bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-Seeking Influence Reflected by Online Health-Related Messages Received on Social Media: Cross-Sectional Survey (Preprint)
Authors: Iftikhar Rahila , Abaalkhail Bahaa
Published: July 2018

BACKGROUND

Major social networking platforms, such as Facebook, WhatsApp, and Twitter, have become popular means through which people share health-related information, irrespective of whether messages disseminated through these channels are authentic.

OBJECTIVE

This study aims to describe the demographic characteristics of patients that may demonstrate their attitudes toward medical information shared on social media networks. Second, we address how information found through social media affects the way people deal with their health. Third, we examine whether patients initiate or alter/discontinue their medications based on information derived from social media.

METHODS

We conducted a cross-sectional survey between April and June 2015 on patients attending outpatient clinics at King Abdulaziz University, Jeddah, Saudi Arabia. Patients who used social media (Facebook, WhatsApp, and Twitter) were included. We designed a questionnaire with closed-ended and multiple-choice questions to assess the type of social media platforms patients used and whether information received on these platforms influenced their health care decisions. We used chi-square test to establish the relationship between categorical variables.

RESULTS

Of the 442 patients who filled in the questionnaires, 401 used Facebook, WhatsApp, or Twitter. The majority of respondents (89.8%, 397/442) used WhatsApp, followed by Facebook (58.6%, 259/442) and Twitter (42.3%, 187/442). In most cases, respondents received health-related messages from WhatsApp and approximately 42.6% (171/401) reported ever stopping treatment as advised on a social media platform. A significantly higher proportion of patients without heart disease (P=.001) and obese persons (P=.01) checked the authenticity of information received on social media. Social media messages influenced decision making among patients without heart disease (P=.04). Respondents without heart disease (P=.001) and obese persons (P=.01) were more likely to discuss health-related information received on social media channels with a health care professional. A significant proportion of WhatsApp users reported that health-related information received on this platform influenced decisions regarding their family’s health care (P=.001). Respondents’ decisions regarding family health care were more likely to be influenced when they used two or all three types of platforms (P=.003).

CONCLUSIONS

Health education in the digital era needs to be accurate, evidence-based, and regulated. As technologies continue to evolve, we must be equipped to face the challenges it brings with it.
Gynecomastia in a Rheumatoid Arthritis patient: A rare side effect of Methotrexate therapy. (Preprint)
Authors: Shaikh Soorih , Shaikh Sarwan
Published: July 2018

UNSTRUCTURED

A 51-year-old male patient with a 3-year history of Rheumatoid Arthritis developed gynecomastia 2-3 months after starting Methotrexate therapy, without folate supplementation. Two months after stopping MTX therapy and initiating folate supplementation, gynecomastia started resolving. Very few cases of gynecomastia due to MTX therapy have been reported worldwide. Although it is a rare yet a significant occurrence and should always be considered in male patients with Rheumatoid Arthritis.
Stepping into the Era of Personal Big Data: a Roadmap to the Design of a Personal Digital Life Coach (Preprint)
Authors: Garcia Nuno M. , Pombo Nuno , Braun Torsten , Flórez-Revuelta Francisco , Chorbev Ivan , Spinsante Susanna , Lamas David , Goleva Rossitza
Published: July 2018

UNSTRUCTURED

The increased availability of devices that can record every aspect of a person’s life will allow the recording of a large amount of data that will be primarily useful for that particular user. These devices and their data will place each and every one of us at the doorstep of the era of personal big data. Using this data, in a not so distant future, we will be able to set a personal digital life coach, a digital platform that will act at an individual level, but also considering a global interaction, not only as a social networking tool, but as a platform that will profit from the individual experiences of its users. This position paper focuses on the identification of the milestones that will mark the creation of such a software and hardware platform, by exploring the opportunities and challenges that it poses to the computer science researchers, and how such a solution can be designed to be a user-adoptable lifestyles monitoring and training tool.
Redirecting behavioural cues using technology: Is there a role for the use of social media in conjunction with activity trackers? (Preprint)
Authors: Lobo Rhannon , Al-Khudairi Rashed , Jameie-Oskooei Sina , Rawson Timothy Miles
Published: July 2018

UNSTRUCTURED

Recent work by Cole-Lewis and colleagues explored the use of health promotion tools within social media to better understand complex network analyses. However, there is a lack of evidence on the use of social media and activity trackers in conjunction to augment health behaviours. This is a novel strategy and we propose its use in combating the growing obesity epidemic.
Lessons From Recruitment to an Internet-Based Survey for Degenerative Cervical Myelopathy: Comparison of Free and Fee-Based Methods (Preprint)
Authors: Davies Benjamin , Kotter Mark
Published: July 2018

BACKGROUND

Degenerative Cervical Myelopathy (DCM) is a syndrome of subacute cervical spinal cord compression due to spinal degeneration. Although DCM is thought to be common, many fundamental questions such as the natural history and epidemiology of DCM remain unknown. In order to answer these, access to a large cohort of patients with DCM is required. With its unrivalled and efficient reach, the Internet has become an attractive tool for medical research and may overcome these limitations in DCM. The most effective recruitment strategy, however, is unknown.

