cessation in China

    From: Journal of Medical Internet Research

    Date Submitted: Feb 16, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone applications (apps) for smoking ces...

    Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone applications (apps) for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS & Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSSG; identical to the U.S. Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSSG. We also recorded the features of smoking cessation apps (e.g., release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence, with an average score of 11.1 for Android and 14.6 for iOS apps, on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China.

  • Development of a Context-Driven Dynamic XML Ophthalmologic Data Capture Application

    From: Journal of Medical Internet Research

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 20, 2017 - Apr 17, 2017

    Background: The capture and integration of ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and re...

    Background: The capture and integration of ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and research is critical. Objective: The purpose of this study was to develop a context-driven dynamic XML ophthalmology data capture application for research and clinical care that could be easily integrated into an electronic health record system. Methods: Stakeholders in the medical, research, and informatics fields were interviewed and surveyed to determine data and system requirements for ophthalmologic data capture. Based on these requirements, an ophthalmology data capture application was developed to collect and store discrete data elements with important graphical information. Results: The context-driven data entry application supports several features including: ink-over drawing capability for documenting eye abnormalities, context-based web controls that guide data entry based on pre-established dependencies, and an adaptable database or XML schema that stores web form specifications and allows for immediate changes in form layout or content. The application utilizes web services to enable data integration with a variety of EHRs for retrieval and storage of patient data. Conclusions: This paper describes the development process used to create a context-driven dynamic XML data capture application for optometry and ophthalmology. The list of ophthalmologic data elements identified as important for care and research can be used as a baseline list for future ophthalmologic data collection activities.

  • An eAlert System Between Family Caregivers and Clinicians Reduces Symptom Distress in Patients With Advanced Cancer: A Pooled Analysis of Two Randomized Clinical Trials

    From: Journal of Medical Internet Research

    Date Submitted: Feb 8, 2017

    Open Peer Review Period: Feb 19, 2017 - Apr 16, 2017

    Background: Symptom distress toward the end of life can change rapidly. Family caregivers have the potential to help manage those symptoms, as well as their own stress, if they are equipped with the p...

    Background: Symptom distress toward the end of life can change rapidly. Family caregivers have the potential to help manage those symptoms, as well as their own stress, if they are equipped with the proper resources. eHealth systems may be able to provide those resources. Very sick patients may not be able to use such systems themselves to report on their symptoms, but family caregivers could. Objective: Assess the effects of an eHealth system that alerts clinicians to significant changes in a cancer patient’s symptom distress, as reported by a family caregiver. Methods: A pooled analysis from two randomized clinical trials (NCT00214162 and NCT00365963) compared outcomes at 12 months for two unblinded groups: a control group (CHESS-Only) that gave caregivers access to an online support system, the Comprehensive Health Enhancement Support System (CHESS), and an experimental group (CHESS+CR [Clinician Report]), which also had CHESS, but with a Clinician Report that automatically alerted clinicians if symptoms exceeded a predetermined threshold. Participants were dyads (n = 235) of patients with advanced lung, breast, or prostate cancer and their family caregivers from five oncology clinics in the United States. The proportion of improved patient threshold symptoms was compared between groups using area-under-the-curve analysis and binomial proportion tests. The proportion of threshold symptoms out of all reported symptoms was also examined. Results: When caregivers in CHESS+CR reported an over-threshold symptom, they were more likely to subsequently report threshold symptom improvement, P < .001, than in the group that did not include CR. Moreover, fewer caregivers in the CHESS+CR group completed symptom reports than in the CHESS-Only group (P < .001). Knowing their reports might be sent to a doctor, they might have been reluctant to “bother” the clinician. Conclusions: This study suggests that a caregiver-focused eHealth system that alerts clinicians to worrisome changes in patient health status may lead to a reduction in patient distress. Clinical Trial: NCT00214162; https://clinicaltrials.gov/ct2/show/NCT00214162 (Archived by WebCite at http://www.webcitation.org/6nmgdGfuD). NCT00365963; https://clinicaltrials.gov/ct2/show/NCT00365963 (Archived by WebCite at http://www.webcitation.org/6nmh0U8VP )

  • Public Perceptions Regarding Use of Virtual Reality in Healthcare: A Social Media Ethnographic Analysis Using Facebook

    From: Journal of Medical Internet Research

    Date Submitted: Feb 7, 2017

    Open Peer Review Period: Feb 8, 2017 - Apr 5, 2017

    Background: Virtual reality (VR) technology provides an immersive, multisensory, and three-dimensional environment that enables users to have modified experiences of reality. VR is increasingly used t...

    Background: Virtual reality (VR) technology provides an immersive, multisensory, and three-dimensional environment that enables users to have modified experiences of reality. VR is increasingly used to manage patients with pain, disability, obesity, neurologic dysfunction, anxiety, or depression. However, public opinion regarding use of VR in healthcare has not been explored. Understanding public attitudes, concerns, beliefs, and recommended use cases for VR is critical to ensure effective implementation and appropriate dissemination of this emerging technology. Objective: We sought to examine public opinion about healthcare VR using digital ethnography, a qualitative analysis method that allows for exploration of unfiltered views of topics discussed online. Methods: In March 2016, NBC News produced a video depicting use of VR for patient care. The video was repackaged by NowThis, a social media news website, and distributed on Facebook by Upworthy, a news aggregator, yielding 4.3 million views and 2,401 comments. We used Microsoft Power Query and ATLAS.ti software to analyze the comments using thematic analysis and categorized the comments around first-, second-, and third-order concepts. We determined self-identified gender from the user’s Facebook page and performed sentiment analysis of language to analyze whether perception of VR differed by gender using Pearson’s chi-square tests. Results: Of the 1,614 analyzable comments, 1,021 (63.26%) were attributed to female Facebook users, 572 (35.44%) to male users, and 21 (1.30%) to users of unknown gender. There were 1,197 comments coded as expressing a positive perception about VR (74.16%), 251 as a negative perception and/or concern (15.55%), and 560 as neutral (34.70%). Respondents identified 20 use cases for VR in healthcare, including for pain and stress reduction, bed-bound individuals, women during labor, and patients undergoing chemotherapy, dialysis, radiation, or imaging procedures, among others. Negative comments expressed concerns about patient safety and overdependence on technology. Respondents also expressed concerns about radiation, infection risk, motion sickness, and the ubiquity of and overall dependence on technology. There was a statistically significant association between language valence and gender of the Facebook user; men were more likely to post negative perceptions about VR use for healthcare, while women were more likely to post positive perceptions (P < 0.001). Conclusions: This study provides a blueprint for healthcare organizations and the VR community regarding where to prioritize research and implementation of VR for patient care. Most respondents to this natural experiment expressed positive perceptions about the use of VR in a wide range of healthcare settings. However, many expressed concerns that should be acknowledged and addressed as healthcare VR continues to evolve. Our results provide guidance in determining whether, when, and where to implement VR in patient care, and offer a formal opportunity for public opinion to shape the VR research agenda.

  • Does a novel wearable device improve health related quality of life of patients with an ostomy? A prospective, observational, crossover study protocol.

