bluuebunny/crossref_metadata_2025 huggingface dataset:
The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Key Indicators Report 2018
Authors: Wiatrek Sarah , Zlotorzynska Maria , Rai Ramona , Sullivan Patrick , Sanchez Travis
Published: January 2021

The American Men’s Internet Survey (AMIS) is an annual web-based behavioral survey conducted in the United States of men who have sex with men (MSM). This rapid surveillance report describes the sixth cycle of data collection (September-December 2018; AMIS 2018). The key indicators were the same as those previously reported for past AMIS cycles. The AMIS methodology has not substantively changed since AMIS 2017. MSM were recruited from a variety of websites using banner advertisements and email blasts. In addition, participants from AMIS 2017 who agreed to be recontacted for future research were emailed a link to AMIS 2018. Men were eligible to participate if they were aged ≥15 years, resided in the United States, provided a valid US ZIP code, and reported ever having sex with a man or identified as gay or bisexual. The analysis was limited to those who reported having oral or anal sex with a male partner in the past 12 months. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by the participants’ self-reported HIV status. The AMIS 2018 round of data collection resulted in 10,129 completed surveys from MSM representing every US state, Puerto Rico, and Guam. Most participants were non-Hispanic White, aged between 15 and 24 years, living in urban areas in the southern United States, and recruited from general social networking websites. The plurality (4230/10,129, 41.76%) of participants was in the youngest age group, 15-24 years, followed by the 40 years and older age group (3088/10,129, 30.49%). The self-reported HIV prevalence was 6.08% (616/10,129). Compared with HIV-negative or unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with a male partner in the past 12 months (adjusted odds ratio [aOR] 2.02, 95% CI 1.63-2.50) and more likely to have had anal sex without a condom with a serodiscordant or an unknown status partner (aOR 3.90, 95% CI 3.27-4.66). The reported use of marijuana in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 1.39, 95% CI 1.15-1.68). The reported use of methamphetamines and other illicit substances in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 3.42, 95% CI 2.41-4.87 and aOR 1.90, 95% CI 1.56-2.32, respectively). Most HIV-negative or unknown status participants (6838/9513, 71.88%) reported ever taking an HIV test previously, and 52.51% (4995/9513) of the participants reported undergoing HIV testing in the past 12 months. HIV-positive participants were more likely to report testing and diagnosis of sexually transmitted infections than HIV-negative or unknown status participants (aOR 3.50, 95% CI 2.89-4.24 and aOR 2.61, 95% CI 2.10-3.25, respectively).
Interpretable Conditional Recurrent Neural Network for Weight Change Prediction: Algorithm Development and Validation Study
Authors: Kim Ho Heon , Kim Youngin , Park Yu Rang
Published: January 2021

Background

In recent years, mobile-based interventions have received more attention as an alternative to on-site obesity management. Despite increased mobile interventions for obesity, there are lost opportunities to achieve better outcomes due to the lack of a predictive model using current existing longitudinal and cross-sectional health data. Noom (Noom Inc) is a mobile app that provides various lifestyle-related logs including food logging, exercise logging, and weight logging.

Objective

The aim of this study was to develop a weight change predictive model using an interpretable artificial intelligence algorithm for mobile-based interventions and to explore contributing factors to weight loss.

Methods

Lifelog mobile app (Noom) user data of individuals who used the weight loss program for 16 weeks in the United States were used to develop an interpretable recurrent neural network algorithm for weight prediction that considers both time-variant and time-fixed variables. From a total of 93,696 users in the coaching program, we excluded users who did not take part in the 16-week weight loss program or who were not overweight or obese or had not entered weight or meal records for the entire 16-week program. This interpretable model was trained and validated with 5-fold cross-validation (training set: 70%; testing: 30%) using the lifelog data. Mean absolute percentage error between actual weight loss and predicted weight was used to measure model performance. To better understand the behavior factors contributing to weight loss or gain, we calculated contribution coefficients in test sets.

Results

A total of 17,867 users’ data were included in the analysis. The overall mean absolute percentage error of the model was 3.50%, and the error of the model declined from 3.78% to 3.45% by the end of the program. The time-level attention weighting was shown to be equally distributed at 0.0625 each week, but this gradually decreased (from 0.0626 to 0.0624) as it approached 16 weeks. Factors such as usage pattern, weight input frequency, meal input adherence, exercise, and sharp decreases in weight trajectories had negative contribution coefficients of –0.021, –0.032, –0.015, and –0.066, respectively. For time-fixed variables, being male had a contribution coefficient of –0.091.