OBJECTIVE

To compare the efficacy of fee-based advertisement with alternative free recruitment strategies to a DCM Internet health survey.

METHODS

An Internet health survey (SurveyMonkey) accessed by a new DCM Internet platform (myelopathy.org) was created. Using multiple survey collectors and the website’s Google Analytics, the efficacy of fee-based recruitment strategies (Google AdWords) and free alternatives (including Facebook, Twitter, and myelopathy.org) were compared.

RESULTS

Overall, 760 surveys (513 [68%] fully completed) were accessed, 305 (40%) from fee-based strategies and 455 (60%) from free alternatives. Accounting for researcher time, fee-based strategies were more expensive ($7.8 per response compared to $3.8 per response for free alternatives) and identified a less motivated audience (Click-Through-Rate of 5% compared to 57% using free alternatives) but were more time efficient for the researcher (2 minutes per response compared to 16 minutes per response for free methods). Facebook was the most effective free strategy, providing 239 (31%) responses, where a single message to 4 existing communities yielded 133 (18%) responses within 7 days.

CONCLUSIONS

The Internet can efficiently reach large numbers of patients. Free and fee-based recruitment strategies both have merits. Facebook communities are a rich resource for Internet researchers.
App-Supported Promotion of Child Growth and Development by Community Health Workers in Kenya: Feasibility and Acceptability Study (Preprint)
Authors: van Heerden Alastair , Sen Debjeet , Desmond Chris , Louw Julia , Richter Linda
Published: July 2018

BACKGROUND

Early childhood is a critical phase of development. In low resource settings, monitoring this stage of development and providing appropriate and timely feedback is a challenge. Community-based service providers play a key role in promoting early childhood development in areas where government services are weak. These community-based service providers are also tasked with the collection of monitoring and evaluation data for donors and local government. Usually, collection of these data aims to provide accountability, learning, and correction leading to improvement. However, such data is rarely used beyond the accountability stage.

OBJECTIVE

The purpose of this study was to test the feasibility and acceptability of the Information for Action (IFA) mobile phone app. The IFA app was designed for use by community health volunteers (CHVs), and repackages routinely collected data about children into useful, offline decision support for caregivers and program managers.

METHODS

The IFA app was tested with a convenience sample of 10 CHVs in West Katweng’a, a sublocation of Rarieda subcounty in western Kenya. CHVs used the IFA app for 5 months as part of their regular home visits to households containing children aged 0 to 5 years, after which a qualitative assessment of the app was conducted. A total of 16 caregivers who received services from the CHVs were randomly selected to participate in 1 of 2 focus group discussions about their experience.

RESULTS

The app was reported to help facilitate interactive dialog between CHVs and caregivers, leading to improved quality of home visits. Caregivers described the app as shifting the relationship from feeling harassed by CHVs to experiencing genuine interest from CHVs. CHVs reported feasibility challenges primarily related to infrastructure. The limited battery life of mobile phones combined with the lack of readily available electricity made it difficult to keep the phones charged. CHVs reported initial anxiety as first-time mobile phones users, including concerns about using the IFA app. With time, increased levels of confidence were seen.

CONCLUSIONS

Acceptability was high with both CHVs and caregivers, who reported an improvement in their client-provider relationship. A number of feasibility challenges were experienced.
Evaluating In-Car Movements in the Design of Mindful Commute Interventions: Exploratory Study (Preprint)
Authors: Paredes Pablo Enrique , Hamdan Nur Al-Huda , Clark Dav , Cai Carrie , Ju Wendy , Landay James A
Published: July 2018

BACKGROUND

The daily commute could be a right moment to teach drivers to use movement or breath towards improving their mental health. Long commutes, the relevance of transitioning from home to work, and vice versa and the privacy of commuting by car make the commute an ideal scenario and time to perform mindful exercises safely. Whereas driving safety is paramount, mindful exercises might help commuters decrease their daily stress while staying alert. Increasing vehicle automation may present new opportunities but also new challenges.

