Round-up of the latest preprints from JMIR
Our AI reads the RSS feed of preprints from JMIR and summarises the findings
The individual reports below - including each headline - were generated automatically by our machine-reading software from recent preprints from the Journal of Medical Internet Research.
The popularity of Instagram to raise awareness of skin cancer has led to a lack of studies describing skin cancer-related content on the photo-sharing platform.
Gomaa and colleagues (2021) described how “it is more than just sunscreen”. Skin cancer, in general, and melanoma, are among the deadliest forms of cancer in the United States. This study aimed to describe the content landscape of skin cancer on Instagram, focusing on the content source and type of information posted by users. Social media platforms may serve as potential intervention modalities that can be employed to raise public awareness of several diseases and health conditions.
1000 posts were included in the research. Some of the researchers’ findings appear to corroborate earlier work in this field: “In contrast to skin cancer content in Facebook groups, a higher percentage of posts included content about prevention awareness and encouraging others to wear sunscreen. This aligns with previous research on Instagram and YouTube,” Gomaa argued. However, “As with other research, this study is not devoid of limitations. For example, the sample of Instagram posts was extracted during the month of May, which was Skin Cancer Awareness Month. Winter months may look different than spring and summer,” concede the authors. They argue that findings from this study call on the medical community and public health officials to collaborate and provide leadership on these platforms. The authors ask them to work on more innovative and interactive techniques to engage with users.
A scoping review of the published literature on “dashboards” in the healthcare sector aims to identify potential research gaps and guide future development in the rapidly evolving field of healthcare informatics.
Danielle Helminski et al. (2021) studied dashboards in healthcare settings. Measuring, monitoring, and responding to metrics about health-related decisions, practices, and outcomes has become an essential business function for modern healthcare organizations. Any abstracts mentioning a healthcare dashboard were retrieved in full-text and are undergoing duplicate review for eligibility. This scoping review will provide a narrative overview of design elements and characteristics of healthcare dashboards. Findings will guide efforts to design and utilize dashboards in the healthcare sector more effectively.
The researchers evaluated 3306 studies. The investigators say that “This scoping review methodology has several limitations. The search strategy does not include grey literature or conference abstracts. This may cause some dashboards described in government and committee reports, dissertations, and conference proceedings to be overlooked.” Data and code to reproduce the analyses can be found at: http://asset.jmir.pub/assets/1b092676467a1ff9483314d5d65bfdec.docx.
Poverty and executive function (EF) skills in early childhood may be influenced by both prenatal and postnatal experiences.
William Mills-Koonce and colleagues (2021) reported on the brain and early Experience study. Children raised in conditions of poverty are at risk for nonoptimal mental health, educational, and occupational outcomes. Individual differences in executive function skills first emerge in early childhood. The Brain and Early Experience study considers prenatal and postnatal experiences that may mediate the association between poverty and EF skills. Poverty adversely influences children’s development through early proximal experiences. The BEE Study examines caregiver-child interaction quality, child sleep hygiene, and language exposure. In this study they will interpret brain development at 2 weeks of age as a product of prenatal experiences and brain.
3267 Potential participants will be involved in the analysis.
A digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ) women has been found to reduce alcohol-related risks among moderate and heavy drinkers.
Sarah Boyle et al. (2021) described feasibility and efficacy of a gamified, social media–inspired, web-based personalized normative feedback alcohol intervention for lesbian, bisexual, and queer-identified women. Findings demonstrate the utility of correcting sexual identity specific drinking and coping norms to reduce alcohol-related risks among LBQ women. Research has reliably documented a greater likelihood of heavy drinking, negative-alcoholrelated consequences, and alcohol dependence among sexual minority women (SMW). SMW includes women who psychologically identify as lesbian, bisexual, or queer (LBQ).
The study involved 2667 diverse LBQ women. Some of the authors’ results claim to consolidate previous studies in this field: “Consistent with the sexual minority stress model, research has linked greater alcohol consumption and negative consequences among SMW to internalization of sexual minority stigma. These findings have informed the recent development of two stigma coping-focused digital programs designed for heavy drinking SMW,” Boyle argued. Discussing potential shortcomings, “Participants in all three PNF conditions described unanticipated, far-reaching psychological benefits associated with broader competition participation including stigma reduction, community connection, and identity strength. Future evaluation efforts should follow participants for a longer duration, incorporate survey-based baseline and follow-up assessments,” they observe. They argue that the stereotype challenge concept and injection of established game mechanics and cultural themes may have similar utility in reaching other high-risk stigmatized minority groups with PNF on drinking and other health-risk behaviors. The authors have provided data and code at: https://preprints.jmir.org/preprint/34853.
A study of exercise-based cardiac rehabilitation after aortic valve implantation.
In ‘Exercise-based real-time telerehabilitation for older patients recently discharged after transcatheter aortic valve implantation, a mixed-method feasibility study’, a group from the Department of Physiotherapy and Occupational Therapy Aalborg University Hospital Aalborg DK led by Barbara Brocki (2021) noted that exercise-based telerehabilitation for older people after TAVI does not seem feasible in its present form, as 70% of the included patients did not complete the study. Field notes showed that the practical tasks learned during the home visit supported most patients in using the technology and joining the online sessions.
The research involved 13 patients. Discussing possible shortcomings, “As a single-center trial with no control group, our study has a limited generalizability. It is a strength that we screened all patients who were scheduled for a TAVI procedure in our hospital. The recruitment rate was similar to the feasibility randomized study performed by Rogers et al,” they acknowledge. The researchers recommend that aspects that support retainment rates and enhance patients’ IT skills need to be further addressed before the program can be used in a larger scale, such as a randomized controlled setting, as intended. Data and code are available from: https://preprints.jmir.org/preprint/34819.
An intervention for self-management in a German primary care setting had no significant impact on patients' quality of life.
Amanda Breckner et al. (2021) reported on “good tool but too soon”. Medical practice assistants with further training (VERAHs) and patients were involved in the development of TelePraCMan. Patients mentioned the simple condition of the application, which did not take much time for them either. Respondents described that the application could gain relevance in pandemic situations like COVID-19. Breckner and colleagues examined the effects of TelePraCMan on patient activation and quality of life. No differences were observed in outcomes before and after the intervention or between intervention and control group. MHealth interventions are expected to provide self-management support interventions, which can be tailored to individual needs.
There were 4 patients included in the analysis. The researchers note that “Study is one of the first studies concerning an mHealth intervention for chronically ill patients in a primary care setting in Germany. Due to small sample size, values had to be interpreted very carefully, as the coefficients may result solely from sampling effects.” The authors advocate that few studies have explored the acceptance and actual use of mHealth interventions by older adults in Germany. Previous studies on older multimorbid patients have shown that further research is needed for a successful integration of the interventions in patients’ everyday life and in the workflow of primary care practices.
The Positive Choices drug prevention website has reached more than 2 million users since its launch five years ago.
In ‘Positive Choices’, Lexine Stapinski et al. (2021) reported that adolescence is marked by considerable emotional, social, and physical changes, including increasing autonomy from parents and greater influence from peers. The current study assesses the impact and effectiveness of the Positive Choices initiative in increasing awareness and implementation of evidence-based AOD prevention strategies. Most of the parents reported that they were already correcting misperceptions about drug use being 'the norm'. A national Australian campaign increased awareness from 8% to 14% post campaign among school staff, and from 15% to 22% among parents. The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information.