    From: JMIR Research Protocols

    Date Submitted: Feb 12, 2017

    Open Peer Review Period: Feb 20, 2017 - Mar 6, 2017

    Background: Ostomy surgeries involving the placement of an ostomy bag (colostomy, ileostomy, urostomy, etc.) have been shown to have a negative impact on health-related quality of life. To date, no s...

    Background: Ostomy surgeries involving the placement of an ostomy bag (colostomy, ileostomy, urostomy, etc.) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on health-related quality of life of ostomy patients. Objective: In the present study, we plan to assess quality of life of ostomy patients using the Ostom-i alert sensor, a portable, wearable, Bluetooth linked biosensor that facilitates easier ostomy bag output measurements. We hypothesize that using the Ostom-i alert sensor will result in an improved, ostomy specific health related quality of life as compared to baseline measurement before the use of the sensor. Methods: A total of 20 ostomy patients will be screened and recruited to participate in this prospective, observational, crossover trial using Ostom-i alert sensor for one month. The primary outcome of this study will compare ostomy specific health related quality of life at baseline (prior to Ostom-i alert sensor use) to ostomy specific health-related quality of life after 2 and 4 weeks of Ostom-i use by utilizing the City of Hope Quality of Life Questionnaire for patients with an Ostomy (CoH-QOL-Ostomy). Secondary outcomes of general health related quality of life and adjustment to ostomy will be evaluated using the Medical Outcomes Study 36-item short form health survey (SF-36) and the Olbrisch Ostomy Adjustment Scale Short Form 2 (OAS-SF2). Results: Proposed benefits of mobile, internet linked personal health monitors such as the Ostom-i include a reduction in the cost of care by reducing resource utilization and infection rates, improving patient-provider communication, reducing time spent as an in-patient as well as improved quality of life. Prior studies have demonstrated decreased health related quality of life in patients with an ostomy bag. We aim to examine the extent to which the Ostom-i™ alert sensor affects health related quality of life of its users. Conclusions: The Ostom-i alert sensor has the potential to improve quality of life of users by giving them freedom and confidence to partake in daily activities with the knowledge that they can check how full their ostomy bag is in a private, discrete manner. Clinical Trial: clinicalTrials.gov: NCT02319434, first registered 15 December 2014.

  • Cognitive impairment evaluation in adult subjects by telemedicine: a review

    From: Journal of Medical Internet Research

    Date Submitted: Feb 9, 2017

    Open Peer Review Period: Feb 10, 2017 - Apr 7, 2017

    Background: Telemedicine covers different aspects of cognitive neurosciences and neuropsychology is one of them. It allows to achieve a cognitive evaluation of adult subjects, to screen cognitive impa...

    Background: Telemedicine covers different aspects of cognitive neurosciences and neuropsychology is one of them. It allows to achieve a cognitive evaluation of adult subjects, to screen cognitive impairments, and can contributes significantly to Alzheimer’s disease diagnosis. Objective: In this work we have investigated, through a systematic analysis of the literature, which neuropsychological tests among those used for diagnosing adult-onset cognitive dysfunctions can be reliably administered applied by telemedicine approaches. Methods: A PubMed search for the 10-years period 2006–2016 was performed. Results: Mini-Mental State Examination (MMSE), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Montreal Cognitive Assessment (MoCA) 5-minute protocol, Token Test, Aural Comprehension of Words and Phrases (ACWP) and Controlled Oral Word Association Test and other tests are reliable when administered by telemedicine. No significant score differences were found compared to the face-to-face modality. However, videoconference-based assessment may require modifications in test instructions and procedures. Conclusions: Telemedicine may be properly applied to neuropsychology and several tests commonly used for dementia disorders can be easily administered at a distance with minor adaptations in their instructions and procedures.

  • Scaling up the adoption and use of health technologies: Insights from practice theory

    From: Journal of Medical Internet Research

    Date Submitted: Feb 10, 2017

    Open Peer Review Period: Feb 11, 2017 - Apr 8, 2017

    Background: The challenge of promoting the spread and scale of new health technologies (including mobile health, telemedicine, and telehealth technologies) is now widely recognized around the world. D...

    Background: The challenge of promoting the spread and scale of new health technologies (including mobile health, telemedicine, and telehealth technologies) is now widely recognized around the world. Despite the growing attention to methods to achieve successful spread and scale, many scale-up initiatives continue to yield disappointing results. One central reason for the continued failure of these scale-up initiatives is a lack of understanding of how context influences the diffusion of technologies. Objective: In this paper we describe the contributions of “practice theory” to informing efforts to scale-up health technologies across entire systems of health and social care. Methods: Drawing on an individual case study from the Studies in co-Creating Assisted Living Solutions (SCALS) research program in the United Kingdom, and a review of practice theory, we identify key considerations in the effort to scale and spread health technologies. After describing the key tenets of practice theory, we present data from a case study of the implementation of a Global Positioning System (GPS) “geo-fence” for a person living with dementia. We conclude by summarizing the key insights that practice theory brings to efforts to scale up this technology and others, and offer questions to guide further work in this important field. Results: Illustrated through the case of the GPS “geo-fence”, practice theory suggests that efforts to scale-up technologies must attend to three key insights. First, scaling up technologies is in part unpredictable as a result of the experience and judgment integrated into clinical decision-making. Second, the successful scale-up of technologies depends on existing social networks, and considering those social networks will enable stronger plans for the scale and spread of health technologies. Finally, scaling up new technologies means changing routines of a wide range of people, raising the importance of understanding which routines are most likely to change. Conclusions: If health care leaders, policymakers, and other figures driving the scaling up of health technologies continue to neglect the real-world contexts of individual experiences, social networks, and habitual routine practices, the scaling up process will continue to be thwarted by the more important stuff that dominates peoples’ everyday lives. Future work in this domain should include a focus on strategies by which new technologies can be tailored to individual needs, and system-level strategies to provide enabling contexts for the integrated of technologies into routine care delivery.

  • Online Physician Ratings for California Physicians on Probation

    From: Journal of Medical Internet Research

    Date Submitted: Feb 10, 2017

    Open Peer Review Period: Feb 10, 2017 - Apr 7, 2017

    Background: Online physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours and disciplin...

    Background: Online physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear. Objective: We sought to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls. Methods: A retrospective review of data from the Medical Board of California for physicians placed on probation from 12/1989 to 9/2015 was performed. Violations were categorized into nine types. Non-probation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Online reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5). Results: 410 physicians were placed on probation for 866 violations. The mean ( standard deviation) number of ratings per doctor was 5.2 7.8 for cases and 4 6.3 for controls (P=0.003). The mean rating for physicians on probation was 3.7 1.6 compared to 4.0 1.0 for controls when all 3 rating websites were pooled (P<0.001). Violations for medical documentation, incompetence, prescription negligence and fraud were found to have statistically significant lower rating scores. Conversely, scores for professionalism, drugs/alcohol, crime, sexual misconduct and personal illness were similar between cases and controls. In a univariate analysis, probation was found to be associated with lower rating, odds ratio = 1.5 (95% confidence interval 1.0 – 2.2). This association was not significant in a multivariate model when we included age and gender. Conclusions: Online physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute difference was quite small. Physician rating websites have utility but are imperfect proxies for competence. Further research on physician online ratings is warranted to understand what they measure and how they are associated with quality.