OBJECTIVE

This study aimed to explore the design space for movement-based mindful interventions for commuters. We used qualitative analysis of simulated driving experiences in combination with simple movements to obtain key design insights.

METHODS

We performed a semistructured viability assessment in 2 parts. First, a think-aloud technique was used to obtain information about a driving task. Drivers (N=12) were given simple instructions to complete movements (configural or breath-based) while engaged in either simple (highway) or complex (city) simulated urban driving tasks using autonomous and manual driving modes. Then, we performed a matching exercise where participants could experience vibrotactile patterns from the back of the car seat and map them to the prior movements.

RESULTS

We report a summary of individual perceptions concerning different movements and vibrotactile patterns. Beside describing situations within a drive when it may be more likely to perform movement-based interventions, we also describe movements that may interfere with driving and those that may complement it well. Furthermore, we identify movements that could be conducive to a more relaxing commute and describe vibrotactile patterns that could guide such movements and exercises. We discuss implications for design such as the influence of driving modality on the adoption of movement, need for personal customization, the influence that social perception has on participants, and the potential role of prior awareness of mindful techniques in the adoption of new movement-based interventions.

CONCLUSIONS

This exploratory study provides insights into which types of movements could be better suited to design mindful interventions to reduce stress for commuters, when to encourage such movements, and how best to guide them using noninvasive haptic stimuli embedded in the car seat.
Search and Graph Database Technologies for Biomedical Semantic Indexing: Experimental Analysis (Preprint)
Authors: Segura Bedmar Isabel , Martínez Paloma , Carruana Martín Adrián
Published: July 2018

BACKGROUND

Biomedical semantic indexing is a very useful support tool for human curators in their efforts for indexing and cataloging the biomedical literature.

OBJECTIVE

The aim of this study was to describe a system to automatically assign Medical Subject Headings (MeSH) to biomedical articles from MEDLINE.

METHODS

Our approach relies on the assumption that similar documents should be classified by similar MeSH terms. Although previous work has already exploited the document similarity by using a k-nearest neighbors algorithm, we represent documents as document vectors by search engine indexing and then compute the similarity between documents using cosine similarity. Once the most similar documents for a given input document are retrieved, we rank their MeSH terms to choose the most suitable set for the input document. To do this, we define a scoring function that takes into account the frequency of the term into the set of retrieved documents and the similarity between the input document and each retrieved document. In addition, we implement guidelines proposed by human curators to annotate MEDLINE articles; in particular, the heuristic that says if 3 MeSH terms are proposed to classify an article and they share the same ancestor, they should be replaced by this ancestor. The representation of the MeSH thesaurus as a graph database allows us to employ graph search algorithms to quickly and easily capture hierarchical relationships such as the lowest common ancestor between terms.

RESULTS

Our experiments show promising results with an F1 of 69% on the test dataset.

CONCLUSIONS

To the best of our knowledge, this is the first work that combines search and graph database technologies for the task of biomedical semantic indexing. Due to its horizontal scalability, ElasticSearch becomes a real solution to index large collections of documents (such as the bibliographic database MEDLINE). Moreover, the use of graph search algorithms for accessing MeSH information could provide a support tool for cataloging MEDLINE abstracts in real time.
Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study (Preprint)
Authors: Gipson Shih , Torous John , Boland Robert , Conrad Erich
Published: July 2018

BACKGROUND

Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear.

OBJECTIVE

In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use.

METHODS

An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use.

RESULTS

All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68).

CONCLUSIONS

We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice.
Comparison of Internet and Telephone Interventions for Weight Loss Among Cancer Survivors: Randomized Controlled Trial and Feasibility Study (Preprint)
Authors: Cox Matthew , Basen-Engquist Karen , Carmack Cindy L , Blalock Janice , Li Yisheng , Murray James , Pisters Louis , Rodriguez-Bigas Miguel , Song Jaejoon , Cox-Martin Emily , Demark-Wahnefried Wendy
Published: July 2018

BACKGROUND

Weight loss interventions have been successfully delivered via several modalities, but recent research has focused on more disseminable and sustainable means such as telephone- or Internet-based platforms.

OBJECTIVE

The aim of this study was to compare an Internet-delivered weight loss intervention to a comparable telephone-delivered weight loss intervention.

METHODS

This randomized pilot study examined the effects of 6-month telephone- and Internet-delivered social cognitive theory–based weight loss interventions among 37 cancer survivors. Measures of body composition, physical activity, diet, and physical performance were the outcomes of interest.