200 participants were involved in the research. Aspects of the authors’ results may diverge from earlier findings in this field: “The majority of surveyed school staff and parents in the current sample reported they were already implementing evidence-based prevention strategies. This may reflect that recruitment strategies attracted a sample who were already interested in and aware of drug prevention approaches,” Stapinski claimed. Discussing possible improvements, “The majority of surveyed school staff and parents in the current sample reported they were already implementing evidence-based prevention strategies and were confident discussing alcohol and drug use. Future studies with a pre-post study design will enable a more comprehensive evaluation of whether the website impacted subsequent behaviours,” they concede. Another limitation is that the targeted campaign used to recruit participants for the evaluation study may have resulted in a sample selection bias. Data and code are available from: http://asset.jmir.pub/assets/86a992382215a6be3fdf2310b73958f3.docx.
Tailored self-monitoring interventions via smartphone apps have a modest but clinically significant effect in reducing blood pressure in patients with hypertension, according to a systematic review and meta-analyses.
Katerina Kassavou et al. (2021) studied how app-based self-monitoring of hypertension-related behaviours reduces high blood pressure. Self-monitoring of behaviour can support lifestyle modifications; they do not know whether such interventions are effective in reducing blood pressure in patients with hypertension. This systematic literature review with meta-analysis included fourteen trials with 7,365 patients. Results showed that app-based behavioural self- Monitoring interventions had a small but statistically significant effect in reducing systolic blood pressure. Future studies should use rigorous methods to explore their effects at supporting changes at both blood pressure and hypertension-related behaviours.
The researchers evaluated 4637 articles. The investigators note that “This review summarizes the currently available evidence to support that app-based tailored self-monitoring behavioural interventions are effective to reduce systolic blood pressure by on average of 2.87mmHg.” The researchers contend that future research should use rigorous methods to investigate their direct impact on health behaviour change and blood pressure, their indirect effects on service provision, and the overall morbidity and premature mortality associated with hypertension. Data and code are available from: http://asset.jmir.pub/assets/f0d948826f92f98615566291c68f3712.docx.
A 10-year public health project aims to increase dementia risk knowledge and promote changes in dementia risk behaviours at individual and population level in Tasmania, Australia.
In the island study Linking Ageing and Neurodegenerative Disease, a research group from the Research and Education Centre University of Tasmania Hobart AU led by Larissa Bartlett (2021) reported that dementia is one of the most prevalent and burdensome conditions impacting the community. Future projections suggest that 152 million people will be affected worldwide by 2050. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) aims to increase dementia risk knowledge and promote changes in dementia risk behaviours at individual and population level. Up to 40% of incident dementia is considered attributable to behavioural and lifestyle factors.
There were 10000 participants in the research. Bartlett and colleagues advocate that the cohort can be segmented for targeting particular interventions or controlled studies of factors that influence or detect change in dementia trajectories. ISLAND participants are invited to contribute biological samples to support further investigation of links between proteins and genetic markers, neurodegenerative disease and brain function.
A review of the emerging area of digital anatomy and the opportunities and challenges for incorporating it in medical science education and research.
Nilmini Wickramasinghe et al. (2021) described digital anatomy. Digital Anatomy is emerging as a new discipline and represents an opportunity to embrace advances in digital health technologies. Virtual or digital dissection tables have been effectively implemented in medical education, providing alternative experience to understand human body complexity and layers of internal structures. 3D-printed anatomy models function as a training tool for both health professionals and patients. For over ten years the relatively nascent domain of digital health has advanced and matured. It was noted that digital anatomy cannot only benefit in situ real time clinical practice. The authors presented a SWOT analysis of the opportunities for incorporating digital anatomy.
They suggest that the impact of new digital anatomy curricula reforms on the retention of future surgical competencies is currently unclear. Future research is required to evaluate the student perceptions and effectiveness of digital simulation in the satisfactory development of surgical skills.
A systematic review of the literature on the application of natural language processing (NLP) to extract hypoglycemia related information from electronic health records (EHRs).
Yaguang Zheng et al. (2021) reported in ‘Identifying Patients with Hypoglycemia Using Natural Language Processing’ that In 2017, direct and indirect costs attributed to diabetes in the U.S. were estimated to $327 billion. Optimal glycemic control (HbA1c < 7%) can be achieved with comprehensive antidiabetic treatment. The application of NLP algorithms is scalable, efficient, and quick to extract unstructured data from a large population. The objective of this systematic review was to synthesize the literature on the application of Natural language processing to extract hypoglycemia from electronic health records resources clinical notes. The combination of NLP and International Classification of Diseases-9/10 codes significantly increased the identification of hypoglycemic events.
The authors reviewed 3 studies. Discussing possible shortcomings, “This is the first systematic review to synthesize the prevalence and incidence of hypoglycemia using NLP in individuals with diabetes. All the studies applied the combination of NLP with ICD codes and/or lab testing,” they concede. The team contend that future research directions should explore comparison of the rule-based and machinelearned approaches to improve NLP efficiency.
The use of artificial intelligence (AI) in health care in Germany is still in its early stages, according to a survey of 609 German hospital IT decision makers.
A research team at the Heidelberg University Hospital Institute for Medical Informatics Heidelberg DE led by Lina Weinert (2021) reported on the perspective of IT decision makers on factors influencing adoption and implementation of AI-technologies in German Hospitals. Study presents the first large-scale, web-based survey of the status quo concerning the adoption and implementation of AI technologies in German hospitals. 84% of participants agreed that their institution lacked financial resources and 94% said a lack in resources overall is a barrier for AI implementation. Qualitative studies with hospital IT decision makers should be conducted to explore the reasons for slow AI adoption in more detail. New Artificial Intelligence tools are being developed at a high speed. Most participants agreed or rather agreed with the statement that AI will be relevant in the future. Since most AI technologies already in use were developed in cooperation with external partners, these relationships should be fostered.
609 possible participants were involved in the analysis. However, “Our study investigated the status quo of AI technologies in German hospitals and the applicability of AI readiness factors derived from literature. We surveyed hospital CIOs as important intermediaries for digital innovation adoption and implementation,” note the investigators. They suggest that further research should continue to monitor the dissemination of AI tools and AI readiness factors. Governmentally supported investments in AI technologies could alleviate financial burdens. Qualitative studies with hospital IT decision makers should be conducted to explore the reasons for slow AI adoption in more detail. The researchers have provided data and code at: http://asset.jmir.pub/assets/af9292592cdc707a955ad9a972eabfb8.docx.
A study on the quality of responses of voice assistants (VAs) to questions about the World Health Organization’s COVID-19 vaccine.
Carlos Figueiredo et al. (2021) reported in ‘Evaluating Voice Assistants Responses in Portuguese for COVID-19 Vaccination ’ that Voice Assistants are devices that respond to human voices and can be commanded to do a variety of tasks. Google Assistant has a better overall performance, and only this VA and Samsung Bixby achieved high scores on question understanding in the Portuguese language. Evaluating Voice Assistants Responses in Portuguese for COVID19 Vaccination. Google Assistant achieved the highest score (73.3%), followed by Siri (64.4%). Bixby (17.8%), Alexa (11.1%), and Cortana (6.7%). Cortana and Google Assistant answered all questions in Brazilian Portuguese and achieved 100% on this criterion. All the voice assistants performed well in terms of comprehension and user-friendliness with scores above 75%.
The research involved 5 popular voice assistants. They suggest that they plan to extend the study to consider other relevant questions about the pandemic crisis. The team want to compare the accuracy of VAs to health questions when specific custom applications are developed, such as Bixby capsules or Alexa skills. Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/34674.