  • Stroke Avoidance for Children in REpública Dominicana (SACRED): A Prospective Study of Stroke Risk and Hydroxyurea Treatment in Sickle Cell Anemia

    From: JMIR Research Protocols

    Date Submitted: Feb 10, 2017

    Open Peer Review Period: Feb 21, 2017 - Mar 7, 2017

    Background: In the Dominican Republic, where the sickle cell burden is high, many children lack access to routine screening and preventative care. Children with sickle cell anemia (SCA) are at risk fo...

    Background: In the Dominican Republic, where the sickle cell burden is high, many children lack access to routine screening and preventative care. Children with sickle cell anemia (SCA) are at risk for stroke, an event that leads to significant morbidity and mortality. In the United States, screening via Transcranial Doppler (TCD) identifies children with SCA at highest stroke risk, allowing early intervention with blood transfusions. The need for indefinite transfusions for primary stroke prevention limits their practicality in limited-resource countries. Hydroxyurea has been shown to lower TCD velocities and to prevent conversion from conditional (170-199 cm/sec) to abnormal (≥200 cm/sec) velocities. In resource-limited settings, implementation of a TCD screening program, coupled with hydroxyurea therapy, could reduce the burden of SCA and stroke. Objective: SACRED aims to screen children with SCA for stroke risk using TCD, to determine the prevalence of elevated velocities in a cross-sectional sample, to identify clinical and laboratory correlates of elevated velocities, to obtain longitudinal data on the natural history of TCD velocities, and to measure effects of hydroxyurea. Methods: This prospective trial designed and conducted by Cincinnati Children’s Hospital Medical Center (CCHMC) and Hospital Infantil Robert Reid Cabral (HIRRC) with Centro de Obstetricia y Ginecología includes a baseline cross-sectional epidemiological survey of the distribution of TCD velocities across a large cohort of children with SCA in the Dominican Republic. Children with conditional velocities are eligible to begin protocol-directed hydroxyurea if laboratory criteria are met. The treatment schedule begins with a fixed-dose of approximately 20 mg/kg/day for six months, after which it escalates to maximum tolerated dose (MTD). All participants will undergo longitudinal TCD evaluation, for a total of at least three exams per participant over a three-year study period. Data are collected using an internet-based REDCap® system with forms translated into Spanish, and both remote and on-site monitoring is used. Results: To date, 122 children with SCA have enrolled in SACRED including 85 (69.7%) with normal, 29 (23.8%) with conditional, 5 (4.1%) with abnormal, and 3 (2.5%) with inadequate TCD velocities. Seventeen children with conditional TCD velocities have initiated hydroxyurea per protocol, with plans for escalation to MTD. Conclusions: The SACRED trial will provide novel epidemiologic data about the prevalence of children with SCA and increased stroke risk in the Dominican Republic. The study also includes investigation of impact of hydroxyurea at MTD on elevated TCD velocities, as well as clinical and laboratory parameters. The design and implementation of SACRED reflect a successful international institutional partnership, one that features local capacity building and training in research methods and clinical care. The trial’s results have important implications for screening and prevention of primary stroke in children with SCA living in resource-limited settings. Clinical Trial: ClinicalTrials.gov NCT02769845

  • PAin Improvement with Novel Combination Analgesic REgimens: The PAIN-CARE Trial

    From: JMIR Research Protocols

    Date Submitted: Feb 10, 2017

    Open Peer Review Period: Feb 21, 2017 - Mar 7, 2017

    Background: Neuropathic pain (NP, including painful diabetic neuropathy, postherpetic neuralgia etc.), affects ~7-8% of the population and is associated with a devastating symptom burden as well as a...

    Background: Neuropathic pain (NP, including painful diabetic neuropathy, postherpetic neuralgia etc.), affects ~7-8% of the population and is associated with a devastating symptom burden as well as a profound economic impact for patients, their families and the healthcare system. Current therapies have limited efficacy and dose-limiting adverse effects (AEs). Rational combination therapy with carefully selected NP drugs has shown potential for measurable improvements in pain relief, quality of life and healthcare utilization. Today, over half of NP patients concurrently receive 2 or more analgesics but combination use is based on little evidence. Research is urgently needed to identify safer, more effective, combinations. Objective: We hypothesize that analgesic combinations containing at least one non-sedating agent would be as safe but more effective than either monotherapy because of additive pain relief without increasing overall AEs. Pregabalin (PGB), a sedating anticonvulsant, is proven effective for NP and the antioxidant, alpha-lipoic acid (ALA), is one of the only non-sedating systemic agents proven effective for NP. Thus, we will conduct a clinical trial to compare a PGB-ALA combination to each monotherapy for NP. Methods: Using a double-blind, double-dummy, crossover design, 54 adults with NP will be randomly allocated to one of six sequences of treatment with PGB, ALA and PGB-ALA combination. During each of three different treatment periods, participants will take two sets of capsules containing 1) ALA (or placebo) and 2) PGB (or placebo) for 31 days, followed by an 11-day taper/washout period. The primary outcome will be mean daily pain intensity (0-10) at maximally tolerated doses (MTD) during each period. Secondary outcomes, assessed at MTD, will include global improvement, adverse events, mood, and quality of life. Results: This trial was registered in the International Standard Randomised Controlled Trial registry January 6, 2017 (ISRCTN #14577546), attained ethics approval December 15, 2016 (Queen’s University Health Sciences Sciences & Affiliated Teaching Hospitals Research Ethics Board protocol number ANAE-305-16), and recruitment is set to start March 2017. Conclusions: This trial will provide rigorous evidence comparing the efficacy of a PGB-ALA combination to PGB alone and ALA alone in the treatment of NP. Clinical Trial: International Standard Randomised Controlled Trial Number ISRCTN14577546, registered January 6, 2017.

  • A systematic review on the effectiveness of school-based sex education program for youth in Asia

    From: JMIR Research Protocols

    Date Submitted: Feb 11, 2017

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

    Background: This is a systematic review to assess the effectiveness of school-based sex education program among youngsters aged 12 or more who are going to school.All school going students with a prog...