Conclusions

An interpretable algorithm, with both time-variant and time-fixed data, was used to precisely predict weight loss while preserving model transparency. This week-to-week prediction model is expected to improve weight loss and provide a global explanation of contributing factors, leading to better outcomes.
The Need for Ethnoracial Equity in Artificial Intelligence for Diabetes Management: Review and Recommendations
Authors: Pham Quynh , Gamble Anissa , Hearn Jason , Cafazzo Joseph A
Published: January 2021

There is clear evidence to suggest that diabetes does not affect all populations equally. Among adults living with diabetes, those from ethnoracial minority communities—foreign-born, immigrant, refugee, and culturally marginalized—are at increased risk of poor health outcomes. Artificial intelligence (AI) is actively being researched as a means of improving diabetes management and care; however, several factors may predispose AI to ethnoracial bias. To better understand whether diabetes AI interventions are being designed in an ethnoracially equitable manner, we conducted a secondary analysis of 141 articles included in a 2018 review by Contreras and Vehi entitled “Artificial Intelligence for Diabetes Management and Decision Support: Literature Review.” Two members of our research team independently reviewed each article and selected those reporting ethnoracial data for further analysis. Only 10 articles (7.1%) were ultimately selected for secondary analysis in our case study. Of the 131 excluded articles, 118 (90.1%) failed to mention participants’ ethnic or racial backgrounds. The included articles reported ethnoracial data under various categories, including race (n=6), ethnicity (n=2), race/ethnicity (n=3), and percentage of Caucasian participants (n=1). Among articles specifically reporting race, the average distribution was 69.5% White, 17.1% Black, and 3.7% Asian. Only 2 articles reported inclusion of Native American participants. Given the clear ethnic and racial differences in diabetes biomarkers, prevalence, and outcomes, the inclusion of ethnoracial training data is likely to improve the accuracy of predictive models. Such considerations are imperative in AI-based tools, which are predisposed to negative biases due to their black-box nature and proneness to distributional shift. Based on our findings, we propose a short questionnaire to assess ethnoracial equity in research describing AI-based diabetes interventions. At this unprecedented time in history, AI can either mitigate or exacerbate disparities in health care. Future accounts of the infancy of diabetes AI must reflect our early and decisive action to confront ethnoracial inequities before they are coded into our systems and perpetuate the very biases we aim to eliminate. If we take deliberate and meaningful steps now toward training our algorithms to be ethnoracially inclusive, we can architect innovations in diabetes care that are bound by the diverse fabric of our society.
COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex Relationship Without Just Cause
Authors: Phiri Peter , Delanerolle Gayathri , Al-Sudani Ayaat , Rathod Shanaya
Published: January 2021

Emerging evidence has indicated a negative and disproportionate impact of COVID-19 on Black, Asian, and minority ethnic (BAME) communities. Previous studies have already reported that biological and social risk factors increase disease susceptibility, particularly in BAME communities. Despite frontline workers in ethnic minority communities in the United Kingdom’s National Health Service attempting to quell the pandemic, disproportionate numbers of BAME physicians and other health care workers have died of COVID-19. This unprecedented situation highlights ethical and moral implications, which could further augment the impact of the pandemic on their mental health. While the government attempts to mitigate the rate of virus transmission, certain key factors inadvertently augment the negative impact of the pandemic on the mental health and general well-being of BAME communities. This study examined the available literature to explore the association between, and the wider impact of, COVID-19 on BAME communities. Furthermore, this study aims to raise awareness and provide a deeper insight into current scientific discussions.
Acceptance of Technologies for Aging in Place: A Conceptual Model
Authors: Jaschinski Christina , Ben Allouch Somaya , Peters Oscar , Cachucho Ricardo , van Dijk Jan A G M
Published: January 2021

Background

Older adults want to preserve their health and autonomy and stay in their own home environment for as long as possible. This is also of interest to policy makers who try to cope with growing staff shortages and increasing health care expenses. Ambient assisted living (AAL) technologies can support the desire for independence and aging in place. However, the implementation of these technologies is much slower than expected. This has been attributed to the lack of focus on user acceptance and user needs.

Objective

The aim of this study is to develop a theoretically grounded understanding of the acceptance of AAL technologies among older adults and to compare the relative importance of different acceptance factors.