A targeted social media campaign aimed at increasing the number of people testing positive for the novel COVID-19 virus increased the rate of testing in certain migrant groups in Norway.
A team led by Ingeborg Elgersma from the Centre for Epidemic Interventions Research Norwegian Institute of Public Health Oslo NO (2021) reported on evaluation of a social media campaign to increase COVID-19 testing in migrant groups. Many migrant groups have been disproportionally affected by COVID-19 in Norway. The use of social media platforms has been crucial when targeting specific groups. The team conducted this trial to assess the effects of a targeted social media campaign on increasing the rates of testing among migrant groups. Individuals born in Syria, Pakistan, Eritrea, Turkey, Russia and Iraq residing in intervention areas were targeted with a social media campaign. The intervention described in this paper was part of the ‘Get tested’-campaign.
The analysis involved 233903 persons with a Norwegian national identity number. Aspects of the researchers’ results may back up what was previously known about this field: “Short messages recorded by health professionals before the winter holidays led to reductions in travel and a decrease in COVID-19 infection at the zip code level in the two-week period starting five days post-holiday,” Elgersma said. The authors observe that “There are some limitations to the findings of this study. The design of the trial limited the scope and content of the campaign. A related limitation is that the campaign may have had spill over effects on the control group.” Data and code are available from: http://asset.jmir.pub/assets/e54350099c3e4523a65d3f23b4ce66a0.docx.
A study on the use of social media to monitor the side effects of geriatric drugs.
Seunghee Lee et al. (2021) reported in ‘Drug_SNSMiner’ that adverse drug reactions are a major public health problem for the aged. They confirmed that well-known side effects may be obtained by utilizing social network studies data. The authors proposed a pharmacovigilance pipeline that can be extended to unknown side effects. Studies are being conducted in which social media data are used as an auxiliary method of adverse drug reaction (ADR) monitoring. They established that these learning data are invaluable for AI requiring the acquisition of ADR posts on efficacious drugs.
There were 25693 social media posts included in the research. However, “Other social channels such as Twitter were not considered. There is insufficient evidence to demonstrate that postings deemed valid and explaining side effects are clinically relevant. More meaningful interpretations might be achieved through ongoing consultation with clinical experts,” note the investigators. The team argue that when there was no indication whether a post found by crawling was, a valid article, they executed the selection based on key words. Lee and colleagues only defined known side effects by constituting Lexicon. If side effects are defined by extension to the Lexicon to detect indications and unknown side effects. Data and code are available from: http://asset.jmir.pub/assets/d2d757624ba779402bc9e8f17e4e57e2.doc.
A study on the development of a regional Digital Health Record (ReDiFa) to improve health information exchange in geriatric treatment in Germany.
Nils Pfeuffer et al. (2021) described development of a regional digital health record for geriatric health care in rural areas. ReDiFa should support the exchange of assessments, diagnoses, medication, assistive device supply and social information. ReDiFa is better accepted by healthcare professionals which are already engaged in an inter-disciplinary, geriatric-focused network. More research is needed on questions, like how to adequately remunerate EHR usage, which legal adjustments are needed, and how to facilitate cross-sectional cooperation in a fragmented health care system. Healthcare providers are interested in participating in the development of a health information exchange system, but they often lack the required time, knowledge and resources.
There were 12 participants involved in the research. However, “The study is based on a small number of very heterogeneous healthcare providers. The results are not representative of the entire community of geriatric healthcare providers,” note the researchers. Pfeuffer and colleagues propose that more research is needed on questions, like how to adequately remunerate EHR usage, which legal adjustments are needed, and how to facilitate cross-sectional cooperation in a fragmented health care system. Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/34568.
The knowledge structure, hotspots, and trends of evolution of the field of Kinase Inhibitors (TKIs) have been revealed by co-word analysis and literature visualization.
A research group led by Jiming Hu at the School of Information Management (2021) reported in ‘Global research Trends in Tyrosine Kinase Inhibitors’ that tyrosine kinases (TKs) are a collective term for dozens of kinases encoded by multiple genes, which can phosphorylate tyrosine residues in cells. The TKIs co-word network was divided into six communities: C1-Non-small Cell Lung Cancer, C2-Targeted Therapy, C3-Chronic Myeloid Leukemia, C4-HER2, C5-Pharmacokinetics, and C6-ALK. TKIs research mainly focused on targeted therapies against varied tumors, against non-small cell lung cancer.
The researchers evaluated 13895 documents. Aspects of the researchers’ findings claim to reinforce previous studies in this subject: “Changes in keyword frequency fluctuate significantly, with some of the words appearing in sudden bursts. We detected keyword bursts and combined their burst weights and durations to reveal changes in the focus of TKIs research,” Hu suggested. However, “Of course, our study also has some limitations: first, our search included only English literature from 2016 to 2020, while non-English literature was excluded. Second, the co-word analysis didn’t take the quality, influence, and rigor of the literature into account,” admit the authors. The authors have provided data and code at: https://preprints.jmir.org/preprint/34548.
A study on the use of an electronic tool for symptom registration at home after knee arthroplasty.
a team led by Torbjørn Rian at the Department of Anaesthesiology and Intensive Care Medicine (2021) report the use of an electronic tool, Eir, for symptom registration at home after knee arthroplasty. This study showed a high feasibility and a high usability of the Eir web tool. The received reports gave the necessary information needed for both research data and clinical follow up. Patient-reported data concerning effect and side effects of the pain treatment were registered daily for 8 days by use of Eir on a tablet and transferred wirelessly to the Eir database. A large majority (70%) of the patients managed to use the tool at home without any technical support.
The analysis involved 134 patients. However, “This symptom assessment system requires a well-developed technological infrastructure, which is present in Norway and many developed countries, but not in all countries. It also demands a population which is familiar with use,” observe the investigators. The authors have provided data and code at: http://asset.jmir.pub/assets/b60c0c4db3b80d4fe9e731bd8a79e526.pdf.
Online nominal group sessions may be a promising alternative to face-to-face research.
In ‘Synchronous online nominal group sessions in times of COVID-19’, Lotte Timmermans and colleagues (2021) reported that the outbreak of the coronavirus disease 2019 (COVID-19) has posed multiple challenges. Performing synchronous online nominal group sessions is challenging but offers opportunities. The main advantage of performing online sessions seems to be the flexibility resulting from the reduced time commitment for both researchers and attendees. In times of COVID-19, they are challenged to experiment with alternative platforms or software to connect people. This paper addresses the issue of synchronous online nominal group sessions, a common consensus method used for group brainstorming.
10 participants were involved in the study. However, “Based on the performance of three sessions, we were able to gain sufficient input to analyse challenges. We did not compare our findings with real-life nominal group sessions. Participants’ experiences were not deeply surveyed or explored,” concede the researchers. They suggest that future research should focus on refining the group technique.. The researchers have provided data and code at: https://preprints.jmir.org/preprint/34539.
An artificial intelligence (ML) algorithm has been developed and validated in a study of intravenous heparin dosing in five hospitals in Queensland, Australia.