    Background: This is a systematic review to assess the effectiveness of school-based sex education program among youngsters aged 12 or more who are going to school.All school going students with a program of sex education as a part of their school are eligible.This review presents the finding from controlled school-based sex education intervention in promoting change in behavior toward sex, risk factors, self-hygiene.All the articles of Randomized control trial, cluster randomized trial, non-randomized trial and quasi-experiment done in any country of Asia are eligible for the study. All the article will be screened as per the inclusion and exclusion criteria and take care of duplicate article by Rev man software. This will be done anonymously by two researchers.After the screening and solving the conflict if any arise will be solved by discussing with the primary author.All the article will be screened by consort guideline and will be provided narrative analysis. Objective: The objective of the review is to find whether the school based- sex education program are effective in changing the behavior of young in controlling HIV, and STI. Methods: We will search the following electronic bibliographic database: MEDLINE, Embase, PUBMED, OVID, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Education and Global Information System (AEGIS) and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS). Studies published between January 2000 and the date the search are run will be sought.The searches will be run just before the final analyses and further studies retrieved for inclusion. We will hand searched the reference lists of all relevant papers from manipal university.The search strategy will include only terms relating to or describing the intervention. The terms will be Combined with the Cochrane MEDLINE filter for controlled trials of interventions.The search terms will be adapted for use with other bibliographic databases in combination with database-specific filters for controlled trials, where these are available. Pubmed search strategy:- 1 sexual health education OR sex education OR Adolescent sex education OR reproductive health education 2 High school OR middle school OR secondary school 3 1 AND 2 4 race OR ethnicity OR black OR african american OR asian OR causation 5 3 AND (sexual orientation OR sexual behaviour) The search will be restricted to: Studies published in english at the time of search Studies conducted in asia Studies conducted in school setting Search string is as follow- effect[All Fields] AND ("schools"[MeSH Terms] OR "schools"[All Fields] OR "school"[All Fields]) AND based[All Fields] AND ("sex education"[MeSH Terms] OR ("sex"[All Fields] AND "education"[All Fields]) OR "sex education"[All Fields]) AND ("Intervention (Amstelveen)"[Journal] OR "intervention"[All Fields] OR "Interv Sch Clin"[Journal] OR "intervention"[All Fields]) AND ("behaviour"[All Fields] OR"behavior"[MeSH Terms] OR "behavior"[All Fields]) AND ("adolescent"[MeSH Terms] OR "adolescent"[All Fields]) Results: The result will be analysis on outcome variables that measure the effectiveness of school-based sex education program.information processing skills (reproductive health, boys, and girls), HIV, STI, students perceptions, risk behavior. change in the percentage of HIV, STI from baseline to last available article.All the article will be given importance on the intervention like the change of behavior.At last, the result will be shared with all the national health authority, WHO, UNICEF. Conclusions: The conclusion will be provided after the analysis of the systematic review. Clinical Trial: Method and content were approved by the Cochrane systematic review and published the protocol in their database.

  • The Paget Trial: A multi-centre, observational cohort, intervention study for the clinical efficacy, safety and immunological response of topical 5% imiquimod cream for vulvar Paget’s disease

    From: JMIR Research Protocols

    Date Submitted: Feb 14, 2017

    Open Peer Review Period: Feb 21, 2017 - Mar 7, 2017

    Background: Vulvar Paget disease is a rare skin disorder which is most common in postmenopausal, Caucasian women. They usually present with an erythematous plaque which may show fine or typical ‘cak...

    Background: Vulvar Paget disease is a rare skin disorder which is most common in postmenopausal, Caucasian women. They usually present with an erythematous plaque which may show fine or typical ‘cake icing’ scaling or ulceration, and may cause itching, pain, irritation or a burning sensation. Although most cases are non-invasive, vulvar Paget disease may be invasive, or associated with an underlying vulvar or distant adenocarcinoma. The histological evidence of so-called ‘Paget cells’, with abundant pale cytoplasm in the epithelium confirms the diagnosis. The origin of these Paget cells is still unclear. Treatment of choice is wide local excision with negative margins. Obtaining clear surgical margins is challenging and may lead to extensive and mutilating surgery. Even then, recurrence rates are high: ranging from 15 to 70%, which emphasizes the need for new treatment options. A number of case reports, retrospective case series and one observational study have shown promising results using the topical immune response modifier imiquimod. Topical 5% imiquimod cream might be an effective and safe treatment alternative for vulvar Paget disease. This study aims to investigate the efficacy, safety and immunological response in patients with non-invasive vulvar Paget disease using a standardized treatment schedule with 5% imiquimod cream. Objective: This study aims to investigate the efficacy, safety and immunological response in patients with non-invasive vulvar Paget disease using a standardized treatment schedule with 5% imiquimod cream. Methods: The Paget Trial is a multi-centre observational cohort study including eight tertiary referral hospitals in the Netherlands. Twenty patients with (recurrent) non-invasive vulvar Paget disease will be treated with topical 5% imiquimod cream 3 times a week, for 16 weeks. The primary efficacy outcome is the reduction in lesion size at 12 weeks after end of treatment. Secondary outcomes are safety, immunological response and quality of life. Safety will be assessed by evaluation of adverse events and tolerability of treatment. To evaluate the immunological response, various immunological markers will be tested on biopsy specimens taken before, during and after treatment. Quality of life will be assessed with three questionnaires taken before, during and after treatment. This study is registered at the Central Committee on Research Involving Human Subjects (CCMO) Register NL51648.091.14, ClinicalTrials.gov NCT02385188. Results: Patients are currently enrolling in the study. First results are expected in the Summer of 2018. Conclusions: This is the first prospective trial investigating the clinical efficacy, safety, quality of life and immunological response of topical 5% imiquimod cream for vulvar Paget disease, using a standardized treatment schedule. Clinical Trial: Central Committee on Research Involving Human Subjects (CCMO) Register NL51648.091.14, ClinicalTrials.gov NCT02385188.

  • Internet-based assessment of oncology healthcare professional learning style and optimization of materials for web-based learning: Controlled trial with concealed allocation

    From: Journal of Medical Internet Research

    Date Submitted: Feb 14, 2017

    Open Peer Review Period: Feb 15, 2017 - Apr 12, 2017

    Background: Precision medicine has resulted in increasing complexity in the treatment of cancer. Web-based educational materials can help address the needs of oncology healthcare professionals seeking...

    Background: Precision medicine has resulted in increasing complexity in the treatment of cancer. Web-based educational materials can help address the needs of oncology healthcare professionals seeking to understand up-to-date treatment strategies. Objective: This study aimed to assess learning styles of oncology healthcare professionals and to determine whether learning style–tailored educational materials leads to enhanced learning. Methods: 21,465 oncology healthcare professionals were invited by email to participate in the fully automated, parallel group study. Enrollment and follow-up occurred between July 13 and September 7, 2015. Self-enrolled participants took a learning style survey and were assigned to the intervention or control arm using concealed alternating allocation. Participants in the intervention group viewed educational materials consistent with their preferences for learning (reading, listening and/or watching); participants in the control group viewed educational materials typical of the My Cancer Genome website. Educational materials covered the topic of treatment of metastatic ER+ breast cancer using CDK4/6 inhibitors. Participant knowledge was assessed immediately before (pre-test), immediately after (post-test), and two weeks after (follow-up test) review of the educational materials. Study statisticians were blinded to group assignment. Results: 751 participants enrolled in the study. Of these, 367 were allocated to the intervention arm, and 384 were allocated to the control arm. Of those allocated to the intervention arm, 256 completed all assessments. Of those allocated to the control arm, 296 completed all assessments. An additional 12 participants were deemed ineligible, and one withdrew. Four hundred thirty-eight of 552 participants (79.3%) self-identified as multi-modal learners. The intervention arm showed greater improvement in post-test score compared to the control group (0.4 points, or 4.0%, more improvement on average; P = 0.004) and a higher follow-up test score than the control group (0.3 points, or 3.3%, more improvement on average; P = 0.016). There were no important harms. Conclusions: While the study demonstrated more learning with learning style–tailored educational materials, the magnitude of increased learning and the largely multimodal learning styles preferred by the study participants led us to conclude that future content-creation efforts should focus on multimodal educational materials rather than learning style–tailored content.