RESULTS

Participants in the telephone intervention (n=13) showed greater decreases in waist circumference (–0.75 cm for telephone vs –0.09 cm for Internet, P=.03) than the Internet condition (n=24), and several other outcomes trended in the same direction. Measures of engagement (eg, number of telephone sessions completed and number of log-ins) suggest differences between groups which may account for the difference in outcomes.

CONCLUSIONS

Cancer survivors in the telephone group evidenced better health outcomes than the Internet group. Group differences may be due to higher engagement in the telephone group. Incorporating a telephone-based component into existing weight loss programs for cancer survivors may help enhance the reach of the intervention while minimizing costs. More research is needed on how to combine Internet and telephone weight loss intervention components so as to maximize engagement and outcomes.

CLINICALTRIAL

ClinicalTrials.gov NCT01311856; https://clinicaltrials.gov/ct2/show/NCT01311856 (Archived by WebCite at http://www.webcitation.org/6tKdklShY)
Engaging a Community for Rare Genetic Disease: Best Practices and Education From Individual Crowdfunding Campaigns (Preprint)
Authors: Ortiz Romina Alicia , Witte Steven , Gouw Arvin , Sanfilippo Ana , Tsai Richard , Fumagalli Danielle , Yu Christine , Lant Karla , Lipintz Nicole , Shepphird Jennifer , Alvina Fidelia B , Cheng-Ho Lin Jimmy
Published: July 2018

BACKGROUND

Genetic sequencing is critically important to diagnostic health care efforts in the United States today, yet it is still inaccessible to many. Meanwhile, the internet and social networking have made crowdfunding a realistic avenue for individuals and groups hoping to fund medical and research causes, including patients in need of whole exome genetic sequencing (WES).

OBJECTIVE

Amplify Hope is an educational program designed to investigate what factors affect the success of medical crowdfunding campaigns. We conducted a needs assessment, a series of 25 interviews concerning crowdfunding, and provided training on best practices identified through our assessment for 11 individuals hoping to run their medical crowdfunding campaigns to raise money for patients to access trio WES to identify the mutated proteins that caused their apparent inherited disease.

METHODS

The crowdfunding education was given in a 30-day training period with resources such as webinars, fact sheets and a crowdfunding training guide emailed to each participant. All campaigns were launched on the same date and were given 30 days to raise the same goal amount of US $5000. Reviewing the 4 crowdfunding campaigns that raised the goal amount within the 30-day period, we sought to identify features that made the 4 crowdfunding campaigns successful. In addition, we sought to assess which factors the resulting 75 donors report as influencing their decision to donate to a campaign. Finally, we investigated whether crowdfunding campaigns for exome sequencing had an impact on increasing applicant’s and donors’ knowledge of genomics.

RESULTS

Of the 86 study inquiries, 11 participants submitted the required forms and launched their crowdfunding campaigns. A total of 4 of the 11 campaigns raised their goal amounts within 30 days.

CONCLUSIONS

We found that social media played an important role in all campaigns. Specifically, a strong social media network, an active outreach process to networks, as well as engagement within the study all correlated with a higher success rate. Amplify Hope donors were more likely to support projects that were near their fundraising goals, and they found video far more effective for learning about genomics than any other medium.
Determinants for Sustained Use of an Activity Tracker: Observational Study (Preprint)
Authors: Hermsen Sander , Moons Jonas , Kerkhof Peter , Wiekens Carina , De Groot Martijn
Published: July 2018

BACKGROUND

A lack of physical activity is considered to cause 6% of deaths globally. Feedback from wearables such as activity trackers has the potential to encourage daily physical activity. To date, little research is available on the natural development of adherence to activity trackers or on potential factors that predict which users manage to keep using their activity tracker during the first year (and thereby increasing the chance of healthy behavior change) and which users discontinue using their trackers after a short time.

OBJECTIVE

The aim of this study was to identify the determinants for sustained use in the first year after purchase. Specifically, we look at the relative importance of demographic and socioeconomic, psychological, health-related, goal-related, technological, user experience–related, and social predictors of feedback device use. Furthermore, this study tests the effect of these predictors on physical activity.

METHODS

A total of 711 participants from four urban areas in France received an activity tracker (Fitbit Zip) and gave permission to use their logged data. Participants filled out three Web-based questionnaires: at start, after 98 days, and after 232 days to measure the aforementioned determinants. Furthermore, for each participant, we collected activity data tracked by their Fitbit tracker for 320 days. We determined the relative importance of all included predictors by using Random Forest, a machine learning analysis technique.