Abdel-Hafez and colleagues (2021) reported on an ensemble model for predicting therapeutic response to unfractionated heparin therapy . Unfractionated heparin (UFH) is a parenteral anticoagulant used for preventing and treating arterial and venous thromboembolic diseases. The researchers built an ensemble regression model to predict aPTT values within 12 hours of UFH bolus dose. In a new patient cohort at a fifth hospital showed similar results with an RMSE of 30.52 for the prediction model and an accuracy of 56.8% and AUC of 0.724 for the multiclassification model. The best performing experiment produced an ensemble with 4x LightGBM models with a root mean square error of 31.35. This dataset was re-purposed as a multi-classification task and achieved a 59.9% accuracy and area under the receiver operating characteristic curve of 0.735. According to the knowledge, this is the first study of Machine learning applied to IV UFH dosing that has been developed and externally validated in a multisite adult general medical inpatient setting.
2783 hospital admissions were included in the research. The investigators note that “Our model was developed and validated using data from EHRs of five Queensland hospitals. The modelling approach only applies to adult inpatients admitted to the general medical and surgical specialties.” They recommend that the modelling approach only applies to adult inpatients admitted to the general medical and surgical specialties. This modelling approach was intended for prediction of aPTT after a prespecified bolus and maintenance dose.
A formal appearance on a Twitter profile picture does not affect the credibility of a doctor posting health advice.
DaJuan Campos-Castillo (2021) described cue the doctor. The profile picture of a physician posting health advice in either formal or casual attire did not elicit significant differences in credibility, with ratings comparable to having no profile image. Among participants assigned the formal appearance condition, those with a regular provider rated the physician higher on a credibility than those without. Findings support Hypothesis 2 and indicate formal attire in a Twitter profile picture can cue credibility for physicians. Practical consequences for professionals engaging with the public on social media include moving past debates about casual versus formal appearances and toward identifying ways to segment audiences.
205 social media users were involved in the study. Some of the researchers’ conclusions appear to reinforce prior work in this area: “A female physician wearing a white lab coat with a stethoscope on her Facebook profile image received higher favorability ratings than when she wore a short-sleeved casual shirt. This aligns with our finding showing credibility ratings were higher in the formal than in the casual attire condition,” Campos-Castillo said. Discussing possible shortcomings, “Previous studies find few differences by physician’s gender in patient preferences for attire,” they observe. They advocate that this aligns with the finding showing credibility ratings were higher in the formal than in the casual attire condition. The group suspect the conditional importance of formal attire will be comparable for tweets by a female physician. Future research should conduct a direct test. Data and code are available from: http://asset.jmir.pub/assets/60bd05738941a1b256a2e4441de8f78f.docx.
The aim of this study is to develop a holistic palliative care program in Iran to improve the health and quality of life of colorectal cancer patients.
Masoumeh Masoumy et al. (2021) studied development a palliative care program for colorectal cancer patients. Colorectal cancer (CRC) is the third most common cancer in Iranian men and the second in Iranian women and it is a serious health problem in the Iran health system. It is a serious health problem in the Iran health system. This study can will provide a better understanding of the demands and problems of coloreCTal cancer patients and their families. This study is developing the first palliative care program for CRC patients based on needs, experiences patients and the socio-cultural condition of Iran.
They suggest that 1.8 million new cases of CRC1 and 700,000 deaths caused by it have been reported in the world. CRC is one of the most prevalent cancers of the gastrointestinal tract in Iran. The prevalence of CRC in Isfahan province has been about 52.6 per 100,000 people.
A text message system that allows patients to wait outside the emergency department and to be recalled closer to the scheduled time of meeting with a physician has been tested in a hospital in Switzerland.
In ‘Use of a Semi-Automatic Text Message System to Improve Satisfaction with Wait Time in the Adult Emergency Department’, Frederic Ehrler et al. (2021) reported that patients with life-threatening and serious conditions are prioritized over less acute patients. A long wait time in the waiting room increases the risk of hospital-acquired infection. Those with a lower level of urgency who may have to wait for a longer time. Ehrler and colleagues aimed to improve the perception of waiting time through the implementation of a semi-automatic text message (SMS) system. A screen available to nurses provides real-time occupancy of the emergency rooms and wait times by triage level. The group found that the majority (87%) of patients with low-to-moderate urgency were interested in waiting outside the ED waiting room when the expected waiting time was 1 hour or more.
70000 patient admissions were involved in the research. Discussing potential improvements, “The selection of patients on the basis of their interest in using the SMS system must be taken into account. A patient with a high stress level could refuse to benefit from the system. The low participation rate of nurses is also a limitation and it will be useful to conduct a further survey,” they admit. The authors have provided data and code at: https://preprints.jmir.org/preprint/34488.
The challenges and opportunities posed by the digital health revolution, and how we can improve the way we care for patients.
Devin Lawrence (2021) described reimagining connected care in the era of digital medicine . The Covid-19 pandemic accelerated the adoption of digital health tools such as telehealth and remote patient monitoring (RPM). Health is not episodic; it is a fundamental part of the human condition, experienced regularly and continuously. The friction in these competing visions of care has contributed to a fragmented, inconsistent healthcare delivery experience. The group present a solution that organizes and optimizes the interaction of automated technologies with human oversight. Lawrence review ramifications of this “augmented continuous connected care” model for clinical practice.
Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/34483.
A proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance abuse was well-received by young people.
In ‘Participatory Design of a Mobile App to Safeguard Mental Resilience in the Context of Drug Use in Young Adults ’, Ofri Ben-Yehuda et al. (2021) noted that the findings provide preliminary encouraging support for the five main features suggested by the research team. Existing mental health apps are largely not aimed at generally healthy young people. An evaluation study based on participants using the app for several months will be needed to assess whether it can significantly reduce the risk of mental health crises. The proposed SafeGuard app is envisioned as offering five high-level features: risk assessment, support for self-monitoring, useful information, resilience development, and a support center. A one-way ANOVA revealed no significant differences based on gender, occupational status, or religious orientation regarding perceptions about the prevalence of drug use among young people.
There were 4 participants in the research. Aspects of the researchers’ findings seem to support earlier work in this subject: “Proposed app offers several ways to get instant support from real people and useful information. Focus group participants concurred with previous findings that the amount of detailed information presented in mental health apps must be balanced with the need for a simple design,” Ben-Yehuda claimed. The authors say that “We derived our findings based on a limited sample size that overrepresents young secular Jewish female students. Future research should also examine the relevance of the proposed app in light of the COVID-19 pandemic.” The researchers suggest that future research should examine the relevance of the proposed app in light of the COVID-19 pandemic. The pandemic has changed many aspects of daily life, affecting people’s behavior, lifestyle, and sense of security. Data and code to reproduce the analyses can be found at: http://asset.jmir.pub/assets/d85605c82ec59f59c58818d4f125f322.docx.
A deep learning-based framework that helps in automatic depression detection has been proposed.
A research team from the Telecommunications Research Institute Dajeon KR led by Ahyoung Kim (2021) report that depression is one of the serious psychiatric illness, affecting more than 300 million of people worldwide. The group investigated the possibility of automatic depression detection using the proposed log mel spectrogram-based deep Convolutional Neural Networks architectures and machine learning models. They found that there were statistically discernable differences between MDD and control groups in the MFCC features extracted through the utterances of reading predefined text-based sentences. This approach has the potential to reduce depression and shows that it is powerful and effective in ADD on via speech.