Methods

A conceptual model of AAL acceptance was developed using the theory of planned behavior as a theoretical starting point. A web-based survey of 1296 older adults was conducted in the Netherlands to validate the theoretical model. Structural equation modeling was used to analyze the hypothesized relationships.

Results

Our conceptual model showed a good fit with the observed data (root mean square error of approximation 0.04; standardized root mean square residual 0.06; comparative fit index 0.93; Tucker-Lewis index 0.92) and explained 69% of the variance in intention to use. All but 2 of the hypothesized paths were significant at the P<.001 level. Overall, older adults were relatively open to the idea of using AAL technologies in the future (mean 3.34, SD 0.73).

Conclusions

This study contributes to a more user-centered and theoretically grounded discourse in AAL research. Understanding the underlying behavioral, normative, and control beliefs that contribute to the decision to use or reject AAL technologies helps developers to make informed design decisions based on users’ needs and concerns. These insights on acceptance factors can be valuable for the broader field of eHealth development and implementation.
Extreme Prematurity and Pulmonary Outcomes Program in Saitama: Protocol for a Prospective Multicenter Cohort Study in Japan
Authors: Namba Fumihiko , Tanaka Kosuke , Omori Sayu , Ikeda Kazushige , Kawabata Ken , Sato Hiroaki , Honda Masakazu , Ichikawa Tomonori , Minosaki Yoshihiro , Michikawa Takehiro , Oka Shuntaro , Kabe Kazuhiko
Published: January 2021

Background

Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also those of long-term respiratory complications of premature birth are increasing, resulting in financial and health burdens in developed countries. Thus far, the risk factors of respiratory morbidities in extremely preterm infants remain unknown. Furthermore, the definition and the predictive ability of BPD for long-term respiratory outcomes are yet to be determined.

Objective

The objective of our study, Extreme Prematurity and Pulmonary Outcomes Program in Saitama, is to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifesting in extremely preterm infants.

Methods

The Extreme Prematurity and Pulmonary Outcomes Program in Saitama is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study are infants (from each clinical center) with gestational ages 22 to 27 weeks. The target is 400 subjects. This study aims to determine the definition of BPD and other perinatal factors that accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, the association between BPD and postprematurity respiratory disease will be investigated using generalized linear models.

Results

The protocol and consent forms were evaluated and approved on September 5, 2019, by the Ethics Committee of Saitama Medical Center, Saitama Medical University. Enrollment began on April 1, 2020. It is expected to end on March 31, 2023. The follow-up for 1 year corrected age is expected to continue through the middle of 2024.

Conclusions

The Extreme Prematurity and Pulmonary Outcomes Program in Saitama incorporates aspects of neonatal care in secondary- and tertiary-level NICUs to develop existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and potential mechanistic and therapeutic targets in at-risk subjects.

International Registered Report Identifier (IRRID)

DERR1-10.2196/22948
Older Adult Peer Support Specialists’ Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges
Authors: Mbao Mbita , Collins-Pisano Caroline , Fortuna Karen
Published: January 2021

Background

Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older adult peer support specialists” is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness.

Objective

This exploratory qualitative study examined older adult peer support specialists’ text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention.

Methods

Older adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants’ smartphones between 8 AM and 10 PM on weekdays and weekends.

Results

Five themes emerged from text message exchanges related to older adult peer support specialists’ age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging).

Conclusions

Older adult peer support specialists’ lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness.
A Theory of Change for Web-Based Therapy and Support Services for Children and Young People: Collaborative Qualitative Exploration
Authors: Hanley Terry , Sefi Aaron , Grauberg Janet , Prescott Julie , Etchebarne Andre
Published: January 2021

Background

Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging.

Objective

This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP.

Methods

A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers).

Results

A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations).

Conclusions

Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers.
An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study
Authors: Lim Hooi Min , Teo Chin Hai , Ng Chirk Jenn , Chiew Thiam Kian , Ng Wei Leik , Abdullah Adina , Abdul Hadi Haireen , Liew Chee Sun , Chan Chee Seng
Published: January 2021

Background

During the COVID-19 pandemic, there was an urgent need to develop an automated COVID-19 symptom monitoring system to reduce the burden on the health care system and to provide better self-monitoring at home.