  • Private mentions of mammography and breast cancer terms on Facebook

    From: Journal of Medical Internet Research

    Date Submitted: Feb 14, 2017

    Open Peer Review Period: Feb 21, 2017 - Apr 18, 2017

    Background: Facebook is the most popular social networking site in the US, an online forum where circles of friends privately create, share and interact with each other’s content. Objective: We soug...

    Background: Facebook is the most popular social networking site in the US, an online forum where circles of friends privately create, share and interact with each other’s content. Objective: We sought to understand what information was being shared regarding breast cancer and screening on Facebook. Methods: We used a novel proprietary tool from Facebook to analyze all the more than 1,700,000 unique interactions (comments on stories, reshares, and emoji reactions) and stories associated with breast cancer screening keywords which were generated by more than 1,100,000 unique Facebook users over the one month between November 15th through December 15th, 2016. We report frequency distributions of most popular shared web content by age group and keywords. Results: On average, each of 59,000 unique stories during the month was reshared one and a half times, commented on nearly 8x, and was reacted to more than 20x by other users. Posted stories were most often authored by women aged 45-54. Users shared, reshared, commented on and reacted to website links predominantly to e-commerce sites (36% of all the most popular links), celebrity news (26%) and major advocacy organizations (15%, almost all American Cancer Society breast cancer site) Conclusions: On Facebook, women shared and reacted to links to commercial and informative websites regarding breast cancer and screening. This information could inform patient outreach regarding breast cancer screening, indirectly through better understanding of key issues, and directly through understanding avenues for paid messaging to women authoring and reacting to content in this space. Clinical Trial: N/A

  • Telerehabilitation: state of the art and application fields

    From: JMIR Rehabilitation and Assistive Technologies

    Date Submitted: Feb 15, 2017

    Open Peer Review Period: Feb 16, 2017 - Apr 13, 2017

    Background: This review article has summarized the present status of telerehabilitation, its most common applications in medicine and the potentialities allowed by the development of new technologies...

    Background: This review article has summarized the present status of telerehabilitation, its most common applications in medicine and the potentialities allowed by the development of new technologies. The focus of this research is mainly centered in the major pathology categories where telerehabilitation is used most, which types of technologies are involved in and finally the main advantages and drawbacks could be obtained using a telerehabilitation approach. The possible future research potentialities of telerehabilitation were also assessed. Objective: Providing a detailed overview of the remote rehabilitation techniques and their application fields with the analysis of the benefits and the drawbacks related to. A discussion about the future of rehabilitation techniques is also provided by observing the present of the high tech, and which new tools will be likelihood used and also what are the areas of application in the short and long term period. Methods: Books, articles and online materials were used to retrieve relevant information and data on telerehabilitation. The keywords used were Telerehabilitation, Telemedicine, Disabling pathologies, Rehabilitation and the Mesch terms listed were Telerehabilitation and Disabling pathologies, Telemedicine and Rehabilitaton. Results: Telerehabilitation is a relatively used application of telemedicine. Although its history is recent, it is reaching a rapid diffusion primarily in developed countries. In general, telerehabilitation reduces the costs of the entities involved such as health providers and patients compared to the traditional rehabilitation. Conclusions: Some benefits could be observed in patients are living in remote place where reach the doctor’s office could be very tough. However, it also has some disadvantages which cannot be understimated such as the skepticism of the patients due to the remote interaction with the physicians.

  • Barriers and facilitators to use eHealth in daily practice, perspectives of patients and professionals in dermatology

    From: Journal of Medical Internet Research

    Date Submitted: Feb 15, 2017

    Open Peer Review Period: Feb 18, 2017 - Apr 15, 2017

    Background: The number of eHealth interventions in the management of chronic diseases, such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interve...

    Background: The number of eHealth interventions in the management of chronic diseases, such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interventions is limited. Objective: This study aimed to assess opinions of most important stakeholders influencing the implementation and use of eHealth services in daily dermatology practice. Methods: A cross sectional survey based on the eHealth implementation toolkit (eHit) was conducted to explore factors influencing the adoption of eHealth interventions offering the possibility of e-consultations, online monitoring and online self-management training among dermatologists and dermatology nurses. Perspectives of patients with atopic dermatitis (AD) regarding the use of eHealth services were discussed in an online focus group. Results: Healthcare professionals (n=99) and patients (n=9) acknowledged the value of eHealth services and were willing to use these digital tools in daily dermatology practice. Key identified barriers in the implementation and adoption of eHealth interventions included concerns about the availability and allocation of resources; financial aspects; reliability, security and confidentially of the intervention itself and the lack of education and training. Conclusions: Healthcare professionals and patients acknowledge the benefits arising from the implementation and use of eHealth services in daily dermatology practice. However, we identified some important barriers that might be useful in addressing the implementation strategy in order to enhance the implementation success of eHealth interventions in dermatology.

  • Toward Timely Data for Cancer Research: Assessment and Re-engineering of Cancer Reporting Process.

    From: JMIR Cancer

    Date Submitted: Feb 15, 2017

    Open Peer Review Period: Feb 16, 2017 - Apr 13, 2017

    Background: Cancer registries systematically collect cancer-related data to support cancer surveillance activities. However, cancer data is often unavailable for months to years after diagnosis, limit...

    Background: Cancer registries systematically collect cancer-related data to support cancer surveillance activities. However, cancer data is often unavailable for months to years after diagnosis, limiting its utility. Objective: The goal of this study is to identify the barriers to rapid cancer reporting and identify ways to shorten the turnaround time. Methods: Certified cancer registrars reporting to the Indiana state cancer registry participated in a semi-structured interview. Registrars were asked to describe the reporting process, estimate the duration of each step, and identify any barriers that may impact the reporting speed. Qualitative data analysis was performed with the intent of generating recommendations for workflow redesign. The existing and redesigned workflow were simulated for comparison. Results: Barriers to rapid reporting included access to medical records from multiple facilities and the waiting period from diagnosis to treatment. The redesigned workflow focused on facilitating data sharing between registrars and applying a more efficient queuing technique while registrars await the delivery of treatment. The simulation results demonstrated that our recommendations to reduce the waiting period and share information could potentially improve the average reporting speed by 87 days. Conclusions: Knowing the time elapsing at each step within the reporting process helps in prioritizing the needs and estimating the impact of future interventions. Where some previous studies focused on automating some of the cancer reporting activities, we anticipate much shorter reporting by leveraging health information technologies to target this waiting period.

  • Impact of a pharmaceutical intervention to improve adherence of inhaled medication in asthma and COPD patients

    From: JMIR Research Protocols

    Date Submitted: Feb 17, 2017

    Open Peer Review Period: Feb 20, 2017 - Mar 6, 2017

    Background: Despite progress in pharmacological and non-pharmacological treatment in recent years, the burden of disease among asthma and COPD patients is high and patients may be frequently hospitali...