The study involved 125 patients. Aspects of the researchers’ results may support previous studies in this area: “Previous studies have shown that the neural responses in inferior frontal gyrus, which is part of the motor syllable program related to phonological processing, is significantly related to depressive disorder. This suggests that the MFCC features can play an important role in developing the prediction model of MDD,” Kim said. The authors observe that “We are confident that these efforts will help build a more robust MDD predictors to apply to our daily lives. We plan to build deeper and narrower networks in the future and expand the types of metadata such as gender or other.” The authors contend that they are confident that these efforts will help build a more robust MDD predictors to apply to the daily lives in the future. They plan to explore different strategies for combining the speech-based systems with various information such as video or physiological signals. Data and code are available from: http://asset.jmir.pub/assets/ed8ac1d1e80c77d0ef94cef88f795659.docx.
The use of a wrist-worn activity tracker that provides feedback is effective in increasing daily activity of older US adults aged 50 and above.
In ‘Does feedback from activity trackers influence physical activity?’, Arie Kapteyn et al. (2021) reported that physical activity has been shown to be associated with a significant reduction in adverse health conditions, all-cause mortality, disabilities, and improved mental and emotional well-being. Less than 25% of the US adults aged 1864 meet the Centers for Disease Control and Prevention recommended activity guidelines. They find that participants accumulated an additional 530 steps in a given day when they wore FV, which provided feedback. The study strength includes: (1) use of study participants from the Understanding American Study (UAS) – a probability-based online panel representative of U.S adult population.
The research involved 32 individuals. Discussing possible shortcomings, “Our study was not designed to disentangle various mechanisms that mediate or moderate the feedback effect, which would require a research design that is more elaborate and expensive than the current study. Our intervention period of 14-15 days was relatively short,” they note. They argue that more research is needed to better understand the extent of wearables alone are effective at promoting physical activity as well as the various ways through which they have differential impacts on subpopulation groups. Data and code are available from: http://asset.jmir.pub/assets/e87bbb2488656bed196d8ccda02a971f.pdf.
An artificial intelligence-aided diagnostic tool has shown better performance than a group of non-ophthalmic physicians in identifying referable blepharoptosis, including true and pseudoptosis.
Ju-Yi Hung and colleagues (2021) reported on an outperforming artificial intelligence model to identify referable blepharoptosis for general practitioners. Blepharoptosis, known as ptosis, is the drooping or inferior displacement of the upper eyelid. VGG16-based artificial intelligence model achieved a sensitivity of 92% and a specificity of 88%. The AI model using convolutional neural networks achieves better performance than the nonophthalmic physician group. It is important for general practitioners to accurately diagnosis ptosis to assist in decision-making. To develop an AI model which accurately identifies referable blephar optosis automatically and to compare the AI model’s performance to non-ophthalmic physicians.
There were 3 oculoplastic surgeons with ptosis involved in the analysis. The investigators acknowledge that “Up to one-third of congenital ptosis patients are at risk for amblyopia. Accurate diagnosis of ptosis based on external photographs would prove especially helpful in the pediatric population, for ophthalmologists and general practitioners alike.” Hung and colleagues recommend that AI assisted detection of congenital ptosis could have a huge impact on preventing and treating amblyopia promptly. Only adults were included in this study, setting limitation for pediatric care. The authors have provided data and code at: https://preprints.jmir.org/preprint/34445.
A study of posts made on the QuitNow community forum shows that encouragement (emotional), compliment (esteem), suggestion/advice (informational), and Companionship (network) are the most prominent types of social support.
Laura Struik et al. (2021) reported in ‘Social support and quitting smoking’ that the purpose of this study is to characterize the posts made on the QuitNow community forum at different stages in the quit journey. They developed both inductive and deductive categories to identify what types of social support smokers need. During the before quit stage, encouragement, compliment, and suggestion/advice were the most prominent types of support offered to users. Tobacco use continues to be the number cause of preventable disease and death around the world. The findings of this study highlight the complexity of how and when different types of social support are exchanged on the QuitNow community forum. These findings provide directions for how social support can be more strategically employed and leveraged in these online contexts to support smoking cessation.
The research involved 506 posts. Aspects of the findings potentially consolidate previous work in this field: “This may suggest that, by this time, individuals feel confident enough to share their successes and feel that they have enough personal credibility to offer advice. Previous literature has found that individuals are often reluctant to share successes too early due to a fear of failure and a lack of confidence,” Struik suggested. The researchers admit that “This study has several limitations. The frequency, duration, and amount of cigarettes smoked among forum users was not data we were able to collect. We did not analyze intersections of identity and their impact on how support was exchanged on the forum.” The authors advocate that the highest and most varied engagement on the forum occurred throughout the first month of quitting. This coincides with the biological processes that occur during cessation. Many users face withdrawal symptoms in the short-term following an attempt to quit. The researchers have provided data and code at: http://asset.jmir.pub/assets/9022e27c63df5cb3b30ca81c04cf1fc5.docx.
A study on the impact of a mobile health engagement platform (mTIP) on sexual and reproductive health (SRH) in Uganda.
A research group led by Louis Kamulegeya at the Infectious Diseases Institute Kampala UG (2021) reported in ‘Feasibility and acceptability of a digitally supported channel of behavioral messaging on modern contraception’ that in 2021, Uganda’s population averaged 42.4 million people representing about 30% growth from 36.9 million as of the last conducted national population census in 2014. The aim of the study was to evaluate the feasibility and acceptability of a telehealth engagement platform targeting primarily men with behavioral and informational messaging on modern contraception. There was a noted 18.1% increment in couple communication attributed to the mTIP and couples opened more about each other on matters concerning family planning.
450 males were included in the research. Some of the findings may reinforce previous work in this field: “A review of demographic health data on SMS based family planning communication within low- and middle-income countries showed an uptake prevalence of about 5.4% within selected Africa countries. This low utilization and uptake mirror our 24% average participation in the periodic quizzes,” Kamulegeya argued. Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/34424.
A study on venous thromboembolism (VTE) after arthroplasty has shed light on the global research status, hotspots and trends in the field.
Wei Song et al. (2021) described global research status and trends in venous thromboembolism after hip or knee arthroplasty from 1990 to 2021. Postoperative venous thromboembolism is a major cause of morbidity, mortality, and healthcare costs in patients undergoing knee or hip arthroplasty. Individualized VTE prevention based on risk factors for each patient will become a novel research trend. Study aimed to identify research trends and hotspots for VTE after hip and knee arthroplasty via integrative analysis of articles published worldwide. USA was the dominant country in terms of contributions to the VTE research.
The researchers reviewed 1245 original articles. Discussing possible improvements, “Only the WOSCC database was analyzed in this study. Follow-up study could be conducted in the future to evaluate the influence of these articles in the field,” they acknowledge. They recommend that rivaroxaban, dabigatran etexilat, and apixaban were found to be more effective than enoxaparin in preventing VTE after TKA and THA. There was no statistical difference in the risk of bleeding. Data and code are available from: https://preprints.jmir.org/preprint/34332.
An eCoach that guided employees through the process of self-reflection did not improve their stress and resilience capacities.
In ‘How Reflective Automated eCoaching Can Help Employees Improve their Capacity for Resilience’, Aniek Lentferink et al. (2021) noted that the automated eCoach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience. The identified events related to stress and resilience were too specific through the guidance offered by the eCoach and the events did not recur. One-third of work-related absenteeism among employees is caused by stress. The design element learning the BringBalance techniques including short clips scored on average 4.1 on a scale from 1 – 5. Participants experienced difficulty integrating strategies relevant to their energy leaks and sources into their daily life.
There were 350 employees in the study. The researchers concede that “The study population consisted of participants with a high educational level. It might be that the performance during the reflection process and the needs for guidance from the automated eCoach by our study’s participants are different for the overall working population.” They argue that future research could study the effects of the suggested improvements on the quality of reflection via an automated eCoach.