RESULTS

The data showed a slow exponential decay in Fitbit use, with 73.9% (526/711) of participants still tracking after 100 days and 16.0% (114/711) of participants tracking after 320 days. On average, participants used the tracker for 129 days. Most important reasons to quit tracking were technical issues such as empty batteries and broken trackers or lost trackers (21.5% of all Q3 respondents, 130/601). Random Forest analysis of predictors revealed that the most influential determinants were age, user experience–related factors, mobile phone type, household type, perceived effect of the Fitbit tracker, and goal-related factors. We explore the role of those predictors that show meaningful differences in the number of days the tracker was worn.

CONCLUSIONS

This study offers an overview of the natural development of the use of an activity tracker, as well as the relative importance of a range of determinants from literature. Decay is exponential but slower than may be expected from existing literature. Many factors have a small contribution to sustained use. The most important determinants are technical condition, age, user experience, and goal-related factors. This finding suggests that activity tracking is potentially beneficial for a broad range of target groups, but more attention should be paid to technical and user experience–related aspects of activity trackers.
Public Perceptions Regarding Use of Virtual Reality in Health Care: A Social Media Content Analysis Using Facebook (Preprint)
Authors: Keller Michelle Sophie , Park Hannah J , Cunningham Maria Elena , Fouladian Joshua Eleazar , Chen Michelle , Spiegel Brennan Mason Ross
Published: July 2018

BACKGROUND

Virtual reality (VR) technology provides an immersive environment that enables users to have modified experiences of reality. VR is increasingly used to manage patients with pain, disability, obesity, neurologic dysfunction, anxiety, and depression. However, public opinion regarding the use of VR in health care has not been explored. Understanding public opinion of VR is critical to ensuring effective implementation of this emerging technology.

OBJECTIVE

This study aimed to examine public opinion about health care VR using social listening, a method that allows for the exploration of unfiltered views of topics discussed on social media and online forums.

METHODS

In March 2016, NBC News produced a video depicting the 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 2401 comments. We used Microsoft Excel Power Query and ATLAS.ti software (version 7.5, Scientific Software Development) to analyze the comments using content 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 the language to analyze whether the perception of VR differed by gender using a Pearson’s chi-square test.

RESULTS

Out of the 1614 analyzable comments, 1021 (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 1197 comments coded as expressing a positive perception about VR (74.16%), 251 coded as expressing a negative perception and/or concern (15.56%), and 560 coded as neutral (34.70%). Informants identified 20 use cases for VR in health care, including the use of VR for pain and stress reduction; bed-bound individuals; women during labor; and patients undergoing chemotherapy, dialysis, radiation, or imaging procedures. Negative comments expressed concerns about radiation, infection risk, motion sickness, and the ubiquity of and overall dependence on technology. There was a statistically significant association between the language valence of the Facebook post and the gender of the Facebook user; men were more likely to post negative perceptions about the use of VR for health care, whereas women were more likely to post positive perceptions (P<.001).

CONCLUSIONS

Most informants expressed positive perceptions about the use of VR in a wide range of health care settings. However, many expressed concerns that should be acknowledged and addressed as health care VR continues to evolve. Our results provide guidance in determining where further research on the use of VR in patient care is needed, and offer a formal opportunity for public opinion to shape the VR research agenda.
Detecting Acute Otitis Media Symptom Episodes Using a Mobile App: Cohort Study (Preprint)
Authors: Prins-van Ginkel Annemarijn C , de Hoog Marieke LA , Uiterwaal C , Smit Henriette A , Bruijning-Verhagen Patricia CJ
Published: July 2018

BACKGROUND

Population cohort studies are useful to study infectious diseases episodes not attended by health care services, but conventional paper diaries and questionnaires to capture cases are prone to noncompliance and recall bias. Use of smart technology in this setting may improve case finding.

OBJECTIVE

The objective of our study was to validate an interactive mobile app for monitoring occurrence of acute infectious diseases episodes in individuals, independent of health care seeking, using acute otitis media (AOM) symptom episodes in infants as a case study. We were interested in determining participant compliance and app performance in detecting and ascertaining (parent-reported) AOM symptom episodes with this novel tool compared with traditional methods used for monitoring study participants.

METHODS

We tested the InfectieApp research app to detect AOM symptom episodes. In 2013, we followed 155 children aged 0 to 3 years for 4 months. Parents recorded the presence of AOM symptoms in a paper diary for 4 consecutive months and completed additional disease questionnaires when AOM symptoms were present. In 2015 in a similar cohort of 69 children, parents used an AOM diary and questionnaire app instead.