    Background: Despite progress in pharmacological and non-pharmacological treatment in recent years, the burden of disease among asthma and COPD patients is high and patients may be frequently hospitalized due to exacerbations. Reasons for uncontrolled disease are manifold, but are frequently associated with poor inhalation technique and non-adherence to the prescribed treatment plan which may cause substantial mortality, morbidity, and cost to the healthcare system. In this respect, the study of causes for non-adherence and the development of measures to increase respectively maintain treatment adherence, particularly in chronic diseases, is of major clinical importance. Objective: The primary objective of this study is to measure medication adherence in patients with chronic obstructive lung diseases such as asthma and COPD, and to investigate the impact of a reminder on disease outcomes and quality of life. Methods: In this ongoing prospective single-blind randomized controlled study, the adherence to inhaled medication is analyzed over a six-months period in at least 154 in- and outpatients with asthma or COPD, who have experienced at least one exacerbation during the last year. Adherence is measured using electronic data capture devices which save date and time of each inhalative device actuation and transfer these data daily via wireless-connection to a web-based database. Patients are randomly assigned to an intervention, respectively control group. Patients assigned to the intervention group will receive audio reminder and support calls in case medication is not been taken as prescribed or if rescue medication is used more frequently than prespecified in the study protocol. During the study, participants are assessed every two months. Results: Recruitment started in January 2014 and to date, a total of 169 patients have been recruited. Follow-up assessments are still ongoing. The study will be concluded in the first quarter of 2017. Data analysis will take place during 2017. Conclusions: To date, only few studies have investigated medication adherence in patients with chronic obstructive lung diseases. With the prospective study design and the use of state-of-the-art devices for measuring adherence, we expect scientifically relevant and clinically meaningful results that will have a substantial and positive impact on the provision of health care in chronically ill patients with asthma or COPD. Clinical Trial: ClinicalTrials.gov: NCT02386722; https://clinicaltrials.gov/ct2/show/NCT02386722 (archives by WebCite at http://www.webcitation.org/6oJq1fel0)

  • Implementation Decisions and Design Trade-offs in Developing an EHR-linked Mobile Application to Reduce Parental Uncertainty Around Childhood Cancer

    From: Journal of Medical Internet Research

    Date Submitted: Feb 16, 2017

    Open Peer Review Period: Feb 20, 2017 - Apr 17, 2017

    Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to...

    Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information. Families of newly diagnosed cancer patients are often bombarded with educational material, however. Technology has the potential to help families manage their informational needs and move towards normalization. Objective: We sought to create a mobile application that pulls together data from both the electronic health record (EHR) and vetted external information resources, in order to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child’s illness. This application was developed to be used by families in a National Institutes of Health (NIH)-funded randomized controlled trial (RCT) aimed at decreasing uncertainty and the subsequent psychological distress. Methods: A 2-phase qualitative study was conducted to elicit the features and content of the mobile application based on the needs and experience of parents of children newly diagnosed with cancer and their providers. Example functions include the ability to view laboratory results, look up appointments, and to access educational material. Educational material was obtained from databases maintained by the National Cancer Institute (NCI) and groups like the Children’s Oncology Group (COG) and care teams within Cincinnati Children’s Hospital Medical Center. The use of EHR-based web services was explored to allow data-like laboratory results to be retrieved in real-time. Results: The ethnographic design process resulted in an application framework that divided the content of the mobile application into 4 sections: 1) information about the patient’s current treatment and other information from the EHR; 2) educational background material; 3) a calendar to view upcoming appointments at their medical center; 4) a section where participants in the RCT document the study data. Integration with the NCI databases was straightforward, however, accessing the EHR web services posed a challenge, though the roadblocks were not technical in nature. The lack of a formal, end-to-end institutional process for requesting web service access and a mechanism to shepherd the request through all stages of implementation proved to be the biggest barrier. Conclusions: We successfully deployed a mobile application with a custom user interface that can integrate with the EHR to retrieve laboratory results and appointment information using vendor-provided web services. Developers should expect to face hurdles when integrating with the EHR, but many of them can be addressed with frequent communication and thorough documentation. Executive sponsorship is also a key factor for success. Clinical Trial: ClinicalTrials.gov NCT02505165

  • An e-recovery portal in community mental health care: An exploratory study of its use and role in shifting practices towards recovery-oriented care

    From: Journal of Medical Internet Research

    Date Submitted: Feb 20, 2017

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

    Background: Mental health care is shifting from a primary focus on symptom reduction towards personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based...

    Background: Mental health care is shifting from a primary focus on symptom reduction towards personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used, or the role they may play in personal recovery. Objective: To illustrate uses and experiences with the e-recovery portal ‘ReConnect’ as an adjunct to ongoing community mental health care and explore its potential role in shifting practices towards recovery. Methods: ReConnect was introduced into two Norwegian mental health care communities and used for six months. The aim was to support personal recovery and service user–health care provider collaboration. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with users through ReConnect. The portal augmented ongoing collaboration as each service user–provider dyad found appropriate, and comprised of; a) a toolbox of resources for articulating and working with recovery processes, e.g.; status/goals/activities relative to life domains (e.g. employment, social network, health), medications, network map, and exercises (e.g. sleep hygiene, mindfulness), b) secure messaging with providers who had partial access to toolbox content, c) peer support forum. Quantitative data (system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (e.g. focus groups, forum postings) are presented relative to La Boutillier et al’s four recovery-oriented practice domains; personally defined recovery, promoting rcitizenship, woking relationships, and organizational commitment. Results: Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses averaging two diagnoses each (range 1-7). The 27 providers represented nine different professional backgrounds. Forum was the most frequently used module with 1870 visits and 542 postings. Service users’ control over toolbox resources (e.g. defining and working towards personal goals), coupled with peer-support, activated service users in their personal recovery processes and in community engagement. Some providers (30%) did not interact with service users through ReConnect. Dyads who used the portal resources, did so in highly diverse ways, and participants reported needing more than six months to discover and adapt optimal uses relative to their individual and collaborative needs. Based on our discussion of findings, hypotheses about e-recovery are proposed relative to La Boutillier et al’s four practice domains. Conclusions: Regardless of providers’ portal use, service users’ control over toolbox resources, coupled with peer-support, offered an empowering common frame of reference that represented an immediate shift towards recovery-oriented practices within communities. While service users’ autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles, e.g. quantified goals for service user involvement in care plans.

  • The digital divide: implications for expansion of e-Health in Sub-Saharan Africa

    From: JMIR mHealth and uHealth

    Date Submitted: Feb 16, 2017

    Open Peer Review Period: Feb 21, 2017 - Apr 18, 2017

    Background: Healthcare systems in Sub-Saharan Africa (SSA) are fraught with numerous governance and infrastructural issues including lack of access to quality care and health worker shortage. Policy m...