A telehealth approach that was set up to support community health workers in rural communities in Uganda with sustaining basic health services and dealing with the COVID-19 pandemic proved useful.
Maarten Kok et al. (2021) studied using telehealth to support 3500 community health workers in rural Uganda. On March 11th, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. Many low-income countries were confronted with a difficult challenge. With little resources and while implementing a stringent lockdown, they had to rapidly train thousands of Community Health Workers in rural and remote areas. The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. By supporting the CHWs, patients in hard-to-reach areas received better services and spent less time and money accessing basic health products.
The study involved 700 community members. Aspects of the authors’ results seem to substantiate what was previously known about this field: “The surveys were conducted amongst active CHWs who can be expected to be aware of severe health problems in communities in which they work. The number of symptomatic COVID-19 cases in Uganda has remained relatively small and mostly concentrated in large urban areas,” Kok suggested. Discussing potential improvements, “The number of potential cases was too small to gain insight into the added value of the telehealth approach for identifying and caring for COVID-19 cases,” they note. They advocate that given the flexibility and relatively low cost of telehealth, it may be interesting to explore how telehealth can be used to support CHWs in diagnosing and treating more complex and chronic health problems. Telehealth can help to further improve access to essential care in rural and remote areas. Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/33715.
A study on the utility of monitoring social media for the detection of vaccine safety signals.
A research team from the Murdoch Children's Research Institute Melbourne AU led by Sedigheh Habibabadi (2021) reported on mining vaccine adverse events mentions from social media using Twitter as a source . High levels of vaccination uptake are required to effectively immunize a population. The VAEM-Mine method successively isolates vaccine adverse event mentions from the massive amount of other vaccine-related Twitter posts. A key finding of the research is that appropriately scored topic modelling is highly effective for identifying social posts that might contain VAEM. A social media based VAEM data stream can be assessed for changes to detect possible emerging vaccine safety signals. The collective experiences and opinions shared by social media users are an accessible wide-ranging data source for tracking emerging trends.
There were 267215 tweets involved in the study.
The person behind the app is crucial for motivation and adherence to healthy behavior post-CR.
Pernille Lunde et al. (2021) studied how technology can`t replace people, but it is a helpful tool. Exercise-based cardiac rehabilitation (CR) is a crucial part of the treatment of patients with cardiac diseases. The aim was to investigate patient experiences with individualized long-term follow-up conducted via an app for one year. They conclude that healthcare providers must actively participate in the patients process of adherence. Exercise-based cardiac rehabilitation Individualized feedback, b) Follow-up based on own goals and c) A lifebuoy in the event of unforeseen events.
There were 10 patients in the research. Some of the conclusions appear to confirm previous studies in this topic: “Background knowledge, ongoing support and in-the-moment understanding, as well as personalization and gamification were concluded as facilitators. However, a recently published systematic qualitative grounded theory review aimed at investigating barriers to and facilitators of technology in CR and self-management,” Lunde said. Data and code to reproduce the analyses can be found at: http://asset.jmir.pub/assets/bbf2f6317bd74874c5cb41e7e6740bb7.docx.
The aim of this study is to investigate the effect of a nutraceutical fungal extract on the complications of colorectal cancer resection.
Cristina Regueiro et al. (2021) studied the effect of the nutraceutical "micodigest 2.0" on the colorectal cancer surgery with curative intent complications rate. This study could identify new features associated with colorectal surgery complications. Data will be analyzed and the results 44 will be disseminated in 2023. Results of this protocol study could help to reduce the surgery complications in patients with CRC. Colorectal cancer (CRC) is one of the most common malignancies in western countries. In 2018, about half a million cases were diagnosed in Europe and 250000 of those affected died due to this disease.
144 patients were involved in the study. Data and code are available from: https://preprints.jmir.org/preprint/34292.
Researchers have used a clustering methodology to investigate patient multimorbidity and complexity in claims data for Swiss residents aged 50+, as reported.
In ‘Exploring patient multimorbidity and complexity using health insurance claims data’, a research team from the Center for Primary Care and Public Health (Unisanté) led by Anna Nicolet (2021) reported that cluster analysis based on pharmacy-cost group information from claims based data is feasible and highlights clinically relevant clusters. Such an approach allows expanding the understanding of multimorbidity beyond simple disease counts. This study may foster the development of integrated and coordinated care. The average OOB misclassification error from the 10 RFs was 0.51, which is quite high. The team demonstrated that individuals with single PCGs of mental diseases or hypertension, individuals with multiple PCGs, or individuals with a single high-cost PCG have different healthcare utilization patterns.
“These findings need to be interpreted with caution due to differences in methodologies, age of the population, and level of details available for background individual characteristics and diagnoses,” Nicolet said. The researchers admit that “The study has certain limitations.” Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/34274.
A pilot study of an intervention to promote HIV-RNA suppression among men who want to have children in South Africa.
In ‘Demonstration and acceptability of a safer conception intervention for men with HIV in South Africa’, Lynn Matthews et al. (2021) reported that many men with HIV (MWH) want to have children. For MWH who want to father a child with an uninfected partner, ART-mediated HIV-RNA suppression effectively eliminates the risk of sexual HIV transmission. The authors developed a male-focused cognitive behavioral therapy (CBT) skills-based intervention to encourage MWH to adopt safer conception behaviors. Twelve men reported disclosure to pregnancy partner. These preliminary data suggest that safer conception care is acceptable to men and has the potential to reduce HIV incidence.
There were 11 men in the analysis. Aspects of the researchers’ conclusions look to provide a counterpoint to earlier research in this field: “To our knowledge this is the first program to attempt to bridge these gaps by addressing the reproductive goals of men. We are not aware of other clinic-based programs that provide malecentered HIV care programming in South Africa,” Matthews claimed. The researchers observe that “There are limitations to this pilot study due to small sample size and lack of comparison arm. The trial was designed to be an important proof of concept, following ORBIT guidelines as part of intervention development.” The group advocate that future work should include men regardless of partner serostatus and larger scale randomized projects are needed to evaluate impact and examine cost effectiveness. Understanding whether and how health care workers, public health administrators would adopt elements of this intervention needs to be explored. The authors have provided data and code at: https://preprints.jmir.org/preprint/34262.
A digital health system designed to promote effective self-care in patients with Heart Failure (HF) has been developed and tested by researchers.
William Johnston et al. (2021) described the human-centred design of a digital health tool to promote effective self-care in heart failure patients. Heart failure (HF) is a significant global public health problem with a prevalence of >100/1,000 population in those aged 65 and over. The mobile application was integrated with the Fitbit activity tracker and smart weighing scales to help the integration of self-care into daily life. Users perceived that the system increased their confidence and motivation to engage in key self-care behaviours. The detailed description of the HCD process used within this research will help guide the development and evaluation of future DHT, across a range of disease use-cases.
The analysis involved 19 participants. However, “A key limitation of the evaluation component of this research was that participants were required to be a smartphone user and have access to the internet. Future HCD efforts should focus on identifying what additional features and/or training would be required to ensure suitability for a wider, more representative sample of HF patients,” acknowledge the authors. The researchers contend that the use of a science-driven approach to design within this work has led to the development of a solution that may be more likely to be used by patients with HF and successfully promote self-care behaviours. Only 3/9 participants initially reported completing daily weighing at the commencement of the study.
A study of patients with cold agglutinin disease (CAD) in the United States has raised new questions about the impact of the disease on their daily lives.