RESULTS

During conventional and app-based recording, 93.13% (17,244/18,516) and 94.56% (7438/7866) of symptom diaries were returned, respectively, and at least one symptom was recorded for 32.50% (n=5606) and 43.99% (n=3272) of diary days (P<.01). The incidence of AOM symptom episodes was 605 and 835 per 1000 child-years, respectively. Disease questionnaires were completed for 59% (17/29) of episodes when participants were using conventional recording, compared with 100% (18/18) for app-based recording.

CONCLUSIONS

The use of the study’s smart diary app improved AOM case finding and disease questionnaire completeness. For common infectious diseases that often remain undetected by health care services, use of this technology can substantially improve the accurateness of disease burden estimates.
Differentiation strategy in online physician competition: Does specialization matter? (Preprint)
Authors: Li Jia , Liu Minghui , Liu Xuan , Ma Ling
Published: July 2018

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.
Facebook Groups for the Management of Chronic Diseases (Preprint)
Authors: Partridge Stephanie R , Gallagher Patrick , Freeman Becky , Gallagher Robyn
Published: July 2018

UNSTRUCTURED

The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group “champions”; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations.
Using Relational Agents to Promote Exercise and Sun Protection: Assessment of Participants� Experiences With Two Interventions (Preprint)
Authors: Sillice Marie A , Morokoff Patricia J , Ferszt Ginette , Bickmore Timothy , Bock Beth C , Lantini Ryan , Velicer Wayne F
Published: July 2018

BACKGROUND

Relational agents (RAs) are electronic computational figures designed to engage participants in the change process. A recent study, Project RAISE, tested the effectiveness of RAs, combined with existing computer-based interventions to increase regular exercise and sun protection behaviors. Results showed these interventions can be effective but need further development.

OBJECTIVE

The purpose of this study was to examine participants’ experiences using RAs to increase participant engagement and promote behavior change .

METHODS

A qualitative approach was primarily utilized. A 25-question interview guide assessed different components of participants’ experiences with the intervention, including motivation, engagement, satisfaction or dissatisfaction, quality of their interaction with the RA, and behavior change. Quantitative assessment of satisfaction was based on a scale of 1 to 10, with 1 representing least satisfied and 10 representing most satisfied. A summative analytic approach was used to assess individuals’ qualitative responses. A single analysis of variance (ANOVA) examined levels of satisfaction by gender.

RESULTS

Of the original 1354 participants enrolled in Project RAISE, 490 of 1354 (36%) were assigned to the RA group. A sample of 216 out of 490 (44%) participants assigned to the RA group completed the interventions, and follow-up assessments were contacted to participate in the semistructured interview. A total of 34 out of 216 (16%) completed the interview. Participants were motivated by, and satisfied with, the intervention. Participants viewed the RA as supportive, informative, caring, and reported positive behavior change in both exercise and sun protection. Some participants (15/34, 44%) noted the RA was less judgmental and less “overbearing” compared with a human counselor; other participants (12/34, 35%) said that the interaction was sometimes repetitive or overly general. The majority of participants (22/34, 65%) viewed the RA as an important contributor to their behavior change for exercise, sun protection, or both. Levels of satisfaction ranged between 7 and 10. There were no gender differences noted in levels of satisfaction (P=.51).

CONCLUSIONS

RAs provide an innovative and attractive platform to increase exercise and sun protection behaviors and potentially other health behaviors.
Systems-Based Training in Graduate Medical Education for Service Learning in the State Legislature in the United States: Pilot Study (Preprint)
Authors: Shah Shikhar H , Clark Maureen D , Hu Kimberly , Shoener Jalene A , Fogel Joshua , Kling William C , Ronayne James
Published: July 2018

BACKGROUND

There is a dearth of advocacy training in graduate medical education in the United States. To address this void, the Legislative Education and Advocacy Development (LEAD) course was developed as an interprofessional experience, partnering a cohort of pediatrics residents, fourth-year medical students, and public health students to be trained in evidence-informed health policy making.

OBJECTIVE

The objective of our study was to evaluate the usefulness and acceptability of a service-based legislative advocacy course.

METHODS

We conducted a pilot study using a single-arm pre-post study design with 10 participants in the LEAD course. The course’s didactic portion taught learners how to define policy problems, research the background of the situation, brainstorm solutions, determine evaluation criteria, develop communication strategies, and formulate policy recommendations for state legislators. Learners worked in teams to create and present policy briefs addressing issues submitted by participating Illinois State legislators. We compared knowledge and attitudes of learners from pre- and postcourse surveys. We obtained qualitative feedback from legislators and pediatric residency directors.