Objective

This paper aimed to describe the development process of the COVID-19 Symptom Monitoring System (CoSMoS), which consists of a self-monitoring, algorithm-based Telegram bot and a teleconsultation system. We describe all the essential steps from the clinical perspective and our technical approach in designing, developing, and integrating the system into clinical practice during the COVID-19 pandemic as well as lessons learned from this development process.

Methods

CoSMoS was developed in three phases: (1) requirement formation to identify clinical problems and to draft the clinical algorithm, (2) development testing iteration using the agile software development method, and (3) integration into clinical practice to design an effective clinical workflow using repeated simulations and role-playing.

Results

We completed the development of CoSMoS in 19 days. In Phase 1 (ie, requirement formation), we identified three main functions: a daily automated reminder system for patients to self-check their symptoms, a safe patient risk assessment to guide patients in clinical decision making, and an active telemonitoring system with real-time phone consultations. The system architecture of CoSMoS involved five components: Telegram instant messaging, a clinician dashboard, system administration (ie, back end), a database, and development and operations infrastructure. The integration of CoSMoS into clinical practice involved the consideration of COVID-19 infectivity and patient safety.

Conclusions

This study demonstrated that developing a COVID-19 symptom monitoring system within a short time during a pandemic is feasible using the agile development method. Time factors and communication between the technical and clinical teams were the main challenges in the development process. The development process and lessons learned from this study can guide the future development of digital monitoring systems during the next pandemic, especially in developing countries.
Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation
Authors: Lindsay Sally , Kolne Kendall , Barker Donna J , Colantonio Angela , Stinson Jennifer , Moll Sandra , Thomson Nicole
Published: January 2021

Background

Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes.

Objective

This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities.

Methods

We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically.

Results

Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures).

Conclusions

Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities.
Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign “Better Off With You”: Qualitative Study
Authors: Carrotte Elise Rose , Webb Marianne , Flego Anna , Vincent Bonnie , Heath Jack , Blanchard Michelle
Published: January 2021

Background

The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia.

Objective

The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You.

Methods

This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis.

Results

In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information.

Conclusions

This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective.
Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study
Authors: Iftikhar Aleeha , Bond Raymond , Mcgilligan Victoria , Leslie Stephen J , Knoery Charles , Shand James , Ramsewak Adesh , Sharma Divyesh , McShane Anne , Rjoob Khaled , Peace Aaron
Published: January 2021

Background

When a patient is suspected of having an acute myocardial infarction, they are accepted or declined for primary percutaneous coronary intervention partly based on clinical assessment of their 12-lead electrocardiogram (ECG) and ST-elevation myocardial infarction criteria.

Objective

We retrospectively determined the agreement rate between human (specialists called activator nurses) and computer interpretations of ECGs of patients who were declined for primary percutaneous coronary intervention.

Methods

Various features of patients who were referred for primary percutaneous coronary intervention were analyzed. Both the human and computer ECG interpretations were simplified to either “suggesting” or “not suggesting” acute myocardial infarction to avoid analysis of complex heterogeneous and synonymous diagnostic terms. Analyses, to measure agreement, and logistic regression, to determine if these ECG interpretations (and other variables such as patient age, chest pain) could predict patient mortality, were carried out.

Results

Of a total of 1464 patients referred to and declined for primary percutaneous coronary intervention, 722 (49.3%) computer diagnoses suggested acute myocardial infarction, whereas 634 (43.3%) of the human interpretations suggested acute myocardial infarction (P<.001). The human and computer agreed that there was a possible acute myocardial infarction for 342 out of 1464 (23.3%) patients. However, there was a higher rate of human–computer agreement for patients not having acute myocardial infarctions (450/1464, 30.7%). The overall agreement rate was 54.1% (792/1464). Cohen κ showed poor agreement (κ=0.08, P=.001). Only the age (odds ratio [OR] 1.07, 95% CI 1.05-1.09) and chest pain (OR 0.59, 95% CI 0.39-0.89) independent variables were statistically significant (P=.008) in predicting mortality after 30 days and 1 year. The odds for mortality within 1 year of referral were lower in patients with chest pain compared to those patients without chest pain. A referral being out of hours was a trending variable (OR 1.41, 95% CI 0.95-2.11, P=.09) for predicting the odds of 1-year mortality.