Florence Joly et al. (2021) conducted an internet-based survey in September 2020 among American patients registered on the Cold Agglutinin disease Unraveled website. Fatigue was mainly reported on a daily basis, and almost a third said it was constant through the day. Autoimmune hemolytic anemias (AIHAs) are rare and heterogeneous disorders characterized by the destruction of red blood cells, through warm or cold antibodies. Over 40% of the study group reported that their symptoms had worsened since the time of diagnosis. The most cited symptoms experienced during a CAD episode were fatigue and shortness of breath.
There were 50 respondents included in the study. Some of their results appear to consolidate previous work in this area: “The present study, involving a larger group of patients, used a questionnaire built with a patient advocacy group, to confirm the main findings published by Su et al,” Joly argued. The investigators say that “Self-administered online nature of the survey is likely to be biased toward patients who have access to the internet and/or are comfortable using computers. Approximately 10% of Americans do not use the internet, and many may have access but decline to take part in online surveys.” They contend that additional studies are necessary to better understand the burden of CAD-related symptoms, especially fatigue. Healthcare professionals should proactively discuss ways to manage fatigue, which is not often discussed during consultations. Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/34248.
What are the key components, barriers, and facilitators in the development, reach, use and implementation of eHealth lifestyle interventions for people with low SES?
A team at the Faculty of Social and Behavioral Sciences Health led by Isra Al-Dhahir (2021) report that chronic diseases such as cardiovascular disease and Type 2 diabetes accounted for 74% of deaths globally in 2019. eHealth lifestyle interventions for people with low socioeconomic status are often delivered via internet-based methods and offline methods, such as texting. Future research should investigate how to customize eHealth lifestyles interventions to meet the needs of low SES participants. This review aimed to identify key components, barriers, and facilitators in the development, reach, use, evaluation and implementation of eHealth lifestyle interventions for people with low SES. The group did not assess the quality of the studies and their results.
The authors reviewed 1323 studies. The results seem to substantiate previous work in this topic: “When behavioral theories were reported, authors rarely elaborated on how they applied these theories. These results seem to be consistent with other research that found that behavioral theories are seldom applied in interventions,” Al-Dhahir claimed. The investigators note that “The current review has some limitations. We only included studies on eHealth interventions that focused on lifestyle behaviors. We did not assess the quality of the studies and their results. Ethnic minorities were often mentioned as an prominent group in the studies.” The authors recommend that future research should investigate how to customize eHealth lifestyle interventions to meet the needs of low SES participants. It should identify components that enhance their reach, use, and effectiveness. Data and code to reproduce the analyses can be found at: http://asset.jmir.pub/assets/c8afab27c8eb06adf3f8dad4e3b534b9.doc.
A study of the use of virtual reality (VR) therapy on psychiatric wards in the UK has found that there is great enthusiasm among patients and staff for the therapy.
A group from the University of Oxford Oxford GB led by Poppy Brown (2021) reported on automated Virtual Reality cognitive therapy on inpatient psychiatric wards. Virtual Reality (VR) has the potential to be used in the treatment of a range of mental health problems. Before trying it for themselves, patients and staff members reported positive expectations of gameChange. After trying the gameChange VR therapy for themselves many staff and patients reported feeling better. Patients and staff were keen for VR to be used on psychiatric wards. Patients and staff viewed automated VR therapy as possible to implement within current care provision. The aim of the gameChange VR therapy is to help patients overcome anxious avoidance of everyday social situations.
There were 19 patients involved in the study. The authors’ conclusions claim to back up earlier work in this field: “Having staff external to the ward, such as peer professionals, dedicated to the delivery of VR therapy, could be the most feasible and popular method of implementing VR therapy. This fits with recommendations within the NHS Long Term Plan to recruit a workforce of Peer Support Workers in acute settings,” Brown posited. The authors acknowledge that “Covid-19 pandemic recruitment took place on only three acute psychiatric wards across two NHS mental health trusts. Participants in implementation studies may represent a more highly motivated group who are less representative of the whole population.” Data and code are available from: http://asset.jmir.pub/assets/91ac445ac95f47f4ba1263acb5eed5a9.pdf.
A web-based nomogram for prediction of survival after hip fracture surgery has been developed.
Graeme McLeod et al. (2021) studied a pilot project informing the design of a web-based dynamic nomogram in order to predict survival one year after hip fracture surgery . Hip fracture is associated with high mortality. Twenty-four patients died within 30 days, 65 within 120 days and 94 within 365 days of surgery. L-1 increased the odds of death 365 days after surgery compared to a plasma lactate level of 1 mmol. Identification of individual risk informs anesthetic and surgical decision making and can reduce the risk of death. The researchers collected data from 329 patients up to 365 days after hip fracture surgery and built four models using packages in RStudio.
Some of the findings may strengthen what was previously known about this field: “and inflammatory effects of trauma have a profound effect that influences mortality up to 12 months after surgery. Our findings are consistent with previous studies demonstrating associations between serum lactate and mortality following hip fracture,” McLeod claimed. However, “Mortality was in-line with national data but provided insufficient data to generate a model incorporating all potential confounders. We used an internal validation method for our model but external validation from other centers would provide greater rigor,” acknowledge the researchers. They contend that future research should aim to assess the validity of this model against larger datasets and investigate its generalizability to wider populations. The authors have provided data and code at: https://preprints.jmir.org/preprint/34096.
A patient with Alagille syndrome has been diagnosed with the disease after the discovery of a novel mutation in the JAG1 gene.
Deepak Panwar et al. (2021) reported on identification of a novel c.3080delC JAG1 gene mutation associated with Alagille syndrome by whole-exome sequencing . Alagille syndrome is an autosomal dominant disorder associated with variable clinical phenotypic features including cholestasis, congenital heart defects, vertebral defects, and dysmorphic facies. Approximately 94% of patients with a clinically confirmed diagnosis of ALGS carry JAG1 mutations. In this study, using the whole exome sequencing, they identified a novel JAG1 mutation associated with early onset of the disease.
Discussing potential improvements, “The classical diagnosis of ALGS includes low numbers of hepatic bile ducts which results in chronic cholestasis leading to cirrhosis and end-stage liver disease. Some patients present with jaundice but do not progress to more serious disease,” they say. The team contend that this mutation has never been reported in public human databases. Further studies could clarify the effect of this mutation to explore its effect on the protein and signaling level.
A global rollout of vaccinations is currently underway to mitigate and protect people from the COVID-19 pandemic, but what are public opinions and sentiments about the vaccines?
In ‘Examining Public Sentiments and Attitudes Towards COVID-19 Vaccination’, Ranganathan Chandrasekaran et al. (2021) noted that since the outbreak of the COVID-19, caused by the SARS-CoV-2 virus in November 2019, the pandemic continues to pose a serious threat to the lives of millions of individuals around the globe. Topic modelling yielded 16 topics that were grouped into 6 broader themes. The most tweeted topic about vaccination was related to vaccination policy - whether vaccines needed to be mandated or optional. Study examines COVID-19 vaccine related tweets from Jan 1, 2020 to April 30, 2021. Top three topics that were tweeted in the January - April 2021 time frame were: regulatory issues - mandatory vs optional (13.94%), vaccine hesitancy (12.63%), and post-vaccination symptoms and side-effects (10.44%). Average compound sentiment scores were found to be negative throughout the time period of the examination.