    Background: Healthcare systems in Sub-Saharan Africa (SSA) are fraught with numerous governance and infrastructural issues including lack of access to quality care and health worker shortage. Policy makers are becoming increasingly interested in adopting novel technologies such as web-based interventions within the scope of e-Health to bridge the gaps in care delivery in a cost-effective and sustainable manner. Successful implementation of these policies is reliant on evidences regarding people’s access to these technologies, which are scarce for countries in SSA. Objective: To 1) measure the prevalence of ever accessing computer and internet among adult population, 2) investigate the variation in the prevalence of accessing computer and internet across regional and socioeconomic groups, 3) assess association between ever accessing computer and internet and knowledge of routes and risk factors of HIV transmission in selected SSA countries. Methods: We analyzed cross-sectional datasets from UNICEF Multiple Indicator Cluster Surveys. Subjects were16,194 men and 39,121 women from Ghana, Guinea Bissau, Malawi and Zimbabwe. Main outcome variable was ever accessing computer and internet for any purpose. Associations were assessed by multivariable regression methods. Results: Lifetime experience of computer usage was respectively 21.5%, 13.4%, 12.3%, 28.4% among men, and 12.5%, 8.3%, 4.8%, 20.5% among women, and that of internet was 14.9%, 11.7%, 10.8%, 34% among men, and 6.4%, 6.9%, 4.2%, 21.6% among women in the aforementioned order. Participants who reported ever using computer and internet were more likely to have higher knowledge regarding the transmission of HIV compared to those who did not. Conclusions: Prevalence of lifetime access to computer and internet was considerably low in all four countries. Several socioeconomic factors appeared to be associated with the access to computer and internet, addressing which might prove beneficial for the successful expansion e-Health in these countries Clinical Trial: NA

  • Health information seeking on the Internet among sexual minority people in the Health Information National Trends Survey (HINTS)

    From: JMIR Public Health and Surveillance

    Date Submitted: Feb 16, 2017

    Open Peer Review Period: Feb 21, 2017 - Mar 7, 2017

    Background: Background. Individuals who face barriers to healthcare are more likely to access the Internet for health information seeking. Pervasive stigma and heterosexism in the healthcare setting a...

    Background: Background. Individuals who face barriers to healthcare are more likely to access the Internet for health information seeking. Pervasive stigma and heterosexism in the healthcare setting are barriers to healthcare for sexual minority people (SMP); therefore SMP may be more likely to use the internet as a source of health and cancer-related information compared to heterosexual people (HP). Currently there is a dearth of published empirical evidence concerning health information seeking on the Internet among SMP, the current project addresses this gap. Objective: Currently there is a dearth of published empirical evidence [9] concerning health information seeking and exposure to health information on the Internet among SMP as compared to heterosexual people (HP). The current project addresses this gap. Our purpose was to determine the rates at which SMP use the Internet to seek health information, to describe incidental media exposure, and estimate how SMP use the Internet for seeking health information compared to HP. We hypothesized that SMP would report higher use of the Internet for health information seeking than HP and that SMP incidental exposure would be similar to HP. Methods: Methods. Data from the 2015 Health Information National Trends Survey (HINTS) FDA Cycle were used to describe and summarize health information seeking among SMP (n=103) and heterosexual people (HP; n=1443). Results. More SMP in this sample reported having access to the Internet (92.4%) than HP (79.4%; p=.001). SMP used the internet for a broad range of health information seeking activities. SMP people were equally as likely as HP (59% vs 58%) to report unintentional exposure to health information while online. Conclusion. SMP are a difficult-to-reach population that experience significant health disparities. Our findings confirm that SMP access the Internet at high rates and seek out health information online. This suggests that online interventions could be valuable for delivering health promoting interventions for SMP. Results: Results. More SMP in this sample reported having access to the Internet (92.4%) than HP (79.4%; p=.001). SMP used the internet for a broad range of health information seeking activities. SMP people were equally as likely as HP (59% vs 58%) to report unintentional exposure to health information while online. Conclusions: Conclusion. SMP are a difficult-to-reach population that experience significant health disparities. Our findings confirm that SMP access the Internet at high rates and seek out health information online. This suggests that online interventions could be valuable for delivering health promoting interventions for SMP.

  • Differentiation strategy in online physician competition: Does specialization matter?

    From: Journal of Medical Internet Research

    Date Submitted: Feb 19, 2017

    Open Peer Review Period: Feb 20, 2017 - Apr 17, 2017

    Background: A successful product differentiation strategy leads to competitive advantages and higher profits for firms, and this is also the case for the hospital industry. However, we do not know whe...

    Background: A successful product differentiation strategy leads to competitive advantages and higher profits for firms, and this is also the case for the hospital industry. However, we do not know whether a physician’s specialization differentiation strategy will have any impact on her online income in an e-Consultation market; nor do we know the market conditions under which this strategy will be more effective. Objective: We aim to investigate how a specialization differentiation strategy impacts a physician’s online income and the market conditions under which a specialization differentiation strategy has stronger effects. Methods: We employed secondary data in an econometric analysis of transactions obtained from an e-Consultation website (haodf.com) for four diseases (infantile pneumonia, diabetes, infertility, and pancreatic cancer) from 2008 to 2015. A total of 1160 physicians were included in the analysis. Results: Specialization, the differentiation strategy, has a significant positive impact on the physician’s online income (β =0.011, p < 0.001). Moreover, specialization will improve a physician’s competitive advantage when market competition is more intense (β =0.116, p < 0.001). Conclusions: Physicians whose expertise is differs from that of the majority have higher online incomes, and this impact will be stronger when market competition is more intense. Our study indicates that e-Consultations may accelerate the specialization trend observed in the health care industry because the online market favors more-specialized physicians, and competition in the online market is stronger than in the offline market. Such an impact may be positive for some very complicated diseases but less positive for some chronic diseases. Policy makers should be careful with the double-edged sword of e-Consultation.

  • Feasibility and Acceptability of an SMS Smoking Cessation Program for Young Adults in Lima: A Pilot Study

    From: Journal of Medical Internet Research

    Date Submitted: Feb 19, 2017

    Open Peer Review Period: Feb 20, 2017 - Apr 17, 2017

    Background: We conducted a pilot study Objective: to assess whether an SMS Cognitive Behavioral Smoking Cessation Program is a suitable and acceptable intervention among Young Adults in Lima, Peru. Me...

    Background: We conducted a pilot study Objective: to assess whether an SMS Cognitive Behavioral Smoking Cessation Program is a suitable and acceptable intervention among Young Adults in Lima, Peru. Methods: Recruitment was primarily through a web page promoted by diverse strategies, including internet social media. Inclusion criteria were: age 18-25 yrs, daily tobacco smoking (4+ cigarettes/day), willing to quit, own mobile phone, SMS once in past year, and Lima resident. Focus groups & in-depth interviews (FG&DI), and a community advisory committee (CAC) fostered development of SMS content and programming of automatic messaging for 6 weeks that included a four week active quit phase. A Beta Test and a Technological Trial (TT) followed; with participants who received either Spanish language quit messages or a control with SMS nutritional content messages. Results: Of 639 recruits who completed initial online surveys, only 42 met inclusion criteria. Of these, 35 consented and participated as follows: n=12 for FG&DI, n=8 for CAC, n=15 for TT. Results FG&DI allowed us to adapt the SMS content of the Smoking Cessation SMS Cognitive Behavioral Program to the target population, their practices, knowledge and perceptions such as “other healthy behaviors compensate the health hazards of tobacco smoking”, common knowledge that does not matched evidence based treatment such as e-cigarettes as an alternative to quit smoking, the perceived relevant smoking effects on their health (eg, shortness of breath with physical activity, early wrinkles, yellow teeth, infertility, male sexual dysfunction). Also FG&DI and CAC allowed us to include their use and preferences of content, message tone, time, number of received SMS message. For the TT a 6 week SMS program, the quit outcome was evaluated via SMS self report to this question, repeated on days 2, 7, and 30 after the smoker's quit day: "Have you remained without smoking (not even a puff) since the day you quit?” (6 in control arm, with 1 quit, and 9 in active quit arm, with 5 quits). Of smokers assigned to the intervention arm, 100% (n=9) completed the program and answered the quit outcome questions, as compared to 83% (n=5) of those in the control arm. At this stage, the TT included neither long-term follow up nor bioassay confirmation. All participants reported that they received valuable health information and approved the times scheduled for delivery of the SMS messages. Conclusions: This pilot experience was promising and allowed us to adapt content and provided initial evidence that an SMS Behavioral Cognitive Program to quit smoking has feasibility and is acceptable for Spanish-fluent urban young adults in Peru. This work was an initial step toward formal RCTs to evaluate effectiveness of the SMS approach and assess long-term abstinence outcomes, and to enhance SMS-enhanced quit programs in Peru.