Conclusions

Mortality in patients who were declined for primary percutaneous coronary intervention was higher than the reported mortality for ST-elevation myocardial infarction patients at 1 year. Agreement between computerized and human ECG interpretation is poor, perhaps leading to a high rate of inappropriate referrals. Work is needed to improve computer and human decision making when reading ECGs to ensure that patients are referred to the correct treatment facility for time-critical therapy.
A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study
Authors: Teckie Sewit , Solomon Jeffrey , Kadapa Karthik , Sanchez Keisy , Orner David , Kraus Dennis , Kamdar Dev P , Pereira Lucio , Frank Douglas , Diefenbach Michael
Published: January 2021

Background

Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes.

Objective

The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms.

Methods

Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80% of the enrolled participants for the duration of the study period), adherence (>50% of the participants completing 100% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction.

Results

Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81% [26/32] male). Overall, 375 of 512 (73.2%) questionnaires were completed, with 17 (53%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors.

Conclusions

This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy.
Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm
Authors: Reeves J Jeffery , Ayers John W , Longhurst Christopher A
Published: January 2021

The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.
Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review
Authors: Lin Yu-Hsuan , Chen Chung-Yen , Wu Shiow-Ing
Published: January 2021

Background

The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health.

Objective

This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic.

Methods

We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper.

Results

Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of <3 points, which suggests that these studies are of very low quality for inclusion in a meta-analysis.

Conclusions

The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies.
Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study
Authors: Naqvi Imama Ali , Montiel Tahani Casameni , Bittar Yazan , Hunter Norma , Okpala Munachi , Johnson Constance , Weiner Mark G , Savitz Sean , Sharrief Anjail , Beauchamp Jennifer Elizabeth Sanner
Published: January 2021

Background

Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers.

Objective

This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers.

Methods

A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables.

Results

Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001).

Conclusions

Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke.
Feasibility and Acceptability of a Digital Intervention to Support Shared Decision-making in Children’s and Young People’s Mental Health: Mixed Methods Pilot Randomized Controlled Trial
Authors: Liverpool Shaun , Edbrooke-Childs Julian
Published: January 2021

Background

Interventions to involve parents in decisions regarding children’s and young people’s mental health are associated with positive outcomes. However, appropriately planning effectiveness studies is critical to ensure that meaningful evidence is collected. It is important to conduct pilot studies to evaluate the feasibility and acceptability of the intervention itself and the feasibility of the protocol to test effectiveness.

Objective

This paper reports the findings from a feasibility and acceptability study of Power Up for Parents, an intervention to promote shared decision-making (SDM) and support parents and caregivers making decisions regarding children’s and young people’s mental health.

Methods

A mixed method study design was adopted. In stage 1, health care professionals and parents provided feedback on acceptability, usefulness, and suggestions for further development. Stage 2 was a multicenter, 3-arm, individual, and cluster randomized controlled pilot feasibility trial with parents accessing services related to children’s and young people’s mental health. Outcome measures collected data on demographics, participation rates, SDM, satisfaction, and parents’ anxiety. Qualitative data were analyzed using thematic analysis. Google Analytics estimates were used to report engagement with the prototype. Outcomes from both stages were tested against a published set of criteria for proceeding to a randomized controlled trial.

Results

Despite evidence suggesting the acceptability of Power Up for Parents, the findings suggest that recruitment modifications are needed to enhance the feasibility of collecting follow-up data before scaling up to a fully powered randomized controlled trial. On the basis of the Go or No-Go criteria, only 50% (6/12) of the sites successfully recruited participants, and only 38% (16/42) of parents completed follow-up measures. Nonetheless, health care practitioners and parents generally accessed and used the intervention. Themes describing appearance and functionality, perceived need and general helpfulness, accessibility and appropriateness, and a wish list for improvement emerged, providing valuable information to inform future development and refinement of the intervention.

Conclusions

Owing to the high attrition observed in the trial, proceeding directly to a full randomized controlled trial may not be feasible with this recruitment strategy. Nonetheless, with some minor adjustments and upgrades to the intervention, this pilot study provides a platform for future evaluations of Power Up for Parents.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN) 39238984; http://www.isrctn.com/ISRCTN39238984.