The research involved 2.94 million COVID-19 vaccine related tweets. The researchers concede that “Study used tweets from January 1 to April 31, 2021. Vaccination efforts accelerated in several parts of the world in Summer 2021. A larger set of population who do not have a presence in social media has not been covered by study.” Data and code to reproduce the analyses can be found at: https://github.com/JustAnotherArchivist/snscrape.
A review of 50 clinical trials using gene therapies to treat non-congenital cardiovascular diseases.
Witold Pińczak and colleagues (2021) reported on characteristics and outcomes of clinical trials on gene therapy in non-congenital cardiovascular diseases. Despite the development of treatment and diagnostics, cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. The last review of previous and ongoing clinical trials of GT in PAD, coronary artery diseases (CAD) and HF was performed in 2017. No study described all clinical trials using GTs among non-congenital cardiovascular diseases. In March 2021, they search for clinical trials in ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomised Controlled Trials Number. The group found that majority of trials searched for efficient GTs for atherosclerotic cardiovascular diseases: PAD and CAD.
3508 records were involved in the research. The findings may support prior research in this field: “30% of clinical trials planned to be completed before 2021 did not disclose their results. We found that unpublished trials were initiated and completed later than those published,” Pińczak suggested. Discussing potential improvements, “We acknowledge several limitations of the study. The number of trials that should be completed before the data collection date was low. For this reason, we could not perform a multivariate logistic regression analysis to indicate independent factors associated with results disclosure,” they observe. The authors have provided data and code at: http://asset.jmir.pub/assets/83dcea1e76d8a03d8d693673ec3fe7a2.xls.
A study of an online smoking cessation program shows that message frame-tailoring based on the need for autonomy can improve the effectiveness of digital health communication interventions.
A research group from the Department of Communication Science Amsterdam School of Communication Research (ASCoR) University of Amsterdam Amsterdam NL led by Inge van Strien (2021) described message frame-tailoring in digital health communication. In 2018, 22.4% of the adult Dutch population indicated to be an occasional smoker. The most autonomy-supportive and controlling message frames were identified. This resulted in a redesigned digital health communication intervention that included message frame-tailoring and had optimal usability. Message frame-tailoring based on the need for autonomy is a promising strategy to improve the effectiveness of digital health communication interventions. A usability test among experts and smokers was conducted.
816 smokers were involved in the analysis. Discussing potential improvements, “Using an existing, already effective intervention is a cost-effective and efficient approach, it also has its limitations. When choosing between developing a new intervention from scratch and redesigning an existing effective intervention, we recommend considering both the cost-effectiveness and efficiency of the approaches and the potential limitations,” they note. The authors recommend that more research is needed to assess the optimum cut-off point for the NFA and to test whether this point differs between subgroups.
A study has used electronic medical records to predict the risk of preterm birth in Chinese women.
A group led by Yichao Zhang of the Hangzhou Normal University Hangzhou CN (2021) reported on prediction model development of preterm birth using time series technology based machine learning . Preterm birth, occurring before 37 weeks of completed gestation, is the primary cause of neonatal death and disability, and affects the long-term health of newborns. The clinical data were collected from 5187 Chinese pregnant women with natural vaginal delivery. Many studies have believed that cervical status is an independent risk factor for preterm birth. It is recommended that cervical length < 25 mm measured by transvaginal ultrasound before 24 weeks is a prediction method for high-risk patients.
5187 Chinese pregnant women with natural vaginal delivery were involved in the study. The researchers concede that “This study also has several limitations. The performance of the model still needs to be improved, although LSTM has great potential. Advanced maternal age is a clear confounding factor, and stratified analysis by age will be considered in the follow-up study.”
A study on the marketing of little filtered cigar (LFC) products on social media suggests that they are not a safe alternative to cigarettes, and that warning labels should be removed.
Erin Mead-Morse et al. (2021) report that tobacco industry has used little filtered cigars (LFCs) as cheap and appealing substitutes. Little filtered cigars are unique because, labeled as cigars, they look and taste more similar to cigarettes. Posts seemed designed to promote the similarity of their LFC to cigarettes, through depictions of cig-a-like packs/sticks. LFCs saw a resurgence in the late 1990s, as the tobacco industry continued to use them as a means to circumvent cigarette regulation.
The group conducted a content analysis of all images posted in 2019 and 2020 on Cheyenne’s Instagram account. They suggest that if LFCs like Cheyenne function and can be classified as cigarettes, future work and regulatory efforts should consider whether they be required to carry graphic warning labels like cigarettes.
A study of overweight and obese civil servants following Intermittent Fasting (IFHP) and Healthy Plate (HP).
In ‘Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting among Overweight and Obese Civil Servants in Malaysia ’, Shazana Abdullah et al. (2021) reported that the CAIFA study was a quasi-experimental study established to determine the cardiometabolic, anthropometric, dietary intake and quality of life changes following IFHP and HP interventions. They found that participants in FCR groups showed significant interaction effects on body weight, body mass index, body composition, blood pressure, total cholesterol and LDL cholesterol. The CAIFA study is a mixed-method study to evaluate the effectiveness of intermittent fasting on cardiometabolic and anthropometric parameters. In 2013, Teng et al compared the effect of dry fasting on Mondays and Thursdays combined with calorie restriction, with control on metabolic parameters.
177 participants were involved in the research. Abdullah and colleagues advocate that all participants were fully informed of the potential risks associated with engaging in this study before enrolling. This study was conducted in conformity with the current revision of the Declaration of Helsinki and the ICH Guidelines for Good Clinical Practice.
More than 80% of medical students from a Peruvian university presented publicly accessible profiles on Facebook, but the proportion of disclosed content was greater in senior and male students.
Carlos Aragón-Ayala et al. (2021) studied accessibility and public information of medical students’ Facebook profiles in Peru. This is the first study that explores the public accessibility of Facebook profiles of medical students in the Latin American context. No statistically significant difference was found among the percentage of publicly accessible profiles between the different years of study or between the sexes. The type of disclosed content that were more prevalent in women compared to men were: any visible post, some photo, and link to other social networking sites. Sexual orientation was visible in 20% of profiles, higher than previous studies with less than 15%, but lower than the study in India with 30%.
Some of their conclusions may confirm earlier work in this subject: “In addition to the risk of harassment, it is important to be aware that the public information on their social media profile can be used for commercial or unforeseen political purposes. An example of this, is the case of Cambridge Analytica where, through a psychological targeting strategy, psychological profiles were developed that allowed directing content that influences their behavior in presidential elections in different countries,” Aragón-Ayala said. The researchers note that “This study has some limitations, the findings are not generalizable to other contexts given their local restriction. A qualitative evaluation of the content was not carried out, so we cannot specify the characteristics of this information.” Data and code are available from: https://preprints.jmir.org/preprint/33432.
An outbreak of measles in Albania may have been caused by an undervaccination of young children.
In ‘Aftershock of a vaccination gap’, Dritan Vyshka (2021) noted that capital of Albania, has seen an acute increase in the measles cases during 2018. The outbreak happened while the country was only witnessing very few and isolated cases for several years, as to have officially declared the disease as eradicated. Undervaccination has been a major factor, with a gap in vaccination that interested precisely the age groups of 16-30 years. Of importance is the geographic distribution of Tirana cases, where the overwhelming majority came from the suburban areas that are populated from internally displaced people. The peak of first-year age children in the overall data regarding the epidemics of 2018 in Tirana might be related to the fact that children are vaccinated after the first year of age.
There were 1234 cases included in the research. Data and code to reproduce the analyses can be found at: https://preprints.jmir.org/preprint/30779.