RESULTS

Self-reported understanding of the health care system increased (mean score from 4 to 3.3, P=.01), with answers scored from 1=highly agree to 5=completely disagree. Mean knowledge-based scores improved (6.8/15 to 12.0/15 correct). Pediatric residency program directors and state legislators provided positive feedback about the LEAD course.

CONCLUSIONS

Promising results were demonstrated for the LEAD approach to incorporate advocacy training into graduate medical education.
Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study (Preprint)
Authors: Danbjørg Dorthe Boe , Villadsen Allan , Gill Ester , Rothmann Mette Juel , Clemensen Jane
Published: July 2018

BACKGROUND

Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends.

OBJECTIVE

This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app.

METHODS

The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation.

RESULTS

Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience.

CONCLUSIONS

This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users’ needs, including motivational and other behavioral factors.
Home-based exercise improves sleep quality, and daytime sleepiness in elderly people: A protocol of randomized controlled clinical trial. (Preprint)
Authors: Brandão Glauber , Brandão Glaudson Sá , Silva Anderson Soares , Urbano Jessica Julioti , Oliveira Ezequiel Fernandes , Perez Eduardo Araujo , Guimarães Leticia Lopes , Peixoto Roger Andre Oliveira , da Palma Renata Kelly , Callou Antônia Adones , Oliveira Luis Vicente Franco , Camelier Aquiles Assunção
Published: July 2018

BACKGROUND

Background: Sleep-disordered breathing is associated with significant morbidity and mortality, presenting a high prevalence in the general population and being considered today as an important public health problem worldwide, affecting about 45% of the world population. It is estimated that about from 50 to 75% of the elderly complain of difficulties in initiating or maintaining sleep. The regular practice of physical activity of mild to moderate intensity is associated with improved sleep quality in the elderly and has increased its recommendation as one of the main non-pharmacological resources of preventive and therapeutic action.

OBJECTIVE

Objective: to verify if the regular practice of semi-supervised home-based exercises increases adherence, which influences the improvement of self-reported sleep quality and the reduction of excessive daytime sleepiness in a sedentary elderly population.

METHODS

Methods: This randomized, controlled, blinded clinical trial was designed, is being conducted and will be reported according to the guidelines of the CONSORT (Consolidated Standards of Reporting Trials) Statement, and is being conducted from July 2016 to December 2017, involving elderly people of both sexes, over 60 years old, living in Senhor do Bonfim. The home physical exercise program is based on the recommendations of the American College of Sports Medicine for exercise and physical activity for the elderly.

RESULTS

Results: The first expected outcome is the improvement of self-reported sleep quality verified through the PSQI. The secondary outcomes are reduction in excessive daytime sleepiness among the sedentary elderly subjects undergoing the semi-supervised home-based physical exercise program, verified by the ESS, and the adherence of the subjects to the program.

CONCLUSIONS

Conclusions: We hope that through this study, we can show that the regular practice of semi-supervised home exercises is effective in improving sleep quality and reducing excessive daytime sleepiness in sedentary elderly people and can be considered as a therapeutic, safe, easy-to-implement, and low-cost non-pharmacological resource.

CLINICALTRIAL

TRIAL REGISTRATION: This protocol study has been approved by the Research Ethics Committee of the Escola Baiana de Medicina e Saúde Pública (Brazil), process no 39072514.6.0000.5544, and was be registered on ensaiosclinicos.gov.br Identificator number: RBR-3cqzfy.
My Hypertension Education and Reaching Target (MyHEART): Development and Dissemination of a Patient-Centered Website for Young Adults with Hypertension (Preprint)
Authors: Johnson Heather M , LaMantia Jamie N , Brown Colleen M , Warner Ryan C , Zeller Laura M , Haggart Ryan C , Stonewall Keven , Lauver Diane R
Published: July 2018

BACKGROUND

Young adults (18 to 39 years old) with hypertension have the lowest rates of blood pressure control (defined as blood pressure less than 140/90 mmHg) compared to other adult age groups. Approximately 1 in 15 young adults have high blood pressure, increasing their risk of future heart attack, stroke, congestive heart failure, and/or chronic kidney disease. Many young adults reported having few resources to address their needs for health education on managing cardiovascular risk.

OBJECTIVE

The goal of our study was to develop and disseminate a website with evidence-based, clinical information and health behavior resources tailored to young adults with hypertension.

METHODS

In collaboration with young adults, health systems, and community stakeholders, the My Hypertension Education and Reaching Target (MyHEART) website was created. A toolkit was also developed for clinicians and healthcare systems to disseminate the website within their organizations. The dissemination plan was guided by the Dissemination Planning Tool of the Agency for Healthcare Research and Quality (AHRQ).