  • A Pilot Study of a Smart Toy to enhance Decision Making Process at Children’s Psychomotor Delays Screening

    From: Journal of Medical Internet Research

    Date Submitted: Feb 20, 2017

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

    Background: EDUCERE is an ecosystem for ubiquitous detection, care and early stimulation of children with developmental disorders. The objectives of this Spanish government funded R&D project are to i...

    Background: EDUCERE is an ecosystem for ubiquitous detection, care and early stimulation of children with developmental disorders. The objectives of this Spanish government funded R&D project are to investigate, develop and evaluate innovative solutions for society, in order to detect changes in psychomotor development through the natural interaction of children with toys and everyday objects, and perform stimulation and early attention activities in real environments such as home and school. Thirty multidisciplinary professionals and three nursery schools worked in EDUCERE project between 2014 and 2017. Objective: The described research encloses the design, implementation and validation of EDUCERE smart toy aimed to detect delays in psychomotor development in an automatic way. The results from initial tests led to enhance the effectiveness of the original design and deployment. The smart toy, based on stackable cubes, has a data collector module and a smart system for detection of developmental delays, called EDUCERE Developmental Delay Screening System (EDUCERE DDSS). Methods: The pilot study involved 65 toddlers aged between 23 and 37 months (average age=29,02) who built a tower with 5 stackable cubes, designed by following the EDUCERE smart toy model. As toddlers make the tower, sensors in the cubes sent data to a collector module through a wireless connection. All trials were video-recorded for further analysis by child development experts. After watching the videos, experts scored the performance of the trials to compare and fine-tune the interpretation of the data automatically gathered by the toy-embedded sensors Results: Judges were highly reliable in an inter-rater agreement analysis (interval of 0.937 to 0.967 with 95% confidence), suggesting that the process was successful to separate different levels of performance. A factor analysis of collected data showed that three factors, “trembling”, “speed” and “accuracy” account for 76.79% of the total variance but only two of them are predictors of performance in a regression analysis: accuracy (p-value=0,001) and speed (p-value=0,002); the other factor, trembling (p-value=0,789), does not have a significant effect on this dependent variable. Conclusions: EDUCERE DDSS is ready to use the regression equation obtained for the dependent variable "performance" as an algorithm for the automatic detection of psychomotor development delays. The results of the factor analysis are valuable to simplify the design of the smart toy by taking into account only the significant variables in the collector module. The fine-tuning of the toy process module will be carried out by following the specifications resulting from the analysis of the data in order to improve the efficiency and effectiveness of the product.

  • Situation of Diabetes and Related Factors among Qatari Adults: Finding from a Community Based Survey-2012

    From: JMIR Diabetes

    Date Submitted: Feb 20, 2017

    Open Peer Review Period: Feb 22, 2017 - Apr 19, 2017

    Background: Diabetes is a prominent public health problem in Qatar with one of the highest prevalence in the GCC region. Obesity continues to be a challenging public health problem in Qatar and along...

    Background: Diabetes is a prominent public health problem in Qatar with one of the highest prevalence in the GCC region. Obesity continues to be a challenging public health problem in Qatar and along with other social determinants contributing to the high diabetes prevalence. This study describes the diabetes prevalence among Qatari adults and the impact of obesity and socio-demographic factors on it. Objective: This paper examines the data from Qatar National STEPwise survey (2012) to determine diabetes prevalence among Qatari adults and identify the effect of both generalized and central obesity on it. The article also describes the contribution of selected social and demographic factors on diabetes prevalence in Qatar. Methods: Secondary data analysis of 1471 Qatari adults (18-64 years) from STEP 3 component of the 2012 STEPwise survey was executed. Multivariate binary logistic regression analysis was carried out to assess the role of social and bio-medical factors in prevalence of diabetes. Results: Among participants, 19% of study population had diabetes. Both generalized (OR=1.8, P=.005) and central obesity (OR=1.9, P<.001) were significantly associated with diabetes when adjusted for various respondent characteristics. Older age (P<.001), marital status=ever married (P<.001) and lower educational status (P=0.01) were associated with diabetes. Hypertension (OR=1.5, P=.003), total cholesterol level ≥190 mg/dl (OR=2.2, P<.001) and triglyceride level ≥150 mg/dl (OR=3.6, P<.001) were significantly associated with diabetes among study participants. While family history of diabetes was significantly associated with development of diabetes (OR=1.7, P=.01), parental consanguinity was not associated with diabetes (OR=0.96, P=.8). Conclusions: The diabetes prevalence in Qatar seems to be highly associated with Obesity; however, various additional population characteristics and co-morbidity factors should also require attention and incorporated while developing intervention strategies. Clinical Trial: NA

  • HomeStyles, A Childhood Obesity Prevention Program for Families with Preschool Children: Design and Methods

    From: JMIR Research Protocols

    Date Submitted: Feb 21, 2017

    Open Peer Review Period: Feb 22, 2017 - Mar 8, 2017

    The home environment is where young children spend most of their time and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and li...

    The home environment is where young children spend most of their time and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and lifestyle patterns remain understudied and few interventions have investigated parent-led makeovers designed to create home environments that are supportive of optimal child health and healthy child weights. To our knowledge, HomeStyles is the first large-scale, rigorously controlled study to test the effectiveness of a multifactorial childhood obesity prevention program that aims to help parents of preschool children shape their home environments and lifestyle practices using quick, easy, low- or no-cost strategies. The thoughtfully developed, evidence-based, behaviorally focused, theory-driven content of the intervention materials is expected to enable and motivate parents to promote optimal home environments, lifestyle practices, and child growth, health, and body weights. A rigorous randomized controlled trial utilizing an experimental group and attention control group receiving a bona fide, contemporaneous treatment equal in non-specific treatment effects and differing only in subject matter content will test the effect of HomeStyles on a diverse sample of families with preschool children. This intervention is based on social cognitive theory and uses a social ecological framework. It will assess intrapersonal characteristics (dietary intake, physical activity level, and sleep) of parents and children; family interpersonal or social characteristics related to diet, physical activity, media use, and parental values and self-efficacy for obesity-protective practices; and home environment food availability, physical activity space and supports in and near the home, and media availability and controls in the home. This paper describes the rationale for HomeStyles, its logic model, and study design and methods.

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