International Registered Report Identifier (IRRID)

RR2-10.2196/14571
Development and Validation of Risk Scores for All-Cause Mortality for a Smartphone-Based “General Health Score” App: Prospective Cohort Study Using the UK Biobank
Authors: Clift Ashley K , Le Lannou Erwann , Tighe Christian P , Shah Sachin S , Beatty Matthew , Hyvärinen Arsi , Lane Stephen J , Strauss Tamir , Dunn Devin D , Lu Jiahe , Aral Mert , Vahdat Dan , Ponzo Sonia , Plans David
Published: January 2021

Background

Given the established links between an individual’s behaviors and lifestyle factors and potentially adverse health outcomes, univariate or simple multivariate health metrics and scores have been developed to quantify general health at a given point in time and estimate risk of negative future outcomes. However, these health metrics may be challenging for widespread use and are unlikely to be successful at capturing the broader determinants of health in the general population. Hence, there is a need for a multidimensional yet widely employable and accessible way to obtain a comprehensive health metric.

Objective

The objective of the study was to develop and validate a novel, easily interpretable, points-based health score (“C-Score”) derived from metrics measurable using smartphone components and iterations thereof that utilize statistical modeling and machine learning (ML) approaches.

Methods

A literature review was conducted to identify relevant predictor variables for inclusion in the first iteration of a points-based model. This was followed by a prospective cohort study in a UK Biobank population for the purposes of validating the C-Score and developing and comparatively validating variations of the score using statistical and ML models to assess the balance between expediency and ease of interpretability and model complexity. Primary and secondary outcome measures were discrimination of a points-based score for all-cause mortality within 10 years (Harrell c-statistic) and discrimination and calibration of Cox proportional hazards models and ML models that incorporate C-Score values (or raw data inputs) and other predictors to predict the risk of all-cause mortality within 10 years.

Results

The study cohort comprised 420,560 individuals. During a cohort follow-up of 4,526,452 person-years, there were 16,188 deaths from any cause (3.85%). The points-based model had good discrimination (c-statistic=0.66). There was a 31% relative reduction in risk of all-cause mortality per decile of increasing C-Score (hazard ratio of 0.69, 95% CI 0.663-0.675). A Cox model integrating age and C-Score had improved discrimination (8 percentage points; c-statistic=0.74) and good calibration. ML approaches did not offer improved discrimination over statistical modeling.

Conclusions

The novel health metric (“C-Score”) has good predictive capabilities for all-cause mortality within 10 years. Embedding the C-Score within a smartphone app may represent a useful tool for democratized, individualized health risk prediction. A simple Cox model using C-Score and age balances parsimony and accuracy of risk predictions and could be used to produce absolute risk estimations for app users.
Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder
Authors: Dopke Cynthia A , McBride Alyssa , Babington Pamela , Jonathan Geneva K , Michaels Tania , Ryan Chloe , Duffecy Jennifer , Mohr David C , Goulding Evan H
Published: January 2021

Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention.
Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts
Authors: Nutley Sara K , Falise Alyssa M , Henderson Rebecca , Apostolou Vasiliki , Mathews Carol A , Striley Catherine W
Published: January 2021

Background

A growing body of evidence is suggesting a significant association between the COVID-19 pandemic and population-level mental health. Study findings suggest that individuals with a lifetime history of disordered eating behavior may be negatively affected by COVID-19–related anxiety, and prevention measures may disrupt daily functioning and limit access to treatment. However, data describing the influence of the COVID-19 pandemic on disordered eating behaviors are limited, and most findings focus on individuals in treatment settings.

Objective

The aim of this study is to characterize the experiences of Reddit users worldwide who post in eating disorder (ED)–related discussion forums describing the influence of the COVID-19 pandemic on their overall mental health and disordered eating behavior.

Methods

Data were collected from popular subreddits acknowledging EDs as their primary discussion topic. Unique discussion posts dated from January 1 to May 31, 2020 that referenced the COVID-19 pandemic were extracted and evaluated using inductive, thematic data analysis.

Results

Six primary themes were identified: change in ED symptoms, change in exercise routine, impact of quarantine on daily life, emotional well-being, help-seeking behavior, and associated risks and health outcomes. The majority of users reported that the COVID-19 pandemic and associated public health prevention measures negatively impacted their psychiatric health and contributed to increased disordered eating behaviors. Feelings of isolation, frustration, and anxiety were common. Many individuals used Reddit forums to share personal experiences, seek advice, and offer shared accountability.

Conclusions

Reddit discussion forums have provided a therapeutic community for individuals to share experiences and provide support for peers with ED during a period of increased psychiatric distress. Future research is needed to assess the impact of the COVID-19 pandemic on disordered eating behavior and to evaluate the role of social media discussion forums in mental health treatment, especially during periods of limited treatment access.