RESULTS

Google Analytics data were acquired for January 1, 2017 to June 29, 2017. The MyHEART website received 1090 visits with 2130 page views; 18.99% (207/1090) were returning visitors. The majority (55.96%, 610/1090) approached the website through organic searches, 34.95% (381/1090) accessed the MyHEART website directly, and 5.96% (65/1090) approached through referrals from other sites. There was a spike in site visits around times of increased efforts to disseminate the website.

CONCLUSIONS

The successfully implemented MyHEART website and toolkit reflect collaborative input from community and healthcare stakeholders to provide evidence-based, portable hypertension education to a hard-to-reach population. The MyHEART website and toolkit can support healthcare providers’ education and counseling with young adults and organizations’ hypertension population health goals.
Reduction in Vegetable Intake Disparities With a Web-Based Nutrition Education Intervention Among Lower-Income Adults in Japan: Randomized Controlled Trial (Preprint)
Authors: Nakamura Saki , Inayama Takayo , Harada Kazuhiro , Arao Takashi
Published: July 2018

BACKGROUND

No existing Web-based nutrition education interventions have been evaluated in light of socioeconomic status just in Japan.

OBJECTIVE

The aim was to investigate the effect of a Web-based intervention program on reducing vegetable intake disparities between low- and middle-income Japanese adults.

METHODS

In this randomized controlled trial, participants were assessed at three time points—baseline, postintervention (5 weeks later), and a follow-up after 3 months—from October 2015 to March 2016. We collected data via a Japanese online research service company from 8564 adults aged 30 to 59 years. Participants were stratified according to national population statistics for gender and age, and randomly selected. They were then randomly allocated into intervention (n=900) and control (n=600) groups such that both groups contained an equal number of individuals with low and middle income. The intervention program encouraged behavior change using behavioral theories and techniques tailored to their assumed stage of change. The outcome was vegetable intake servings per day (1 serving being approximately 70 g).

RESULTS

Out of 900 participants who started, 450 were from the middle income group (of which 386 or 85.7% completed the intervention), and 450 were from the low income group (of which 371 or 82.4% completed). In the intervention group, vegetable intake increased in the low-income participants from baseline to postintervention (0.42 servings, 95% CI 0.11-0.72). A two-way analysis of variance showed that low-income participants had significant main effects of group (η2=0.04, P=.01) and time (η2=0.01, P<.001), and a significant interaction (η2=0.01, P=.009). Middle-income participants also had a significant main effect of time (η2=0.01, P=.006) and a significant interaction (η2=0.01, P=.046).

CONCLUSIONS

This Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income adults in Japan, and is expected to prevent noncommunicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetable intake for other groups.

CLINICALTRIAL

Current Controlled Trials (UMIN-ICDR): UMIN000019376; https://upload.umin.ac.jp/cgi-open-bin/ icdr_e/ctr_view.cgi?recptno=R000022404 (Archived by WebCite at http://www.webcitation.org/6u9wihBZU)
Getting to the Root of Fine Motor Skill Performance in Dentistry: Brain Activity During Dental Tasks in a Virtual Reality Haptic Simulation (Preprint)
Authors: Perry Suzanne , Bridges Susan M , Zhu Frank , Leung W Keung , Burrow Michael F , Poolton Jamie , Masters Rich SW
Published: July 2018

BACKGROUND

There is little evidence considering the relationship between movement-specific reinvestment (a dimension of personality which refers to the propensity for individuals to consciously monitor and control their movements) and working memory during motor skill performance. Functional near-infrared spectroscopy (fNIRS) measuring oxyhemoglobin demands in the frontal cortex during performance of virtual reality (VR) psychomotor tasks can be used to examine this research gap.

OBJECTIVE

The aim of this study was to determine the potential relationship between the propensity to reinvest and blood flow to the dorsolateral prefrontal cortices of the brain. A secondary aim was to determine the propensity to reinvest and performance during 2 dental tasks carried out using haptic VR simulators.

METHODS

We used fNIRS to assess oxygen demands in 24 undergraduate dental students during 2 dental tasks (clinical, nonclinical) on a VR haptic simulator. We used the Movement-Specific Reinvestment Scale questionnaire to assess the students’ propensity to reinvest.

RESULTS

Students with a high propensity for movement-specific reinvestment displayed significantly greater oxyhemoglobin demands in an area associated with working memory during the nonclinical task (Spearman correlation, rs=.49, P=.03).

CONCLUSIONS

This small-scale study suggests that neurophysiological differences are evident between high and low reinvesters during a dental VR task in terms of oxyhemoglobin demands in an area associated with working memory.